Literary, Rhetorical, & Communication Studies

All in Your Head: Making Sense of Pediatric Pain

Mara Buchbinder

This book project draws on 18 months of fieldwork in a multidisciplinary pediatric pain clinic and close analyses of clinical language to explore how clinicians, adolescent patients, and their families understand intractable pain and explain puzzling symptoms. The book is premised on the assumptions that chronic pain is one of the last great medical mysteries, and that explaining this mystery takes significant cultural and interactional work. The working title references its exploration of two related themes. First, it examines how cultural models of and metaphors for mind and brain are mobilized in explanations of pain. Secondly, it explores longstanding anthropological questions about how people assign meaning and causality to illness and misfortune. By illustrating how different explanatory frameworks for chronic pain (e.g. neurobiological, psychodynamic, and societal stress) become foregrounded by clinicians and families at different points in the therapeutic process, I suggest that there is seldom a single explanation for pain. Instead, I argue that causality is best understood in terms of a shifting constellation of explanatory factors that become mobilized for different pragmatic purposes.

Patient-Provider Communication about Pain and Analgesics in the Emergency Department

Mara Buchbinder

Common pain conditions affect at least 116 million U.S. adults, at an estimated cost of $560-635 billion per year. Emergency departments (EDs) are important sites of pain treatment because they are open 24 hours per day and provide a critical safety net for access to care. However, significant barriers to effective pain treatment in the ED setting have been documented at the patient, physician, and systems levels. With the support of a UNC CTSA Interdisciplinary Clinical Research Career Development Award (KL2), this study will use qualitative and quantitative analysis to characterize ED communication about analgesics using transcripts of 100 audio-recordings of interactions between patients with back pain and providers in a hospital emergency room.

Wounded Chiasms: A Rhetorical, Philosophical, and Historical Inquiry

Barry Saunders

This book project is a somewhat theoretical intervention in “medical humanities.” It concerns the importance of the wound, the cut, in various registers of human experience. Specifically, it is about cuts of “chiasms”: the optic chiasm of anatomy (a crossing of nerves between the eyes and brain), chiasmus of classical rhetoric (a figure that repeats particular linguistic elements in reverse order), and a philosophical chiasm of French phenomenology (invested by Merleau-Ponty in the 1960s). Each of these chiasms involves turnings, crossings—of nerve impulses, of linguistic signifiers, of enfleshed experience. Each is susceptible to forms of wounding—that produce blind spots, other rhetorical tropes, and for Merleau-Ponty, distinctions between subject and object. My book will compare these various versions of chiasmic crossing, and productive wounding, in a series of historically-situated case studies. This project engages history of neuroscience and medicine, rhetoric and semiotics, postwar French intellectual history, and a singular poem by Raymond Roussel entitled “Nouvelles Impressions d’Afrique.”