Abstract

Kelsey O’Connell

Community Discourse and Rhetorical

Strategies in the Development of the

New Diagnostic and Statistical Manual

of Mental Disorders (DSM-5)

PURPOSE

CONTEXT MESSAGE SPEAKER

AUDIENCE

RHETORICAL TRIANGLE

Community Building in DSM Forwards Community Building in GAD White Papers

Major Findings

Context

Methods

DSM-I

DSM-III

Forwards Neo-Aristotelian analysis focused on the DSM-I and DSM-III Creation Story framing: They tell the story of the origin of a community. They layout underlying values and beliefs of the community. They serve to legitimize the rest of the text within the mythos of the community, thereby lending ethos to the rest of the text. Generalized Anxiety Disorder Neo-Aristotelian analysis of representative white papers Interviews with practitioners

Research Funded by Elon University

Lumen Scholarship

Tells the story of the origin of a community

Utilizes the language of a creation myth

Serves to legitimize the rest of the text within the mythos

of the community, thereby lending ethos to the rest of the

text

Tells the story of the origin of a community

Lays out the underlying values and beliefs of the community

Poster Session 5: NR5-17

DSM-I DSM-II DSM-III DSM-IV

Rhetorical Strategies

“Armed with this wealth of thoughtful ma-terial” Descriptive lan-guage Use of exam-ples

DSM presented as “proper” and entitled

More standard-ized language DSM portrayed as a product

Formal, unin-terested writing Euphemisms Technical lan-guage

Main Points DSM is neces-sary DSM is backed by valid associ-ations The community wants the DSM

DSM-II con-tributes to US and world psy-chiatry

Promote new axial structure DSM-III is the most accurate yet

DSM growth is necessary Emphasizing accuracy

My research examines the rhetorical strategies at work in the community discussions regarding the development of the new Diagnostic and Statistical Manual of Mental Disorders (DSM), especially as related to Generalized Anxiety Disorder (GAD). I have the unique opportunity to be one of the first to collect and contextualize the rhetorical conversations that are facilitating the development of the DSM-5. Throughout my research process, I will annotate changes related to GAD throughout the four DSMs; examine DSM-5 development and work group publications from the American Psychiatric Association (APA) and the National Institute of Mental Health (NIMH) related to GAD; and conduct before and after interviews with approximately fifteen practicing psychiatrists about their experiences with the DSM diagnostic guidelines, DSM development process for GAD, and DSM revision process.

Professional Writing and Rhetoric (PWR) has a long history of exploring com-plex communities like social work and engineering. This research is looking into the mental health community and the text that governs their work, the DSM. This research asks: what are the community-building rhetorical strategies in the DSM?

Rhetorical

Strategies

Pathos Ethos Logos

Definition Appealing to emotion Persuading the audi-

ence of the credibility

of the author

Appealing to reason

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The forwards are individually and collectively the creation story for the mental health community.

The forwards utilize rhetorical strategies to build, bolster, and continue the mental health community.

Citation Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, Rapee RM, Ruscio AM, Stanley MA. Generalized Worry Disorder: A review of DSM-IV Generalized Anxiety Disorder and Options for DSM-V. Depression & Anxiety, 2010; 27:134-147.

Beesdo, K., Winkel, S., Pine, D., Hoyer, J., Lieb, R., & Wittchen, H.-U. The diagnostic threshold of generalized anxiety disorder in the community: A developmental perspective. Journal of Psychiat-ric Research 2011; in press. doi:10.1016/j.jpsychires.2010.12.007

Countries of Origin Australia, Germany, and USA Germany, Switzerland, and USA Purpose & Methodol-ogy

Purpose: (1) identify the evidence that previous DSM Work Groups relied upon to create criteria for the DSM-III-R and the DSM-IV; (2) argue for or against changes to the criteria for generalized anxiety disorder Lit review of Annotated Listings of Changes in each DSM, the DSM-IV Sourcebooks, the DSM-IV Options Book, and manuscripts relied on/or published by previous reviewers of GAD diag-nosis

Databases searched: SCOPUS, GOOGLEBOOK, MEDLINE

Purpose: argue for and against changes to the criteria for generalized anxiety disorder, particu-larly the youth-related criteria. DSM-IV GAD was assessed using the M-CIDI in a community sample of adolescents and young adults. Diagnostic thresholds were modified in two age spans (9-20 and 21-34) using a person by year data file (N=38,534 cases).

Statistical analysis

Definition of GAD “Generalized anxiety disorder (GAD) is a chronic and impairing disorder, interdependent of its substantial comorbidity with other mental disor-ders. Although it shares some risk and clinical similarities with other internalizing/emotional disorders, it can be distinguished from these dis-orders.”

GAD, instead of being defined for this article, is described through a history of the DSM’s criteria for GAD.

Style of Writing Clear tone common of lit reviews Slightly casual Example: “The classification has thus progressed beyond treating GAD as a residual category or the ‘‘confusing stepchild among the anxiety disor-ders’’ as it was in DSMIII.”

Dense, though logically organized Places emphasis on facts Technical language Example: “Focusing on one relaxed criterion, GAD rates in the total sample increased by 60.0% when duration was required to be only three months and by 46.7% when anxiety was not required to be excessive.”

Ethos Wide range of source types Grant funded Example: Contributor’s qualifications displayed on the first page

Extensive citations Professional charts and tables Grant funded Example: “This work is part of the Early Devel-opmental Stages of Psychopathy (EDSP) Study which was funded by the German Federal Minis-try of Education and Research (BMBF) project no. 01EB9405/6, 01EB 9901/6, EB01016200, 01EB0140, and 01EB0440.”

Pathos None evident None evident Logos Results, text moves through the DSM-IV criteria,

logically addressing each point of controversy Example: “DSM-I Criterion A: The Nature, Fo-cus, and Duration of Anxiety and Worry” moves into “DSM-V Options for the Excessiveness Re-quirement.”

Very few statements are made by the author without backing from another source

Example: “DSM-III (APA, 1980) defined GAD as ‘generalized, persistent anxiety of at least 1 month duration’ accompanied by an unspecified number of various other symptoms.”

Observations Writing is slightly more casual Emphasis placed on organization Lit review placed in study format

Writing is dense, scientific Emphasis placed on logos appeals Typical study format

Elon University

What rhetorical strategies are used in the community building featured in the for-

wards of the DSM editions?

References