This article describes an experimental, interdisciplinary course on the immune system that was co-taught by a humanist and a scientist, and that (inadvertently) coincided with the start of the COVID-19 crisis in the United States. We propose the term “codisciplinary code-switching” to capture the pedagogical strategy we developed in designing the course and adapting it over the semester to grapple with current events. We focus, in particular, on how this approach helped our students navigate the entanglement of science and society in the shifting, uncertain world of the pandemic. Although these were peculiar circumstances, codisciplinary code-switching has broader possibilities and points to alternative ways of integrating the humanities and sciences in medical education that respects both disciplines as rigorous tools for reading bodies, texts, and contexts.

This past decade, the healthcare industry has undergone a transformation with where, how, and why writing happens. For example, what the health and medical professions conceive of as “documentation” or “charting” is writing, even though practitioners call it by another name. Additionally, most writing in healthcare settings is now also multimodal, incorporating textual, digital, visual, and aural content. This essay focuses on the patient decision aid as pedagogical tool that embraces the technological and multimodal changes in health and medicine. Patient decision aids can be understood as a multimodal tool guiding shared decision-making practices. As a genre, the decision aid prompts students to engage in a series of writing modalities – visuals, narrative, texts – as well as the application of user experience and design. Finally, the decision aid as an assignment offers explicit connections between humanities-based students and broader healthcare industries.

In this article, I analyze the trigger warning, a pedagogical practice often framed as student-responsive and trauma-informed, to elucidate the ways in which trauma-informed pedagogy functions rhetorically to pathologize and individualize experiences of racism and other societal inequities that cause collective trauma. I draw upon original interview data and rhetorical analysis through a systems framework to explore how reductive pedagogical practices developed within the confines of a white, western notion of trauma may subsequently perpetuate students’ marginalization. Finally, I highlight the potential for more comprehensive, inclusive pedagogies to address student trauma, acknowledge societal conditions that impact individual experiences, and shift popular discourse that pathologizes trauma.

Complex health and medical contexts demand not only responsive, mutable research but also responsive, flexible pedagogies. Arguing for a shift from the dominant conception of pedagogy as a pre-planned, linear scaffold, this article proposes instead an approach—called Lego™ Learning—that re-conceptualizes instructional content as self-standing, short-term units or modules, much like Lego™ bricks. Because such modules have self-contained learning objectives and corresponding tasks, they can be shifted within a course or across courses as-needed. This approach allows rhetoric of health and medicine (RHM) instructional content to respond to, and prepare students for, the ever-changing exigencies and contexts of RHM-related work. It also encourages collaborations across classes, institutions, and other contexts. In this entry, we frame our discussion around four learning outcomes and teaching practices that can be facilitated through this approach, and we provide an extended example of an ongoing cross-institutional partnership that employs Lego™ Learning.

Editors' introduction to volume 4, issue 2.

Editors introduction to volume 4, issue 3 by J. Blake Scott, Cathryn Molloy, and Lisa Melonçon.

Using the 1980s Centers for Disease Control’s (CDC) surveillance definitions for AIDS, this article examines how the CDC’s rhetorical techniques may have been harnessed to create more inclusive AIDS morbidity and mortality data in the U.S. epidemic’s first decade. The CDC’s decision to privilege disease specificity over sensitivity led women, people of color, and drug users to be underrepresented in epidemiological reporting due to AIDS’s manifestation as more commonly seen—­and therefore less specific—­diseases in these populations. My analysis of the first three AIDS definitions shows heavy reliance on four classical topoi as the CDC sought to constrain who was and was not considered an AIDS case for national reporting. I argue that, while these four topoi—­space, time, correlation, and causation—­did constrain symptoms to the desired specificity, the CDC had the ability to place similar specifications on common diseases for the sake of including vulnerable communities in surveillance data.

Abduction, a mode of reasoning identified by Charles Sanders Peirce, informs theories of clinical decision-­making, but its existing applications to the medical sciences have remained narrow. Building from existing research in the context of patient noncompliance and clinical inertia, this paper advocates a broader understanding of abductive reasoning rooted within the nature of language itself. An example of such a reading of abduction is the theory of triadic communication articulated by American doctor-­turned-­novelist Walker Percy. Percy’s scholarship offers an impetus to examine noncompliance, inertia, and other loci of uncertainty as opportunities for learning, growth, and development of RHM perspectives.

