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Running Head: IDEOLOGICAL UNDERPINNINGS
The Ideological Underpinnings of Social Movement Transformation: A
Structuration Analysis of an Alliance for the Mentally Ill's
Public Relations Communication
Zoraida R. Cozier
Stream: The movements and moments of organizational change
Fourth International Conference on Critical Management Studies
Paper submitted to Goran Ahrne, Stockholm University, Sweden; Raphael
Alcadipani, EAESP, Brazil; Steve May, University of North Carolina; and Craig
Prichard, Massey University, New Zealand.
Correspondence concerning this article should be addressed to Zoraida R. Cozier, assistant professor of public relations, Georgia Southern University, Communication Arts, P.O. Box 8091, Plant Road, Statesboro, GA, 30460. Electronic mail may be sent to email@example.com. Contact phone numbers are (912) 489-5584. The theoretical developments and findings reported in this abstract are original and contribute to the body of knowledge in public relations and have not been published previously. The appropriate Institutional Review Board approved the study after a full review.
A five-month ethnographic case study examined a social movement’s
public relations communication (i.e., negotiation of ideologies) as members
simultaneously dismantled its institutionalized sector to reclaim its
uninstitutionalized sector. A structurationist perspective of public relations
(Cozier, 2001) examined an affiliate of the National Alliance for the Mentally Ill’s
ideological tensions and contradictions that evolved throughout its transformation
and implicated its public presentation. Findings revealed that the transformation
of advocacy led to a politics of consent. Members enacted resistance to the
management practices to recreate the family movement. Public relations officers
need to identify and manage identities and ideologies rather than dictate
campaign directives. Understanding how organizations’ ideological contradictions
can facilitate the segmentation of publics based on discourse, ideologies, and
The Ideological Underpinnings of Social Movement Transformation: A
Structuration Analysis of an Alliance for the Mentally Ill's
Public Relations Communication
Public relations and organizational scholars examine organizational
discourse and identity management in relation to change and crises. For
instance, Willihnganz, Hart, & Leichty (2004) illustrated how “radical transitions in
an organization’s narrative can create severe organizational identity crises”
(p.231). Tretheway (1997) illustrated how discourse and forms of resistance
influenced organizational change and empowered marginalized individuals. This
paper presents findings of a structuration analysis (Giddens, 1984) of a
movement’s contestation of ideologies and attendant identities in relation to the
homeostatic processes that accounted for its transformation.
Drawing on the assumption that public relations professionals are
boundary spanners who enact environments, public relations scholars focus on
how practitioners manage communication with publics at the organizational-
environmental interface (e.g., Dozier, Grunig, & Grunig, 1995). Cozier & Witmer
(2001) argued that publics are typically considered homogeneous with one
collective identity. Conceptions of publics and public relations communication
offer limited explanations of the communicative aspects of public relations
throughout system transformation and expose the ideological tensions and
attendant contradictions and identities. Public relations communicators can better
segment publics by understanding the plurality of ideologies that a public
embraces and rejects, which, in turn, implicates its actions.
This case study draws on a structurationist perspective of public relations
(SPPR) (Cozier, 2001) developed from the works of Anthony Giddens (1979,
1984, 1991) structuration theory and Deetz (1992, 1995) and Mumby’s (1989)
political perspective. This perspective presupposes that amidst a contestation of
ideologies, members enforce a dominant ideology that influences the
organization's public presentation (Cozier & Witmer, 2001). Public presentation
entails public communicative practices and the presence and absence of public-
A SPPR treats public relations
as a communicative force that reproduces
or transforms an organization's ideology and attendant identities. Public relations
is defined in terms of members' negotiation of dominant and
resistant ideologies at the interactional and institutional levels. Furthermore, the
synthesis of an organization's public relations communication and public
presentation constitute its communicative role
which entails the boundary
spanning processes that aim to balance the members' primary interests with
interests advanced by alternative ideologies (Cozier, 2001). The SPPR defines
as knowledge environments in which local
knowledge emerges as members integrate ideologies from alternative systems
into their own systems. Access points connects points of expertise to lay
Purpose of The Study
This paper presents partial results of an ethnographic, multi-site case
study of the National Alliance for the Mentally Ill's (NAMI) public relations efforts.
This study examined the link among the multiple ideologies, identities, and public
communication goals of the Family Alliance for the Mentally Ill (FAMI), an affiliate
of the National Alliance for the Mentally Ill's (NAMI). NAMI is a social movement,
comprised of over 1400 affiliates, that aims to eradicate the stigma of mental
illnesses and advocate for clients or individuals with mental illnesses.
