Language, Discourse and Anxiety [1 ed.] 9781009250085, 9781009250139, 9781009250122

Citation preview

Language, Discourse and Anxiety Why is language so important to the ways that we make sense of anxiety? This book uses corpus-assisted discourse analysis to examine 23 million words of text posted to a forum for people with anxiety. It shows how linguistic techniques such as catastrophisation and anthropomorphisation can result in very different conceptualisations of anxiety, as well as how aspects of identity such as age, sex and cultural background can impact on understandings of anxiety and how it ought to be managed. It tracks the changing identities of posters, from their first posts to their last, and incorporates a range of corpus-based techniques to examine the language data, enabling consideration of interaction between participants and features associated with online forms of communication such as emoji. It ultimately provides a step towards a better understanding of different responses to anxiety and aims to promote further engagement with this topic in the field of Applied Linguistics. Luke Collins is a Senior Research Associate with the ESRC Centre for Corpus Approaches to Social Science at Lancaster University, specialising in the study of health and digital communication using corpus linguistics. Paul Baker is Professor of English Language at Lancaster University. He has written twenty-two books on various aspects of language, discourse and corpus linguistics. He is the commissioning editor of the journal Corpora and a Fellow of the Royal Society of Arts.

Published online by Cambridge University Press

THE CAMBRIDGE APPLIED LINGUISTICS SERIES The authority on cutting-edge Applied Linguistics research Series Editors

2007–present: Carol A. Chapelle and Susan Hunston 1988–2007: Michael H. Long and Jack C. Richards

For a complete list of titles please visit: www.cambridge.org Recent titles in this series Language Aptitude Theory and Practice Edited by Zhisheng (Edward) Wen, Peter Skehan and Richard L. Sparks Learning Vocabulary in Another Language 3rd edition I.S.P. Nation Reading in a Second Language Moving from Theory to Practice 2nd edition William Grabe and Junko Yamashita Corpora in Applied Linguistics 2nd edition Susan Hunston The Language of Mental Illness Corpus Linguistics and the Construction of Mental Illness in the Press Hazel Price Mobile Assisted Language Learning Concepts, Contexts and Challenges Glenn Stockwell Research Genres Across Languages Multilingual Communication Online Carmen Pérez-Llantada Validity Argument in Language Testing Case Studies of Validation Research Edited by Carol A. Chapelle and Erik Voss Doing English Grammar Theory, Description and Practice Roger Berry Learner Corpus Research Meets Second Language Acquisition Bert Le Bruyn and Magali Paquot Second Language Speech Fluency From Research to Practice Parvaneh Tavakoli and Clare Wright Ontologies of English Conceptualising the Language for Learning, Teaching, and Assessment Edited by Christopher J. Hall and Rachel Wicaksono Task-Based Language Teaching Theory and Practice

Published online by Cambridge University Press

Rod Ellis, Peter Skehan, Shaofeng Li, Natsuko Shintani and Craig Lambert Feedback in Second Language Writing Contexts and Issues 2nd Edition Edited by Ken Hyland and Fiona Hyland Language and Television Series A Linguistic Approach to TV Dialogue Monika Bednarek Intelligibility, Oral Communication, and the Teaching of Pronunciation John M. Levis Multilingual Education Between Language Learning and Translanguaging Edited by Jasone Cenoz and Durk Gorter Learning Vocabulary in Another Language 2nd Edition I. S. P. Nation Narrative Research in Applied Linguistics Edited by Gary Barkhuizen Teacher Research in Language Teaching A Critical Analysis Simon Borg Figurative Language, Genre and Register Alice Deignan, Jeannette Littlemore and Elena Semino Exploring ELF Academic English Shaped by Non-native Speakers Anna Mauranen Genres across the Disciplines Student Writing in Higher Education Hilary Nesi and Sheena Gardner Disciplinary Identities Individuality and Community in Academic Discourse Ken Hyland Replication Research in Applied Linguistics Edited by Graeme Porte The Language of Business Meetings Michael Handford

Reading in a Second Language Moving from Theory to Practice William Grabe

Exploring the Dynamics of Second Language Writing Edited by Barbara Kroll

Modelling and Assessing Vocabulary Knowledge Edited by Helmut Daller, James Milton and Jeanine Treffers-Daller

