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Understanding depression as a rhetorical phenomenon opens a space for analysis that attends to the discursive forms that shape the illness and the identities of its sufferers. The signs of illness—withdrawal from social contact, recurrent painful and guilty thoughts, loss of enjoyment in activities and interactions—paint sufferers as profoundly silenced, yet the volume of contemporary talk and text belies this characterization. The discourse of depression articulates the illness within a series of gendered identities in both senses of that verb: joining features into a single illness, and pronouncing distinctly the identities associated with it. Historically, this verb also encompassed the activities of coming to terms, via the acceptance of articles or conditions, and of capitulating to such terms.1 These now obsolete definitions nevertheless echo within the self-doctoring practices mandated within the contemporary discourse of depression. As individuals define themselves using the vocabulary common to medical practice, they relinquish personal autonomy in favor of medical recognition and pharmaceutical treatment. While such capitulations may result in effective treatments for some, evidence suggests that for a significant number of individuals these interventions are of limited value. A rhetorical analysis, then, makes visible the joints by which the illness itself is assembled and voiced. Direct-to-consumer advertisements represent the most obvious textual site for locating practices of self-doctoring, as they encourage individuals to act as their own physicians and to model their behaviors and self-assessments on the “ideal” images projected. According to the U.S. Government Accountability Office, spending on direct-to-consumer marketing materials for pharmaceuticals nearly tripled between 1997 and 2005, from $1.1 billion to $4.2 billion annually .2 This increase attests to a business model that has moved prescription drug promotion out of the doctor’s office and into homes via television and 34 2 bbbbbbbbbbbbbbbbbbbbbbbb Articulate Depression The Discursive Legacy of Biological Psychiatry print media. It also represents a shift within medical rhetoric, which has traditionally consisted of doctor-patient dyads and a relatively closed system of expert knowledge. In the late twentieth century, however, the rapid growth of direct-to-consumer pharmaceutical promotion and the development of information delivery systems such as WebMD have reconfigured the system of expertise and the balance of power in medical encounters.3 Such developments precipitate new medical rhetorics, especially those configured around the authority of pharmaceutical companies. Among the most highly marketed pharmaceuticals are the class of antidepressants known as the selective serotonin reuptake inhibitors (SSRIs, such as Prozac, Paxil, and Zoloft), and their cousins the selective serotonin norepinephrine reuptake inhibitors (SSNRIs, such as Cymbalta and Effexor), which additionally block the reuptake of norepinephrine . These drugs have likely saved and improved many lives, but they have also undoubtedly changed what it means to be alive and mentally well (or ill).4 These new definitions of mental health result not directly from the new chemical compounds and their effects on temperament or brain functioning, but from the rhetoric that attends their development, marketing, and use. Depression and the drugs used to treat it have entered the public lexicon thoroughly and irrevocably. Prozac, and the pharmaceutical complex it metonymically represents, is now a resource for constructing individual and collective understandings of the self and its mental health needs.5 The successes of the pharmaceutical industry have conditioned the statements it is possible to make about depression and the self. Such statements are not mere rhetoric, but rather consequential heuristics through which individuals experience their lives and their selves. In one of my interviews with women experiencing symptoms of depression, Stephanie admitted, “I honestly do think that I have a chemical imbalance” even as she adamantly refused to accept medical or other therapeutic interventions in her life. While Stephanie has not fully embraced the illness identity that requires pharmaceutical intervention, she is clearly beginning to see herself in biochemical terms. For medical rhetoricians, understanding the linguistic impact of biological psychiatry offers a chance to explore how individuals such as Stephanie become patients and how illnesses become identities. Language filters and organizes experience, naming and categorizing both feelings and symptoms as “normal” or “dysfunctional.” Alongside the scientific developments of biological psychiatry, a set of standard linguistic structures encourages isolated acts of self-doctoring by encompassing broad and strategically imprecise definitions of illness, by offering figurative and narrative descriptions that model gendered responses to illnesses such as depression, and by making available genres such as the symptoms quiz that direct individuals to their doctors’ offices. Therefore...

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