Narrative Therapy: On the Rhetorics of Mental Illness

This account represents some of my thinking on rhetoric and the ways taht mental disability affects the lives of students and faculry in academic institutions, namely the ways that mental illness is identified and valued (or, as the case usually is, devalued) in this space. I have not defined a thesis and this is not a linear argument. It’s intended to be more an introductory pastiche, as I document some of what I’ve learned from other scholars via journal articles and research studies. I attempt to apply some of this to my own personal narrative.


Mental Illness in the Academy

Higher education depends on the work of a rational mind. Aristotle’s famous declaration that man is a rational animal is so ingrained in our understanding of education and scholarship today that concepts such as reason, rationality, and critical thinking have infiltrated what we consider to be a good liberal arts education. The academy as a place of reason is a bellicose trope so familiar that it has become definitive of what it means to become an scholar. So what does it mean for those students and faculty who have mental disabilities characterized by irrationality and distorted thinking? In her (fantastic) book, Mad at School: Rhetorics of Mental Disability and Academic Life, Margaret Price (2011) uses rhetoric as a frame in order to highlight the obvious privileging of ableism in higher education. She demonstrates the variety of ways that colleges and universities, in their current design, exclude students and faculty with mental disabilities. She notes that “the instruments of exclusion are not visible or dramatic—men in white coats dragging people away—but quiet, insidious: We flunk out or drop out. We fail to get tenure. We take jobs as adjuncts rather than tenure-track faculty. We transfer schools; we find a way to get a job or a degree elsewhere. Or not” (p. 6). Price reveals how individuals suffering from mental disabilities—which she defines broadly to include not only intellectual and developmental disabilities, but also autism, learning disabilities, and mental illnesses—are excluded, ignored, and targeted in higher education. With this exclusion, people with mental disabilities are “presumed not to be competent, nor understandable, nor valuable, nor whole” (p. 10). They are viewed as nonhuman since they are not rational animals in the Aristotelian sense. In essence, they lose their personhood. Price argues that to be disabled mentally is to be disabled rhetorically. Catherine Prendergast (2003, 2008) has echoed Price’s claim that people with mental disabilities lack rhetoricity. She has insisted that people with mental disabilities, and people with schizophrenia in particular, exist in “a rhetorical black hole” (p. 198). Furthermore, Stephanie Kerschbaum (2014) has argued that many people in society still understand “disability as incompetence” (p. 69).

Mental Illness and Rhetoricity

Can there ever be a rhetoric where people with mental disabilities are welcome and valued as rhetors?

Cynthia Lewiecki-Wilson (2003) argues that rhetoricity is required to secure the life needs—“material and emotional support, access to medical care and technology, and caring intersubjective relationships for a full life” (p. 163)—of people with mental disabilities. Traditional liberal rhetoric cannot grant rhetorical power to individuals with mental impairments so severe they “impede their ability to ever function as independent, autonomous rhetors” due to it being modeled on a universalized, independent rhetor who communicates through speech and writing in the public sphere. In order words, traditional rhetoric “creates a barrier excluding the severely mentally disabled not only from rhetoricity but also from full citizenship, tied as traditional rhetoric is to the liberal ideology of the public forum, where good men (sic), speaking well, engage in civic debate” (p. 158). Lewiecki-Wilson offers a new, mediated rhetoric to people with severe mental disabilities. It’s a collaborative rhetoric, “co-constructed by the disabled and their advocates” (p. 163). Lewiecki-Wilson believes that this offers human value to individuals with severe mental disorders by generating (inter)subjectivity.

Within the current tradition of rhetoric, the memoir genre has been increasingly tasked with bestowing rhetorical authority for people with mental disabilities. Katie Rose Guest Pryal (2010) explores the use of “mood memoirs” as a way of generating rhetorical agency for those diagnosed. She argues that narrative-based disclosures, “and memoirs in particular, can intercede rhetorically on behalf of people such as the mentally ill who are traditionally excluded from rhetorical participation” (p. 483). In addition, the rhetorical authority generated to the memoirist, “an authority grounded in stories supported by reasons—provides a way to speak back at experts” (p. 483). Pryal outlines four rhetorical moves characteristic of mood memoirs: an apologia where the author gives her reasons for writing the memoir; a “moment of awakening” to the reality of her mental disability (in psychiatry, the moment of awakening is referred to as insight, the ability to recognize her mental disability diagnosis and begin treatment); a criticism of “bad” doctors which is a judgement is made against the medical establishment based on the author’s experiential knowledge; and auxesis, which allows for the author to create rhetorical authority by “laying claim” to other sufferers of mental disabilities (p. 495). Pryal argues that the primary intention of the mood memoir is to generate ethos for the author as well as others suffering from mood disorders. 

