Figure 1. Screen capture of passersby registered as potential users by Microsoft’s Kinect sensor. Image was originally published at the following URL: http://www.pervasive.jku.at/Teaching/lvaInfo.php?key=298

Introduction: Selfe and Selfe’s Impact on (Graphical-User) Interface Studies

In computers and writing (C&W) scholarship, interface studies has been a minor but persistent scholarly topic in numerous publications. Beginning with Patricia Sullivan’s article from the late 1980s, in which she argues that scholars associated with technical communication should turn their attention to the subject, “interface” has been explored by scholars in a wide range of fields and sub-fields associated with C&W, including the following: rhetoric theory (Carnegie; Carpenter; Brooke), composition theory and pedagogy (Buck; Haas and Gardner; Mardsjo; Rosinski and Squire; Selfe and Selfe), multimodal composition (Fagerjord; Skulstad and Morrison), and technical and networked communication (Grabill; Spinuzzi).² One approach to interface studies that has predominated in the scholarship is related to socio-political issues of equity, identity, and access, and since its publication almost twenty years ago, Cynthia Selfe and Richard Selfe’s article, “The Politics of the Interface,” has been a touchstone for this critical approach.

Selfe and Selfe’s article is an oft-cited reference in articles about the socio-political impact of technological interfaces for good reason. The article is an impassioned call for a “critical and reflective stance” toward the adoption of computers in the classroom (482). It was written at a time when a growing number of administrators and faculty viewed computers as a relatively benign but powerful way to update our classrooms and methods of teaching. Countering that early-adopter fever, Selfe and Selfe challenged us to scrutinize the ways in which software interfaces reintroduce forms of oppression and marginalization that we had been working to extricate from our classrooms. Like a Trojan Horse, the socio-cultural biases against which we’d fought for so long risked being inadvertently reinscribed into the newly established forms of human-computer interaction. After all, technologies are not neutral, and interfaces in particular are expressive of a wide range of socio-cultural and epistemological biases that can impede our pedagogical objectives.

Figure 2. Screen shot of a Macintosh interface around the publication date of Selfe and Selfe’s’ article

Selfe and Selfe’s article is divided in two parts. The first comprises their critiques of interface technologies. It is the longer of the two sections. Three of the arguments they develop are the following. First, computers do not necessarily serve democratic ends: “Computer interfaces . . . are also sites within which the ideological and material legacies of racism, sexism, and colonialism are continuously written and rewritten” (484). Second, the “desktop metaphor” expresses the values of corporate culture, which reinforces the values of white middle- and upper-class users (487). Third, the structure and logic of computer interfaces are aligned with the values of rationality, hierarchy, and logocentrism characteristic of Western patriarchal cultures (491). In the shorter second part, they offer three tactics or suggestions for addressing the problems with interfaces that they had just critiqued. First, they encourage a general level of critical awareness about technology issues on the part of both pre-service and in-service teachers (496). Second, they encourage faculty to develop their own interfaces, their own software (497). Finally, they invite students to create mock-ups of their preferred interfaces—interfaces expressive of an alternative (499).

While Selfe and Selfe’s article has had a lasting effect on our field because it helped us recognize the socio-politics of the graphical-user interface (GUI), twenty years is a ‘long time ago’ in the history of popular computing. In that time, the shift from GUI to NUI (natural-user interface) technologies has transformed what a computing environment is. Today, computing environments are increasingly immersive experiences in which it is difficult to distinguish between a user and a system, which means that the ways in which we achieve a critical and reflective stance is changing.

Figure 3. Advertisement for Microsoft’s Kinect, “You are the Controller!”

Epitomizing the difficulties NUI technologies introduce is one of the tag lines for Microsoft’s Kinect, “You are the controller!” (see Figure 3 above). If we are the controller/interface, from where do we stand in order to act critically and reflectively? If, in an immersive, NUI environment it’s no longer possible to have a standpoint, a point of perspective, how do we critique the technology?

In order to extend the legacy of Selfe and Selfe’s contribution to interface studies, I offer two interrelated propositions. The first, related to the exigence of the user-as-interface, is that we redirect our critical attention from the interface on the screen to what Adrienne Rich once called the “geography closest in” (i.e., our bodies)—and specifically to tactical or critical explorations of a body’s potential. The power of NUI technologies is derived from the use of our voice and gestures to engage with a system. At this point, most NUI interfaces with which we interact look like GUIs, but, as NUIs mature, the ways in which we control a computational environment will have less to do with on-screen metaphors, icons, and buttons and more to do with an ethos that we perform. Anticipating this radical shift in computing is an opportunity to redefine the focal point of our critical concerns.

The second proposition is in response to the mainstreaming of computational thinking—in part due to the availability of easy-to-learn programming languages. Since Selfe and Selfe’s article was published, programming is no longer something that wizards do exclusively on the other side of the two-cultures split. At this point in the history of popular computing, humanists can engage directly with computational media. Numerous high-level languages have become available that have lowered the learning curve, and several of those languages, such as Processing, offer novice programmers powerful ways to design immersive, interactive environments. Related to this point, computers and networks have become fast enough to make programming an expressive art because the historical limits on memory, bandwidth, and processor speed do not constrain programmers to the equivalent of a current-traditional emphasis on conciseness and clarity in writing. Today, alongside computer science, an experimental, ad hoc culture of open (i.e., free and collaborative), experimental work has blossomed.

For these reasons, it’s time to focus on the production of novel interfaces that embody our critical values and concerns, rather than limiting ourselves to the analysis and critique of someone else’s technologies. In Selfe and Selfe’s article, the call to invent new interfaces is overshadowed by a focus on representational critique. As I’ll explain shortly, based in part on my experiences working with Microsoft’s Kinect, socio-cultural critique in immersive NUI environments leads to the conclusion that representational critique must be transformed into an inventional art, a post-representational, tactical pursuit.

NUI on the Rise

Figure 4. Detail from August de los Reyes’ presentation, “Predicting the Past”

In a presentation titled “Predicting the Past,” August de los Reyes explains that NUIs comprise a suite of human-computer technologies including voice, touch, gesture, and stylus or pen. When you interact with a computer system by speaking to it, tapping or swiping across it, gesturing toward it in the air, or using a stylus to write on a screen, you are using a NUI technology. According to De los Reyes, NUI will be the third paradigm shift in computing. In Figure 4 above, which is a graphic from his PowerPoint presentation, De Los Reyes depicts an evolution in popular computing that begins with the command-line interface, and after the present era of GUI, shifts to NUI. It’s also worthwhile emphasizing that the historical movement toward NUI coincides with a movement toward the increasingly intuitive and directly accessed, which means that the implied line separating self and technology is blurred.

It is important to note that some NUI technologies have been around for several decades, but it’s the relatively recent explosion of interest in and profitability from products including Apple’s iPhone and iPad and Microsoft’s Kinect that has led to the uptrend in positive discourse and outright evangelism about them—especially from Microsoft.

In the following three quotes, which are paradigmatic of the optimism and excitement around NUIs, a new age of computing seems apparent. In their book, Brave NUI World, Daniel Wigdor and Dennis Wixon write, “Now we stand at the brink of another potential evolution in computing. Natural-user interfaces (NUIs) seem to be in a position similar to the GUI in the early 1980s” (2). Chief Research and Strategy Officer at Microsoft Craig Mundie claims, “The transition to a natural user interface will change everything from the way students write term papers and play computer games to how scientists study global population growth and its impact on our natural resources.” Even Bill Gates has responded to the promise of NUI. In an essay titled “The Power of the Natural User Interface,” in which he focuses on the Kinect, Gates writes, “One of the most important current trends in digital technology is the emergence of natural user interface, or NUI. We’ve had things like touch screen and voice recognition for a while now. But with Kinect, we are seeing the impact when people can interact with technology in the same ways that they interact with each other.”

Only time will tell if NUI technologies will be the next computing paradigm, but based on my own experiments with the Kinect, I see considerable opportunities for radically new approaches to theory and practice associated with both rhetoric and writing. And if NUI does eclipse GUI, leading to new conventions for human-computer interaction, some of us will turn to Selfe and Selfe’s article because of its long-valued contribution to a socio-political approach to interface studies.

Exploring the Kinect’s Potential

My own work with the Kinect began in early 2011 with two colleagues in the College of Design at NC State. We developed an interactive art project that enabled users to “write” graffiti on a screen projected on the side of a building. The “Interactive Graffiti Project” was based on the skeletal or joint data streaming from the system. Arguably, the most impressive part of the Kinect is that it can identify human figures from everything else in its viewing frame, break each of them down into a set of twenty joints, and track all twenty joints continuously at 30 frames-per-second. This capability had not been so easily available for research before the Kinect was released.

Figure 5. Depiction of skeletal data for two users in front of the Kinect sensor

For a programmer, access to the skeletal data means that you have access to twenty three-dimensional data points representative of a user’s position and movements around and in front of the sensor, in “real-time.” This is the data stream on which most of the commercial games for Kinect are based: the ability to make an on-screen avatar kick balls, jump around, or dance is based on your redefinition as a surface comprising twenty points.

Although the Kinect defines a jointed body in conventional terms, and many of the on-screen interfaces reinforce that perspective to-date, there’s no limit to the ways in which those data points can be redefined computationally. For example, you could redeploy skeletal data from a user as points (or folds) comprising a novel, topological surface. Once we deterritorialize the origin of those points, we can experiment, developing new types of bodily gesture and movement contributing to a new canon of digital delivery. And once a user’s movements and position are redefined radically, the environmental feedback from the projected movements has the potential to transform how that user experiences herself, which can lead to new, counter-hegemonic experiences of self. In Materializing New Media, Anna Munster emphasizes the potential for developing new experiences of our bodies in our “encounters” with code when she writes,

Computers offer us multiplications and extensions of our bodily actions… These multiplications by no means provide seamless matches between body and code; the mismatch characteristics of divergent series triggers the extension of our corporeality out toward our informatic counterparts… It is this extensive vector that draws embodiment away from its historical capture within a notion that the body is a bounded interiority. (33)

Munster is not writing explicitly about politics in this excerpt, but her argument extends easily to it. If we equate her description of a bounded interiority with the socio-cultural constraints constitutive of person’s sense of self, her point is that mismatches between body and code, which might emerge from a novel redefinition of the skeletal data points, can lead to new experiences of our embodied selves. And if these mismatches are designed tactically, they can change the limits of the bounded interiorities interfacing with the code. Related to the trope of the ‘geography closest in,’ we might characterize this kind of NUI-based approach to tactical invention as a novel form of geopolitics born of an extensive vector that points beyond the centripetalism of hegemonic relations.

Depth is Flat

One of the other data streams on which creative work is now based is the depth data. At thirty frames-per-second, the Kinect sends a 640×480 frame or image of depth values representative of the depth of every object in the sensor’s viewing range. In other words, it streams a 640×480 matrix of depth values representative of an approximately 8×14’ space in front of the sensor.

Figure 6. Screen capture of emBody(text) {

In a project titled emBody(text) {, Kevin Brock and I used the Kinect’s depth data stream to develop an embodied, hypertextual environment. Our goal was to create an interactive experience that would be intuitive and compelling for an audience largely unfamiliar with the Kinect’s technical capabilities. In a way, emBody(text) { was our “Hello, World” program. Our digital writing project debuted in a group exhibit titled ID:ENTITY at Raleigh’s contemporary art museum, CAM Raleigh (see Figure 7 above), and then at the CHAT Festival at Duke University. A few months later, in collaboration with Rachel Bagby, a Twitter-based version of the project titled emBody(dekaaz) { was on display at CCCC 2012. For the version at CCCC 2012, the interface was based on the following characteristics:

• We imagined that the space in front of the Kinect was divided among ten distinct zones.
• We created ten equivalent zones or layers along the z-axis in the virtual, 3D space of the projected screen.
• We distributed each of the ten most recent tweets to #dekaaz in one of the ten virtual depth planes.
• We made it possible to “mash up” or combine parts of different tweets when participants interacted with two or more zones in front of the Kinect sensor.
• We developed a method of identifying which of the ten zones had the most activity at a given moment in order to shift perspective on the 3D space.

The effect of all of this was something like an embodied hypertext. On the second floor of the convention center at CCCC 2012, passive or active participation with emBody(dekaaz) { led to mash-ups of the three-stanza poems sent to #dekaaz.

As I reflect on my experiences with the Kinect’s depth data, it occurs to me that it is a “degree zero” for experimental work because the data is (in Deleuzian terms) an intensive form, pure potential. ³Whereas you have to “deconstruct” the implied (human) territory or ground of the skeletal data points in order to reach an ontologically flat plane, the depth data is an already-posthumanized space. Ontologically, it’s already flat. Working with the depth data puts one in the kind of uncountry that Victor Vitanza once characterized as wild and savage (53), and which, due to its savage nature, we might then value as a space in which the bricoleur practices a (computational) ‘science of the concrete.’⁴ The opportunities for developing new forms of interactions are considerable.

Conclusion

Figure 7. Exploratory “hack” of Kinect depth data by Samantha Swartz (click image to follow link)

As Selfe and Selfe explained in their article, politics reside in the interfaces of our techno-mediated worlds, and since the interface of a NUI environment has shifted, so should the focus of our attention. In Samantha Swartz’s “hack” of the Kinect (see Figure 7 above), which is based on the depth data, we are presented with a complex, ever-changing series of curving, pointilized surfaces. During the film, we realize that the surfaces are two participants; at one point, we can see them holding hands. But the identifiable hands and arms soon melt away into an intensive swirl of movement. The depiction of those bodies—the projected feedback—is based on the interface that Swartz designed. Swartz’s hack is an example of the ways in which the mismatch about which Munster wrote can lead to new relations between bodies and code.

As a field, we have an opportunity to explore new forms of digital writing and rhetoric by critically and creatively engaging with the data streams that represent who we are and what we can be. In immersive NUI computing environments, the politics of the interface are derived from the ways in which we experience the feedback of our selves. In fact, the interface itself is a derivative of a dynamic equation comprising bodies and code; politics associated with interface design is a kind of integral calculus, as we can see in Swartz’s experiment. If we contribute to the development of new interfaces, thereby changing some of the ways in which we experience the data streams that would otherwise serve convention, we can accomplish two important things simultaneously. We can extend a critical legacy toward interface studies inaugurated by Selfe and Selfe, and, perhaps most importantly, we can elevate the role and value of invention serving those ends in today’s brave new NUI worlds.

Endnotes

1. Image was originally published at the following URL: http://www.pervasive.jku.at/Teaching/lvaInfo.php?key=298return
2. In his article, “On Divides and Interfaces,” Jeffrey Grabill hazards that Patricia Sullivan “provides perhaps the first mention of interface design in Computers and Composition” (469). I hazard to agree with him.return
3. In Writing Degree Zero, Roland Barthes characterizes poetic language unrestricted by convention and acculturation as “reduced to a sort of zero degree, pregnant with all past and future specifications” (Barthes 48). My Barthean allusion is meant to characterize the depth data as similarly pregnant with potential. The allusion to Deleuze’s concept of intensive qualities parallels the reason for the Barthean one.return
4. A “science of the concrete” and bricolage are allusions to Claude Levi-Strauss’ opening chapter, “The Science of the Concrete,” in Savage Mind. return

Works Cited

• Bagby, Rachel. “Dekaaz: Word Jazz for the Mind.” Rachel Bagby: Bless Your Voice. Be the Song. 2012. Web.
• Barthes, Roland. Writing Degree Zero. Trans. Annette Lavers and Colin Smith. New York: Farrar, Straus & Giroux, 1977. Print.
• Brooke, Collin Gifford. Lingua Fracta: Toward a Rhetoric of New Media. Cresskill, NJ: Hampton, 2009. Print.
• Buck, Amber M. “The Invisible Interface: MS Word in the Writing Center.” Computers and Composition 25.4 (2008): 396-415. Print.
• Carnegie, Teena A. M. “Interface as Exordium: The Rhetoric of Interactivity.” Computers and Composition 26.3 (2009): 164-173. Print.
• Carpenter, Rick. “Boundary Negotiations: Electronic Environments as Interface.” Computers and Composition 26.3 (2009): 138-148. Print.
• De los Reyes, August. “Predicting the Past.” Web Directions South. Sydney Convention Center. 25 Sept. 2008. Web.
• Fagerjord, Anders. “Between Place and Interface: Designing Situated Sound for the iPhone.” Computers and Composition 28.3 (2011): 255-263. Print.
• Gates, Bill. “The Power of the Natural User Interface.” The Gates Notes. 28 Oct. 2011. Web.
• Grabill, Jeffrey T. “On Divides and Interfaces: Access, Class, and Computers.” Computers and Composition 20.4 (2003): 455-472. Print.
• Haas, Mark, and Clinton Gardner. “MOO in Your Face: Researching, Designing, and Programming a User-Friendly Interface.” Computers and Composition 16.3 (1999): 341-358. Print.
• Hayles, N. Katherine. “Deeper into the Machine: Learning to Speak Digital.” Computers and Composition 19.4 (2002): 371-386. Print.
• Levi-Strauss, Claude. The Savage Mind. Chicago: U of Chicago P, 1968. Print.
• Mardsjo, Karin. “Interfacing Technology.” Computers and Composition 13.3 (1996): 303-316. Print.
• Mundie, Craig. “Computing Naturally.” Microsoft News Center. 3 Mar. 2010. Web.
• Munster, Anna. Materializing New Media: Embodiment in Information Aesthetics. Hanover, NH: Dartmouth College P, 2006. Print.
• Ramsay, Stephen. “On Building.” Stephen Ramsey Blog. N.d. Web.
• Rieder, David M., and Kevin Brock. “emBody(text) {.” ID:ENTITY. Self: Perception + Reality. 3rd Emerging Artists Series. CAM Raleigh. 18 Nov. 2011-13 Feb. 2012. Digital Interactive.
• Rieder, David M., Kevin Brock, and Rachel Bagby. “emBody(dekaaz) {.” Conference on College Composition and Communication. St. Louis Convention Center, St. Louis. 22 Mar. 2012. Digital Interactive.
• Rosinski, Paula, and Megan Squire. “Strange Bedfellows: Human-Computer Interaction, Interface Design, and Composition Pedagogy.” Computers and Composition 26.3 (2009): 149-163. Print.
• Selfe, Cynthia, and Richard Selfe. “The Politics of the Interface: Power and Its Exercise in Electronic Contact Zones.” College Composition and Communication 45.4 (1994): 480-504. Print.
• Skjulstad, Synne, and Andrew Morrison. “Movement in the Interface.” Computers and Composition 22.4 (2005): 413-433. Print.
• Spinuzzi, Clay. “Light Green Doesn’t Mean Hydrology: Toward a Visual-Rhetorical Framework for Interface Design.” Computers and Composition 18.1 (2001): 39-53. Print.
• Sullivan, Patricia. “Human-Computer Interaction Perspectives on Word-Processing Issues.” Computers and Composition 6.3 (1989): 11-33. Print.
• Vitanza, Victor J. Negation, Subjectivity, and the History of Rhetoric. Albany: SUNY P, 1997. Print.
• Wigdor, Daniel, and Dennis Wixon. Brave NUI World: Designing Natural User Interfaces for Touch and Gesture. New York: Morgan Kaufman, 2011. Print.

