A burgeoning research area in the rhetoric of health and medicine, mental health rhetoric research (MHRR) is a term that J. Fred Reynolds (2018) used in the inaugural issue of the Rhetoric of Health and Medicine journal to describe the “significant body of work applying the tools and terms of rhetoric to the world of mental health” that first appeared in the 1980s and continued in fits and starts for the decades to follow (p. 1). As Reynolds documented, in the past, rhetoricians have studied issues of mental health from a variety of (inter)disciplinary angles using a wide range of methodological approaches (see brief bibliography below for further reading).
This peer-reviewed collection, edited by Lisa Melonçon and Cathryn Molloy and tentatively titled “Mental Health Rhetoric Research: Toward Strategic Interventions,” will add to the vibrant existing literature in MHRR through studies that examine a variety of topics that fall within the broad spectrum of “mental health” through the lens of “interventions.” The chapters therein will, thus, use rhetorical theories and concepts and/or rhetorically inflected concepts that grow out of bodies of knowledge in technical communication to propose strategic interventions into a specific mental health reality. Explicitly building productive methodological, theoretical, and practical bridges among the various sub-specialties of the broad field of writing studies interested in mental health, the book offers interventions in the areas of activism, methodology, and pedagogy.
The book will be divided into three sections:
- activist interventions to end stigma and impact material conditions related to specific cultures, laws, and institutions
- methodological interventions for studying and researching specific communities with approaches aimed at helping future researchers to collect, analyze, and theorize compelling data related to mental health
- pedagogical and co-curricular interventions for work with academic programs, student groups, and learning centers—especially as such interventions relate to dispelling misconceptions and promoting the affordances of “mad” subjectivities and/or neurodiversities
The word “interventions,” of course, implies an “intermediary” who is “‘stepping in’, or interfering in any affair, so as to affect its course or issue” (OED Online). Interventions put forward in each chapter that grow out of rhetorical theories, thus, use an expansive view of rhetoric to purposefully craft such involvements. Rhetorical interventions are firmly transgressive and, thus, require tenacity, creativity, and boldness, and chapters are written with these guiding principles.
In each section, we include chapters that employ a wide variety of methodological approaches (critical discourse analyses, ethnographic inquiries, autoethnographic inquiries, case studies, textual analyses) to engage such topics as postpartum depression among Chinese mothers; insanity pleas; anosognosia; issues of intimacy, access, and embodiment in research projects; community support groups; women in alcoholics anonymous; and mental health in writing centers, faculty workshops, and university online health tools.
Annotated table of contents
Chapter 1: Designing Strategic Interventions in Mental Health Rhetoric Research
Lisa Melonçon and Cathryn Molloy
The editors’ introduction theorizes and operationalizes “interventions” in mental health rhetoric research while introducing the content and arguments of each chapter. The focus of the introduction is on how this new collection fills gaps in the current mental health rhetoric research and how it contributes to the rhetoric of health and medicine and to rhetorical studies more generally. It concludes with the editors’ recommendations for how the book might be used in a variety of undergraduate and graduate courses as well as in faculty development work.
Part One: Methodological Interventions
Chapter 2: Toward a Theory of Distributed Intimacy
Lisa Melonçon and Lora Arduser
RHM scholars have long looked at online discourse as a research site and information in online spaces as research artifacts to understand communication practices around different health conditions (e.g., diabetes or breast cancer patients).However, the emergence of RHM as an identified sub-field of scholarly inquiry has led scholars to question what more can be learned from singular studies of specific disease or health concerns. In other words, RHM has looked at online health forums in isolation. One way to address this concern is through theory-building by attempting to reimagine ways scholars can view existing scholarship on online forums or by approaching future research in new ways. In this chapter, we build the theory of distributed intimacy. This theory becomes the basis for rethinking the relationship between humans, technology, and information as experienced in online health forums. We then put the theory into practice by using it as a lens to examine disparate forums across diseases or illnesses to make broader claims or gain a better understanding of how intimacy is formed. The theory and subsequent examination of existing scholarship provides RHM scholars to move toward answering more complex questions about the role and importance of patient to patient information exchange.
Chapter 3: Bridging the Gap between Theory-Building and Access-Building in Emergent Mental Health Rhetoric Research
This chapter argues for critical access as a framework for situating emergent research in mental health rhetoric research. As an anti-ableist interpretive framework, critical access invites readers to consider how research brings people, spaces, and technologies together. Attending to access—both participants’ and researchers’—is thus an ethical strategy for negotiating the tensions that sometimes occur between emerging research and the emerging relationships and reciprocities projects produce. To illustrate the usefulness of these concepts for new scholars in particular, the author describes how his research on the self-advocacy practices of rhetors with intellectual/developmental disabilities led to reflections on the ways in which methods and tactics denied access to some participants while extending it to others. As a result, ideas and perspectives failed to emerge and were lost. For methodologically mutable mental health rhetoric research to be possible, the chapter concludes, critical access is therefore an essential consideration.
