bs_bs_banner
New Zealand Geographer (2013) 69, 83–93
doi: 10.1111/nzg.12011
Research Article
Obsessive–compulsive disorder (OCD): Gendered metaphors, blogs and online forums Rebecca Campbell and Robyn Longhurst Geography Programme, University of Waikato, Private Bag 3105, Hamilton 3201, New Zealand
Abstract: In order to understand social recovery from mental illness, it is important to examine the role played by social space, including virtual space. This article examined blogs and online forums for people with obsessive–compulsive disorder (OCD). In particular, it addressed gender differences in the metaphors used by men and women in these virtual spaces. Empirical data illustrated that, in general, women are more likely to frame their experiences of OCD as a journey, whereas men are more likely to frame them as a battle. Use of these different metaphors has potential implications for social recovery. Key words: battle, gender, journey, metaphor, OCD, subjectivity.
Hester Parr (2008) argues that people with mental health problems are active in ‘rescripting’ their own recoveries from the social stigmatisation of being mentally unwell and that understanding practices within an array of social spaces is central to this process (see also Moss and Dyck 2003, who discuss people with chronic illness ‘rescripting’ their identities). Building on this idea, we examine how people with obsessive–compulsive disorder (OCD) ‘rescript’ their own social recoveries in the space of blogs and online forums. In particular, we address whether there are gendered differences in the information posted, especially the metaphors employed, by men and women in blogs and online forums and, if so, what might be the potential implications of these gendered differences for how individuals understand ‘the self’ and their recovery? Over the past few years, work has begun to emerge on how virtual forums might be seen as
spaces in which people with mental illness and other disabilities are able to revision their subjectivities (Davidson 2003, 2008; Parr & Davidson 2008; Skelton & Valentine 2010). As Parr (2008) notes, contemporary technologies play an important role in shaping social support services for groups such as the ill and disabled. She writes: ‘Mental health forums are entangled textual spaces for “self-writing” (Foucault 1997b) with confusing implications for individual and collective “improvement” ’ (Parr 2008, p. 158). On one hand, people with mental health problems can be seen as creating ‘new geographies of belonging through the Internet’ (Parr 2008, p. 159); on the other hand, they also live in offline worlds such as Hamilton, New Zealand, where the authors are based. The skills for social recovery accumulated through virtual spaces do not always translate easily into ‘real’ world spaces such as Hamilton. People may feel empowered online to share in
Note about authors: Rebecca Campbell completed her Masters in Geography at University of Waikato. She is currently employed by Waikato University to teach English at Shanghai International Studies University. Rebecca is also preparing a doctoral proposal on mental health, well-being and virtual space. Robyn Longhurst is Professor of Geography at University of Waikato. She teaches and researches on gender, sexuality, bodies, space and place. E-mail:
[email protected] © 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
84
R. Campbell and R. Longhurst
an environment where they understand themselves to be anonymous or supported by those with whom they share common experiences but would be otherwise constrained in the company of ‘real’ people in their everyday lives. The Internet as a technology, therefore, does not always have emancipatory effects (Davidson & Parr 2010). As Dobransky and Hargittai (2006) point out, it is not helpful to generalise about disabled people’s use of the internet or its effects on their lives, instead, there is a need for more in-depth research into specific dimensions of the use of Information Communication Technologies and the experiences of different disabled groups. This research therefore focuses on one particular dimension of people with OCDs use of online forums, that is, their use of metaphor, because we think this has an important effect on the kind of ‘generative space’ (Madge & O’Connor 2005, p. 93) or sense of well-being (Fleuret & Atkinson 2007) that can potentially be created. As many social and cultural geographers note, there is a connectedness between offline and online worlds. For example, Madge and O’Connor (2005, p. 83) argue that there is a ‘simultaneity of online/offline worlds in cyberspace mothers’ lives’. They explain that online and offline spaces coexist and that ‘although cyberspace can result in the production of new selves, these selves have residual attachments to embodied experiences and practices’ (Madge & O’Connor 2005, p. 83). Interactions in virtual space affect interactions in real space and vice versa (Graham 1998). Discourses, including online discussions between people with OCD, do not simply describe pre-existing social spaces and relations but also shape them. For example, our experiences in Hamilton suggest that many living in the city still tend to feel uncomfortable discussing mental health issues including OCD. In Christchurch, the group ‘Anxiety Support Canterbury’ offers information and support to those who experience OCD, but no such similar group operates in the Waikato. The topic of OCD sometimes arises in conversation but usually in jest with people describing themselves and/or others as ‘so OCD’, meaning, they are fixated on something, with little thought given to the painful experiences of those who actually suffer from OCD. The ‘real’ spaces of Hamilton, therefore,