“I’m willing to entertain the fact that some people are uncomfortable with the idea that gay people are just like us.”
—Martin Sheen as attorney Ted Olson in 8

Background on 8 the Play

The recently debuted 8, a play by Dustin Lance Black, the Oscar winning screenwriter of Milk, recreates the June 2010 trial that overturned Proposition 8 (Prop 8) in California. The lawsuit giving rise to the trial involved two couples—one lesbian and one gay—who sued the state of California for the ability to marry under California law, a right that had been taken away by the passage of Prop 8. The case could very well be described as the Scopes trial¹ of the gay rights movement, pitting secular vs. religious arguments against LGBTQ people that fall miserably flat in the twenty-first century. Black based his ninety-minute play on twelve days of trial transcripts, interviews with the two couples who served as plaintiffs, and firsthand accounts of the proceedings.²

8, also known as 8 the Play, debuted on Broadway on September 19, 2011, and has since been performed widely at community theaters and university campuses. In the analysis that follows, I focus on the version of 8 that was performed live at the Ebell Theatre in Los Angeles on March 3, 2012. The play was live streamed on YouTube and, as of this publication, is still viewable. Broadcasting a play live on YouTube marks a significant shift in making what normally is considered an elitist genre of theater available to audiences on a much wider scale. The decision of the play’s producers to make the LA performance available on YouTube, as well as releasing the script and production rights to theater groups across the US, aligns with the exigency of the play: to expose the arguments made in the Prop 8 trial to a wide audience.

The plaintiff’s legal counsel, the unlikely pairing of Ted Olson and David Boies, believed that showing the public what actually happened in the courtroom would be a devastating blow to antigay rights battles in the court of public opinion, but a Supreme Court decision barred videos or live feeds of the trial. Black’s 8 was born out of this ruling. He takes a courtroom transcript with legal arguments and jargon and puts flesh and blood on it by creating two couples who are carefully constructed not “simply” as gay or lesbian but also as human beings with hopes, fears, loves, and lives the play’s audience can relate to.

8 features a condensed reenactment of the Prop 8 trial as well as fictional exchanges between the two couples and between the lesbian partners and their two teenage sons that act as a rhetorical frame. A short dialogue between the two sons forms the opening scene, and several other fictional dialogues and monologues break up the snapshots of the actual court proceedings, intended to provide the audience with a more personal experience of the trial and its effects on real people. What began, then, as an alternative way of getting the trial contents out to the public becomes, in 8, something much more rhetorically strategic than an O. J. Simpson-style live courtroom drama: Black humanizes and personalizes the arguments for and against gay rights. More specifically, I argue here that by employing rhetorical empathy—appeals to emotion and personal connection based on shared experience—the play creates a strategic identification between straight and gay people to further the cause of gay rights.

The questions that drive this inquiry and analysis are as follows: How does rhetorical empathy function in 8? How can we situate the function of rhetorical empathy in 8 within the larger context of appeals by the LGBTQ community for equal rights? And, finally, what does this site of analysis suggest about the value of rhetorical empathy as an inventional strategy and heuristic for engaging with the Other?³

Rhetorical Empathy

The strategy of using emotion and personal connection has a long history in Euro-American rhetorical history, dating back to Aristotle’s notion of pathos and more recently to Kenneth Burke’s theory of rhetorical identification. I define rhetorical empathy as a way of extending Burke’s identification by entering into the experience of the Other using appeals based on emotion and personal connection. Rhetorical empathy functions as an inventional topos and a rhetorical strategy, a conscious choice to connect with an Other, and also as an unconscious, often emotional, response to the experience of others.

In Euro-American epistemology, specifically within psychology, empathy often is associated with either cognition/thought or affect/emotion: cognitive empathy and affective empathy; however, recent work in cultural studies (Ahmed), rhetorical theory (Gross), and neuroscience (Decety and Meyer 1074) has complicated the degree to which emotions (including empathy) are hardwired components of our biological makeup or cognitive functions highly depending on context and learned behavior. Rhetorical empathy is a recursive process that may involve both cognition (conscious choice) and affect (which may be unconscious but is constructed by culture nonetheless). Although characteristics of empathy weave throughout the history of rhetoric and composition as a discipline in both theory and classroom practice (Burke’s identification, Rogerian rhetoric, Wayne Booth’s listening rhetoric, Krista Ratcliffe’s rhetorical listening), empathy has yet to be conceptualized as a rhetorical strategy or topos.

As an inventional stance, rhetorical empathy offers a way “in” to challenging discursive engagements between polarized groups. As a rhetorical strategy, rhetorical empathy focuses on the embodied subject position of both the rhetor and an Other in the form of lived experiences. Choosing to identify with an Other who may be hostile involves vulnerability and risk, but such a strategy offers possibilities for engaging across difference. As a somewhat conservative, nonconfrontational rhetorical strategy, rhetorical empathy can open doors to discussion and address fears and threats that may prevent listening and engagement.

Rhetorical empathy functions by establishing a connection based on shared emotion and, relatedly, shared points of identity.⁴ In Rhetorical Listening, Krista Ratcliffe critiques Burke’s identification for allowing only for “necessary” difference and rejecting the rest in favor of common ground and for ignoring differences in the cultural and political positions of various subjects, a critique that could be leveled at much of modern rhetorical theory (47-49). Rhetorical empathy assumes that shared identification/identity can be a starting point for rhetorical dialogue and engagement that recognizes unequal power relationships, historical context, and systemic and institutional forms of oppression. After an initial threshold of analogous identification has been established (e.g., in 8, the argument is that gay and lesbian couples are similar to straight couples), rhetorical empathy can create openings to highlight difference and unequal power relationships, as I demonstrate in my analysis below.

Rhetorical Empathy in 8

Rhetorical empathy functions in 8 on a number of levels: by appealing to emotion and pathos, to shared identity, and to shared experiences that attempt to reduce the Other’s sense of threat and promote empathy.

In the lead-up to the vote on Prop 8 in 2008, the logos-based appeals the “No on 8” campaign used to counter the antigay “Yes on 8” rhetoric fell flat with voters. This failure highlights Sharon Crowley’s argument in Toward a Civil Discourse that progressives will fare much better countering fundamentalism with other, more expansive tools offered by classical rhetoric—including pathos—rather than with logical appeals and reason as relics of an Enlightenment approach to public discourse (23). Three of the most prominent and egregious thirty-second commercials produced by the “Yes on 8” campaign prior to the vote on Prop 8 are shown to the audience during 8 so that they become part of the script itself. The arguments in the commercials appeal to fears that marriage equality would undermine “traditional” marriage, would threaten religious freedoms, and that children would be “exposed to homosexuality” in schools despite their parents’ disapproval.

Unlike 8 the Play, which uses a personalized, emotion-based approach that I’m characterizing as rhetorical empathy, the “No on 8” strategy focused on logical appeals attempting to refute the falsehoods in the pathos-laden “Yes on 8” commercials. A prominent example, “Proponents of Prop 8 Are Using Lies to Scare You” features a calm, male voice reasoning with viewers to reject the fear-based “Yes on 8” rhetoric. After all, the voice-over declares, “they’re using lies to persuade you. Prop 8 will not affect church tax status; that’s a lie. And it will not affect teaching in schools; that’s another lie. It’s time to shut down the scare tactics.”

Another prominent appeal in 8 the Play associated with rhetorical empathy involves creating a sense of shared identity between the characters in the play and the audience as well as personalizing the experiences of the two plaintiff couples so that the issues raised by the play become more than legal problems to be solved and falsehoods to be countered. The choice of the plaintiffs themselves and their portrayal in the West Coast premier on YouTube represents an embodied form of rhetorical empathy designed specifically to reduce the sense of threat to straight audiences that same-sex marriage may elicit.

For example, nearly all of the actors portraying the real-life lesbian and gay couples in 8 identify as straight: only Matt Bomer has publicly identified as gay. In the play, the plaintiffs and their kids are portrayed as real people whom their straight audiences can relate to, with backgrounds, life histories, love stories, and kids who get on their nerves, but whom they care deeply for. The plaintiffs are also portrayed as unwilling activists who simply want to live their everyday lives with their spouses and kids without being harassed or made to feel inferior because they’re gay. In the first scene, for example, one of the teenage sons of the lesbian couple—Eliott—says of his moms, “You associate the word activism with signs and extremists. When I think of Kris and Sandy I think of people who . . . don’t force their views on people” (1:20). This nonthreatening “we’re just like you” approach attempts to create a sense of identification with the potential audience of the play who may be turned off by a more direct, confrontational approach to the arguments at issue, specifically an audience beyond those (likely supporters) at the LA premiere who may see the recorded performance on YouTube or the play performed at a high school, college, or community theater.

Rhetorical empathy functions in the play as a form of strategic essentialism; the characters are, for the most part, heteronormative in their appearance and gender performance, and, except for the fact that they’re gay, they could easily be a member of any one of the straight couples in the audience. The queer in LGBTQ is erased, and what 8 portrays is two couples who could be the straight couples next door in the suburbs but who just “happen” to be gay. Reinforcing this strategy is the argument made by Olson and Boies in the play that being gay is an immutable orientation. This is not gay life in the Castro as in Milk; this is mainstream gay life in the same vein as 2011’s The Kids Are All Right, intended to put an attractive, palatable face on the Other, on the enemy who the “Yes on 8” campaign suggests just might be coming after your children—after he or she comes home from work, takes his or her own kids to soccer practice and attends the PTA meeting.

Once the audience has been invited to identify and empathize with the couples as a metonymic representation of gay couples, they’re invited to imagine what it’s like to be blatantly discriminated against. In one scene Jeff and Paul describe their relationship to the audience by facing them directly, creating an intimacy and deeply personal tone in the play. Jeff says, “It’s always an awkward situation at the front desk of a hotel. The individual working at the desk will look at us, perplexed: You ordered a king-sized bed. Is that really what you want?” (8:20). Paul adds, “Unless you have to go through that constant validation of self, there’s no way to really describe how it feels . . . . I can’t speak as an expert; I can speak as a human being who’s lived it” (9:06). In another scene Kris describes the emotional toll of having to make the constant decision whether to come out “at PTA, at soccer; it’s exhausting” (34:37). Paul implicitly asks the audience how it would make them feel to be considered a threat to children:

When I think of protecting your children, you protect them from people who perpetrate crimes against them . . . but when I think that my marrying Jeff is going to harm some child somewhere, it’s so damning and so angering (sic) because if you put my nieces and nephews on the stand right now, I’d be the cool uncle. To think that you have to protect someone from me, from Jeff and from our community, there’s no recovering from that. And unless you’ve experienced that moment, regardless of how proud you are, you feel ashamed. (38:52)

In 8, rhetorical empathy, characterized by analogous appeals based on similarities, becomes a process-focused appeal that invites an audience to imagine what it is like on the other side of the binary of gay/straight and then to, at least rhetorically, deconstruct the unequal power distribution within that binary. As an alternative to logos-based appeals, rhetorical empathy in 8 both enacts and invites vulnerability by appealing to emotions, to embodiment, and to shared experiences. As a form of strategic essentialism, approaches based on rhetorical empathy risk over essentializing, in the case of 8, a diverse group of people who identify along the LGBTQ spectrum. Despite its risks, rhetorical empathy offers possibilities for engagement between groups that may not normally engage with one another based on historical and cultural differences and harmful stereotypes. A rhetorical stance and way of being in the world characterized by rhetorical empathy requires that we see the Other as a real person rather than as a disembodied, threatening argument—someone who may be more like us than we want to believe.

Endnotes

1. The Scopes trial (1925), a landmark legal case pitting Christian fundamentalist against modern scientific worldviews, involved a high school teacher in Dayton, Tennessee, John Scopes, being tried for teaching evolution in violation of the Butler Act (1922), which outlawed the teaching of evolution in state-funded institutions (“Scopes”). The trial has striking parallels to the Prop 8 trial: famous litigators in Clarence Darrow, representing Scopes for the American Civil Liberties Union, and William Jennings Bryan, arguing for the state in defense of a religious fundamentalist view of US civil society and education, and a focus on the implications of teaching evolution (or, as Prop 8 proponents claimed, teaching about gay marriage) to children in public schools. return
2. The August 4, 2010, ruling of Chief District Court Judge Vaughn Walker (played by Brad Pitt in 8) on Perry v. Schwarzenegger for the US District Court for the Northern District of California held that Proposition 8 violated the Due Process and Equal Protection Clause of the Fourteenth Amendment to the US Constitution. Chief Judge Walker’s ruling was immediately appealed. On February 7, 2012, a three-judge panel for the Ninth District US Court of Appeals affirmed his decision in the case, now known as Perry v. Brown (“Perry”). Appeals continue now to the eleven-member Ninth Circuit Court and then to the Supreme Court. return
3. I am relying on concepts of the Other in Simone de Beauvoir and Michael Warner (gender) as well as in Edward Saïd (nationality and race). return
4. Here I rely on intersectionality theory, articulated by Kimberlé Williams Crenshaw and Patricia Hill Collins as a critical consciousness of “particular forms of intersecting oppressions—race and gender or sexuality and nation” (Collins 21). An awareness of multiple subject positions and intersectionality complicates ways in which rhetors can approach Others within polarized discourse. return

Works Cited

• 8. By Dustin Lance Black. Dir. Rob Reiner. Perf. Martin Sheen, Brad Pitt, George Clooney, Christine Lahti, Jamie Lee Curtis, Matthew Morrison, Matt Bomer, Chris Colfer, Kevin Bacon, John C. Reilly. Ebell Theatre, Los Angeles. 3 Mar. 2012. YouTube. Web. 15 Mar. 2012. <http://www.youtube.com/watch?v=qlUG8F9uVgM>.
• Ahmed, Sara. The Cultural Politics of Emotion. New York: Routledge, 2004. Print.
• Aristotle. On Rhetoric: A Theory of Civic Discourse. Trans. George A. Kennedy. New York: Oxford UP, 1991. Print.
• Beauvoir, Simone de. The Second Sex. 1952. New York: Vintage, 1989. Print.
• Booth, Wayne. The Rhetoric of Rhetoric: The Quest for Effective Communication. Malden: Blackwell, 2004. Print.
• Burke, Kenneth. A Rhetoric of Motives. 1950. Berkeley: U of California P, 1969. Print.
• Collins, Patricia Hill. Black Feminist Thought. 2nd ed. London: Routledge, 2009. Print.
• Crenshaw, Kimberlé Williams. “Mapping the Margins: Intersectionality, Identity Politics, and Violence Against Women of Color.” In Critical Race Theory: The Key Writings that Formed the Movement. Ed. Kimberlé Williams Crenshaw. New York: New P, 1995. 357-83. Print.
• Crowley, Sharon. Toward a Civil Discourse: Rhetoric and Fundamentalism. Pittsburgh, PA: University of Pittsburgh Press, 2006. Print.
• Decety, Jean, and Meghan Meyer. “From Emotion Resonance to Empathic Understanding: A Social Developmental Neuroscience Account.” Development and Psychopathology 20 (2008): 1053–80. Print.
• Gross, Daniel. The Secret History of Emotion. Chicago: U of Chicago P, 2006. Print.
• “Perry v. Brown: S189476.” California Courts: The Judicial Branch of California. Judicial Council of California / Administrative Office of the Courts, 2013. Web. 2 Apr. 2012. <http://www.courts.ca.gov/13401.htm>.
• Ratcliffe, Krista. Rhetorical Listening: Identification, Gender, Whiteness. Carbondale: Southern Illinois UP, 2005. Print.
• Saïd, Edward. Orientalism. New York: Vintage, 1979. Print.
• “The Scopes Trial.” eHistory. Ohio State University Department of History, 5 Aug. 2010. Web. 6 Aug. 2012. <http://ehistory.osu.edu/osu/mmh/clash/Scopes/scopes-page1.htm>.
• Warner, Michael. The Trouble with Normal: Sex, Politics, and the Ethics of Queer Life. Cambridge: Harvard UP, 1999. Print.

