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    Psych Motivation Textbook

    Uploaded by

    Hailey Coutu

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    © All Rights Reserved
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    CONTENTS is of tastrations and Tables i Acknowledgments s Introduction: Depression and Gender in the ‘Age of Self-Care 1 1 Depression, a Rhetorical ilness 8 2. Articulate Depression: The Discursve Legacy of Biological Psychiatry a 13 Strategic Imprecsion and the Self-Doctoring Drive e 4. Isolating Words: Metaphors That Shape Depression’s, Identities o 5 Teling Stories of Depression: Models for the Gendered Self ue 6 Diagnostic Genres and the Reconfiguring of Medical Expertise ws ‘Conclusion: Toward a Rhetorical Care of the Self 180 Notes 9 Index 209 Introduction Depression and Gender in the Age of Self-Care ‘Aca*menta ines.” depression sits at the intersection of physical, cognitive, sc utmotional realities; itis particularly vulnerable to the means ofits own arfeanton, Without diagnostics such as blood tess or X-ray imaging, depres” vor becomes visible or remains invisible through the language used to Teaibe i, Thotlanguegetrom pharmaceutical advertising slogans to epi- “Temlologial models of the liness's frequency, rom cologuil phrases such as ofan te blues” to diagnostic terminology such as “pchomotor agitation or eurdation” both refecs and shapes contemporary attitudes toward health ceatiners, and in particular toward gendered expectations of whois wa ‘leand of whose responsibility it sto maintain individual well-being, tn the decade spanning the turn ofthe twenty-frst century, publi talk about depres Gon seemed ubiquitous in the United States. Diret-t-consumer advertise foents for entidepressent medications began to sppear in print magasines and ton ibe radio and television, ae result ofa 1997 Food and Drug Administration (fA) ruling tat relaxed restrictions on ths form of marketing, Peter Kramer's Desiselling book Listening fo Prozac, originally published in 1993, was revolensed with a new efferword in 1967. And, Bizabeth Wurtze's popular ‘manoir, Prozac Nation, published in 1994, was made into a fstare film starring (Cristina Rice and Jason Bigg in 2001 Indeed efter the 3987 FDA epproval of ‘reac the ist of a new clas of antidepressants, depression became a much tnare commonly discussed lines. ln his 2001 memoir/encyelopedia of depres- Hon, Andrew Solomon remarks that “everyone and his uncle Bob seemed to be feting depressed and battling depression and aking about baring depression {his cacophony produced a sent of progress—depression was no longer & ‘Shumeful secret-and it fostered a eres of rhetorical forms that articulated the ilnss and the identities of ts suflerers. Such language patterns, for example, the definitions, metaphor, stock characters, and diagnostic genres that recut 2 BLACK DOGS AND BLUE WoRDS ‘throughout talk about the illness, constitute a discourse of depression that encourages what cal “self-doctoring™—an incressed attention to one's own, health and, indeed, one's gendered sel Prartces of sel-doctoring define the contemporary mental health expert fence an shape its activities and interventions. na 2007 New Yorke carton ty Wiliam eft, a woman seated ether computer asked by the man who walks behind her, “How's the setdiagnoss coming” (igure 1)? The vignette ny ‘because itso succintl captures the migration of medical authority frm doc: ‘or oe to individual, computer-mediated reflection. The woman's ci) ‘described by her companion as sel-diggnosis"—can be read in at lest two ays. Sis serving as her own doctor, diagnosing her own potenti ins end ‘thereby sequring the authority traditionally granted to medical profesionals And. he is also investigating herself, moaeuting it againet a tandard prvided bythe islormation she consumes online. In ech case though, ex presumsbly "How the self-diagnosis coming?