University: Virginia Tech
Description of Work:
Right now I am working on a book manuscript that is tentatively titled Being at Genetic Risk: Toward a Rhetoric of Care. In brief, the aim of this book is to find a way within rhetorical studies to engage the discourses of genetic risk without being “for or against” the new genetics and biomedicine more generally. Historically, critics in the humanities and social sciences have taken a constructivist approach to understanding the nature of genetic risk, and in this book, I show how that approach has repeatedly led to arguments aimed at distinguishing the reality of genetic medicine (e.g., heterosexist gender norms) from the appearance of genetic medicine (e.g., better health through personal choice). Further, I argue that these efforts to distinguish appearance from reality have been ineffective and have not led to the kind of emancipation or disillusionment they’ve sought. Drawing on the work of rhetoricians like John Muckelbauer, Janet Atwill, Celeste Condit, Richard McKeon, and Carl Herndl, among others, I argue that we need a way of engaging the discourses of genetic risk that is oriented toward invention, or toward figuring out what an artifact can do rather than what it means. In order to do that, however, I argue that a prior move is necessary: we must try to cultivate the “stubbornly realist attitude” that Bruno Latour has called for and move away from the constructivist paradigm that has dominated scholarship (especially in rhetoric) for so long. That is the purpose of the portion of the chapter I will be presenting here—to initiate such a move through a praxiographic inquiry into BRCA risk.
Material Rhetoric/Material Risk
This paper is an attempt to bring the critical theory associated with the “new materialisms” to bear on our understanding of genetic risk, specifically genetic risk for breast and ovarian cancers associated with BRCA1 and BRCA2 mutations. I begin this work with an acknowledgment that because constructivist views of genetic risk have acted as a safeguard against geneticization, we have to be careful when trying to cultivate the “stubbornly realist” critical attitude that scholars associated with the new materialisms have called for. To simply reject a social constructionist view of risk in favor of a techno-scientific view would be tantamount to collapsing the fragile line between mutation and disease, thus accepting the idea that those at genetic risk are “presymptomatically ill.” But I argue that to maintain a constructivist view is to risk remaining trapped within a hermeneutic project whose insights have become predictable and ineffective. As a way out of this bind, I argue that we should read genetic risk estimates for breast and ovarian cancers as objects that are enacted in surveillance and prevention practices.
Before I make this argument, I review efforts within rhetoric and communication studies to theorize the relationship between language and materiality. Moving from the work of “critical rhetoric” theorists like Michael Calvin McGee, Dana Cloud, and Raymie McKerrow to elaborations and refutations of that work from scholars like Ronald Greene, Barbara Biesecker, Celeste Condit, John Lynne, and John Lynch, I explain that most of these efforts have focused on the ways in which language either reproduces oppressive material conditions or participates in the creation of material reality. While acknowledging the differences between these two approaches, I contend that they are connected by a reluctance to theorize a material world outside of symbolicity. Historically, rhetoricians have avoided such a move because of its potential to reestablish the kind of dual ontology that relegates rhetoric to a managerial function. However, I discuss Celeste Condit’s 1983 essay, “Beyond Rhetorical Relativism: A Structural-Material Model of Truth and Objective Reality” as an early and important exception to this reluctance, tracing its claims about the “bounded network” in which language works to her 1999 “The Materiality of Coding: Rhetoric, Genetics, and the Matter of Life.” I argue that Condit’s work prefigures recent efforts in rhetoric and communication to “give materiality its due” (Coole and Frost 7) and then review those efforts, focusing on two key 2013 publications, Thomas Rickert’s Ambient Rhetoric and Scott Graham and Carl Herndl’s “Multiple Ontologies in Pain Management: Toward a Postplural Rhetoric of Science.”
Finally, in the last part of this paper, I offer a materialist reading of genetic risk that provides an alternative to constructivist readings. To do this, I first review what current genetic risk estimates for breast and ovarian cancers are, how they are determined, and how scientists believe they are related to the functions of the BRCA1 and BRCA2 genes. From here I move to Bruno Latour’s notion of a “quasi-object,” and John Law’s notion of a “fire object,” explaining the possibilities each holds for understanding genetic risk as something that incorporates elements of the social and the natural but cannot be reduced to either one without creating considerable problems. As helpful as these possibilities are, however, I argue that the most promising approach to reading genetic risk as real (without embracing naïve realism) lies in Mol’s notion of praxiography, which she explains in her 2002 The Body Multiple: Ontology in Medical Practice. Here Mol argues that an object is real by virtue of its enactment in practices. Since objects can be enacted in many ways, she reasons, they can have multiple realities. Her goal in The Body Multiple is to track down the multiple realities of a particular object—atherosclerosis—by “following” it through a hospital in the Netherlands. I argue that because genetic risk for breast and ovarian cancers is enacted in a variety of practices every day, its realities can also be tracked down. Of course, for some critics, this is precisely the problem: through these enactments, risk is treated as disease. I recognize this problem but contend that it does not warrant our continued commitment to an interpretive paradigm that denies the reality of risk. For the thousands of patients whose inherited risk of breast and ovarian cancers engages them in practices ranging from mammography, ultrasound, and biopsy to prophylactic surgery and chemoprevention, risk is real, or rather, it has realities. I track these realities through several sets of data (e.g., patient interviews, guidebooks, medical texts, and memoirs), focusing on how the habitual actions and material contexts associated with two broad categories of practices—practices of surveillance and practices of prevention—produce the object of genetic risk in distinct but overlapping ways.