Specifically, this naturalistic study explored the Family-Oriented Alliance
for the Mentally Ill’s (FAMI) , a NAMI affiliate, ideological tensions that both
fostered and implicated its transformation. Ideological tensions arose between
FAMI’s advocacy and program arms. Members’ ideologies of mental illnesses
fostered a quest to revert back to the uninstitutionalized social movement. AMI
members' ideological conceptions of mental illnesses posed implications on its
public communication and, in turn, the parent organization's (NAMI's) national
communication campaign goals. The study addressed the two research
How did FAMI's dominant ideological meaning systems,
constituted through its communicative practices, serve to
rhetorically construct a shared reality that served a political
How did FAMI's dominant ideological meaning systems
In a broader sense, an assessment of the communicative role examines
how an organization's public relations communication (i.e., negotiated ideologies)
influences the organization's public presentation (e.g., stakeholder relations,
identity management). Overall, the questions addressed the link between FAMI’s
public advocacy role in back and front regions.
NAMI affiliates range from closed, traditional family support groups to
highly open and politically active groups that embrace client participation and the
assistance of professionals. Three sectors of NAMI entail (a) family members or
care providers; (b) clients, individuals who have mental illnesses; and (c) medical
professionals. FAMI represented both the family and medical professionals’
sectors. In the 1970s, 31 parents of adults with schizophrenia created a self-help
group. These founders became instrumental in the formation of the family
movement, NAMI, in 1979. Within a decade, FAMI added a comprehensive
mental health service component including the Brooke Center Information
Program, contracts with medical carve -out programs, and a corporate board.
As an “advocacy service sector”, FAMI fulfilled the missions of both a
social movement and an institutionalized sector. Typically social movements tend
to be characterized by their level of uninstitutionalization, use of social channels,
and a resistant societal structure (Stewart et al., 1994). Yet, FAMI’s program arm
became institutionalized. Throughout this study, FAMI experienced a change in
leadership, a dissolution of its corporate board, and cost-cutting measures.
Moreover, many members displayed a desire to move a way from programs and
This ethnographic multi-site case study entailed four and a half months of
participant observation and two weeks devoted to a volunteer project based at
the office. Data sources included four monthly share and care sessions, two-in-
services, one communication workshop, two board meetings, six
education/advocacy meetings, two local mental health meetings, and several
related community meetings on the local county’s move to the privatization of
health coverage, documents, and three interviews. Overall, I observed and
analyzed the ways that FAMI members’ discursive and institutional practices
legitimized, and delegitimized conceptions of mental illnesses.
Pseudonyms are used throughout this report to insure confidentiality.
A structuration analysis investigates how organizational members attain a
sense of intersubjectivity or how members negotiate meanings, particularly
"ideological meaning systems" (Deetz & Mumby, 1990; Mumby, 1989). I
conducted a strategic conduct analysis, an institutional analysis, and an ideology
critique. An ideology critique required an analysis of “how structures of
signification were mobilized to legitimize the sectional interests of hegemonic
I utilized NUDIST, Nonnumerical Unstructured Data Indexing Searching
and Theory building, for the data reduction, organization, and analysis. Two
phases of the analysis entailed the "constant comparative method" (Huberman
and Miles, 1994, p. 70) and "critical organizational discourse analysis" (Mumby &
This analysis of FAMI’s ideological field and public presentation exposed
the ideological struggle over the institutional sector and local and global
influences. Due to space limitations, limited data texts are provided for each
theme. Theme 1 illustrates that the advocacy service system’s divergent
knowledge environments sustained a high degree of openness and diverse
connotations of the clients, family members, and mental health systems.
Findings and Interpretation
Pluralism: Multiple Systems of Representation
Theme 1: FAMI members transformed the institution of advocacy into a system
that legitimized and sustained multiple connotations of the multi-faceted identities
of the family members and clients.
FAMI members legitimized mental illnesses as brain diseases through the
penetration of structures drawn from NAMI, scientific/medical expertise, and the
mental health systems. This advocacy/service system’s adhere nce to the brain
disorder paradigm legitimized scientific claims associated with the medical
models of mental illnesses. FAMI’s main practices focused on the mental health
system’s approach to rehabilitation and the system’s move to managed mental
health care. In back regions, FAMI members meandered between divergent
conceptions of mental illnesses as they supported the social movement that
founded FAMI, performed case management, and endorsed a business
philosophy that undergirded the county mental health redesign plan.