In 1907, the National Tuberculosis Association (NTA) began selling Christmas Seals to raise money for the fight against tuberculosis (TB). The decorative holiday stamps quickly became a hallmark of American popular culture throughout much of the 1900s. This project asks how the Christmas Seals, sold between 1920 and 1968, shaped the depiction, imaginary, and understanding of tuberculosis in popular culture. Through visual, rhetorical analysis of the Seals’ presented and suggested elements, I show that the Seals make present normalized images of Whiteness, health, and holiday settings. I argue that the Seals presented elements made absent images of tuberculosis, distancing an invoked, White audience from the realities of the disease and playing on their hope and desire for a world free of TB. This case study considers the rhetorical function and value of popular, non-­medical expert images, adds to the historical literature on tuberculosis, and offers a framework for the continued study of medical fundraising images.

Review of: Diagnosing Madness: The Discursive Construction of the Psychiatric Patient, 1850–1920. Cristina Hanganu-Bresch and Carol Berkenkotter. Columbia: University of South Carolina Press, 2019. 192 pages, $49.99 paperback, $49.99 e-book. Publisher webpage: https://www.sc.edu/uscpress/books/2019/6025.html

Contralateral prophylactic mastectomy (CPM) is the removal of both breasts when one is affected by cancer. Researchers and journalists typically attribute increased use of this controversial procedure to patient misunderstanding of breast cancer risk. Thus, efforts to curb CPM use focus on better patient education. I argue that such efforts are potentially ineffective insofar as they fail to recognize that risk isn’t just something that patients know but also something that they do, and that how they do it affects their healthcare decisions. I further argue that this failure can lead to impaired communication about CPM by perpetuating sexist stereotypes of women as too emotional to make good decisions. To improve communication, then, I draw on screening guidelines and public discourse about CPM to show how patients do breast cancer risk, arguing that they often experience a kind of overtreatment that makes CPM an effective, if unconventional, treatment choice.

Review of: You’re Doing It Wrong!: Mothering, Media, and Medical Expertise. Bethany L. Johnson & Margaret M. Quinlan. New Brunswick, NJ: Rutgers University Press, 2019. 259 pages, $29.95 paperback, $99.95 cloth, $29.95 PDF, $29.95 EPUB. Publisher webpage: https://www.rutgersuniversitypress.org/youre-doing-it-wrong/9780813593784

According to a recent study by the Brookings Institution (Reeves & Krause, 2016), vasectomies are safer, more effective, and less expensive than most other voluntary sterilization methods. While the procedure has grown in popularity in recent years, particularly in the United Kingdom and Canada, it is much less common in the United States. This discrepancy can be attributed to both social (a perception that contraception is “women’s work”) and policy-­based factors (lack of coverage under the Affordable Care Act). This paper examines the role and extent to which invitational rhetoric could be a useful communicative lens for both partners and providers considering vasectomies, thus increasing access to and utilization of the safe, effective, and affordable procedure. In this policy brief, we suggest strategies for incorporating invitational rhetoric into health professions education curricula, patient counseling literature, and policy language in order to address some of the social stigma around the procedure.

Co-Editor Lisa Melonçon contextualizes the Vol. 4 issue 2 Special Issue on Food as Medicine in this short historic essay. Read online or download here.

This dialogue piece provides scholars of the rhetoric of health and medicine with a close examination of vegan and vegetarian diets/lifestyles through the perspective of several scholars, activists, and/or medical practitioners. Through these conversations, the authors illuminate many key areas of interest and future examination related to vegan and vegetarian diets through the lens of several subtopics including health impact, ethics, cultural influence on diet, gender, medical advice, emerging “meat” technologies, and societal rhetoric about vegans and vegetarians.The dialogue participants provide a discussion on how vegetarian diets—and vegan diets in particular—can progress individual and public human health, liberate non-human animals, improve the environment, and provide a vehicle in which several important social justice movements (for both humans and animals) can take root, all the while recognizing the many reasons reasons people might choose a vegetarian or vegan diet.

This manuscript explores the rhetorical coupling of food as a holistic health initiative across two Indigenous organizations—Indian Health Services (IHS) and the American Indian Cancer Foundation (AICF). Drawing upon contemporary literatures of rhetorical ecologies, I position “kincentricity” (Salmón, 2000, 2012) as a particularly provocative framework to reconceptualize the body as its own rhetorical ecosystem, contending that Indigenous dimensions of RHM offer radically creative ways to decolonize the body/body politic. My analysis demonstrates theways in which IHS and AICF engage in kincentric logics to repurpose rhetorics of food within the Native medicine wheel, most notably by emphasizing (1) pre-Columbian diets, (2) traditional harvesting and cooking methods, and (3) spiritual food-based rituals—all of which explicitly link tribal food(ways) to bodily wellbeing. Finally, this essay encourages RHM scholars to reorient rhetorical vocabularies and understandings toward more pluralistic and non-Western accounts of health, medicine, and collective wellness.