™ agnosis cartoon, 2007. (© The New Yorker Collection 2007 the sli-dagnostic quizes really avallable on consumer Web sites—mediate per epert" and "patint” identities The cartoon displays growing ellance on {interactions between isolated individuals and the texts that construct health fad ilsess. The woman's companion does not look at her ashe passes; there i fo indication that she ls in dialogue with anyone else; her Sl- diagnosis isa tmonoagcal practice (which ie pat of what the cartoon parotie). "The woman's apparent sel-ellance reflects a growing sense of patient empowerment in the late twentieth century, particularly in tx realm of mental healthand illness Recent advances in treatments for mental linesses such es depression have been widely publicized and discussed in popular media, and Information about bot illness and trestments have become ready avallable to individual patients ‘This self-eliance results in part from the rhetoris of patient self ‘ermpowerment that characterized the lat twentieth Century particularly in the realm of menial Health end ilinss, As health-care information has become tmore accesible, new regime of selfdocioring practices as developed, fone that Amy Harmon documents in the New York Times és a trend not only toward self-diagnosis but also toward self-medication. Harmon writes “For a sable group of people in their 20s and 30s, deciding on their own what drugs to tale—in particular, stimulants, entidepressants and other psychiatric rmedications—is becoming the norm. Confident oftheir bilities and often ‘Skeptical of payhlatit’ expertise, they choose to rely of hlr own research ‘and each other's experience in treating problems ik depression, fatigue anxi- fora lackof concentration. A medial degre, in their view, i useful, but not ‘essential, end certainly not suficlent" For these individu nesses such as Gepression become research projects es wells, or perhaps more than, medical ‘onditons and this is one result of the availablity of ealit-cee information in forms accesible to nonspecialists. Harmon's young people want “to feel better-less depressed, less stressed out, more focused, better rested," and they fall these desires by self-doctoring practices that include monitoring indl- vidual symptoms, researching pharmaceuticals and ilneses, and using the personal experiences s diagnostic euthority. language underites these prac- tices cf sel doctoring: it provides the justification fr attening tothe self as 8 site for medical, oten pharmaceutical intervention, it unlike Harmon's ebjers, wr are all doctors. or atleast dispensers of medical wisdom, in thie new age of self-care. Whether we research potential allments online, note particular pharmaceutical advertisements in favorite rmaguines or on television, or conult health-care engjlopedias and selP-help texts, we are preoccupied not onl with our potential sed agnoses but also in sharicg the results of our investigations. That we can now casually discuss pre= scriptions for Prozac and courses of hormone replacemen: therapy indicates, 4 ___ BLACK DOGS AND BLUE WoRDS ‘of day ie and, on the other hand, an increased monitoring ad regulating of Individual bodies * The ability to discuss mental linesses such as depression openiy and honesty has certainly helped many individuals seek treatment for serious problems. But, just as surely, the openness has also trained medical attention on individuals and behaviors once considered noma The develop ‘ment of new clases of antidepressants inthe late 1980s lad to new optimism about the tretment, even cue, ofthe illness. But alongside the burgeoning ‘pharmaceutical industry, an increased rhetorical producticn has fostered new racises of recognizing and responding to the sel and its health and/or lines, ‘ais talkand text reflects and helps construct the sates of health in con- temporary USS. society It requires practices of seli-care, both eal FFeguling and sel'doctoring behaviors seh asthe increased use of drugs and alternative ‘herapes, and, also, potentilly more rhetorically sophisticated responses ‘8: wel. The language through which we experience and express our health (or illness) plays @crcial role in preparing our physical eves fr medial inter- venti, This, then isthe power of such language: it can precipitate ation by ‘mapping the cognitive terain and persuading us that we are (or are not) in ‘ed cf treatment, and itcan shape the forme of treatment towhich we are wil Jing to subject ourselves. To attend tothe language of mental health and ines |sto ind oneselt drawn intoa series of debetes, many of which are caried out In forms that leave unexamined the illness labels through which individuls, strug to define ther lived experiences. Inrecentbiethical and psychological scholarship, depression bas