Strategic Interventions in Mental Health Rhetoric

Lisa Melonçon, Cathryn Molloy, Lisa Melonçon, Cathryn Molloy

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000534962
• Edition: 1
• Topic: Filología
• Subtopic: Retórica

Offering rhetorically informed strategic interventions, this innovative collection moves beyond critiques of mental health issues, problems, and care. With sections that focus on methodological, cultural and legal, and pedagogical interventions, readers will find an engaging discussion of a discrete mental health phenomenon as well as a clear interventional takeaway in each chapter.

Contributors make use of critical discourse analyses, ethnographic inquiries, autoethnographic inquiries, case studies, and textual analyses to engage such mental health research topics as postpartum depression among Chinese mothers; insanity pleas; anosognosia; issues of intimacy, access, and embodiment in research projects; community support groups; Black mental health; women in Alcoholics Anonymous; and mental health in faculty workshops and university online health tools. The authors and editors create scholarship on mental health that explicitly builds productive methodological, theoretical, and practical bridges among scholars and teachers in the various specialties of writing and communication.

This collection will interest scholars, students, and practitioners in health and medical humanities; rhetoric of health and medicine; health communication; medical anthropology; scientific and technical communication; disability studies; and rhetorical studies generally.

PART I Methodological Interventions

1 A THEORY OF COLLECTIVE INTIMACY

Lisa Melonçon and Lora Arduser

DOI: 10.4324/9781003144854-3

As new fields, mental health rhetoric (MHR) and its sister field rhetoric of health and medicine (RHM) have embraced methodological mutability or creative approaches to rethinking methodologies, methods, and theories in ways that are responsive to specific, local projects (Scott and Melonçon, 2018). In doing so, the fields have introduced a number of new theories (see, e.g., Bivens, Arduser, Welhausen, & Faris, 2018; Campbell and Angeli, 2019; Kessler, 2020; Melonçon, 2018a) to frame research practice and to guide analysis and interpretation of artifacts. We follow this trend—as well as the interventional directive of this volume—to offer a theoretical intervention that can be used as a methodological framework.

Thinking of intervention as an invitation to create new theories and to intervene in existing practices, we offer the theory of “collective intimacy” (defined at length below). Our choice to theory-build has been conceptualized in the RHM chapter: “Theory building’ call[s] attention to the act of creating, extending, or adapting theory as an inventional practice and as a key contribution of rhetorical inquiry” (Scott & Gouge, 2019, p. 181; also see Scott & Melonçon, 2018). Creating a theory as an inventional practice allows an expansion of rhetorical inquiry such that it might adapt to changes in communication patterns. We illustrate theory-building via “collective intimacy,” which is a theory that offers a generative framework for understanding the multiple layers that contribute to communication practices in online health forums. In doing so, we participate in theory-building that “emerge[d] through the challenging of established patterns rather than through attempts to put the bits of the jigsaw back together” (Alvesson & Kärreman, 2011, p. 21).

For the purposes of this chapter, we operationalize online health forums as locations where patients, their families, or caregivers congregate to share information and find support. We use “online health forum” generically to include sponsored forums from US health organizations (e.g., the American Diabetes Association), patient-sponsored groups (e.g., TuDiabetes), Facebook groups, and communities that form around specific twitter hashtags (e.g., #migraine). RHM scholars have examined such online health forums as research sites (see, e.g., Arduser 2017a, 2017b, 2013, 2011; McCaughey, 2021; Pengilly, 2019).¹ A notable exception is Drew Holladay’s (2016) study that examined how writers grapple with mental health diagnostic discourses in online discussion boards. His study is most illuminating in its use of interviews with forum participants. Yet, what is still missing from his and other MHR and RHM literature is a strong methodological apparatus that could help researchers to draw innovative conclusions from studying online health forums.

Likewise, while existing work on health forums is important, we sense that research that focuses on theme spotting or discourse analysis within a singular forum focused on one condition potentially limits scholars’ understanding of the relationships between people, information, and technology. In this chapter, therefore, we offer a theoretical framework to analyze and to examine how relationships are being reconfigured and mediated in multiple online health spaces. Digital technologies have rapidly changed where people engage in information and dialogue exchange. Technologies that enable online health forums help people overcome constraints, such as local cultural norms governing intimacy, as well as logistical barriers to meeting face-to-face or in public. The increased reliance on digital technologies means scholars are having to consider new ways of understanding the relationships that form online because these relationships are more prevalent and are frequently taking place in people’s homes. The latter means there is a necessity to understand how the relative privacy of home—a site of intimacy between partners, families, and friends—now also come to be sites of intimacy between relative strangers. To examine this tension in the rest of this chapter, we offer an extended definition of collective intimacy as a theory that draws attention to the complex ontologies of online health forums and offers ways that rhetorical scholars in RHM and MHR can consider using this theory in their own work.

Theory Building in MHR and RHM

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 (see, e.g., Arduser, 2017b, 2013; de Hertogh, 2015; McKinley, 2019). However, the nature of most of those investigations are looking at a single site and, therefore, provide one-dimensional insights into a narrow realm of the particular forum. For example, Katrina Hinson’s (2016) analysis of a Facebook group of people who suffered a venous thrombolytic event confirmed many of the same findings as other studies on online health forums. That is, Hinson claimed that the group helped to transform the participants, while also helping others through eliciting empathy, sharing experiences, and developing a platform upon which to critique healthcare practices. These insights are important, yet more work is needed to deepen the conclusions that can be drawn from examining such research sites.