In her article “Mental Disability and Rhetoricity Retold: The Memoir on Drugs,” Catherine Prendergast (2008) revisits issues of rhetoricity for people suffering from schizophrenia. She admits her motivation behind writing this piece has to do with an earlier claim she made that people with schizophrenia lacked rhetoricity. Prendergast now finds that people with schizophrenia are exercising rhetorical agency through narrative  due in large part to advances in psychotropic medications. The “memoir on drugs” describes a genre that potentially enables individuals diagnosed with schizophrenia to assert their subjectivity. What is characteristic about the memoir on drugs is that it provides a way for the rhetor to remain critical of the medical establishment while also acknowledging “the necessity of medication and treatment as a means toward maintaining their relationships, activism, and professional lives” (2007, p. 61). Prendergast fully believes that the impact of atypical antipsychotics on shaping the public writing of people diagnosed with schizophrenia is so revolutionary that it may be on par with the advent of the birth control pill in terms of it’s significance for the larger culture (p. 65).

Other scholars have also taken up narrative-based writing and speaking was tools for people with mental disabilities to employ in service of generating rhetorical power through agency and ethos. Renuka Uthappa (2017) argues that rhetorical agency and ethos may be generated through “deep disclosure” of one’s lived experience with a mental disability. Uthappa highlights her involvement in an activist group comprised of people who publicly narrate their lived experiences with mental disabilities to high school and college psychology classes. The group is driven by a shared “pedagogical purpose to fight the stigmatization of psychiatric diagnoses…through public education” (p. 164). The hope is that the delivery of an oratory narrative will generate agency and ethos for the rhetor while also reducing stigmatization of mental disability. Uthappa sees a general lack of credibility in the public’s eyes for people with mental disabilities. Therefore, the goal of the rhetor’s public performance is “to get the audience to believe our individual depictions of how mental disability affects our lives. We want that belief to help audience members reach through the barrier thrown up by stigma and draw closer to us as human beings” (p. 165).

It’s important to note that disclosure doesn’t guarantee ethos and or reduction in stigma. Stephanie Kerschbaum (2014) reminds us that disclosure is always contingent and uncertain and while “personal narratives are often seen as tools that individuals can use to engage, resist, challenge, and combat stereotypes and fixed identities, they do not always work as intended” (p. 68). Risk is always a factor inherent in any performance of personal disclosure. There is always the chance that ethos can be undermined or damaged through the performance of a personal disclosure.

Still, Uthappa encourages us to think about vulnerability, not in terms of risk, but as potentially beneficial. She suggests that while risk can never be removed from the equation, “vulnerability can be something beneficial in instances when it moves the speaker closer to the audience’s ability to embrace or reject his plea for acceptance” (p. 165). Furthermore, Kerschbaum importantly points out that even if it is impossible for a writer or speaker to predict the different orientations their audience will take to a disclosure, the rhetor still has the freedom to choose the shape their disclosure takes and this itself is a deeply agentive act, even when it results in an unintended reaction from others.

“Coming Into Presence”

“How does one begin to speak of something so shrouded in silence, so wrapped in darkness that it is almost possible to believe it doesn’t exist at all? That which is hidden must have light shone on it to be seen; silence can only be broken by a question being asked: ‘Are there professors diagnosed with severe mental illness working on university landscapes?’ The answer must be yes, since I am one such person, and I doubt that I am alone. But then why do I feel like I must be the only one?”

(Skogen, 2012, p. 492)

Rochelle Skogen is a professor at the University of Alberta who has bipolar disorder. In 2012, she published “‘Coming into Presence’ as Mentally Ill in Academia: A New Logic of Emancipation” in the Harvard Educational Review where she wrote about mental disability, stigma, and her life as a faculty member with a serious mental illness. She begins the article by describing her resistance to opening up about her bipolar disorder, fearing that going public with her mental disability would result in inaccurate perceptions and negative judgement from others and would discount her credibility as a scholar and teacher.