become ‘8 foca. point for arguments about “enhancement technologies," about the ‘validity of various categories of mental ines, and about the medicalizaton of ‘human emotion. in each of these debates, depression sometimes serves as ‘convenient example, but the definition of ines tet rarely receives clarifce tion through such uses For example, David Healey argues tat antidepressants such as roma are “one ofa growing numberof agents that modulate fees rather than cue diseases" His argument directs attention toward the uses of antidepressant medications that respond to social zather than biological needs, land it therefore lay the foundation fora retorcal examination ofthe produc tion of such social needs. Nevertheless, Healeys focus doesnot specifically ‘sccourt forthe hetoricl pressures that condition the prescription and inges- tion o! antidepressant medications. Similarly, Allan Honwits and Jerome ‘Waketia's The Los of Sadness suggests thet “what our culture ance Viewed a & reaction to filed hopes and aspirations it now regards as pchiati ness” Porwitz and Wakefield's examination ofthe role of prychisty in promoting this medicalization of sadness implies the power of rhetorical procestes, but ‘limatey focuses primarily the professional maneuvers ‘ht shape health- ‘are practice instead ofan the specifics ofthe words and genres through which sed about depression—anguage that is often metaphorical (as in the expres sion “the black dog of depretsion” and figurative ($i the blues"}-hs gone ‘unremalked and unexamined Ths sa significant oversight since the struc tures of language fundamentally shape, rather than merely reflect, catural sssumplions. Recent studies have yet to produce an adequate account ofthe role of guage inthe procesesof defining depression and shaping thellness identities eallable in te twenty-first century. This is my project in the follow: Ing pages: to interrogate the rhetorical forms—the definitional words, ‘metaphors, typical stores, and genses—through which depression is exressed. experienced, and treated inorder to understand the gendered lines dentiies that arevaiable for adoption and, perhaps, rhetorical edeptation, Depression’s Imperative: Sel Doctoring for Social Recognition ‘illiamSyron scorns the term depression as “a noun with bland tonahty and lacking any magisterial presence... true wimp ofa word for such «major ilness.* Deriding the linguistic emascultion of depression (and perhaps ‘betraying an ansety about the potential feminzing power of depression ast is eurtenty constructed), Styron voices the common belle thet language is simply ¢ matter of vocabulary: replace the name and the lines will chieve appropriate recognition. By contrast, understand deprasion as an organizing principe that subject a range of symptoms and behevior to increased satiny ‘and medical intervention, Far from “lacking... presence” depression via ‘atonal environment, acquires and maintains broad and permeable bound- aie far example, so-called normal gre over the death ofa loved one may ‘shade irto depression ifthe symptoms pert long enough (over two months) ‘order socal fantionin” too much, This potential for slippage rom grief tonsa potential that s measured by standards articulated in tems Such "social funetioning™relforces the need for close stention to the language ‘that exressesatfectve experiences and peoriances ofthe sell. Depiession, 15 contellation of textual, social, and gendered experiences, offers animpor tant site fr exploring the language of health care andthe discursive shaping: of ilnes identities. As Iwill discuss in more detail in chapter 3, the bolce of terms for depression, especially the categorical terms disease snd ies, pertcularly fraught. Medical anthropologists end sociologists distinguish _beneet dss, a biological malfunction, end les, a socal experencs ofthe ‘body, inorder io nalye diferent calturel response to health statuses, Decause ‘Tam interested in the contemporary social construction of depression, will relerto:t as an ns rather than asa dias, endl ntend to explore therhetor- ical tramework through which individuals interpret their alfectve experiences ‘ather than the biologicl or neurochemical structures that may contribute the rapid deployment ofa new form of public communication about ineses ‘and svalable treatments. There milestones mark high points i the