Reimagining the Boundaries of Health and Medical Discourse in Technical Communication

ABSTRACT

In this introduction, we emphasize the urgency of centering bodyminds and communities whose lives and experiences have been disregarded, or viewed as disposable, in medical and technical communication. With an expansive vision of health, we set the interdisciplinary stage for authors who answer the call of multiply-marginalized scholars working in (and beyond) medical rhetorics to reimagine health-related research that centers the perspectives, experiences, and embodied realities of multiply-marginalized communities (Jones, 2020; Walton, Moore, Jones 2019).

KEYWORDS:

• Health/medical communication
• Cultural studies
• Gender research
• Interdisciplinary

The field of technical and professional communication (TPC) is increasingly critiqued for pretending and/or believing that communication is neutral and objective (Jones, 2016; Jones & Williams, 2018; Mckoy et al., 2020). As social-justice-driven scholars in the field point out, TPC is never neutral or objective and, in fact, is frequently used to maintain and build structures of oppression. When it comes to healthcare, longstanding documented evidence of structural oppression shows that TPC, and technical communicators themselves, can and do perpetuate injustice, particularly in relation to the embodied experiences of multiply marginalized individuals¹ (Bloom-Pojar & Barker, 2020; Edenfield, 2019; Edenfield & Ledbetter, 2019; Frost & Eble, 2020; Frost & Haas, 2017; Harper, 2020).

In conceptualizing this special issue on healthcare, we emphasize the urgency of centering bodyminds² and communities whose lives and experiences have been disregarded, or viewed as disposable, in medical communication and other TPC. Beyond the medical field’s penchant for centering white cisgender men (Dusenbery, 2018; Jackson, 2019), medical communication and other TPC have also long functioned as the invisible hand of biopower––e.g., in gynecological medicine’s progress narratives that intentionally erase its history of torturing and abusing Black cisgender women (Ivy, 2016; Owens, 2017; Washington, 2006); trans healthcare researchers’ disavowal of the white supremacist origins of gender-affirming treatments (Gill-Peterson, 2014, 2018; Hsu, 2019; Snorton, 2017); HIV public health campaigns that continually traffic in racism, misogynoir and transphobia (Bailey et al., 2019; D’Avanzo et al., 2019; Jeffries & Henny, 2019; Mulé et al., 2009; Rosen et al., 2019; Young & Meyer, 2005); the Supreme Court’s (1927) Buck v. Bell ruling that legalized the forced sterilization of Black, Brown, Indigenous, and incarcerated women and dfab people (Davis, 2018; Dow, 2018; Lawrence, 2000; Luna, 2009; Scully, 2004; Whatcott, 2018); decades of government policy that has intentionally underfunded the Indian Health Services (Jaramillo & Willging, 2021; Lewis, 2018; Sarche & Spicer, 2008); medical and nursing schools which enshrine and continually fail to interrogate their white supremacist curricula (Beagan, 2003; Brooks, 2015; Loder et al., 2020; Scharff et al., 2010; Zappas, Walton-Moss, Sanchez, Hildebrand, & Kirkland, 2020); and calls for participants which intentionally frame BIPOC and LGBTQ patients as unideal candidates for clinical research (George, Duran, & Norris, 2014; Rabelais & Walker, 2021; Washington, 2006).

While technical and medical writing has worked to buttress biopolitical violence, this is not the only story. Multiply-marginalized individuals and collectives––particularly Black people––have long engaged methods and strategies designed to navigate (and resist) structural oppression in healthcare (Jones & Williams, 2020). As Jones and Williams (2020) clarify,

To be clear, Black folks have been imagining justice for centuries: imagining our streets without police and police violence; imagining preventative healthcare that is available and affordable to all of us; imagining that gardens replace food deserts; imagining that sustainable consumption replaces consumerism; imagining that the goal of education is inspiration rather than institutionalization; imagining that art and creativity inform our philosophy of life, and imagining that our lived, collective experiences of oppression will be understood as profoundly human, and as such, deserving of liberation, protection, and dignity.