Applying an ecological rhetorical approach, this article examines the online circulation of arguments about food choice in two seemingly disparate sites: clean, medicinal food rhetoric and the rhetoric of “food swamps.” Studying snack food conglomerate Mondelez International’s “Mindful Snacking” campaign in juxtaposition with clean eating brand Sakara Life’s “made-for-Instagram” marketing materials demonstrates how clean, medicinal food texts emerge as acts of communicative resistance to the normalization of fast and processed food, yet slip back into the same meritocratic logic emphasizing individual responsibility and ultimately reproduce the ideological conditions that maintain inequitable access to healthy food. This article concludes with suggestions for disrupting and transforming the pervasive individualizing frameworks of food choice that locate health and diet concerns in the individual as opposed to the wider political, economic, and environmental context.

The public’s declining trust in health advice from traditional outlets has long been noted by scholars. But what makes alternative sources for health information appear more trustworthy to some audiences? In this analysis, the author traces the use of expertise and experience as forms of multivocality in the textual artifacts of Gwyneth Paltrow and her enterprise, Goop—specifically those that promote clean eating and detox diets. The analysis illustrates how Goop creates a superficially neutral platform for different voices that make the texts seem polyphonic and by extension more trustworthy given that readers can choose which health plan is right for them. But upon further analysis the author illustrates that Goop blends each voice so that they “move in step” as a choir, combining with Paltrow’s own voice, and ultimately creating an illusion of polyphony and masking a dominant homophonic message that ties together mandates to “ask questions,” empower ourselves, and embrace the assumption that young, slender bodies are signifiers of health and wellness.

This article explores how food-related practices are discursively constructed in an employee wellness program (EWP). Drawing on qualitative grounded theory analyses of internal-and external-facing EWP materials, the author theorizes how food-related practices, technology, institutional power, and wellness intersect. By entwining health, medicine, and food under the umbrella of wellness, the EWP promotes food-as-wellness (eating the right foods will lead to individual holistic well-being by improving the already-healthy person) while incenting and effectuating food-as-medicine (eating the right foods can help cure individual illness/disease or intervene as a treatment for a disease risk factor such as overweight or obesity) because of food-as-economics (collectively eating the right foods can help solve rising health insurance costs). The theory advanced in this article expands our understanding of wellness discourses and points to the need for research examining how such discourse impacts lived experience.

Guest editor's introduction to the special issue on the rhetoric of food and health.

This manuscript explores the rhetorical coupling of food as a holistic health initiative across two Indigenous organizations—Indian Health Services (IHS) and the American Indian Cancer Foundation (AICF). Drawing upon contemporary literatures of rhetorical ecologies, I position “kincentricity” (Salmón, 2000, 2012) as a particularly provocative framework to reconceptualize the body as its own rhetorical ecosystem, contending that Indigenous dimensions of RHM offer radically creative ways to decolonize the body/body politic. My analysis demonstrates theways in which IHS and AICF engage in kincentric logics to repurpose rhetorics of food within the Native medicine wheel, most notably by emphasizing (1) pre-Columbian diets, (2) traditional harvesting and cooking methods, and (3) spiritual food-based rituals—all of which explicitly link tribal food(ways) to bodily wellbeing. Finally, this essay encourages RHM scholars to reorient rhetorical vocabularies and understandings toward more pluralistic and non-Western accounts of health, medicine, and collective wellness.

Guest editor's introduction to the special issue on the rhetoric of food and health.

