Race, Risk, and Pathology in Psychiatric Culture: Disease Awareness Campaigns as Governmental Rhetoric

Abstract

In 2006, the National Alliance on Mental Illness and the National Urban League, along with five other organizations, introduced the Depression is Real Campaign, a disease-awareness campaign targeting racial minorities. I trace the ways in which the Depression is Real Campaign frames the expansion of the depression diagnosis and pharmaceutical consumption as shared goals for racial justice advocacy groups and pharmaceutical corporations, focusing on the campaign's attempts to target African Americans. Although the campaign is framed as an antistigma, prorecovery intervention in the name of racial empowerment, it articulates racial and cultural differences as “risks” in the context of illness that must be eradicated through individual initiatives via the agency of medical science. Highly visible appeals to race are ultimately neutralized in the campaign's affirmation of a mobile neoliberal subjectivity unencumbered by the “weight” of racial history, structural inequality, or collective identification.

Keywords:

• Governmentality
• Neoliberal Race
• Psychiatric Rhetoric

Acknowledgements

A previous version of this essay was presented at the 2009 NCA Convention in Chicago, IL.

She would like to thank the Brown Working Papers program and her colleagues at Southwestern University for their helpful feedback. She would especially like to thank Julia Johnson, Bob Bednar, and David Olson, as well as the editor and reviewers for CSMC.

Notes

1. In 2008, the Depression is Real coalition augmented its “Elevator” campaign with a new series of PSAs, organized under the theme “It is Depression.” As of August 2010, the Elevator campaign continues to be available under the archives section of the Depression is Real website.

2. In late 2008, the National Urban League and the League of United Latin American Citizens resigned as members of the Depression is Real Coalition, although they “continue to support the need to increase awareness as a real, biological disease” (Hand, 2009). There has been no public announcement or press coverage of the resignation, and as of August 2010, the Depression is Real Web site continues to post resource information under the names of the two racial advocacy organizations, and provides direct links to the official Web sites of the National Urban League and the LULAC. Diana Hand, January 5, 2009, personal e-mail communication with the author.

3. It is important to note that this “color-aversive” conception of identity intersects with what Whiteness studies and critical race studies scholars have theorized as “discursive Whiteness.” For example, both neoliberal subjectivities and “White” subjectivities are constructed in dominant discourses around tropes of mobility, universality and paradoxical “placelessness” (see Dyer, 1997; Jackson, 1999; Jackson, Shin, & Wilson, 2000; Shome, 1996; Watts, 2005). Although my own analysis here is primarily framed by theories of governmentality and the regulative functions of identity, I am attentive to the resonsances between “Whiteness” and neoliberal constructions of race.

4. By “subjectifications,” I follow Miller and Rose in attending not to the essence of neoliberal identities, but the predominant vocabularies, practices and habits available for individuals to use in assembling their lifestyles and identities. See Miller and Rose (2008, p. 7).

5. The FDA has asked pharmaceutical corporations increase their spending on unbranded advertisements to retain the education benefits of direct-to-consumer advertising without the risks of corruption associated with the profit motive of branded advertisements. One of Pfizer's recent unbranded ads for depression features a television ad with Lorriane Bracco, whose battle with depression was aided with Zoloft (Arnold, 2005, Medical Marketing & Media). The television ad leads viewers to a Web site, depressionhelp.com, which takes users directly to a page for Zoloft. A related trend is corporate sponsorship of free depression screenings and event sponsorship, such as Eli Lilly's “2007 Empowerment Tour for a Healthier Life,” titled “Finding Balance: Emotions, Depression and Mental Well-Being.” The events, such as a convention held at Enon Tabernacle Baptist Church, feature discussion of African American women and their vulnerability to depression and hope for treatment. This illustrates how novel advertising campaigns can align church, health, and corporate interests. Similar events are sponsored as part of the Depression is Real Campaign.

6. In 2005, pressure on pharmaceutical corporations to regulate their use of direct-to-consumer advertising (DTCA)reached a critical juncture, and PhRMA (Pharmaceutical Research and Manufacturers of America), an organization that represents corporations in the pharmaceutical and biotechnology industries, announced new industry guidelines for DTCA, partly in response to Congressional pressure. One of the principles of these guidelines is “Health Awareness”: “Companies are encouraged to promote health and disease awareness as part of their DTC advertising” (quoted in Royne & Myers, 2008, p. 66). Although these guidelines are voluntary for corporations, their issue signals a recognition amongst the pharmaceutical industry of the “bad press” associated with DTCA and the need to find more palatable marketing outlets.

7. For discussions of race and neoliberalism, see for example Giroux (2003). Giroux points to the ways in which neoliberal discourses “individualize” goals like freedom and empowerment. Freedom is de-linked from any notion of collectivity, and is reduced to “an exercise of self-development rather than social responsibility, reducing politics to either the celebration of consumerism or a privileging of a market-based notion of agency and choice that appear quite indifferent to how power, equity and justice offer enabling conditions for real individual and collective choice to be both made and acted upon” (p. 197). Jodi Melamed (2006) also discusses the invisibility of race under the reign of neoliberalism in “The Spirit of Neoliberalism: From Racial Liberalism to Neoliberal Multiculturalism.” Melamed describes the way that African American cultural formations are divided into “healthy” (a code for “a race-erased ‘general American culture’”) and “pathological” categories. I also want to acknowledge my debt to Dana Cloud here, whose work on therapeutic rhetoric make great contributions to the study of psychiatric discourse in the context of racial, gender and economic inequalities (see Cloud, 1998). I believe my work on psychiatric differs from Cloud's primarily because I seek to understand the ways that psychiatric rhetoric is a productive discourse that is attractive to and accommodating of multiple interests, and Cloud is more focused on the repressive consequences of its individualizing functions. In some ways, this might be at least partly a matter of emphasis and theoretical framing, as I share many of Cloud's concerns about the individualizing and ahistorical nature of psychiatric rhetoric.

8. Over the past decade, discourses of “diversity” have increasingly populated psychiatric rhetoric. One trend is that a number of different projects are attempting to translate the depression diagnosis to be more palatable for ethnically and culturally diverse audiences. For instance, as Yeung and Kam (2006, p. 50) describe, for example, depression is constructed in a European and North American cultural context and its translation can prove difficulty. They write, “This lack of translatability of the illness construct from the dominant Western culture into Chinese and other Asian cultures represents a significant and difficult barrier” to the acceptance of the diagnosis and pharmaceutical treatment of depression. The emphasis on diversity in contemporary psychiatric rhetoric, including the rhetorical productions of pharmaceutical corporations, often takes the form of breaking down cultural “barriers” to acceptance of the diagnosis and drug treatments.

9. I use “discursive Whiteness” to refer to patterns of values, codes, signifiers and tropes that contribute to the social and rhetorical construction of a cultural category. I do not refer to an “essential identity,” but a mutable discursive assemblage. I am referring generally here to the ways in which the cultural category of Whiteness is associated with visual and verbal signifiers of mobility (Dyer, 1997; Jackson, 1999; Watts, 2005).

Additional information

Notes on contributors

Davi Johnson Thornton

Davi Johnson Thornton is an assistant professor of Communication Studies at Southwestern University