Therefore, FAMI’s public relations communication or negotiation of
dominant ideological meaning systems enacted a multi-dimensional approach to
advocacy for individuals with mental illnesses. FAMI’s institution of advocacy
experienced transformations from (a) a change in its leadership, (b) NAMI’s
evolving directives for affiliates, and (c) societal influences. In FAMI’s
environments of ambiguity and change, three systems of representation
penetrated sources of signification and legitimation included (a) the scientific
community, (b) managed care practices, and (c) the family movement. Systems
of representation are the “systems of meaning through which we represent the
world to ourselves and one another” (Hall, 1985, p. 103).
The next section shows how systems of representation guided members’
practices and framed members’ conceptions of themselves and of clients.
Members enacted scientific and system representation; in other words,
perpetuated meaning systems (i.e., signification) and rules o f normative action
(i.e., legitimation) drawn from the medical/scientific communities and the local
managed mental health care systems. The family movement’s resistant ideology
concurrently sustained a collective identity.
The array of theoretical discourses of mental illnesses in the scientific
community produced a sense of “ambiguity” (Weick, 1995, p. 92). Members’
subscription to scientific expertise required an adherence to a brain disorder
paradigm that depicts the client as a patient. These structures of signification
entered into the structuring of the advocacy arm and transformed members as
they replaced societal conceptions of family members within a medical frame that
depicts family members as careproviders of ill relative s.
FAMI members provided open forums for all scientific claims that
legitimized brain disorders. Throughout the case study, scientific presentations
and office literature represented a broad spectrum of scientific/medical meaning
systems. This level of openness to scientific claims emerged at the global level
as well. For example, NAMI’s newsletter entitled, “Decade of the Brain” published
conflicting, but related theories of mental illnesses offered by various mental
health and scientific organizations. NAMI and FAMI presented an ideological
puzzle comprised of several scientific possibilities.
FAMI’s education/advocacy sessions acted as one locus of access points.
Throughout the study, three presenters wrestled with the dilemma of
communicating science to FAMI members. First, a geneticist argued that the
evidence indicates that a gene is responsible for mental illnesses. But the
geneticist also acknowledged that 35 percent of the cause of mental illness is
unaccounted for. Second, a neuroscientist who claimed that mental illness is a
result of gatekeeping, or “an inability to shut out or inhibit” information, stated that
he is “not sure what triggers it.” In addition, both the geneticist and neuroscientist
concurred that no one knows what really causes it. Finally, the third presenter, a
promoter of Paxil, identified risk factors of mental illnesses such as stressful life
events, social isolation, and drug therapies rather than brain chemistry per se.
These scientific meaning systems acted as fitting responses to critics who
utilized environmental factors to blame family members.
FAMI’s contractual programs with the mental health system reorganized
FAMI’s practices to meet its advocacy goals. Through the structures drawn from
the mental health systems, FAMI enacted management practices that acted as
access points to mental health systems, both private and public. The mental
health system’s knowledge and practices penetrated deeply into FAMI’s local
Through these access points, the managerial discursive genre enacted
system representation. FAMI’s program arm catered to the needs of both family
members and clients as members simultaneously performed a service for the
mental health system and providers. This became evident in the 24-hour Brooke
Center Information Program enforced a system of rules for staff members who
respond to callers. FAMI’s normative conduct entailed the maintenance of an
“objective role” in the education and referral process. On one hand, these rules
enabled family members to be part of the recovery and treatment process. On
the other hand, obligations required family members to execute a neutral role
and subordinate themselves to mental health professionals.
FAMI’s programs presupposed, endorsed, and reinforced the principles of
managed care. Both the public-sector-psychiatry and the private managed
mental health care system required conceptions of clients as ill and in need of a
wide array of services that only a medical system could provide. The brain
disorder paradigm offered a medical lens that not only medicalized behaviors
associated with mental illnesses as treatable illnesses, but also placed the
patients into a domain of medical management.
Next, I discuss how members enacted family representation to sustain
NAMI’s conception of the brain disorder paradigm and recreated the family
During the case study, family representation appeared minimal due to the
prevalence of the contractual programs. As a discourse of resistance, family
representation permeated FAMI through FAMI’s advocacy and social support
genres. Family members’ ideologies evolved as family members made sense of
medical classifications, medications, side effects, and their ill relatives’ behaviors.
FAMI’s pro -sharing practices enacted therapeutic environments through
which family members experienced communicative opportunities unavailable in
other settings. Through narratives, family members constructed and enforced a
sense of shared realities of mental illnesses. Members subscribed to a brain
disorder paradigm, but they did not invoke the scientific discourse of statistics
and correlations. Nor did family members espouse the case
management/managed care ideologies of mental illnesses that both elevated
mental health professionals and systems. Instead, the family movement enacted
its long-established tradition of locating mental illnesses in family settings in
which the careproviders’ expertise on how to manage their crises prevailed.
