Based on ethnographic research in cardiac rehabilitation clinics, this article demonstrates how messages about risk are contradictory and shifting. In education sessions that teach clients about risk, technicians shift back and forth between oppositional logics: from the logic of epidemiology to the logic of the clinic, from narratives of biological fate to lifestyle determinism, and from depictions of medical knowledge as factual scientific progress to medical practice as uncertain craft. Shifts in logic are strategically communicated to discourage fatalistic pessimism, excessive guilt, self-blame, and false hopes about illness and instead encourage risk reduction among clients. Technicians’ accounts of risk individualize illness and reproduce biological and behavioral reductionisms of biomedicine. The analysis shows how rehabilitation risk discourse offers moralistic messages, which stigmatize and blame people with heart disease for so-called unhealthy lifestyles. Rehabilitation risk discourse masks social sources of disease and diverts attention from politically progressive strategies of health promotion.
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