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1 Introduction Introduction: The What, Why, and How of a Rhetoric of Medicine This book is for a range of readers: rhetorical theorists, rhetoricians of science, medical anthropologists, historians of medicine, and other scholars; health practitioners and health researchers with a special interest in the book’s topics (for example, migraine, health anxiety, end-of-life decision making, values in health policy, patient “compliance”); health practitioners and health researchers with a critical interest in their own discourse and practice; and other persons interested in health and medicine more generally. The premise of the book is that rhetorical study— essentially, the study of persuasion1 —is a good means of illuminating and recasting problems in health and medicine. Health is the more encompassing term for our study; typically in Western culture, medicine provides the set of terms through which health is primarily understood. The rest of this introduction is in three parts. The first considers the what and the why of studying health and medicine rhetorically; the second considers the how of it; the third part is a chapter outline of the rest of the book. What and Why Persuasion is a central element in many medical situations. Patients may have to persuade physicians that they are ill and in need of care; physicians seek to persuade patients to adhere to courses of treatment; experts 2 Introduction persuade the public to count some states and behaviors as pathological and others not; pharmaceutical companies persuade consumers to request their products, and physicians to prescribe them. Moreover, the very terms in which persuasion takes place in health and medicine themselves condition outcomes. The phrase social anxiety disorder persuades the very shy person that he or she may be a candidate for drug treatment; the word breakthrough persuades the public to imagine medical research as a dramatic sort of enterprise; the phrase fighting disease persuades persons that they have failed at something when they cannot stop being ill; the term survivor leaves the dead person looking somehow culpable. Caregiver creates a class of care receivers and tips the economy of families; antibacterial enters public discourse as a term of general praise. Rhetorical criticism identifies the persuasive element in the discourse of health and medicine and asks, “Who is persuading whom of what?” and “What are the means of persuasion?” The goal of rhetorical criticism is a greater understanding of human action. Rhetorical theory, as a whole, has considerable explanatory power in a world in which we act upon each other by influence.2 The relations of rhetoric and medicine are various and webbed. As my mentor in rhetoric, Nan Johnson, taught me, you can start rhetorical investigation anywhere, and you can get everywhere from there. The first questions of my own studies in rhetoric and medicine were about strategies of influence in medical authorship, about the means by which medical authors persuade medical readers on matters of disease etiology, diagnosis , and treatment. In order to write my doctoral dissertation, I read hundreds of medical journal articles in a rhetorical-analytic mode. S. Michael Halloran has said, in a landmark essay in the rhetoric of science, that while many theorists claimed that scientific writing was rhetorical, few scholars had actually examined the writing to describe how, exactly, it was so. The purpose of my dissertation was to isolate and describe persuasive strategies in medical journal articles and then to suggest a procedure for reading medical prose as rhetoric, as a motivated discourse with persuasive force. My project was theory-based, but it was not itself theoretical ; rather, it was analytic and descriptive (see Segal, “Reading Medical Prose as Rhetoric”). Analysis and description are never very far from criticism, though, or theory. I discovered that the rhetorical features of medical journal articles are particularly well suited to biomedicine and, in a sense, enact its values. The textual markers of certainty, for example, are tied to conventions of medical authority; statistical argumentation plays out the scientific bent of biomedicine; the inquiring mind is a trope aimed at securing 3 Introduction professional cooperation, and so on. Furthermore, medical texts perform much of their rhetorical work on a large scale, generically, with or without the intentions of particular authors. Medicine is not only rhetorical as it is reproduced in published texts; it is also rhetorical as a system of norms and values operating discursively in doctor-patient interviews, in conversations in hospital corridors, in public debate on health policy, and in the apparatus of disease classification . So, for example, rhetorical...


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