Reading Responses   4 comments

Lay Response

In The Rhetoric of Midwifery by Mary M. Lay, the primary conflict arises between the valuing of experiential knowledge and the valuing of institutions of regulation and standardization made more complicated by the imposition of a medical professionals and the rhetoric of pathology the developed around pregnancy as technology and male professionals defined more births as abnormal and outside of the realm of expertise of the midwife. The historic moves of rhetorically reconstructing midwifery, pregnancy and birth were echoed in the Minnesota debates on the legality of midwives practices.

I believe in our last class Leandra mentioned the documentary The Business of Being Born, which I’d seen before so I consider myself at least somewhat familiar with the issue. However, the rhetorical analysis surrounding the direct-entry midwives and Rita Ortiz forced me to look at my own internalized biases towards the medical institutions. I realized that I had previously understood and supported the practices of nurse-midwives, but still was skeptical about direct-entry midwives, despite the long history, the importance of experiential knowledge and the importance of apprenticeship.

In Chapter 5, the understanding of how public rhetoric manipulates power around a specific subject. Lay says “Before the public, a profession can claim the right to practice as its member see fit, to exclude other practitioners and to dominate public definition of the tasks of the competing practices” (102). It’s clear through Lay’s arguments that because of the power that we give to medial professionals, we give them the rhetorical power to control the issue unilaterally. What is so important about this rhetorical analysis of the Minnesota hearings is the uncovering of what social constructions surround birth that go largely unexamined.

Segal Response
In Segal’s chapter on hypochondria as a rhetorical disorder the discussion focuses on how hypochondria represents a rhetorical construction on the part of the hypochondriac patient, the medical professions that must deal with the challenges of the hypochondriac patient, and public beliefs about hypochondria. It’s interesting to think about how the hypochondriac patient, in the absence of organic disease, must use words to convince medical professionals of the presence of disease. However, a person is only defined as a hypochondriac when rhetoric fails to convince others of the presence of organic disease.

What was really interesting to me was the way in which the rhetoric of society plays a role in the construction of hypochondria. As Segal says, “hypochondria…in taking difference forms at different times reveals itself as a means of social persuasion regulating behavior through the discourse of risk…Furthermore, the hypochondriac is, in this, a personal location for a more general (cultural) hypochondrical frame of mind” (89). This whole section really makes clear that our rhetoric around health creates the conditions of the hypochondriac personality because what we as a society focus on.

Chapter 5 on the rhetoric of death and dying reminded me of one of my favorite quotes. “I do not fear death. I had been dead for billions and billions of years before I was born, and had not suffered the slightest inconvenience from it.” This quote from Mark Twain seems in line with some of the trends that Segal notes about current public discussion surrounding death and the ability to see it as part of a larger process. The idea that end of life discussions between medical professionals and patients and family are not rhetoric because one party is not fully informed about the discussion. The Riverview Project or similar projects, seem to be an important part of the solution to creating better communication and more informed decisions.

I do have a few questions. First, if we think of hypochondria as a reflection of social health concerns, what in addition to the contemporary “health nut” might be some of the hypochondriac conditions of our current health discourse? As for midwifery practices, what do you personally feel should be the appropriate level of state regulation or should there be regulation of midwifery practices at all?

Posted September 14, 2010 by kathryndunlap in Uncategorized

4 responses to “Reading Responses

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  1. Questions Inspired by Lay and Our Project

    On page 21 of Lay, “Through language and discourse, knowledge and actions are negotiated within a community…”

    My question: How does the EHR community–is there only one–negotiate knowledge?

    The entire debate about certification.

    My question:

    How will EHR creators, users, services be certified?

    On page 22: “Because knowledge does not exist separate from its knowers…how….a particular discourse community…
    one gets to be a knower”

    My question: Who are the knowers in the world of EHR? How did they become knowers? How will this definition change over time?

    On page 24: “alternative practitioners such as acupuncturists…”

    My question: Will EHR be available to alternative medicine practitioners? Will this increase the communication between alternative practitioners and traditional doctors?


  2. To answer your question, two phenomena we might examine are cyberchondria and, as Leandra discusses, aesthetic hypochondria.

  3. The question of current hypochondriacal conditions makes me think of articles I’ve read recently on the in-process revision of the DSM. It seems, for example, that diagnostic committees are considering that grieving for (someone’s version of) excessively long may constitute a psychiatric disorder. That is, your partner dies; two years later, you are still grieving; perhaps you have a mental illness. We should, perhaps, all be worried that we will be invited to consider ourselves as mentally ill (or imagine that we are) are worried that we are, when, in fact, we are just living our lives.

  4. The suggestion that grieving might force us to consider our own mental illness made me think of some of the eco-guilt articles I’ve been seeing around from time to time late.

    Here’s an example:

    This green worry isn’t a condition that has an organic cause. There may be underlying depression, but neurochemistry does not cause worry about polar bears.

    To put it in layers, green worry is caused by the rhetoric of ecological concerns, expressed through the rhetoric of the patient and explored and hopefully relieved through the rhetorically constructed relationship between patient and therapist.

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