Rhetoric of Health & Medicine

Vol. 4, No. 4, pp. 403–412

The Joy and Debt of Service

J. Blake Scott and Lisa Melonçon

We open our final introduction with a simple idea—to reflect on what it means, and what it has meant to us as co-editors, to serve. We weren’t sure how we would feel when writing this final introduction, but now that we’re here, we can attest that the feeling isn’t all that different from the times before. More than anything, as we have been all along, we are grateful. Grateful for being entrusted in these roles (indeed, gratitude was what drove us to take them on in the first place), grateful for all of your roles in ensuring that the journal and larger field of RHM has flourished, and grateful, perhaps most of all, for the future.

Our reflection about gratitude in service brings forth two distinct but also, we think, related forms of experience—joy and debt—that we want to briefly acknowledge and unpack, in part because we see their possibilities for shaping our collective future. Like gratitude, both joy and debt are connective experiences that “serve socially adaptive functions,” prompting us to “alter our behaviors toward [and with] others” (DeSteno, 2013), in this case around imaginative and reciprocal care in the ongoing shaping of the RHM “dwelling place.”

Joy may not be the first emotion many of us readily associate with editorial work or our scholarship. Editorial work feels unrelenting and sometimes tedious and disparaged. Much RHM work focuses on and aims to ameliorate experiences related to illness, disease, trauma, suffering, and fear, along with such patterns as health inequities, lack or loss of agency, discrimination, and other forms of oppression. Some work in our field even draws on scholars’ own embodied familiarity with such topics (Molloy et al., 2018). For many, the stress, despair, and constraints of the ongoing COVID-19 pandemic has made joy in our work even harder to find. Yet, throughout our term as co-editors, including these last two years, we have been constantly reminded by our work with you that joy can accompany tediousness, stress, despair, vicarious trauma or suffering, and the other difficult parts of what we do in and beyond RHM. We have found joy in big moments, of course, such as the publication of our inaugural issue and first special issue, seeing examples of the new scholarly genres (e.g., persuasion briefs, “ethical exposure” essays) we imagined, having RHM articles reprinted in the “Best of the Journals in Rhetoric & Composition” collections, supporting folks’ tenure applications with articles published in the journal, and winning the best new journal award. But even more joy has been present in the smaller, more ordinary acts of service and witnessing, such as reading insightful and generous manuscript reviews, hearing graduate students excitedly tell their peers about our new field as a potential scholarly home, watching a fellow scholar have a “eureka” moment through conversations about manuscript development, finishing each other’s thoughts as editors, seeing “Rhetoric of Health & Medicine” listed in a growing number of faculty profiles and search ads, reading through a third manuscript revision to recognize that the argument has fully arrived, and getting a “thank you” email from a scholar whose work was rejected but who nevertheless felt affirmed by the decision letter.

In her book Caring for Joy (2016), theologian Mary Clark Morschella describes joy not only as an emotional experience—often involving flashes of lightness, warmth, wonder, and, well, gratitude—but also as a “broader and more enduring phenomenon” that is like “way of perceiving … a disposition, even” (p. 6). “Joy of this sort,” she goes on to explain, “involves not turning away from suffering, sorrow, or injustice—but paying attention and staying engaged … feeling one’s way toward all the goodness and grace one can find or forge, together with others, in communities of solidarity” (p. 6). Morschella describes joy as a habit of mind and practice, suggesting that caring for joy is an embodied form of perception that can be learned and cultivated (see p. 10). For us, scholarly service is, or should be, about caring for and cultivating joy as much as anything else, in part because it can generate vulnerability, generosity, and solidarity (Morschella, p. 5).

To further enact this cultivation of joy, we might look to examples from healthcare. In response to healthcare worker’s experiences with stress, trauma, moral injury, and burnout during the COVID-19 pandemic, some organizations have turned to the healing power of joy. In a podcast series called “Finding Joy,” for example, Washington State University medical students and their physician teachers discuss their experiences in not only finding but cultivating joy, through such topics as the value of team members in destressing (see https://findingjoy.buzzsprout.com/). The Mayo Clinic implemented a “joy in the workplace” program to support the well-being of its workers through, among other things, a program for sharing stories of joy among peers (Kelsey, 2021). Even before the pandemic emerged, the Institute for Healthcare Improvement developed a white paper about a “Framework for Improving Joy in Work” (Perlo et al., 2017) that takes a systems approach to creating opportunities for joy across all organizational levels and personnel. We similarly view caring for joy as a collective disposition and practice. Just as we cannot expect nurses and other healthcare workers to develop resilience and well-being only or even primarily through self-care, we cannot cultivate joy in our scholarly practices by putting the burden on individuals. Rather, we can together create, recognize, and amplify moments of joy, especially in our everyday scholarly exchanges with others and especially for those who are marginalized and vulnerable, while also developing collective habits of and tactics for finding joy.

