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Gaming Theory As a Strategy for Building Digital Health Literacy

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Gaming Theory As a Strategy for Building Digital Health Literacy IN NETWORK: GAMING THEORY AS A STRATEGY FOR BUILDING DIGITAL HEALTH LITERACY Emily Dawn Bunner A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of English and Comparative Literature. Chapel Hill 2015 Approved by: Todd Taylor Jane Danielewicz Dan Anderson Jordynn Jack Cynthia Haynes © 2015 Emily Dawn Bunner ALL RIGHTS RESERVED ii ABSTRACT Emily Bunner: In Network: Gaming Theory as a Strategy for Building Digital Health Literacy (Under the direction of Todd Taylor) This dissertation examines how theories and rhetorics from game studies create deeper understanding of the literacy needs for writers in the networked, multimodal environment surrounding American health care. I combine video game and social network theories to explore how computational algorithms and protocols interact with social networks in the communication of high- stakes knowledge. Gaming theory is a timely tool with which to address health literacy because contemporary medical communication flows through and is shaped by a technologically mediated system that can be understood as a set of rules both supporting and constraining action. My work demonstrates the importance of game studies to literacy scholarship by showing the rhetorical dimensions of networked health information and play. This dissertation includes in-depth case studies on the formation of knowledge around gluten sensitivity, vaccine refusal, and rhetorical constructions of diagnosis in networked media. It concludes with a plan for how we can incorporate network theories informed by game studies in Writing in Disciplines and Writing across the Curriculum instruction on medical writing and other high-stakes professional discourse. The literacies supported by this approach will train writers in the ability to think more ably and ethically across a variety of language communities. iii To my mentors in study, in survival, and in serious play. iv ACKNOWLEDGMENTS I often remind my students that life doesn’t wait for college to end: things are going to go wrong along the way. Work ahead, have a plan, and surround yourself with good people. The complex and occasionally hilarious journey to the completion of this dissertation was made possible by a collection of excellent companions and guides. My advisor and mentor Todd Taylor maintained faith in me from the first day that we discussed this project. My committee members, Jane Danielewicz, Jordynn Jack, Cynthia Haynes, and Dan Anderson provided a wealth of resources, cross-referencing magic, and simply-worded encouragement. My family, which certainly extends to the entire Computers and Writing community, continually reflected back to me an image of the scholar I could become. As always, I offer the deepest personal thanks to my partner, Kory, for finding all of the light switches, to Jill for providing the ponies, to the crew at Linda’s for saving my seat, to #TeamRhetoric for the writing group power sessions, and to my guild, Knowledge is Power, for continuing to prove that it really is turtles all the way down. v TABLE OF CONTENTS LIST OF FIGURES ................................................................................................................ vii INTRODUCTION .................................................................................................................... 1 CHAPTER ONE: GAMING THEORY AND HIGH STAKES LITERACY .......................... 7 Gaming as System Building ................................................................................................ 25 Play within Systems ............................................................................................................ 28 A Narrative Tour of a Knowledge System .......................................................................... 32 CHAPTER TWO: HOW GAMING THEORY OPERATES IN MEDICAL COMMUNICATION SYSTEMS ........................................................................................... 38 Social networking in high stakes discourse ......................................................................... 51 CHAPTER THREE: GLUTEN SENSITIVITY: RULEPLAY IN THE RHETORIC OF PERSONAL DIAGNOSIS ..................................................................................................... 62 The science of diagnosis in the age of gadgetry .................................................................. 87 The performance of patient sociality in a gameful network: a note on ethos ..................... 97 CHAPTER FOUR: VACCINE RESISTANCE: NETWORKED AGENCY AGAINST “MEDICAL CERTAINTY” ................................................................................................. 103 The Construction of Vaccine Resistance .......................................................................... 108 Creating Counter-Knowledge through Networked Community Resistance ..................... 115 CHAPTER FIVE: WHY NETWORKED GAMING THEORY MATTERS IN THE SCIENCE COMPOSITION CLASSROOM ........................................................................ 146 References ............................................................................................................................. 167 vi LIST OF FIGURES Figure 3.1: Google Trends report on the popularity of the phrase “gluten sensitivity” in Google web searches between 2005 and 2015. ...................................................................... 65 Figure 3.2: Ngram graph of the usage frequency of the word “wellness,” including variation in capitalization, in all books catalogued by Google Books with publications dates between 1800 and 2000. ........................................................................................................................ 85 Figure 4.1: Google Chart generated by Lucy Bmq to show motivations for vaccination resistance among VRM members. ........................................................................................ 115 Figure 4.2: Image showing rationale for avoiding vaccination based on chemical safety concerns. ............................................................................................................................... 120 Figure 4.3: “Chemistry Cat” meme showing the amount of research supporting vaccine injury risk .............................................................................................................................. 122 Figure 4.4: Meme showing community opposition to Jenny McCarthy as a spokesperson for the anti-vaccination movement. ............................................................................................ 125 Figure 4.5: Meme showing that patient research goes beyond Google searches and may provide better results than mainstream medical doctors. ...................................................... 127 Figure 4.6: Meme showing intense skepticism about doctors’ knowledge of vaccine ingredients. ............................................................................................................................ 128 Figure 4.7: Shared image showing patient questioning of side effect reporting. ................. 131 Figure 4.8: Meme showing supposed contradictions of safety recommendations on the Merck website. ................................................................................................................................. 132 Figure 4.9: Shared image showing an alternate explanation of the biological link between vaccines and autism. ............................................................................................................. 133 Figure 4.10: “Most interesting man in the world” meme showing skepticism of the political interests of the CDC. ............................................................................................................. 135 Figure 4.11: Image pointing out previous failures of the FDA to regulate treatment safety. 137 vii Figure 4.12: Image suggesting conspiracy on the part of those who profit from illness to prevent treatment of illnesses. ............................................................................................... 139 Figure 4.13: Image claiming that compulsory vaccination violates the Nuremburg code. .. 140 Figure 4.14: Image of Rosie the Riveter claiming that vaccinations violate a woman’s right to choose. .................................................................................................................................. 142 viii INTRODUCTION This dissertation will examine how our rhetorical understanding of social media systems can benefit from the application of gaming theory.1 I will analyze the construction of medical knowledge by providers and patients to demonstrate how networked media influence and shape communal discourse in rule-based systems. First, I will outline how gaming theory is defined and used in the field of rhetoric. Next, I will explain current problems in networked medical communication that gaming theory can help. Finally, I will suggest how we can use gaming theory to prepare students to address these communication problems in WiD and WAC composition classes. A useful connection exists between gaming studies and health communication because contemporary medical discourse is shaped by a technologically mediated system, and gaming theory is a highly effective tool for allowing us to understand and intervene in diverse technologically mediated systems. I will approach the broader problem of how gaming theory
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