Ellen Defossez awarded Graduate Writing Award in Literacy, Pedagogy and Rhetoric

"Between control and constraint: Charting three rhetorics of patient agency."

This essay shifts attention away from the concept of rhetorical agency, and towards what I am calling here the  “rhetoric of agency,” or how appeals to individual agency have persuasive force. Simply pointing out that one can do something (i.e. has agency) can be a way of subtly suggesting that one should do it. The discourses of health and medicine offer an entry point for considering the rhetoric of agency; in the last century, the list of things that can be done in order to preserve or promote health has grown alongside the list of things that health subjects are socially and often morally expected to do.

This article examines the rhetoric of patient agency at play within public discourses of health and medicine, and medical humanities scholarship. I argue that despite increased salience, the concept of patient agency remains vague, and is capable of being operationalized and moralized in ways that escape attention. To illustrate this, I chart the rhetorical dynamics of patient agency in both public discourses of health and medicine, and medical humanities scholarship. In so doing, I find that patient agency tends to be rhetoricized as one of three overlapping patient capacities: the capacity to know, the capacity to prevent, and the capacity to decide.

The rhetorics of patient agency identified here are all, at root, concerned with the promotion of bodily control: control through knowledge, control through prevention, and control through decision. One antonym of “control is “chance,” and it is undeniable that much of what happens to our bodies results by chance, through contingencies over which we are not always able to exercise control. Ultimately, I suggest that these rhetorics of patient agency can be deployed to cultivate health subjectivities that are imbued with untenable ideals of individual control that constrain, rather than open, rhetorical choices for making sense of the bodily contingencies that characterize our lives. For this reason, the rhetorical dynamics of patient agency should continue to be scrutinized, and new rhetorics that open a space for acknowledging contingency should be imagined.

More information about this award can be found here.