Understanding Expertise in Teaching Case Studies of Second Language Teachers Amy B. M. Tsui

Practice in a Second Language Perspectives from Applied Linguistics and Cognitive Psychology Edited by Robert M. DeKeyser Task-Based Language Education From Theory to Practice Edited by Kris van den Branden Second Language Needs Analysis Edited by Michael H. Long Insights into Second Language Reading A Cross-Linguistic Approach Keiko Koda Research Genres Exploration and Applications John M. Swales Critical Pedagogies and Language Learning Edited by Bonny Norton and Kelleen Toohey

Published online by Cambridge University Press

Criterion-Referenced Language Testing James Dean Brown and Thom Hudson Corpora in Applied Linguistics Susan Hunston Pragmatics in Language Teaching Edited by Kenneth R. Rose and Gabriele Kasper Cognition and Second Language Instruction Edited by Peter Robinson Research Perspectives on English for Academic Purposes Edited by John Flowerdew and Matthew Peacock Computer Applications in Second Language Acquisition Foundations for Teaching, Testing and Research Carol A. Chapelle

Published online by Cambridge University Press

Language, Discourse and Anxiety Luke Collins Lancaster University

Paul Baker Lancaster University

Published online by Cambridge University Press

Shaftesbury Road, Cambridge CB2 8EA, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 103 Penang Road, #05–06/07, Visioncrest Commercial, Singapore 238467 Cambridge University Press is part of Cambridge University Press & Assessment, a department of the University of Cambridge. We share the University’s mission to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781009250085 DOI: 10.1017/9781009250139 © Luke Collins and Paul Baker 2023 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press & Assessment. First published 2023 A catalogue record for this publication is available from the British Library. A Cataloging-in-Publication data record for this book is available from the Library of Congress. ISBN 978-1-009-25008-5 Hardback ISBN 978-1-009-25012-2 Paperback Cambridge University Press & Assessment has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Published online by Cambridge University Press

Contents

List of Figures List of Tables Acknowledgements Preface

page ix x xii xiii

1

Anxiety, Online Fora and This Study Introduction Anxiety Disorders Investigating the Language of Anxiety Disorders Online Forums HealthUnlocked: the Anxiety Support Forum Overview of the Book

1 1 2 6 17 19 26

2

Sketching Anxiety Introduction Meaning by Association The Meaning of Anxiety Word Sketch Conclusion

29 29 30 32 36 61

3

The Lived Experience Introduction Online Forums as Computer-Mediated Communication Keyness What Do Members of the Anxiety Support Forum Set Out to Discuss? Emoticons and Emoji Conclusion

62 62 62 67

4

Creating a Community Introduction Forum Interactions Replies in the Anxiety Support Forum Documenting Forum Interactions

69 91 94 96 96 97 98 103

vii

Published online by Cambridge University Press

viii

Contents

Discourse Unit Patterns Combinations of Discourse Units within Posts Sequences of Functional Discourse Units Discussion Conclusion

111 121 124 132 133

5

Sex and Gender Introduction Sex, Gender and Anxiety Disorders Male and Female Keywords Discussion Discourses of Gender Conclusion

135 135 135 139 155 156 164

6

Comparing Cultures Introduction Cultural Keywords Conclusion

166 166 168 189

7

Time Introduction Comparing Years Changing Themes over Time Comparing Age The Journey from First to Last Post Conclusion

191 191 192 197 201 219 227

8

Conclusion Introduction Working with a Corpus of Forum Posts Conceptualising Anxiety Strategies The Value of the Forum Future Directions Concluding Remarks

