Grace Cooke, Lorenzo Meira-Gobel and Rory Hankins ask: what might it mean to approach English for Speakers of Other Languages (ESOL) teaching through the lens of the medical humanities?
This was the question that shaped our research for a co-led panel at the 2025 NNMHR Congress – TONGUES: Medical Humanities Across Linguistic and Cultural Frontiers. As undergraduate researchers, it was both a rare opportunity and a real privilege to bring together perspectives from language education, cultural theory, and lived ESOL experience to explore how English language teaching intersects with systems of care and authority.
The broader medical humanities have long been concerned with the entangled relationships between power and embodiment in healthcare. Yet these conversations rarely extend to those navigating medical institutions in a second or third language, often under conditions shaped by trauma or displacement. In such contexts, medical English is not simply ‘technical vocabulary’, but the language through which people must articulate pain, negotiate power, and, crucially, consent to treatment. It carries immense weight and, with that, risk.
The following overview reflects on discussions from our interactive panel, drawing on insights from presenters and participants, including those that informed the development of our subsequent digital toolkit for trauma-informed ESOL teaching, to explore how trauma and spatial theory in classroom experience might inform more ethical approaches to ESOL pedagogy. The toolkit itself contains best practices and resources for trauma-informed ESOL education from many of our participants. We begin the following from the position that language classrooms, especially those focused on medical English, are never apolitical. They either replicate institutional harm or actively resist it. By drawing on the interdisciplinary nature of the medical humanities, we argue for a reimagining of the ESOL classroom as a space of care and collaboration. In doing so, our aim is to begin to reframe language education as a deeply human practice, attuned not just to grammar, but to lived experience.
The practical experience of ESOL
Language skills are a vital asset in rebuilding the lives of displaced people, as they facilitate “building social relations in new countries and maintaining ties with homes and families elsewhere in the world” (Capstick 2016, 3). In Lancaster and across the UK, language education, specifically ESOL, is severely underfunded. Under Conservative leadership (2010-2024), ESOL provision was “constrained by restrictive funding, exclusionary policies, and anti-migrant rhetoric” (Flanagan 2025, 1). Between 2008 and 2018 funding shrank from £212.3m to £105m (Refugee Action 2019, 2). As such, such funding cuts have led to a reliance on the third sector, including charities such as Global Link, a Morecambe and Lancaster based education centre.
Over the 2023/24 academic year Global Link, established in 1991, supported 710 asylum seekers and refugees. Many of the classes are in the community education space, where there is a kitchen, a shared clothes room, a garden, and sofas. It is a homely and welcoming environment where classes are not overly formal, reassuring for people who might have experienced trauma in previous learning environments. Learners can come and go as they wish, for example to answer a phone call or find a quiet space if they need to, without feeling any obligation to return until they are ready. It is community and togetherness combating social isolation and trauma.
Together with “stigma around refugees” and “political narratives that fuel hatred” (Ateek 2024, 162), underfunded ESOL provision contributes to marginalisation experienced by refugees and asylum seekers today, as ESOL is critical for independence and successful integration (Refugee Action 2016, 1). Harmful political narratives and anti-migrant rhetoric, perpetuated by the far right, frame minorities as scapegoats and lead to attempts to exclude and isolate them.
Community engagement with ESOL, however, can combat exclusionary stigma and political narratives by bringing people together. ESOL lessons often act as a major source of cultural information for refugees about their new home (Khatri 2016, 82). Additionally, they can be opportunities to be heard and to ask for help. Covering healthcare topics in class can make healthcare accessible, but equally the ESOL lessons themselves can be understood as sites of healthcare as they offer moments of healing, allowing participants to integrate culturally, seek help, receive advice, and spend time with others.
Theoretical approaches and future directions
When we teach English to people seeking asylum, we engage with emotional and neurological landscapes shaped by violence and displacement, not just grammar and vocabulary. In her research, The Impact of PTSD on Refugee Language Learners, Martha Clayton outlines four key PTSD symptom clusters: intrusive thoughts, avoidance, negative mood alterations, and hypervigilance (Clayton 2015). These often manifest visibly in the classroom as disengagement, dissociation, and impaired recall. Clayton, citing Kosa and Hansen, shows that such symptoms can “act as a catalyst for diminished or delayed learning” too (Clayton 2015, 8; Kosa 2006). She also draws on UNCHR’s Global Trends Report: World at War, which notes a 58.6 per cent increase in displaced persons over the past decade. Children, nearly half of the global refugee population, are frequently removed from formal education to assume adult responsibilities (Global Trends 2015). Crucially, Clayton notes that PTSD severity inversely affects second-language acquisiton, underscoring the need for both trauma-sensitive curricula and classroom support strategies.
