Theorizing About Health Communication

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Theorizing About Health Communication

• Week 3, Lecture 5
• 1/23/2006

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Defining Theory

• No broadly accepted definition of theory both
  impossible and undesirable to construct such a
  definition
• Theory consciously elaborated, justified, and
  uncertain understanding
• Consciously constructed understanding different
  from the tacit formulations that guide us
  unawares and are difficult, if not impossible, to
  access consciously
• Justified theories emerge from processes and
  practices of sense-making and justify belief in
  or perception of the reasonableness of the
  emerging, elaborated constructions
• Uncertain uncertainty may be ontological
  (uncertainty concerning the nature of the world
  we are attempting to theorized about) or
  epistemological (rooted in the nature of how we
  come to know)

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Theory Practice

• Health communication theory is meaningless if it
  does not influence practices related to health
  and illness (Babrow Mattson, 2003, p. 37)
• Claims related to the influence of theory on
  health practices limited to the extent that
  although we can make judgments about the past or
  present value of any particular theory, they do
  not necessarily anticipate the theorys value in
  future
• Foregoing consideration must NOT be taken as
  license to pursue a theory without thought about
  its potential future impact on practice
• Important to remember that theoretical
  applications can also be harmful (single minded
  application of URT uncertainty as the ONLY
  motivation for women to seek breast self-exam
  disempowers women harms their health)
• Whatever claims we may make about theory and
  practice, they depend on a set of values
  (axiological issues)

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Characterizing Health Communication Theory

• Points of contention
• What constitutes health communication theory
• Difficulties in defining both health and
  communication
• Because health communication scholarship informs
  and is informed by the broader field of
  communication, the criticisms that preoccupy the
  broader field, in terms of legitimacy, status,
  distinctiveness, and so on, also apply to health
  communication
• Much of what passes as health communication
  theory could be subsumed within interpersonal and
  mass communication scholarship
• BOTTOM LINE Health and illness most elemental
  realm in which to study the nature and importance
  of communication

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Characterizing Health Communication Theory -
Continued

• Unifying themes with other domains of
  communication
• Regardless of context, nonverbal displays of
  emotion and the constitutive rules of speech acts
  will be the same
• Whether the content involves politics, health, or
  other social concerns
• Media act as agenda-setters
• Media shape our sense of what is important to
  think about
• Medial legitimize some ways of thinking while
  delegitimizing others through issues of selective
  attention and framing
• Distinctive features of health communication
• Interplay of body and communication
• Science and humanism
• Idiosyncracy and commonality
• (Un)certainties and values, Expectations and
  desires

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Interplay of the Body and Communication

• Physical disease shapes communication (e.g.
  pointed cry of pain, seeking support)
  communication acts and processes, in turn,
  influence bodily states (e.g. relief), and so on
• Specific and local experiences of the interplay
  of communication and the body are shaped by
• Powerful social and cultural forces influencing
  individuals behaviors
• Communities transmit values and norms that
  symbolically circumscribe some behavioral choices
  and discourage others
• Communities establish opportunities for people to
  behave in some ways, but not others
• The communicative interweaving of bodily
  sensation, cognitive-emotional sense-making, and
  various layers of social structures and practices
  fabricate the social meaning of physical states
  and the physical meaning of social states (p. 40)

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Interplay of the Body and Communication-Continued

• Interplay powerfully illustrated in the
  processes by which physical sensations and
  diseases are conceptualized and labeled
• Culture shapes how we label our physical states
  and clearly we react to and treat ailments
  differently depending on how they are labeled
  (e.g. terrible (Jewish) pain vs. annoying
  (Irish) pain)
• The interplay of language and bodily sensations
  shapes the experience of illness these
  interactions are themselves shaped by
  historically bound socio-cultural constraints
• Metaphorical conceptualizations of illness
  influence understanding of the illness, attitudes
  towards it, and social action
• BOTTOM LINE Given the centrality of health
  communication in promoting the interplay of
  communication and body, theories of health
  communication that recognize this interplay have
  the potential to illuminate one of the key
  distinguishing features of health communication

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Science and Humanism

• Tension between scientific and humanistic
  assumptions, values, aspirations, and limitations
• Biomedical vs. biopsychosocial models
• Disease vs. illness
• Technique vs. meaning
• Traditional vs. alternative therapies
• Poignant illustration of this contrast and
  tension found in contemporary attitudes and
  practices related to death and dying
• Death, rather than occurring shortly after the
  onset of an acute illness or injury, now
  typically is the endpoint of one or more lengthy
  chronic illnesses, thanks to advances in
  nutrition, sanitation, engineering, and medical
  technology
• Death has replaced sex as a core cultural taboo
• Individuals have lost the willingness and,
  perhaps, the capacity to talk openly about death
  except in the bloodless technical terms of
  medicine and the law

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Idiosyncracy and Commonality

• This tension
• reflects the debate between advocates of two
  major models of disease and illness
• Ontological (diseases are seen as existing
  outside their manifestations in a particular
  individual) vs. Holistic (illness exists only in
  individuals)
• Point of contention is it necessary to treat the
  whole person if one can rid him or her speedily
  and painlessly of the disease and, consequently,
  prevent the necessity of a long-term association
  with the medical professional vs. the argument
  that disease/illness is frequently not that
  simple to treat
• constitutes a faultline in scholarly conceptions
  of health care and promotion, in the interactions
  between patients and health care providers, and
  in the conceptions of risk held by health
  communicators and their audiences
• manifested in the distinction between affirming
  the personal meanings of an illness and affirming
  our common humanity illness is at once a
  private and public matter and human flight from
  dependency on others is a flight from humanity

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(Un)certainties and values, Expectations and
Desires

• Uncertainty
• central to the experience of illness
• locus for much of the tension between the realms
  of communication and the body, scientific and
  humanistic assumptions and aspirations, and
  idiosyncracy and commonality
• Expectations play a role in
• the production of somatic disorders
• the processes by which disorders are labeled as
  worthy or medical care and illness labels are
  applied, and
• recovery and prevention

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(Un)certainties and values, Expectations and
Desires - Continued

• Problematic integration theory (PIT) suggests
• Uncertainties take on meaning only relative to
  the values at stake in health and illness
• PIT counters a wide variety of common
  misconceptions about uncertainty, including that
• It has a single or narrow homogeneous meaning,
  such as that it is necessarily bad or the result
  of insufficient information
• The main response to uncertainty is
  information-seeking, the aim and significant
  outcome of any encounter with uncertainty is its
  reduction and such reduction is always possible
• Uncertainty and its attendant problem are
  resolved exclusively by managing the level of
  uncertainty
• Any one resolution of an unpleasant uncertainty
  is the final punctuation of experience that any
  dilemma involving expectation and desire has a
  clear first cause
• The course of such dilemma is predictable in a
  specific and robust sense

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In summary,

• Much recent theorizing about health communication
  has emphasized
• uncertainty pervades illness experiences and
  communication about health and illness
• meaning of uncertainty in general is profoundly
  dependent on the values at stake
• our evaluation of whatever is at stake depends on
  how we formulate and manage uncertainty
• our sense of possibilities, our construction of
  the unknown, of the knowable, and of the nature
  of what it means to know conditions what we value
  and the extent to which we value it
• In health communication, therefore, values force
  the rearticulation of (un)certainty and
  (un)certainty compels the rearticulation of
  values