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Aporetic Rhetoric: the Seu of Uncertainty in Healthcare Contexts Adam S University of South Carolina Scholar Commons Theses and Dissertations 2018 Aporetic Rhetoric: The seU of Uncertainty in Healthcare Contexts Adam S. Lerner University of South Carolina Follow this and additional works at: https://scholarcommons.sc.edu/etd Part of the English Language and Literature Commons Recommended Citation Lerner, A. S.(2018). Aporetic Rhetoric: The Use of Uncertainty in Healthcare Contexts. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/4708 This Open Access Dissertation is brought to you by Scholar Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. Aporetic Rhetoric: The Use of Uncertainty in Healthcare Contexts by Adam S. Lerner Bachelor of Arts Purdue University, 2011 Master of Arts Purdue University, 2013 Submitted in Partial Fulfillment of the Requirements For the Degree of Doctor of Philosophy in English College of Arts and Sciences University of South Carolina 2018 Accepted by: Pat J. Gehrke, Major Professor John Muckelbauer, Committee Member Kevin Brock, Committee Member Lisa Meloncon, Committee Member Cheryl L. Addy, Vice Provost and Dean of the Graduate School © Copyright by Adam S. Lerner, 2018 All Rights Reserved ii Dedication To Anna iii Acknowledgments I am indebted to many who have helped and supported this project along the way. For starters, I wish to thank my dissertation chair Pat Gehrke for supporting this project, providing opportunities for me to grow and learn throughout graduate school, and for being an all-around amazing person. Next, I would like to thank my committee. John Muckelbauer, Kevin Brock, and Lisa Meloncon have all been incredible mentors along the way. I thank you all for your support and encouragement. This dissertation would not have been possible without the help and support of family and friends. I want to first thank my fiancée Anna Barry, who is my everything. I would also like to thank Chris and Mike Barry, who are the most gracious and generous future in-laws I could ask for. I am also thankful to Mike Barry for acting as a liaison between myself and the veterans I interviewed for this project. I also want to thank my fellow rhetoric colleagues in no particular order: Trevor Meyer, Ben Harley, Amber Lee, Alana Hatley, Sebastian Ivy, Kimberly Overmier, Mary Fratini, Gerald Jackson, Mark Schaukowitch, and Anthony Stagliano. You have all been important sounding boards and interlocutors on this journey, and I am honored to have you as colleagues and friends. Finally, I wish to thank the Russell J. and Dorothy S. Bilinski foundation for their generous financial support. iv Abstract This project examines how uncertainty is rhetorically deployed in healthcare contexts. Investigating four major healthcare contexts, I study how different forms of uncertainty produce distinct rhetorical effects and consequences. In Chapter 1, I explore how the haphazard use of Agent Orange during the Vietnam war makes it difficult for veterans to prove their exposure to this deadly chemical. In Chapter 2, I examine the rhetorical strategies of mental illness skeptics and denialists, looking at how each deploys uncertainty in different and related ways. In Chapter 3, I investigate the intersection between design, emotion, and uncertainty as it appears in the patient experience process. Finally, in Chapter 4, I look at different methods of theory-building in addiction science, and argue that how theories wrangle with uncertainty lends them different virtues and vulnerabilities. Concluding, I suggest that the rhetorical use of uncertainty has “pharmaceutical” qualities, an argument that ups the stakes for both rhetoric and healthcare practice and theory. v Table of Contents Dedication ........................................................................................................................... iii Acknowledgments............................................................................................................... iv Abstract ................................................................................................................................ v List of Figures ...................................................................................................................... vi Introduction: Aporetic Rhetoric .......................................................................................... 1 1. A History of Aporia .............................................................................................. 2 2. A Typology of Uncertainty .................................................................................. 5 3. Aporetic Rhetoric .............................................................................................. 28 Chapter 1: Agent Orange and Aporetic Resistance .......................................................... 34 1. The Deadliest Chemical on Earth ...................................................................... 35 2. Aporetic Rhetoric and Spatial Uncertainty ....................................................... 40 3. Mapping Agent Orange Veterans Using Activity Theory .................................. 44 4. Rhetorically Limiting Activity Network ............................................................. 53 5. Rhetorically Amplifying/Neutral Activity Network ........................................... 62 6. Aporetic Tensions.............................................................................................. 72 Chapter 2: Aporetic Strategies and Mental Illness ........................................................... 77 1. Doubting Mental Illness .................................................................................... 78 vi 2. Skepticism Vs. Denialism ................................................................................... 81 3. DSM Skepticism ................................................................................................. 84 4. Poststructuralist Skepticism .............................................................................. 95 5. Mental Illness Denialism ................................................................................. 102 6. Psychopharmaceutical Skepticism and Denialism .......................................... 109 Chapter 3: Aporetic Amplification in Patient Experience Design ................................... 119 1. A Patient Experience Narrative ....................................................................... 120 2. Uncertainty and Affect .................................................................................... 122 3. The Intersections of Patient Experience Design ............................................. 126 4. Mapping the Patient Experience Process ....................................................... 132 5. Healthcare’s Conceits...................................................................................... 154 Chapter 4: Addiction Theory, Urgency, and Aporetic Rhetoric ...................................... 159 1. A Brief History of Addiction ............................................................................ 160 2. Expeditious and Fastidious Theory-Building ................................................... 164 3. Piazza and Deroche-Gamonet’s Multistep Theory of Addiction .................... 172 4. West and Brown’s Synthetic Theory of Addiction .......................................... 183 5. Aporetic Rhetoric and Urgency ....................................................................... 195 6. An Aporetic Overview ..................................................................................... 198 Conclusion: Aporia’s Pharmakon .................................................................................... 205 vi 1. Flipping the Script ........................................................................................... 206 2. Rhetoric and Medicine’s Shared Historical Foundations ................................ 207 3. The Logos-Pharmakon Connection ................................................................. 213 4. Aporia’s Pharmakon ........................................................................................ 223 Notes ............................................................................................................................... 228 Bibliography .................................................................................................................... 250 vii List of Figures Figure 1.1 – Activity Systems Model ................................................................................. 46 Figure 1.2 – Rhetorical Activity Network .......................................................................... 53 Figure 1.3 – Rhetorical Activity Network (limiting) .......................................................... 54 Figure 1.4 – Rhetorical Activity Network (amplifying) ...................................................... 64 Figure 4.1 – DSM-5 SUD Criteria ..................................................................................... 174 Figure 4.2 – Addiction Theory Chart ............................................................................... 185 Figure 4.3 – The PRIME Model ........................................................................................ 188 Figure 4.4 – The HEAD Model ......................................................................................... 191 Figure 4.5 – An Uncertainty/Urgency Matrix.................................................................
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