The Curious Contradictions of Popularity

Popularity is a curious phenomenon. Some authors desperately court it for the texts they create. Others seek an audience while purposefully avoiding the kind of attention that might get them associated with too much popularity. Popularity might inspire worship, jealousy, or even, outright disgust (“I’d rather be tarred and feathered than watch an episode of Everybody Loves Raymond”). Sometimes popularity is accompanied by a specter of inauthenticity (the boy bands of the late 1990s) or a sense of something blanched to the lowest common denominator (the oft-criticized writing of popular books by authors like Dan Brown or Stephenie Meyer). Popularity can be gained through a meteoric rise (the dawn of pogs) and just as easily disappear in an instant (the fall of pogs). Never guaranteed and always contested, discussing popularity usually becomes a tricky mix of contradictions.

I’m interested in the ways both cultural theorists and everyday people talk about popular texts (and the crossover between them), especially when both evoke longstanding arguments filled with hostility and suspicion toward popularity. Perhaps without even knowing the cultural theories of the late nineteenth century and the later prevailing schools of thought, everyday people constantly evoke their general premises as they discuss popular culture. When people make arguments that one text is somehow intrinsically better than another, they evoke Matthew Arnold’s famous definition of culture: “the best that has been thought and said in the world” (7). When someone complains about his or her favorite band “selling out,” the argument evokes a Frankfurt School position, which laments a culture of conformity that produces homogeneity in the name of capitalistic domination. When subcultural texts are elevated over popular ones, people evoke a Birmingham School notion that culture is a site of ideological struggle where everyday people battle the hegemonic dominance of media outlets.¹ Though each school has legitimate reasons for its hostility toward popularity, the fact that these positions have seeped into the conversations of non-scholar fans and critics of popular culture creates a curious contradiction. Namely, if popularity elicits suspicion, then why do these arguments against popularity seem so popular?

Commonplace Arguments

The hostility often expressed toward popularity may be best thought of in relation to the commonplaces of classical rhetoric. The Latin phrase for commonplaces, locis communis, bears etymological similarity to both our English “common” and “community.” This similarity is appropriate, for the commonplaces were, in the words of Sharon Crowley and Debra Hawhee, “available to anyone who spoke or wrote the language in which they were couched and who was reasonably familiar with the ethical and political discussions taking place in the community. No experts need apply” (76). Because they were based in common sense and belonged to the community, commonplaces ensured that not exclusively experts could make arguments in the public sphere. Now, commonplaces are built by a process of perceived community consensus and can change over time. As Crowley and Hawhee explained, a rhetor has little interest in evaluating them as true or false; the commonplaces represent what the community believes to be true (84).²

An exhaustive list of commonplaces is found in Aristotle’s On Rhetoric. Aristotle links commonplaces to the artistic modes of persuasion and considers them a part of logos along with deduction and the enthymeme. He further divides them into two kinds: the common (or koina) and the special (or eide). The koina do not focus on any particular subject and may be employed toward any argument subject. The eide focus on specific subject matters. These classifications easily map onto the ways popularity has been (and still is) discussed. People argue from conjecture (a koina tactic) when they evoke a mythical past in which popular culture was not debased by corporate ownership and monopoly interests. The case for highbrow versus lowbrow interests depends on the koina of the greater/lesser, as does the argument that a text is more authentic if fewer people seem to like it. Additionally, popular culture itself has become such a topic of debate that it has become an argumentative eide. The go-to arguments about popularity are so prevalent that it’s almost impossible to talk about popular texts without wandering through them.

To establish a commonplace, it first must be rigorously thought out. Nobody could accuse British cultural studies of not thinking through their objections and criticisms (one of the many reasons their insights are still written about today).³ The problem is that, over time, a commonplace idea threatens to become a rote and routine utterance that lacks exploration of the argument’s premises and awareness of why it’s made.⁴ Past arguments and theories so permeate US cultural studies (and the minds of pop culture consumers) that they offer easy inroads into talking about popular texts. Of course, this may be part of their appeal. As Crowley and Hawhee explained, commonplaces are intimately related to ideologies. They become a body of belief that helps us make sense of the world while simultaneously suggesting that others have made sense of the world in the same way. They may be experienced as an individual given that we encounter and adapt them through personal experience. However, “they are not entirely private; experiences, and our memories of them, are influenced by prevailing cultural attitudes” (77). They circulate through discussion and provide entry points to check one’s beliefs against another’s.

The Big Scary Commonplace of the “Mass”

Commonplace arguments against popularity are built upon an even more nefarious commonplace that fuels their seductive appeal. Namely, they revolve around commonplace arguments against the “mass.” The idea of the mass grew quickly with intellectuals and thinkers of the late nineteenth and early twentieth centuries. Henrik Ibsen’s 1882 play, An Enemy of the People, highlighted “the isolated, righteous individual as victim of a corrupt mass” (Carey 5). The founding of the Eugenics Education Society in the 1880s posited scientific grounds for eliminating the inferior breeds that flocked together into the base masses. In The Will to Power, Nietzsche argued that “a declaration of war on the masses by higher men is needed” (77); however, John Carey noted

what this intellectual effort failed to acknowledge was that the masses do not exist. The mass, that is to say, is a metaphor for the unknowable and invisible. We cannot see the mass. Crowds can be seen; but the mass is the crowd in its metaphysical aspect—the sum of all possible crowds—and that can take on conceptual form only as a metaphor. (21)

A metaphor, yes, but one that proved useful as intellectuals dealt with fears of capitalist production and ideological influence. For example, the Frankfurt and Birmingham Schools both employed the commonplace of the mass (albeit in different ways). For the Frankfurt School, the masses are subjected to texts that deal solely in standardization and mass production. The text that becomes popular within the culture industry has no aesthetic value. As Horkheimer and Adorno wrote, “Everything has value only in so far as it can be exchanged, not in so far as it is something in itself” (128). Further, “texts and radio no longer need to present themselves as art. The truth that they are nothing but business is used as an ideology to legitimize the trash they intentionally produce” (95). In short, according to the Frankfurt School, the culture industry ensures that the people remain a mass of consumers so it can structure their work and leisure time in its best interest. For the Birmingham School, people do not have to be passive absorbers of discourse. They can negotiate meaning with the text—a meaning possibly at odds with the producer’s intention; however, certain codes may be “so widely distributed in a specific language community or culture . . . that they appear not to be constructed . . . but to be naturally given” (Hall 132). Due to the naturalization of problematic codes that breed inequality or subordination, mass thought and interpretation are easily perpetuated.

Even though both schools make valid points, when talking about popular culture, it’s important to separate out academic thought on the subject from the fluid practices of everyday publics. I’d suggest most people aren’t concerned with the ideological manipulation hidden deep in their textual entertainment (people are also smarter than given credit for in noticing when it’s present). Further, in a criticism of theories that argue for the duped or manipulated consumer, Slavoj Žižek has reformulated Marx’s maxim “They do not know it, but they are doing it” into “They know very well what they are doing, but still, they are doing it” (25). Žižek’s statement comes out of Peter Sloterdijk’s notion of cynical ideology. Both authors suggest that nonacademic fans and critics of popular culture know that the commonplace of the mass is problematic; however, it still proves useful in different ways. Whereas modern elites found one general mass of uncultured people sufficient for their purposes, in popular usage, conceptions of the mass are more differentiated. Now, people construct masses on the fly: a mass of “Justin Bieber Fans” to express fears about the cookie-cutter production of art, a mass of “Avril Lavigne Fans” to express fears about the co-opting of punk ethos, or a mass of “Grand Theft Auto Fans” to argue that violent texts create violent users. People construct different conceptions of a mass based on their personal and contextual needs.

With the construction of different kinds of masses, there exist subsets of masses that people don’t mind feeling connected to if they are the “right” ones. Or, more accurately, we don’t feel like we’re part of a mass when we’re surrounded by (or feel related to) people who agree with us on the value of a text. When there is perceived agreement, the mass is conceptually turned into a community (or what Herbert Gans refers to as a “taste public”). Other members of this community may be just as technically unknown as the mass, but we are more likely to give them the benefit of the doubt and to assert their personhood. We want to stand out from a bland mass; we want to be associated with the perceived benefits of the community.

The Personal Relationship to Commonplaces

If standing out from the mass is so appealing, then why do consumers perpetuate commonplaces that have been constructed by the agreement of so many other faceless people? Perhaps, just as we perceive those in agreement with us as a  “community,” buying into the commonplace doesn’t feel like we are sacrificing our individuality. Although constructed socially, its power lies in how we come to it on—what feels like—individual terms. With the argument-ness of the argument obscured through entrenched use, the commonplace gets treated like an essentialized given that is just out there. Likewise, the commonplace either affirms or creates dissonance with our personal experiences, but the choice to use it or not feels individually made. This is especially true with the negative commonplaces about popularity since they encourage people to argue against the experiences, values, and practices of others. They are commonplaces that value a very modernist notion of the individual (one that is autonomous, immune to influence, and attentive to hierarchies), and all of them assert this individuality at the expense of others.

But we always have a perceived notion of the kinds of people who like a text. When these masses co-opt your favorite underground indie band, your relationship to the band hasn’t changed; the problem is the now perceived connection to a mass of people with whom you don’t want to be associated. Strangely, since people usually flock to and connect with others who possess similar interests, it’s most likely that someone making arguments against popular texts knows very little about the actual people or actual texts he or she is critiquing (how many people mock Twilight without having ever read a single word?).

Likewise, when fans think about people with similar interests, unless they know them from personal experience, the process of generalization is similar. Without access to a fleshed-out image of whom they are, people elevate what little information they know about the others’ tastes (They like Mad Men) and fill-in related conclusions (I like them because people who like Mad Men are smart enough to appreciate strong writing and characterization). To think about popularity is to always be thinking about other people. Whether an individual mentally turns them into a “mass” or a “community” tells us a lot about how one thinks about the benefits or harms of the text associated with the grouping.

The Rational Appeal of the Commonplaces

I suspect that most people don’t want to think their value judgments and assessments of others are fueled by gross generalizations, simple categorization, and (questionably) causal links. We fancy ourselves rational, nuanced, and critically thinking animals, and commonplaces help perpetuate this fantasy. Commonplaces operate through deduction, induction, and enthymematic reasoning. They utilize common examples that can be dissected as evidence. They have the appeal of beliefs supported by a firm system of logic. The commonplaces do a fine job of applying rationality to our thinking about both people and texts because they locate essential qualities in the texts themselves and assume predictable effects on masses of people.

Perhaps the greatest draw of commonplace arguments against popularity is how this focus on textual effects provides a gloss of rationality and causality over irrational and unconscious behaviors found in both ourselves and others. If thinking about popularity were not glossed over with convenient commonplace arguments about textual effects and predictable behaviors, then the perpetuation of our many personal fictions would be threatened. We want to think that we can resist what we think needs resisting. We want to think that we can do it consciously and with purpose. We want to think that we are in relative control of the tastes and values that we hold to be so personal and intimate. Finally, we sometimes want to ignore that other people influence and affect the tastes and pleasures that we enjoy.⁵

In the end, I’m not calling for a simple reversal in which popularity is uncritically embraced as an essential good. I’m suggesting that cultural theorists need to revisit the commonplace arguments about popularity’s perils and not uncritically accept premises that stall potential developments in the study of popular culture. In the most straightforward of terms, I’m arguing that theorists look closer at the complexity of popularity itself. As Lawrence Grossberg aptly summarized, “When it is at all considered, popular culture is treated as if it were either high art—amenable to the same kinds of critical concerns and practices as the more institutionally sanctioned forms of culture—or documentary evidence—as if its status as popular were insignificant to its active insertion into the lives of people” (“Putting” 177). That “status” is not as simple as a textual quality or predictable ideology. Popularity itself is often complex, irrational, and unconscious. Textual and ideological analysis, though useful at times, are not the only tools at our theoretical disposal.⁶ Recognizing and exploring how irrational drives and desires shape conceptions of popular culture offers a more productive direction for scholarly work than recycling commonplace and rote objections—no matter how seductive they may be.

Endnotes

1. These are not entirely satisfactory summations of the various schools’ complex positions. There are many books that go into detail regarding their history and theories. For the thoughts of early mass culture anxieties, see Matthew Arnold’s Culture and Anarchy (1960). For an excellent history of the Frankfurt School, see Martin Jay’s The Dialectical Imagination: A History of the Frankfurt School and the Institute of Social Research (1973). For the Birmingham School, see Stuart Hall, Dorothy Hobson, Andrew Lowe, and Paul Willis’s edited collection Culture, Media, Language (1996). return
2. I don’t fully agree that a rhetor has no interest in evaluating whether commonplaces are true or false. Though, in this essay, I’m adopting that view—somewhat. I’m interested in exploring why people like using them and, simultaneously, how they can encumber new directions of inquiry. return
3. Although it’s easy to dismiss the Frankfurt School for their palatable elitism, it’s important to consider the contexts in which they wrote. Based on the failure of the proletariat and the tragic rise of Nazism through public propaganda, their fears were historically situated and critical of the Marxist thinking that considered itself out of time. Further, their move to America and the witnessing of further proliferation of propaganda techniques and capitalist entrenchment fueled a desire for “authentic” art and expression. Likewise, the Birmingham School rigorously engaged the polysemous possibilities of semiotics and Antonio Gramsci’s earlier writing that reworked the concept of hegemony. Their willingness to give popular culture serious attention (and to give audiences interpretive agency through Stuart Hall’s encoding/decoding model) was a fundamental development in pop culture studies. In short, neither school can be accused of intellectual laziness. return
4. Lawrence Grossberg explains how these familiar arguments have led to a dead end and a general lack of surprise in cultural studies discussions: “You always find domination just where you expected it (e.g., the capitalist media produce sexist, racist, homophobic, Eurocentric, etc., messages), and there is little you can do except stand outside such messages and rally against them; you always find resistance just where you expected it; the only response is to turn the means of cultural production over to the dominated (e.g., as if it were guaranteed that the form and content of cultural productions from the margins would embody a different and correct politics since, presumably, marginal populations are always resisting)” (Dancing 275). return
5. Regarding my liberal use of “we,” I side with Lawrence Grossberg who wrote, “My use of ‘we’ is neither referential nor singular. It is intended to be slippery and multifunctional . . . . It is an invitation to belong within the space opened up by my discourse . . . . It is an invitation to care” (Dancing 26). return
6. The claim that scholars don’t look at “popularity” might seem ridiculous considering the existence of journals like The Journal of Popular Culture; however, a close look at most of its content reveals the continued pursuit of textual analysis, and the pop culture texts under consideration are usually not ones that have a staggering degree of popularity (theorists seem to prefer “cult” hits like Buffy the Vampire Slayer or narratively complex texts like Lost). When massively popular texts are looked at, the approach is often based in pointing out their shortcomings as pieces of narrative or ideology. Popular texts might be getting examined, but their actual popularity often remains untouched. return

Works Cited

• Aristotle. On Rhetoric: A Theory of Civic Discourse. 2nd ed. Trans. George A. Kennedy. New York: Oxford UP, 2007. Print.
• Arnold, Matthew. Culture and Anarchy. Cambridge: Cambridge UP, 1960. Print.
• Carey, John. The Intellectuals and the Masses: Pride and Prejudice among the Literary Intelligensia, 1880-1939. Chicago: Academy Chicago, 2005. Print.
• Crowley, Sharon, and Debra Hawhee. Ancient Rhetorics for Contemporary Students. 2nd ed. Needham Heights: Allyn and Bacon, 1999. Print.
• During, Simon. Culture Studies: A Critical Introduction. London: Routledge, 2005. Print.
• Gans, Herbert J. Popular Culture and High Culture: An Analysis and Evaluation of Taste. New York: Basic, 1999. Print.
• Grossberg, Lawrence. Dancing in Spite of Myself: Essays on Popular Culture. Durham: Duke UP, 1997. Print.
• —. “Putting the Pop Back in Postmodernism.” Social Text 21 (1989): 167-89. Print.
• Hall, Stuart, Dorothy Hobson, Andrew Lowe, and Paul Willis, eds. Culture, Media, Language. New York: Routledge, 1996. Print.
• Horkheimer, Max, and Theodor W. Adorno. Dialectic of Enlightenment. Stanford: Stanford UP, 2002. Print.
• Jay, Martin. The Dialectical Imagination: A History of the Frankfurt School and the Institute of Social Research, 1923-1950. Berkeley: U of California P, 1973. Print.
• Nietzsche, Friedrich. The Will to Power. Trans. Walter Kaufmann and R. J. Hollingdale. London: Weidenfeld and Nicolson, 1968. Print.
• Žižek, Slavoj. The Sublime Object of Ideology. New York: Verso, 2008. Print.