Members subscribed to NAMI’s familial ideology (see Hatfield, 1991).
Characteristics of NAMI’s ideology were embedded in members’ interactions.
These characteristics included the themes that (a) mental illness is a no-fault
disease, (b) family involvement is critical for support and treatment, and (c) lay
people are competent to run an organization.
Patterns revealed that two main sectors of NAMI emerged in FAMI’s
advocacy and social support practices. These included “old-timers” who typically
resisted systems of authority and minimized client participation in sharing
sessions and “regulars” who retained the family perspective, but supported
NAMI’s call to increase client involvement, work with professionals, and utilize an
FAMI’s share and cares also exhibited “unhelpful characteristics”(Kurtz,
1997, p. 30) such as a lack of regular facilitators and low participation from both
the old-timers and regulars. Even the number of newcomers remained low. The
absence of facilitators that had medical backgrounds created communicative
opportunities for family members to become directly involved in the share and
care sessions. Therefore, the share and care sessions permitted FAMI to utilize
family expertise in the construction and legitimation of mental illnesses. A leader
once said, “Facilitators come and go, but the group stands on its own.” These
modes of domination typify NAMI’s ideology by positioning family expertise over
other forms of expertise (e.g., medical) and utilizing laypersons. As family
members shared stories, they instituted rules on how to manage their
relationships with doctors and how to empower themselves through their
Enablements of Multiple Representations: Life Politics
FAMI’s practices enacted life politics through which family members
continually asked existential questions related to the self (Giddens, 1991). Life
politics concerns questions of self-actualization and is a politics of life decisions
that impacts on one’s self-identity. Members created a sense of ontological
security and in turn, a collective identity.
Members produced and reproduced structures of signification through a
family frame. Family stories continually co-constructed mental illnesses and
managed their identities through the transformative capacity of biographical
narratives (see Giddens, 1991). Family members attained intersubjective
understandings of these illnesses via biological as opposed to psychoanalytic or
familial theories of etiology. Stories, thus, required not just a mere telling of their
ill relatives’ behaviors, but a recreation of their crises via the medicalization of
FAMI’s platform of divergent ideologies offered communicative means by
which members could represent facets of NA MI, participate in NAMI’s campaign,
and foster relationships with community organizations to garner public
acceptance. Therefore, family members could abandon the protest signs and
step into medical and political arenas to resolve their problems. Yet, the
separation of the program and advocacy arms created space for traditional forms
of resistance. As Nancy recounted in an interview, “They specifically separated
the two groups to protect the advocacy arm from the tainted program arm so that
the advocacy arm could still get in the face of whoever they needed to . . . be
Theme 2 exhibits the duality of structure that arose from FAMI’s practices.
To FAMI’s dismay, the unintended consequences of the separation of the two
arms led to the disablement of the advocacy arm and the masking of
contradictions. The management practices engendered hegemonic control of the
family members and suppressed their motivations for self-actualization and
Institution of Advocacy Fragmented by Oppositional Ideologies
Theme 2 posits that FAMI’s practices developed to transform advocacy
produced structures that restricted the family members’ advocacy agenda and in
turn, prompted family members’ resistance.
First, I begin by illustrating how the structures drawn from a management
orientation imposed constraints on the family movement’s institution of advocacy.
Second, I show how primary and secondary contradictions generated ideological
tensions and engendered family resistance.
Management Practices and Domination
The business environment created to facilitate FAMI’s advocacy goals
represented the mental health system’s ideologies. These representational
practices enacted transformative capacities that reframed the advocacy mission
to insure “consent “(Deetz, 1995, p. XV). Critical theorists argue that ideology (a)
generates frames of reference that impose constraints on agents’ sensemaking
processes, (b) fixes meaning, and (c) sustains power relations, which in turn,
reconstitutes agents’ existing ideology (Deetz & Mumby, 1990; Hall, 1985;
Mumby, 1989). Hence, FAMI’s representational practices enacted an institutional
bias that reproduced power relations and sustained preferred conceptions and
treatment of clients. I present three examples of the emergent patterns.
the management practices enacted “discursive closure” (Deetz,
1992) through an ideological form that “represented sectional interests as
universal” (Giddens, 1979, p. 193) and eventually undercut the initial goals of
NAMI’s family movement. The act of disqualification exemplified one mode of
domination through which the board and staff members enacted power over the
membership. Through disqualification, FAMI’s program arm disempowered family
members by closing off opportunities for the expression of their interests and
needs. “Disqualification can occur through the denial of the right of
expression“(Deetz, 1992, p. 187). One way this practice occurred was through
the execution of programs without representation of the membership. As board
members made financial, political, and strategic decisions in interactions such as
board meetings, they denied members access to these critical interactions.