A second form of experience we associate with our service—which can also be understood as a state of mind and habit of practice related to gratitude—is debt. In part because of the joy we’ve found along the way, to serve has not been an onerous task to just get through, but rather a fulfilling and edifying practice of collective knowledge-making. In their formulation of a different politics of debt, one that is “without payment, without credit, without limit” (p. 64), Stefano Harney and Fred Moton (2013) give us a way to think about our service as a form of debt that is less about an obligation to repay or recognition of credit than about a collective process of extending grace to and creating opportunities for one another. This type of shared indebtedness is about mutual gift-giving, about participating in a “debt that is mutual” wherein “the debtor seeks refuge among other debtors, acquires debt from them, offers debt to them” (Harney & Moten, p. 61).

In our roles as editors, we have tried to show gratitude to and honor our champions and collaborations who have made this journal possible—from our field-shaping mentors like Susan Wells and Fred Reynolds, to our stellar editorial board and team, to our generous reviewers, to the community of authors and readers, and especially to the incomparable Cathryn Molloy who has shared part of our journey and also anchored the transition to the journal’s next phase. As we have learned to navigate and reenvision what editorial service means to us and to the field, these are some of the debts we have tried to “pay it forward.” Just as we have come to recognize our joy as radically distributed and mutually enacted, so have we come to recognize our debt. Here we recall Max Liboiron’s (2020) words about footnotes: “see these footnotes enacting an ethic of gratitude, acknowledgement, and reciprocity for their work. They make it harder to imagine these words are just mine, an uninterrupted monologue. They are not stashed at the end, but physically interrupt the text to support it and show my relationships” (p. ix). Sure, we can point to authors of specific pieces published in the journal, but in another way, in terms of our collective dwelling place, every word and image on every page, every video and podcast on the journal’s online site, every special issue and section call, every citation and award, is part of the debt we all share, we all love.

While we maintain that expressing gratitude is a vital and joyful part of service, we want to shift the sense of debt and gratitude away from obligated recognition and toward mutual action—“a debt you play, a debt you walk, a debt you love” (Harney & Moten, 2013, p. 64). It is also a debt we have built collectively in the dwelling place of the journal and larger field. We hope it is evident that we have indeed sought “refuge among other debtors” and also, with you, co-created a dwelling place where others could also find a refuge, as a welcoming scholarly community, for their ideas.

Harney and Moton’s (2013) debt is in motion; it “runs in every direction, scatters, escapes, seeks refuge” (p. 61). This reminds us that our dwelling place must also be in motion, both within and across its boundaries, as the “we” of our enterprise expands in more diverse and inclusive directions. To serve as editors means to consistently work with others to build and, more importantly, to expand the relationships of knowledge found in and found by RHM scholars. Our job is to cultivate mutual joy, and also mutually empowering debt.

We hand off editorial duties knowing that we approached the tasks through a generosity and care that offered one model on how to serve.

Introduction to the articles in this issue

Even as our teaching, like our scholarship, has been fraught with frustration and anxiety over the course of the COVID-19 pandemic, it has, for many of us, also remained a source of joy and is therefore worth amplifying. In addition, sharing our teaching experiments and approaches can be one of the more intimate ways we enact service and mutual debt, as illustrated by the Teaching section on medicalrhetoric.com. For these reasons, it is fitting that we would end our tenure as editors with a special issue on teaching. We’ve not to this point published a piece on teaching, and what started as a special section became a full special issue when we saw the quality and diversity of submissions.

We received such a robust number of submissions that we worked to include as many as possible to show the range of issues and concerns about teaching RHM. This issue uses our online platform to its full advantage with a full print issue of five articles along with five articles online.1 Our issue opens with Mara Lee Grayson’s examination of reductive pedagogical practices that develop within the confines of a white, Western notion of trauma, such as the controversial pedagogical practice of the trigger warning, which may work to perpetuate students’ marginalization. Grayson analyzes the trigger warning as a pedagogical practice that functions rhetorically to pathologize and individualize experiences of racism and other societal inequities that cause collective trauma. Ultimately, because the trigger warner provides space for white-dominant logic, and white ways of knowing and doing, Grayson concludes that there is a need for more comprehensive, inclusive pedagogies to address student trauma, acknowledge societal conditions that impact individual experiences, and shift popular discourse that pathologizes human suffering and maintains the status quo.