popularity ion, oer longer explorations of dep snes articles posibly can tn adation, these texts areften rms of comfort, identiice search Newsweek and the New York Times from January 1, 1985, through December 31,2005. The resu so ctve pressures published or revise after 2000 (8 texts, 18,868 words) nalyable collection compres 239 articles and 238,035 words added first-person memoirs of depression published in frame. I chose five single-author texts writen by men, 0 BLACK DOGS AND BLUE WORDS ‘and Stephanie, an undergraduate inthe hum Included four mental health profes Inall of my interviews, used an ethnographic methodology to ‘demographic and ‘r0ups of women provde an important balance o my analysis of news end pub lic informational texts about depression, Thee conversitons provide evidence ‘ofthe persuasive power of the discourse that both defines and resists defining jon too narowiy atthe turn ofthe twenty-fist century They aio sug {est moments when individuals can challenge the discourse and make personal ‘se of the language through which they must experience and expres health and ilines. characters, and ge Aeseribe below—encourage practices of selt-doctoring that ‘the submission ofthe self to medical and chemical interventions these may be appr td for thos of dectoring that currently prevail, follow explore structural phenomena within the dis- 0 provide a more nuanced explanat viduals are complied to perfor ions, these chapters expos for exploring the con- struction of gendered health and lines identities, Chapter 2 describes in more ‘emphasize Literate and semi- seem to work against monological responses, opening (Chapter 6 begins withthe genre {eal genre theory, which holds that genres ae social actions rather than static BLACK BOGS ANO BLUE WORDS 1 patients, Inviting users to diagnose themselves, the genre performs asa refer ring physician, challenging the traditional authority vested in primary cae doc practices of self-doctoring, borrow fram mlipe disciplines to imag ine series of dialog «also on the promotion of individuals rhtoia ses of such const “chairperson (which collected mixed sex images)—despte the then-current 1d even geographical ched to madness—the the rapid delnstitutionalization of the men- pears natural and inevitable due to another change in medical rheto- BLACK DOGS AND BLUE WORDS spor ‘complex understanding of gender, the sl, and mental helt ‘The current character of depressio ther than the acceptance 1 BLACK DOGS AND BLUE WORDS sets recognized a loss of pleasure) and what gets ignored ultaneously reinforcing norms abou toning, and gender roles, Compulsive Storytelling: Authoring the Prozac N The discourse of de nearly a quar- ter of her acquaintances are taking antidepressants, This number doesnot sut- ‘The Rhetoric of the DSM ‘the American Peychiatric Association's Diagnostic and Statistical Manual of ‘Mental Disorders (ne DSM) functions a & master genze tha coordinates much discourse of depression, I ocupes the rarefied and rarely questioned ‘categories serve a varie ol experiencing the symptoms "The DSM, published in 1952, and al ofits successors contain various ds- fen further confuse the thresholds between everyday iences and medica ym least paral) accepted the biochemical ines identity ton ress on the medical stu diagnosis wll produ BLACK DOGS AND BLUE WORDS surround them. The desire o provide “larity of language" to find objective and translerable strict language hope to cont _bsM as much as they do to confine the mesnings ofthe wor DEPRESSION, A RHETORICAL ILLNESS as and a fourth may be met only "observed by others retardation) These modes of ascertaining symptoms and its interactions, and they involve individuals and ther close acquaintances {in their own diagnoses. Despite this invitation to participate, only one of the ‘Self-Monitoring, elf-Modeling, and the Persuasive Power of Depression ‘very heat of being human." Indeed, the serves to confue its definition, according to David Karp, Jackson and Karp seem to conflate an emotional sate with lines: in common it doce to mental lines. Such lexical imprecision encourages the potential for psychopharms perception. after the conclusion of her treatment with Protac, one of Kramer's fined Tes's understanding of what was essential to her and what was Sntrusive and pathological * 3 and visible representations of health