Beverly, a leader, described this form of closure in a follow-up interview, “I had
no idea that we had all of these programs. . . . I don’t think any of the members of
FAMI realized that we had taken on these programs and understood completely
how they were facilitated, and what part we played in them or anything else.” She
later stated in an interview, “I think most members of our, a lot of the alliances,
that they don’t really want to get into programs and provide all types of services.
Second, structures of legitimation enforced through system representation
fostered power relations between the mental health systems and the family
members. For instance, Henry’s, the former leader, memo enforced a normative
order that established rules to minimize FAMI’s social movement rhetoric. The
staff members could not take ad vantage of these calls to counsel or encourage
callers to file legislative acts against the system. Henry employed business
practices to redefine family members’ role in the education, social support, and
advocacy functions; therefore, he imposed a contradictory set of obligations and
rites onto the family. The memorandum clearly outlined the legislative problems
that FAMI could confront if members did not take a neutral role.
Third, members continually positioned the expertise of the mental health
experts over the family members’ and clients’ interests. One way that FAMI
accomplished this was through the selection of speakers for the
education/advocacy sessions. FAMI selected speakers that represented systems
of managed care including two insurance representatives at an
education/advocacy session. These speakers organized members’ realities of
facets of the managed mental health care system (e.g., benefits). These
speakers treated doctors and the systems as experts and clients as patrons or
planned members of these systems. Therefore, client representation remained
minimal. Clients did not serve on FAMI’s board and had limited outlets for
expression. This practice contrasted NAMI’s call for client participation.
In sum, FAMI’s cultural institution of advocacy experienced fragmentation
due to the ideological tensions. In the next section, I address the ideological
tensions that evolved from the system’s contradictions.
Ideology functions to conceal primary and secondary contradictions
inherent in social systems (Giddens, 1979). The primary contradiction evolved
from the coexistence of system and family representation. On the one hand,
FAMI presented its advocacy mission as families united around their immediate
and ongoing exigencies. On the other hand, FAMI’s program arm, was influenced
by, and in turn, supported mental health providers and institutions through their
representation practices. FAMI’s social arrangements designed to empower
family members and facilitate family representation served to recreate a
dominant order that precluded family members’ involvement in pertinent
Secondary contradictions, those that evolved from the primary
contradictions, revealed the ideological struggle that generated conflicting
meaning systems. I briefly outline three examples.
Cost control vs. right to the best treatment
. Segment I is an excerpt
from a recorded board meeting. This excerpt revealed a systems contradiction
that evolved from FAMI’s prevailing management orientation. At a board meeting,
board members displayed the clash between FAMI’s endorsement of managed
care principle of cost-control measures and the family members’ rights to
involvement in the treatment of their loved ones.
Segment I Board Meeting
So I don’t know, policy I think it is a bad idea, but from people I
talk to, it seems that so many people, so many clients have
Beverly: Yah, but they take them away. I can vouch for Tammy now. Um,
they told me that the drug she was doing well on, now was very
costly and they sent in a TAR. They evidently approved it for so
many days, for so much of a month, they took it off of it again,
Beverly: So, I myself am very vocal about it and I (because of the costs
So, they took it off because the TAR was denied?
Beverly: They said it’s about 700 dollars a month, and I said, so I need to
get back to her doctor. I said I don’t care about the costs. Then I
Putnam (1985) describes this as a contradiction that emanates from “a
clash between the prevailing objectives, goals, or structure and the constraining
effects of these creations (p. 161). FAMI’s discursive practice of communicating
its perspective of managed care indicated that FAMI endorsed managed care.
Yet, FAMI board members rejected the cost-cutting measures. Furthermore, the
leader considered this action on the TAR, treatment authorization plan, an item
that demanded legislative attention. Therefore, the structures of signification and
legitimation drawn from system representation impacted the family members’
involvement and advocacy efforts. But Beverly’s willingness to assume the
financial responsibility displayed a sense of complicity to this normative order.