affect how people might interact with others online. For example, people might initially be reticent in discussing particular issues due to negative ‘real’ life past experiences. Their online interactions with people from other places (e.g. many OCD blog and forum users appear to be based in the USA) may in turn affect how they interact with people in Hamilton, for example, bringing new knowledge into everyday conversations with colleagues, friends, family and loved ones. OCD is an anxiety ‘disorder’, which has historically been identified affecting 1–2% of the adult population, though more recent research suggests that this percentage may be a conservative estimate (Lapidas & Gilbert 2010). OCD is characterised by two main symptoms: obsessions and compulsions. Obsessions are thoughts and/or images that are recurrent, intrusive and often disturbing. Such thoughts and images are acknowledged by the individual experiencing them to be excessive and/or irrational but, despite this knowledge, they cannot be dislodged (Goodman 2006; see also Rapoport 1989; De Silva 2003). Compulsions are the result of a person’s need to lessen the anxiety caused by his or her distressing and disturbing obsessions (Segrott & Doel 2004). Compulsions often, but not always, manifest in the form of elaborate rituals. People with OCD feel driven to perform rituals in order to alleviate their distress. OCD is a highly spatial practice with fears necessitating ‘the formation of psychosocial boundaries in ways that are similar to agoraphobia and other mental-health problems’ (Segrott & Doel 2004, p. 597; Bondi 2005). In this article, we address two research questions: (i) in what ways are blogs and online forums on OCD gendered spaces in relation to the metaphors invoked?; and (ii) what are the potential implications of these metaphors for how individuals understand themselves and their recovery? It is generally acknowledged by mental health professionals that OCD affects men and women equally in terms of its prevalence or incidence (Camarena et al. 2001), but this does not mean that the condition is unaffected by gender or is ‘gender neutral’. Our research illustrates that while the incidence of OCD may be similar among men and women, experiences of OCD, including the way that men and women talk about it, or do not talk
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
Obsessive–compulsive disorder (OCD)
about it (online spaces for those with OCD, especially blogs, appear to be dominated by women) is highly gendered. As we argue, many (but certainly not all) of the blogs and forums on OCD that we examined illustrate differences in the way that women and men tend to talk (or do not talk as in the case for some men) about their experiences. This article begins with a discussion about the use of metaphor in relation to health and illness. There is an existing body of research that provides a platform from which it is possible to offer new empirical insights on metaphor in relation to people with OCD. The methodological process used to conduct the research is then outlined.This primarily involved analysing blogs and online forums for people with OCD. We then focus on what we found were the two most commonly used metaphors associated with the condition: the ‘journey’ (often, but not solely, used by women) and the ‘battle’ (often, but not solely, used by men). We conclude by examining how these gendered metaphors might potentially aid or hinder those living with OCD in relation to their social recovery.
Using metaphor to conceptualise OCD The linguistic framework through which people understand the body as it materially exists is limited, and therefore embodied experiences are often interpreted through conceptual linguistic frames such as metaphor (Pritzker 2003; see also Reid-Henry 2012 for an example of research on geography and metaphor). Metaphors are statements based on some kind of analogy where two things are compared (St. Clair 2000). They are used in everyday conversation in order to concretely grasp what might otherwise be too abstract to fully understand. Many metaphors have become so ingrained in the contemporary English lexicon that they are often overlooked, and yet they play an important and powerful role in shaping subjectivity and spaces such as clinics, cafes and workplaces (Lakoff & Johnson 1980). People use metaphors in everyday conversations about a range of things, including health, disability, impairment and illness (Kirmayer 1992; see also Kleinman 1988 on ‘illness narratives’).
85
For those experiencing a mental health ‘condition’ such as OCD, the use of metaphor to frame the experience is significant because not only does it reflect people’s ideas, but it also shapes the ways in which we know and experience ourselves and the discursive, psychological and material spaces we occupy. For example, Frank (1995) identifies three types of illness narrative or metaphor – restitution, chaos and quest – that patients use to make sense of their illness experiences. Hunsaker Hawkins (1999) discusses what she refers to as five central reoccurring myths in illness narratives: battle and journey, rebirth, death, healthy mindedness, and environmental causation. Metaphor is then far more important than might first be imagined (St. Clair 2000). It is used not just to conceptualise a pre-existing reality but actually creates reality (Lakoff & Johnson 1980). It plays a vital role in the (re)construction of bodies, social relations and spaces enabling people to use their linguistic ability to make sense of their subjectivities and embeddedness in particular contexts. These contexts may be virtual such as blogs and forums made up of people from various places around the world, or ‘real’ such as bars, sports clubs and schools in cities such as Hamilton, Apia, Tokyo and London. As Kearns (1997, p. 271) points out, the use of metaphor ‘represents a discursive coping strategy deployed by interpretative communities to construct understandings of their changing places and changing place-in-the-world’. Those who have a mental health condition such as OCD – and their friends and families – are often faced with extenuating circumstances and difficult situations (Davidson 2003; Parr & Philo 2003; Segrott & Doel 2004), especially in places such as New Zealand, where there has long been an expectation that those who are unwell, especially mentally unwell, simply need to ‘harden up’, ‘get over it’ or ‘pull themselves up by their bootstraps’. For people with OCD, their sense of belonging and normality are challenged by the nature of their ‘illnesses’ (Parr & Butler 1999; Moss & Dyck 2003). It is perhaps unsurprising therefore that metaphor is very much present in mental health discourses. Language plays a pivotal role in the ‘construction of health and healing contexts’ (Kearns 1997, p. 273). The ways in which we understand and
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
86
R. Campbell and R. Longhurst
conceive of the world impinge on language – consequently, so too does how we (re)construct the contexts of illness, disability, healing, health and well-being (e.g. see Sontag 1978 on conceptualising cancer as the ‘Big C’). Conceptualising illness using metaphor can afford some people who are ‘unwell’ a sense of agency. What kind of metaphor is employed, and in what context, however, is likely to affect the experience?