In December 2011, comedian Louis C.K. captured headlines with his self-produced and self-distributed comedy special Live at the Beacon Theatre. A former writer for Chris Rock and Conan O’Brien, a film director, and a stand-up comedian known for his absurdist brand of humor, C.K. has become one of the most popular comedians in the U.S. His stand-up act is wide-ranging, dealing with his life as a father, white privilege, and everything in between. C.K. filmed, edited, and produced Live at the Beacon Theatre with his own money and then released it on his website as a $5 download. The project’s success surprised everyone, including C.K., who was hoping that the experiment would break even financially. Instead, it grossed more than $1 million. The distribution model of Live at the Beacon Theatre takes advantage of a media environment in which authors and artists can distribute their work with fewer intermediaries. And while this model is relevant to digital rhetoricians, C.K.’s potential contribution to a networked rhetoric resides not in how he has decided to distribute his comedy but rather in his method of invention. C.K.’s approach to kairos, to the complex forces that shape rhetorical situations, offers an alternative to the dominant mode of contemporary networked rhetoric: snark.

Networked rhetorical situations mean that audiences and critics arrive from all angles, regardless of invitation. Networks, for all of their promise, raise difficult questions about audience and expose the rhetor’s vulnerability. Jeff Rice points to these contradictory forces when he describes networks as “open places of rhetorical production” that make for fluid relations: “because of the influence of new content, other ideas, and alternate places of meaning, a connection that exists right now might not exist later” (131). These connections that link up and then dissolve make for difficult rhetorical spaces. Others arrive from all angles, and these arrivals invite us to consider how the rhetor is called to respond. This problem is not created by networked life, but life in the network certainly exposes the predicaments of vulnerability to others. For Diane Davis, the arrival of others exposes a rhetorical imperative, “an originary (or preoriginary) rhetoricity—an affectability or persuadability—that is the condition for symbolic action” (2). Before we act or argue or persuade, we are affected and called forth by various others.

Similarly, Richard Marback has argued that rhetorical theory might benefit from a different consideration of vulnerability, one that moves beyond understanding it in terms of weakness. Instead, he argues for a more sustained consideration of how vulnerability lays the groundwork for rhetorical action:

What we gain in acknowledging and accepting our vulnerability to the appeals of others is an awareness of ourselves in our responsiveness to others. If we are aware of our responsiveness to others, we are aware of ourselves as being affected by them; we are aware at some level and in some sense of the irresistible power of their persuasiveness. Such awareness cannot but sensitize us to the subtleties and gradations of our vulnerabilities. (10–11)

Marback goes on to argue that recognizing vulnerability would mean to “acknowledge our openness to the conditions of living” (12). Both Davis and Marback show us that vulnerability is an unavoidable condition, one with which rhetoricians must continually grapple, particularly in our networked encounters. For this reason, a networked rhetoric needs to be attuned to kairos, the opportune and unpredictable moments of persuasion, moments that call on the rhetor to respond. The vulnerable rhetor may be called to respond at any moment by a wide variety of interlocutors and audiences. This predicament calls for something more than scripted responses.

A rhetor can only prepare for the unpredictability and mess of rhetorical situations through practice. The rhetorical tradition of the progymnasmata—a set of pedagogical exercises—was designed for just this type of practice. With exercises such as imitation or the writing of fables, teachers in the rhetorical tradition have helped students attune themselves to the unpredictability of rhetorical situations. Through experimentation, students can use the progymnasmata to craft a rhetorical sensibility.

Louis C.K. uses a similar method, but he acts as his own instructor. He attunes himself to the possibilities and predicaments of kairos by not only responding to unpredictable rhetorical situations but also by constructing his own predicaments. By creating (or, better, composing) difficult situations, C.K. forces himself to confront the vulnerability and shame of the kairotic moment. Placing himself in front of an audience and opening himself to the possibility of failure, C.K. must respond to the opportunities and pitfalls of kairos. In effect, he is allowing us to see his ever-evolving rhetorical education—he is continually performing his rhetorical experiments in public. This practicing in public stems from C.K.’s willingness to be exposed, to be placed in a vulnerable situation, to open himself up to risky situations in front of an audience.

C.K.’s method is a response to the vulnerability of life in a networked society. In an interview on Marc Maron’s popular WTF podcast, C.K. described his processes of invention. Based on that interview, we can glean a great deal about C.K.’s method of invention, a “weird ethic” of practicing in public. If teachers of ancient rhetoric used tools like the progymnasmata for attuning students to the unpredictability of kairos, C.K. is showing us how such rhetorical practice need not always be performed behind closed doors or in the classroom. But he is also showing us an alternative to the dominant mode of networked rhetorical situations: snark.

Snark

Given that contemporary rhetorical practice is largely defined by snark, C.K.’s willingness to place himself in tight spots and unpredictable situations provides a novel mode of invention. Snark—a portmanteau of “snide” and “remark”—defines contemporary rhetoric in the network. From the mocking tone of Gawker blogs to YouTube comment trolls to flame wars, digital spaces can be caustic places. Snark is one response to this set of problems. It offers jabs and opinions in a knowing tone, attacking the opposition coldly or preemptively insulating the author against attacks and trolling. This response to the unpredictability of the network is what currently dominates rhetorical practice in digital spaces. Thrown into a kairotic situation where various audiences will view your video or listen to your podcast or respond to your blog post, the digital rhetor can use snark to make it clear that the various others with which they collide are doing no damage. Snark attempts to protect against shame and vulnerability.

But we can hardly blame the rhetor that turns to snark. An example will help clarify what I mean. In a 2010 story about the difficulties of online conversation, NPR correspondent Laura Sydell offered the story of Miki Hsu Leavey. After the passage of the Patient Protection and Affordable Care Act, Leavey wrote a “heartfelt, thankful letter” to The Napa Valley Register (Sydell). In the letter, published on the Register’s website, she explained that the bill would allow her to get coverage regardless of her Lupus, her husband’s liver cancer, and her son’s pre-existing heart condition. In response to this letter, a commenter on the Register’s website wrote the following:

This letter is indicative of the intellectual bankruptcy of the left. Rather than explain in any way how the new legislation will empower providers to heal the sick more efficiently, reduce the bureaucratic restrictions to access, bring new treatments to market or reduce the cost to society, all they do is make a shameless appeal to the heartstrings. ‘oh, my poor baby is sick; only the Great Obama can save him!’ Makes me sick just reading it. The inference, of course, is that anyone opposing this government power grab must be in favor of crippling our children, abandoning the elderly and torturing the disabled. Intellectually bankrupt! (“Discussion”)

The commenter responds to a perceived attack on his or her own position (opposition to a “government power grab”) by assuming that Leavey is a stand-in for “the left.” Feeling that s/he has been put in the position of villain, the commenter mocks Leavey for turning to “the Great Obama.” Given such comments, could one blame Leavey for second-guessing her decision to expose herself to the network? This commenter’s snarky response exposes not only Leavey’s vulnerability but also the commenter’s exposedness, which causes the commenter to employ snark when confronted with a letter that threatens his or her political position and identity. In a space of collisions, networked rhetors often seek solace in snark. In his willingness to embrace vulnerability, Louis C.K. shows us another way.

On a High Wire

C.K’s appearance on Maron’s WTF podcast is particularly useful for understanding his methods and processes. Maron has known C.K. since his early days as a stand-up comedian, and his interview questions link C.K.’s recent success to his early days in stand-up comedy. During the interview, Maron offers an interesting encapsulation of C.K.’s guiding ethic: “You very consciously let things get so fucking bad for yourself in order to see if you can rise from it . . . that’s always been this weird ethic you had” (Maron, Louis C.K. Part 1). Maron provides various examples of this from early in C.K.’s career, including his decision to purchase a BMW on his American Express card (he subsequently defaulted). This early behavior was erratic and reckless, and his stand-up comedy at the time did not necessarily benefit from it. C.K. admits that his stand-up act, until recent years, was a scripted one that could be thrown off by a simple comment from an audience member. More recently, he has demonstrated a willingness to emerge from a kairotic moment by constructing predicaments and responding to them.

In the interview with Maron, C.K. expresses admiration for performers with this kairotic sensibility, and he offers Jackie Gleason as an example:

Gleason didn’t come to rehearsals. Everybody rehearsed without him, and then he would just come in and go ‘Alright what are we doing?’ And he’d know half his lines, and he didn’t know the blocking . . . . Back then, everyone on the planet Earth watched The Honeymooners . . . . It was like 50 million people. So, in front of all those people . . . you could see him in some scenes like ‘I’m not sure where I am or what’s supposed to happen in this scene. I’m just going to do this: Bwaaa!’ And he would just be hilarious. (Maron, Louis C.K. Part 2)

Gleason was forced to respond in front of a massive audience, and he did so by relying on an attunement to kairos rather than the memorization of a script. C.K. expresses an admiration for this approach, saying that Gleason “put himself on a high wire.” He knew he had to perform his way out of the situation.

This same approach is evident in C.K.’s own work as he insists that material he has performed be discarded as soon as it airs on television. While waiting for his HBO series Lucky Louie to air, C.K. created a one-hour stand-up special of brand new material. Knowing that the TV show would either be a success (meaning the end of his stand-up career) or a flop (meaning that he needed to make money to support his family), C.K. began developing material for this special, entitled Shameless. As he explains, every stand-up set that he did in preparation for Shameless was high stakes. Forced into this situation, C.K. filmed Shameless and then made a daring choice: “I threw away every minute of it . . . I’m never telling those jokes again. Never” (Maron, Louis C.K. Part 2). This approach is somewhat rare in the stand-up comedy community. While comedians are always developing new material, they rarely commit to throwing away all previous material. In fact, comedians are often much like musicians, relying on their “hits” during performances.

What is the rhetorical value of painting oneself into a corner in this way, throwing away material that has proven successful? This method insists upon an opening up to kairos and vulnerability. The rhetor exposes herself to shame. S/he is placed into a vulnerable position and must craft a kairotic sensibility not unlike Gleason during his work on The Honeymooners. There is no practicing behind the scenes or using snark to guard against unpredictability. Instead, the rhetor practices in front of the audience, creating a high stakes situation to which s/he must respond effectively.

‘Can you get me a helicopter?’

Louie – Helicopter Scene from Jim Brown on Vimeo.

This scene from the pilot episode of the hit television show Louie (this is not the same show as Lucky Louie, which was not renewed after its first season on HBO) is a perfect example of C.K.’s absurdist humor. At the end of a disastrous first date, C.K’s companion is so uncomfortable that she escapes via helicopter. The scene arrives, seemingly, out of nowhere. But for C.K., it is the most important part of the episode for a number of reasons: “things like the helicopter exist for two reasons. One is just that I like it . . . [but] also I get off on squeezing a lot out of very little money. The budget for this show was tiny, and I wanted to show FX [the show’s network] that I could do a lot with money” (Maron, Louis C.K. Part 2). When shooting for Louie started, C.K. asked his production manager, Blaire Breard, for the helicopter: “I said to her: ‘Can you get me a helicopter?’ That was like one of the first things I said to her” (Maron, Louis C.K. Part 2). This was not an easy task, and Breard continued to try to talk C.K. out of it, due to its expense. But the helicopter scene happened because C.K. committed to the absurd request and insisted that his crew do so as well:

She would say to me ‘I’m not finding a helicopter yet. Start thinking of an alternate, and I’d say to her there isn’t an alternate. Get a helicopter. And she’d keep working on it and working on it. And then she found this dude who, he’s a new helicopter guy. He’s the new guy in town. (Maron, Louis C.K. Part 2)

Typically, the helicopter scene might be seen as an extravagance, a way to flaunt a large budget. For C.K., it’s precisely the opposite. He committed to this scene knowing the risks involved. There was no plan B. Yes, this is a commitment to absurdist comedy, but it is also a commitment to a manufactured constraint, one that forces C.K. and those around him into a kairotic predicament and the possibility of failure. It is this commitment that offers an answer to snark, which is allergic to failure and vulnerability.

Shame and Rhetoric in the Network

In the wake of Live at the Beacon Theatre, designer and writer Frank Chimero blogged about C.K.’s recent success. From a hit television show to sold out theatres, C.K. has tapped into something, and Chimero believes that something is shame:

Louie [sic] CK has jokes because he is ashamed of his body, ashamed of his thoughts, his culture, his whiteness, whatever. Every joke seems to be about shame in some way. Ashamed of the things he doesn’t do that he knows he should. (Chimero)

An example of C.K.’s discussions of shame might help here. Here’s a brief clip from Live at the Beacon Theatre.

“First Class” from Jim Brown on Vimeo.

In this clip, C.K. shares with us his own shame, expressing something universal about how we fantasize about good deeds in order to provide ourselves with enjoyment. Chimero argues that “shame is diffused through its publication and distribution. Shame is reduced through its sharing.” While I’m not sure that shame is reduced through sharing, it seems clear that the material is rhetorically effective. Chimero is right. The commonplace of shame runs through all of C.K.’s material, from his stand-up comedy to his television shows. And this commonplace is tied directly to the method of invention I’ve been tracing out here. Stripped of the crutches of a previous material or the scaffolding of old jokes, committed to absurd premises, open and affectable, C.K. is forced (and forces himself) to stand naked in front of his audience. He insists upon crafting difficult situations, leaving open the possibility of shame, and then responding.

Embracing the shame and vulnerability of kairos offers one alternative to the snark of contemporary rhetoric in the network. Snark emerges as a defense mechanism against the vulnerability of a networked world. But an attunement to kairos requires that the rhetor resist falling back on the callous, cynical defense mechanisms built in anticipation of the judgment of others. Let’s be clear: This is not about meeting snark with a saccharine form of sincerity. Anyone who has seen Louis C.K.’s act knows that this would be a radical mischaracterization. Instead, C.K.’s commitment to shame is a result of his willingness to emerge from kairos by forcing himself to, as Chimero notes, distribute his shame. This is the true significance of Live at the Beacon Theatre, an hour of brand new material that continues C.K’s penchant for shame and humiliation (his own and ours). He offers an alternative to the armor that snark attempts to create—a shell that guards against the shame of being exposed to/by others, an exposedness that is unavoidable in a networked society.

There are other ways to link Louis C.K. to rhetoric and technology. During their interview, Maron reminisces about a computer that he and C.K. found on the street. C.K.’s mother was a computer programmer, and he was a self-described junior high AV nerd. He fixed the computer that he and Maron found, and he ended up mining various files for standup material. He writes and edits his television show on a 13-inch MacBook Pro. He shoots the show on the RED digital camera and uses fixed focus lenses, meaning that lenses have to be changed out for every shot. In his own words, he does things in “the most complicated way possible.” But like his choice to distribute his comedy special online, this use of technology is really just an example of his weird ethic, his choice to put himself on a high wire. With his talent for creating tight spots, for constructing situations that he will have to write his way out of, for remaining open to vulnerability, failure, and shame, C.K. provides us with an alternative to snark and cynicism. By cultivating an attunement to kairos and a recognition of the rhetorical value of exposedness in the network, as C.K. does, rhetors can learn how to practice in public and avoid the trappings of snark.

Works Cited

• Chimero, Frank. “Louis CK’s Shameful Dirty Comedy.” Frankchimero.com. 19 Dec. 2011. Web. 1 June 2012.
• Davis, Diane. Inessential Solidarity: Rhetoric and Foreigner Relations. 1st ed. U of Pittsburgh P, 2010. Print.
• “Discussion : Health Care Bill Lifts a Burden.” Napa Valley Register. Napa Valley Register, n.d. Web. 1 June 2012.
• Marback, Richard. “A Meditation on Vulnerability in Rhetoric.” Rhetoric Review 29.1 (2010): 1-13. Print.
• Maron, Marc. Louis C.K. Part 1. Audio Recording. WTF with Marc Maron.
• —. Louis C.K. Part 2. Audio Recording. WTF with Marc Maron.
• Rice, Jeff. “Networks and New Media.” College English 69.2 (2006): 127-133. Print.
• Sydell, Laura. “Website Editors Strive To Rein In Nasty Comments : NPR.” NPR.org. NPR, 27 May 2010. Web. 1 June 2012.

Medical rhetoric scholars often react to international and local issues, including epidemics, health care reform, political campaigns, legislation, government funding, and community-based care. Medical rhetoric projects “aim to be useful,” and projects’ “usefulness lies in their ability simply to pose questions that are prior to the questions typically posed by health researchers” (Segal 228). As such, medical rhetoricians frequently study “language events within the medical professions” and within larger public discourse (Heifferon and Brown 246). Because medical rhetoric scholars attend to global and local health issues, this research affects each of us in multiple ways: as scholars, researchers, and teachers, but also as recipients of the policies, procedures, and pharmaceuticals examined in this issue. By studying the rhetorical aspects of these subjects, we as health care recipients and rhetoricians can make more informed decisions about our health care and possibly bring about positive change in health and medicine. This issue’s authors, representing global and local views, exemplify this commitment.