and iness through which the selfs experienced, Depression’s Apparent Gender The consequences of gender are deemed appropriate for one 2 BLACK BOGS AND BLUE WORDS DEPRESSION. A RHETORICAL ILLNESS ” 1 group. Kramers pronouncement—that deprssives make bad ing of depression, end, further reports: women are more likely to appear depressed than men. Whi depression constrats women in general ae be considered en established scientific fact, it has also taken on the gue of ‘undesirable, both of which ental addivo selffulling prophesy. women to ameliorate. Men do not escape the discou strong, sllent men are jut as In fact, men are represented as tan to adit thei feings of preston, ‘The messages women and men de more than medical vie. changing e sell-doctoring ton of emotion int 2 BLACK DOGS AND BLUE WORDS Cheyer nated ates nat states enc het of esl which understand linens aches depesion hou delgad rather ten orl engeenent ih texts sens a eaten ‘nig oa of deasin ins has he pen ine somo fl nin rte eon pe i of tar ntrveton, which ny rm, tml or eaten dein or nd Tat, taal eas hp ay fom ator ccs doctring nos more vee melee Strategic Imprecision and the Self-Doctoring Drive strategic pre Such structures blur the bou ferperience and symptom, largely by dep ‘vocabulary that has come to sign as this strategie imprecision res potential to overshadow necessery forms of sl fstenton tothe long historical record of depression and melanct ‘yoluminous archive that similarly fils to circumscribe the Burton's Anatomy of Melancholy, published in five ever-expanding edi tnd 1638, grows, as Wiliam Gass describes fargantuen” Burton's obsessive tinkering with and additions to his ext reveal ‘more than his personal fascination: his encylopedic work collects folklore and ‘mythology alongside the scentifc discoveries of his eri testifies toan already generative illness experience, Amid these rames, depression exists asa more complex and multifaceted experi the sll than the contemporary discourse grants Inthe late twentieth ‘and academic studies of the ilinese. But these texts while nevertheless offering a very limited texts that I assembled, attempts 1 contain it ven the most cursory i revels ness, Robert gue [A fist, this seems fo counter the needs of biomedicine, where a precise What Is Depression? Under the heeding "What i a Depressive Disorder the NIMH general Interest pamphlet, Depresion, provides the following explanation: “A depressive disor- eri an ness that involves the body, mood, and thoughts It affects the way & person eats and sleps, the way one fees about ones, andthe way one thinks 66. BLACK DOGS AND BLUE WORDS ss well Elen, psychiatrist, speaks next ELLEN: Tagre that you see alot of ditferent faces of depression. And I always have to clarity with people. ‘And, frequently they have a ‘people, being depressed means they STRATEGIC IMPRECISION 6 ‘means? Elen’ encounters with patients ‘more cl becoming depres ‘al definitions take precedence over clinical or professional di practice runs os BLACK DOGS AND BLUE WORDS STRATEGIC IMPRECISION IOAN: ~absolutely= FLLEN, oh yeah= laughs) don’ know, ues it depends on who you ae ad what themselves as depressed. They do so in response ‘the illness ie communicated, language tht tan toms and people into patients anguage through which experience into symp. “Semantic Damage”: The Vocabulary of Hiness ‘experience with depression: ere was this thing called depression that was not definable in any sort, STRATEGIC IMPRECISION ‘uncertain and occasion heightened social negotiation and monitoring, A isase model of depression appears to sult pharmaceutical companies~thd! hear disease or cancer tard to think of mental illnesses in the same way as {we] think about thin the contemporary discouree. For Peter sbout depression—inclding, presume 6 BLACK DOGS AND BLUE WoRDS five times, while the phrase mental disease occurs only once in the neatly 240,000 words. This suggests wht we ultimately know: depression i discussed Frequency of Clasiicatory Terms for Depresion inthe Corpus Teal Defing Percentage of eeurences Depresion Taal Defitons 266 50 36 2950 8 535, oy taken fom research corpus of contemporary language 2008). 