Analysing blogs and online forums Parr (2008, p. 136) notes that ‘Figures for Internet use specifically by people with mental health problems are hard to obtain’ but one source estimates that one in five Internet users has looked for mental health information, whereas another source lists approximately 12 million mental health pages indicating the importance of the Internet as a social space in which mental health is constituted. Two important dimensions of this space are blogs and online forums. Blogs are a frequently (or infrequently, as the case may be) updated, reverse-chronological series of entries posted on a single webpage (Blood 2004). Bloggers who are sometimes ‘driven to document their lives, provide commentary and opinions, express deeply felt emotions, articulate ideas through writing, and form and maintain community forums’ (Nardi et al. 2004, p. 41). Online forums are websites or areas of websites specifically designed to enable discussion. They are not ‘real-time’ conversations as in online chat rooms. Rather, messages can be posted, read and replied to at any time by members of the forum and, in some cases, the public. Examples of online forums that we visited include: OCD-UK Discussion Forums; StuckInADoorway forums; and OCD sections of the SocialPhobiaWorld forums. The blogs and online forums on OCD, and the threads within them, are numerous (within an online forum, members can post messages and read and/or reply to the messages of others in conversations referred to as threads). Many threads have titles like ‘Having a bad day’ or ‘OCD taking over my life’, which provide little indication as to what exactly the thread is about. Therefore, we made a decision to look
only at threads that had more than three replies as we concluded that the most robust discussions would likely be taking place within these threads. In total, between 2011 and 2012, we analysed 16 blogs and online forums used by people to share their experiences of OCD. We fully immersed ourselves in the online worlds of those with OCD, choosing to examine blogs produced by individuals rather than by organisations such as clinics and mental health information websites, as the latter tended to focus more on medical information and on means of obtaining help rather than on metaphor, affect, emotion and experience. The information that we gathered from forums and blogs was ‘published’ on public webpages that were accessible without any sort of membership. It is important to note, for the purposes of this project, that it was not always possible to establish definitively the gender of bloggers or those posting in forums, although pseudonyms and usernames such as ellowoman, ocdprincess, ocdbloggergirl, Jack, Ann, krystal and Shana tended to indicate the gender of a person. In this research, we chose not to identify individuals by their usernames and instead refer to them by pseudonyms because usernames can be as revealing and important to people as their ‘real’ identities (Frankel and Siang 1999). We also chose not to list the web addresses of the sites we examined, again, to protect the anonymity of participants as much as possible. This research is also informed by (although does not directly report on) work carried out by Rebecca in 2009–2010, which examined the experiences of people with OCD in a range of social spaces. Rebecca conducted semistructured interviews (recruited through an article published in the community newspaper Hamilton News) with two women and two men who have OCD and live in Hamilton, New Zealand. She also interviewed a psychologist who specialises in treating anxiety ‘disorders’ about the clinical aspects of OCD and how the condition might manifest differently in women and in men. Additionally, Rebecca examined film texts about individuals with OCD (e.g. The Aviator (2004), As Good As It Gets (1997), and Matchstick Men (2003)). Finally, she drew on autobiography reflecting on her own experiences of being diagnosed with OCD several years ago when she was in her late teens.
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
Obsessive–compulsive disorder (OCD)
Rebecca now considers herself to be in a ‘remission-type’ phase where obsessions and compulsions have a much smaller presence in her life than they once did (see Campbell 2010, 2011).