In contrast, Beverly’s introduction at a recorded education/advocacy
meeting on managed care exposed role conflict and contradictory messages
about family members’ responses to anticipated changes in managed care
programs. This introduction displayed FAMI’s pro -managed care stance, but
[I] know that the managed care is a big question mark to all of us . . . . I
can only say that as your leader that I have worked with managed care,
the HMOs, because I have been in health insurance. So, I am familiar with
what they have done and with what their intent is. And I think they’re some
very positive things about managed care. And I know that for us who have
our very vulnerable. . . . We find that it is a sort of a scary situation. . . . It’s
back to the HMO. And let them know your dislikes. The fact that things
aren’t working for you, the fact that this is very bothersome. They have to
have feedback; it’s not a new insurance necessarily.
This introduction employed her experience as an employee of an HMO to create
a business frame from which members could endorse managed care as it
simultaneously, encouraged members to advocate for their loved ones.
Systems representation vs. familial representation
. Another source of
system contradictions stemmed from the management practices themselves,
more specifically FAMI’s alignment with the mental health systems. This
contradiction evolved from the prevailing structure’s constraints on FAMI’s
system monitoring role, socio-political rhetoric, and stakeholder enactment. In an
interview, a mental health system’s administrator explained the contradiction in
the statement, “When you enter into a county contract, you can’t do the talking,
you got to let other people do the talking as far as advocacy is concerned.” The
acceptance of county funds imposed restrictions on FAMI’s advocacy efforts and,
thereby created communicative constraints. FAMI’s allegiance to the county
implicitly established support for a system that disempowered clients and family
members through its outcome orientation and minimized the possibility for
Neurobiological disorder as a disability.
A paradox cycle emerged from
FAMI’s legitimation of NAMI’s neurobiological disorder (NBD) approach. The
NBD approach requires the acceptance that mental illnesses are equated
physical illnesses to proclaim that mental illnesses are also disabilities. However,
member rejected the way the mental health system collapsed these categories of
individuals. This became evident in Michelle, a presenter, presentation’s. First,
Michelle argued that early vocational rehabilitation system placed clients in
menial jobs because they were considered as severely disabled as individuals
with developmental disabilities. “They had a tendency to confuse the people in
the psychiatric community with the people in the developmental disabled
This is an exemplification of a paradox cycle in which the unintended
consequences of the structures of signification (e.g., mental illnesses are
equated with physical illnesses) created rules that counteracted their conception
The next section discusses how FAMI experienced changes as a result of
the ideological tensions between FAMI’s sectors of dominance and resistance.
Family Resistance to the Institutionalization of the AMI Movement
To Giddens (1979), power relationships are two -way. “Ideology provides
the possibility for the production and reproduction of relations of domination but
which, simultaneously, embodies the possibility for resistance and change”(p.
Mumby, 1989, 298). Giddens (1979) conceptualizes this resistance as a dialectic
of control through which agents participate in or resist the reproduction of
systems that restrict their autonomy (pp. 145-150).
Throughout the case study, the incumbent leadership reclaimed family
representation through a dialectic of control through stories that called for a
reversal of the management practices. Board members resisted FAMI’s shift in
allegiances and interests that counteracted the NAMI movement. In a follow-up
interview, the leader once acknowledged that in the past, board members “just
sort of nodded yes and agreed with it.”
Prior to a board meeting, Mary, a board member, mentioned that the
transitions, extensive discussions on the reparation of FAMI’s financial situation,
and the dissolution of a second board represented “a time to refocus on AMI” and
“move away from being a business.” In addition, at one of FAMI’s board meeting,
the minutes stipulated that this organization “cannot absorb any of the costs”
connected to a county project. These minutes also recorded the board’s motion
to wean from programs associated with the second program board. FAMI “needs
to focus its funds, resources, time, and volunteers on its fundamental mission,”
FAMI also created opportunities for family members to learn how to
engage in advocacy communication. At an advocacy training workshop, family
members developed letter-writing skills and learned how to make requests from
mental health institutions to commit their loved ones or to extend their ill relatives’
hospitalization. In addition, FAMI’s co-founders and board members reinstituted
norms of family advocacy communication by communicating their experiential
realities to others. Family stories recreated their experiences to define family
members’ roles and responsibilities. In a share and care and a recorded
education/advocacy session, the leader repeatedly stated, “Sharing is what we
need to be about.” Sharing offered members ontological security by maintaining
trust relations through the process of mutual self-disclosure (Giddens, 1991).
Thus, family representation resurfaced to reconstruct FAMI’s business
environments into advocacy and therapeutic environments.
Members managed their contradictions by “expanding alternatives,
creating new insights, and reframing events, organizational members
reconstructed the prevailing system to overcome its constraining
effects”(Putnam, 1985, p. 164). Family members’ dialectic of control fostered
resistance and redirected FAMI’s mission by dismantling the corporate board and
redirecting its resources toward family representation.
