Hillary A. Ash explains the importance of the study of rhetoric in the medical humanities as part of our ‘MedHums 101’ series.
At first glance, it may not be readily apparent how pervasively persuasion occurs in health and medical contexts. But consider only a few steps of the medical complaint process. Initially, a person must be persuaded—typically through health narratives in their culture—that what they are experiencing is worthy of medical attention. For those who follow through with their physician, they then must convince the doctor that their symptoms are real. This isn’t hard for some, but for others with certain types of bodies, it becomes an almost impossible task.
If they can convince their doctor, the patient, in turn, must be persuaded to follow the doctor’s treatment plan. This sometimes includes prescription drugs. The doctor, of course, will have already been persuaded by experts of the drug’s efficacy. This might be at odds with the patient’s own beliefs about the drugs.
At each step in this process, persuasion is everywhere. Some scholars are particularly interested in how persuasion functions in health and medicine. This work is called rhetoric of health and medicine.
What is Rhetoric?
The term ‘rhetoric’ has come to signal both empty promises and insidious messaging in popular media today. While some rhetorical scholars—or rhetoricians—do study this darker side of rhetoric, we have a much broader understanding of what rhetoric means as a discipline.
Orality and its formal study were subjects of interest across the ancient world. From the Sumerian proverbs in The Instructions of Šuruppag (c.2600-c.2500 BCE) (Johandi 2015), to the Egyptian teaching text The Instructions of Ptahhotep (c.2400-c.2300 BCE) (Lichtheim 1996), and even Confucius’s philosophical writings (c.550-450 BCE) (Ding 2007; Lu 1998), people have always shown interest in how to behave as a public speaker. However, the field of rhetoric draws much of its knowledge from Ancient Greek and Roman traditions.
In his dialogue Gorgias (c. 387 BCE), the Greek philosopher Plato defined rhetoric as an ability to skillfully persuade others, typically in ways that benefit the speaker (458d-466c). In this sense, Plato thought of rhetoric much like we do today: it’s manipulation and often unethical. Aristotle, Plato’s student, disagreed with his teacher and claimed that, in fact, rhetoric is a touchstone of democratic civil discourse (Hauser 1991, 9). These two rhetorical traditions continued throughout the Middle Ages and beyond where its study became a cornerstone of Western education. Rhetoricians continue to debate the best definition of rhetoric and its scope. Yet most agree that rhetoric, at its core, is the art of persuasion. We can say that rhetoric is an academic field that studies how people persuade others.
Until the late 20th Century, scholars confined their rhetorical studies to the written and spoken word. Now the field has grown to include areas such as visual rhetoric, embodied or performance rhetorics, and even animal rhetorics. Our understanding of what persuasion is has grown as well; some define it quite narrowly while others suggest that, effectively, everything we do is persuasion.
Rhetoric of Health and Medicine
With persuasion as rhetorical studies’ focal point, scholars have no shortage of topics to research. In the mid-1990s to early 2000s, some rhetoricians began to take an interest in how persuasion occurred in medical settings. Of course, rhetoricians had studied medical texts and interactions prior to this (and scientific texts even before that); the influx of publications around rhetoric and medicine, however, led to the informal creation of the interdisciplinary subfield we call rhetoric of health and medicine (RHM).
Malkowski, Scott, and Keränen (2017) describe RHM as an interdisciplinary subfield that “seeks to uncover how [language] structure[s] thought and action in health and medical texts, discourses, settings, and materials.” RHM scholars explore how persuasion works in “health and medical research, clinical medicine, health and medical policymaking, consumer health and personal health management, health advocacy, and community-based health practices” among other pertinent areas (Scott and Meloncon 2018, 4). As a highly interdisciplinary area of inquiry, RHM scholars draw theories, methodologies, and research findings from the medical and health humanities, science and technology studies, technical and scientific communication, communication studies, anthropology, sociology, philosophy, history, public health, clinical medicine, and biomedical research (Scott and Meloncon 2018, 4).
While rhetoricians of health and medicine certainly do study biomedical institutions and their rhetoric, health is the privileged site of inquiry. When we focus on health more generally, we can foreground “the myriad of actors (especially flesh-and-blood people) with varying relationships to and stakes in health, illness, and wellness rather than solely focusing on the medical establishment and the medical model of care” (Scott and Meloncon 2018, 7).
Case Study: Metaphor and Genre in Breast Cancer Discourse
To illustrate how persuasion shapes our responses to health and medicine, I turn to the case of breast cancer rhetorics, or persuasion in its various forms in the context of breast cancer.
We make sense of our world through figurative language like simile and metaphor, which are rhetorical devices. When we discuss cancer, the most common metaphor is cancer-as-warfare. People ‘fight’ cancer. They seek help to boost their body’s ‘defenses’ against cancer cells. As the site of war, bodies are ‘scanned’ by advanced technology during treatment, which people hope will ‘kill’ the cancerous cells. Those who ‘beat’ cancer are ‘survivors’; those who don’t have ‘lost their battle’ with cancer (Sontag 1990, 64-65).
We can trace this military metaphor back to the 1880s and the discovery of bacteria (Sontag 1990, 65-66). To help understand this new organism and its interaction with humans, a deeply complex, novel process was simplified into a related series of accessible metaphors. In describing bacteria as something that ‘invaded’ the human body, military metaphors entered medical discourse. Since then, these metaphors have become so entrenched in how we think about disease that they have lost their figurative meaning: we no longer question the utility of the metaphors or their implications.