OCD as journey In a blog titled ‘Why are we all women?’ the author writes: I love the community of OCD bloggers that’s grown up in the last couple of years . . . But I also think it’s funny that we’re pretty much all women. I don’t know of any data that indicate that woman [sic] are more prone to OCD . . . And yet here we are, a support group of women. Responses to this post suggest that men might be less comfortable than women talking about mental illness, because it is widely perceived as weakness (especially in men), that men might feel more shame, be in denial, and/or not feel comfortable sharing stories. Despite this possibility that men do not join online OCD groups as readily as women, we did find at least four blogs that appeared to be written by men, and two online forums that men contributed to, for example, the post titled: ‘The mindfulness for OCD blog: one man’s personal experiences’. What we are most interested in here, however, is not so much the number of posts written by men and women but rather how the posts might be qualitatively different. One major difference, and the one we focus on, is the metaphors employed to discuss experiences of OCD. The metaphor of a ‘journey’ is particularly evident in women’s blogs on OCD. For example, Jill titles her blog ‘My journey through OCD’. In her ‘About me’ section, she states: ‘I’ve been on this journey in and out of OCD for more years than I want . . . These are the voyages of [author’s name] as she boldly (or not so boldly) goes thru the universe of OCD.’ Jill invokes metaphors of journeys, movements and steps. For example, when she goes to the movies and has an OCD ‘episode’ in the theatre, she describes her experience thus: ‘After a few minutes of intense guilt . . . other thoughts get thru. The ones that say, take it slow. One step at a time.’ In Jill’s post on 3
87
March 2012, she mentions the idea of ‘recovery’ but also of ‘going backwards’ in her journey stating: ‘I have to decide lots whether to give in or not and i keep reminding myself of what Dr. Tompkins said in his book about recovery . . . I just keep on top of what I can already do so I don’t go backwards too much’. In another post, Jill acknowledges that ‘OCD isn’t necessarily something that can be fixed, the journey does not just end’. She states: Yesterday was my last day of therapy . . . I’m excited and happy- it’s been a long hard journey- but also nervous because this doesn’t mean that ocd has disappeared, only that i am now capeable [sic] of dealing with it as it happens and with cbt [cognitive behaviour therapy] and act [acceptance and commitment therapy] tools, before it gets too far. Another blogger, ‘fullofdoubt’, whose husband also experiences OCD says: ‘Well, tomorrow could decide the direction of the rest of my life. After my worst OCD episode yet, I’m at a crossroads: Should I attend an intensive outpatient program for OCD?’ In another post, ‘fullofdoubt’ reflects on her journey saying: ‘I have improved. It was gradual with a few bumps in the road, and I’m still climbing’. Another blogger, Carolyn, upon being invited to speak at the International OCD Foundation (IOCDF) annual convention, writes that she will be speaking about her ‘journey on the path with OCD’. Journeys typically have starting points, paths, steps, landmarks and a final destination. We found that while people with OCD do not tend to talk much about their journey’s starting point, they do discuss at length the journey itself. For example,‘everydaygirl’ usually avoids outings, particularly visits to her family, as she fears that somebody will be sick and that she herself will catch the illness. When she goes to a family gathering without first taking a shower (something she does in order to alleviate her intense anxiety), she describes this as being ‘a HUGE step forward’ in her treatment. Some women bloggers appear to often take pride in their accomplishments framing them as small ‘steps’ in their journey. For example, Claire, in describing her experiences of cognitive– behavioural therapy for OCD, says that she
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
88
R. Campbell and R. Longhurst
thinks of her own personal achievements as being steps, or ‘stepping stones’, on a ‘long path’ towards being able to manage the condition. Blog authors not only talk about steps, however, but also about the numerous obstacles they face in their journeys. Blog content, for men and women, commonly focuses on the challenges and difficulties faced by their authors as they struggle to ‘manage’ their OCD. Postings are commonly concerned with events that waylay progress in treatment or with ‘bad days’ in which no one thing but a combination of things leave the author feeling depressed and discouraged. Holly states that on such days, she feels as though she is ‘spiralling downward and there is no way [to] come back again’. Elisabeth writes that when she is very upset, she feels like ‘I’m losing something . . . I could assume the worst and take my changing behavior as proof that I no longer have any interest in my disorder and am back to square one’. Elisabeth’s comment illustrates how feelings of depression or failure can result in people thinking that they have regressed or lost momentum in their journey. Paths typically have some end or final destination, and in relation to OCD, this is typically to recover which tends to mean living a life in which OCD can be managed often through treatments and medications. For example, Elisabeth writes about her ‘ups and downs in the process of recovery’ after finding appropriate treatment. ‘ShellyBeach3’ says that she wants to share what has worked for her with ‘Exposure and Response Prevention Therapy.’ In many of the blogs, we analysed it was obvious that the OCD journey is one best not walked alone. Mary explains that she sees her blog as a means of ‘connecting with others who have OCD, sharing my struggle with the [sic] those who don’t understand, refusing to suffer alone in society’. Susan wants to share what works for her stating that hopefully her blog will be useful to readers. Forging connections with other people who have OCD is an important facet of the journey. Davidson (2003), in her research on agoraphobia, highlights the importance of creating links or friendships with others who have similar experiences of a (mental) health condition. Davidson used self-help groups as focus groups in her research and found that being a