Chapter 4: Material embodiment, physical insult, and mental health rhetoric: Culture-centered articulations
Lisa DeTora and Tomeka Robinson
This chapter aims to resituate the rhetoric of mental health research and clinical practice vis a vis a connection with embodied experiences in order to better articulate the necessary elements to theorize a culture-centered approach to rhetorical study in this area. Rather than critiquing perceived deficits in the biomedical literature, the authors suggest ways of seeing that literature on its own terms, then map out methodological interventions needed by rhetorical and communication scholars and practitioners to reach appropriate publics. The chapter takes up the critical question: at what point does physical insult intersect with mental illness? Examining the means by which cultural information about subjects is included or excluded from healthcare decision-making, the chapter addresses the fact that while explicit displays of discrimination in healthcare settings have declined, implicit attitudes persist and may influence provider behavior and treatment choices. Variations in provider behaviors are often unconscious, therefore making it harder to acknowledge and control, which suggests that rhetorical interventions are necessary to achieve parity.
Chapter 5: Facilitating Rhetoric: Para-Therapeutic Activity in Community Support Groups
This chapter combines textual analysis of support group documentation (curricula, handouts, and facilitator training materials) with autoethnographic inquiry to examine the rhetoric of support groups from the perspective of a facilitator. Specifically, the author draws on her experiences as a mental health rhetoric research scholar who has facilitated nearly 100 hours of discussion and writing-based support groups for fellow survivors of domestic violence at a women’s center in the southeastern United States. Her analysis attends to recent criticisms of “support” as a misguided mental health intervention that divests members of narrative agency, discourages political activism, or otherwise exacerbates the distress it would relieve. Studying how one organization constructs the goals of its support groups in facilitator documents—and reflecting on the scholarly and experiential knowledge that informs my discursive practices as a facilitator—the chapter argues the para-therapeutic rhetoric of support groups serves an essential function in clarifying participants’ past and present relationships to mental health. Ultimately, non-traditional care settings like support groups present an unexpected opportunity for mental health rhetoric research scholar-citizens to be “useful” to their communities by facilitating expressions of uncategorized, but nonetheless transformative, distress.
Part Two: Legal, Cultural, and Institutional Interventions
Chapter 6: “‘Women of Dignity and Grace’: Politics of Respectability in Alcoholics Anonymous.”
Stephanie Kelley-Romano and Lori Joseph
This chapter explores the ways that women make sense of their lived experience in getting, and staying, sober within Alcoholics Anonymous. In articulating these interpretive justifications, the chapter intervenes by giving voice to women’s lived experience and identifying sites of tension between expectations of respectability and the authenticity of self. To capture this tension, the authors reply on ethnographic observations from meetings of Alcoholics Anonymous, informal interviews with women participants, and AA “speaker tapes” to understand how women integrate lived experiences often marked by stigma (criminality, promiscuity, and violation of traditional gendered roles) into their recovery journeys. The resulting analysis identifies the rhetorical strategies (including redefinition, humor, and transcendence) instrumental to constructing a coherent narrative of recovery for women which remains confined within the bounds of “respectable.”
Chapter 7: Rhetorically Knitting: New Chinese Moms Fighting Postpartum Depression
This chapter addresses stigma surrounding postpartum depression in China where the condition is often erroneously believed to be the result of new mom’s weakness or her negative feelings. As a result, postpartum depression is often misdiagnosed and thus not treated properly. Since postpartum depression ranks second among China’s top mental problems and Chinese public awareness of postpartum depression is very low, many women do not seek psychological help, avoid medical treatment, and receive little support from their families for their postpartum depression. In some cases, the condition is an aggravating factor of self-harm and suicide. Through a case study, rhetorical analysis and the rhetorical approach of Burke’s identification, and drawing on secondary sources such as the interviews of the depressed new mom and coverages of her in news outlets, this study analyzes how the depressed mom Mao Wan fights depression by knitting and posting her knitting objects in social media; how she creates a knitting group via social media to teach other depressed moms across China knitting skills or share their embodied depression experiences to fight postpartum depression; and how the depressed moms of the knitting group use their knitting cute animals, clouds and waves to decorate the shopping street in Shanghai’s Pudong District to bring attention to postpartum depression. These women knitters, the author argues, actively participate in shaping crucial spaces for identification in online and real-life spaces.
Chapter 8: Without a Defense: Developing and Articulating Legal Interventions in MHRR
Mark Hannah and Susie Salmon
Changes to laws regarding insanity plea defenses in 5 U.S. states (AK, ID, KS MT, UT) have created a new mental health reality for mentally ill defendants within the U.S. criminal justice system. In particular, the removal of the plea as an affirmative defense leaves these defendants vulnerable to unjust legal consequences. The proposed chapter outlines a framework for technical communicators to act as intermediaries between support stakeholders and help those stakeholders develop and present arguments that combat stigmas associated with insanity defenses and also support defendants’ claims they are not criminally responsible for their actions. Through a case study of a change to the Kansas insanity defense law, the chapter examines relevant legal documents (briefs, transcripts, opinions) that formally shape how the defendant is perceived and represented as either having or lacking the requisite legal intent to act. To complement this analysis, the case study will examine press items (newspapers, magazines, blogs, websites) that informally shape public perceptions of the defendant. Through comparing the formal and informal representations of the defendant, the case study will explicate how technical communicators can prepare for and identify emergent intervention points within a legal case and then later function as co-producers of the law when acting as intermediaries in the support networks.
