Associate Professor of English & Director of Composition
Case Western Reserve University
I describe myself as a “medical rhetorician” interested in how we use language to define and experience the states of health and illness. By “we,” I mean contemporary US speaker-writers, though I hope to expand that in future projects (globally and/or historically). I find it important to focus on both health and illness because I’m concerned with the ways those two states are not separate territories (as Sontag and others seem to map them), but rather two interdependent sets of experiences that shade into one another (often imperceptibly). I’m curious about how the way we talk about illnesses (in my case, the mental illness depression) affects the way we understand our own health (that women should monitor their emotional well-being and attend to their own and their family’s/community’s mental states in order to avoid illness). My monograph, Black Dogs and Blue Words: Depression and Gender in the Age of Self-Care (Rutgers UP, 2010), argues that the language (metaphors, genres, narratives, definitions) we use to understand depression in the US shapes more than just our picture of the illness. That language defines and promotes practices of self-doctoring, which I define as an increased attention to our (mental) health/illness and a specifically gendered set of practices for noting, defining, and responding to our self-appraisals.
This work grew out of my earlier work on the concept of “uptake” within rhetorical genre studies. Uptake refers to a bidirectional relationship between two related genres: a jury’s verdict is taken up by the judge’s sentencing. That relationship is both constrained and constraining – it is not freely variable. For me, this proves really useful for getting into (and partially out of) questions of agency – we have some, but not unlimited, choice in how we respond in given contexts. In my study of depression, I was struck not just by the way particular genres (the symptoms quiz/checklist) secured particular uptakes (a self-diagnosis), but also by the way that particular phrases (“chemical imbalance”) also secured particular self-actualizations (“there is something wrong with my neurotransmitters” but also, “there is an ideal balance of neurotransmitters” and then, “a chemical/pharmaceutical solution is necessary and will restore that balance”). Thus, for me, uptake is not just a generic phenomenon; it is also a discursive one. All of this is to say that my work focuses on the circulation of language and the effects of disciplinary/generic border crossing on individuals’ health identities.
I am currently embarking on a new project – so new, in fact, that I find it difficult to wrap my own head around it, let alone describe it here (my apologies!). I am working with the Dittrick Medical History Center archivist to help identify and catalog one (or several) as-yet-un-sorted collections from local Cleveland physicians. I hope to find out more about the curriculum in our medical school in the mid-20th century and to find ways to ask questions about how medical faculty and students were using narrative (and/or other reflective genres) prior to the current fascination with “narrative medicine.” I also hope to learn how to work in archives, a kind of research work that I have not done actively, but that my graduate program is encouraging for its students. (CWRU sits in Cleveland’s University Circle – amid the city’s premier cultural institutions and their archives: the Cleveland Museum of Art, the Western Reserve Historical Society, the Natural History Museum, Severance Hall, etc.) Finally, I hope to be able to think about museum and archival practice (and the logistical/practical organization of materials) as rhetorical work (within the rhetorical canons, but also more generally as argumentative/persuasive activity).
Keywords to describe work
Discourse analysis, rhetorical genre studies, depression/mental illness, gender, health identity, medical archives
Work in relation to symposium keywords
I find myself drawn toward connections because I find myself wanting to learn more across an ever-broader network of researchers and scholars. For me, academic work can be lonely, but finding overlap among disciplines and projects is energizing. I also think of connections as the in-between spaces, the actions that link entities, the messy middles – all of which are important to my work as well. Ethics is also something I’m terribly interested in of late. How do we develop as ethical scholars? How do we instill a sense of ethnical research in our students? How do we assess/document our own and our students’ successes in “being ethical”? I am also very interested in IRB protocols and assessment procedures, which (in my experience) tend to cloud rather than shed light on ethical dilemmas.
• How do you explain/define what you do to medical personnel and/or other stakeholders in the research process or to the public?
I find that my “in” with medical personnel (and, really, most other non-academic audiences) tends to be my involvement with my university’s writing program. Everyone seems to have concerns/complaints with how students are writing “these days.” (This often leads to a lengthy digression on my part about the history of such complaints and to a discussion of what, specifically, we ask students to write and how we scaffold their learning of those kinds of communication.) When the conversation turns to research, I try to articulate the ways that a study of language complements a “hard-science” approach to whatever topic we are discussing. I like to use very obvious examples, such as: how does it change our understanding of patients who might not be taking their medicines regularly when we refer to them as “non-compliant”? Does this shorthand elide a series of barriers to the prescribed behavior and focus only on the patient’s recalcitrance? Does it set up an interpersonal dynamic between doctor and patient that is (un)productive? For me, medical rhetoric is the study of what appears to be commonplace language to determine where messages might be having unintended and unobserved consequences. It’s a form of pattern recognition – but instead of looking for patterns of symptoms (as a physician might), I’m looking for patterns of language.
• How would you describe the relationship between medical rhetoric/health communication (however you see yourself) with other fields and sub-fields (e.g., rhetoric of science)? For example, we struggled with what to name the symposium. Some suggested medical rhetoric, but that doesn’t comfortably fit some from Communication nor from English Studies. In other words, how do you align what may be a specific focus with broader disciplinary concerns and tensions?