228 228 228 232 234 235 239 241

References Index

242 259

Published online by Cambridge University Press

Figures

4.1 Number of Main posts according to number of direct replies 7.1 Frequency of posts over time (months) 7.2 Relative frequency of categories of terms increasing over time 7.3 Relative frequency of categories of terms decreasing or remaining stable over time 7.4 Combined relative frequencies per million words of literally, really, constantly, everything, extremely, seriously, completely, super and whole in spoken corpora 7.5 The number of contributors who made between 1 and 20 posts

page 98 193 199 200

208 219

ix

Published online by Cambridge University Press

Tables

2.1 Synonyms for anxiety derived from the English Web 2020 corpus page 36 2.2 Medicalising representation of anxiety 40 2.3 Normalising representation of anxiety 43 2.4 Catastrophising representation of anxiety 45 2.5 Minimising representation of anxiety 48 2.6 Anthropomorphising representation of anxiety 51 2.7 Anxiety as an abstract entity 55 2.8 Owning representation of anxiety 58 2.9 Distancing representation of anxiety 59 2.10 References to DETERMINER + anxiety according to post type 60 3.1 Keywords and key terms relating to Health issues and symptoms 71 3.2 Keywords and key terms in the category Time 73 3.3 Keywords and key terms relating to Persons and things 75 3.4 Keywords and key terms relating to Medical tests, remedies and coping strategies 77 3.5 Keywords and key terms in the categories Feelings & emotion and Cognition 78 3.6 Keywords and key terms relating to Forum relations 80 3.7 Keywords and key terms relating to Personal circumstances 81 3.8 Keywords and key terms in the category Body parts and processes 82 3.9 Keywords and key terms in the categories Negative evaluation, Positive evaluation, Minimal and Maximal 83 3.10 Keywords and key terms in the categories Auxiliary & modal verbs and Lexical verbs 84 3.11 Key 6-grams in Main posts 87 3.12 Key 6-grams in Replies 89 3.13 Frequent emoticons and emoji in Main posts and Replies 91

x

Published online by Cambridge University Press

List of Tables

4.1 Keywords for Main posts that elicited replies compared with Main posts with zero replies 4.2 Forum members with a high rate of Main posts receiving zero replies 4.3 The nine types of communicative purposes 4.4 The occurrence of each communicative purpose according to their ranked prominence 4.5 Sequence of DUs involving jok coding 4.6 Coding of communicative purposes in a post containing conflict 4.7 Number of posts with different numbers of DUs 4.8 Combinations of dominant communicative purposes in posts with two DUs 4.9 Frequent combinations of dominant (score 3) communicative purposes across the three DUs in a post 4.10 Coding of DUs and communicative purposes for a fel Main post 5.1 Breakdown of the Anxiety Support forum corpus according to gender categories 5.2 Male and female keywords and key terms 6.1 Contributions to the Anxiety Support forum by country 6.2 American and British keywords and key terms 6.3 Key terms that intersect country and sex 7.1 Annual keywords 7.2 Categories of frequent words in the corpus 7.3 Number of posts by age category 7.4 Keywords by age group 7.5 Age-related keywords intersecting with sex and location 7.6 Keywords associated with different stages of posting

Published online by Cambridge University Press

xi 99 101 108 112 118 120 121 122 123 125 138 140 167 169 189 194 198 202 203 218 220

Acknowledgements

The research reported in this book is based on the project Anxiety support in an online forum undertaken within the ESRC Centre for Corpus Approaches to Social Science (CASS) at Lancaster University (Grant reference ES/R008906/1). We would like to thank Andrew Hardie for his technical assistance throughout the project and Kevin Gerigk for his coding work in Chapter 4. We also wish to thank Rebecca Taylor at Cambridge University Press for her support. Finally, we are indebted to HealthUnlocked for providing us with forum data and to the members of the Anxiety Support forum who gave permission for their posts to be used in academic research.

xii

Published online by Cambridge University Press

Preface

Mental health is an increasingly important issue in today’s world, with long-lasting conditions such as anxiety being difficult to diagnose and to treat. An important response to this situation is the growth of online forums that host virtual communities where people with a specific, healthrelated condition can exchange information and support. The linguistic records created by such communities invite linguistic research. The authors of Language, Discourse and Anxiety have responded with a large-scale, corpus-based study of posts to an anxiety forum. This welcome addition to the Cambridge Applied Linguistics series shows how participants in an online forum use language to conceptualise and represent anxiety while creating a virtual community. It also demonstrates the usefulness of corpus linguistics to reveal meanings that are made in a specific discourse type. It stresses the importance of looking at both the accumulated patterning observed in large quantities of language and the detail of individual messages conveyed by participants. The authors answer questions such as how anxiety is described by those who live with the condition; how members of the forum respond to expressions of feeling or appeals for support; and how the language chosen is related to aspects of identity such as gender and age. By identifying language patterning beyond individual posts, the authors reveal meaning and attitude that would remain unnoticed by reading alone. In broader terms, the project reported in this book offers an example of using corpus methods in Applied Linguistics. It shows the steps in the research journey from the issues involved in collecting data relating to a sensitive and personal topic, through the classification of material and the application of quantitative measures, to the qualitative interpretation of the output from those measures. It provides a model for undertaking studies of similar material and so for applying the study of language to the support of those experiencing challenging life events.