7 2 BLACK DOGS AND BLUE WORDS STRATEGIC IMPRECISION 3 les commenting on med tobe less rerpen- depression signals an state Danquah and Manning both acept, even expect, aleve of depression in “Modifier for Depression in the Corpus Moder No. Moder Ne Modifier Major 6 6 Moderate Chie 29 Serious at Normal 6 Source amples then from research corpus of contemporary language shout depression (984-2008. BLACK DOGS AND BLUE WORDS STRATEGIC IMPRECISION a The Ambiguous Logic of Not Statements they nevertheless confuse the boundaries confusion leds to both over and underdiagncssby indivi ‘represented primarily by proponents ofa biocbe labeling depression a brain disease, as one then all women of childbearing age fons of depres ‘son, the continuum provides an important underying cognitive structure that anchors depression alongside everyday emotional experiences” Solomon's pi depression isan excess of something common’ works thresholds, offering only quantity as an imprecise measure “a many as one in sx people” wil some time in thelr lives" The warrant ad leaving the reader not Headlines Linking Dep fon and “the Blues" ating Having a Bad Hai Dayo he Sout ‘Rythm and the mies Online and Bummed Out Don't tet Your Buby ues Go CodeRed ven CFOs Get the use Five Yeus Old and Already Blue taken ffom research corpus of contemporary language ‘Complications and Co-occurrences: Depression and Heart Disease ‘Asan argument for calturally accepted oo BLACK DOGS AND BLUE WORDS STRATEGIC IMPRECISION 8s including complicating other son! experience encourages 0 forthe sake of a productive economy. Assimilatng generic “sk” of nest into Individual identities proves tobe one ofthe ton of gendered identities ie sements of Women's versus Men's Risk of Depression ikstatement By oficial counts, women in this country become depressed at ney twice es ken trom research corpus of contemporary language shout depression (1985-2005) oe BLACK DOGS ANO BLUE WORDS fre brave enough to seek help... Confronting depres: More often it's about restoring shaw, when asked what be tnd other articles wor to maintain gendered social performances, particulaty in statements such as “Getting help with depression is a consistent wits 7 aut: Mn me, xe why LAURIE: Two to three to one. Two to one, Two to one; hee to one. One way or the other. depends on age groupings and things les of being helps, or we're expected tobe helpless, real setup for somebody becoming depressed fomweRs: Maum hmm, ater puberty women show more depression than men.“ The mythic quality of ‘there numbers serves a foundation for other social and cultural responses to epression y campound teem Meiteaton Worth Help cited Py Appraisal STRATEGIC IMPRECISION a ‘Compounds with Sef inthe Corpus compound Compound cure Herm Ccontot Deprecating Diagnosed ing (Guardianship Hypnosis bested Soothing Isolating Words Metaphors That Shape Depression’s Identities woros 9s the most common metaphors. he recognition and rite uch about contemporary p tance of sympathetic communication, for exam 96 BLACK DOGS AND BLUE WORDS ISOLATING WoRDS 9° DSM eriterion of “psychomotor retardtion™ prevailing understanding of an imbalance be and also structure our behavior inthe world ‘nreasingly isolated and responses to depression become retricted to matters Canonical work on cognitive metaphors demonstrates, for example, that eren- of chemistry oof individual se help. As suc tational metaphors suchas uri coo0 and pow AD ae roted in the relies encourage narrow practices of rel-dostoring ofthe term—for enemu/enamie, 5 5 dhs proven tobe a tractable Pychological problems, bess, ate an because depression shouldn't be yet another i oe ? Ral: ii Bgat3 £ . gaeii 23 gipigeed ld) + eogelF se PERG eele) ze PllGaeele i LEHI zt Be fe elt ST 2/68 ial! aiid < a i ica tat I asim emphasize the ing depression* inclade and “her primte ‘depression. Battling depression does nota ‘an also mean fighting forthe self and is representation, atin Jong battle with the stigma of her disease. In this instance, again, the battle turns inward is significant, though perhaps unsurprising ‘that these examples are predominantly frale. The lexical eld fr battle woul at iret seem to suggest a masculine colloction. However, when the battle ‘understood as primarily intemal and interpersonal, a isthe cage inthe dis ‘course of depression, the arsociation with women becomes a manifestation of struggles with themselves, do not conform to the prom Their and che ntany—that surg! srt" s possible ax

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