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Narrative Constructions of Health Care Issues and Policies: The Case of President Clinton’s Apology-by-Proxy for the Tuskegee Syphilis Experiment

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Abstract

The Tuskegee Syphilis Experiment (TSE) has shaped African Americans’ views of the American health care system, contributing to a reluctance to participate in biomedical research and a suspicion of the medical system. This essay examines public discourses surrounding President Clinton’s attempt to restore African Americans’ trust by apologizing for the TSE. Through a narrative reading, we illustrate the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public. We conclude by noting the limitations of rhetoric when equal prominence is not given to policy proposals in national apologies.

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Notes

  1. V.N. Gamble, “Under the Shadow of Tuskegee: African Americans and Health Care,” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. S.M. Reverby (Chapel Hill: University of North Carolina Press, 2000), 443; S.B. Thomas and S.C. Quinn, “The Tuskegee Syphilis Study, 1932–1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community,” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. S.M. Reverby (Chapel Hill, NC: University of North Carolina Press, 2000), 405.

  2. J.H. Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1993), 14.

  3. B.R. Bates and T.M. Harris, “The Tuskegee Study of Untreated Syphilis and Public Perceptions of Biomedical Research: A Focus Group Study,” Journal of the National Medical Association 96 (2004): 1053.

  4. W.J. Clinton, “Remarks in Apology to African-Americans on the Tuskegee Experiment,” Weekly Compilation of Presidential Documents 33 (1997): 718–720.

  5. L.M. Harter, R J. Stephens, and P.M. Japp, “President Clinton’s Apology for the Tuskegee Syphilis Experiment: A Narrative of Remembrance, Redefinition and Reconciliation,” The Howard Journal of Communications 11 (2000): 19; L.A. Ford and G. Yep, “Working Along The Margins: Developing Community-Based Strategies For Communicating About Health With Marginalized Groups,” in Handbook of Health Communication, ed. T.L. Thompson, A. Dorsey, K. Miller, and R. Parrott (Mahwah, NJ: Lawrence Erlbaum), 241.

  6. B.D. Smedley, A.Y. Stith, and A.R. Nelson, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, DC: National Academies Press, 2003), 1.

  7. C.O. Airhihenbuwa, Health and Culture: Beyond the Western Paradigm (Thousand Oaks, CA: Sage, 1995), 92; P.A. King, “The Dangers of Difference,” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. S.M. Reverby (Chapel Hill, NC: University of North Carolina Press, 2000), 424.

  8. Jones, 14.

  9. A.M. Brandt, “Racism and Research: The Case of the Tuskegee Syphilis Experiment.” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. S.M. Reverby (Chapel Hill, NC: University of North Carolina Press, 2000), 15.

  10. Jones, 66.

  11. Jones, 5.

  12. Jones, 210.

  13. F.D. Gray, The Tuskegee Syphilis Study: The Real Story and Beyond (River City: Montgomery, AL, 1998), 17.

  14. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research (Department of Health, Education, and Welfare: Washington, 1979), passim.

  15. The Legacy Committee, “The Legacy Committee request.” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. S.M. Reverby (Chapel Hill: University of North Carolina Press, 2000), 561.

  16. Thomas and Quinn, 413

  17. S.M. Reverby, “Rethinking the Tuskegee Syphilis Study: Nurse Rivers, Silence, and the Meaning of Treatment,” in Tuskegee’s Truths: Ret hinking the Tuskegee Syphilis Study, ed. S.M. Reverby (Chapel Hill, NC: University of North Carolina Press, 2000), 365.

  18. Reverby, 366.

  19. The Presidential Papers (Lindon, UT: CDex Information Group, 1995).

  20. Clinton, “Remarks in Apology,” 719.

  21. M.E. Stuckey, The President as Interpreter-in-Chief (Chatham, NJ: Chatham House, 1991), 1.

  22. H. White, “The Value of Narrativity in the Representation of Reality,” Critical Inquiry 7 (1980): 5; J. Bruner, Making Stories: Law, Literature, Life (New York: Farrar, Straus, and Giroux, 2002), 23.