member of a group of people who share experiences is an ‘important factor in mediating the respondents’ sense of self and group identity . . . [it] can offer its members a collective identity based on the mutual recognition of shared experiences and a shared “form of life” ’ (Davidson 2003, p. 34). This appears to be similar for those with OCD. Authors provide hyperlinks to each other’s blogs on their own webpages and comment on each other’s postings. Blog author Gail illustrates this desire to connect with others, saying: ‘I hope that by sharing my journey, I can help bring compassionate awareness to Obsessive Compulsive Disorder, bring hope to those bound by this secret struggle, and inspire everyone to fight for their own free spirit’. Janice writes: ‘These are my reflections on how OCD has impacted my life, both in the past and the present, as well as a chance for me to share my ups and downs in the process of recovery. I hope that my thoughts and experiences resonate with other sufferers as theirs have resonated with and inspired me!’ It is also worth noting that these comments reflect stereotypical conceptualisations of gender in which women are positioned as nurturers (Laws 1997). Although the journey metaphor often tends to be feminised, it is not only women who invoke it. There are disjunctions that are important to highlight because they assist thinking about the social–spatial implications of such discourses and the complex ways in which they may be drawn upon. Take, for example, Stephen’s blog that rests heavily on the metaphor of the journey. He writes:‘These days journaling is a big part of healing. It has allowed me to get my emotions out through new avenues. To me journaling and writing in a personal diary are the same thing. To some of the guys around the world, writing in a diary might be sissy, but it is all up to the individual. Just do not judge me as sissy’. Stephen refutes the weight of signification he sees in associating journaling with women and the feminine (or ‘sissy’ to use his term). In another part of the blog, Stephen expresses his journaling as invoking a desire to help others (again, something that is often feminised) and in another part again, about wanting to keep his OCD ‘under control’ (rather than fighting it). In complex ways, then, Stephen reproduces feminised discourses of
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
Obsessive–compulsive disorder (OCD)
OCD as a journey but also disrupts them through his male embodiment (see Berg 1994; Berg & Longhurst 2003). Interestingly, the metaphor of journey appears increasingly in popular culture, especially in reality television. As Caitriona Noonan (2011, p. 730) writes,‘individuals are tasked with managing their own path to personal growth and moral development, the ultimate goal of which is to achieve the idealized self’. Noonan focuses on ‘religious television’, but the journey metaphor is also evident in popular programmes such as Masterchef, The Biggest Loser and American/Australian/New Zealand Idol. Contestants on these shows embark upon individual journeys of discovery,finding new ways of managing the self (whether it be through religion, cooking, health, or singing and performance). As with OCD and other and medical and clinical discourses of self-governance, the journey is used to frame and mobilise the responsibility of the individual in society.
Battles, struggles and monsters The battle metaphor (or what Reisfield & Wilson 2004 refer to as the ‘martial metaphor’) is also used frequently in medical, clinical and disease discourses. Bacteria, for example, are often represented as ‘agents of disease’ (Sontag 1999, p. 139) that ‘infiltrate’, ‘wage war’ upon or ‘invade’ the body. This metaphor sets up clear body boundaries that, when breached, are positioned as being ‘under attack’. Thus, the attacker – the illness, whether psychological or physical – is framed as a threat to the body and mind. It is Other – something the body must fight. Stan, in a forum, writes that OCD is ‘impossible to beat’ and that every day he fights himself. He asks: ‘is anybody else tired of fighting there [sic] self [sic]’. Roger, a guest on the same forum (although in a different discussion thread) says: ‘One half of me says I want to do it [rituals to allay fear] and the other fights it and so there is a major internal conflict’. In an online OCD forum, Stanley writes a poem that reflects his experiences with OCD. It includes the lines: ‘how do you beat the bug’ (he uses this term to refer to his condition), ‘you try to argue back to him’, and ‘now he gets you angry and you start to kick and scream\you punch and shout and try to fight’. Men’s tendency to refer
89
to their lives with OCD as comprised of a series of struggles or battles often implies and situates the self as being in opposition to an external threat – an Other. The ways in which many men (and some women) represent their experiences of OCD as being battles or struggles position the condition (which is perceived to be rooted in the mind) as being something that sits apart from themselves. In online forum postings, OCD is often referred to as a fight that has to be won. This fight is often waged at monsters. For example, the IOCDF organised a conference on 26 July 2010 that used the catchphrase ‘I can beat the OCD monster!’ as part of its promotional materials on Facebook. David, who contributed his own story to the Anxiety Disorders Association of America, describes his experiences with the condition as ‘fighting the monster of OCD’ (Anxiety Disorders Association of America 2011, para. 1). Monsters are not the sole metaphorical domain of men, however. To say that women always employ the metaphor of journey while men employ metaphors of battles and monsters would be to create a false binary. Some women, not only in blogs and forums but also in other discursive spaces, also use the term ‘monster’ to describe OCD. For example, when Lauren was interviewed for a story about OCD in a magazine supplement Tempo in the newspaper Waikato Times, she referred to her OCD as a monster that she has to ‘get rid of’ (Cronin 2011, p. 4). She describes it as ‘an intrusion, an external thing’ (Cronin 2011, p. 4). Gillian, in her blog, also portrays her OCD as something Other and calls it ‘the monster that lives in my head’. This interpretation of OCD suggests that it is something that has invaded the self. It also potentially suggests that OCD is something unnatural and freakish. Chantel, in her blog, entitles one post ‘OCD – the monster with multiple personalities’ illustrating it with a picture of a three-headed dragon shooting flames from its mouths. The creature is depicted as aggressive and dangerous. Not only do some individuals who themselves live with OCD portray it through metaphors of battle and struggle but also some physicians and health workers. The OCD Resource Centre of Florida describes their suggested strategies to manage obsessions and
