CORE Metadata, citation and similar papers at core.ac.uk Provided by Texas A&M University (RE)CONCEPTUALIZING NEOLIBERAL HEALTH DISCOURSES AS CONSTITUTIVE RELATIONSHIPS A Dissertation by TRAVIS LLOYD COX Submitted to the Office of Graduate and Professional Studies of Texas A&M University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Chair of Committee, Kristan Poirot Co-Chair of Committee, Tasha Dubriwny Committee Members, Jennifer Jones Barbour Richard Street Kirsten Pullen Head of Department, J. Kevin Barge August 2017 Major Subject: Communication Copyright 2017 Travis Lloyd Cox ABSTRACT Over the last several decades, a neoliberal shift in medical practice from institutional treatment to self-care and prevention has moved many engagements with medical authority figures out of the clinic and into society more broadly. In this context, medical authority has become more complex and difficult to locate as Western medical knowledges and practices have dispersed and intermingled with a range of other health informations and forms of healthcare. As a result, this dissertation uses a constitutive rhetorical approach to locate and examine contemporary forms of medical authority by interrogating the relationship between health subjects and medical authority in neoliberal health discourses. Rather than treat health discourses as fixed asymmetrical texts by which health subjects are either disciplined or empowered, I argue that analyzing these discourses as constitutive relationships by interrogating how health subjects and various forms of medical authority interact with and constitute each other through these texts reveals a more nuanced understanding of how both authority and subjectivity are negotiated and sustained in these contemporary neoliberal sites of engagement. The three case studies in this dissertation explore diverse ways health subjectivity and medical authority are interactively constituted through various health discourses. In analyzing American Girl’s The Care & Keeping of You advice books, the daytime talk show The Dr. Oz Show, and user engagement with Fitbit activity trackers as constitutive relationships, this dissertation illustrates the emergence of a complex understanding of the relationship between subjectivity and authority. I suggest that a relational approach ii allows us to move beyond analyzing how health subjects are constituted as they align themselves with health discourses, to examine how health subjects also participate in constituting medical authority as they engage in various forms of interaction. Indeed, reconceptualizing how medical authority emerges from and participates in various interactions with health subjects both expands our understanding of neoliberal health discourses as well as develops a more nuanced approach to critiquing health subject’s sustained engagement with these increasingly ubiquitous texts. iii I dedicate this work to my beautiful wife Stephanie and my soon-to-be son Emmett. I owe my success and efficiency in completing this project to you. Emmett, I cannot wait to meet you. I love you both. iv ACKNOWLEDGEMENTS I would like to thank my advisors, Kristan Poirot and Tasha Dubriwny, for their invaluable knowledge, feedback, and encouragement throughout the process of bringing this project to fruition. Kristan, thank you for helping me keep my butt in my chair and write, especially on days when it would have been more fun to talk about Disney. Tasha, thank you for the many last minute and frantic meetings in which you helped me talk out my problems and focus my work. Both of your investment in my research and my life is something that I will take with me the rest of my life. I also want to thank my committee members, Jennifer Jones Barbour, Kirsten Pullen, and Richard Street, for their thoughtful insight and enthusiasm. I would like to thank the faculty, staff, and fellow graduate students at Texas A&M and Oregon State Universities. Your guidance, support, and friendship has pushed me farther academically than I ever thought I would go. I would like to thank Brad and the rest of my Small Group at Brazos Fellowship. Your friendship and encouragement has helped me through both the good times and bad. I will always treasure our time together. I would like to thank the Blue Baker on University Drive for comfortable seats, Wi-Fi, and delicious cookies. I would like to thank my family for both the opportunity to pursue this degree and their unwavering support. Thank you Stephanie for your love, patience, encouragement, and inspiration every single day. v Finally, I would like to thank Jesus Christ, the One with and by Whom all things, including this dissertation, are made possible – in You we live, and move, and have our being, and to You be the glory, honor, and praise, forever. vi CONTRIBUTORS AND FUNDING SOURCES Contributors This work was supervised by a dissertation committee consisting of Professors Kristan Poirot [advisor], Tasha Dubriwny [co-advisor], Jennifer Jones Barbour, and Richard Street of the Department of Communication and Professor Kirsten Pullen of the Department of Performance Studies. All other work for the dissertation was completed independently by the student. Funding Sources This work was made possible in part by a research grant from Texas A&M University’s Department of Communication. Its contents are solely the responsibility of the author and do not necessarily represent the official views of Texas A&M University or the Department of Communication. vii TABLE OF CONTENTS Page ABSTRACT .............................................................................................................. ii DEDICATION .......................................................................................................... iv ACKNOWLEDGEMENTS ...................................................................................... v CONTRIBUTORS AND FUNDING SOURCES ..................................................... vii TABLE OF CONTENTS .......................................................................................... viii CHAPTER I INTRODUCTION ............................................................................... 1 Contextualizing Health Subjectivity and Medical Authority ....................... 5 Neoliberal Health Discourse and the Rhetoric of Health and Medicine ...... 20 Case Studies ................................................................................................. 27 CHAPTER II THE CARE & KEEPING OF YOU ................................................... 31 Neoliberalism, Postfeminism, and the Medicalization of Appearance ........ 34 American Girl and The Care & Keeping of You .......................................... 38 Constituting the Health Subject/Reader ....................................................... 41 American Girl’s Medicalization of Appearance .......................................... 46 Conclusion .................................................................................................... 58 CHAPTER III THE DR. OZ SHOW ........................................................................ 62 Daytime Talk Shows, Celebrity, and Medical Authority ............................. 66 Dr. Oz, the Flexible Medical Authority Figure ............................................ 70 Expanding Medical Authority ...................................................................... 75 Conclusion .................................................................................................... 82 CHAPTER IV FITBIT .............................................................................................. 87 The Rise of Wearables ................................................................................. 90 Fitbit, the Sum of Your Life ......................................................................... 96 Underlying Medical Authority ..................................................................... 98 Numbers and Notifications ........................................................................... 101 Virtual Trainers ............................................................................................ 106 viii Page Fashion in Fitness ......................................................................................... 110 Conclusion .................................................................................................... 114 CHAPTER V CONCLUSION .................................................................................. 118 Neoliberal Health Discourses and Constitutive Relationships ...................... 119 The Implications of Critiquing Constitutive Relationships ........................... 124 Directions for Future Research...................................................................... 129 NOTES ...................................................................................................................... 131 BIBLIOGRAPHY ..................................................................................................... 152 ix CHAPTER I INTRODUCTION Seven years ago I decided that I needed to do something about my health. After years of sedentary living with three college roommates who played video games continually and ate fast food for every meal, like many Americans,1 I found myself increasingly unhappy with my body and concerned with the threat that obesity, diabetes, heart disease, and other health related issues posed to my lifespan and well-being. As a result, I substantially changed my diet and