Introduction to the Special Issue: Medical Humanities and/or the Rhetoric of Health and Medicine

In 2015, my (Elizabeth’s) dad was diagnosed with liver disease and was in liver failure by summer, 2017. He was added to the liver transplant waiting list that summer, putting my family on a journey that involves three main stages: pretransplant, which can last weeks to years as the recipient waits for a donor match; transplant, which lasts many hours in the operating room and is followed by weeks to months of healing and rehabilitation in the hospital; and posttransplant, which refers to the rest of the recipient’s life with the donor organ. Each stage has its own challenges unique to the situation and my dad’s health, but my family knew two things for sure throughout the process. First, we would be receiving a deluge of health information and specific care instructions at each stage, some of which had fatal consequences if not followed correctly; and second, we would work with the “Liver Team” at each stage of the transplant. This team includes four transplant surgeons, eight transplant physicians, nine nurse practitioners and physicians’ assistants, one transplant pharmacist, one transplant social worker, one financial coordinator, and three transplant coordinators who are registered nurses (one coordinator is assigned to the patient for each transplant stage).

Throughout this process, and still today posttransplant, I learned how the rhetoric of health and medicine (RHM), medical humanities, and technical communication can inform one another. Scholars in these fields study and help manage the rhetorical negotiation involved in intersections of healthcare communication, patient education, and evidence-based medicine. This rhetorical negotiation was apparent while my parents and I kept track of all the specialists’ roles and their relationship to my dad’s care (e.g., transplant surgery, hepatology, cardiology, nephrology, psychiatry, infectious disease, critical care, dietetics, physical and occupational therapy, spiritual care). We received a binder labeled “Liver Transplant Education” once my dad was placed on the transplant list that outlined this information. Although the binder contained useful information, it was text heavy, and some of the graphics were illegible to nonmedical audiences, especially as they experienced the extreme stress of the transplant process—and the Liver Team agreed.

For my family’s purposes, the most useful—but also the most confusing—information included the bios of various members of the Liver Team, their specialties, and their contact information. These professionals were our go-to people for questions and concerns around the clock, but my parents and I struggled to keep track of which person we were supposed to contact with which health concern, especially pretransplant as more of my dad’s bodily systems were deteriorating due to his failed liver. At one point before the transplant surgery, I suggested that we amend the transplant education materials by making a map of the Liver Team so that we could better understand the relationships among everyone. Following spatial mapping practices used in technical communication (e.g., Brizee, 2015; Porter, Sullivan, Blythe, Grabill, & Miles, 2000; Simmons, 2007; Spinuzzi, 2003; Sullivan & Porter, 1997), we placed my dad in the center and listed around him each specialist, their medical role in the transplant process, what questions they could answer for us, and their contact information. This visual supplement created a snapshot of the key players in my dad’s care and quickly allowed us to share this information with other family members, like my brother who lives out of state and who helped care for our dad posttransplant.

This experience taught me that the medical humanities, RHM, and technical communication extend into the “everydayness” of exchanges in healthcare, exchanges that the authors in this special issue explore. As Meloncon and Frost (2015) astutely note, these exchanges are “one of the most important dimensions of health and medicine” because they allow those involved in medicine to create and share knowledge, which ultimately facilitates patient care, health, and wellness (p. 7). In these exchanges, and in this special issue, we can see how RHM, the medical humanities, and technical communication can work together to contribute to the healthcare field, especially by preparing preprofessional health and medical students, impacting healthcare providers’ practices, and supporting patients and their caregivers as they navigate the healthcare system.

Purpose of the special issue and significance to the field of technical communication

The articles in this special issue explore the intersections and tensions between the emerging fields of the medical humanities and RHM, especially as they relate to technical communication. The medical humanities tend to approach the field from traditional pathways familiar to the humanities and liberal arts, such as history, philosophy, ethics, literary studies, sociology, and political science. As a result, research and curricula in the medical humanities tend to be critical, theoretical, interpretive, historical, and reflective. Somewhat differently, RHM tends to be more application oriented, researching current communication practices and identifying best practices among healthcare providers. Researchers in RHM are often looking for ways to strengthen and streamline communication practices in healthcare and medical workplaces, while developing curricula and training to improve those practices. As a result, RHM has been more closely aligned with technical communication because these two fields are application oriented and therefore share many common goals and motivations. The medical humanities have generally had a less direct relationship with technical communication, collaborating more with literature, ethics, sociology, history, gender studies, and cultural studies.

The differences between the medical humanities and RHM have been observed by others, such as Scott, Segal, and Keränen (2013) and Solomon (2008). However, these distinctions have not been explored in a comprehensive way. In this special issue, the authors explore the intersections and tensions between these two academic approaches to the healthcare workplace. Our aim with this special issue is to bring these fields side by side in a way that will open exciting new pathways for research, analysis, expression, and application in the field of technical communication.

