Constructing Chronicity and Clouding Kairos The Fragmentation of Temporal Dialectics in Descriptions of Chronic Depression

Main Article Content

Ellen Defossez

Abstract

Extending Sarah Singer and Jordynn Jack’s (2020) definition of illness chronicity as a complex rhetorical process of identification, this essay suggests that the development of specific temporal vocabularies (ways of defining and describing time) is an important part of this process, one that precedes and enables identification. Drawing from underemphasized temporal themes in Kenneth Burke’s work, this essay analyzes a collection of public descriptions of chronic depression to identify implicit patterns of temporal vocabulary development and to consider how these patterns relate to identification. The analysis shows that descriptions of chronic depression consistently utilize what Burke termed “directional” strategies of definition, which center permanence as the essence of the illness experience, obscuring recognition of change. While this definitional strategy enables two potentially ameliorative disidentifications, it comes at the expense of precluding kairos, which requires a dialectically-intact temporal vocabulary featuring terms of both permanence and change.  

Article Details

Section
Research Article

References

Akiskal, Hagop S. (2001). Dysthymia and cyclothymia in psychiatric practice a century after Kraepelin. Journal of Affective Disorders, 62, 17–31. https://doi.orgn/ 10.1016/s0165-0327(00)00347-5

Akiskal, Hagop. S. & Cassano, Giovanni. B. (1999). Dysthymia and the spectrum of chronic depressions. Guilford Press.

American Psychiatric Association. (1980). Depressive disorders. In Diagnostic and statistical manual of mental disorders (3rd ed.).

American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

Arduser, Lora. (2017). Living chronic: Agency and expertise in the rhetoric of diabetes. The Ohio State University Press.

Bass, Christopher & Halligan, Peter. (2014). Factitious disorders and malingering: Challenges for clinical assessment and management. The Lancet, 383(9926), 1422–1432. https://doi.org/10.1016/S0140-6736(13)62186-8

Bennett, Jeffrey. (2009). Banning queer blood: Rhetorics of citizenship, contagion, and resistance. The University of Alabama Press.

Bond, C., Osman, H., Hind, M., Bronwen, T. &, Hewitt-Taylor, J. (2013). The conceptual and practical ethical dilemmas of using health discussion board posts as research data. Journal of Medical Internet Research, 15(6), 1-10. https://doi.org/10.2196/jmir.2435

Burke, Kenneth. (1945). A grammar of motives. Prentice-Hall.

Burke, Kenneth. (1950). A rhetoric of motives. Prentice-Hall.

Burke, Kenneth. (1954). Permanence and change: An anatomy of purpose. University of California Press.

Burke, Kenneth. (1977). (Nonsymbolic) motion/(symbolic) action. Critical Inquiry 4(4), 809– 838.

Bury, Michael. (1982). Chronic illness as biographical disruption. Sociology of Health & Illness, 4(2), 167-182. https://doi.org/10.1111/1467-9566.00191

Centers for Disease Control and Prevention. (2021). Chronic diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm

Charmaz, Kathy. (1992). Good days, bad days: The self in chronic illness and time. Rutgers University Press.

Charmaz, Kathy. (2006). Constructing grounded theory: A practical guide through qualitative analysis. SAGE publications.

Cole, K. (2022). Selling a cure for chronicity: A layered analysis of direct-to-consumer Humira advertisements. Rhetoric of Health & Medicine, 5(2), 212-239. https://doi.org/10.5744/rhm.2022.5011

Crable, Bryan. (2003). Symbolizing motion: Burke’s dialectic and rhetoric of the body. Rhetoric Review, 22(2), 121-137. https://doi.org/10.1207/S15327981RR2202_2

Davis, Diane. (2008). Identification: Burke and Freud on who you are. Rhetoric Society Quarterly, 38(2), 123-147. https://doi.org/10.1080/02773940701779785

Defossez, Ellen. (2020). No magic pills: A Burkean view on the ambiguity of mild depression. Rhetoric Review, 39(3), 330-342. https://doi.org/10.1080/07350198.2020.1764750

Dumit, Joseph. (2003). Is it me or my brain?: Depression and neuroscientific facts. Journal and Medical Humanities, 24(1), 35-47. https://doi.org/10.1023/A:1021353631347

Emmons, Kimberly. (2010). Black dogs and blue words: Depression and gender in the age of self-care. Rutgers University Press.

Fink, Paul. (2010). Rethinking the dysthymic disorder diagnosis. MDedge. https://www.mdedge.com/psychiatry/article/24151/depression/rethinking-dysthymic-disorder-diagnosis

Foss, Sonja. (2009). Rhetorical criticism: Exploration and practice. Waveland Press.

Frank, Arthur. W. (1995). The wounded storyteller: Body, illness, and ethics. University of Chicago Press.

Friz, Amanda. (2022). Rhetorical enactment theory and a rhetoric of chronicity for Alzheimer’s disease. Rhetoric of Health & Medicine, 5(2), 181-211. https://doi.org/10.5744/rhm.2022.5010

Gardner, Christine. J. (2011). Making chastity sexy: The rhetoric of evangelical abstinence campaigns. University of California Press.

Gelang, Marie. (2013). Kairos and the rhythm of timing. Thamyris, 26, 89-102. https://doi.org/10.1163/9789401208871_007

Graham, Scott. S. (2015). The politics of pain medicine: A rhetorical-ontological inquiry. The University of Chicago Press.

Greenstein, Luna (2018, January 17). Understanding dysthymia. NAMI. https://nami.org/Blogs/NAMI-Blog/January-2018/Understanding-Dysthymia

Holladay, Drew & Price, Margaret. (2020). Mediating minds: Disability studies and the rhetoric of mental health. In Lisa Melonçon, Scott Graham, Jennell Johnson, John A. Lynch & Cynthia Ryan (Eds.), Rhetoric of health and medicine as/is (pp. 33-51). Ohio University Press.