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
90
R. Campbell and R. Longhurst
compulsions as ‘weapons in your arsenal in this battle against OCD Resource Centre of Florida’ (2011, para. 2). While it is difficult to ascertain whether this statement was written by a man or woman, what is actually more important to note is that the psychological profession as a whole is historically male dominated (Standley & Soule 1974). Gender of the author aside, the words ‘weapons’,‘arsenal’ and ‘battle’ all invoke notions of aggression, violence and conquest and are commonly associated with discourses of war. Such discourses, it can be argued, are masculinist. Traditionally, men have been identified as being active aggressors imbued with inherent physical strength. There appears to be an idea, among men particularly, that having OCD is akin to being at war. Referring to oneself as ‘fighting’ OCD could potentially afford a sense of agency in that as Reisfield and Wilson (2004, p. 4025) argue, the battle metaphor ‘has an exceptionally strong focusing quality, and its images of power and aggression serve as strong counterpoints to the powerlessness and passivity often associated with serious illness’. It is understandable, then, why some with a mental health condition, or who are family related or friends of a person with a mental health condition, might choose to engage with this metaphor. However, the battle metaphor could also set people up for ‘failure in combat’. Some remarks made by those with OCD suggest that it can seem so overwhelming and all-encompassing that it can emotionally incapacitate those who have it. Indeed, blog author Karen indicates that having the condition makes her feel weak and helpless. Such feelings are illustrated in her blog postings, one of which states: ‘some days I feel like giving up. The OCD monster is sucking the life out of me.’ This statement suggests that, at this point in time at least, Karen feels like something of a passive victim rather than the active fighter that much of the aggressive and battle-oriented discourse implies men to be.
Conclusion The aim of this research was to examine how people with OCD rescript their own social recoveries in the space of blogs and online forums by addressing gender differences in the information posted, especially the metaphors
employed, by men and women. We found that while not wanting to make over generalised claims or create binary divisions, there are some ascertainable gendered differences in the metaphors used online by men and women who live with OCD. Evidence illustrates that women more typically invoke the metaphor of a journey while men invoke the metaphor of a battle. We were also keen to determine what might be the potential implications of these gendered differences for how individuals understand themselves and their recovery. Like Reisfield and Wilson (2004), we do not think that metaphors are necessarily inherently good or bad, empowering or disabling, but there are some points to consider in relation to the use of journey and battle metaphors to discuss experiences of OCD. Arguably, the journey metaphor may function to place the responsibility of discovery and find new ways of being squarely on the shoulders of the individual rather than on society. However, more is at stake. Our research indicates, on a more positive note, that the journey metaphor also tends to position OCD as a part of the self, rather than as distinctly Other to the self. In negotiating obstacles along the way and reaching landmarks, an individual experiences changes that occur within the self. The idea of OCD as a journey rests upon a notion that the mind and body are inseparable. Reisfield and Wilson (2004, p. 4026) argue (in relation to cancer patients, but we think it is also applicable to those with OCD) that the journey metaphor ‘allows for discussions of goals, direction, and progress’. The battle metaphor also has something to offer towards ‘recovery’ in that it can afford a sense of agency. However, blogs and online forums indicate that it can potentially also set people up for ‘failure in combat’. Furthermore, portraying OCD as being a fight implies that there must be an opponent to beat or vanquish. Thus, the condition is often framed as some sort of external enemy – an Other – threatening to encroach upon the individual or self. Again, we return to the work of Reisfield and Wilson (2004, p. 4025), who argue that the battle (or martial metaphor as they term it) is ‘inherently masculine, power-based, paternalistic and violent’ and does not acknowledge that aggression and conflict are necessarily always a
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
Obsessive–compulsive disorder (OCD)
person’s preferred method of coping with an illness or other health concerns. Reisfield and Wilson (2004) suggest that ‘winning the war’, or overcoming the condition, simply comes down to fighting hard enough. Therefore, blame tends to be placed on the individual if the ‘war’ is ‘lost’. It is the person who fails treatment or therapy, not the treatment or therapy that fails the person. The battle metaphor invokes a self that is positioned in opposition to an Other. It separates the self into component parts that battle each other – good versus bad, rational versus irrational, mind versus body, self versus Other, etc. As long as OCD continues to be discursively constructed as Other, selfawareness, acceptance and even love of the self, and recovery could prove difficult for some. Clearly, people with OCD will continue to also devise other metaphors based on things they know and value to understand their experiences in meaningful ways, but what is important is that both those with OCD and others in their lives recognise that metaphors can have an important effect on the experience of OCD because they facilitate (or sometimes fail to facilitate) communication. Examining the ways in which people ‘rescript’ their own social recoveries not only in spaces such as blogs and online forums but also in ‘real’ spaces at a variety of scales (e.g. homes, community spaces, cities, regions, nation states) is important, and this research is but one small step towards developing a fuller understanding of the ‘entangled textual spaces for “self-writing” ’ (Parr 2008, p. 158) for those who live with mental illness. Future research that extends the brief to consider carefully not just online spaces but also the material spaces in which people with OCD eat, sleep, love, cry, perform rituals and so on, would give rise to a deeper understanding of the ways in which invoking particular metaphors affects lived experience.
