Title: PhD candidate, Graduate Instructor of Record
University: New Mexico State University
Email: kwhit@nmsu.edu
Twitter: N/A
Website: N/A
Description of Work:
As an RHM scholar, I’m interested in examining how medical discourses—by which I mean language, actions, practices, and matters—work on, through, and with bodies. To do this, I ask myself this guiding question: What does medical discourse do and how does it do it? This question allows me to excavate medical literature and examine, for instance, the discursive formation of medical guidelines, the ways bodies make and are made by medical processes and practices, and relationships between and mobilizations of power and knowledge. My research reflects a larger commitment to analyzing the ethical, epistemological, and cultural work of medical discourse by uncovering the co-constitutive relationship between medical discourse and social relations.
I extend this question, what medical discourse does and how it does it, to my current project wherein I investigate the discursive formation of the well-woman visit, or women’s annual gynecologic exam. I examine medical literature to trace the distinct cultural, medical, and technological formations that enabled the well-woman visit’s emergence and analyze how its emergence normalized the human and nonhuman bodies that participate in preventive gynecologic care. What and who becomes normalized in preventive care has implications on social inequities in medicine and on what becomes identifiable as quality preventive care. The project I submitted to this symposium addresses one of these implications, specifically the technologies that have become normalized in, and perhaps even synecdochal of, medical practices.
Symposium Submission:
Technology, Haptics, and Coming to Know Medical Bodies
Humanist accounts of medicine have traditionally centered on the human bodies—patients and medical providers—that occupy those spaces, and in doing so, presuppose the materiality and agency of human bodies. To bring attention to the ways bodies materialize and knowledge comes to matter in medical settings, recent RHM efforts have decentered human bodies from medical accounts and shifted attention to the ontological and epistemological work of the nonhuman matter and practices (Graham; Graham and Herndl; Mol). I extend these investigations of the materialization of bodies, matter, and knowledge in medical settings to analyze one specific site: women’s annual preventive gynecological practice, otherwise known as the well-woman visit. In this article, I draw from multiple ontologies theory and haptics studies to analyze the ways human and nonhuman bodies materialize in medical settings and how this materialization, in turn, communicates to both medical providers and women what counts as preventive gynecological care. Though RHM scholarship continues to add nuance the ways we make sense of communication in medical settings (see Gouge), one area that has yet to be developed is the role of touch in communication. Therefore, I analyze the functions of touch in the pelvic exam, which is one component of the well-woman visit, and in doing so, I argue that, through touch, human and nonhuman bodies emerge in the clinical encounter and communicate to medical providers and women biomedical ways of knowing and mattering.
To support this argument, I first discuss the exigence of this analysis. In 2014, medical and
government organizations published new guidelines for the well-woman visit, specifically on the practice of the pelvic exam. Citing new understandings of cervical cancer, these organizations advise women to receive a pelvic exam every 3-5 years, depending on her health history, risk factors, and age. These guidelines reversed what had become the standard practice to screen women annually. While these new guidelines were met with disparate reactions from medical providers, a concern that unifies those on all sides of the issue is that the new screening schedules for the pelvic exam will signify to women they no longer need their well-woman visit. While the pelvic exam is one component of the well-woman visit, medical providers’ concerns that women will conflate the two leads me to ask: How have women and medical providers come to understand the purposes and practices of the well-woman visit and the pelvic exam? How has the pelvic exam become synecdochic of the well-woman visit? How do the practices and matters of the pelvic exam communicate to both women and medical providers what counts as quality preventive health care?
Next, with the exigence and research questions established, I build the theoretical framework
through which I analyze the practices and matters of the well-woman visit. Multiple ontologies theory, a strain of new materialisms, brings attention to the ways that “ontologies emerge from practices or performances” (Graham and Herndl 110). Still committed to “matter’s immanent vitality” (Coole and Frost 8), multiple ontologies theory examines the practices through which realities and conditions come into being and call into relief the materiality of these practices. In other words, tracing the ontologies that emerge from practices [1] suggests that medical conditions, bodies, and matters aren’t stable or singular but come into being per the practices that recognize and mark them as such and [2] surfaces the materials and bodies that come to matter or materialize through these practices. When intersected with haptics—the meaning(s) that the act of touching constructs (see Walters)—multiple ontologies offers a way to study how touch functions in the pelvic exam to make the human and nonhuman bodies come to matter and the conditions that emerge through this materialization. In other words, the means through which bodies come to matter and conditions emerge, I claim, communicate and “stick” to human bodies as knowledge (see Ahmed).
With this theoretical framework, I trace the practices and matters of the pelvic exam and analyze the ways the specific types and uses of technologies—such as the insertion of the speculum into the woman—communicate to both the medical provider and the woman. The repetition of both the types of technologies used and how they have been used codified for medical providers and women what it means to screen and equated technological intervention with preventive care. For example, when women receive a pelvic exam, they lie on the exam table with feet in stirrups and feel the paper crinkle on their backs. They also feel the medical providers’ hands press down on their abdomen, the insertion of the speculum, and the swab as it collects cervical cells. Each of these moments that women are touched by and touch these human and nonhuman matter, and the annual repetition of these forms of touch, leaves its impression on the woman’s body and communicates to women what it means to receive preventive gynecological screening. As a result, women have come to expect, even demand, the specific technologies and practices that for decades had been narrated as necessary for preventive gynecological care, which becomes problematic with the new guidelines that reduce the frequency of the pelvic exam and, consequently, the technologies and practices that accompany it.
In response to the new guidelines and women’s various reactions and concerns over the new
guidelines, many medical providers claim that improved patient education and doctor-patient
communication are needed so the patient understands that fewer screenings do, in fact, ensure, and maybe even improve, preventive care. Explaining to patients that advances in medical knowledge and technologies have led to revised practices will, they claim, help to resolve issues with patient compliance or satisfaction. While few would disagree that improvements in patient education and communication are needed, reducing doctor-patient communication to human-to-human language neglects other considerable persuasive elements that are actively communicating to and making knowledge for patients. Therefore, I conclude this analysis with calls for more robust accounts of how knowledge and communication emerge and circulate in medical contexts by paying attention to the human and nonhuman practices and matters of clinical encounters. Also, to address potential ethical concerns of decentering the human in an inherently human practice such as medicine doesn’t ignore or dismiss humanity but calls into relief the effects of nonhuman matter on the human body.