​2. Depression is a Nominalization

In this post, we look at nominalization—one symptom of medicus incomprehensibilis. It is the process of making an abstract noun out of a verb or adjective. It often takes the form of a long word. Medical writing uses too much nominalization.  Here is an excerpt from an article published in Mayo Clinic Proceedings,(1) where we underlined instances of nominalization. ​

There are a number of proposed explanations for the relationship between exercise and improved mood and reduced depression symptoms, including both psychological and physiological mechanisms. (WSEG= 25/25.0/2.1/19.1)

This sentence seems a bit long (25 words). It has a reading ease score of 2.1 on a scale from 0.0 to 100.0. The grade level is 19.1, which means university plus 3.1 more years of education.

​How can we improve reading ease?

Since this excerpt doesn’t involve overly-complex science, we can probably find a way to improve reading ease. To start with, nominalization is a grammatical form. Therefore, it rarely qualifies as an essential scientific term. The word depression may be an exception, since it is the name of a medical diagnosis.(2) 
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Two techniques can help make writing that uses nominalization clearer. One is to convert it into the verb or adjective in root form. The other is to find a shorter word, or a few short words, that mean about the same thing. Let’s try these techniques (Table 1).

Table 1 - Looking for root forms or shorter words

Nominalization	Root verb or adjective	Shorter words that mean about the same thing
explanations	to explain	why? Tell why
relationship	to relate	akin, related, link, cause, why?
exercise	to exert	move, movement, sport, train
depression	to depress	sad, blue, down, feel bad
mechanisms	(machine like)	how? why?

Table 2 shows our attempt to revise to reduce nominalization.

Table 2 - Revising to reduce nominalization

Original	Revised
There are a number of proposed explanations for the relationship between exercise and improved mood and reduced depression symptoms, including both psychological and physiological mechanisms. (WSEG= 25/25.0/2.1/19.1)	Why does exercise make people feel better? Many reasons have been proposed; some involve psychology, some physiology. (WSEG=17/8.5/46.8/8.1)

Is this a good paraphrase of the original? Do you find it easier to grasp? Perhaps, you can think of a better way to say the same thing.

Let’s compare WSEG scores for the excerpt and our revision (Table 3). 

Table 3 - Comparing WSEG scores

WSEG	Meaning	Original	Revised	Change
W	Total words	25	17	-8
S	Average sentence length	25.0	8.5	-16.5
E	Flesch reading ease	2.1	46.8	44.7
G	Flesch-Kincaid grade level	19.1	8.1	-11.0

These data show a reader would likely find the revision much easier to read. If the whole article could be revised in plain English, it could reach a much wider audience.

Conclusion

In this post, we looked at nominalization—one symptom of medicus incomprehensibilis. We showed how we would revise to reduce nominalization and improve reading ease. We talk more about nominalization in Chapter 4 of our book, Plain English for Doctors and Other Medical Scientists (Oxford University Press, Spring 2017).

This blog post is second in a series on Symptoms of Medicus Incomprehensibilis.

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(1) Edwards M, Lorinzi P. “Effects of Sedentary Behavior—Inducing Randomized Controlled Intervention on Depression and Mood Profile in Active Young Adults,” Mayo Clin Proc 91, No. 8 (2016): 985.
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(2) Stedman’s Medical Dictionary. 28th ed. Philadelphia: Lippincott Williams & Wilkins, 2006, s.v. “Depression.”