Abstract

My research examines the rhetorical strategies at work in the community discussions regarding the development of the new Diagnostic and Statistical Manual of Mental Disorders (DSM), especially as related to Generalized Anxiety Disorder (GAD). I have the unique opportunity to be one of the first to collect and contextualize the rhetorical conversations that are facilitating the development of the DSM-5. Throughout my research process, I will annotate changes related to GAD throughout the four DSMs; examine DSM-5 development and work group publications from the American Psychiatric Association (APA) and the National Institute of Mental Health (NIMH) related to GAD; and conduct before and after interviews with approximately fifteen practicing psychiatrists about their experiences with the DSM diagnostic guidelines, DSM development process for GAD, and DSM revision process.

Poster Session 5: NR5-17

Community Discourse and Rhetorical Strategies in the Development of the New Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Kelsey OConnell
Elon University
Research Funded by Elon University Lumen Scholarship

Context
Professional Writing and Rhetoric (PWR) has a long history of exploring complex communities like social work and engineering. This research is looking into the mental health community and the text that governs their work, the DSM. This research asks: what are the community-building rhetorical strategies in the DSM?

Community Building in DSM Forwards

What rhetorical strategies are used in the community building featured in the forwards of the DSM editions?

Community Building in GAD White Papers

Citation Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, Rapee RM, Ruscio AM, Stanley MA. Generalized Worry Disorder: A review of DSM-IV Generalized Anxiety Disorder and Options for DSM-V. Depression & Anxiety, 2010; 27:134-147. Countries of Origin Australia, Germany, and USA Purpose & Methodol- Purpose: (1) identify the evidence that previous ogy DSM Work Groups relied upon to create criteria for the DSM-III-R and the DSM-IV; (2) argue for or against changes to the criteria for generalized anxiety disorder Lit review of Annotated Listings of Changes in each DSM, the DSM-IV Sourcebooks, the DSMIV Options Book, and manuscripts relied on/or published by previous reviewers of GAD diagnosis Databases searched: SCOPUS, GOOGLEBOOK, MEDLINE Definition of GAD Generalized anxiety disorder (GAD) is a chronic and impairing disorder, interdependent of its substantial comorbidity with other mental disorders. Although it shares some risk and clinical similarities with other internalizing/emotional disorders, it can be distinguished from these disorders. Style of Writing Clear tone common of lit reviews Slightly casual Example: The classification has thus progressed beyond treating GAD as a residual category or the confusing stepchild among the anxiety disorders as it was in DSMIII. Ethos Wide range of source types Grant funded Example: Contributors qualifications displayed on the first page Beesdo, K., Winkel, S., Pine, D., Hoyer, J., Lieb, R., & Wittchen, H.-U. The diagnostic threshold of generalized anxiety disorder in the community: A developmental perspective. Journal of Psychiatric Research 2011; in press. doi:10.1016/ j.jpsychires.2010.12.007 Germany, Switzerland, and USA Purpose: argue for and against changes to the criteria for generalized anxiety disorder, particularly the youth-related criteria. DSM-IV GAD was assessed using the M-CIDI in a community sample of adolescents and young adults. Diagnostic thresholds were modified in two age spans (9-20 and 21-34) using a person by year data file (N=38,534 cases). Statistical analysis

DSM-I

Rhetorical Strategies Definition

Pathos

Ethos

Logos

Tells the story of the origin of a community

Appealing to emotion

Persuading the audience of the credibility of the author

Appealing to reason Utilizes the language of a creation myth

GAD, instead of being defined for this article, is described through a history of the DSMs criteria for GAD.

RHETORICAL TRIANGLE
AUDIENCE

Serves to legitimize the rest of the text within the mythos of the community, thereby lending ethos to the rest of the text

Dense, though logically organized Places emphasis on facts Technical language Example: Focusing on one relaxed criterion, GAD rates in the total sample increased by 60.0% when duration was required to be only three months and by 46.7% when anxiety was not required to be excessive. Extensive citations Professional charts and tables Grant funded

DSM-III
PURPOSE Tells the story of the origin of a community
Pathos Logos

Example: This work is part of the Early Developmental Stages of Psychopathy (EDSP) Study which was funded by the German Federal Ministry of Education and Research (BMBF) project no. 01EB9405/6, 01EB 9901/6, EB01016200, 01EB0140, and 01EB0440. None evident None evident Results, text moves through the DSM-IV criteria, Very few statements are made by the author logically addressing each point of controversy without backing from another source Example: DSM-I Criterion A: The Nature, Focus, and Duration of Anxiety and Worry moves into DSM-V Options for the Excessiveness Requirement. Writing is slightly more casual Emphasis placed on organization Lit review placed in study format Example: DSM-III (APA, 1980) defined GAD as generalized, persistent anxiety of at least 1 month duration accompanied by an unspecified number of various other symptoms. Writing is dense, scientific Emphasis placed on logos appeals Typical study format

SPEAKER

MESSAGE CONTEXT

Lays out the underlying values and beliefs of the community

Observations

Methods
Forwards Neo-Aristotelian analysis focused on the DSM-I and DSM-III Creation Story framing: They tell the story of the origin of a community. They layout underlying values and beliefs of the community. They serve to legitimize the rest of the text within the mythos of the community, thereby lending ethos to the rest of the text.

