‘You May Need to Read This Leaflet Again’: Epistemic and Deontic Modality in US vs. Italian Antidepressant Medicine Package Inserts

This contribution focuses on medicine Patient Package Inserts (PPIs). Aimed at popularizing specific procedural knowledge outside the framework of clinical medicine, these texts are cognitively designed to mediate key therapeutic protocols for non-specialized readers. In concert with the recent evolution of medical communication towards more socially mediated and interdiscursive practices, and enabling users to perform their own therapeutic routine (albeit under the guidance of a doctor), leaflets indeed offer a pro-active representation of patients as fully-fledged subjects within the empirical protocol of medical cure. Such a process is evidenced by the language of PPIs, and in particular by the way they construct deonticity and epistemicity, whereby what patients may, should or should not do with a medicine, and the effects that the medicine can, might or is expected to have on the patient, are an essential part of the referential and performative meanings conveyed by the leaflet. Different linguistic systems and healthcare environments, however, codify such meanings in different ways, and although active principles are marketed worldwide, the modal strategies deployed in leaflets can vary across languages and contexts. This paper analyses and compares the English and Italian texts accompanying all fluoxetine-based antidepressant products currently licensed by the US Food and Drug Administration and the Italian Agenzia del Farmaco. By investigating the grammatical and lexical construction of deontic and epistemic modality in PPIs, the study aims to highlight the linguistic strategies codifying both the pharmacological management of depression and the role of patients and doctors in the therapeutic process.