Dissertation

Defining Injury, Managing Uncertainty: Articulating Definitions of Traumatic Brain Injury (2017, Purdue University)

Traumatic brain injury (TBI) is a significant national and global health issue and has seen increased public attention recently because of TBIs in youth, college, and professional sports as well as the military. Despite this attention, biomedical research faces continual challenges in locating treatments, predicting patient outcomes, and understanding how the condition works and progresses. For these reasons, TBI has been called “the most complicated disease of the most complex organ in the body” (Marklund & Hillered, 2011, p. 1208). This complexity makes TBI difficult to define, classify, identify, or diagnose. These challenges compound difficulties in resolving public questions about TBI, such as the extent of and proper response to the relationship between concussion and chronic impairment. These challenges at multiple levels are ripe for rhetorical study, though TBI remains an underexplored topic for both the rhetoric of health and medicine (RHM) and technical communication (Lindsley, 2015).

This dissertation analyzes explicit and implicit definitions of TBI in order to locate areas of common concern between scientific, public, and survivor discourses and develop a language for often subtle differences in how TBI is understood. I argue that rhetoric is well suited to make these differences visible and mediate between them. To that end, I present a matrix that functions as a heuristic for comparing explicit and implicit definitions across several analytical categories, including references to time, measurement, causes, and symptoms, and choosing which definition is most suited to stakeholder interests in particular contexts.

I begin by illustrating this method and situating my inquiry in RHM scholarship and definitional theory. Chapter 2 examines published scientific discourse about the continued failure of clinical trials for TBI treatments, including proposals to revise clinical trial methodology. This case in scientific response to failure reveals shifts in how biomedical evidence is produced that can be understood in definitional terms. Chapter 3 charts competing risk frames in the public debate over football-related concussion. While sports conglomerates present a frame that football can be made safe, their critics argue that long-term risks of concussion cannot be easily managed. As awareness efforts have, at times, exaggerated this risk, both of these frames obscure important facets of the debate, making emerging attempts to discuss concussion with balance and nuance difficult but necessary. Chapter 4 uses recurring concepts from the previous chapters to analyze implicit definitions in blog posts written by TBI survivors. Time, an important dimension of clinical trial failure and concussion risk, emerges as a salient definitional category survivors’ experiences with medical practitioners, identity re-negotiation, and everyday barriers to access. I ultimately argue that the challenges TBI poses reveal limitations in the ways that scientists study complex medical phenomena and members of the public debate them in ways that impact people with TBI. Using definitions to chart the larger network of TBI challenges reveals that divergent time constructs, competing risk frames, and regimes of standardization are central to how varied actors respond to TBI and how complex issues like TBI can be addressed rhetorically.

References

 

Lindsley, T. (2015). Legitimizing the wound: Mapping the military’s diagnostic discourse of traumatic brain injury. Technical Communication Quarterly, 24, 235-257.

Marklund, N., & Hillered, L. (2011). Animal modelling of traumatic brain injury in preclinical drug development: Where do we go from here? British Journal of Pharmacology, 164(4), 1207-29.