Huprich, Steven. (2009). What should become of depressive personality disorder in DSM-V? Harvard Review of Psychiatry, 19(1), 41–59. 10.1080/10673220902735694

Japp, Phyllis. (1986). Rhetoric and time: Dimensions of temporality in theory and criticism. (Publication No. 8620811) [Doctoral dissertation, University of Nebraska-Lincoln]. University Microfilms International.

Johnson, Jenell. (2010). The skeleton on the couch: The Eagleton affair, rhetorical disability, and the stigma of mental illness. Rhetoric Society Quarterly, 40(5), 459–478. https://doi.org/10.1080/02773945.2010.517234

Kearney, Cassandra. (2020). A historical perspective on the “mental health as motive” narrative. Rhetoric of Health & Medicine, 3(1), 34–62. https://doi.org/10.5744/rhm.2020.1002

Kessler, Molly. (2022). Stigma stories: Rhetoric, lived experience, and chronic illness. Ohio State University Press.

LeWine, Howard. (2015, January 8). People with type 1 diabetes are living longer. Harvard Health Blog. https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611.

Martin, Emily. (2010). Self-making and the brain. Subjectivity, 3(4), 366-381. https://doi.org/10.1057/sub.2010.23

Molloy, Cathryn (2015). Recuperative ethos and agile epistemologies: Toward a vernacular engagement with mental illness ontologies. Rhetoric Society Quarterly, 45(2), 138–163. https://doi.org/10.1080/02773945.2015.1010125

Murphy, M., Kontos, N., & Freudenreich, O. (2016). Electronic support groups: An open line of communication in contested illness. Psychosomatics, 57(6), 547-555. 10.1016/j.psym.2016.04.006

Opel, Dawn. (2018). Ethical research in ‘Health 2.0’: Considerations for scholars of medical rhetoric. In Lisa Melonçon & J. Blake Scott (Eds.), Methodologies for the Rhetoric of Health & Medicine (pp. 176-194).Routledge.

Parfit, Derek. (1984). Reasons and persons. Oxford University Press.

Peary, Alexandria. (2016). The role of mindfulness in kairos. Rhetoric Review, 35(1), 22–34. https://doi.org/10.1080/07350198.2016.1107825

Personality. (n.d.). American Psychological Association. https://www.apa.org/topics/personality.

Pryal, Katie. R. G. (2010). The genre of the mood memoir and the ethos of psychiatric disability. Rhetoric Society Quarterly, 40(5), 479–501. https://doi.org/10.1080/02773945.2010.516304

Radley, A. & Billig, M. (1996). Accounts of health and illness: Dilemmas and representations. Sociology of Health and Illness, 18(2), 220–240. 10.1111/1467-9566.EP10934984

Reynolds, Fred. (2008). The rhetoric of mental health care. In Barbara Heifferon & Stuart Brown (Eds.), Rhetoric of healthcare: Essays towards a new disciplinary inquiry (pp. 149–157). Hampton.

Reynolds, Fred. (2018). A short history of mental health rhetoric research (MHRR). Rhetoric of Health & Medicine, 1(2), 1–18. https://doi.org/10.5744/rhm.2018.1003

Rothfelder, Katy. & Thornton, Davi. J. (2017). Man interrupted: Mental illness narrative as a rhetoric of proximity. Rhetoric Society Quarterly, 47(4), 359–382. https://doi.org/10.1080/02773945.2017.1279343

Segal, Judy. (2005). Health and the rhetoric of medicine. Southern Illinois University Press.

Sheehan, Lindsay, Nieweglowski, Katherine, & Corrigan, Patrick. (2016). The stigma of personality disorders. Current Psychiatry Reports, 18(1), 1-7. https://doi.org/10.1007/s11920-015-0654-1

Shorter, Edward. (2008). Before Prozac: The troubled history of mood disorders in psychiatry. Oxford University Press.

Shorter, Edward. (2013). How everyone became depressed: The rise and fall of the nervous breakdown. Oxford University Press.

Singer, Sarah. (2022). Patients as researchers: Chronicity, health data, and emergent attribution practices. Rhetoric of Health & Medicine, 5(2), 130–160. https://doi.org/10.5744/rhm.2022.5008

Singer, Singer & Jack, Jordynn. (2020). Theorizing chronicity: Rhetoric, representation, and identification, on Pinterest. In L. Meloncon, S. Graham, J. Johnson, C. & Ryan, (Eds.), Rhetoric of health and medicine as/is (pp. 123-142). Ohio University Press.

Smith, John. (1986). Time and qualitative time. Review of Metaphysics, 40(1), 3-16.

Solomon, Andrew. (2001). The noonday demon: An atlas of depression. Scribner.

Tartakovsky, Margarita. (2016). A current look at chronic depression. Psych Central. https://psychcentral.com/lib/a-current-look-at-chronic-depression/

Thase, M. & Lang, S. (2004). Beating the blues: New approaches to overcoming dysthymia and chronic mild depression. Oxford University Press.

Trapani, William & Maldonado, Chandra. (2018). Kairos: On the limits to our (rhetorical) situation. Rhetoric Society Quarterly, 48(3), 278-286. https://doi.org/10.1080/02773945.2018.1454211

Walsh, Linda & Boyle, Casey. (2017). Topologies as techniques for a post-critical rhetoric. Palgrave Macmillan.

Watt, Annaliese. (1998). Burke on narrative: The dialectic of temporal embodiment and eternal essence. Narrative, 6(1), 49–71.