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 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. Abstract
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 communication 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 organizational environments 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. Case Description
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 Design
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. Data Analysis
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. Scientific Representation
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. Systems Representation
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 Family Representation
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. First, 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. Ideological Tensions
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. Loop one. 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 Loop two. 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. In this 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 Loop three. 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 Implications
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. References
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