That said, our intention is not to merge the medical humanities and RHM into one field because doing so would overlook their important institutional differences. Rather, we believe, and as the authors in this special issue show, that both the medical humanities and RHM would gain by exploring these intersections and tensions. For example, the medical humanities and RHM are built on a foundation of rhetoric, which leads to productive research on narrative, metaphor, invention, identity, genre, collaboration, style, memory, rhetorical analysis, negotiation, and collaboration, among many other issues (see, e.g., Angeli, 2015; Charon, 2006; Ding, 2009; Donovan, 2014; Emmons, 2010; Fountain, 2014; Graham, 2015; Heifferon, 2008; Jensen, 2015; Lyne, 2001; Mol, 2003; Popham, 2005; Stormer, 2002; Teston, 2017; Wells, 2010). By developing connections between the medical humanities and RHM, scholars of technical communication can take advantage of both fields’ strengths, allowing us to engage more directly with issues involving ethics, history, sociology, literary studies, and curricular design—issues that the authors explore in this special issue.

Likewise, the medical humanities and RHM, as we have seen in Technical Communication Quarterly (TCQ) and other journals in our field, have great promise as fields of research and expression. By bridging the gap between the medical humanities and RHM, we believe scholars in technical communication would improve their access to research funding and development gifts, which are currently more available in the medical humanities than RHM. These bridges will also open opportunities to collaborate with new colleagues across the curriculum, foster curriculum development, and attract institutional funding for building programs. In kind, the medical humanities would benefit from RHM’s emphasis on empirical research and application. By building stronger bridges between these two related disciplines, we hope also to broaden technical communication’s opportunities to conduct funded research, promote healing, and develop curricula that are beneficial to healthcare education and communications.

Definitions of the medical humanities and RHM

To understand better where the medical humanities and RHM intersect, we begin by defining these terms. Defining the medical humanities is easier and harder than defining RHM. It’s easier because the medical humanities have a long history that can be drawn back decades, centuries, and even thousands of years. Hippocrates is often quoted by scholars of medical humanities as saying, “Wherever the art of Medicine is loved, there is also a love of humanity.” Likewise, Plato drew repeated parallels among medicine, rhetoric, and philosophy in the Gorgias, Phaedrus, and other dialogues. Eighteenth-century literary giants, such as Oliver Goldsmith, John Keats, and Friedrich von Schiller, were practicing physicians who used their literary talents to explore medical issues in print. Unfortunately, this long history also makes identifying a starting place for the medical humanities as an academic field much more difficult. Do we point to the coining of the term medical humanities by George Sarton in the 1940s (Horwitz & Dakir, 2009) Do we draw the starting line in 1967 with the establishment of a Department of Humanities in Penn State’s College of Medicine? Do we note the founding of flagship journals such as the Journal of Medical Humanities in 1979, Literature and Medicine in 1982, or Medical Humanities in 2000?

Definitions of the medical humanities are similarly indeterminate, often describing the scope of the field rather than capturing its essence. The definition used by the National Library of Medicine (2004) at the National Institutes of Health is typical:

This field emphasizes the humane aspects of medicine and health care and has expanded to include research in social sciences disciplines that are informed by humanistic scholarship, such as cultural studies, anthropology, and medical sociology. The literature is diverse, and includes scholarly research, reflective essays, and critical interpretations of artistic and literary works.

In a prominent textbook in the field, Cole, Carson, and Carlin (2014) offer a similarly imprecise definition: “We define medical humanities as an inter- and multi-disciplinary field that explores contexts, experiences, and critical and conceptual issues in medicine and health care, while supporting professional identity formation” (p. 12). These types of definitions may be unavoidable, given the transdisciplinary nature of the medical humanities, even though they seem more indicative than intrinsic.

We also note that the medical humanities as a field may be evolving, recently taking on the label “health humanities” to reflect the reality that health involves more than what happens in hospitals, clinics, doctors’ offices, laboratories, or medical schools. Indeed, a couple of our authors have consciously chosen to use the term health humanities to reflect this broader understanding of the field. As the editors, we made a judgment call to use the more established term, medical humanities, while fully acknowledging the merit of the broadened term and even its potential future dominance.

The history and definition of RHM is more settled. In a 2000 special issue of TCQ on “Medical Rhetoric,” editors Barbara Heifferon and Stuart Brown situated this emerging area of research in the fields of rhetoric, technical communication, and writing across the curriculum. Their introductory article notes how the humanities—specifically rhetoric and technical communication—could “suggest alternative discursive practices” in medicine (p. 247), and they saw medical rhetoric as a space to merge rhetoric and medicine, a division that dated back to Platonic times (Bell, Walch, & Katz, 2000). They argued that medicine, like rhetoric, was an art, and as specialists in language practice, rhetoricians were well positioned to bridge language and medicine.

