My central claim in this project is that medicine and health are implicated in aporetic rhetoric, and vice versa. Healthcare contexts tend to amplify the use and management of aporetic rhetoric, and aporetic rhetoric has a “pharmaceutical” quality
that mimics the functions of medicine. Because the stakes of communication in healthcare settings are so high, aporetic rhetoric is both widespread and potent in healthcare contexts. The widespread appearance and importance of aporetic rhetoric in healthcare contexts is due to a fundamental tension between humankind’s desire to
eliminate the uncertainty of illness and death, and the limits of our intellectual, technological, and physical ability to do so. In other words, aporetic rhetoric is deeply entwined in practice, research, and communication in healthcare settings because humans possess an instinctual and deep desire for continued life, vitality, and health, coupled with an equally fundamental inability to determine how to prevent death, incapacity, and illness. Despite our species’ best efforts, Spinoza’s claim in 1677 that
“nobody as yet knows the structure of the body so accurately as to explain all its functions” holds true today.40 These epistemological limits, coupled with our desire to
overcome the pains and failures of bodies, enables the theory and practice of healthcare to be inundated by aporetic rhetoric.
Flipping this claim on its head, aporetic rhetoric is also a pharmaceutical.
Deriving from the Greek term “pharmakon,” which broadly refers to drugs, the term
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The connection between pharmakon and language is made in section 14 of Gorgias’ Encomium of Helen, where he describes logos as a pharmakon:
The power of speech has the same relation to the disposition of the soul as the application of drugs on the disposition of the body. For just as different drugs draw different juices out of the body, and some end disease but others end life, so also some speeches produce pain, some enjoyment, some fear; some instill courage in hearers; some drug and beguile the soul with a kind of evil
persuasion.41
Gorgias’ connection between communication (logos) and pharmakon is not simply one of healing, but of displacement. In the above passage, it is not that drugs and speech change the soul or the body, rather, they alter the disposition of the soul or the body. Aporetic rhetoric functions as a pharmaceutical by altering the state of our “souls,” or
cognition, through an act of displacement. When a medicine helps alleviate the symptoms of a cold, the cold remains, but the symptoms are displaced. The cold is
“beguiled,” to flip Gorgias’ analogy. Alternatively, when a drug intoxicates our minds, our ability to think and perceive remain, but are displaced by the effects of the drug.
Drugs are “mind-altering,” not “mind-changing.”
Aporetic rhetoric functions in debate in the same way that medicine displaces symptoms or drugs alter minds. Deploying aporetic rhetoric does not close down,
eliminate, or settle disputes, it displaces them. For example, the claim that “more research needs to be done” on a drug does not imply the drug is dangerous or not, rather, it displaces questions of value. Thus, each chapter of this project will investigate
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how aporetic rhetoric is deployed in different healthcare settings. In these settings, aporetic rhetoric is functioning pharmaceutically.
In Chapter 1, I use actor-network theory to examine how different organizations and individuals leverage and resist uncertainty surrounding Agent Orange. Many
Vietnam Veterans were exposed to one of the most dangerous chemicals ever crafted by human hands during the occupation of Vietnam. Furthermore, how, where, and to what extent Agent Orange was used in Vietnam is largely uncertain. In this chapter, I argue that the CDC and other governmental research agencies deploy spatial
uncertainty to cover their inability to determine the dangers of Agent Orange. In addition, I explore how veterans who were exposed to Agent Orange have managed to overcome these uncertainties and receive remuneration for their injuries.
In Chapter 2, I examine different forms of the anti-psychiatric movement. Differentiating between mental illness skepticism and denialism, I suggest that what separates these two rhetorical positions is their deployment of uncertainty. Mental illness skeptics tends to undermine concepts of diagnostic objectivity, positivism, and the stability of mental health categories, but denialists often avoid concrete evidence and argument, instead opting to circumvent traditional argumentative strategies by conflating hypotheticals with realities. Walking through different modes of mental illness skepticism and denialism, I identify how different types of uncertainty lend different characteristics to aporetic rhetoric.
Chapter 3 argues that the connection between design, affect, and uncertainty impairs patient outcomes. Often eliciting negative emotional affects from patients, I
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suggest that the systems, structures, and designs that dominate patients’ experiences
with medical professionals alter their decision-making processes, leading them to overestimate either risks or rewards in clinical settings. Using psychological research, I make two central connections between uncertainty and patient experience design. First
is the “uncertainty intensification hypothesis,” which states that uncertainty during an
emotional experience makes unpleasant experiences more unpleasant, and pleasant
experiences more pleasant. Second is the “affect heuristic,” which posits that in
situations where someone possesses a positive emotional affect, it is much easier for them to overlook high risks and low benefits. The opposite is also true. If someone has a negative emotional affect, they are more likely to infer high risks and low benefits. Thus, positive affects tend to push people to overlook the risks of uncertainty, while negative affects tend to accentuate the risks of uncertainty. Both the uncertainty intensification hypothesis and affect heuristic illustrate conditions in which aporetic rhetoric is
amplified. Since most healthcare experiences are neither positive nor pleasant, and since many healthcare designs lead to patient uncertainty, the average patient
experience design prevents patients and physicians from maximizing the effectiveness of healthcare decision-making.
Chapter 4 unpacks the debate over what counts as an addiction. Here, I argue that the gap between theory and reality, especially as it pertains to human behaviors, is a persistent form of uncertainty that haunts addiction science. Furthermore, how addiction researchers engage with this uncertainty will alter the rhetorical efficacy of their addiction theories. Expeditious addiction theories tend to manage, constrain, or
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“wrangle with” uncertainty. These theories are rhetorically functional because they are
comprehensible, easily tested, and allow quick categorization and rapid comparison. Expeditious theories also tend to fall victim to counter-examples, tend to gloss over specifics in their search for rigid categories, and tend to produce representations of reality that are more intuitive than realistic. On the other hand, fastidious addiction theories tend to embrace, precisely describe, or otherwise account for uncertainty. These theories are rhetorically efficacious because they are exhaustive, applicable with high levels of accuracy, and tend to draw on the strengths of multiple perspectives. Fastidious theories are also unwieldy and difficult to explain. My central claim in this chapter is that both theory-building strategies are rhetorically workable means of managing uncertainty, but their efficacy is context-dependent.
Reaching the final conclusion of this project, I expand and elaborate on my claim that aporetic rhetoric is a pharmaceutical. First, I turn the central argumentative thrust of this project upside down, and instead of examining how aporetic rhetoric is
prominent in healthcare settings, unravel how healthcare is implicated in aporetic rhetoric. Exploring rhetorical scholarship on the concept of pharmakon, I synthesize the concept of pharmaceutical with each chapter, explaining how aporetic rhetoric’s effects can be seen in a pharmaceutical light, since uncertainty displaces rather than settles argument and debate. By way of conclusion, I argue that the implications of this claim are two-fold. First, given the potency and efficaciousness of pharmaceutical rhetorics, rhetorical scholarship should begin to examine sites besides aporetic rhetoric. Second, healthcare theorists and practitioners need to assess the implications of viewing
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language and communication as indistinguishable from other drugs they administer. In both cases, aporetic rhetoric becomes one example of a much wider universe of pharmaceutical rhetorics, imbuing rhetoric and medicine with new and higher stakes.
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