The Politics of Pain Medicine

Rhetoric and STS Need Each Other

Admittedly, this subheading may provoke ire from rhetoricians and STS scholars alike. Yet, as I have suggested above and will further elaborate below, insights from both rhetorical studies and STS are required to adequately explore recent developments in pain science. The establishment of a nonmodern or biopsychosocial approach to pain requires addressing questions of medical science and practice. And here, I mean practice in a way that transcends the postmodern desire to reduce practice to talk, to representation. Scientific practice and clinical performances involve doing things— poking, prodding, cutting, scanning, drugging— things that have real impacts on real patients, things that cannot be so easily (or ethically) reduced to discourse. Certainly, this history of STS inquiry offers a great number of tools that can assist in the investigation of these medical doings. But STS is still not enough. Not only are the doings of clinical practice permeated by talk (discourse), the educational and advocacy efforts of the MPG, AAPM, and the IASP are dominated by acts of representation, including (re-)presentations of clinical practice designed to (re-)present the perspectives of individual clinicians and coalitional organizations. And here, of course, rhetoric has much to offer. While compelling, the demands of the current case may not be enough to convince some of my readers of the value of this cross- disciplinary proposal. So, additionally, I would argue that the internal discussions of each area of inquiry actually demonstrate the need for increased cooperation and conversation between rhetorical studies and STS.

In making this case, I turn first to the benefits that rhetorical studies can offer STS. In 2008, well- known historian of science Peter Galison published an essay in Isis titled “Ten Problems in History and Philosophy of Science.” Problems one and three articulate Galison’s concern that history and philosophy of science would benefit from more sustained and rigorous attention to the contexts and technologies of argumentation. He argues for an increasing focus on issues of intertextuality and strategies of linguistic and visual argumentative practices in the sciences. Specifically, in problem one, “What is context?,” Galison suggests that historians and philosophers of science need to develop a more nuanced approach to issues of context, and further that such an approach needs to be built on the fusion of insights from the contextual approaches of each field (history and philosophy) (p. 112). In so doing, Galison argues that philosophers tend to talk about the context of an argument in terms of what rhetoricians would dub “intertextuality”— that is, the relationships among moments of discourse and argument that led up to and are contemporary with the current argument under analysis. In contrast, Galison suggests that historians tend to intentionally ignore discursive contexts in favor of “political, institutional, industrial, or ideological” aspects of the environment (p. 113).

I would argue this is one place where scholars in rhetorical studies have a great deal to contribute to the broader STS community. The notion of context— alongside audience and purpose— is typically identified by rhetoricians as one of the core features of any moment of discourse, and subsequently has been the subject of much scholarly scrutiny. Certainly the notion of “context” means many different things to many different rhetoricians, and the meaning is most typically— but not always— allied with the notion of context Galison locates with philosophers. However, it is precisely this rich and nuanced tradition of inquiry into context that has the potential to make rhetorical studies so valuable to STS. While problem one may potentially open up the opportunity for more productive conversations among rhetorical studies and STS disciplines, Galison’s third problem is a manifestly clear appeal for the expertise of rhetorician— even if not by name.

In problem three, Galison argues that historians and philosophers of science lack a nuanced understanding of and vocabulary for the “technologies of argumentation”:

When the focus is on scientific practices (rather than discipline- specific scientific results per se), what are the concepts, tools, and procedures needed at a given time to construct an acceptable scientific argument? We already have some good examples of steps toward a history and philosophy of practices: instrument making, probability, objectivity, observation, model building, and collecting. We are beginning to know something about the nature of thought experiments—but there is clearly much more to learn. The same could be said for scientific visualization, where, by now, we have a large number of empirical case studies but a relatively impoverished analytic scheme for understanding how visualization practices work. So, cutting across subdisciplines and even disciplines, what is the toolkit of argumentation and demonstration— and what is its historical trajectory? (p. 116)

Here Galison outlines what he sees as an important new research endeavor for historians and philosophers. He does not explicitly invite rhetoricians to join in this conversation. In fact, I am not aware of any moment in Galison’s oeuvre where he specifically addresses rhetorical studies as a discipline. Nevertheless, this call for increased research along these lines is the ideal location for an increased intersection between STS and rhetorical studies. Indeed, rhetoricians have a long history (2,500 years, in fact) of exploration into both the contexts and technologies of argumentation. This research tradition— which begins with the pre- Socratics and is exemplified in a long list of thinkers including Aristotle, Cicero, Quintilian, Vico, Nietzsche, Bakhtin, Burke, and a wide variety of contemporary scholars— can offer a ready- made and nuanced approach to the gaps that Galison notes in STS. Furthermore, a great deal of more recent scholarship has been devoted to exploring the technologies of visualization and visual argumentation, and there is a strong history (particularly in the English rhetoric tradition) of exploring the relationship between scientific investigation and the development of visuals and data displays for a wide variety of different settings. My work here draws on each of these intellectual traditions as a part of my demonstrative suggestion for a combined approach to science and medicine.