Acknowledgement Rebecca would like to thank the people who, over the past couple of years since she began this research, gave of their time freely to talk with her about their experiences of OCD. Rebecca would also like to thank Jo Clarkson for sharing her knowledge and books on OCD.
91
We would both like to acknowledge the helpful comments of the anonymous referees and editor Nicolas Lewis.
References Anxiety Disorders Association of America (2011). Fighting the Monster of OCD. [Cited 5 May 2011.] Available from URL: http://www.adaa. org/living-with-anxiety/personal-stories/ fighting-monster-ocd Berg L (1994). Masculinity, place and a binary discourse of ‘theory’ and ‘empirical investigation’ in the human geography of Aotearoa/New Zealand. Gender, Place and Culture: A Journal of Feminist Geography 1 (2), 245–60. Berg L, Longhurst R (2003). Placing masculinities and geography. Gender, Place and Culture: A Journal of Feminist Geography 10 (4), 351–60. Blood R (2004). How blogging software reshapes the online community. Communications of the ACM 47 (12), 53–5. Bondi L (2005). Making connections and thinking through emotions: between geography and psychotherapy. Transactions of the Institute of British Geographers 30 (4), 433–48. Camarena B, Rinetti G, Cruz C, Gómez A, de la Fuente JR, Nicolini H (2001). Additional evidence that genetic variation of MAO-A gene supports a gender subtype in obsessivecompulsive disorder. American Journal of Medical Genetics 105 (3), 279–82. Campbell R (2010). Ritualising space: lived experiences of OCD. Unpublished Honours Dissertation. University of Waikato, Geography Programme, Hamilton, New Zealand. Campbell R (2011). Journeys and battles: spatial and gendered discourses of obsessive compulsive disorder. Unpublished Masters Thesis. University of Waikato, Geography Programme, Hamilton, New Zealand. Cronin A (2011). OCD the monster [Newspaper Supplement]. Waikato Times 27 April (p. 4). Davidson J (2003). Phobic Geographies. The Phenomenology and Spatiality of Identity. Ashgate, Aldershot. Davidson J (2008). Autistic culture online: virtual communication and cultural expression on the spectrum. Social and Cultural Geography 9 (7), 791–806. Davidson J, Parr H (2010). Enabling cultures of disorder online. In: Chouinard V, Hall E, Wilton R, eds. Towards Enabling Geographies: ‘Disabled’ Bodies and Minds in Society and Space. Ashgate, Farnham, pp. 63–83. De Silva P (2003). The phenomenology of obsessivecompulsive disorder. In: Menzies RG, De Silva P, eds. Obsessive-Compulsive Disorder: Theory,
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
92
R. Campbell and R. Longhurst
Research and Treatment. Wiley, Chichester, pp. 21–38. Dobransky K, Hargittai E (2006). The disability divide in Internet access and use. Information, Communication and Society 9 (3), 313–34. Fleuret S, Atkinson S (2007). Wellbeing, health and geography. New Zealand Geographer 63, 106– 18. Frank AW (1995). The Wounded Storyteller: Body, Illness and Ethics. University of Chicago Press, Chicago, IL. Frankel MS, Siang S (1999). Ethical and Legal Aspects of Human Subjects Research on the Internet. A report of a workshop, June 10–11, 1999 Washington, DC. [Cited 1 Dec 2011.] Available from URL: http://www.aaas.org./spp/sfrl/ projects/intres/report.pdf Goodman WK (2006). Obsessive-Compulsive Disorder: OCD Information and Treatment. [Cited 1 Dec 2011.] Available from URL: http:// psychcentral.com/disorders/ocd/ Graham S (1998). The end of geography or the explosion of place? Conceptualising space, place and information technologies. Progress in Human Geography 22 (2), 165–85. Hunsaker Hawkins A (1999). Reconstructing Illness: Studies in Pathography. Purdue University Press, West Lafayette, IN. Kearns RA (1997). Narrative and metaphor in health geographies. Progress in Human Geography 21 (2), 269–77. Kirmayer LJ (1992). The body’s insistence on meaning: metaphor as presentation and representation