Kathryn Swacha and Kirk St.Amant argue against the dominant conception of pedagogy as a pre-planned, linear scaffold; instead, the authors propose a pedagogical concept called the Lego Learning approach to re-conceptualize instructional content as self-standing, short-term units. Lego Learning enables modules of instructional content to be freely integrated and moved within and across a course or courses depending on the adaptability of the curriculum. Lego Learning encourages collaboration across classes, institutions, and other contexts. Swacha and St.Amant frame their discussion around four learning outcomes and teaching practices that can be applied in praxis, along with ongoing Lego Learning examples. Lego Learning provides a model for responding to unforeseeable health and medical issues, constructing an approach that empowers instructors and students to become active contributors in various situations using flexibility of thought and action.

In her contribution, Heather Adams discusses an RHM-based course about reproduction that foregrounded gendered and raced sites of health in/justice. The value of cultivating health-oriented rhetorical agency and advocacy creates a hopefulness for reproductive justice to be used as an activist framework within pedagogical spaces. Adams’s article provides an overview of reproductive justice as an activist framework, details the rhetorical functions of that framework, and follows with a description of course exigency, teaching context, and course design. By opening up this space for more collaborative exploration, critical and culturally dismissed health experiences can be given new light and students are encouraged to explore avenues for self-sponsored rhetorical activity which fosters hopefulness in RHM.

The next article focuses on the patient’s decision aid as a pedagogical tool that embraces the technological changes in health and medicine. Maria Novotny, William Hart-Davidson, and Dawn Opel make the case that patient decision aids can be understood as a multimodal tool which guides shared decision-making practices. Their article works to make transparent connections in writing and rhetoric classrooms, offering the decision aid as an assignment that links humanities-based students with broader healthcare industries.

Amanda Greene and Jennifer Swann describe an experimental, interdisciplinary course on the immune system that was co-taught by a humanist and a scientist. This course’s creation coincided with the start of the COVID-19 pandemic in the United States. In turn, the course was designed to grapple with current events, helping students navigate the entanglement of science and society. Greene and Swann argue that this type of medical education can nurture students’ capacities for more complex, nuanced, and powerful forms of code-switching, integrating medical praxis as a form of reading and interpretation, respecting both disciplines as tools for reading bodies, texts, and contexts.

Extending the print issue online (http://medicalrhetoric.com/journal/4-4/) is a piece by CE Mackenzie exploring harm reduction (a public health practice that rejects iterations of capitalism) as an epistemological model that can be adapted pedagogically in rhetoric, communications and composition classes. Concluding that harm reduction has epistemological value, such as an emphasis on temporality and its privileging of process, Mackenzie makes connections to use harm reduction as a method for teaching writing, rhetoric, and communications.

Deborah Harris acknowledges the responsibility that writing instructors feel for their students, particularly in helping them address challenges and inequalities while in the classroom when unforeseen traumatic events are happening in our communities. In this frame of mind, Harris recounts the experiences in the classroom during the global Covid-19 pandemic and Black Lives Matter movement, taking advantage of these kairotic moments to give students the space and the agency to explore these current topics.

In her contribution, Cynthia Ryan identifies gray areas of medical research which can be understood through the acknowledgement that health and medicine texts are inseparable from the rhetorical conditions in which they are shaped and disseminated. Ryan uses this case study scenario to situate students in a complex scenario, asking them to collaboratively address double standards in research, openness or hesitance to new knowledge and new perspectives, and the fluidity of knowledge in any context; this experience helps students gain transferable skills to apply in navigating a situation that seems insurmountable.

Lori Beth De Hertogh and Danielle DeVasto center the foundational idea of patient-centered care of seeing patients as people and not just bodies that need repair. Within this framework, students are positioned as both content creators and as content users which maintains a valuable concern for usefulness and effectiveness. While UX-informed pedagogy models can be utilized across educational spaces such as a writing studies class, this approach is particularly applicable to RHM courses, cultivating students’ own professional contexts and approaches to doing patient-centered work.

