In technical and professional communication (my primary field), the idea that our writing is situated, that it is connected to a specific place and context, has become so common as to not be controversial. However, as I worked on two projects, one to deliver complex environmental health data to rural Appalachians and another to deliver equally complex medical data to newly diagnosed type 2 diabetics, I realized that the information had to be presented differently, using different theories and practices, in large part because the place—and all the cultural, social, political, and economic factors associated with it—impacted the delivery of that information. When I turned to the literature in my field to try and make sense of this, I found there was a paucity of scholarship that directly engages with issues of place and space. I asked myself how it could be that we believed in both theory and practice that context and situation—that place—matter, but we hadn’t taken the time to critically examine why and how place matters to the discourse that we produce.
While other fields have taken a “spatial turn,” technical and professional writing has not yet engaged with place and space as a means to understand the interrelated nature of discourse and the places that produce and/or impact that same discourse. (Here, I am using discourse in its traditional sense as a stand in term to mean written and spoken communication.) My book length project, Geographic Histories of the Rhetoric of Health and Medicine, fills this void by illustrating that health and medical discourse is a set of practices and products that have both a history and a geography. By paying close attention to the geographic aspects of discourse production and circulation, I want to show the intimate connections between physical locations and the discourses they produce and in doing so to illustrate how each place is a distinct area of knowledge making. Moreover, by incorporating a critical geographic perspective, we can reappraise the relationship between medicine, technology, and ideologies as seen through language and place. In other words, by giving discourses both a history and a geography, I am able to trace the production, circulation, and use of health and medical discourse. This attention to place affords the field a greater understanding of the intricacies, functions, roles, and possibilities of the discourses of health and medicine.
My interest in geography dates back to my master’s degree when I had to choose a specialty content area. I chose geography because I wanted to learn about GIS (geographic information systems) technology, which was new at that time. What was most appealing about GIS was that it visually displayed information, and that visual display was both technical and rhetorical, where rhetorical means the production of texts to suit the needs of a particular audience. Since then, I’ve come to realize that geographic theory merged with rhetorical theory is useful to understanding writing and communicative practices. In several of my published articles (2007, 2009a, 2009b, 2012, 2013) and in my historical book under review (Vernacular Health and Healing), I explore the impacts of space and place on the circulation and use of information. My ongoing reading and writing about space/place and other geographic theories will form the theoretical groundwork for Tracing Medicine, as I move to use this perspective in my new research trajectory situated in health and medicine.
In For Space (2005), geographer Doreen Massey argues that we presently are in the “habit of thinking of space as a surface,” something material that needs to be crossed or conquered. In considering space, Massey asks what “happens to our implicit imagination of time and space” when we perceive space “as a meeting up of histories.” What Massey wants us to do is to give space the opportunity to tell its own narrative through a multitude of different trajectories (4-5). Her position is important to the field of technical and professional writing, particularly those of us who study health and medical discourse. What happens to our thinking and doing, if we, as Massey claims, continue to think of these new spaces as something to be crossed or conquered? What happens, if instead, we follow Massey’s lead and allow these spaces to write their own narratives? What happens when we begin to critically assess writing and language from its positionality and place? What happens to health and medical discourse when it is opened up to a myriad of new spaces? Finally, what can we learn about health and medical discourse if we trace it through the places and spaces where it circulates?
Through Massey’s theoretical work (and other geographers such as Thrift, Adams, Kitchin and Dodge) and embodiment theory (Grosz, Idhe, Titchkosky, and Merleau Ponty), I want to explore the ecological aspects of writing and the relationships between discourses in a number of healthscapes (which is just another way of saying locations where health and medicine are practiced). Humanists are good at the case study because it provides moments that can be analyzed in depth to illustrate a particular point. The case studies in Tracing Medicine do exactly that by illustrating the importance of place on discourse within the healthcare system.
Discourses can be seen as an ecological phenomenon imbued spatially and relationally. Here I refer to a broad range of spaces such as
- a small town that is predominately African American in Southeast Texas and the local discourse around how community members perceive the dangers from a local plant and its destruction of a nerve gas agent on their environment and health
- a small town in rural Ohio and their perceptions of genetics and how the environment impacts genetics
- virtual spaces of health information seeking and the material places that information is used
- technological places of electronic medical records and personal health records as a place that represents the interior part of the patient’s body
- virtual technological places that doctors and patients frequent, particularly patient social networks and twitter
- mobile spaces of wearable technology that tracks the “quantified self” for improved wellness
Each case study is an example of not only a specific communication problem/issue but also of a specific place that can enable us to see the multiple forces at work within the healthcare system through the discourses created.
This sort of analysis uncovers existing places within the system that are dominated by hegemonic discourses that do not emphasize the patient or the basic tenets of care. Integrated studies that merge human, social, natural, and technological systems reveal new and complex patterns and processes not previously seen. This increased spatial awareness can also produce new places for technical and professional writing to make specific impacts in society.
Moreover, existing work in health and medicine is either around a single idea (e.g. breast cancer, breast feeding, consent forms) using a textually based rhetorical analysis or some textually based study combined with some limited interviews/focus groups. At present the limited focus of research makes it impossible to generalize conclusions across disease domains (e.g., what works in chronic care education is not successful in in non-chronic cases) and/or impossible to re-create in other situations (e.g., group health appointments do not work in rural community based environments for a number of culturally based reasons). Geographic Histories offers a new way of solving the problem of “how can we communicate complex health information better to a wide variety of audiences” and the closely related problem/question of “how can we improve efficiency and effectiveness of communication about health and medicine?” The best ways to answer these questions involve tracing medical discourse through its multiple locations and then analyzing those discourses along the way. We can’t understand the role of communication and communication practices until we can understand how these discourses function across the healthcare system. Thus, by giving discourses both a history and a geography, we are better able to understand the circulations of discourse and how to improve and/or use those discourses.