in illness experience. Medical Anthropology Quarterly 6 (4), 323–46. Kleinman A (1988). The Illness Narratives: Suffering, Healing and the Human Condition. Basic Books, New York. Lakoff G, Johnson M (1980). Metaphors We Live By. University of Chicago, Chicago, IL. Lapidas KAB, Gilbert AR (2010). Treatment of paediatric OCD. Child and Adolescent Psychopharmacology News 15 (5), 6–12. Laws G (1997). Women’s lifecourses, spatial mobility, and state policies. In: Jones JP, Nast HJ, Roberts SM, eds. Thresholds in Feminist Geography: Difference, Methodology, Representation. Rowman and Littlefield, Lanham, MD, pp. 47–64. Madge C, O’Connor H (2005). Mothers in the making? Exploring liminality in cyber/space. Transactions of the Institute of British Geographers 30 (1), 83–97. Moss P, Dyck I (2003). Woman, Body, Illness: Space and Identity in the Everyday Lives of Women with Chronic Illness. Rowman and Littlefield, Lanham, MD. Nardi BA, Schiano DJ, Gumbrecht M, Swartz L (2004). Why we blog. Communications of the ACM 47 (12), 41–6.
Noonan C (2011). ‘Big stuff in a beautiful way with interesting people’: the spiritual discourse in UK religious television. European Journal of Cultural Studies 14 (6), 727–46. OCD Resource Centre of Florida (2011). Self-Help Principles for OCD. [Cited 4 Jul 2011.] Available from URL: http://www.ocdhope.com/ocd-selfhelp.php Parr H (2008). Mental Health and Social Space: Towards Inclusionary Geographies. Wiley, Chichester. Parr H, Butler J (1999). New geographies of illness, impairment and disability. In: Butler J, Parr H, eds. Mind and Body Spaces: Geographies of Illness, Impairment and Disability. Routledge, London, pp. 1–24. Parr H, Davidson J (2008). ‘Virtual trust’: online emotional intimacies in mental health support. In: Brownlie J, Greene A, Howson A, eds. Researching Trust and Health. Routledge, New York, pp. 33–53. Parr H, Philo C (2003). Rural mental health and social geographies of caring. Social & Cultural Geography 4 (4), 471–88. Pritzker S (2003). The role of metaphor in culture, consciousness, and medicine: a preliminary inquiry into the metaphors of depression in Chinese and western medical and common languages. Clinical Acupuncture and Oriental Medicine 4 (1), 11–28. Rapoport JL (1989). The Boy Who Couldn’t Stop Washing. The Experience and Treatment of Obsessive Compulsive Disorder. Signet, New York. Reid-Henry S (2012). Geography and metaphors: a response to ‘writing the land’. Transactions of the Institute of British Geographers 37, 365– 9. Reisfield GM, Wilson GR (2004). Use of metaphor in the discourse on cancer. Journal of Clinical Oncology 22 (19), 4024–7. Segrott J, Doel MA (2004). Disturbing geography: obsessive-compulsive disorder as spatial practice. Social & Cultural Geography 5 (4), 597– 614. Skelton T, Valentine G (2010). ‘It’s my umbilical cord to the world . . . the Internet’: D/deal and hard of hearing people’s information communication practices. In: Chouinard V, Hall E, Wilton R, eds. Towards Enabling Geographies: ‘Disabled’ Bodies and Minds in Society and Space. Ashgate, Farnham, pp. 85–105. Sontag S (1978). Illness as Metaphor. Farrar, Straus and Giroux, New York. Sontag S (1999). Illness as metaphor and AIDS and its metaphors. In: Samson C, ed. Health Studies: A Critical and Cross-Cultural Reader. Blackwell, Oxford, UK, pp. 133–149.
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society
Obsessive–compulsive disorder (OCD) St. Clair R (2000). Visual metaphor, cultural knowledge, and the new rhetoric. In: Reyhner J, Martin J, Lockard L, Sakiestewa Gilbert W, eds. Learn in Beauty: Indigenous Education for a New Century. Northern Arizona University, Flagstaff, AZ, pp. 85–101.
93
Standley R, Soule B (1974). Women in maledominated professions: contrasts in their personal and vocational histories. Journal of Vocational Behavior 4, 245–58.
© 2013 The Authors New Zealand Geographer © 2013 New Zealand Geographical Society