xiii

https://doi.org/10.1017/9781009250139.001 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.001 Published online by Cambridge University Press

1

Anxiety, Online Fora and This Study

Introduction The following excerpts are taken from posts made online to a health forum about anxiety: I know that the evil anxiety wants me to give into it. I try not to. I try my hardest to fight it but it’s hard when you feel horrible most the time :( Do diabetics feel guilty because they need meds? No, they don’t, and niether should you. Anxiety is a disease/illness just like any other, just not as well understood as most illnesses. No shame in taking this med if you need it, none at all! I finally found the love of my life after being single so long and my anxiety is destroying everything I constantly second guess her and myself always paranoid

These excerpts were chosen because they demonstrate a range of different ways that people can make linguistic choices to represent anxiety in different ways. The first poster describes anxiety as evil and goes on to characterise it as a sentient being which has its own agenda (wants me to give in). The poster describes themself as trying to fight anxiety. The second poster represents anxiety as a disease or illness, comparing it to diabetes, whereas the third poster describes anxiety as part of them: my anxiety, then uses superlative language – it is destroying everything, they constantly second guess their partner and they are always paranoid. The poster also describes anxiety as carrying out an action – destroying. Like many subjects, it is possible to talk about anxiety in multiple ways. However, we would argue that the language we use around anxiety is likely to play an extremely important role in the way that people make sense of it, which in turn will impact on the ways that they will try to manage anxious feelings and their chances of success in doing so. As we will demonstrate later, anxiety can be debilitating and is certainly widespread; if anything, it is becoming more commonly

1

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

2

Anxiety, Online Fora and This Study

recognised. In this book we examine anxiety in respect of the language used about it, presenting analyses of hundreds of thousands of posts of the type shown earlier. We aim to gain a clearer understanding about the lived experiences of anxiety, what it means to those who experience it, how they have tried to manage it and how they interact with others who are in a similar position. This book will not outline a set of ‘good’ and ‘bad’ uses of language in relation to anxiety – everyone is different and we do not believe that people will benefit equally from a ‘one-size-fits-all’ set of suggestions. Instead, we aim in this book to illustrate the range of ways that different people have used language in relation to anxiety. For people who experience anxiety, this may be useful in terms of helping them to recognise their own linguistic strategies, and in cases where they feel they are not coping well with anxiety, the book should offer the possibility of alternatives. In later chapters of the book, we focus on the kinds of language use that are typical of different types of people – young and old, male and female, American and British, indicating that to an extent, the way we conceptualise anxiety is influenced by aspects of our identity or the culture we live in. In this chapter we begin by identifying the key types, definitions, symptoms and treatments of anxiety as well as providing estimates on the number of people who experience it. We then review existing work on language and mental health, focusing on studies that have used discourse analysis, computational linguistics and corpus linguistics. This section also helps to familiarise readers with aspects of methods that we will be using in our own analyses. After that we consider analyses of language use in online forums, particularly those related to mental health, which leads to a description of the forum we focus on in this book, the Anxiety Support forum from the site HealthUnlocked. We discuss how we collected posts from this site and how we approached issues such as spelling variation, use of emoji and graphics and the ethical considerations of working with texts posted online. Finally, we provide an overview of the remaining chapters of the book.