At stake here is an antiracist and decolonial challenge to a white-supremacist conception of “health,” which stubbornly frames health in terms of individual patient outcomes, ignores systemic oppression’s axiomatic role in creating toxic environments, and perpetuates the neoliberal lie that disability and illness are a result of personal failure––as if one didn’t try hard enough to achieve “health” (Piepzna-Samarasinha, 2018, pp. 29–32).

With an expansive vision of health in mind, this special issue answers the call of multiply marginalized scholars working in (and beyond) medical rhetorics to reimagine health-related research that centers the perspectives, experiences, and embodied realities of multiply marginalized communities (Jones, 2020; Walton, Moore, & Jones, 2019). In editing this issue, we take care to answer Jones’s (2020) call to “emphasize the justice work across disciplines and across justice-related interventions that we develop to address intersectional oppressions based on race, gender, disability, sexuality, ethnicity, and more” (p. 517). To this end, the articles included in the issue speak to TPC research, while also drawing on interdisciplinary conversations outside the field that illustrate the work that multiply marginalized scholars, communities, and activists have long been imagining and enacting.

About interdisciplinarity

The social justice turn in TPC pushes scholars and teachers to “re-envision the field” through a “larger tapestry” that not only draws on, but perhaps centralizes, interdisciplinary research and practice (Jones, Moore, & Walton, 2016, p. 223). To continue working toward inclusion, as many TPC researchers have shown (Del Hierro, 2019; Haas & Eble, 2018; Jones, 2016; Shelton, 2019), it’s important the field expands its disciplinary grounding by incorporating research from fields outside of TPC that have engaged in efforts for justice and inclusion for many centuries. This is especially true, we argue, when doing TPC research in areas like healthcare – as there is a wide body of work in a wide variety of fields that addresses the complexities of healthcare but a dearth of TPC literature that takes up more than a few token topics in these important areas. These interdisciplinary conversations should be of particular interest to technical communicators because they are read as specialized – i.e., technical – and thus imbued with a sense of authority that can exacerbate unjust practices.

For example, Sabrina Strings (2019) engages bodies at the intersections of fields such as Fat Studies, Critical Race Theory, and Gender Studies to discuss health issues such as food insecurity and type 2 diabetes. Relatedly, Zakiya Luna (2009) examines Sister Song’s women of color feminism (and organizing) to push academic conversations beyond the limited scope of reproductive rights and toward a more expansive vision of reproductive justice, which fights for access to equitable living conditions – often denied by systemic oppression – that a person needs to decide whether or not (and how) they want to have children. In an adjacent vein, C. Riley Snorton (2017) and Julian Gill-Peterson (2018) both examine how contemporary medical advances used to provide gender-affirming care for (some, often more privileged) trans people were borne from centuries of white supremacist abuse – enacted by white doctors and their enablers who targeted, enslaved, incarcerated, institutionalized, and/or kidnapped Black, Brown, immigrant, intersex, disabled, and poor people for the purpose of coerced, nonconsensual, and unnecessary medical experimentation (and torture). In TPC, Edenfield, Holmes, and Colton (2019) analyze user-generated instructions for administering do-it-yourself hormone replacement therapy (DIY HRT), urging the field to develop a new approach to queer theory that “refuses to align queer agency with stable identities” (p. 177). In these examples, looking outside the boundaries of what is considered “traditional” TPC is a critical element to highlighting the voices and experiences that have too long been deemed “outside” the field. Drawing on such interdisciplinary research, then, this special issue emphasizes the importance of approaching healthcare through multiple frameworks that center the experiences of multiply marginalized bodies. These multiple approaches are necessary when accounting for the interlocking oppressions (Crenshaw, 1989) that multiply marginalized bodies face in healthcare, particularly through the intersections of race, gender, class, and disability.