  23. Harter, Stephens, and Japp, 27.

  24. S. Phelan, Sexual Strangers: Gays, Lesbians, and Dilemmas of Citizenship (Philadelphia: Temple University Press, 2001), 7.

  25. W.R. Fisher, “Narration as a Human Communication Paradigm: The Case of Public Moral Argument,” Communication Monographs 51 (1984): 1; W.R. Fisher, “Narrative Paradigm: An Elaboration,” Communication Monographs 52 (1985): 347.

  26. C. Mattingly, “Emergent Narratives,” in Narrative and the Cultural Construction of Illness and Healing, eds. C. Mattingly and L. Garro (Berkeley: University of California Press, 2000), 181; C. Mattingly, Healing Dramas and Clinical Plots: The Narrative Structure of Experience (Cambridge, England: Cambridge University Press, 2001), 23.

  27. A.W. Frank, The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago, 1995), 14; A.W. Frank, “Enacting Illness Stories: When, What, and Why,” in Stories and Their Limits: Narrative Approaches to Bioethics, ed. H.L. Nelson (New York: Routledge, 1997), 31; A.W. Frank, The Renewal of Generosity: Illness, Medicine, and How to Live (Chicago: University of Chicago Press, 2004), 7; C.K. Riessman, “‘Even If We Don’t Have Children [We] Can Live’: Stigma and Infertility in South India,” in Narrative and the Cultural Construction of Illness and Healing, eds. C. Mattingly and L. Garro (Berkeley: University of California Press, 2000), 128.

  28. R. Charon, “Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,” Journal of the American Medical Association 286 (1002): 1897; A. Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition (New York: Basic Books, 1988), 31.

  29. Bruner, 14. D.E. Polkinghorne, Narrative Knowing And The Human Sciences (Albany: State University of New York, 1988), 151.

  30. A.P. Bochner, “Perspectives on Inquiry III: The Moral of Stories” in Handbook of Interpersonal Communication (3rd ed.), eds. M.L. Knapp & J.A. Daly (Thousand Oaks, CA: Sage, 2002), 73; D. Carbaugh, “‘The People Will Come To You’: Blackfeet Narratives as a Resource for Contemporary Living,” in Narrative and Identity: Studies in Autobiography, Self and Culture, eds. J. Brockmeier and D. Carbaugh (Amsterdam: John Benjamins, 2001), 103; K. M. Langellier and E.E. Peterson, Storytelling in Daily Life: Performing Narrative (Philadelphia: Temple University Press, 2004), 7.

  31. D.B. Morris, Illness and Culture in the Postmodern Age (Berkeley: University of California Press, 1998), 250.

  32. Bruner, 89.

  33. K. Burke, A Grammar of Motives (Berkeley: University of California Press, 1969), xvi.

  34. Frank, The Wounded Storyteller, 5; H.L. Nelson, Damaged Identities, Narrative Repair (Ithaca, NY: Cornell University Press, 2001), xii.

  35. V. Turner, “Social Dramas and Stories About Them,” Critical Inquiry 7 (1980): 141.

  36. D.M. Boje, Narrative Methods For Organizational and Communication Research (Thousand Oaks, CA: Sage, 2001), 27.

  37. J.K. Barge, “Antenarrative and Managerial Practice,” Communication Studies 55 (2004): 106.

  38. L.M. Harter, P.M. Japp, and C.S. Beck, “Vital Problematics of Narrative Theorizing about Health and Healing” in Narratives, Health, and Healing: Communication Theory, Research, and Practice, eds. L.M. Harter, P.M. Japp, and C.S. Beck (Mahwah, NJ: Lawrence Erlbaum, 2005), 7; R.P. Clair, “Spirituality and Aesthetics: Embracing Narrative Theory” in Essays on Communication and Spirituality, ed. A. Rodriguez (New York: University Press of America, 2001), 73.