Anxiety Disorders Anxiety is a feeling of unease, characterised by fear or worry, which can be accompanied by physical symptoms. The experience of anxiety in response to a perceived threat is an adaptive behaviour that has contributed to humankind’s very survival. However, a distinction can be made between adaptive and maladaptive behaviours, the latter

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Anxiety Disorders

3

requiring treatment and determined to be pathological. Unfortunately, establishing this distinction is not easy and usually requires clinical judgement. As such, better understanding of experiences of anxiety is required, from both the biophysical standpoint of clinical medicine and the experiential viewpoint that can be conveyed through language. Descriptions of experiences of what would now be understood as anxiety and mood disorders are found in medical texts from Ancient Greece, though it was with the growth of modern psychiatry in the late nineteenth century that diagnostic classifications relating to anxiety were developed (Crocq, 2015). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA, 2013) groups recognised anxiety disorders into three categories: anxiety; obsessive– compulsive disorder (OCD); and trauma- and stressor-related disorders. Distinctions between anxiety disorders are typically based on the situations or objects that are associated with excessive fear and anxiety. For instance, the four most common anxiety disorders are generalised anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD) and agoraphobia (Bandelow et al., 2017) and are characterised, respectively, in relation to anxiety caused by everyday events, social interactions, sudden attacks of fear or anxiety, and anxiety that arises from a concern about being in a situation or place from which it might be difficult or embarrassing to escape (APA, 2013). Other anxiety disorders are similarly labelled in relation to what is the source of excessive fear, such as separation anxiety disorder, health anxiety and phobias (e.g., animal, natural environmental, blood-injection injury). OCD and related conditions, such as body dysmorphic disorder, hoarding disorder and excoriation (skin picking) disorder, are categorised as distinct from anxiety disorders since they are characterised by obsessions and compulsions, rather than anxiety. Trauma- and stressor-related disorders include acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). Although anxiety disorders are various, there are some common behavioural responses and physical symptoms that are included in the diagnostic criteria across anxiety disorders. The Rethink Mental Illness factsheet on anxiety disorders (Rethink Mental Illness, 2022) lists the following reported effects: • • • • • •

racing thoughts uncontrollable over-thinking difficulties concentrating feelings of dread, panic or ‘impending doom’ feeling irritable heightened alertness

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

4

• • • •

Anxiety, Online Fora and This Study

problems with sleep changes in appetite wanting to escape from the situation you are in dissociation (feeling like you are not connected to your own body, or like you are watching things happen around you without feeling it).

They also list the following physical symptoms: • • • • • • • • • •

sweating heavy and fast breathing hot flushes or blushing dry mouth shaking hair loss fast heartbeat extreme tiredness or lack of energy dizziness and fainting stomach aches and sickness.

These effects and symptoms can exacerbate the experience of anxiety, resulting in a vicious circle. Despite awareness of associated symptoms, the DSM-5 states that a diagnosis of an anxiety disorder occurs ‘only when the symptoms are not attributable to the physiological effects of a substance/medication or to another medical condition or are not better explained by another mental disorder’ (APA, 2013, p. 189). This means that individuals experiencing excessive fear or anxiety are typically subject to a range of diagnostic tests designed to identify other conditions in order to rule them out. It also means that a degree of uncertainty is inherent in the diagnosis of an anxiety disorder, since it is characterised not by the positive identification of markers, but the absence of those indicative of other conditions. This uncertainty can itself be a source of distress, which is further complicated by the fact that a given anxiety disorder often co-occurs with another anxiety disorder, and/or with major depression, personality disorders and substance abuse disorders (Bandelow et al., 2017). Neurobiological research has yet to identify specific biomarkers for anxiety disorders and the aetiology of anxiety disorders is more strictly tied to psychosocial factors such as childhood adversity, stress or trauma (Bandelow et al., 2017). As such, understanding an individual’s personal history and appraisal of events in their life is key to managing their relationship with their anxiety. Health professionals rely on lay descriptions of experiences of anxiety in order to prescribe treatments and to deliver talking therapies such as cognitive behavioural therapy (CBT). Treatment for anxiety