Politics of Consent
Theme 2 illustrates how FAMI’s structuration processes produced
constraints on the organization’s mission and family members as it
simultaneously fostered resistance. The organization’s management practices
restricted family members’ expression and participation in the decision-making
processes. Thus, FAMI’s institutional practices enacted a politics of consent.
“Consent processes designate the variety of situations and activities in which
someone actively, although often unknowingly, accomplishes the interests of
others in the faulty attempt to fulfill his or her own”(Deetz, 1995, p. 118). The
isolation of the program arm actually disempowered family members by (a)
privileging the expertise of professionals over family members, (b) suppressing
potential conflict b y withholding information from family members, and (c)
denying members access to decision-making processes. Through a duality of
structure, advocacy aided family members, but also restricted them by
reproducing the family member-professional relationships that family members
Causal Loop: From Ideologies in Back Regions to Public Presentation
In this section, I show how FAMI’s causal loops were communicatively
accomplished through members’ reflexive self-regulation. These causal loops
illustrate how FAMI’s public relations communication influenced the
organization’s public presentation. I briefly discuss the enactment of FAMI’s
public presentation and the communicative consequences of FAMI’s
enablements and constraints. FAMI’s public prese ntation engendered both
communicative constraints and opportunities.
Theme 3 posits that FAMI’s public presentation reflected its dominant
ideologies, articulated in its PRC. The public expression of particular ideologies
varied based on the recipients’ interests. Despite FAMI’s preference for
programming, the resistant ideologies permitted a focus on the family members’
needs and rights. Theme 3 shows how FAMI’s ideologies bounded members’
expression and influenced who got represented in its interactions with its publics
Theme 3 posits that FAMI’s hegemonic practices served mental health
systems by privileging public communication engagements associated with its
management practices over the public advocacy practices that typify social
movements. Resistant ideologies penetrated the system to set limits to
managerial control and to propose more extensive family advocacy
Giddens’ (1979, 1984) conception of social systems became evident in the
consequences of FAMI’s practices. The systemness of a social system, degree
of interdependence of action, is analyzable through a system’s causal loops that
sustain homeostasis, members’ reflexive self-regulation, and system feedback.
Members needed to manage the competing ideologies that arose from their local
Three of FAMI’s practices included the enactment of: (a) a plurality of
conceptions of mental illnesses; (b) management practices that enacted system
representation; and (c) family members’ dialectic of control. FAMI’s dominant
ideological meaning systems framed members’ discourses and both facilitated
and bounded members’ actions. The consequences of each of the structure’s
enabling and constraining properties are manifested in FAMI’s public
presentation. These causal loops represented FAMI’s PRC in back and front
regions. The proceeding section briefly summarizes FAMI’s causal loops.
The first causal loop can be expressed as FAMI’s political
function of divergent ideologies or pluralism enacted through the articulation of
three expert systems that generated three enablements: (a) identity construction,
(b) legitimation of a brain disorder, and (c) alliances with multiple stakeholder
groups. Consequently, these enablements engendered fragmented public
relations communication that resulted in a platform of supporting and competing
ideologies that represented multiple stakeholders and theories of mental
illnesses. For instance, FAMI interacted with scientific researchers and
organizations that represented individuals with general mental illnesses (as
. The second causal loop expresses how members engaged in
FAMI’s public communication practices. This causal loop can be expressed as
FAMI’s system representation: (a) fostered public acceptance by its stakeholder
groups, (b) supported collaboration with mental health professionals, and (c)
enhanced its public advocacy efforts. System representation, in contrast,
counteracted FAMI’s advocacy mission. The very practices that provided the
resources to fulfill its advocacy efforts undermined the family members’ advocacy
Two unintended consequences evolved as an image problem for FAMI as
its representational practices directly contrasted NAMI’s policy platform. First,
FAMI’s accountability to its funding sources resulted in high visibility in the mental
health and mental illness communities. Beverly once said that she could never
understand why they could not be all one AMI. But in my interactions with the
other three local AMIs, I learned that other AMIs conceived of FAMI as a
corporate-board. Although FAMI’s name incorporated all of the local AMIs, other
Second, FAMI’s system representation revealed tensions in NAMI’s policy
platform. In sho rt, contractual programs not only restricted its advocacy
communication, but also enforced practices that reproduced the professional-
family relationships that initially contributed to the family burden. Ironically, at the
end of the case study, Weber, a former administrator of the anticipated managed
mental health care plan, expressed his perspective about FAMI’s proposed
Office for Public affairs. Weber argued that the managed mental health system
could not create an office to handle grievances and potential lawsuits against the
A third unintended consequence emerged as FAMI’s departure from NAMI
positions on client participation, managed care, and rehabilitation. Members
acknowledged that they “lagged far behind in supporting and promoting the client
movement.” FAMI maintained a pro-managed care stance despite NAMI’s
publication entitled Stand and Deliver: Action Call to a Failing Industry.