What’s in a name? I find myself struggling with this question quite a bit – where does the work I do fit in some larger ecology? – and not finding many satisfactory answers. The way I’ve resolved this is to (try to) revel in the tension itself. For me, medical rhetoric is not a territory to be mapped in the way we often attempt to do with discrete fields of study, but rather a busy, multi-directional intersection: we benefit from a variety of methodologies, canons, and theoretical orientations; we have a good view of a larger landscape. We are the crossroads where activist disability studies and pragmatic health communications meet, where rhetorical theory and criticism blend with medical practice, where the rhetoric of science confronts the individual human body. Such a position represents promise and peril: it affords opportunities to explore the embodied rhetorics closest to our own experiences, but it also risks the invisibility of a crossroads – a place passed through in search of other destinations. In addition, I have begun to notice that the parallels between our sub-field and others – particularly the rhetoric of science and disability studies – have begun to diverge in ways that trouble me. Attending our Medical Rhetoric SIG at CCCC a few years ago, a friend of mine who works in disability studies commented (to my ear a bit derisively) that we were “too invested in the medical model.” Recently, I found myself answering the question “Do you work in the Rhetoric of Science” with, “No, I’m in Medical Rhetoric.” It was an unconscious slip that reveals my own anxieties about my scholarly location. So, the question I have for all of us is: how can we make this intersection legible and credible, to ourselves and our larger (inter)disciplinary communities?
• What research challenges have you experienced and how did you solve them? Choose to focus on one or two specific examples that can help the group develop strategies for overcoming these types of challenges.
I don’t think I can provide solutions to research challenges, but I have several that I’d be very glad to get other perspectives on. I think these are pretty relevant to many of us (especially on the rhet/comp side of the street), and especially so for upcoming graduate students who will be conducting the most cutting edge research. So, without claiming to provide answers, here are four significant challenges for (my own) medical rhetoric scholarship.
1. How do I get into one of those awesome collaborative, interdisciplinary working groups that seems to produce gobs of scholarship in a range of publication venues?
At my institution, interdisciplinarity is a buzz word, but there are real institutional barriers to the actual practice of cross-school (in my case) collaboration: from larger questions of locating viable collaborators in disparate schools/locations to the micro-level challenges of different academic calendars (our medical school, school of social work, and school of nursing all operate on academic calendars and course scheduling blocks that are independent from the main CWRU undergraduate/graduate school). I’m still working on this, but some of the additional challenges I am facing include how to make the collaborations meaningful on both sides. For example, I don’t want to be added to a research team in order to provide writing support to students (or faculty), even though I might be interested in the educational practice of medical student narratives/reflections/portfolios. I also find it challenging to gain access to data collected in large studies (with large budgets for transcribers) – there is a willingness among the researchers I have talked with, but not necessarily the practical will to wade through the paperwork (my own reluctance included) to make it happen.
2. How do I articulate my research protocols in language that is comprehensible to University IRB boards?
I have had some success in this area, but find myself often on shifting ground – the nature of the IRB process is: ask us first. This makes sense, from a regulatory standpoint, but many of the procedures (ethnographic interviewing, etc.) are not necessarily suited to the idea of a standard “protocol” that is outlined in advance. I’ve had success describing such practices and providing “sample interview questions” as well as the general topics for interviews…but I wonder whether IRB processes are just not well suited to the sorts of projects medical rhetoricians wish to pursue. The best piece of advice I have for my own students who are interested in using people (and people’s words/texts) in their research is: call up the IRB office and describe your project and do that before you start the paperwork. Find out how the IRB describes the kind of work you are doing, and use that language in your protocol.
A digression: I think there’s a smart paper waiting to be written about the language of IRB paperwork. What defines a “potential risk” to participants? What might be a “benefit”? What counts as “contact” with “human subjects” (why not “study participants” – are they inactive in the process?)…
3. How do I secure funding (and time) to complete time-intensive interviewing, transcribing, etc.?
I am quite jealous of my colleagues in scientific disciplines, with laboratories built into their start-up costs as faculty, and graduate assistants assigned to their laboratories. Even more, I am jealous of those whose R1 grants provide funds to pay transcriptionists for their hundreds of taped interviews. I think medical rhetoricians are in a good place to apply for external funding, but grant writing was certainly not something that I was taught in graduate school. (And then there’s are added problems – once I secure funding, where do I find reliable & trustworthy & academically savvy transcriptionists, especially if I’m looking for more precise linguistic markers? How do I learn to manage research teams? Again, things that a traditional English Ph.D. didn’t teach me.)
I think there is another significant challenge (beyond finding funding sources and the time to write the grants) is to find ways to articulate our projects outside of our fields. How much jargon is too much? How do I learn to read the rhetorical situation/audience for a particular grant? Should we be asking graduate students to produce grant proposals as well as articles within their graduate training? (My program is about to do this – at least for some students, who can apply for internal funding for special projects.) If we do require this as part of graduate training, where do we fit into our curricula the instruction in this new form of writing (or do we just assume grads will “pick it up” as most of us have had to)?
4. How can I balance my time between my administrative work (many/most Ph.D.s trained in rhet/comp will be administrators in their careers) and my scholarship in medical rhetoric?
This is the biggest question I haven’t had time to answer (here or in “real life”). I’d like to make the argument that my administrative work is part of my scholarship (and lately, I’ve been working with a group of faculty developers to publish in that field), and I do…but I doubt my colleagues (even in my own department) really buy that argument fully. Nevertheless, the time spent on program matters – designing curriculum, mentoring new teachers (graduate and post-graduate), consulting with faculty across the university, serving on committees, etc. – is significant (and rewarding). But, where is there time for research (much less writing another monograph)? I’d be glad to have this conversation with colleagues, but especially so with graduate students – for those on the rhet/comp side of the street, I think we can all expect to be involved in program administration at some point (or continuously) in our careers. Where are the intersections between administration, writing programs, and medical rhetoric research? What are the benefits and drawbacks of accepting administrative responsibilities?
From my own experience, being an untenured WPA meant that I met lots of people on campus from lots of different disciplines and administrative offices: that’s been valuable to me in guiding graduate students and finding potential projects of my own. The downside: barely making the tenure deadline for a book contract and a lot of time spent “split” between program concerns and research concerns. This is a practical/career question, but one that I think needs to be considered alongside more theoretical/research-based questions.