In constructing the special issue, we’ve organized the respective articles with Walton et al.’s (2019) articulation of the “4Rs: Recognize, Reveal, Reject, and Replace” in mind, recognizing that the scholarship contained herein may move across those notions and also may provoke “dis-ease” for those of us who identify primarily as TPC scholars unused to critique from beyond our disciplinary silo. But, importantly, if the field of TPC is to understand the complex ways in which oppressive systems operate on multiply marginalized peoples, it must forward proactive change where TPC has traditionally remained passive. An advance toward redressing one of the most glaring causes of our field’s relative absence from interdisciplinary inquiry into the embodied experiences of multiply marginalized people in healthcare is to take on and take in interdisciplinarity, an action that can be intimidating because of the enormous responsibility it entails. However, part of the work of the social justice turn in TPC, then, must push TPC scholarship to reconsider precisely where the field’s responsibilities lie. Some pieces in this special issue purposefully draw in other disciplines and leave the reader to make the connections to TPC. We help toward that project with this introduction, but we (again, purposefully) expect readers to do work as well in making those connections – and building on them further. Additionally, we position this issue as a cohesive whole that speaks back to the existing body of TPC scholarship. You will find here a serious commitment to interdisciplinarity. We challenge readers to sit with the discomfort of reading work that levels critique at our existing scholarship even when that work comes from “outside.”

Summary of articles

In “Tired as a mutha: Black mother activists and the fight for affordable housing and healthcare,” Kimberly Harper argues and illustrates that TPC documents and tactics are never neutral in her analysis of the Moms 4 Housing movement in Oakland, California. Theorizing ethos differently for the Black women in the movement, Harper contends that acknowledging the intersectional complexity of ethos for Black mothers “is in fact crucial to dismantling systems of oppression and addressing the goals of Reproductive Justice activism.” She makes her argument by contrasting the TPC genres “used by activists (websites, press releases, social media posts, memos, and position statements) … to redress oppression” with “the written communication strategies of government establishments (regulatory writing) [that] help maintain systems of inequity.” By highlighting the TPC skills that Moms 4 Housing uses to leverage regulatory knowledge and public communication tools, Harper invites readers to recognize Black women who experience housing insecurity as savvy technical communicators, who skillfully navigate the intersecting oppressions that make them and their children vulnerable to harmful systems.

In their article “Health and wellness as resistance: Tactical folk medicine,” Jamal-Jared Alexander and Avery Edenfield identify a series of barriers trans African American patients experience by examining two case studies that, as they say, “explore (a) African Americans’ use of complementary and alternative medicine throughout history, and (b) trans tactics addressing institutional oppression.” Exploring these two case studies as examples of tactical technical communication while reading them through a feminist lens, Alexander and Edenfield provide insights into how these bodies navigate medical institutions, thus “mak[ing] room for further research to be conducted to better assist marginalized communities.”

In “Re/producing knowledge in health and medicine: Designing research methods for women’s mental health,” Peter Cannon and Katie Walkup address how “research on healthcare, and on MH [mental health] care specifically, has excluded participants, particularly on the basis of race, gender, class, and ability, among other groups.” Cannon and Walkup thus argue that such exclusions have contributed to a lack of knowledge about MH and that the lack of knowledge leads to a cascading effect of lack of treatment, health disparities, discrimination, and other detrimental and inequitable health effects. Cannon and Walkup address these inequities by designing MH interventions that respond to their particular study’s distinct situations. In doing so, the authors suggest that “the knowledge that these communities create then reforms MH research.” Finally, the authors “assess [our] interventions by developing protocols that protect participant privacy while supporting persuasive results that can lead to further funding.”

In “Negative, on PrEP: Unruly bodies and queer(ing) HIV disclosure on Grindr,” McKinley Green uses narrative methods to illustrate how youth living with HIV discuss their serostatus on the dating app Grindr. Combining research in TPC, rhetoric, and user experience with unruliness – a framework drawn from queer of color and crip theory – to understand moments when individuals resist digital infrastructures that are designed specifically to accommodate their embodied experiences, Green provides detailed accounts of how youth living with HIV make disclosure decisions as they navigate Grindr. Working primarily with youth of color in this analysis, Green provides an intersectional perspective on issues of race, sexuality, technology, and health. Through intersectional queer theory, Green argues that user experiences question the underlying stability and ideological aims of terms like “risk” and “safety,” instead revealing ulterior practices of health and wellness that stem from the embodied realities of living with HIV. Grindr’s interface fails to hold space for such embodied experiences, and, in doing so, centers on and normalizes the experiences of HIV-negative users.