Review of: White-Farnham, J., Siegel Finer, B., & Molloy, C. (Eds.) (2020). Women's health advocacy: Rhetorical ingeniuty for the 21st century. Routledge. https://doi.org/10.4324/9780429201165

Drawing from my experience conducting an interview-based study on vaccine hesitancy, this essay explores the ethical negotiations RHM researchers face when recruiting participants from online communities, and especially communities that are stigmatized or otherwise distrustful of researchers. I discuss the specific challenges I faced during this process, and offer four suggestions for researchers engaged in this work. These include the valuable role of reflexive journaling, the need for participant input in the distribution of recruitment messages, the importance of accounting for the dynamic nature of online communication, and the ways that participant communication online may shape off-line interactions. This essay can offer guidance to RHM scholars facing similar situations, and contribute to the broader conversation about practice-level ethical concerns in RHM research involving online communities

This article considers the problem of conflicting researcher obligations in RHM, particularly when professional medical rhetoric is analyzed with the goal of improving patient care. Taking one case as illustrative, this article argues that medical professional participants are in positions of relative power, and that their choice to participate in RHM research or not can have downstream effects on more vulnerable patients. Furthermore, this case demonstrates that the interests of medical professional participants may diverge from the interests of their patients. As a result, when RHM researchers assume traditional orientations towards medical professional research participants, they may find themselves unable to advocate for more vulnerable patient populations.

This article examines the rhetorical effects of a rape accusation on the survivor and on the survivor’s community of social justice activists. Relying on interviews with the survivor and with the community affected by the allegation, the article analyzes responses to the allegation, articulates how those responses are informed by rape culture, and illustrates how those responses affected the survivor and her rhetorical agency. The article argues that rhetorical agency can be productively distributed across various allies to assist survivors and help restore the rhetorical agency that rape erodes. Establishing sexual assault as a public health issue, the article recommends broad education in rhetorical listening to improve how those entrusted to hear assault stories listen, respond, and, when appropriate, help survivors speak or act.

This paper explores how I navigated the complicated terrain of opposition research during the dissertation phase of my doctoral program. Drawing from ethnographic research conducted on a pro-life organization, I illustrate that care-based ethics (Held, 2006; Tronto, 1994) is not just for vulnerable and agreeable participants but is valuable and appropriate for researching powerful groups whom we oppose. Furthermore, I argue that rhetorical listening (Glenn & Ratcliffe, 2011; Ratcliffe, 1999, Ratcliffe, 2005) is not just a valuable methodological approach to research, but also a form of reciprocity, especially critical when studying groups we oppose. Such an approach promotes the mutually beneficial goals of respect and understanding.

As the introduction to this issue makes clear, the ethical exposure essays we include here are the start of an ongoing initiative in the journal—to include focused sections of shorter pieces on critical threads or matters of concern in ongoing RHM work, in this case ethical conundra encountered in practice-level enactments of methodologies. In setting the tone for this special section, we now attempt to parse an “ethics in praxis” that is characterized by situational, embodied, and reflexive orientations rather thanby attributes more common in virtue ethics. This emphasis on praxis allows us to put forward an idea of ethics in and for RHM that is responsive to critique as we articulate it in the overall introduction to this issue: as kairos-driven and attuned to crises as they unfold in the present and as they anticipate and offer opportunities to “play” at various imagined futures.

We argue that by using existing data and sharing research in a databank, RHM scholars can practice a research habit that conserves and optimizes intellectual and institutional resources. When possible, by using existing datasets, scholars avoid data waste, that is ignoring or bypassing existing data. The data distinctions that we call attention to—derived, compiled, and designed—account for various ethical and rhetorical concerns regarding privacy and confidentiality, expected context, and consent. Equally important to the aforementioned data deliberations we explore, collecting and managing shared RHM data in a databank, while possible, are not without ethical, logistical, and rhetorical difficulties.

The intersection of industry sponsorship, government regulation, academic interests, and medical journals is a core interest in biomedical research, and one that overlaps with concerns in the rhetoric of health and medicine (RHM). At stake in conversations about this intersection are authority and participation: who is and is not invited to offer opinions and, even when invited, whose opinions are taken seriously. Following, colleagues with ties to the International Society of Medical Publication Professionals (ISMPP) present their ideas in response to questions about authorship and authority posed by another, who is also an RHM scholar. The answers of medical journal editors and publications professionals employed by corporate entities largely align with the view that both authorship and authority should be determined by scientific practice and knowledge rather than power relations or politics. A philosopher who gave an invited plenary talk at the national ISMPP meeting and participated in the organization’s first white paper offers a different perspective, considering the ways that fields self-constitute in part by bounding authority and authorship.

When we began drafting this issue introduction, extending from a previous introduction in which we committed “to do more and better in cultivating, sponsoring, publishing, and promoting scholarship that addresses racism and interlocking systems of oppression as public health (and/or other health or medical) issues,” we knew we wanted to continue to foster a space in which RHM scholars could ask new and newly exigent questions born out of the rupture of our current moment of swirling, interconnected crises, some longstanding and others novel.