Clayton advocates for emotionally safe materials that avoid colonial tropes and encourage low-risk expression, an imperative in such diverse classroom settings. These might include image-based storytelling or non-autobiographical activities, particularly vital in medical ESOL contexts where triggering content is often unavoidable. This is supported by Adeline Moussion-Esteve’s critique of how trauma models often overlook the domestic and emotional strategies people already use to respond to fear (Moussion-Esteve 2022). Rather than relying solely on biomedical frameworks of trauma as ‘terror’, she argues for recognising how individuals draw on lived resources. In the ESOL classroom, this means curating content that fosters cultural safety and care, while resisting institutional erasure. This is especially evident in contexts such as Global Link in Lancaster.
This in turn raises broader questions about the spatial and relational architecture of language education. How must we rethink not only what we teach, but where and how we teach it? This pivot brings us to Marc Augé’s concept of the non-place: transitory, depersonalised spaces such as airports or shopping centres that lack relational and historical significance, designed purely for function (Augé 1995). When applied to medical contexts, hospitals, GP waiting rooms, and clinics echo this non-place logic. From a Foucauldian perspective, unlike organic places such as piazzas, hospitals foster anonymity and conformity (Foucualt 2007). They are procedural environments where interactions are orchestrated, not spontaneous, and people are processed, not welcomed. Teaching medical English in such contexts, especially to trauma-affected learners navigating alien systems, becomes not just a pedagogical challenge but an ethical one. The classroom must resist spatial and emotional alienation and become a meaningful and caring environment. This means rethinking space, embracing flexible structures (rejecting rigidity), validating non-verbal communication and shifting from authority to collaboration. Above all, it means creating classrooms that foster safety so they become not just sites of instruction, but spaces of healing. In doing so, we can see ESOL as the start of a remedy for a broken and challenging system.
The lived experience of the impact of ESOL
For refugees living with acute trauma, seeking medical attention in the UK is accompanied not only by unfamiliar procedures, but also by profound linguistic isolation. Too often, discussions around healthcare and forced migration neglect the burden of silence, the absence of speech that permeates the room when a patient is unable to find the words in a language other than their own. Language becomes a border within the body, marking every unasked question and unspoken feeling because of a lack of understanding. Vulnerability collapses into solitude; every wound is made worse by mistranslation or miscomprehension.
In our experience, medical appointments in the UK are routinely conducted without interpreters. Translators are under-funded, inconsistent, or absent altogether. Consequently, the responsibility to be understood falls squarely on the patient, in misunderstood gestures towards fevers and body parts; in men nodding through diagnoses they cannot understand; in children interpreting for parents long before they should have to. We often forget that care is not only medical but interdisciplinary: listening, translating, writing, and understanding. To deny someone their words in moments of vulnerability is not just delaying treatment, it is quietly unmaking their humanity in the most bureaucratic ways. The current healthcare system rests on a quiet hierarchy of exclusion shaped by a bureaucracy that assumes literacy and cultural familiarity. Those who speak the ‘right’ words are heard. Those who cannot are made to wait, in silence and pain. The system, as is, is rigid; it does not bend but rather forces patients to contort and translate their suffering into a dropdown menu of ‘yes’ or ‘no’ responses. For us, the right to be heard becomes the right be recognised as full people. Language does not merely transmit meaning but carries the weight of belonging, of who is permitted to speak and be understood. So, when it fails, so too does the link between patient and provider.
And yet, it is language itself that can offer a way through.
In ESOL classrooms, learners gather not as patients but as contributing participants. The dynamic in such a fluid environment shifts. Words are not demanded but developed and expressed, slowly and collaboratively without the pressure of medical performance. Within the ESOL classroom that cares, language returns not as a burden, but as a possibility. What emerges is not just fluency, but dignity: the ability to name one’s pain, to advocate for a child, to understand a prescription. These are not small things. They are recognitions that language, when taught with care, can rethread what the system has unpicked, offering not just access, but a restoration of voice and agency.
About the authors
Grace Cooke (she/her) has recently completed her undergraduate studies in Linguistics and French at Lancaster University. Her research interests include linguistic landscapes in Brittany, specifically the role of Breton under late capitalism, and housing in relation to health, wellbeing, and care through the medical humanities.
Lorenzo Meira-Gobel (he/him) has recently completed his undergraduate studies in Modern Languages at Lancaster University. Brazilian-born and fluent in English, Portuguese, Spanish, French, and Italian, he actively contributes to the Lancaster University FASS Decolonising Team, organising inclusive, culturally enriching events, and facilitating meaningful discussions on decolonisation to promote collaboration and inclusivity.
Rory Hankins (he/him) has recently completed his undergraduate studies in English Literature and French at Lancaster University. His research explores how contemporary thought can reshape understandings of medical education, architecture, and literature. He is particularly interested in how the philosophies of Catherine Malabou and Marc Augé can help reimagine the classroom and hospital as future-oriented spaces of care.
References
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