Following Present Tense’s mission of exploring social, cultural, and political issues through a rhetorical lens, the authors examine timely and important issues as they relate to health and medicine. The subjects explored by the authors in this issue are especially intriguing and potentially influential given the health care policies debated in the current U.S. presidential election. Our special issue includes the following pieces:

A Womb With a View: Identifying the Culturally Iconic Fetal Image in Prenatal Ultrasound Provisions – Grounding her piece in House Bill 15, Rochelle Gregory illustrates how ultrasound visualization is a transformative act with political, medical, and ethical repercussions.

Inoculating the Public: Managing Vaccine Rhetoric – Monica Brown asserts that, in light of the most recent flu epidemic, rhetorical analysis serves to correct mistakes in vaccination campaigns, thus offering public health campaigns and the public control of health messages and behaviors.

Laboring Bodies and Writing Work: The Pregnant First-Year Writing Instructor – Jessica Restaino details the political and pedagogical complexities and challenges surrounding pregnant composition teachers inside the classroom and the larger academic institution.

Stasis Theory and Meaningful Participation in Pharmaceutical Policy – Christa Teston and S. Scott Graham use stasis theory to analyze the FDA’s public hearings on Avastin, a breast cancer drug, concluding that the hearings allowed only certain types of discussion and resulted in stakeholders disagreeing on crucial points.

“Wellness” as Incipient Illness: Dietary Supplements in a Biomedical Culture – Colleen Derkatch uses the rhetoric of dietary supplements to highlight popular notions of “wellness” and the public and political implications of these notions.

The Concept of Choice as Phallusy: A Few Reasons Why We Could Not Agree More – Situating their piece in the historical and current context of abortion debates, Amy Koerber, Amanda K. Booher, and Rebecca J. Rickly depict the rhetorical spaces surrounding these debates and the role women’s stories play in these spaces.

Healthy Eating: Metaphors We Live By? – Philippa Spoel, Roma Harris, and Flis Henwood’s empirical research illustrates how metaphors used in daily discourse construct our understanding of “healthy eating.”

Epideictic Rhetoric and the Reinvention of Disability: A Study of Ceremony at the New York State Asylum for “Idiots” – Zosha Stuckey argues that uses of epidiectic rhetoric reformed treatment paradigms and understandings of disability.

Research Update: Pain Medication and the Figure of the Pain Patient – Judy Z. Segal discusses a current research project in which she reconstructs the pain patient in public and medical settings.

An Annotated Bibliography of Literature on the Rhetoric of Health and Medicine – Jessica Masri Eberhard provides one of the first published annotated bibliographies on medical rhetoric.

Interview: Transplant Deliberations and Patient Advocacy – Melissa Christian, an organ transplant coordinator, spoke with Present Tense editors about how communication influences her everyday interaction with transplant teams, patients, and families. As a working medical professional, Christian provides medical rhetoricians with suggestions for how their work can contribute to medical practice.

Book Review: Black Dogs and Blue Words – Patty A. Kelly reviews Kimberly Emmons’ book on the rhetoric of depression, suggesting that a wide, cross-disciplinary audience may benefit from Emmons’ work.

Book Review: Disability and Mothering: Liminal Spaces of Embodied Knowledge – Ashlynn Reynolds-Dyk reviews Cynthia Lewiecki-Wilson and Jen Cellio’s edited collection. Reynolds-Dyk summarizes the book’s four parts and concludes with reflective thoughts on how different audiences may use this collection.

One goal of medical rhetoric is to contribute to public discussions of medicine and health. By making this special issue widely and freely available to the general public, we hope to add to these discussions. We hope you will participate in the conversation by commenting at the end of each article and reposting, tweeting, sharing, and “liking” the articles. We also hope you will find these articles useful in your classrooms. We invite you to comment on your pedagogical approaches in the comment fields below the articles.

In closing, we would like to thank our authors for their contributions to this issue. We also thank our guest editors, Steve Bernhardt, Scott Graham, Karen Kopelson, Dora Ramirez-Dhoore, J. Blake Scott, Judy Z. Segal, and Denise Valdés, for reviewing and recruiting submissions and providing feedback and advice. The success of this issue is due in large part to the authors’ and guest editors’ ongoing commitment to furthering medical rhetoric scholarship.

Sincerely,

Elizabeth L. Angeli, Annotated Bibliography Editor
Joshua Prenosil, General Editor
Cristyn L. Elder, Managing Editor
Megan Schoen, Managing Editor
Ehren Helmut Pflugfelder, Managing Editor
Caitlan Spronk, Technical Editor
Allen Brizee, Review Editor
Alexandra Hidalgo, Multimedia Editor
Don Unger, Print Editor
Jessica E. Clements, Style Editor
John Williford, Design Editor

Works Cited

• Heifferon, Barbara, and Stuart C. Brown. “Guest Editors’ Column.” Technical Communication Quarterly 9.3 (Summer 2000): 245-248. Print.
• Segal, Judy Z. “Rhetoric of Health and Medicine.” The SAGE Handbook of Rhetorical Studies. Eds. Andrea A. Lunsford, Kirt H. Wilson, and Rosa A. Eberly. Thousand Oaks, CA: SAGE, 2009. 227-245. Print.

In the past fifty years, medical advances have allowed doctors to view human embryos (less than ten weeks’ gestation) and fetuses (after ten weeks’ gestation) via prenatal ultrasound technology (“Fetal Development”). These procedures allow doctors to identify potential birth defects and maternal dangers without imposing risks upon the mother or the viability of the embryo or fetus. Fetal images, though, are neither self-explanatory nor universally recognized and have become “sites of struggle for meaning” (Perlmutter 22), meaning that this article will attempt to explore by arguing that ultrasound visualization is a complex and transformative act.

For abortion opponents, prenatal ultrasound images offer a “definitive declaration that these pictures tell one story and unveil one truth—that life begins at the moment of conception” (Boucher 9). These images have been used, for example, to deter women from terminating their pregnancies in anti-abortion media such as the film The Silent Scream, at interactive mall kiosks like Truth Booth’s A Window to the Womb, and on websites such as National Right to Life, Pro-Life Action League, Abortionfacts.com, and the Heritage House 76. And, since the mid-1990s, lawmakers in Texas and twenty other states have enacted legislation that “regulate[s] the provision of ultrasound” by requiring providers to perform or offer to perform an ultrasound on each patient seeking an abortion (“Requirements for Ultrasound”).

Most recently in 2011, Texas Governor Rick Perry signed House Bill 15, more commonly known as the Texas Abortion-Sonogram Law; House Bill 15 is considered the most restrictive legislation of its kind in the United States since it requires doctors to display the images to the patient from live, real-time prenatal ultrasounds and to “make the heartbeat audible and describe the fetus’ [or embryo’s] dimensions, cardiac activity and internal and external organs” (Ackerman). Additionally, this legislation requires that “the provider must give [a patient] a detailed verbal description of the image unless she was raped, has a court order waiving parental consent or is ending the pregnancy because of a fetal abnormality” (“Abortion”).

Proponents of ultrasound provisions have stated that such legislation’s purpose is to dissuade women from terminating their pregnancies. During the House and Senate debates on the legislation, proponents including Governor Perry argued that the law would ensure that “Texans have access to all the information when making such an important decision” and that the legislation is a “critical step in our efforts to protect life” (qtd. in Tinsely), and Senator Jane Nelson of Flower Mound, Texas stated, “I believe that women will understand [with this bill] that if they choose to have an abortion, that is indeed a life” (qtd. in Tinsely). Critics of the bill, however, have argued that the law is an attempt to shame and humiliate a patient seeking an abortion in order to discourage her from terminating her pregnancy. Senator Wendy Davis of Fort Worth, Texas noted that the law is “cloaked under the guise of informing women … but the intent is to torture women psychologically” (qtd. in Tinsely). As one online commentator noted, “Conservative legislators have fantasies of women seeing fully formed babies on monitors, bursting into tears, and running out of the clinics” (Marcotte).

Still, it is clear that for representatives like Nelson and Perry, prenatal ultrasounds offer self-evident images that require little explanation, interpretation, or mediation of the embryo or fetus as it exists within a woman’s womb. Images of embryos and fetuses affect not only the “larger cultural climate of reproductive politics but also the experience and consciousness of pregnant women” (Petchesky 265) and often provoke strong reactions, including outrage. Ultrasound provisions, specifically, exploit the cultural significance of the iconic fetal image in order to dissuade a patient from terminating her pregnancy. In essence, these legislative measures encourage a patient to identify (inappropriately and incorrectly) her embryo or fetus as the culturally iconic fetus, one that is viable, fully developed, and autonomous.

Transformation of the Culturally Iconic Fetal Image

At the onset, prenatal ultrasounds appear to offer photographic representations of embryonic and fetal development in utero. These images are perceived to be indexical signs that stand “unequivocally for this or that existing thing” (Peirce 4: 531) due to the perceived “genuine relationship” or “direct physical connection” between the embryo or fetus and the image (Peirce 2: 285). Other examples of indexical signs might include driver’s license or passport photographs or an exit sign with an arrow pointing toward the door. The image of the embryo or fetus is a sign in which the “signifier is not arbitrary but is directly connected in some way (physically or causally) to the signified” (Chandler 37); in this case, an indexical sign of a fetus at six weeks’ gestation might appear on screen as indistinguishable on a monitor (Figure 1). As an indexical sign, the prenatal ultrasound image conveys “a certain mystique in our culture that [might] be described by terms such as ‘absolutely analogical’ and ‘message without a code’” (Mitchell 61).

Figure 1 (“Sonogram Human Foetal Ultrasound Scan at 6 Weeks”)

However, a closer examination of prenatal ultrasound images illustrates how they are considered to be persuasive tools that will dissuade women from terminating their pregnancies because prenatal ultrasound images of the embryo or fetus are attributed with the cultural status of being iconic signs. Iconic signs, by definition, resemble or possess a likeness of what they signify and “have the modality of direct perception” (Hodge and Kress 27). Additionally, while iconic signs are supposedly transparent, they reflect cultural conventions that often make these signs highly evocative (Chandler 40). In this case, the culturally iconic image is the autonomous, fully developed (regardless of gestational age), eight-pound, twenty-inch fetus (Figure 2).

Figure 2 (“Sonogram Human Foetal Ultrasound Scan at 22 Weeks”

An examination of these fetal ultrasound images illustrates how they transform from indexical to iconic signs in the cultural contexts of reproductive legislation. Ultrasound legislation intends to dissuade patients from terminating their pregnancies because they are expected to visualize the culturally iconic image of a fully formed, healthy, miniature human floating in the space of its amniotic sac. In short, in the context of legislation like House Bill 15, the image of the embryo or fetus is perceived to be a persuasive tool for pro-life advocates and legislators because there is no recognition or awareness that a transformation of an indexical sign to the culturally iconic one has occurred during the visualization.

This shift—from the indexical sign to the culturally iconic image—is possible because, as iconic signs, prenatal ultrasound images vaguely represent the embryos’ or fetus’ physical features, are absent of color and definite form, and lack specificity. The culturally iconic image of embryo and fetus displaces the “mother” by representing “the fetus as primary and autonomous, the woman as absent or peripheral” (Petchesky 268). The prenatal ultrasound image reduces the “incidental elements” of the mother, the doctor, and the technology itself. As such, the fetus is completely independent from the womb and appears to be completely viable—irrespective of gestational development.

While research suggests that ultrasound provisions have no effect on abortion rates (Gold), legislators perceive these images to be effective rhetorical tools that would dissuade a patient from attaining an abortion because these images blur “the boundary between fetus and baby; they reinforce the idea that the fetus’s identity as separate and autonomous from the mother (the ‘living, separate child’) exists from the start” (Petchesky 272). The significance of the culturally iconic image is evident considering that if a woman were viewing a prenatal ultrasound image prior to an abortion, the embryo or fetus on the monitor is (in most cases) less than twelve weeks’ gestation.

Despite this significant distinction, ultrasound provisions seek to exploit the shift from an indexical sign to the culturally iconic image of the fetus in order to dissuade women from terminating their pregnancies. As Governor Perry issued in a statement, ultrasound provisions ensure that women, upon viewing the ultrasound image, understand “the devastating impact of such a life-ending decision” (“Statement”). Texas Right to Life Director Elizabeth Graham and Legislative Director John Seago concur that the legislation is intended to dissuade women from terminating their pregnancies by encouraging women to see themselves in the ultrasound images as mothers (to unborn, yet fully formed infants) rather than as naïve young girls: “A sonogram transforms a confused customer into a mother willing to rise off the table, walk out of the abortion mill, and choose Life. The last option [abortion providers such as] Planned Parenthood wants is for a frightened girl to take time, to even think, to have a chance to change her mind” (qtd. in Ertelt).

Irrefutability and Timelessness of Fetal Images as Iconic Signs

The persuasive appeal of the iconic fetal image is its supposed irrefutability and timelessness. As a culturally iconic sign, the fetal image reductively “epitomizes the distortion inherent in all photographic images: their tendency to slice up reality into tiny bits wrenched out of real space and time” (Petchesky 268). The fetal image as a sign relies on the outlines of objects and entails a “‘reduction’ of objects’ outlines into a more elementary representational form, in which only the basic underlying structure is retained and many incidental elements are discarded” (Messaris 13). Iconic signs appear to be factual, positive, educational, and informative, but what we see when looking at a prenatal ultrasound image is a reflection of our experiences and desires. As David Blakesley writes, “What we see, even at the moment of perception, is a consequence of what we’re looking for” (130). As such, legislation like House Bill 15 seeks to exploit this transformation of the fetal image from an indexical sign of a six-week fetus to the culturally iconic image of the thirty-two-week fetus. What viewers perceive to be the image of the fetus on the computer screen is really a collection of shaded pixels according to certain criteria programmed into the computer; the resulting image appears to be “human” although it must be interpreted and described by qualified technicians and physicians.

Additionally, the visualization and transformation of the fetal image relies on the technology to capture fetal images—technology that is neither invisible nor neutral. Technology is “impure” and can easily manipulate “humans and what it means to be human” (Burnett 141). Medical and scientific images that seem to “peer” into the body particularly challenge notions of “what it means to be flesh and blood” (141); visualization involves “the embodiment and the transformation of information into knowledge and understanding through human activity and the conversion of [that] information and knowledge by humans into material and aesthetic forms” (202). Despite the perceived transparency of the fetal image presumed by legislators, the prenatal ultrasound requires doctors and skilled technicians to interpret what appear to the patient as black and white dots. Nothing is inherently “life-like” in the image; rather, in this case, through the visualization of the image, it has transformed into a means of immersion, where parents become a part of the image and the experience, and a perceived connection and closeness with the image exists. As such, viewing has become a “haze of mediation, experience, and screen” (Burnett 7).

Burnett’s point—that visualization and transformation are social acts—illustrates the complexities of prenatal ultrasound images. These images are, on the one hand, supposedly easily understood and representational images of gestational development that should be removed from biological contexts. In the scenario, then, of a woman seeking an abortion, the prenatal ultrasound image directly represents the embryo or fetus, which according to legislators should be a very powerful visual rhetoric against terminating a pregnancy. However, this scene illustrates the contradiction of such rhetoric considering that medical experts must interpret and describe the image in order to reinforce to the patient what she sees and hears during the procedure. In this scenario, then, only trained technicians who are able to “read” prenatal ultrasounds can administer them—a point that undercuts all claims to the indexical or self-evidentiary nature of these images. In other words, the abortion-sonogram legislation requires doctors to describe the images because, without such a description, patients would not make the appropriate transformation from an indexical sign to a culturally iconic one. Only an expert can interpret prenatal ultrasound images—a point that identifies any “doubts about the clarity of what is being seen” (Boucher 16). Prenatal ultrasound images are only considered “factual” by those who accept an ethos of medical technology as definitively and objectively “truthful.”

Just as visual images’ constructed meanings are not “transparent and universally understood, but culturally specific” (Kress and van Leeuwen 3), these images are hardly irrefutable and timeless because their rhetorical effectiveness relies on the cultural contexts in which the images appear. Prenatal ultrasound images are perceived to be factual, positive, educational, and informative in a cultural context that accepts them as such, and maternal bonding through the awareness of the human body is culturally specific and defined. While this awareness has been defined as unequivocally biologically linked, all “positive” awareness is culturally defined. As Petchesky notes, arguments that suggest the “timing of maternal-fetus or maternal-infant attachment is a biological given […] contradict women’s changing historical experience” (283).

An example of this transformation and mediation is clear in the popularity and appropriation by anti-abortion advocates of Lennart Nilsson’s famous images of the fetus suspended in the womb in Life magazine on April 30, 1965 (later republished in “Drama of Life Before Birth: Landmark Work Five Decades Later”) and in his book and on his website A Child is Born. While Nilsson’s images have been widely used and distributed in anti-abortion literature, Nilsson’s photographs were actually aborted fetuses, a point that illustrates how technology mediates and transforms an iconic sign:

Although claiming to show the living fetus, Nilsson actually photographed abortus material obtained from women who terminated their pregnancies under the liberal Swedish law. Working with dead embryos allowed Nilsson to experiment with lighting, background and positions, such as placing the thumb into the fetus’ mouth. (“The Lonesome Space Traveller”)

These famous photographs have been manipulated in anti-abortion discourses as symbolic props that continue to shape reproductive rights campaigns some fifty years after they were first published.