Over the last several decades there have been rapid advancements in treatment options available for infertility. Consequently, infertility has become a medicalized disease, which privileges a masculine epistemology. Problematically, this masculinist perception of infertility diminishes concern for the lived experiences of women living with infertility and ignores the many ways in which infertility manifests as a social condition. This study examines narratives of women diagnosed with infertility, gathered from online support groups. Through these narratives I introduces the concept of “invitational knowledge” as a means to understand how knowledge functions rhetorically to create space for discourses that deviate from the medicalized assumptions of infertility. Invitational knowledge highlights the epistemological roots of invitational rhetoric through adoption of a postmodern feminist epistemology and is characterized by five features: 1) rhetor agency; 2) emotional knowledge; 3) transformative discourse; 4) shared knowledge; and 5) asking questions rather than making judgments.

Introduction to Volume 4, Number 1

Introduction to Volume 4, Number 1

The following commentary follows on and flows out of an initial response to reading “Multiple Voices on Authorship and Authority in Biomedical Publications” by DeTora and colleagues (2020), which appeared in volume 3 issue 4 of Rhetoric of Health and Medicine. This response, by rhetorician of science, health, and medicine Celeste Condit, begins by situating questions about authorship and authority in biomedicine against a classical rhetorical source, Plato’s Gorgias. In so doing, Condit identifies a messy truth—that rhetoric potentially can pose dangers when applied to health and medicine. The authors then construct a Platonic dialogue that situates authorship, ethos, and authority in the context of biomedicine. Ultimately, the two authors illustrate the messiness that results when attempting to mount a discussion of these terms across intellectual registers.

Weight-inclusive approaches such as Health at Every SizeÒ (HAESÒ) that once were used primarily by scientists or other health experts are more frequently being taken up by lay audiences. Most notably, popular members of online communities known as social media influencers rely on principles of HAESÒ to spread weight-neutral rhetoric across platforms like Instagram. Analyzing how influencers domesticate, or make their own, the specific science-based principles of HAESÒ warrants exploration. In this study, I draw from an analysis of 20 Instagram accounts run by influencers to explicate how domestication occurs within the body positive and weight-inclusive community. The findings suggest three primary patterns through which domestication occurs: anecdotal narratives and personalization, science and education, and social justice. I argue these influential users domesticate HAESÒ by drawing on their own education, life experience, and personal identity while upholding the core norms of the influencer industry: authenticity and credibility.

Building connections with professionals in subject matter disciplines—practitioners and/or academics—is a growing area of interest for many scholars working in the rhetoric of health and medicine (RHM). However, strategies for creating and building meaningful, productive interdisciplinary relationships has not been a central theme in RHM-focused scholarship. This entry endeavors to address this gap by using RHM’s emerging version of the “dialogue” genre to describe the author’s experience co-chairing the communications track for an international public health conference. The author weaves in commentary from contributors who participated in the conference and discusses and reflects upon two key challenges that emerged: 1) differences in language choice/terminology, and 2) epistemic conflict. Through this reflective discussion, this dialogue proposes several strategies that RHM scholars might draw from in building their own interdisciplinary relationships moving forward: 1) negotiate shared meanings and goals, 2) find commonalities, and 3) normalize rhetorical inquiry. 
 Featured Contributors: Nicholas Bustamante, MFA; Alina Deshpande, PhD; Amy Ising, MS; Jamie Newman, PhD; Kirk St.Amant, PhD

Medical device manufacturers and other high-technology companies increasingly incorporate algorithmic data surveillance in next-generation medical wearables. These devices, including hearing aids, leverage patient data created through human-computer interaction to not only power devices but also increase corporate profits. Although data protection laws establish privacy requirements for personal information collection and use, these companies continue to use patients’ personal information with little notice or education, significantly curtailing the agency of wearers. We explore the complex ecology of the Starkey Halo smart hearing aid, focusing on the opacity of its algorithmic functionality and examining patient education materials for disclosures of data surveillance. We contextualize these findings within privacy law in the United States and European Union that are relevant to algorithmic surveillance and recommend specific steps to enhance wearer agency through informed decision-making.

