Nathan A. Crick
Poststructuralism represents a set of attitudes and a style of critique that developed in critical response to the growth and identification of the logic of structural relations that underlie social institutions—whether they exist in terms of politics, economics, education, medicine, literature, or the sciences. Poststructuralism should therefore not be thought of as a distinct philosophy that exists separately as its own “structure”—a proposition that would undermine its most fundamental attitudes. Rather, poststructuralism should be thought of as developing or arising only in response to pre-existing structures and, as a set of attitudes, helping us better understand, interpret, and alter our social environment by calling established meanings into question, revealing the points of ambiguity and indeterminacy inherent in any system, rejecting the rationalistic piety that all systems are internally coherent and circle around an unchanging center, showing how discourses are carriers of power capable of turning us into subjects, and placing upon us the burden of ethical responsibility that accompanies the acceptance of freedom.
Although poststructuralism by its very nature as a set of attitudes denies any attempt at comprehensive definition, this essay examines three of the major postructuralist thinkers in order to relate their thought to the study of communication. First, following Derrida, poststructuralist thought invites a critical deconstruction of any discourse that presents itself as completely coherent, centered, and rational. Poststructuralist approaches thus do not argue against a position by harnessing counterarguments drawing on a different set of principles. Rather, it deconstructs a discourse by occupying it and exposing the gaps, contradictions, paradoxes, and deferments, thus revealing its established hierarchies, binaries, logical conclusions, and principles to be far more loosely structured and poly-vocal than its advocates wish to present them. Second, following Barthes, poststructuralism refuses to locate any single point of origin of any text that can ground its meaning—particularly by pointing to some ground of the author. Although not denying that writers exist, Barthes refuses to identify the meaning of a text with the author’s biography and intentions, instead inviting multiple interpretations from the perspective of individual readers who encounter the text as a unique event. Therefore, just as discourses do not have a unified structure, neither do individual texts or the authors that produce them. Lastly, following Fouacult, poststructuralism invites an inquiry into how discourses, texts, and acts of communication are always implicated in relations of power that act upon possible actions. Following the first two propositions, poststructuralism does not analyze these relations of power as completely structured and determinate, however. Power relations are always within a dynamic relationship with acts of resistance, thereby constantly leaving space for freedom and possibility.
Nathan A. Crick
When John Dewey announced that communication was the most wonderful of all affairs, he recognized the centrality of communication within the tradition of American pragmatism. In other traditions of philosophy, such as idealism or empiricism, communication certainly played a role, but usually it was a secondary function of transmitting ideas from one mind to another. In idealism, ideas were discovered through intuitive revelation of the whole and only later expressed through transcendent eloquence, whereas in empiricism, particular data was attained purely by the senses and communication served a kind of documentary function of fact gathering. Pragmatism, however, inverted this traditional hierarchy. By arguing that the meaning of our ideas was only found in their effects and consequences in experience, particularly those consequences brought about through shared experience, pragmatists made communication both the origin and consummation of knowledge—regardless if that knowledge was practical, scientific, aesthetic, or social. Consequently, pragmatists believed that improving the quality of communication practices was central to improving not only the state of knowledge but the quality of our experience living together in a common world.
Jennifer A. Malkowski, J. Blake Scott, and Lisa Keränen
Rhetoric, commonly understood as the art, practice, and analysis of persuasion, has longstanding connections to medicine and health. Rhetorical scholars, or rhetoricians, have increasingly applied rhetorical theories, concepts, and methods to the texts, contexts, discourses, practices, materials, and digital and visual artifacts related to health and medicine. As an emerging interdisciplinary subfield, the rhetoric of health and medicine seeks to uncover how symbolic patterns shape thought and action in health and medical texts, discourses, settings, and materials.
In practice, rhetoricians who study health and medicine draw from the standard modes of rhetorical analysis, such as rhetorical criticism and rhetorical historiography, as well as from social science methods—including participant observation, interviewing, content analysis, and visual mapping—in order to deepen understanding of how language functions across health and medical objects, issues, and discussions. The objects of analysis for rhetorical studies of health and medicine span medical research, education, and clinical practice from laboratory notes to provider–patient interaction; health policymaking and practice from draft policies through standards of care; public health texts and artifacts; consumer health practices and patient advocacy on- and offline; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health information; popular entertainments and medical dramas; and alternative and complementary medicine. Despite its methodological breadth, rhetorical approaches to science and medicine consistently involve the systematic examination and production of symbolic exchanges occurring across interactional, institutional, and public contexts to determine how individuals and groups create knowledge, meanings, identities, understandings, and courses of action about health and illness.
Katherine E. Rowan
Explanations designed to teach, rather than to support scientific claims in scholarly works, are essential in health and risk communication. Patients explain why they think their symptoms warrant medical attention. Clinicians elicit information from patients and explain diagnoses and treatments. Families and friends explain health and risk concerns to one another. In addition, there are websites, brochures, fact sheets, museum exhibits, health fairs, and news stories explaining health and risk to lay audiences. Unfortunately, research on this important discursive goal is less extensive than is research on persuasion, that is, efforts to gain agreement. One problem is that explanation-as-teaching has not been carefully conceptualized. Some confuse this communication goal and discursive type with its frequent verbal and visual features, such as simple wording or diagrams. Others believe explanation-as-teaching does not exist as a distinctive communication goal, maintaining that all communication is solely persuasive: that is, designed to gain agreement.
Explanation-as-teaching is a distinct and important health communication goal. Patient involvement in decision making requires that both clinicians and patients understand options underlying health-care choices. To explore types of explanation-as-teaching, research provides (a) several ways of categorizing health and risk explanations for lay audiences; (b) evidence that certain textual and graphic features overcome predictable confusions, and (c) illustrations of each explanation type. Additionally, explanation types succeed or fail in part because of the social or emotional conditions in which they are presented so it is important to note research on conditions that support patients, families, and clinicians in benefiting from explanations of health and risk complexities and curricula designed to enhance clinicians’ explanatory skill.