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Anxiety Disorders

5

disorders typically involves psychotherapy, pharmacotherapy or a combination of the two and Bandelow et al. (2017) emphasise the importance of individual factors in determining the appropriate treatment, which could include the patient’s preference, their history with previous treatment attempts and comorbidities. CBT has been shown to be the most effective psychotherapeutic treatment for anxiety disorders (Carpenter et al., 2018) and is predicated on changing maladaptive beliefs about the perceived threat, that is, manipulating dysfunctional ways of thinking to change patterns of behaviour and support emotion regulation. As a development of CBT, acceptance and commitment therapy (ACT) has been shown to be effective in treating anxiety disorders (A-Tjak et al., 2015), pursuing psychological health in terms of the ability to consciously experience feelings and thoughts as they are and guiding behaviour change according to patients’ goals and values (Hayes et al., 2012). Fundamental to this approach is the acceptance (and the reduced avoidance) of anxiety, rather than prioritising symptom reduction per se. One of the strengths of talking therapies such as CBT and ACT is that they can be tailored to patients, since they focus on each patient’s values and beliefs. As such, their potential for maximising adherence and increasing selfefficacy in patients is contingent upon understanding the individual perspective. The World Health Organization (WHO, 2017) reports that the total estimated number of people living with anxiety disorders in the world is 264 million and this total for 2015 reflects a 14.9% increase since 2005 (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, 2016) as a result of population growth and ageing. Furthermore, anxiety disorders were ranked the sixth largest contributor to non-fatal health loss, globally (WHO, 2017). In addition to the personal hardships felt by individuals experiencing anxiety, a systematic review of studies assessing the cost of illness for anxiety disorders reports that the average direct costs corresponded to 2.1% of healthcare costs and 0.2% of gross domestic product (Konnopka and König, 2020). Despite their documented prevalence, anxiety disorders are severely underdiagnosed and undertreated. In a large-scale study of the prevalence of mood, anxiety and alcohol-related disorders throughout Europe, Alonso et al. (2009) report that only 20.6% of participants with an anxiety disorder sought professional help and of those who did contact healthcare services, 23.2% received no treatment at all. Barriers to receiving treatment include clinical shortage, long wait times, social stigma and high treatment costs (Shim et al., 2017), highlighting the need for alternative support and treatment options.

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

6

Anxiety, Online Fora and This Study

Domhardt et al. (2019) argue that internet- and mobile-based interventions have value in mitigating some of these barriers, by offering time- and space-independent delivery, potential anonymity, and different degrees of human support involving text-based and asynchronous communication. They also constitute low-cost interventions that are scalable. Furthermore, opportunities for self-management can benefit health services looking to make cost savings in the face of populations living longer with chronic disease, and for patients, improving health knowledge and self-efficacy adds to their expertise derived from lived experience (Armstrong et al., 2012). Online support forums are an increasingly common resource facilitating selfmanagement, increasing patient autonomy while also offering social support, which manifests in information exchange and sharing of experiences. Writing with respect to experiences of depression, Sik (2021, p. 756) describes online forums as ‘narrative sandboxes’, where ‘an attempt is made to express the experience of depression, to re-enter intersubjectivity in a low threshold interaction and find mutual explanations to the suffering’. In this sense, online forums support the elaboration of identity-narratives, which are fundamental to the restoration of a coherent self in a world burdened by illness and which offer an alternative to the biomedical paradigm that is imposed when those with mental health issues engage with health professionals (Sik, 2021). The anonymity of online spaces facilitates the discussion of sensitive topics as well as helping to overcome geographical and social isolation and providing opportunities for gathering practical information and advice (Sik, 2021). In this book, we investigate an online forum offering support for anxiety disorders, focusing on the representations offered by those with experience of anxiety disorders through the language they use to report those experiences, and the communicative exchanges that demonstrate how online communities provide social support. In focusing on language as the conduit through which feelings, beliefs and discussions about anxiety disorders are expressed, we can consider how members of the forum reconfigure lay and expert knowledge about anxiety, which can subsequently inform how those with anxiety are supported, including by health professionals.