Furthermore, Galison is not the only STS scholar who identifies the need for increased engagement with the insights that can be found in rhetorical studies. Philosopher of science and technology Steve Fuller has been interfacing with rhetorical studies since at least 1999. Furthermore, in The Philosophy of Science and Technology Studies (2006), Fuller explicitly calls for multidisciplinary engagements with

the debating teams affiliated with the Departments of Speech, Rhetoric, and Communications Studies across college campuses in the United States. Their grassroots initiatives [are] consolidated as the science policy forum convened by the American Association for the Rhetoric of Science and Technology, or AARST. (p. 174)

Fuller’s invitation here is grounded in the broad recognition that scientists can no longer maintain the fiction of isolation and political disinterest. With increasing frequency, scientists are being called to participate publicly in the management of divisive political issues. Prominent examples include climate change, H1N1, BSE (mad cow disease), genetic engineering, and nuclear power. Indeed, with such issues, it is considered a matter of course to bring a spate of scientific experts to Washington to provide congressional testimony. As science continues its prominent location within political decision making, attention must be paid to the rhetorical and argumentative dimensions of such debate. And hence, we find another entrée for rhetorical studies into the broader STS conversation. Examples of rhetorical scholarship addressing the role of science in public policy are too numerous to name. A few prominent examples, however, include Lisa Keränen’s Scientific Characters (2010), Carl Herndl and Stewart Brown’s Green Culture (1996), Craig Waddell’s “The Role of Pathos in the Decision-Making Process” (1990), and Alan Gross’s “The Role of Rhetoric in Public Understandings of Science” (1994).

As the introduction to this section suggested, the internal discourse of rhetorical studies also suggests a strong need for increased interface with STS. I begin my exploration with an infamous— among rhetoricians of science, anyway— critique of the discipline offered by Dilip Gaonkar (1997). His “The Idea of Rhetoric in the Rhetoric of Science” was so scathing and subsequently so much discussed that many scholars in the rhetoric of science are, quite frankly, tired of hearing about it. I return to this critique here not so much to revisit the theoretical problems—some of which were quite serious— of early rhetoric of science as to celebrate a new era of scholarship that I believe is finally overcoming the challenges leveled by Gaonkar so long ago. (And in large part, I find this due to the increasing success rhetoricians have found in integrating STS theory into their scholarship.)

The core of Gaonkar’s critique involves two key issues: (1) the “thinness” of rhetorical theory and (2) the legacy of humanist agency theory in rhetorical studies. In terms of “thinness,” Gaonkar argues that rhetorical theory is overly plastic and adaptable and thus lacks explanatory clarity and precision. His argument stems from the correct assertion that rhetorical studies began (with Aristotle and the Sophists) as a series of generative dictums. Indeed, the earliest works on rhetoric are treaties on the most effective means for generating arguments. They were the textbooks—to use an anachronism— of the day for the aristocracy of ancient Greece who needed to learn the art of civic participation for all manner of political and judicial debates. This legacy provides rhetorical studies with a highly adaptable vocabulary designed to help the progenitors to politicians and lawyers develop effective arguments for whatever situation might arise. These dictums were not originally intended to be used as an analytic frame and have required significant adaptation and refinement to be deployed effectively for scholarly inquiry. In objecting to the thinness of rhetorical theory, Gaonkar contraposes then- recent research in the sociology of scientific knowledge (SSK). Specifically, he argues that “SSK has developed into a complex empirical research program that displays considerable internal variation in theory and methodology, while [rhetoric of science] remains little more than an uncoordinated research initiative carried out by a handful of committed individuals” (p. 42). This is certainly damning criticism, to say the least, but it is also a product of its time—a time that, I would argue, has passed for rhetorical studies of science.

While I agree with Gaonkar that the instrumentalist focus on early texts in rhetorical studies provides a limited range of analytic techniques— that the vocabulary of classical rhetorical theory can be used to describe an argumentative technique (for example, a specific trope or mode of claim building)—the approach sometimes fails to capture issues like the role of larger sociocultural and/or materialist forces that surround and interpenetrate argument. Of course, it should be noted that the two approaches are not mutually exclusive. In fact, prominent STS scholars like Donna Haraway (see, for example, Modest.Witness, 2002) artfully deploy the tools of classical rhetoric— for instance, the identification of specific tropes and figures— as a part of their interrogation of ideological issues in the cultures of technoscience. In fact, the fusion of scholarly approaches derived from rhetorical theory and critical/cultural studies has become commonplace in rhetorical studies, and is finding increased purchase (with the inclusion of STS) in rhetorics of science and technology. A few especially noteworthy examples come from the work J. Blake Scott (2003, 2004), Amy Koerber (2006a, 2006b), Carl Herndl (2002), Herndl and Brown (1996), Wilson and Herndl (2007), and so on.

Beyond these intradisciplinary calls for cross- disciplinarity, The Politics of Pain Medicine argues that scholars of rhetoric and STS have reached an exciting moment of theoretical symmetry. Scholars from both areas of inquiry have recently embraced and argued for intellectual and scholarly approaches to science, technology, and medicine grounded in what’s become known as “new materialisms.” And it is this new synergy that constitutes an excellent ground for a more thorough establishment of rhetorical ontological inquiry as a significant contributor to the broader STS project. The remainder of the theoretical work in this introduction will be devoted to exploring these arguments of new materialisms and reflecting on how the combined efforts of STS scholars and rhetoricians alike can contribute to fleshing out new materialist approaches to science, technology, and medicine.

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