publication, NAMI gave HMOs bad report cards including the two HMOs
represented at one of FAMI’s education/advocacy session. NAMI failed both of
the HMOs on treatment guidelines and practice protocols, medication access,
and gave one an incomplete on consumer and family involvement and failed the
. The third causal loop exhibited the family members’
responses to the system contradictions. Members’ reflexive self-regulation
occurred as they enacted resisting meaning formations to alter the character of
FAMI’s prevailing order. This causal loop can be expressed as family
representation enabled family members to enact its dialectic of control to reclaim
the initial aims of the movement. FAMI attempted to re -politicize the family
burden. This loop is an indication of how family members politicized the personal
through their discourse of transition, needs, and rights. Family members’ stories
appeared in political letters, advocacy training materials, and public meetings.
Segment II displays Jen’s, a FAMI officer, presentation made to a local
board. At this public meeting, the two officers told brief stories of clients’ and
family members’ crises. FAMI officers represented a program called Psychiatric
Emergency Aid or PEA, a collaboration between mental health professionals, law
FAMI found a civil way to manage police brutality, destigmatize mental
illnesses, and position mental health professionals as part of the solution. The
success of PEA relied on the team members’ view that clients who were
considered dangerous to others had treatable illnesses which required medical
forms of treatment rather than incarceration.
Segment II: Public Health Board Meeting
I’m Jen with the Family Alliance for the Mentally Ill. I’m
representing families who have a loved one with a very
terrible, terrible disease. I don’t know of a worse disease,
and I have a lot of experience with many in my family. We
have a nightmare, as a family we have got somebody that
can go into crisis. And right now in Pacifica County, we don’t
deal with that in the most appropriate way like the Pacifica
Police Department is now doing. PEA is the most
appropriate way, is the dignified way, it’s the humane way
and it’s a safe way, for the victim, for the family, community
and for law enforcement. Two years ago, a 17-year-old boy
from North Pacifica called me. His mother had
decompensated. He called the police in North Pacifica. They
came and forced her out of the bathroom and shot her to
death. And I am forever haunted by what happened to that
young man. I know in Pacifica [a board member] was in an
incident a few years ago, throughout the county they’ve had
incidents. You board members can give us the safest, the
most humane, the best way possible to deal with this.
This form of public presentation displayed how FAMI members articulated family
stories in front regions as a mode of public presentation.
More importantly, members’ plans for community outreach and public
relations displayed the risk communication associated with public disclosure that
characterized family representation. Since FAMI’s inception, members engaged
in risk communication to advocate for their relatives with mental illnesses. The
social and familial exigencies propelled family members into the public arena and
forced them to disclose their relations hips with ill relatives. Despite family
members’ resistance to the program arm, members displayed a need to develop
and sustain alliances. FAMI complied with NAMI’s demands for this form of risk
communication in its countless calls for public advocacy.
Family members gained power as they altered FAMI’s priorities. The
advocacy arm disabled the program arm by (a) reallocating funds to the
advocacy arm, (b) providing information to the members on their financial
situation and programs, and (c) making family advocacy central. In addition,
system-wide changes entailed a transfer of some of the FAMI’s contractual
programs to the new managed mental health care organization.
This analysis revealed that this social movement did not exhibit one
collective identity o r set of ideologies. Thus, FAMI’s co -existence of dominant
and resisting ideologies resulted in FAMI’s fragmented public relations
communication that paralleled and, at times, diverged from its parent
organization’s ideology. Knowledge environments emerged through the ways in
which members aligned with, and rejected, alternative ideological meaning
At practical level, FAMI and NAMI’s public relations officers’ communicative
role needs to manage the multiple identities and ideologies rather than dictate
similar campaign directives to all affiliates. At a theoretical level, understanding
how organizations are imbued with ideological contradictions and tensions can
facilitate the segmentation of publics based on discourse, multiple ideologies,
and risk communication. These findings are consistent with Jone’s (2002)
argument that publics form in relation to discourse and identities in risk societies.
A question for further research can address how social movement members
manage the multiple identities as they attempt to sustain a unified mission.
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