Investigating the Language of Anxiety Disorders Language is crucial to the ways that we convey our experiences of health and illness to health professionals, family members and friends in order to obtain treatment and support. Language also constitutes how we make sense of health and illness as part of a wider life

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Investigating the Language of Anxiety Disorders

7

experience. Language-based studies of the experience of anxiety disorders, like those of many other types of mental illness, have sought to describe patterns in language use that reflect and characterise a broader psychological experience. One of the earliest studies in this area was carried out by Capps and Ochs (1997), who identified a ‘grammar of panic’: a shortlist of language features that they reported were characteristic of experiences of anxiety and more acute panic attacks. This included the use of adverbials such as all of a sudden and a high proportion of mental verbs such as think and realise. Furthermore, they found that participants positioned themselves as helpless and that this was realised through: • • • •

Referring to self in semantic roles other than agent or actor Using modal verbs that frame action as necessity (i.e., not voluntary) Using grammatical forms to imply failure to achieve a goal Using grammatical forms that intensify vulnerability and deintensify one’s ability to cope and control. (Capps and Ochs, 1997, p. 67)

The identification of linguistic patterns, as used in particular contexts and by certain participants, intended towards select communicative ends, is consistent with investigations of discourse. The analysis of discourse is both linguistic and social, in that we discuss the construction of discourses in terms of the aggregation of precise linguistic features, with a view to understanding how people use language to manage interactions, cultivate particular representations of themselves, other people and objects, and express ideas and beliefs – with varying degrees of explicitness. Thus, we can talk about language at the level of word choices, standard grammatical relations and textual features such as orthography. When we consider what is appropriate to a particular mode of communication – such as an online forum – and reflective of particular social conventions, such as the language used by health professionals during a consultation, the awareness that the communicator has for what is typical gives us insights into the discourses shaping that interaction. Georgaca (2014, p. 55) discusses how discourse analytic approaches draw on principles of social constructionism to investigate ‘systemic ways of speaking’ about mental health and illness across clinical categories, public and policy texts, as well as user experiences. Studies in this area work to destabilise the taken-as-given nature and objective status of, for example, medical descriptions of illness and demonstrate that definitions and representations are socially and historically constructed. For example, medical discourses have historically conceptualised mental distress as illness, located in the human

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

8

Anxiety, Online Fora and This Study

body while positioning patients as passive sufferers and medical professionals as experts. Alternative discourses work to empower the individuals who experience the distress as active agents and as having expertise derived from their lived experience, which has in turn informed effective therapeutic interventions (Nissling et al., 2021). Studies of representations of illness in the media have also set out to ‘disrupt’ the discourses that have represented those who experience mental disorders as dangerous, criminal, pitiable or diminished, subsequently fuelling the stigmatisation of mental illness (Hannaford, 2017). Georgaca (2014, p. 58) concludes that ‘This field of social constructionist research which critically examines the production and maintenance of dominant clinical categories and attempts to denaturalize and destabilize them through a series of deconstructive strategies has been one of the major contributions of discursive approaches to critical mental health work.’ As mentioned earlier, online forums offer one such space where those with knowledge derived from experience can recontextualise and reconfigure the discourse around anxiety that may come from health professionals or the media. Through a close examination of language produced in this context, we are afforded a view of how social and institutional practices are realised at the micro-level. Informing our analysis of the language used in online forums is a recognition that there are certain textual features and social conventions associated with the platform as a form of computer-mediated communication (CMC). Researchers have attributed the structural features of CMC to its technical affordances, in that while users cannot utilise the kinds of paralinguistic features associated with face-to-face communication (intonation, gesture, facial expressions), there are options more germane to online communication – such as hyperlinks, emoji and multimodal features such as video. Herring and Dainas (2017) collectively refer to the visual elements of CMC as ‘graphicons’, which would include emoji, stickers, graphics interchange format (GIF) files, images and videos. In addition, there are CMC practices that serve as proxy to audible features, such as CAPITALS to indicate volume (Riordan and Kreuz, 2010). Not only will the data we observe be influenced by what the forum allows users to contribute, at a technical level, but those technical aspects will also shape the interpersonal dynamics of how participants (are able to) interact with one another. For instance, members are afforded a high degree of anonymity and the opportunity to manage which aspects of their disembodied identity are visible to others. This, combined with the fact that participants are more likely to be communicating with peers, means that support groups potentially offer a more deliberative space compared

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Investigating the Language of Anxiety Disorders

9

with, for example, exchanges between patients and healthcare professionals where there are more tangible power asymmetries. As such, we are interested not only in how members of the forum craft their posts using text characters and emoji, for instance, but also how they express affiliation and operate as a peer community. By linking the social practices of an online forum to specific features of language, we can use computer tools and software to help us process the multitudinous forms of expression and interaction between the vast number of users of online forums. Computing these textual features on a large scale supports us in identifying how even simple word choices aggregate to form the discourses that characterise representations of anxiety in this context, as we will now explain.

