University: The Ohio State University
Description of Work:
Mostly, I’m interested in how people make decisions. And because sites of medical practice are so complex (mediated by a wide range of expertise, technologies, languages, visuals, and other embodied sensory input), I tend to turn my investigative lens thusly. Some recent observational sites include the Food and Drug Administration, hospitals’ tumor board meetings, pharmaceutical clinical trial procedures, physicians’ use of electronic medical record software systems, and pathologists’ laboratory practice of visually rendering bodies’ data.
I’m in the early stages of a book-length project tentatively titled Decriminalizing Uncertainty: Studies of Communication and Human Health. Each chapter in this book examines a particular case wherein uncertainty about future action persists. Subjects for each of these cases are informed by several recent events. First, I’m haunted by the Italian government’s imprisonment of scientists who did not accurately predict and/or report an earthquake threat. This case is complicated not only by how scientists know, with some certainty, about an event that’s yet to occur, but also how they communicate it to non-scientists, and then to whom they’re beholden when failures occur anywhere along that long line of scientific practice. While this case isn’t explicitly “medical” in nature, it is about human health. The L’Aquilla, Italy events became heuristic for me as I encountered other more medically relevant uncertainties.
Consider, for instance, Angelina Jolie’s decision to undergo preventative surgery after testing positively for the BRCA gene mutation. This case not only initiated popular discourse about women’s health, but it drew attention to the complex relationship between knowledge or certainty about future events and unequal distribution of (healthcare) resources.
This book is also in response to a project I completed with S. Scott Graham wherein we tried to better understand how decisions about pharmaceutical approvals were made by key stakeholders within or affiliated with the Food and Drug Administration (FDA). One of our key findings is that there is little to no way for medical and scientific experts to measure or quantify clinical benefits provided by certain drugs that aren’t obviously related in one way or another to overall survival. In other words, say, for instance, a drug improved a patient’s quality of life but did not actually help them live longer. Drug companies, patients, patients’ families, and any other stakeholder advocating for the effectiveness of the drug is hamstrung. They cannot provide the evidence that matters to the decision-makers (overall survival), and so their testimonies are largely dismissed. Scott and I believe there has to be a better way, and we draw on Callon, Lascoumes, and Barthe’s theory of “hybrid forums” as a starting point for how we might reimagine deliberative events like the ones sponsored by the FDA.
While I’ve not yet fully worked through the theoretical and practical implications of what it would mean to “decriminalize” uncertainty, I’m confident that these moments, some of which I’ve described above, are significant. They’re the kinds of fractured, unwieldy, complex rhetorical events that are hard to study. And this is precisely why I’m drawn to them as a rhetorician.
Exploring Feminist Materialisms in Contexts of Health and Medicine
More than a decade ago, Karen Barad (2003) argued that “language has been granted too much power” and that “the only thing that does not seem to matter anymore is matter” (p. 801). Well prior to Barad’s bold assertion, Berg & Mol (1998) argued, “medicine is a heterogeneous coalition of ways of handling bodies, studying pictures, making numbers, conducting conversations” (p. 3). In my own research, I have tried to deploy these claims about the important of medicine’s materiality as a theoretical lens. I have extended my gaze beyond Barad, Berg, and Mol to include scholarship that some might characterize as new materialism, object oriented ontologies, and/or feminist materialisms. For the purpose of this proposal, I’ll collapse these scholarly lines of inquiry into “feminist materialisms.” During this symposium, I am interested in sharing and discussing ways in which these scholarly threads can be paired productively with objects of study in health and medicine. Although such a conversation might require that we eschew the descriptive prefix, “discourses of” in our symposium’s title, I hope the organizers might see merit in exploring these theories for what they offer our research.
Exigency for inquiring about what feminist materialisms offers scholars in medical rhetorics/discourses lies in my own book project, tentatively titled Evidential Attunements: Methods for Managing Medical Uncertainty. Here, I am invoking Thomas Rickert’s (2013) notion of attunement. He argues that attunement,
Indicates one’s disposition in the world, how one finds oneself embedded in a situation. This point needs emphasis: being so entangled, so caught up in the richness of the situation, an attunement is nothing subjective. It is neither inside nor outside, as Heidegger says, but ‘the way of our being there with one another’ (FCM 66). It results from the co-responsive and inclusive interaction that brings out both immersion (being with) and specificity (the way of our being there). (p. 9)
Rickert invokes the Greek word “periechon” to make a case for the ways in which “the surrounding environment becomes understood as more than a neutral, objective stage on which human drama and activity play out” (p. 9), and “the local environment is not just a passive stage for human activity but an integral, active element in its own right” (p. 10). I extend what Rickert refers to as environment to include material spaces where medical professionals and scientists engage in the everyday work of creating order from chaos. I argue that their meticulous, methodical approaches to constructing, assessing, and synthesizing evidence are material methods for or a way of being with uncertainty.
For example, how pathologists dwell amidst uncertainties presented by biological processes invisible to the naked eye is a matter of attunement. In other words, how the pathologist can render meaningful (vis-à-vis diagnosis or prognosis) from a morass of cellular and molecular chaos is due in part to evidential attunement. My aim, therefore, is to reveal how material techniques for managing medical uncertainty are composed of human, nonhuman, and computational labor whose entanglements and intra-actions (Barad), when disciplined by method, can afford a sense of certainty. Evidential attunements create possibilities for sense-making amidst what appears to be non-sense.
Detecting cancer, seeing pre- and post-operative differences, and determining a pharmacological intervention’s effectiveness are all a matter of evidential attunement vis-à-vis method. Even as I endorse the work of colleagues in our field who emphasize that moving from uncertainty to certainty depends on discourse, texts, and rhetorical decision-making by human agents, I add a new dimension to our analyses: the suasive potential of material objects that have either been overlooked or regarded only as epiphenomenal to acts of diagnosis, treatment, and prognosis. Indeed, the scientist makes meaningful the move from matter to evidence. But matter-turned-evidence is not mere material marionette enlivened by human manipulators’ scientific strings. To investigate ways in which matter matters in contexts of health and medicine, I’m interested in exploring the following theories and constructs—some of which may still be characterized as emerging.
• Barad’s “intra-action,” “agential realism,” and “onto-epistem-ology”
• Bennett’s material vitality, or “effectivity of nonhuman or not-quite-human things” (ix)
• Rickert’s “ambient rhetoric”
• Frost’s notion that matter and bodies “have a peculiar and distinctive kind of agency”
• Haraway’s “situated knowledges,” “partial perspectives,” and “thinking technologies”
• Bradiotti (via Deleuze & Guattari)’s “rhizome”
• Coole’s theories about agency