“As teachers, we are perhaps even more exposed when standing in from of a classroom of students whose ideas and minds we are hoping to shape. We present ourselves with all our credentials and all our knowledge and ask stu­dents to believe in our expertise. What might happen if they no longer see us in this light? How might this change if they find out that the professor they look up to is mentally ill? Fearing how our peers, the public, and our students might react to the fact that we suffer from a mental illness can be summed up, it seems, by our fear of being stigmatized, which includes a fear that those whom we hope will respect, admire, and trust us will no longer do so. Why would anyone take such a risk?”

(p. 492)

After some times, however, she began to feel an urgent need to talk about her mental disability in order to make mental disability visible in academia as well as serve as a model for others to come out of hiding. Skogen frames her essay in terms of stigma—the existing stigma that pervades mental disability discourse and the imagined stigma that might likely result from a public figure disclosing a serious mental disability. In this article, I found her conceptualization of stigma to be poetic:

“I have come to think of stigma as the bogeyman of our dreams. We run and run in terror even though we don’t actually know what it is that is chasing us. All we know is that if it catches us something terrible will happen. For those of us diagnosed with severe mental illness, stigma is our bogeyman. We know that it is out there waiting to hurt us. We fear it without really knowing what or where it is or what it will do to us if it catches us. But we imagine what might happen, and we hear its whispers: ‘Students won’t respect me’…’My peers might use it against me’…’I’ll lose the admiration of society’…and on and on. But just like the nightmare, we don’t know that such things will actually come to pass. In fact, many psychoanalysts tell us that if and when we actually do turn around to look at what is chasing us, it is not some evil entity but rather a friend trying to show us something important about ourselves. Could this also be the case with stigma and disclosure? Is it possible that on disclosing our condition publicly we are not met by one of our worst-case scenarios but by understanding and maybe even respect? Of course, we cannot know until we do it, until we turn around and confront what it is that has been chasing us.”

(p. 493)

For Skogen, disclosure is the only way to destigmatize mental disability in academia. It’s a political act geared toward emancipation for the mentally disabled community. Drawing on the work of Jacques Rancière, she argues that current anti-stigma campaigns do not work because they rely on the goodwill of the able-minded. Despite data showing that these campaigns are not improving societal perceptions of mental disability, they continue to be used. Skogen suggests that “waiting on our would-be emancipators to free us from stigma is a ploy that keeps us eternally silent and submissive” (p. 500) and asserts that “we, the mentally ill, are doing ourselves a great disservice if we depend on the goodwill of others to emancipate us from society’s stigma” (p. 498). Her alternative logic of emancipation is based on Rancière’s theory of subjectification which argues that people must make a name and identity for themselves rather than be labeled by an existing identity in the community. “Coming into presence” as faculty member with a mental disability requires a rupture to the natural and “normal” order of things and requires individuals suffering from mental disabilities to face their fears and vulnerabilities and confront stigma head-on. Skogen’s article provides a conceptual map for thinking through my own fears around stigma and negative judgement as a graduate student with schizophrenia. 

Words Matter

No term in the history of madness is neutral. 

Geoffrey Reaume

Scott Lunsford (2005) writes about discourse on disabilities by suggesting that this discourse must begin by “confronting its own disability” (p. 330). He suggests that this can be accomplished in three steps: first, through making disability visible by recognizing the role hegemony plays in constructing disability as invisible through silence; second, by expanding our awareness of disability through sensitive use of language; and third, by continuing to question the language we see used in the context of disability. Rhetoric, he writes, is concerned with “studying words and the realities they create” and therefore it is crucial that we pay close attention to to words “sometimes on their own merit” (p. 331). A linguistic choice by my former grad school department recently has caused me to think about words, specifically one word: crazy. When is this an appropriate word? Who gets to choose? And is it really the best word? My answer to the last question is a resounding no.

An argument could be made that “Crazy Smart” in this context, while technically still describing mental illness, is not being used to specially refer to mental illness. One could even argue that crazy is being used with positively. But intentions become irrelevant if the word crazy makes people with mental disabilities feel stigmatized, ashamed, and isolated. Even when employed with the best of intentions, it doesn’t lessen how insulting it can be for those who hear this word and feel as though what they experience isn’t being taken seriously. 

Myself, I don’t have much problem with the word. I don’t mind when my friends say stuff like, “That made me crazy,” or “I feel crazy.” When it’s used as an adverb, it feels even more harmless. There are lots of times when I somewhat endearingly refer to myself as crazy. But what I don’t appreciate is being called crazy by anyone who isn’t saying it with love and appreciation or seeing the word used by anyone who lacks the ethos to be using it. Colleges and universities fail mental health big time. Counseling services are severely lacking and many students even face punishment for their mental disability. The result is a dangerous culture of silence and stigma. When I see the university brand their students as “Crazy Smart,” I see red. How dare you take something that’s inextricable and central to the experiences of so many—myself included—and use it so frivolously and flippantly to promote yourself.