The focus on language and texts as a hallmark feature of medical rhetoric research and theory continued throughout the early 2000s. The special issue of Journal of Business and Technical Communication edited by Barton (2005) illustrated that the study of medical discourse was becoming a place where many disciplines in the humanities, the social sciences, and medicine merged, and the common ground on which they stood was language practice, specifically genre theory and analysis. Special issues of Technical Communication Quarterly (Heifferon & Brown, 2008) and Written Communication (Haas, 2009) explored writing practices as related to medicine, including the writing practices of medical practitioners and online health information. These collections continued to reflect the field’s growing interdisciplinary path, which was evident in the research methods, research sites, and research questions used in scholarship ranging from textual analysis (e.g., Heifferon, 2008; Segal, 2005), discourse analysis (e.g., Barton & Eggly, 2009; Teston, Graham, Baldwinson, Li, & Swift, 2014), rhetorical-cultural studies (e.g., Scott, 2003), and a variety of ethnographic methods, including interviews, focus groups, and observations (e.g., Burleson, 2014; Lingard, Garwood, Schryer, & Spafford, 2003; Lingard, Reznick, Espin, Regehr, DeVito, 2002; Teston, 2009).

As more scholarship was published, the name medical rhetoric shifted to rhetoric of health and medicine to be more specific and expansive. This new name more precisely accounted for the broader range of scholarship that was under the moniker medical rhetoric, and the addition of health and medicine account for the work scholars were doing with health, wellness, and prevention, thereby encompassing more than a biomedical model of medicine. Still grounded in language practice, RHM has explored neurorhetorics (Jack 2010), rhetorical questions in health and medicine (Leach & Dysart-Gale, 2010), gender and body rhetorics (Angeli et al., 2012), disability studies (Meloncon, 2013), public engagement (Keränen, 2014), communication design (Meloncon & Frost, 2015), user experience design and technology (Heifferon, 2017), and research methodologies (Meloncon & Scott, 2017). This diverse body of work suggests that RHM scholars are interested in describing, developing, and teaching the rhetorical strategies used in health and medicine by healthcare’s various stakeholders, including providers, patients, and caregivers.

Tensions between RHM and the medical humanities

This special issue stemmed from our mutual concern that RHM, as an emerging field developing its own identity, might be separating itself from the medical humanities, with implications for scholars in technical communication who study RHM and medical humanities. We observed these tensions, among other places, during meetings at our institutions regarding creating medical humanities programs. We felt RHM projects were similar enough to the medical humanities to participate in these conversations about curricular development and funding opportunities, but they were different enough from the medical humanities partly because of their research methods. RHM methods currently live in between humanities research and social sciences research and often do not fit easily into these either-or categories that are often required in grant applications. We saw these moments as opportunities to enact the Scott et al. (2013) observation that RHM complements but is different from the medical humanities, and this special issue offered a formal opportunity to publish scholarship on the tensions that can emerge in our everyday work.

We wondered whether separating RHM from the medical humanities might dilute opportunities for research, curriculum development, and engagement. Separation could restrict research funding opportunities and might limit access to the political capital built up by the medical humanities. Ideologically, this split also risks reinforcing an outmoded but still existent two-culture division between the liberal arts and the STEM fields, undermining the reunification of rhetoric and medicine that Heifferon and Brown (2000) thought medical rhetoric could achieve. For practical reasons, we were concerned that such a split could potentially cut off RHM and technical communication from the financial and political resources that are currently flowing into the medical humanities, which is one of the fastest growing areas in academia today. To reveal our bias, we believe RHM and the medical humanities are stronger together and that researchers in RHM have much to gain politically and financially from collaborating with their kindred souls in the medical humanities. Meanwhile, scholars of technical communication should not feel pressure to decide between these two promising and engaging paths.

Conclusion

In sum, the aim of this special issue is to explore the intersections and tensions between the medical humanities and RHM. By building stronger bridges between these two related disciplines, we hope also to broaden technical communication’s opportunities to do funded research, promote healing, and develop curriculum that is beneficial to the healthcare workplace.

We came at this special issue from our two different perspectives. Elizabeth has been publishing in the field of RHM, doing empirical research and looking for applications. Richard founded the Cancer, Culture, Community collaboration at Purdue 10 years ago with Purdue’s Oncological Sciences Center. He has been building Purdue’s medical humanities program, while broadening the university’s offerings in medical writing. Our different perspectives have let us work out some of the similarities and tensions that the authors, and we, explore in this special issue.

Acknowledgments

We want to thank the reviewers for this special edition, who offered fantastic feedback and advice to the authors and us.

Additional information

Notes on contributors

Elizabeth L. Angeli

Elizabeth L. Angeli is an assistant professor of English at Marquette University, where she teaches first-year writing, rhetoric, and workplace writing. Her current book project, Rhetorical Work in Emergency Medical Services, investigates how healthcare providers harness rhetoric’s power to communicate effectively in unpredictable medical environments. Her work has been published in Written Communication, Communication Design Quarterly, and the Journal of Technical Writing and Communication, and she serves as annotated bibliography editor of Present Tense: A Journal of Rhetoric in Society.

Richard Johnson-Sheehan

Richard Johnson-Sheehan is a professor of English (rhetoric and composition) at Purdue University, where he teaches professional writing, medical writing, science writing, and classical rhetoric. He is author of many articles in scientific and technical communication and a few textbooks, including Technical Communication Today. He is a fellow of the Association of Teachers of Technical Writing (ATTW) and a recipient of the Society for Technical Communication's Jay R. Gould Award for Excellence in Teaching Technical Communication.