  39. M. Foucault, The Birth of the Clinic. (New York: Vintage, 1995), 196.

  40. Burke Grammar, 237; L. Wittgenstein, Philosophical Investigations (New York: MacMillan, 1953), 143.

  41. M.M. Bakhtin, The Dialogic Imagination (Austin: University of Texas Press, 1981), 341; M. M. Bakhtin, Problems of Dostoevsky’s Poetics (Minneapolis: University of Minnesota Press, 1984), 10.

  42. Bakhtin, Dialogic Imagination, 276.

  43. P.J. Achter, “Narrative, Intertextuality, and Apologia in Contemporary Political Scandals,” Southern Communication Journal 65 (2000): 330.

  44. Clinton, “Remarks in Apology,” 718.

  45. M. McCurry, Press Briefings. Delivered at the White House (Washington, DC, 1997): Available: http://library.whitehouse.gov.

  46. W.J. Clinton, “Remarks at the Morgan State University Commencement Ceremony in Baltimore, Maryland,” Weekly Compilation of Presidential Documents 33 (1997): 727.

  47. C.M. Condit and B.R. Bates, “Rhetorical Methods in Applied Communication Research,” in Handbook of Applied Communication Research, eds. L.R. Frey and K.N. Cisna (Mahwah, NJ: Lawrence Erlbaum, 2007), in press.

  48. H.L. Goodall, Jr. and G.M Phillips, “Assumption of the Burden: Science of Criticism?” Communication Quarterly 29 (1981): 283; G. R. Miller, “‘I Think My Schizophrenia Is Better Today,’ Said the Communication Researcher Unanimously: Some Thoughts on the Dysfunctional Dichotomy between Pure and Applied Communication Research,” in Applied Communication in the 21st Century, ed. K.N. Cissna (Mahwah, NJ: Lawrence Erlbaum, 1995), 470.

  49. Clinton, “Remarks in Apology,” 719.

  50. McCurry, n.p.

  51. W.J. Clinton, Building One America for the 21 st Century. (Washington, DC: President of the United States, 1998): Retrieved August 24, 2004, from the National Archives and Records Administration, Clinton Presidential Materials Project Web site: http://clinton4.nara.gov/Initiatives/OneAmerica/america.html

  52. The Legacy Committee, 559.

  53. Nomination of Henry W. Foster, Jr., of Tennessee, to be medical director in the Regular Corps of the Public Health Service, and to be Surgeon General of the Public Health Service: Hearings before the Committee on Labor and Human Resources, United States Senate, 104th Cong., 1st Sess. (1995), n.p.

  54. Legacy Committee, 561.

  55. J. Beck, “Apology Can’t Erase Tuskegee Horror; Experiment on Black Men Remains a Blot on American History,” St. Louis Post-Dispatch, 20 May 1997, 7B.

  56. “A National Apology,” Washington Post, 18 May 1997, C6.

  57. E. Kane, “Can Apology Make Up For The Tuskegee Experiment?” Milwaukee Journal Sentinel, 13 April 1997, 3.

  58. T. Ackerman, “UH Professor Excited Tuskegee Apology Finally Coming,” Houston Chronicle, 14 April 1997, 13.

  59. Legacy Committee, 562.

  60. H. Shaw, “Herman Shaw’s Remarks,” in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, ed. S.M. Reverby (Chapel Hill: University of North Carolina Press, 2000), 572.

  61. Harter, Stephens, and Japp, 25.

  62. “The Tuskegee Apology,” St. Louis Post-Dispatch, 21 May 1997, 6C.

  63. Burke, Grammar, 20.

  64. “The Tuskegee Apology,” 6C.

  65. T. Samuel, “Clinton Tries to Span Nation’s Racial Divide: Tuskegee Apology Is First Step in His Effort,” St. Louis Post-Dispatch, 18 May 1997, 1A.