Using mental disability for the purpose of insult or superlative shapes our way of thinking about mental disabilities and our engagement with those who experience them. Ableist language not only stigmatizes students, staff, and faculty with mental disabilities, it also teaches those without that using such language is OK. There are much more descriptive, specific, and creative words to use that will ultimately better communicate the message that Tech is trying to send here. Are we really so attached to using an overused and ineloquent word that we don’t put any thought behind? I can’t believe that could be the case. Here’s my advice: when it comes down to it, if there is a less harmful way to say something, you should always err on that side of things.

Concluding Remarks

Academic discourse is responsible for enforcing a number of tropes like as rationality, criticality, participation, productivity, and collegiality, all of which place a particular burden on those with disabled minds (Price, 2011). What does participation mean for a student who is too deeply depressed to get out of bed in the mornings? What becomes of the faculty member who has such severe, crushing anxiety that she abhors presenting under the bright lights of a professional conference? It is currently estimated that one in five adult Americans will suffer from mental illness in a given year, and those numbers are only increasing.

Statistics pertaining to the academic life can provide further evidence to suggest that people with mental disabilities are entering universities and colleges in unprecedented numbers. According to a 2008 study published in the Archives of General Psychiatry, nearly half of college students reported having experienced some psychiatric disorder in the previous year (note: this study leaves out disorders such as autism, ADHD, and learning disabilities). By far, the most staggering statistic of all is the high dropout rate for mentally disabled students (and probably faculty as well, although I could not come by any reliable numbers). A 2005 survey of university disability services appearing in the American Journal of Orthopsychiatry estimates that “86% of individuals who have a psychiatric disorder withdraw from college prior to the completion of their degree” (Collins & Mowbray, p. 304). Deep research and discussion at the intersection of rhetoric, academic discourse, and mental disability is past due.


Bibliography

Blanco, Carlos, Mayumi Okuda, et al. “Mental Health of College Students and Their Non-College Attending Peers: Results from the National Epidemiological Study on Alcohol and Related Conditions.” Archives of General Psychiatry 65, no. 12 (2008): 1429-1437.

Collins, Mary Elizabeth and Carol T. Mowbray. “Higher Education and Psychiatric Disabilities: National Survey of Campus Disability Services.” American Journal of Orthopsychiatry 75, no. 2 (2005): 304-315.

Kerschbaum, Stephanie L. “On Rhetorical Agency and Disclosing Disability in Academic Writing.” Rhetoric Review 33, no. 1 (2014): 55-71.

Lewiecki-Wilson, Cynthia. “Rethinking Rhetoric through Mental Disabilities.” Rhetoric Review 22, no. 2 (2003): 156-167.

Lunsford, Scott. “Seeking a Rhetoric of the Rhetoric of Dis/Abilities.” Rhetoric Review 24, no. 3 (2005): 330-333.

Prendergast, Catherine. “On the Rhetorics of Mental Disability.” In Towards a Rhetoric of Everyday Life: New Directions in Research on Writing, Text, and Discourse. Edited by Martin Nystrand. Madison: University of Wisconsin Press, 2003. 

Prendergast, Catherine. “Mental Disability and Rhetoricity Retold: The Memoir on Drugs.” In Changing Social Attitudes Toward Disability. Edited by David Bolt. New York: Routledge, 2014. 

Price, Margaret. “Accessing Disability: A Nondisabled Student Works the Hyphen.” College Composition and Communication 59, no. 1 (2007): 53-76.

Price, Margaret. Mad at School: Rhetorics of Mental Disability and Academic Life. Ann Arbor: University of Michigan Press, 2011.

Pryal, Katie Rose Guest. “The Genre of the Mood Memoir and the Ethos of Psychiatric Disability.” Rhetoric Society Quarterly 40, no. 5 (2010): 479-501.

Skogen, Rochelle. “‘Coming Into Presence’ as Mentally Ill in Academia: A New Logic of Emancipation.” Harvard Educational Review 82, no. 4 (2012): 491-510.

Uthappa, N. Renuka. “Moving Closer: Speakers with Mental Disabilities, Deep Disclosure, and Agency Through Vulnerability.” Rhetoric Review 36, no. 2 (2017): 164-175.