Being at Genetic Risk: Toward a Rhetoric of Care. Kelly Pender. University Park, PA, The Pennsylvania State Press, 2018. 174 pages, $69.95 hardcover. Publisher webpage: https://www.psupress.org/books/titles/978-0-271-08212-7.html

Between 1842 and 1890, 23 women wrote 33 memoirs about their time spent incarcerated in American insane asylums. While a handful of these memoirs have been studied, there has not been a recognition of how many asylum mem­oirs exist and their significance as a collective body of work. Grounded in an inductive analysis of the collective 33 works, this article begins a process of recovering a mostly forgotten moment in time when former patients took agency over their experience, ethos, and rhetoricity to break down the institutional wall of silence and give the public the first patient-centered memoirs. I argue that these women rhetors did this by foregrounding their own identity as patient and by creating a rhetorical position from which their readers would feel the trauma of asylum life. Both rhetorical moves countered institutionalization’s dehumanizing effects by placing the patient experience at the center of understanding the asy­lum experience.

This pilot study of a mental health call center clinician’s workplace tools, processes, and organizational structures proposes a preliminary theory of “distributed and mediated ethos.” A distributed and mediated ethos refers to how an organization uses various resources—artifacts, technologies, and processes—situated across dis¬parate locations in order to expand and control their identity in the service of extend¬ing their reach and capacity to render essential services. An analysis of a participant clinician’s rhetorical context flowcharts and network pictures shows how an agency’s ethos is mediated through various technologies. Findings suggest that a distributed ethos (1) projects the impression of being “always there”; (2) relies on dexterity across several human and nonhuman actors; and (3) necessitates targeted tasks from branches that extend ethos farther from the organization. This pilot study, thus, provides researchers of rhetoric of health and medicine (RHM) with a new tool for exploring the intricate and complex nature of health at a distance and other complicated 21st century healthcare delivery formats.

This article analyzes psychiatrists’ metadiscourse about the textual standardiza­tion of discourse practices in the third edition of the American Psychiatric Asso­ciation’s diagnostic manual, DSM-III (1980). I argue that DSM-III’s “common language” represents the development of a professional style for American psy­chiatry, and I suggest that the codification of that style in DSM-III results in a handbook of usage. One of the professional aims of the textual standardization of the diagnostic manual is to position psychiatrists as scientists who use scientific standards of practice and scientific research methods to produce psychiatric knowledge. As a consequence, the chief style attributes of DSM-III help deter­mine the chief professional attributes such that the textual standardization of the profession’s diagnostic manual becomes inseparable from the standardization of psychiatric knowledge.

Using primary source materials from medical, government, and journalism archives, this study of public medical discourse reveals the role of argumentation in posi­tively shaping public perceptions of traumatized soldiers and locates the contem­porary origins of the trope of “soldier as psychological victim of war”—a perception that continues to inform public policy and medical research. Using Jasinski’s (1998) concepts of interior and exterior constitutive potential to analyze the public writ­ings, interviews, and Congressional testimony of VVAW-affiliated psychiatrists, the study finds that the radical psychiatrists’ interior (directed at veterans) and exte­rior (directed at public and medical institutions) rhetorics were (and arguably remain) mutually effective in creating an identity for veterans to occupy that exculpated them from their involvement in war, while allowing them to garner benefits for their ser­vice. The article concludes with two examples of the “veteran as psychological vic­tim of war” trope as it shapes the contemporary rhetorical ecology of former servicemembers.

Nine people with mental health diagnoses wrote a dialogue to discuss how we navigate our conditions and ask for accommodations within an academic setting. We cogitate on the challenges of obtaining a diagnosis, how and when we disclose, the affordances and challenges of our symptoms, seeking accommodations, and advocating for ourselves. We consider how current scholarship and other perspectives are changing the conversation about mental health in the academy. We conclude that while the 2008 revisions to the Americans with Disabilities Act have addressed necessary accommodations, that those with mental health conditions are still seeking access.

In an effort to better understand the historical significance of the “mental illness as motive” narrative, this essay investigates what has been recognized as the first mass shooting in the modern United States—Howard Unruh’s 1949 mass shoot¬ing in Camden, New Jersey. Given that mass shootings were an unprecedented phenomenon, the news media played an important role in explaining the event. As will be shown, many Americans felt uncertain about how mental illness man¬ifested and who was vulnerable. Given the often undisclosed, albeit perceived threat of schizophrenia, the public needed reassurance that there would be some indicator of insanity. Accordingly, the media used evidence of religious fanaticism and unfavorable physical descriptions of Unruh to cast him as separate, outside, or an “other.” Ultimately, the media’s rhetorical choices differentiated Unruh and attempted to make mental illness easier to identify for an audience afraid of its influence.