Hua Wang introduces readers to China’s most popular pregnancy and mothering app, Babytree, as a site for leveraging feminist rhetoric in an examination of the complications of agency and consent. Wang shows that Chinese women face economic disadvantage when they become mothers, and Babytree provides an infrastructure that allows them to capitalize (literally) on their mothering experiences. By sharing their embodied experiences on the app, they earn income. This is a way of re-asserting rhetorical agency to political and economic ends. Further, some women on the app are explicitly aware of what they’re doing and are willing to critique the unstable situation of Chinese mothers. As Wang puts it, “These women’s practices are feminist and rhetorical acts which promote reproductive justice over time and space through social media.”

Cana Uluak Itchuaqiyaq and Breeanne Matheson’s “Decolonial dinners: Ethical considerations of ‘decolonial’ metaphors in TPC” uses experiential narrative to “theorize about technology as it relates to decolonial perspectives on bodies and nutrition.” Drawing a distinction between decolonial scholarship and anti-colonial discourse, Itchuaqiyaq and Matheson urge technical communicators to consider how scholarship labeled “decolonial” should be work that directly “supports, respects, and restores the sovereignty of Indigenous peoples, lands, and knowledges.” As technical communicators continue working to engage in decolonial work, it’s important to move beyond the use of decolonial metaphors, toward the direct and intentional rematriation of Indigenous land. Through their study of urban foraging through the use of an app and in relation with their own collaborative methodology, Itchuaqiyaq and Matheson demonstrate how technical communicators should further consider and centralize land in discussions of health and food justice.

Finally, we are pleased to include Kari Campeau’s review of Rachel Bloom-Pojar’s book Translanguaging outside the academy: Negotiating rhetoric and healthcare in the Spanish Caribbean. As Campeau articulates, Bloom-Pojar’s work provides a framework for rhetoricians, TPC scholars, and interdisciplinary and community-academic teams to engage and explore the question: “What forms of knowing and caregiving emerge when marginalized practices and languages are protected and valued in the clinic?”

Conclusion

Contributors to this issue demonstrate the importance of approaching this work through justice-driven perspectives that challenge traditional narratives in TPC. We hope that the articles in this issue help technical communicators continue to envision the possibilities of building coalitional research related to healthcare that centralizes the experiences of multiply marginalized communities. As the field continues expanding its commitments to social justice in healthcare, we envision future possibilities for work that examines how rhetorics of health and medicine both reflect and influence which lives, and whose bodies, matter.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Erin A. Frost

Erin A. Frost is a technical communication, rhetoric, and composition specialist. Her scholarly interests center on issues of gender and feminism in technical communication, most often as they manifest in rhetorics of health and medicine, environmental rhetorics, and risk communication.

Laura Gonzales

Laura Gonzales is an assistant professor of digital writing and cultural rhetorics in the Department of English at the University of Florida. Her research focuses on the intersections of language diversity, technical communication, and community engagement.

Marie E. Moeller

Marie E. Moeller is a professor of technical communication and rhetoric in the Department of English at the University of Wisconsin-La Crosse. Her research focuses on the intersections of technical communication, advocacy studies, rhetorics of health and medicine, and theories of embodiment.

GPat Patterson

GPat Patterson (they/them) is an Associate Professor of English and LGBT Studies Coordinator at Kent State University Tuscarawas. G’s research interests include curriculum development, rhetorics of social justice, queer rhetorics, and transgender studies.

Cecilia D. Shelton

Cecilia D. Shelton is a TPC scholar whose work draws on Black feminism as a source of theory and praxis. She prioritizes the perspectives, goals, and experiences of Black people (and other marginalized communities) as a way to achieve more equitable communication solutions to contemporary social, political, and organizational problems. She is an Assistant Professor of English at the University of Maryland.

Notes

1. By multiply marginalized, we mean those whose social location occupies multiple vectors of precarity.

2. Here we invoke the term “bodyminds” as employed by Margaret Price (2015) and Sami Schalk (2018). Per Schalk, echoing and parsing Price’s definition, “bodymind” is a “materialist feminist disability studies concept … that refers to the enmeshment of the mind and body … and highlights how processes within our being impact one another in such a way that the notion of a physical versus mental process is difficult, if not impossible, to clearly discern in most cases” (8-9).