  66. Ibid.

  67. K. Burke, The Rhetoric of Religion: Studies in Logology (Boston: Beacon, 1961), 211.

  68. Samuel, A1.

  69. Kane, 3.

  70. J. Pascal, “An Apology from the President,” The Independent (London), 16 September 1998, 11.

  71. J. Jacoby, “All the President’s Apologies,” Times-Picayune (New Orleans, LA), 27 May 1997, B7.

  72. D. Britt, “An Apology: So Much More than Words,” Washington Post, 20 June 1997, B1.

  73. Burke, Grammar, 286.

  74. J. Leo, “Group Apologies Are Not in Order,” Tampa Tribune, 24 June 1997, 7.

  75. Kane, 3.

  76. N. Gaouette, “America Struggles with Issue of Race,” Christian Science Monitor, 20 June 1997, 1.

  77. Gaouette, 1.

  78. Jacoby, B7.

  79. Burke, Rhetoric, 279.

  80. Burke, Rhetoric, 207.

  81. Burke Rhetoric, 4–5.

  82. Burke, Grammar, 406

  83. Burke, Grammar, 265.

  84. J. Malone, “Clinton Opens Dialogue with Tuskegee Apology,” Atlanta Journal-Constitution, 15 May 1997, 9A.

  85. Ibid.

  86. Kane, 3.

  87. Jacoby, B7.

  88. Ibid.

  89. Gaouette, 1.

  90. Burke, Rhetoric, 212.

  91. Bakhtin, Problems, 189; see also Bakhtin, Dialogic Imagination, 304.

  92. Bakhtin, Dialogic Imagination, 199.

  93. M.M. Bakhtin, Speech Genres & Other Late Essays (Austin: University of Texas Press, 1986), 93.

  94. S. Ross, “Clinton Tells Tuskegee Survivors US is Sorry,” Chicago Sun-Times, 16 May 1997, 3.

  95. “‘We Were Treated...Like Guinea Pigs:’ Syphilis Test Survivors Hope US Apology Helps Heal Nation,” Toronto Star, 16 May 1997, A18.

  96. Thomas and Quinn, 405.

  97. Back, 7.

  98. Ibid.

  99. P. Morris, “‘Sorry’ Isn’t Enough to Make Blacks Trust Medicine,” Plain Dealer (Cleveland, OH), 22 April 1997, 9B.

  100. Kane, 3.

  101. Leo, 7.

  102. Gaouette, 1.

  103. R. Franklin, “Tuskegee Apology Has Some Heft, Ethicist Says: Some Say the Official Apology Comes 25 Years Late,” Star Tribune (Minneapolis, MN), 16 May 1997, 8A.

  104. M. Dejevesky, “Clinton Begs Forgiveness for Shameful Tests on Blacks: Poor Syphilis Victims Were Used for Research,” The Independent (London), 17 May 1997, 13.

  105. Malone, 9A.

  106. Bakhtin, Speech Genres, 152.

  107. Bakhtin, Dialogic Imagination, 250.

  108. Bakhtin, Dialogic Imagination, 100.

  109. J. Fiske, Television Culture (London: Meuthen & Co., 1987), 15.

  110. Leo, 7.

  111. Ibid.

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Authors and Affiliations

  1. Department of Communication, Missouri State University, 90 South National Avenue, Springfield, MO, 65897, USA

    Heather J. Carmack

  2. School of Communication, Ohio University, 006 Lasher Hall, Athens, OH, 45701, USA

    Benjamin R. Bates & Lynn M. Harter

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  3. Lynn M. Harter
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Correspondence to Heather J. Carmack.

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Carmack, H.J., Bates, B.R. & Harter, L.M. Narrative Constructions of Health Care Issues and Policies: The Case of President Clinton’s Apology-by-Proxy for the Tuskegee Syphilis Experiment. J Med Humanit 29, 89–109 (2008). https://doi.org/10.1007/s10912-008-9053-5

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