Black Dogs and Blue Words

Emmons, Kimberly K. Black Dogs and Blue Words: Depression and Gender in the Age of Self-Care. New Brunswick, NJ: Rutgers University Press, 2010.

The language through which we experience and express our health or illness is crucial to preparing our physical selves to medical intervention. Much of the current language surrounding depression has gone unexamined which is very unfortunate since language fundamentally shapes cultural assumptions. Kimberly Emmons’ aim in writing Black Dogs and Blue Words: Depression and Gender in the Age of Self-Care is “to interrogate the rhetorical forms—the definitional words, metaphors, typical stories, and genres—through which depression is expressed, experienced, and treated in order to understand the gendered illness identities that are available for adoption” (p. 5). The language that Emmons rhetorically analyzes comes from a range of sources: direct-to-consumer pharmaceutical advertisements, memoirs, ethnographic interviews, and articles from newspapers, popular journals, and newsletters. Emmons seeks to remind us that words matter in the discourse of depression. By exploring language patterns, Emmons presents the persuasive power of depression as a rhetorical illness—a real and tangible condition that is both constructed and made recognizable by language. Within the current discourse of depression, a variety of rhetorical structures reflect and privilege the language of biological psychiatry.

In Chapter 1, Emmons demonstrates how rhetoric shapes the experience of depression. She discusses the language of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which coordinates much of the language about depression. She argues that the patterns of expression through which individuals articulate their experiences with depression fundamentally shape their ideas of health and illness. Collectively, these patterns form a discourse of depression. She draws on Michel Foucault’s concept of discourse to mean the collection of statements a culture makes about a given subject within a particular historical moment. She advocates for an alternative to self-doctoring, which encourages individuals (mostly women) “to monitor their affective experiences closely and to suspect brain chemistry when those experiences do not meet expectations” (p. 16). As an alternative to self-doctoring, Emmons conceptualizes a rhetorical care of the self which requires paying attention to the discourse of depression in order to open avenues for dialogue, critique, and social action. She writes that “a healthy suspicion of diagnostic criteria may lead some individuals to more complex understandings of their experiences” (p. 25). She also points out the gendering of depression in which women are assumed to be at greater risk for depression than men. This “fact” encourages women to put their emotional lives under greater scrutiny and self-surveillance.

In Chapter 2, she argues that direct-to-consumer pharmaceutical advertisements represent an obvious textual site for locating practices of self-doctoring as they encourage individuals to take their ability to diagnose their depression into their own hands. In popular discourse, depression has been reduced to a biological and chemical phenomenon. The “biological turn” in psychiatry establishes the desire for a quick fix solution to depression. Advertisements portray the self as an object that has been lost and medication as the means to reclaiming it. Imprecise definitions of what depression is work to ensure the broadest possible audience for pharmaceutical companies. Emmons draws on the work of Emily Martin, who through her ethnographic study of those living with manic depression found that individuals lacked a rich vocabulary to articulate their experiences and instead relied on narrow categories of illness that are dictated by medical conventions such as the DSM. Medical discourses have traditionally been about disempowering people. She argues that self-doctoring ignores Foucault’s concept of “curiosity” which might enable individuals to act in more personally meaningful ways within the discourse of depression. A rhetorical care of the self requires a series of tactics that counter powerful texts that construct depression such as the DSM and direct-to-consumer pharmaceutical advertising. Rhetorical self-care “advocates a self-conscious critique and skeptical orientation toward the dominant discourses of biological psychiatry” (p. 59).

In Chapter 3, Emmons sets her focus on the unclear and imprecise definition of depression. Examining definitional practices within the discourse of depression becomes a first step in taking a critical stance toward these prescribed illness identities. Emmons explains her use of the term illness over disease in describing depression. She argues that disease is predominately biomedical and ignores the experiences of individuals with depression. It also suits the interests of pharmaceutical companies. The use of the term illness ensures that depression is primarily made a social phenomenon as it focuses attention on the affective status of suffers and the meanings made of their experiences. Definitional practices within the discourse of depression do not promote clarity but instead sustain porous boundaries and encourage practices of self-doctoring.