Having carved out their space in cancer discourse, these normalised metaphors became the building blocks for narrative genres. In her exploration of the breast cancer narrative genre, Segal (2007) argued that breast cancer stories are not just about imparting information, but also meant ‘to evaluate and govern us’ (7). The genre persuades us of at least three things: (1) breast cancer occurs individually, (2) survivorship should be celebrated through commodities, and (3) positivity is the only way to get through breast cancer. For brevity’s sake, I’ll elaborate upon only the first and last.
The story of breast cancer is the story of the individual. Breast cancer memoirs and forums are filled with women’s stories about their own experience. The typical breast cancer narrative begins with the “appearance of unwanted tissue in an individual body”, continues through diagnosis and treatment, and has a happy ending (Segal 2007, 4). Telling one’s individual story isn’t a bad thing! But the deluge of individual stories forms a narrative that convinces us of the uniqueness of breast cancer and disguises the fact that breast cancer is also “a disease of populations, enacted and reenacted in individual bodies” (Segal 2007, 8). When we are persuaded to look away from the population-level problem, we focus far less energy on examining the systemic causes of breast cancer, such as environmental pollutants caused by fracking.
Most breast cancer stories include a singular message at their core: be like me (Segal 2007, 4). This prescribes behavior that almost always requires having a positive outlook and to do something “in the name of breast cancer” (Segal 2007, 8). For instance, in a series of breast cancer narratives, women recounted that: “Cancer was a blessing in disguise… Cancer inspires me” and “six months after returning home [from the hospital], she got a divorce, started a chocolate business in her hometown… and signed up for photography lessons” (Segal 2007, 10).
This quickly becomes toxic positivity, and it dominates breast cancer discourse, defining what it means to be a ‘good’ cancer patient. Some women have expressed “[irritation] by pressure exerted on them by popular narratives to… look only on the ‘bright side’ of breast cancer” (King 2008). These accounts are not surprising because “illness narratives not only document and catalogue experience, they also reflect and reinscribe a hierarchy of values for such an experience: humour is good; despair is bad; surviving is noble; dying, by implication, is not. Moreover, the genre itself of illness narratives renders some accounts more familiar than others, more welcome, more permissible, and, finally, more speakable” (Segal 2007, 13-14).
Building better discourses around health
The field of RHM looks to issues in health and medicine like the one above with an eye towards moments of persuasion, of which there are often many. In the above case, persuasion finds articulation in the historical account of metaphors and the influence those metaphors have on our thinking and conduct. It shapes how we make sense of our experiences and which rhetorical techniques are used to direct our attention towards and away from particular things. These insights can be curated into reports that influence policy, ethics, and education. And, importantly, RHM can intervene in astoundingly complex biomedical systems to build better, more inclusive discourses around health.
Ding, Huiling. 2007. “Confucius’s Virtue-Centered Rhetoric: A Case Study of Mixed Research Methods in Comparative Rhetoric.” Rhetoric Review 26, no. 2: 142–159.
Hauser, Gerald. 1991. “Aristotle on Epideictic: The Formation of Public Reality.” Rhetoric Society Quarterly 29, no. 1: 5-23.
Johandi, Andreas. 2015. “Public Speaking in Ancient Mesopotamia: Speeches Before Earthly and Divine Battles.” In When Gods Spoke: Researches and Reflections on Religious Phenomena and Artefacts, edited by Märt Läänemets, Vladimir Sazonov, and Peeter Espak, 71-106. Tartu: University of Tartu Press.
King, Samantha. 2008. “The Great Pinkwashing: Breast Cancer, Cause Marketing, and the Politics of Women’s Health.” Public lecture. Simon Fraiser University, 18 February 2008.
Lu, Xing. 1998. Rhetoric in Ancient China, Fifth to Third Century B.C.E.: A Comparison with Classical Greek Rhetoric. Columbia: University of South Carolina Press.
Malkowski, Jennifer A., J. Blake Scott, and Lisa Keränen. 2016. “Rhetorical Approaches to Health and Medicine.” In Oxford Encyclopedia of Communication. NY: Oxford University Press.
Scott, J. Blake and Lisa Meloncon. 2018. “Manifesting Methodologies for the Rhetoric of Health & Medicine.” In Methodologies for the Rhetoric of Health & Medicine, edited by Lisa Meloncon and J. Blake Scott, 1-21. New York: Routledge.
Segal, Judy Z. 2007. “Breast Cancer Narratives as Public Rhetoric: Genre Itself and the Maintenance of Ignorance.” Linguistics and the Human Sciences 3, no. 1 (2007): 3-23.
Sontag, Susan. 1990. Illness as Metaphor and AIDS and Its Metaphors. New York: Anchor Books.
About the author
Hillary A. Ash is an Assistant Professor at Saint Louis University researching rhetorics surrounding women and medical injustices. She completed her PhD on women’s invisibility during the first decade of the U.S. AIDS epidemic in 2020. You can find her on Twitter at @hillaryaash.
Our ‘MedHums 101’ series explores the key concepts, debates and historical points of the critical medical humanities for those new to the field. View the full ‘MedHums 101’ series.