Chapter 9: An autoethnographic exploration of anti-stigmatization efforts in the black community and beyond
This chapter argues that mental health is an integral part of one’s overall health and well-being. Thus, like physical wellness, it is imperative that one seeks assistance to improve their mental wellness when needed. However, the stigmatization of mental health and illness is arguably one of the biggest inhibitors of people seeking assistance to improve one’s mental health, especially within the Black community. Certain cultural and contextual factors have led to the discursive normalization of mental health and illness stigma within the Black community. Yet, the chapter argues, these various discourses are being resisted by community members to destigmatize and promote healthy mental wellness. Although such efforts are becoming more prominent, stigmatization is still high and due to this stigmatization people tend to mostly confide in others whom they are closest to. Presenting a rhetorical autoethnography, the author presents a critical analysis of how displacing one’s emotional load onto a loved one can lead to high self-awareness and that such moves can add to anti-stigmatization efforts in the Black community and beyond.
Chapter 10: “Fixing” Joe: A Firsthand Account and Rhetorical Study of Blurred Diagnoses, Insufficient Interventions, and Devastating Outcomes
This chapter focuses on the concept “anosognosia” via the case of antisocial personality disorder. The author works through a set of rhetorical lenses, mediated by her autoethnographic observations alongside her knowledge of diagnostic practices and attendant artifacts. Through delving severe psychosis and on a controversial concept used to justify forced treatment on the one hand and to account for resistance to health/help-seeking/compliance/concordance on the other, the chapter breaks new ground in mental health rhetoric research. Ultimately, she uses her autoethnographic data to complicate the term and to show how it hasn’t led to effective change, but it has animated diametrically opposed viewpoints on mental healthcare. The chapter concludes by using the analysis to offer up an alternative intervention.
Part Three: Pedagogical and Co-Curricular Interventions
Chapter 11: A faculty workshop to dispel misunderstandings of students’ mental health
Addressing the challenge of educating faculty on mental health realities, this chapter begins with an anecdotal account of an assignment she encountered in her university’s writing center; the assignment asked students to use textual evidence to prove that a character had a mental illness. Parsing the ways such assignments perpetuate stigma, the author describes how she sought to combat the stigmas and misinformation surrounding student behavior and mental health through creating a faculty development workshop (in cooperation with her counseling department) that emphasizes scenario-based learning and narrative analysis of selections published on The Mighty for an audience of instructors. The goal of these workshops as interventions is to encourage faculty to practice empathy when students appear to be disengaged and to recognize that what appears to be disengagement may also reflect sincere mental health struggles that students may not wish to share. The chapter outlines the ways that this workshop sought to function as a method of teaching rhetorical empathy to faculty.
Chapter 12: “Do you feel like :(”: Discursive interventions in university mental health rhetorics
Leslie Anglesey and Adam Hubrig
This chapter draws on mental health rhetoric methodologies rooted in textual analysis. Drawing from a pool of US university websites, the authors gather a corpus of public-facing resources as they pertain to mental health services. Combining textual analysis with grounded theory for coding to create a mixed methodology, the chapter explores how universities construct mental health within their institutions. By applying concept coding and value coding, the authors demonstrate how universities create complex discourses around mental health that, on one hand, normalize and destigmatize mental health, but on the other hand, prioritize student productivity as a primary impetus for mental health services. The chapter concludes with ways to intervene in the rhetorical project that frames the university as mental health champion while placing the onus of mental health care on its students, ignoring the institutional role sites of post- secondary education play in contributing to and exacerbating anxiety, depression, and other mental health concerns while minimizing a need for institutional change.
Chapter 13: Online University Mental Health Tools: Narratives as Interventions
Rachel Blasiman and Barbara George
This chapter applies a rhetorical lens to understand the ways that narratives can shape how students “read” and engage with online mental health support tools offered at a small midwestern university. In an effort to end stigma surrounding mental health and to encourage mental help-seeking, universities have developed online mental health supports for students. These tools have shown some promise in de-stigmatizing mental health, but there are questions about how students access, perceive, and use online supports, resulting in calls for more research to evaluate online mental health support tools offered by universities. The authors respond to that call by using data from focus group discussions to illuminate whether different types of contextualizing narratives paired with online mental health tools impact students’ emerging understanding of mental health definitions. The data is presented in two parts: First, the authors apply discourse analysis to assess language patterns in the existing online mental health support tools to determine whether the online tools present mental health concerns in a clinical or narrative language pattern. Next, they compare students’ emerging mental health definitions and responses to different narrative frames across three experimental conditions: online, instructor-led, and counselor framed narratives. The chapter ultimately explores multiple framing narratives to highlight how these narratives impact student mental health-seeking behaviors and understanding of mental health definitions.