By Christa Teston
Christa Teston has been applying the tools of rhetoric to medical practice for a while, authoring a series of articles that specifically focus on how medical professionals use agreed-upon methodological principles to work across fields. In this book, she pulls that work together, using Annemarie Mol's work on multiple ontologies to theorize this cross-field work. Here, Teston focuses squarely on methodology: how it is used to generate authority (p.1) and negotiate uncertainty (p.2).
Specifically, Teston looks at cancer care, and four ways to negotiate uncertainty in this activity: "evidential visualization, evidential assessment, evidential synthesis, and evidential computation" (p.2). Evidence, here, is understood as fundamentally rhetorical, and "backstage methods" (in the Goffman sense) allow medical professionals to "coproduc[e] evidential order from biological chaos" (p.15). Medical professionals use these methods to deal with inevitable flux, creating "evidential attunement," which "necessitates entanglements between human, nonhuman and computational actors" (p.15).
To develop this argument, Teston draws on "the so-called new materialist and nonhuman turn" (p.18). Perhaps Teston dislikes the term "new materialism" as much as I do: after name-checking Latour, Callon, and Bennett, she adds, "Although some have called this brand of materialism new, others (i.e., those who align themselves with materialist feminists) would suggest that there is nothing new about this materialism" (p.18). She goes on to discuss others in this vein, such as Hekman, Pickering, and Deleuze & Guattari, then concludes, "In this book, I locate material-discursive intra-actions between humans and nonhumans at the seat of method" (p.18).
She adds that although medical care strives for certainty, "this book unearths reasons for how and why it is that cancer care is not and can never be an objective science." She is not critiquing the "black boxes" of cancer care, which "are essential" because they "do the hard work of stabilizing, qualifying, and mobilizing 'future use of ideas and facts' while aggregating and mobilizing alliances (Danius 2002, 41-42)" (p.22). Rather, she seeks to examine how this work happens rhetorically, demonstrating rhetorical theory's explanatory power (p.22).
To reach this goal, Teston draws on case studies in which she investigates method attunement in cross-field medical work related to cancer care. She describes these qualitative studies and draws on rhetorical tools and concepts—Toulmin analysis, stasis theory, enthymematic reasoning, kairos, phronesis—to take apart the suasive work happening in each. And I appreciate that she performs these cases with a high degree of methodological explanation, demonstrating the rigor of each case.
On the strength of these cases, Teston concludes that "defining and diagnosing disease is a kind of quixotic empiricism" (p.169). Within these cross-field cases, she says, evidences result from rhetorical attunements—"In medical practice, rhetoric is a material-discursive performance that involves dissecting corporeal differences and similarities into manageable bits and bytes. Rhetoric is a material-discursive act of designing and deploying algorithmic protocols capable of predicting and communicating about possibility" (p.171).
Overall, the book was well done, both methodologically and theoretically. Teston offers a materialist approach to understanding medical rhetoric in particular and methodology in general. If you're interested in medical rhetoric, scientific rhetoric, materialist approaches to rhetoric, or methodology, definitely take a look.