In the final article, Scott Mogull makes the case for developing RHM knowledge integrity through preparing RHM students, researchers, and practitioners to be careful curators and communicators of information from medical literature. Overall, this article works to provide instructors guides for navigating this approach in a classroom and helping students develop rhetorical application for a process that differs from programmed prior learning.

As a whole, this issue illustrates the robust and diverse ways that RHM scholarship can be taught and can influence the classroom in productive ways. Each of the pieces provides specific practical applications others can use in their own classrooms or inspirations to create similarly inspired assignments and activities.

RHM awards

In conjunction with the RHM Symposium (http://medicalrhetoric.com/symposium2021/), we announced our annual Sue Wells Reviewer awards. We awarded these for the first-time in 2020 (see issue 3.3 for the announcements), and we wanted to continue to acknowledge the intellectual labor of the reviewers. We have always been fortunate that at RHM our reviewers have been extraordinarily generous with their constructive reviews, and we hope that they, too, see their service as both joy and debt. Selecting award winners was difficult, and we looked to reviews that helped the authors substantially strengthen their own ideas and scholarship. Please join us in thanking and celebrating Dan Ehrenfeld and Wendy Pringle for their excellent reviews.

The RHM Symposium also acknowledges excellent works in progress. The 2021 winner of the Judy Segal Top Paper Award went to the collaborative team of Megan Poole, Shavonnie Carthens, and Abigail Koenig for their paper, “ ‘Getting the Listening’ in Louisville: Public Health Literacy and Environmental Justice In and Around Rubbertown.” The review committee praised your paper for “reinventing methodologies for enacting public health research, reinventing ways of working with and learning from/for various publics, and reinventing what the purpose and value of public health research even is.”

The winner of the Barbara Heifferon Graduate Student Fellowship is Brynn Fitzsimmons for her paper, “Holding Space: Life-Affirming Institutions and Kansas City’s City Hall Occupation,” which “examines the rhetorical strategies activists used during People’s City, a 21-day occupation of Kansas City’s city hall, to create and hold discursive space to image and practice activists’ demands for ‘life-affirming institutions.’” Honorable Mention for the Heifferon Award went to Danielle Stambler for her paper, “Access to Employee Wellness: Barriers for Marginalized Populations.” Stambler’s project investigates the impact of employee wellness programs’ eating-related programming on people’s lived experiences with food.

Thank you

With this issue, we officially hand off our role as co-editors, and without doubt we know the journal is in good hands. We end our editorship with such gratitude and thanks to the assistant editors, the editorial board, the reviewers, and especially the authors and RHM community.

We remain humbled that the community entrusted us to take a nascent idea of the potential of a journal and usher it into the world. We have been honored to be temporary caretakers for its intellectual vitality.

We both hold this experience as one of the most important highlights of our careers, and we will forever be grateful for having had the opportunity to serve. But even more than the past, gratitude is about the future, “making sure that tomorrow, and the day after, you will have something to be grateful for” (DeSteno, 2013). And we so look forward to seeing what happens next.

References

DeSteno, David. (20 November 2013). Gratitude is about the future, not the past. Huffington Post Blog. https://www.huffpost.com/entry/gratitude-research_b_3932043

Harney, Stefano, & Moton, Fred. (2013). The undercommons: Fugitive planning and Black study. Automomedia.

Kelsey, Elizabeth A. (2021). Joy in the workplace: The Mayo Clinic experience. American Journal of Lifestyle Medicine, 1-5.

Molly, Cathryn, Beemer, Cristy, Bennett, Jeffrey, Green, Ann, Johnson, J, Kessler, Molly, Novotny, Maria, & Siegel-Finer, Bryna. (2018). A dialogue on the possibilities for embodied methodologies in the Rhetoric of health and medicine. Rhetoric of Health & Medicine, 1(3-4), 349-371.

Moschella, Mary C. (2016). Caring for joy: Narrative, theology, and practice. Brill.

Perlo Jessica, Balik, Barbara, Swensen, Stephen, Kabcenell, Andrea, Landsman, Julie, & Feeley, Derek. (2017). IHI framework for improving joy in work. Institute for Healthcare Improvement.

Washington State University Health Sciences. (2021) Finding joy: The health care professional’s journey to wellness and resiliency. https://findingjoy.buzzsprout.com/

1 While we are always grateful for the help of our editorial team, we want to give a special thank you to Haley Jones, who is one of the graduate student journal assistants. Haley went above and beyond with this issue, including drafting key points for this section and putting all the information online.