In Health and the Rhetoric of Medicine, Judy Segal offers a broad introduction to the idea of rhetorical analysis and criticism as applied to biomedicine. Segal targets an interdisciplinary audience of rhetoricians, historians, philosophers, sociologists, healthcare providers, and industry representatives, suggesting that the tools of rhetorical criticism can help shed new light on a variety of issues in contemporary biomedicine. After her introductory justification for a “rhetoric of medicine”(with particular reference to Aristotle and Burke), Segal provides the reader with six chapters on various issues in health as approached from the standpoint of rhetorical criticism.
In chapter one: “A Kairology of Biomedicine,” Segal uses a concept of kairos as “contingency and fitness-to-situation” (p. 22) to provide a rhetorical history or “kairology” of biomedicine—“the ‘official’ medicine of the Western world” (p. 23). This kairology traces the dominant cultural and rhetorical themes in the history of Western medicine from Hippocrates to the present. Segal explores eighteenth century “heroic medicine,” the establishment of Foucault’s concept of the “clinical gaze,” the medical progress narrative, issues of medical authority, and the metaphor of the gene.
Chapter two: “Patient Audience: The Rhetorical Construction of the Migraineur” explores a conceptual history of the migraine patient. Segal argues that medical practitioners develop a rhetorical construct of the migraine patient through the “inter(textual) play between at least, medical publication and the physician-patient encounter” (p. 39). Chapter two traces the history of the migraineur-as-rhetorical construct from its initial configuration as those of passionate, ambitious, or intellectual personality in the 1800s to an inflexible or sexually maladjusted women in the 1950s, to a pharmaceutically-based conception in contemporary medicine.
Chapter three, “The Epideictic Rhetoric of Pathography” explores the role of narrative and narrative epistemology in the construction of a patients complaint(s) and medical history “pathography.” In this chapter Segal explores how autobiographical illness narratives help configure popular and professional understandings of a given illness.
In chapter four, “Hypochondria as a Rhetorical Disorder,” Segal agues that hypochondria is a disorder that stands out as fundamentally rhetorical in nature. To support this claim, Segal suggests that to be suffering from hypochondria is a function of persuasion—specifically, “Contemporary hypochondriacs are people who have become persuaded in the absence of an organic precipitating cause that they are ill” (p. 74). With this concept as a starting point, Segal explores the persuasive character of hypochondria through the lens of Burkeian dramatism.
Chapter 5, “A Rhetoric of Death and Dying” interrogates argumentation and decision making during “end of life” physician consultations. Using the rhetorical theory of Chaim Perelman and Lucie Olbrechts-Tyteca, Segal argues that these discussions are less than ideal communicative interactions because there is so great a barrier between physician and patient or patient family that there can be no “contact of minds” (p. 91). Segal explores the problems of end-of-life consultations through the personal case-study of her mother’s death and through exploring interview data from healthcare providers interested in improving end-of-life consultations.
“Values, Metaphors, and Health Policy” (chapter 6) explores master metaphors and metanarratives in the discourses of biomedicine. Specifically, Segal interrogates the role of the “medicine is war,” “doctor as hero,” and the “person is genes” metaphors. Ultimately, Segal argues that the discourses of biomedicine are thoroughly metaphor-laden, and that these metaphors have a significant impact not only on popular understandings of biomedicine, but also on the practices of diagnosis and treatment.
Segal, in Chapter 7: “The Problem of Patient ‘Noncompliance’: Paternalism, Expertise, and the Ethos of the Physician,” surveys the discourse responding to the problem of patient noncompliance or as it has been recently recast “concordance” (p. 134). She argues that though western biomedicine is becoming increasingly aware of the challenges to concordance, it is not a new phenomenon in western healthcare. However, Segal suggests that challenges to physician ethos are more prevalent than they have been for sometime, and that problems of concordance can usually be traced to