The fetal image, like Nilsson’s, presents what Roland Barthes referred to as a coded iconic message that requires little interpretation because “there is always the stupefying evidence of this is how it was, giving us, by a precious miracle, a reality from which we are sheltered” (44). In this case, the prenatal ultrasound offers a woman the opportunity to transform what is presented on the monitor into a baby floating within intrauterine shelter of the womb beyond culture and context. This iconic image of the fetus offers an “abstract individualism, effacing the pregnant woman and the fetus’s dependence on her” (Petchesky 270). This iconic fetal image possesses a “symbolic transparency” that encourages us to “read in it ourselves, our lost babies, our mythic secure past” (270).

Conclusions

As this article has shown, the iconicity of the fetal image is all the more relevant considering reproductive legislation has emotional, fiscal, and legislative repercussions on women’s reproductive health and freedom. The significance of the cultural iconic fetal image is illustrated even as legislators currently debate, amongst other concerns, whether to require invasive trans-vaginal ultrasounds (internal ultrasounds that are often required in cases where the gestation age is less than six weeks gestation) and how 3D technology will change ultrasound provisions. Additionally, some advocates of abortion provisions have demanded legislative inclusions that require only doctors and sonographers who do not have a financial interest in the abortion decision to administer prenatal ultrasounds (provisions that would require a patient to seek out a doctor to perform the ultrasound procedure who had no financial interest the patient’s decision to proceed with an abortion). These advocates of provisions have also demanded requirements that doctors must determine and explain to patients that they are terminating “viable pregnancies” (Glessner). These iconic images have continued to shape political agendas that have far-reaching implications on women’s health, and considering that fetal images are afforded an iconic status that plays a significant role in women’s reproductive rights, they require a contextuality that is often, but cannot be, ignored.

Works Cited

• “Abortion.” Guttmacher Institute. Guttmacher Institute, 1 May 2012. Web. 15 May 2012.
• Ackerman, Todd. “Judge Stays Sonogram Law.” Chron.com. Houston Chronicle, 30 Aug. 2011. Web. 15 May 2012.
• Barthes, Roland. Image-Music-Text. Trans. Stephen Heath. New York: Hill and Wang, 1977. Print.
• Blakesley, David. “Defining Film Rhetoric: The Case of Hitchcock’s Vertigo.” Defining Visual Rhetorics. Eds. Charles A. Hill and Marguerite Helmers. Mahwah, NJ: Erlbaum, 2004. 111-34. Print.
• Boucher, Joanne. “Ultrasound: A Window to the Womb?: Obstetric Ultrasound and the Abortion Rights Debate.” Journal of Medical Humanities 25.1 (2004): 7-19. EBSCO Academic Search Premiere. Web. 14 Oct. 2005.
• Burnett, Ron. How Images Think. Cambridge, MA: MIT P, 2005. Print.
• Chandler, Daniel. The Basics: Semiotics. New York: Routledge, 2002. Print.
• “Drama of Life Before Birth: Landmark Work Five Decades Later.” Life. Life, 2012. Web. 6 June 2012.
• Ertelt, Steven. “Victory: Appeals Court Upholds Texas’ Ultrasound-Abortion Law.” LifeNews. LifeNews, 10 Jan. 2012. Web. 15 May 2012.
• “Fetal Development.” Medline Plus. U. S. National Library of Medicine and National Institutes of Health, 19 Apr. 2012. Web. 15 May 2012.
• Glessner, Thomas. “Effective Lifesaving Ultrasound Legislation.” At the Center 13.1 (Winter 2012): N. pag. Web. 15 May 2012.
• Gold, Rachel Benson. “All That’s Old Is New Again: The Long Campaign To Persuade Women to Forgo Abortion.” Guttmacher Policy Review 12.2 (Spring 2009): N. pag. Web. 2 Jan. 2012.
• Hodge, Robert, and Gunther Kress. Social Semiotics. Ithaca: Cornell UP, 1988. Print.
• “House Bill 15.” Texas Legislature Online. State of Texas, 19 May 2011. Web. 2 Jan. 2012.
• Kress, Gunther, and Theo van Leeuwen. Reading Images: The Grammar of Visual Design. New York: Routledge, 2005. Print.
• “The Lonesome Space Traveller.” Making Visible Embryos. University of Cambridge, 2008. Web. 2 Jan. 2012.
• Marcotte, Amanda. “Texas Passes Ultrasound Requirement.” XXFactor. Slate, 11 May 2011. Web. 2 Jan. 2012.
• Messaris, Paul. Visual Literacy: Image, Mind, and Reality. Boulder: Westview, 1994. Print.
• Mitchell, W. J. T. Iconology: Image, Text, Ideology. Chicago: U of Chicago P, 1986. Print.
• Nilsson, Lennart. A Child is Born. Lennart Nilsson, n.d. Web. 6 June 2012.
• Peirce, Charles. Collected Papers. Eds. Charles Hartshorne and Paul Weiss. 6 vols. Cambridge, MA: Harvard UP, 1931-35. Print.
• Petchesky, Rosalind Pollack. “Fetal Images: The Power of Visual Culture in the Politics of Reproduction.” Feminist Studies 13.2 (1987): 269-92. JSTOR. Web. 14 Oct. 2005.
• Perlmutter, David D. Photojournalism and Foreign Policy: Icons of Outrage in International Crisis. Westport, CT: Praeger, 1998. Print.
• “Requirements for Ultrasound.” Guttmacher Institute. Guttmacher Institute, 1 May 2012. Web. 15 May 2012.
• “Sonogram Human Foetal Ultrasound Scan at 6 Weeks.” DHD Multimedia Gallery. Damon Hart-Davis, n.d. Web. 3 Jan. 2012.
• “Sonogram Human Foetal Ultrasound Scan at 22 Weeks.” DHD Multimedia Gallery. Damon Hart-Davis, n.d. Web. 3 Jan. 2012.
• “Statement by Gov. Rick Perry on Federal Appeals Court Overturning Injunction of Sonogram Law.” The Office of Governor Rick Perry. Rick Perry, 10 Jan. 2012. Web. 15 Jan. 2012.

This past year, the onset of North America’s flu season coincided with reporting on a novel turn in the ongoing effort to fend off contagion: the use of social media to coordinate “pox parties” and to market mail-order lollipops “infected” with chicken pox to parents planning to expose their children to the live virus.¹ The reasoning behind these practices, that helping children develop “natural immunity” would be less harmful than exposing them to the varicella (chicken pox) vaccine, positioned this emerging issue as a development in the anti-vaccination movement, a movement motivated by the discredited link between autism and the measles, mumps, and rubella (MMR) vaccine first proposed by Dr. Andrew Wakefield in the early nineties. In challenging the effectiveness and safety of childhood vaccination, vaccine opponents weaken public confidence in immunization programs such as MMR. Vaccine proponents therefore often counter that, by framing immunization as if it is, first and foremost, a matter of personal opinion, vaccine debate itself risks intensifying the anti-vaccination movement and undermining one of our most effective defenses against contagion.² Indeed, whether news reports accurately reflect growing health trends, attention paid by the media to unconventional alternatives to vaccination would seem to encourage the persistence of the vaccine debate.

In raising questions about the relationship between scientific knowledge, health beliefs, and public-health policy and practice, the vaccine debate presents an opportunity to consider what part persuasion plays in the management of public health. In this article, I argue that contemporary public health campaigns characterize rhetoric itself as corrective, a method of managing the health of the group through the isolation of harmful attitudes and beliefs. My aim is not simply to displace this view but to understand it in relation to contemporary social and epistemological shifts, such as the use of the web to circulate information about public-health emergencies. From there, I critique the ability of public health campaigns based on a sense of rhetoric as corrective to adequately counter anti-vaccination. In particular, I take up one of the most pervasive rhetorical strategies for constituting, and countering, the two sides to the vaccine issue, the commonplace that holds there to be “facts and fictions” or “myths” of science. I consider this strategy in light of a cornerstone of contemporary public health, scientia potentia est, or “knowledge is power,” a premise that often underlies and structures public health policy and practice, sometimes in implicitly disempowering ways.³

Public Misunderstanding of Science, Anti-Vaccination, and the “Age of Credulity”

At the end of this past summer, Ottawa Citizen science reporter Tom Spears bemoaned the “age of credulity” in which we live, “a constant state of disbelief where, despite having more education than any society in human history, people would rather take the word of an anonymous Internet post over that of a recognized authority, especially where there’s a conspiracy theory” (A1). The hallmark of this age, as Spears elaborates, is the public misunderstanding of science, the worst symptom of which is the anti-vaccination movement because it can be linked to recent outbreaks of measles and, more problematically, the spread of “claims that H1N1 vaccine will kill you” (A1). Spears is one voice in a bigger debate over how the scientific community can adapt the burden of proof in the face of communication technologies that remediate, reframe, and recirculate their research faster and farther than ever before, as well as in response to social movements, such as anti-vaccination, that threaten to undo the triumphs over infectious disease that marked the mid-twentieth century.

Recently, for example, a group of psychologists from Cardiff University argued in a Guardian op-ed that scientists should “be allowed to check stories on their work before publication” on the grounds that “public trust in science, and in science reporting, is harmed far more by inaccuracy than by non-independence” (Sumner, Boy, and Chambers n. p.). This was a response to Ananyo Bhattacharya, the online editor of Nature, who two weeks earlier had argued that copy checking should be prohibited because “scientists have a vested interest in the way their work is portrayed in the media” (n. p.)—not least of which is funding. During that same month, however, while being interviewed for the podcast, “This Week in Virology,” medical writer Trine Tsouderos argued in support of copy checking by describing science journalism as akin to a non-native speaker presenting Chinese to a fluent audience, and characterizing science as a “grammar” that needed to be corrected by an expert whenever it was moved from the scientific community into the media.

Tsouderos’s discussion of fact-checking prompted this response from co-host and molecular biologist Rich Condit: “Wow, I hope there’s a whole bunch of people listening, okay? . . . ’cause this is important stuff, that’s great” (Racaniello and Despommier n. p.). That this discussion took place on a “podcast about viruses—the kind that make you sick” served as a reminder that the vaccine wars have unfolded against the backdrop of ongoing apprehension over how scientific knowledge is reported to the public. While much of this discussion has centered on the possibility of allowing scientists more control over how their research is conveyed, the suggestion that scientific knowledge, when abstracted from its original context, may be harmful to the public has been made much more persuasive by the attribution of the return of preventable childhood infections such as measles to a rise in unfounded beliefs about vaccine science, rather than to other issues that have gained greater attention in the past year, such as the growing wage gap in North America and inadequate access to health care. In other words, while it’s critical that correlation does not equal causation in the context of vaccine science, the same principle is often moot in assessments of vaccine rhetoric.

Flu Facts, Flu Fictions

Preoccupation with the harmfulness of vaccine rhetoric took on new exigency more than two years ago, when the World Health Organization (WHO) declared H1N1 a Phase Six pandemic alert and North Americans were faced with immunization on a massive scale. In October 2009, science advocate and vaccine developer Paul Offit voiced emphatic concern over how vaccine skepticism would affect Americans’ ability to cope with H1N1. In a New York Times op-ed titled “Nothing to Fear but the Flu Itself,” Offit characterized anti-vaccination as both a health risk and a strain on public resources, observing that “[p]ublic officials [were then] battling not only a fast-spreading influenza virus but also unfounded fears about the vaccine that can prevent it” (n. p.). Offit then raised, and quickly dismissed, four beliefs about the H1N1 vaccine, most of which apply to anti-vaccination in a broader sense: first, that it was unsafe; second, that it was untested; third, that it contained a dangerous adjuvant; and fourth, that it had a dangerous preservative. These beliefs were “myths,” according to Offit, and he added that they were underwritten by the more insidious belief that “Americans have more to fear from the vaccine than the deadly disease it prevents.” Vaccine myths, which were circulating, unchecked, via “TV talk shows and the Web,” would make it harder for frontline health workers to distribute vaccine to those who need it most (n. p.).

The point of the op-ed was not to encourage vaccination by motivating sympathy for health professionals, however. Apart from the pathos characteristic of the op-ed genre, Offit’s appeal was made on the grounds that beliefs themselves can be harmful to your health. As Offit puts it at the close of his piece,

New myths will inevitably arise as some of the millions of people who are inoculated against H1N1 flu suffer unrelated illnesses . . . . One can only hope that the American public will understand that subsequence isn’t necessarily consequence, and not be scared away from a vaccine that can save lives. (n. p.)

Offit thus tackled the health risk of anti-vaccination beliefs by reinforcing the boundary between the facts and fictions of vaccine science—the boundary between “good” knowledge and “bad” belief—in a move that is exemplary of the most pervasive rhetorical strategy adopted by public health agencies to encourage individuals to get the H1N1 vaccine. This strategy, which has a kinship with the commonplace of knowledge as power, continues on in the present-day promotion of the annual flu vaccine.

On the U.S. website Flu.gov, for example, information about the flu vaccine is provided under the heading, “Misconceptions about Seasonal Influenza and Influenza Vaccines” (see Figure 1). Whoever encoded this material for the web named the file “Myths.html” in a move suggestive of the pervasiveness of this conception of vaccine rhetoric. The discussion of everything from the timing to the potential side effects of flu shots is here presented as if hesitation to vaccinate is always irrevocably the result of misunderstanding, a lack of proper knowledge that can be remedied through targeted corrective. Little else is said about what other reasons might prohibit individuals and families from being vaccinated—financial limitations, time management and childcare needs, lack of continuity of healthcare—not to mention how they might be supported by the agency in overcoming such obstacles.

Figure 1: Screenshot of “Misconceptions about the Flu Shots” page from Flu.gov; 8 September 2011; Web; 15 November 2011.

Ontario’s Ministry of Health and Long-Term Care also continues to provide information by enumerating seven “myths” of the flu virus, from “I don’t need another flu shot. I got one last year” to “I’m young and healthy. I don’t need a flu shot” (“Flu Virus,” n. p., see Figure 2). Tension between the sense of these reasons as myths, on the one hand, and excuses, on the other, perhaps marks the point at which the rhetorical management of vaccine skepticism as a matter of the public’s misunderstanding of science begins to break down.

Figure 2: Screenshot of Seven Myths of Flu from “Flu Virus” page of Health.gov.on.ca; Ontario Ministry of Health and Long-Term Care, 30 November 2010; Web; 15 November 2011.

Even when the language of fact and fiction is conspicuously absent from web-based North American flu shot campaigns, information is still conveyed online by way of “Frequently Asked Questions,” a format not unique to public health but nevertheless suggestive of asymmetry between what an individual user believes and what is actually true. Nearly every page of the Public Health Agency of Canada’s website gives information about H1N1 and influenza via question and answer. One question, however, reads, “Why does your information about H1N1 keep changing?” (“Frequently Asked Questions – H1N1 Flu Virus,” n. p.). (This was, in fact, my question when I noticed how many updates had been made to the Public Health Agency’s H1N1 page in early 2011, well after the pandemic had been declared over.) It is the only question on a national public health web page that even remotely addresses a potential cause for confusion over vaccination besides misunderstanding.

If it is the case that North Americans make decisions about vaccination not only by consulting public health campaigns but also by engaging in the vaccine debate, then it is possible that the uptake of the H1N1 vaccine was stymied by the reliance, on both sides of the controversy, of the same grounds for urging North Americans to decide either in favor of or against getting the shot.⁴ In vaccine public discourse, getting it and not getting it were both strenuously represented as posing potentially serious health risks. On one hand, the vaccine, especially the vaccine with an adjuvant, was represented as a health risk that could, at the very least, cause swine flu, and, at the worst, induce paralysis or death. On the other hand, an anti-vaccine stance was frequently portrayed as a potentially bigger risk because it could jeopardize the health of the individual and the group. And these individuals would not only be spreading swine flu; they would also be spreading a “panic virus” that could induce a kind of intellectual paralysis among those who might otherwise opt for inoculation.

Better Living through Rhetoric

Because it allows us to hypothesize a link between specific lines of public-health argument and the empirical outcomes of epidemic, rhetorical analysis may be, like fact-checking, a relevant method of correcting misunderstanding, one that could lead to the development of better public health campaigns: that is, rhetoricians can offer right arguments for seeking the vaccine, and can point out exactly where public health is failing the public. Yet, rhetoricians of health and medicine can also challenge and critique the effectiveness of the instrumental view of persuasion entailed by the commonplaces that regulate public health, such as that knowledge is power and that fact is knowledge, while belief is fiction. These simple constructions compete with an equally problematic view of persuasion suggested by a metaphor that dominates the broader public debate over vaccination: the metaphor of vaccine rhetoric as itself an epidemic. The metaphor of anti-vaccination belief as an epidemic is a particularly virulent one, inversely related to the view of knowledge as an inoculation. The ubiquity of this novel subtype of the broader metaphor of beliefs and ideas as epidemics is itself ironic considering the predicament we find ourselves in, as vaccination rates drop and previously eliminated contagions make their return. That is, why frame public-health knowledge—which is, in a word, public-health power—as an inoculation at a moment when vaccination rates have apparently hit a record low? The epidemic metaphor frames belief as itself potentially deadly, to be combated through simple rhetorical intervention. Yet belief is not something we could do without if we want individuals to accept vaccine science, nor is it mutually exclusive from knowledge.