Major Findings
The forwards are individually and collectively the creation story for the mental health community. The forwards utilize rhetorical strategies to build, bolster, and continue the mental health community.
Rhetorical Strategies

DSM-I
Armed with this wealth of thoughtful material Descriptive language Use of examples Main Points DSM is necessary DSM is backed by valid associations The community wants the DSM

DSM-II
DSM presented as proper and entitled

DSM-III
More standardized language DSM portrayed as a product

DSM-IV
Formal, uninterested writing Euphemisms Technical language

References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 1952. . Diagnostic and Statistical Manual of Mental Disorders, Third Edition. 1980. . DSM-IV-TR: The Current Manual. n.d. 31 October 2011 <http://www.psych.org/MainMenu/Research/DSMIV/ DSMIVTR.aspx>. Bloor, G. and P. Dawson. "Understanding professional culture in organizational context." Organizational Studies (1994): 275-295. Campbell, Joseph. Myths to Live By. Arkana: The Viking Press, Inc., 1972. Coopman, S.J. and K.B. Meidlinger. "Power, hierarchy, and change: The stories of a Catholic parish staff." Management Communication Quarterly (2000): 567-625. Coupe, Laurence. Myth. London: Routledge, 1997. Cupitt, Don. The World to Come. London: SCM Press, 1982. Dundes, Alan. Sacred Narrative: Readings in the Theory of Myth. Berkeley: University of California Press, 1984. Freund, Philip. Myths of Creation. New York: Washington Square Press, Inc. , 1965. Grob, Gerald. "Origins of DSM-I." Am J Psychiatry (1991): 421-431. Hackett, T. "The psychiatrist: In the mainstream or on the banks of medicine?" American Journal of Psychiatry (1977): 134, 432-435. Hale, N. The rise and crisis of psychoanalysis in the United States: Freud and the Americans, 1917 -1985. New York: Oxford University Press, 1995. Herman, E. The romance of American psychology: Political culture in the age of experts. Berkeley: University of California Press, 1995. Horwitz, A. Creating mental illness. Chicago: University of Chicago Press, 2002. Keyton, Joann. Communication & Organizational Culture: A key to understanding work experiences. Thousand Oaks: Sage Publications, 2005. Kirk, Stuart and Herb Kutchins. Making Us Crazy. New York: The Free Press, 1997. . Selling of DSM. New York: Aldine de Gruyter, 1992. Leeming, David Adams and Margaret Adams Leeming. A Dictionary of Creation Myths. New York: Oxford University Press, 1994. Lunbeck, E. The psychiatric persuasion: Knowledge, gender, and power in modern America. Princeton: Princeton University Press, 1994. Mayes , Rick and Allan V Horwitz. "DSM-III and the Revolution in the Classification of Mental Illness." Journal of the History of the Behavioral Sciences (2005): 249-267. Menninger, Roy W and John C Nemiah. American Psychiatry After World War II,1944-1994. Washington, DC: American Psychiatric Press, Inc., 2000. Mohan, M.L. Organizational communication and cultural vision: Approaches for analysis. Albany: State University of New York Press, 1993. Raines, George. "Foreword." Association, American Psychiatric. Diagnostic and Statistical Manual for Mental Disorders. 1952. Spitzer, Robert. "Introduction." Association, American Psychiatric. Diagnostic and Statistical Manual of Mental Disorders (Third Edition). Cambridge: University of Cambridge, 1980. 1-12. Sproul, Barbara C. Primal Myths: Creation Myths Around the World. New York: HarperCollins, 1991. Taylor, J.R. and E.J. Van Every. The emergent organization: Communication as its site and surface. Mahwah: Lawrence Erlbaum, 2000. Thury, Eva and Margaret Devinney. Introduction ty Mythology: Contemporary Approaches to Classical and World Myths. New York: Oxford University Press, 2005. Trice, H.M. and J.M Beyer. The cultures of work organizations. Englewood Cliffs: Prentice Hall, 1993. Van Maanen, J and S Barley. "Occupational Communities: Culture and control in organizations." Research in Organizational Behavior 1984: 287-365.

Generalized Anxiety Disorder Neo-Aristotelian analysis of representative white papers Interviews with practitioners

DSM-II contributes to US and world psychiatry

Promote new axial structure DSM-III is the most accurate yet

DSM growth is necessary Emphasizing accuracy