The same problems hold true in MHR. Recent work specific to mental health online forums has pointed to some limitations of current research approaches. For example, health communication researcher Jesse W. C. Yip (2020) argued that content analysis—the primary research method for examining online forums—can no longer stand alone to understand emotional and informational support for those who post on mental health forums. Yip claimed mixed methods approaches were needed, where Holladay’s (2017) work can be taken as an example. As another MHR example, psychologist Julie Prescott and colleagues Terry Hanley and Katalin Ujhelyi (2017) confirmed previous research that online health forums are helpful for young people and their mental health. Their contribution was gaining insights into the types of approaches (directive or nondirective) used for support within the forum, but by their own admission, their findings likely have little relevance outside of the forum itself. What current research in RHM, rhetoric, and other fields do have in common in regard to looking at online health forums is the highly focused examination of the textual as a way to understand the patient perspective through their language. We argue that this approach, while valuable in uncovering patients’ vernacular approaches to health literacies, still leave many questions unanswered about context and material conditions at the backdrop of the posts and, more particularly, about the relationship of people, information, and technologies. Importantly, such studies leave scholars needing additional ways to make sense of information across forums and to consider communication dimensions outside of the isolation of one particular context.

Sanna Malinen’s (2015) systematic review of empirical studies of user participation in online communities found that in the spite of the “large amount of research conducted on the topic [of online communities], a theoretical and conceptual framework for user participation remains undefined as most of the research has approached participation in terms of its quantity” (p. 228). As scholars know, the power and benefit of theory is that it provides alternative ways to understand a phenomenon, and without new theories, scholarship risks stagnating. What MHR and RHM need, then, is to develop ways of extending our analytic techniques to gain deeper and more extensive ways of examining online heath forums. A key role of theory building around online health forums is to address Malinen’s concern and implicit call for more nuanced approaches. Research in RHM and MHR and in related fields have studied online health forums through the lens of communities (Beemer, 2016; King, 2017; Lian & Grue, 2017; Willis, 2016; Willis & Royne, 2017). Some studies, such as Lora Arduser’s (2011), take community a step further and examine ways the forum members describe their experiences. Our goal with building out our term “collective intimacy” is to advance the approach Arduser (2011) took in trying to understand online health forums outside of a singular community framework.

While such studies do provide insight into how patients communicate, examining forums in isolation does not actually help scholars understand how the forums function. Rather, the intense focus on the discourses within the forum seems to gloss over what the forums may actually be able to tell researchers about their function. That is, there are consequences for the form of the discourse within the forums. Creating new theories or new conceptual apparatus to understand those consequences is a key goal for scholars in rhetoric and in RHM. In other words, community and the existing scholarship on it does not adequately provide a theoretical mechanism to fully uncover the dynamics of relationships across and between multiple communities.

More so, moving beyond community as a descriptor or characteristic of why people gather allows deeper insights into why people continue to connect in these spaces. While existing research certainly lays a strong foundation for understanding online health forums, the evolution of online health forums now requires scholars to go one step farther, to move toward new interventions. Thinking of the collection’s focus on “interventions” as providing an imperative to make an impact leads us to consider it as inherently inventional. That is, we see “interventions” in relation to rhetorical methodologies for studying online health forums as providing us with a space to think through what is needed to impact and advance this area of inquiry. Our response is that theory-building is needed to intervene effectively in established communities of research practice, and our specific intervention—our theory “collective intimacy”—provides an example of how new theories promise to fundamentally shift research practice in highly generative ways.

In the next section, we build the theory of collective intimacy to both show how theory building can be an intervention into an established set of practices and to provide an intervention into the routinized research practices surrounding rhetoric and/of online health forums. This theory of collective intimacy becomes the basis for rethinking the relationship between humans, technology, and information as experienced in online health forums. Conceptual and theoretical distinctions and dimensions matter in how we view discourses, primarily patient and caregiver discourses, in online forums. The vulnerability of the moment when someone is moved to participate in an online health forum—the need for a different type of relationship from language—means that we need different theoretical orientations to fully understand the dimensions, affect, and ramifications of these sites. 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 (or peer-to-peer) information exchange.

Collective Intimacy

When we were considering how to describe the theory we envisioned, we needed a descriptor before “intimacy.” Since “intimacy” is so readily associated with personal relationships, we wanted to signal that this form of intimacy was somewhat different than this traditional form. We settled on “collective” because it encapsulates two important features of the theoretical construct we are building.

First, “collective” invokes a sense of the cumulative. In her analysis of video logs of trans YouTube creators, Laura Horak (2014) claimed that “there is a strong formal similarity from one vlog to the next” and that “the cumulative force of these statements of presence draw upon each other to establish community” (p. 581). In the same way, words, phrases, themes, and tropes repeat across various health forums (i.e., vlogs, online forums) in ways that accumulate and help to establish the wider community of everyday health information and support-seeking as it unfolds online. This collective and the accumulation of its key features become a collection worth further examination, which is vital if scholarship is going to move from forum to forum and channel to chan...