Vaccines have afforded us some control over communicable disease, making it that much easier to cope with contagion and, by extension, with life in the group. Out of that control extended a reasonably clear chain of command over a critical area of public health. In that context, knowledge was power because it meant knowing medicine could treat devastations that formerly fell under the purview of morality. Now, however, as suggested by discussions, in expert, professional, and public arenas, on how to manage vaccine rhetoric for the sake of our health, the stakes of scientific knowledge have changed. Rhetorical analysis might support the development of better public health campaigns. However, as rhetoricians, we might, in lending to this effort, apply ourselves toward further examination of the motivations of these same campaigns, such as the notion that they can be used to effectively inoculate the public against scientific misconceptions. Knowledge isn’t the same thing it was in the early years of microbiology, nor is health. Stepping back to think about vaccine skepticism differently might both improve vaccination rates and fend off a return of deadly illness. Communicable disease is a human problem—and it is a global problem. In that context, treatment, not knowledge, is power.

Endnotes

1. See, e.g., “Parents Warned About Mail Order Chicken Pox Lollipops,” (Tanglao).return
2. Many proponents see vaccine debate as a manufactured scientific controversy. “A scientific controversy is ‘manufactured’ in the public sphere,” writes rhetorician Leah Ceccarelli, “when an arguer announces that there is ongoing scientific debate in the technical sphere about a matter for which there is actually an overwhelming scientific consensus” (196). The purpose of the manufactured scientific controversy is to promote or delay public policy, but another effect of the will to debate motivated by this rhetorical strategy is the sense that “agreement to debate is taken by audiences to indicate that there are two equally strong sides on the matter within the scientific community” (198). In his account of MMR vaccine controversy, The Panic Virus, journalist Seth Mnookin discusses the use of what Ceccarelli calls “the fairness appeal” (198) to gain air time for the views of the anti-vaccination movement. Under this appeal, debate is permitted as a result of “needing to be fair to those on ‘both sides’ of an issue about which there was nothing up for debate—at least not in the real world” (Mnookin 9).return
3. For a more detailed discussion of the knowledge enthymeme in public health, see Blake Scott’s Risky Rhetoric.return
4. Health Canada, for example, reported in 2010 that four in 10 Canadians opted to get the H1N1 vaccine (see “H1N1 Shots Skipped by 60% of Canadians”).return

Works Cited

• Bhattacharya, Ananyo. “Scientists Should Not Be Allowed to Copy-Check Stories about their Work.” The Guardian, 29 Sept. 2011. Web. 27 Oct. 2011.
• Ceccarelli, Leah. “Manufactured Scientific Controversy: Science, Rhetoric, and Public Debate.” Rhetoric & Public Affairs 14.2 (2011): 195-228. Print.
• “Flu Virus.” Health.gov.on.ca. Ontario Ministry of Health and Long-Term Care, 30 Nov. 2010. Web. 1 Nov. 2011.
• “Frequently Asked Questions – H1N1 Flu Virus.” FightFlu.ca. The Public Health Agency of Canada, 28 Sept. 2010. Web. 27 Oct. 2011.
• “H1N1 Shots Skipped by 60% of Canadians.” CBCNews Health, 30 Sept. 2010. Web. 15 Nov. 2011.
• “Misconceptions About Seasonal Influenza and Influenza Vaccines.” Flu.gov. Flu.gov, 8 Sept. 2011. Web. 27 Oct. 2011.
• Mnookin, Seth. The Panic Virus: A True Story of Medicine, Science, and Fear. New York: Simon & Schuster, 2011. Print.
• Offit, Paul A. “Nothing to Fear but the Flu Itself.” The New York Times, 11 Oct. 2009. Web. 27 Oct. 2011.
• Racaniello, Vincent, and Dick Despommier. “Live at ICAAC in the Windy City.” This Week in Virology, 18 Sept. 2011. Web. 27 Oct. 2011.
• Scott, J. Blake. Risky Rhetoric: AIDS and the Cultural Practices of HIV Testing. Carbondale, IL: Southern Illinois University Press, 2006. Print.
• Spears, Tom. “The Age of Credulity.” The Ottawa Citizen 7 July 2011: A1. Print.
• Sumner, Petroc, Frederic Boy, and Chris Chambers. “Scientists Should Be Allowed to Check Stories on their Work Before Publication.” The Guardian, 11 Oct. 2011. Web. 27 Oct. 2011.
• Tanglao, Leezel. “Parents Warned About Mail Order Chicken Pox Lollipops.” ABC News, 6 Nov. 2011. Web. 6 Nov. 2011.

The last stage of the laboring society…demands of its members a sheer automatic functioning, as though individual life had actually been submerged in the overall life process of the species and the only active decision still required of the individual were to let go, so to speak, to abandon his still individually sensed pain and trouble of living, and acquiesce in a dazed, ‘tranquilized,’ functional type of behavior. (Arendt 322)

In her three-part theory of the human condition, Arendt describes as “labor” those tasks that must be repeated endlessly to ensure survival. Such efforts support the remaining two components of the human condition, action and work, which for Arendt represent our tide-changing “words and deeds” and the many artifacts made by human hands, respectively. Our work often commemorates or makes possible our action, and neither could exist without our basic source of sustenance, our labor. Still, Arendt’s greatest fear in The Human Condition (1958), as she watched society move into an increasingly machine-driven age, is that laboring might overtake action and work, defining much, if not all, that we do.¹ This, for Arendt, is the triumph of the assembly line over human craft, namelessness over the individual. In this essay, I want to use Arendt’s concept of labor as a building block for understanding the particular positioning of the pregnant writing teacher as she functions in two decidedly conflicted, and often misread spaces: the first-year writing classroom and the maternal body. Drawing on Emily Martin’s work in medical anthropology, as well as well-established critiques of first-year writing’s positioning in the university, I will argue that in the pregnant composition teacher we see a dangerously stacked set of circumstances at work upon each other. Enclosed in a body that far exceeds her control, she is a kind of microcosm for the larger system in which she must teach.

Framing Labor: Martin and Arendt for the First-Year Writing Classroom

Published thirty years after Arendt’s work, Emily Martin’s The Woman in the Body: A Cultural Analysis of Reproduction describes medical textbooks’ linguistic treatment of pregnancy, labor, and birth in ways that point at the potential validity of Arendt’s fears realized in the context of maternity. Martin argues that the language of medical textbooks assigns a machine-like functionality to women’s reproductive bodily processes, though she doubts this to be a fair physiological representation. For example, in the medical writing Martin cites, uterine contractions during labor are typically regarded as automatic and beyond the woman’s control; we are essentially given the “uterus-as-machine” (65). At the same time, medical staff assisting the birth typically tell the laboring woman how she is doing, to push harder, or give the unthinkable direction to resist pushing entirely, thus creating a contradictory tension between the uterus-as-machine and the woman-as-laborer or agent in the birth process. According to Martin, the doctor is regarded in the literature as “manager” of the laboring event, providing interventions as needed to keep the uterus/woman machine/laborer on track and as efficient as possible. She writes:

When medical doctors describe the labor that women do in childbirth, their expectations center on how labor of other kinds is organized in our society and how technology and machinery can be used to control those who labor. In both cases women lose, in the first by being overlooked and in the second by having a complex process that interrelates physical, emotional, and mental experience treated as if it could be broken down and managed like other forms of production (65).

Thus, from Arendt and from Martin, we have a concern about the assembly line, whether the machine or the speechless laborer who must be “managed” so as not to impede the process or break the pace. In either case, Arendt’s “individually sense pain and trouble of living” is superseded by the functionality of the process, by “doing” alone.

What I find so compelling about the frameworks that Arendt and Martin provide is that both illustrate a series of core conflicts that are framed through binaries: body versus brain; generic versus particular; doing versus saying. Like most dichotomies, these pairings suggest oversimplification, clean lines where really there are plenty of blurred edges, hierarchy where none exists. But these pairings invite us to think about maternity as it functions in the first-year writing classroom, a space marked undeniably by similar dichotomous divisions given composition’s complex positioning in the university.² If, as Martin suggests, the “woman in the body” is continuously eclipsed by her physical capacities, so too is the composition instructor potentially overrun by the “machine” that is first-year writing in many universities today.

In his essay, “Knowledge Work, Teaching Work, and Doing Composition,” Christopher Ferry lays bare these tensions as defined by traditional notions of academic knowledge-making:

We read student texts, not ‘great’ texts. We do not write groundbreaking analyses or exegeses but rather responses to these modest efforts. This is what disturbs us most, that compositionists might not be, as Kurt Spellmeyer says, ‘knowledge-workers’ (‘After Theory’ 901), trading in big ideas but instead teamsters, performing the heavy lifting necessary to keep the university afloat. (249)

The role of “keep[ing] the university afloat” echoes Arendt’s definition of labor very clearly and, given the many pressures that compromise first-year writing—from its long-contested “service status,” to the ghettoizing of scholarship that takes root there, to its reliance on exploited laborers—I would argue that Arendt’s worry about the domination of laboring seems very real.³ When labor defines all we do, for Arendt, we lose our capacity to be change agents, innovators, or “knowledge-workers.” In first-year writing, this means staffing classrooms with instructors who lack adequate support and training; it means pushing students through the course despite under-preparedness for college writing; it means dismissing research and scholarship in exchange for too-heavy teaching loads. And all because the machine demands it: there are too many students; too few faculty; not enough sections; a writing program administrator denied tenure because she never had time to write, or because what she did write had as its focus “second-class” content, first-year students and the struggle to teach them.

Given the already-contested nature of the first-year writing classroom, the presence of a pregnant teacher, which is certainly no surprise because women still make up the majority of instructors, brings problematically together two highly conflicted spaces or, two highly conflicted material conditions. Here the “woman in the body,” to borrow Martin’s language, attempts to move within the classroom space and ultimately to articulate and enact a pedagogy against the maternal body that defines her (at least externally), against the intrinsic goals of the first-year course, and against the more mechanistic limitations imposed upon first-year writing by the larger university. When we examine the experience of the pregnant first-year writing instructor, we find a battleground between doing and the ideas that come to life only through words.

In her 2009 essay, “Changing Tables and Changing Culture: Pregnancy, Parenting, and First-Year Writing,” Denise Comer paints a convincing picture of this tension. Referencing Eileen Schell’s work on contingent faculty, mothering, and the teaching of composition, the pressure to be “competent and nurturing” (cited in Comer), she writes:

At times, this physical intimacy can generate the most insidious features of Susan Bordo’s “politics of appearance” (27), where some first-year writing students feel entitled to ask a barrage of seemingly innocuous personal questions that, consciously or not, enable them to situate their pregnant professor within or against a set of perceived cultural norms: Is she married? Is she heterosexual? Did she conceive through intercourse? During the semesters in which I have taught as a visibly pregnant woman, my students have known more about my personal life than in any other semester of my thirteen-year teaching career. They knew more about my personal life than I would have, given the choice, shared. (95)

Here Comer describes a loss of control, where the pregnant instructor finds herself “read” and explored in ways that far exceed her professional boundaries, or even her personal desires. Describing her awareness of “pedagogical shifts,” Comer asks, “Does all of this distraction—the increased physical and emotional intimacy with students, a focus on pregnancy (or children), the visibility of the body—get in the way of the so-called real business of the first-year writing classroom?” (99). I think Comer’s last phrase points tellingly towards the tension she understands well: the first-year writing classroom is often undermined on its own terms, its “business” is already in question. The pregnant instructor thus becomes, compromised by all Comer highlights, the ringleader whose power was always already unstable by virtue of her positioning in two independent spaces: the pregnant body and the first-year composition classroom. The dynamics of these two spaces coming together brings us again to Martin’s depiction of the “managed” birth process, where the goal becomes to keep the pregnant woman out of the way—through interventions and verbal directions—of a process that is defined as out of her control anyway. Applying this model, we can imagine at once the pregnant writing instructor as the “manager” of the first-year class, which itself is driven by the larger material forces that so define it, while she herself undergoes these very same dynamics in the context of her own positioning in the body.⁴

Stories and Questions: Going Forward in Our Bodies and Classrooms

Of course, we might argue that pregnant bodies face these kinds of challenges wherever they go, and that such systems are far from unique to the first-year writing classroom. While I agree with the argument that pregnant bodies are contested spaces in their own right, I also want to maintain that the first-year classroom is a petri dish filled with its own fertile challenges, staffed by—to revisit Ferry’s words—“teamsters” who are saddled with the work of “keeping the university afloat” while simultaneously denied the status of “knowledge-makers” (249). I approach this contention as someone who has had the good fortune, as a tenured faculty member, to teach concurrently in first-year writing classrooms and advanced-level classrooms while pregnant, including graduate courses.⁵ I began my faculty position with a five month-old baby, a feat for which the fair hiring practices of my colleagues must be acknowledged (I was about eight months pregnant for my campus visit). As a new mother in my first year on the tenure track, I went to great lengths to portray myself as a professional unfettered by a new infant at home (or, for that matter, a life turned upside-down). Somehow I still batted away surprising questions in the workplace (was I nursing, a senior male colleague wanted to know as I nervously retrieved my mail). About four years later, I taught up until two weeks before the birth of my second child. In the final weeks of my pregnancy, burdened by a diastasis recti (separated abdominal muscles), I frequently had to sit, lost my breath, lumbered painfully and slowly, and had to wear a belt to support the weight of my uterus, which had protruded from between my separated muscles like a hernia. In short, I was a sight to behold and could do little to divert attention from my situation.

At this time, I taught a first-year writing course and advanced undergraduate level courses. The public attention I received in my first-year course was entirely unique to that class, unlike anything I experienced while teaching my other courses. As I took attendance and set up my materials, I had to literally compete with my pregnancy to get the class focused each day, faced with comments about my changing size and shape and even, on one shocking occasion, a question about sexual position and its impact on the sex of the baby. This discussion came exclusively from the women in the class—and women were the majority—but I often felt it alienated the smaller group of male students, whom I perceived to be generally quiet and uncomfortable with the dialogue. I routinely had to aggressively shift students’ focus and often blamed myself for somehow enabling the inappropriate intimacy that happened in that class. During a conference, one of my female students shared with me her decision, at 19, to have a baby with her boyfriend: that she had gotten pregnant just before the start of the semester, and then had miscarried, and that she planned to try again, and, finally, in the last week of our class, that she was, in fact, again pregnant. My status as “pregnant” seemed to assure her that we were equals, women in a shared situation, in ways that undermined my other status: professor who would ultimately would grade her work.

My anecdotal evidence is meant only to open up a series of questions and to point at the tensions around language and material that I see as so embedded in any discussion of pregnant or maternal bodies, and the work we try to do while occupying them. But I want to also insist that first-year writing deserves our particular attention and energy precisely because of its complex positioning in the university and its over-reliance on women to staff its classrooms.⁶ Accordingly, I end with these questions: To what extent is the teaching of first-year writing defined—or redefined—by the presence of the pregnant teacher? If we agree that the FYW classroom is a particularly contested and potentially problematic space for the pregnant/teaching body, what role might WPAs play in negotiating/supporting mother/teachers? In addition to the classroom space itself, in what ways does the pregnant body complicate the work of writing program administrators in the specific context of the parallel tensions at the heart of both the pregnant body and first-year writing in the university? Lastly, how do we use language to assign value to what we do, to who we are, and thus initiate attitudinal, scholarly, and policy changes? In other words, where do action and words come together in ways that override the worrisome possibility that, really, words alone just might not be enough? I offer this last question with the caution that the theoretical frame I offer in this piece is meant only for the sake of illumination and access. The professional and political challenges posed to the maternal body often demand a step beyond comprehension and into action. Accordingly, my call at the close of this essay is not only for further academic exploration of a complex topic, but also for practical, institutional initiatives to celebrate and support the woman (composition instructor) in the body.

Endnotes

1. For further discussion of the relevancy of the “machine age” to the 1950s and, especially, to the “baby boom” which cultural historians have explored in this context, see Wendy Kline’s Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (2005). return
2. Far more work than I can list here explores the dynamics of composition’s status in the larger university system; among many important titles, see Sharon Crowley’s Composition in the University: Historical and Polemical Essays (1998) and Bousquet, Scott, and Parascondola’s edited collection, Tenured Bosses and Disposable Teachers: Writing Instruction in the Managed University (2004). return
3. I explore these connections in much greater detail in the context of graduate student writing instructors in First Semester: Graduate Students, Teaching Writing, and the Challenge of Middle Ground, published in the Studies in Writing and Rhetoric series by Southern Illinois University Press and the Conference on College Composition and Communication (2012). return
4. Here I am reminded of Anne Fausto-Sterling’s well-known Russian nesting doll metaphor meant to describe systems around the “sexed” body, which she establishes in her 2000 book Sexing the Body: Gender Politics and the Construction of Sexuality (253-4). return
5. I want to stress here the important distinction Comer—and others—have made between full-time and contingent faculty members; that first-year writing classrooms are more often staffed with contingent and graduate student instructors who are often under-supported, and who lack security of employment, is an important factor in the tensions we find there. return
6. See especially the Committee on the Status of Women in the Profession via the Conference on College Composition and Communication. return

Works Cited

• Arendt, Hannah. The Human Condition. Chicago: University of Chicago Press, 1958. Print.
• Comer, D.K. “Changing Tables and Changing Culture: Pregnancy, Parenting, and First-Year Writing.” Composition Studies 37.2 (Fall 2009): 91-113.
• Fausto-Sterling, Anne. Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books, 2000.
• Ferry, Christopher. “Knowledge Work, Teaching Work, and Doing Composition.” Tenured Bosses and Disposable Teachers: Composition in the Managed University. Eds. Marc Bousquet, Tony Scott, and Leo Parascondola. Carbondale: Southern Illinois University Press, 2004. 242-249. Print.
• Kline, Wendy. Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom. Berkeley: University of California Press, 2005.
• Martin, Emily. The Woman in the Body: A Cultural Analysis of Reproduction. 1987. Boston: Beacon Press, 2001. Print.