In Chapter 4, she explores the metaphors that shape identities of depression. She argues that metaphors used in the context of the discourse of depression serve to isolate the sufferer. She notes the importance of metaphors in shaping how we see the world by drawing on the work of George Lakoff and Mark Johnson who demonstrated that metaphors such as “up is good” and “down is bad” are rooted in the realities of our corporeal activity. She argues that figurative understandings of depression have the potential to direct research (for example, thinking of depression in terms of a chemical imbalance can lead to more research into neurobiology). She explores metaphors of war and mechanical metaphors, where depression is something that can be “repaired.” Mechanical metaphors usually serve two groups: those who are seeking parity between physical and mental illnesses and the pharmaceutical industry. One of the major problems with mechanical metaphors is that they render human agency second to the mechanical system. She also explores spatial metaphors and those that involve travel. Within this discourse of depression, she argues that the self is something to be mapped, studied, and traversed.

In Chapter 5, Emmons presents the gendered reality of the discourse of depression. She examines narratives of depression from popular memoirs and news reports and finds that storytelling is an integral part of the experience of depression. However, the stories that are told have certain formulas that are different for women and men. Stock characters and familiar plot lines set up gendered expectations for performances of the self. Through rhetorical analysis, she finds that women often display sadness and accommodation whereas men display anger and dominance over their depression. Women’s concern for family is often noted. Women also tend to become defined by their illness whereas this is not the case for men. Memoirs written by women are praised for their sensitivity and emotionality and memoirs written by men are praised for their objectivity and rationality. Emmons writes, “Stories of depression establish gendered dynamics of illness—angry, stoic men and tearful, emotional women—and of treatment: networked care-taking for men, solitary self-help for women” (p. 142). Dialogue and the questioning of stereotypical assumptions about women’s and men’s emotional lives offers up the possibility for a rhetorical care of the self. Emmons argues that treating narratives as objects of analyses has “the potential to open new spaces for self-articulation” (p. 154).

In Chapter 6, penultimate to the conclusion, Emmons focuses on the self-diagnosis genres of the DSM, symptoms lists and self-diagnostic quizzes. These texts, like the narratives of depression in Chapter 5, suggest that it is a woman’s duty to be aware and vigilant about her feelings in ways that men are not encouraged to be. The symptoms list is a genre that was developed in the mid-twentieth century as a means of standardizing and organizing illnesses for the purpose of research and documentation. As a tool, symptoms lists encourage practices of self-doctoring. For individuals who are experiencing depression, the symptoms list provides a way to articulate and document their experience. Another popular genre are self-diagnostic tools that are often found on pharmaceutical websites. This genre helps shape the interaction between doctors and potential patients. Though these self-diagnostic tools appear to streamline the diagnosis of depression, they do so at the expense of a dialogical engagement with experiences of depression. These tools also reinforce gendered stereotypes of depression. The women who Emmons interviewed tended to view symptoms lists as established fact and therefore did not interrogate their contents. “By doing so,” writes Emmons, “they accept the contours of the illness and gendered identities codified in the genre. Such a reduction of suffering (an experiential entity) to mere symptoms (diagnostic entities) empties suffering of its social and moral significance” (p. 173). By accepting lists of symptoms as “facts” we fail to see them for what they really are, a culturally determined set of guidelines.

In her conclusion, Emmons reiterates that what we are working towards is a rhetorical care of the self. However, the texts that appear to promote personal autonomy and dialogue tend to have gendered identities embedded in them. The discourse of depression is constantly evolving and reflects the interests of powerful social and biomedical institutions who are often the ones generating the texts on depression. In order to foster a rhetorical care of the self, what is needed is a critical engagement with texts that allows individuals to live under health and illness descriptions with more consciousness and more flexibility in how they respond to the discourses of depression. What is required is a rhetorical orientation towards the information that is presented to us. Most of all, a rhetorical care of the self requires a constant reevaluation of definitions, metaphors, stories and genres that define mental illness.