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37 Patient Audience 2 Patient Audience: The Rhetorical Construction of the Migraineur The patient takes on certain new characteristics when regarded as a speaker and an audience involved in a rhetorical situation. In the physician’s office, the patient is not only an ill person or a person with a complaint; he or she is also an interlocutor in a persuasive encounter in which the reward of credibility may be best care, and the price of lack of credibility may be more sickness or pain. Moreover, credibility is not something that the patient can easily carry into the medical rhetorical situation from outside of it; rather, credibility is granted by the situation itself or created by it. In many cases, in order to be positioned to receive the best possible care, the patient must be credible not as an accountant or a sister or a gardener; the patient must be credible as a patient. Furthermore, the role of patient exists primarily in relation to the role of physician; the patient is also the physician’s audience and is for that reason also a construct of the physician. Perhaps more than any other element, the notion of audience defines rhetorical theory. There is no rhetoric without an audience. There is no speech without listeners, no writing without readers. A core principle of rhetorical theory is that discursive encounters are conditioned by speakers ’ audiences. As Aristotle says, “‘Persuasive’ means persuasive to a person ” (11); the speech is “the joint result of three things—the speaker, his subject matter, and the person addressed” (16). 38 Patient Audience Twentieth-century rhetorical theory is particularly focused on the idea of audience. Kenneth Burke says that rhetoric is, essentially, addressed. Richard M. Weaver refers to the dual obligations of rhetoric: to the “external order of things” and to the audience to which it is addressed (“Language ”). Chaim Perelman and Lucie Olbrechts-Tyteca identify three kinds of audience as playing a normative role in argumentation. The first is the universal audience, “the whole of mankind, or at least . . . all normal, adult persons.” The second is the “single interlocutor whom a speaker addresses in a dialogue. The third is the subject himself when he deliberates or gives himself reasons for his actions” (30). The audience of contemporary theory is conceptually more expansive than the audience of classical theory; it is also based on a more communal model of rhetoric: The speaker is himself or herself a member of the audience who rises, at least metaphorically, to speak. In every formulation, the audience inhabits the imagination of the speaker, who, to do his or her job well, composes the speech in light of it. “The writer’s audience,” says Walter J. Ong, “is always a fiction,” the audience-construct in the mind of the rhetor in the act of composition. Maurice Charland takes the idea of a constructed audience further, to talk about the audience as not only imagined by the rhetor but also constituted by the speech. In a way quite helpful for thinking about the patient audience—the patient as audience—Charland writes about how a policy paper on Quebec sovereignty, the 1979 “White Paper,” addressed primarily to the French-speaking population of the province of Quebec, interpellated or called forth an audience, a “peuple Québécois,” which did not as a collective preexist the paper itself (Charland cites Louis Althusser on the condition of the subject): [T]he White Paper calls on those it has addressed to follow narrative consistency and the motives through which they are constituted as audience members. . . . [A]udiences do not exist outside rhetoric, merely addressed by it, but live inside rhetoric. Indeed, from the moment they enter into the world of language, they are subjects; the very moment of recognition of an address constitutes an entry into a subject position to which inheres a set of motives that render a rhetorical discourse intelligible. (232) In general, twentieth-century rhetorical theory holds that we are, each of us, made in rhetorical interchange with other people. As we encounter each other in language, we come to be who we are. This view of audience 39 Patient Audience has two levels, at least. We are social beings whose very selves are made in symbolic interaction with other people (see Wayne C. Booth, for example ); also, each time we are addressed, we are invited, sometimes irresistibly , to take on the shape of a particular audience. I am interested in what can be learned about...


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