“…the absence of evidence is not evidence of absence.” (Hal Barron, MD [VP of Global Product Development and Chief Medical Office at Genentech Roche Pharmaceuticals], FDA Avastin Hearing, 29 June 2011)

“What endpoint then is sufficient for your approval? Months, years? Despite potential side effects from Avastin, metastatic breast cancer has only one, death. Certainly, Avastin can do no worse.” (Priscilla Howard [Breast Cancer Survivor], FDA Avastin Hearing, 28 June 2011)

The voices cited above are representative viewpoints of the medical professionals and breast cancer survivors who testified at a heated public hearing in which the FDA decided the fate of Avastin (bevacizumab) for the treatment of metastatic breast cancer. Avastin was first approved for the treatment of metastatic breast cancer under the Food and Drug Administration’s (FDA’s) accelerated approval program in February 2008, which made the drug publicly available for use in an expedited fashion. One condition of accelerated approval is that the pharmaceuticals must continue rigorous clinical trials that are later subject to the standard approval process. After Genentech Roche—the makers of Avastin—submitted the drug for final approval, the Oncologic Drugs Advisory Committee (ODAC) denied regular approval. This July 2010 denial was followed by a public outcry from breast cancer survivors and clinicians who viewed Avastin as a last line of defense. Responding to this fervor, the FDA granted a rare public hearing (convened on June 28 and June 29, 2011) to decide whether Avastin should continue to be approved as a treatment option for metastatic breast cancer patients.

Following this hearing and after a review of “thousands of pages submitted to a public docket [and] data from several clinical trials,” FDA Commissioner Margaret A. Hamburg, MD, announced that she was upholding the ODAC’s earlier finding and “revoking the agency’s approval of the breast cancer indication for Avastin” (FDA News Release). Specifically, Commissioner Hamburg stated “there was not, at the time of approval, credible evidence of increased overall survival or increased quality of life, and there is no such evidence now. Instead, CDER [the Center for Drug Evaluation and Research] based its accelerated approval on a different measure, referred to as ‘progression free survival’” (Hamburg). Avastin retains approval predominantly for the treatment of colorectal and other cancers; however, without the specific breast cancer indication, many insurance companies will no longer pay for patients to receive Avastin—a drug that can cost up to $5,000 per treatment (Medical News Today).

Questions regarding the appropriateness of the Avastin revocation or the validity of the arguments that led to that revocation are beyond the scope of this article. Rather, our goal is to analyze how the FDA’s deliberative procedures afforded the capture of key stakeholder discourse and whether that discourse is meaningfully incorporated into final policy decisions. In what follows, therefore, we describe the ways that disagreement about how meaningful clinical endpoints were defined—what we see as key stasis points in this deliberation—yielded a lack of agreement between stakeholders about whether Avastin should retain approval for the treatment of metastatic breast cancer. Our findings suggest that the FDA’s deliberative procedures might more adequately capture stakeholder testimony if they were to incorporate a prehearing event wherein all parties agreed to definitions for key stasis points.

Hybrid Methodological Approach

A hybrid of qualitative content analysis and rhetorical stasis theory was deployed as a way to analyze over 500 pages of transcripts from two days of Avastin Hearing testimony and Commissioner Hamburg’s seventy-page written decision that followed the hearing.¹ Initial analyses of the data set yielded several key themes or patterns. We coded for the kinds of stakeholders involved in the hearing (e.g., advocates, survivors, healthcare practitioners, etc.), the regimes of practices from which each participant hailed (e.g., evidence-based medicine, clinical practice, survivorship, etc.), whether the participant was for or against Avastin’s approval, and moments in the debate where disagreement about a key issue in the debate was made explicit.

Each researcher identified that the final code—moments where disagreement was made explicit—consistently involved an invoking of how a meaningful “clinical endpoint” should be defined. The two primary definitions for a meaningful clinical endpoint were (1) progression-free survival (PFS) and (2) overall survival (OS). PFS is a statistical measurement of the average amount of time tumor growth is delayed while OS measures the average increase in lifespan for patients taking a given drug and is widely considered the gold standard in cancer pharmaceuticals research.² The clinical trials designed to assess the efficacy of Avastin for breast cancer patients either did not measure or were not able to demonstrate an increase in OS. Qualitative data analysis software (i.e., nVivo 9) allowed us to numerically identify how many times PFS and OS were invoked in the data set. PFS was invoked more than 1,300 times, and OS was invoked 819 times. As a point of comparison, the word “cancer” was invoked 581 times, and “Avastin” itself was invoked 830 times. This preliminary finding—disagreement about the meaningfulness of either PFS or OS as an endpoint—led us to conduct a closer examination of the data set using Directed Content Analysis.³

Directed Content Analysis (DCA) is a qualitative coding procedure wherein content categories are determined by preexisting theory and research. In this case, we used stasis theory as an analytic lens in subsequent analyses because each researcher consistently identified disagreement about PFS versus OS as a moment of stoppage in the debate; stasis theory suggests that, in the course of any public debate, points of contention will arise that need to be adjudicated before the overall issue for which said debate was called can be decided. Traditional neoclassical stases include questions of fact (e.g., did something happen?), definition (e.g., how do we define it?), quality (e.g., is what happened good, bad, etc.?), and jurisdiction (e.g., is this the right time, place, etc. for this debate?). More recent scholarship in rhetorical theory has updated points of stasis to account for the nature of debate in science, healthcare, and health policy.⁴ This body of research has provided rhetorical studies with an elaborate taxonomy of medico-scientific stases—the full interrogation of which lies beyond the scope of this article.

The portion of our DCA coding schema discussed herein focuses on what are known as evidentiary and methodological stases,⁵ which respectively address the following questions: (1) What is the appropriate form of evidence in determining which drugs are effective? (2) What are the appropriate methodologies for conducting drug efficacy trials?

Hearing transcripts and the Decision of the Commissioner were coded for instances of evidentiary and methodological stasis.

Stasis in Action: The Avastin Hearings⁶

As the opening epigraphs suggest, the key issues on which Avastin’s approval hinged were (1) the paucity of acceptable evidence and (2) the methodological definition of “clinical benefit.” In fact, the following four questions outlined by the FDA in the first moments of the hearing point back to these two issues:

1. Do the . . . trials fail to verify the clinical benefit of Avastin for the breast cancer indication for which it was approved?

2. Does the available evidence on Avastin demonstrate that the drug has not been shown to be effective for the breast cancer indication for which it was approved?

3. Does the available evidence on Avastin demonstrate that the drug has not been shown to be safe for the breast cancer indication for which it was approved and that Avastin has not been shown to present a clinical benefit that justifies the risks associated with use of the product for this indication?

4. If the Commissioner agrees with the grounds for withdrawal set out in Issue 1, Issue 2, or Issue 3, should the FDA nevertheless continue the approval of the breast cancer indication while the sponsor designs and conducts additional studies intended to verify the drug’s clinical benefit? (Day 1, pp. 10-11, emphasis ours)

What counts as “clinical benefit” and “available, meaningful evidence” lies at the heart of the Avastin deliberations. Both evidentiary and methodological stases are best embodied by the debate about whether PFS was an acceptable and meaningful form of evidence. For instance, one participant in the hearing argued that “we strongly believe that the FDA should lead a broader public discussion at this time, not about whether a specific drug has met specific endpoints, but about whether those endpoints are even the right ones in the first place” (Dr. Ivy Ahmed, Advocate, Day 1, p. 84, emphasis ours). Additionally, early in the hearing, a clinician argued that he thought everyone should “agree that clinical trials are intended to be pure scientific experiments which must have valid endpoints. Progression-free survival or PFS is often the most objective and, hence, most valid endpoint in a clinical trial” (Robert Berger, Clinician, Day 1, p. 46). Yet another participant argued that

[u]nfortunately, the existing evidence from randomized controlled trials conducted by the drug’s manufacturer has demonstrated that Avastin has not lived up to the initial hype. Trials completed demonstrated some improvement in progression-free survival. We remain convinced that it is not enough to justify FDA approval for treating metastatic breast cancer. (Vernal Branch, Advocacy Organization Rep., Day 1, p. 97)

Our findings suggest that disagreement about whether Avastin should retain its approval for the treatment of breast cancerwere predicated on disagreement about the availability and appropriateness of efficacy evidence. The deliberators who maintained that Avastin’s approval for metastatic breast cancer should be revoked used the absence of OS data as a recurrent point of justification. For instance, one participant argued that “[p]rogression-free survival is an endpoint that benefits women with metastatic breast cancer only if it predicts overall survival or demonstrates improved quality of life. Avastin has done neither” (Helen Schiff, Advocacy Organization Rep., Day 1, p. 81).

In contrast, Avastin proponents argued for continued approval by using the  clinical trials that treated PFS as the primary, meaningful measure. For instance,

[t]here is substantial anecdotal [evidence] from metastatic breast cancer patients and providers that indicates this combination results in increased progression-free survival as well as prolonged patient life. A study that includes data from patients and their doctors with Avastin and paclitaxel experience is appropriate. (Karen Zinka, Advocate, Day 1, p.112)

Embedded in each of these arguments are evidentiary or methodological stases that halt agreement about whether Avastin should retain approval for the treatment of metastatic breast cancer. That is, questions about whether PFS data counts as evidence or whether a lack of OS evidence should mandate revocation must be answered before the final decision can be made.

Available Evidence and Clinical Benefit: Beyond PFS and OS

But where do these stasis questions leave the public? If, as our analysis suggests, the Avastin decision was predicated primarily on evidentiary and methodological stases, then what place does that leave for the testimony of breast cancer survivors? Given the ways the deliberation hinged on PFS versus OS, it is clear that what counted as “available evidence” and “clinical benefit” for credentialed, researching stakeholders was based only in scientific literature; alternative definitions of available evidence presented by non- researching stakeholders (e.g., clinical oncologists, breast cancer survivors, etc.) were often implicitly excluded and sometimes explicitly marginalized. Preoccupation with whether OS was a more meaningful measure of clinical benefit than PFS actually served to distract from, if not discount, other kinds of evidence presented by non-researching clinicians, patients, and their families.

One hearing participant, for instance, anticipated the ways her evidence might not be deemed meaningful by the FDA: “I wish I could provide more than my individual case, as I know there are many variables. However, I hope the committee will consider individual experiences presented today as we represent the story behind the numbers” (Nancy Hauty, Breast Cancer Survivor, Day 1, pp. 30-31,). Another participant argued that “[a] woman’s individual experience with a treatment may be different than the aggregate results from a clinical trial” (Dr. Beth Baugham DuPree, Advocate and Healthcare Practitioner, Day 1, p. 67). A physician who treated his patient with Avastin pointed to a woman in the audience and implored the FDA to “[l]ook at Elizabeth. Does she look sick?” (Dr. Stanley Waintraub, Healthcare Practitioner, Day 1, p. 51). Two other examples demonstrate how other participants invoked very different kinds of evidence against Avastin’s approval:

1. The FDA’s decision on Avastin must be based on scientific evidence from well-done trials and cannot be based on any one individual story, no matter how compelling. This decision cannot be driven by anecdotes. It must be driven by science. (Christine Brunswick, Advocacy Rep., Breast Cancer Survivor, Day 1, p. 91)

2. While we acknowledge the pain and suffering caused by cancer, our job in making decisions about drug approval is to focus on the available scientific evidence. Our regulatory decisions are based on data from adequate and well-controlled clinical trials. (Richard Padzur, Center for Drug Evaluation and Research, Day 1, pp. 126-127)

So while the FDA reported strong interests and investments in the inclusion of key stakeholders (Lewis), the extent to which non-researching stakeholders’ testimony was elided in the Avastin deliberations is troubling. Members of the FDA did listen to 35 three-minute public presentations by so-called “non-parties”—including some of the voices cited above—, but these presentations amounted to no more than a quarter of the hearing.

Concluding Thoughts

Ultimately, our analysis suggests that the enactment of the four decision-making aims outlined at the outset of the trial followed by the FDA’s preoccupation with OS versus PFS after non-party testimony was completed invited and validated only certain kinds of testimony or debate—none of which included the testimony of non-researching experts (who, quite frequently, were as fully versed in the scientific specifications of the disease as FDA members). The FDA did not include as part of its deliberations an opportunity for all participants to agree upon (1) what would count as a clinical benefit and (2) what kinds of evidence would be deemed meaningful.

If future studies determine this to be a pervasive problem for FDA deliberations, then it might be of value to incorporate a kind of pretrial hearing wherein the very terms upon which the deliberation hinges are negotiated and successfully defined. The United States Supreme Court provides one model for achieving pretrial agreement about definitions for key terms; in cases where a plaintiff alleges patent infringement, a pretrial hearing is held wherein a judge determines the definitions for relevant keywords that will be invoked during the actual trial. This pretrial event is often referred to as a “Markman Hearing” or a “Claim Construction Hearing.” Judges in Markman Hearings yield to Federal Rules of Evidence in selecting experts to help construct claims and definitions. According to said Federal Rules of Evidence, expertise may come from “knowledge, skill, experience, training, or education” (Federal Rules of Evidence). A similar model may be of benefit to the FDA or other organizations charged with managing the science-policy interface.

Endnotes

1. See Herndl et al., pp. 440-444, for an in-depth discussion of a similar hybrid approach. return
2. See Zhuang, Ziu, and Elsayed, pp. 395-397. return
3. See Hsieu and Shannon, pp. 1281-1283, for a discussion of Direct Content Analysis. return
4. See, for example, Prelli, pp. 303-308; Fahnestock and Secor, pp. 431-435; and Graham and Herndl, pp. 160-165. return
5. See, for example, Prelli, pp. 303-308, and Graham and Herndl, pp. 157-160. return
6. For the following sections of this paper, we use a modified MLA citation style in order to reflect stakeholders’ ethos, day of debate, and page number in the official transcript, which can be found here. return

Works Cited

• Fahnestock, Jeanne, and Marie Secor. “The Stases in Scientific and Literary Argument.” Written Communication 5.9 (1998): 427-43. Print.
• Graham, S. Scott, and Carl G. Herndl. “Talking Off-label: A Non-modern Science of Pain in the Medical-Industrial Complex.” Rhetoric Society Quarterly 42.2 (2011): 145-67. Print.
• Hamburg, Margaret, and the Department of Health and Human Services Food and Drug Administration. “Proposal to Withdraw Approval for the Breast Cancer Indication for AVASTIN (Bevacizumab): Decision of the Commissioner.” 2011. Web. 19 Nov. 2011. PDF file.
• Herndl, Carl G., Jean Goodwin, Lee Honeycutt, Greg Wilson, S. Scott Graham, and David Niedergeses. “Talking Sustainability: Identification and Division in an Iowa Community.” Journal of Sustainable Agriculture 35.4 (2011): 436-61. Print.
• Hsieh, Hsiu-Fang, and Sarah E. Shannon. “Three Approaches to Qualitative Content Analysis.” Qualitative Health Research 15 (2005): 1277-88. Print.
• Lewis, Carol. “Advisory Committees: FDA’s Primary Stakeholders Have a Say.” FDA.gov, 18 June 2009. Web. 19 Nov. 2011.
• Prelli, Lawrence. ‘‘Stasis and the Problem of Incommensurate Communication: The Case of Spousal Violence Research.’’ Rhetoric and Incommensurability. Ed. Randy Allen Harris. West Lafayette, IN: Parlor, 2005. 294–333. Print.
• United States Committee of the Judiciary House of Representatives. “Federal Rules of Evidence.” 2010. Web. 19 Nov. 2011. PDF file.
• United States Food and Drug Administration. “FDA Commissioner Announces Avastin Decision.” 18 Nov. 2011. Web. 19 Nov. 2011. News Release.
• —. “Hearing on Proposal to Withdraw Approval for Breast Cancer Indication for Bevavizumb (Avastin).” 28, 29 June 2011. Web. 1 Oct. 2011.
• Zhuang, Sen H., Liang Xiu, and Yusri A. Elsayed. “Overall Survival: A Gold Standard in Search of a Surrogate: the Value of Progression-free Survival and Time to Progression as End Points of Drug Efficacy.” Cancer Journal 15.5 (2009): 395-400. Print.