Computational Linguistics Recent studies investigating language features associated with communities discussing anxiety and mood disorders have benefitted from approaches in computational linguistics and natural language processing (NLP) to conduct large-scale studies of, in particular, CMC, such as social media and forum posts. Automated procedures that enable us to process lots of data quickly also help us to discern statistically meaningful patterns in language use. For instance, there have been indications that increased use of first-person singular pronouns (I, me, my) is a robust indicator of depression, though their use in relation to anxiety is sparser and, at times, contradictory (Haase, 2021). AlMosaiwi and Johnstone (2018) report that anxiety, depression and suicidal ideation forums contain more absolutist words than control forums (categorised as general, asthma, diabetes and cancer forums), with these especially favoured in suicidal ideation forums. The researchers generated their own absolutist and non-absolutist dictionaries through introspection, with both categories indicating magnitudes and probabilities but absolutist words doing so without nuance (always, totally, entire) compared with no-absolutist words, which carry some nuance (rather, somewhat, likely). One of the more commonly used tools in language-based investigations of mental health and illness is the Linguistic Inquiry Word Count (LIWC) program (Tausczik and Pennebaker, 2010), a text analysis program that calculates the percentage of words in a given text that falls into one or more of over 80 linguistic, psychological and topical categories indicating various social, cognitive and affective processes (e.g., ‘negative emotion’). Lyons et al. (2018) used the LIWC program in comparing the linguistic content of individuals in online communities for different types of mental distress (generalized anxiety disorder,

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

10

Anxiety, Online Fora and This Study

borderline personality disorder, major depressive disorder, obsessive– compulsive disorder, and schizophrenia) and a control group (a finance discussion forum). Compared to the control group, people who experience one of the forms of distress displayed a higher frequency of singular personal pronouns and higher frequency of negative emotion word use. Although frequently deployed to investigate language-in-use, the LIWC program does have certain limitations that inhibit the extent to which we can understand how language is used in context. Hunt and Brookes (2020) argue that in relying upon individual words and/or rudimentary word combinations, the tool is likely to lead to simplistic analytical claims that do not take into account various levels of context (including co-text, register or audience design). As such, Slonim (2014, p. 17) argues that LIWC is not suited to tracking the ‘ebb-and-flow’ of language across time, or even across the course of a text. Slonim (2014) also offers a critical evaluation of the studies that have used LIWC, identifying mixed results on purported claims that, for example, people with depression use the first-person pronoun ‘I’ more than other people, use more negatively valanced emotion words (and fewer positively valanced emotion words) and more cognitive mechanism words (e.g., think, realise). Slonim (2014, p. 15) argues that one of the limitations of these studies is that they have not identified markers that are specific to depression and in the case of ‘I’, this is acknowledged by Pennebaker (2011, p. 289), who states that: Depending on the context, using I-words at high rates may signal insecurity, honesty, and depression proneness but also that you aren’t planning on declaring war any time in the near future.1 Using I-words at low rates, on the other hand, may get you into college and boost your grade-point average but may hurt your chances of making close friends.

Whether using the pre-determined LIWC categories or an alternative, there is a tendency in works relying on automated classification and processing to develop bespoke dictionaries that purportedly tie lexical items to psychological constructs; however, those links remain unsupported. Slonim (2014, p. 16) refers to studies by Vanheule et al. (2009) and Ramirez-Esparza et al. (2008) as examples where it is implied that semantic categories of words (such as ‘positive emotion words’) are indicative of positive or negative affect, but there is no theoretical explanation to support this proposition. As such, while it is not particularly surprising to find that people experiencing mood disorders 1

Pennebaker (2011) provides the anecdotal example that Harry Truman used far more I-words than Barack Obama.

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Investigating the Language of Anxiety Disorders

11

and anxiety refer to ‘negative emotions’ more frequently, we must also be cautious about inferring that the use of these terms is indicative of mental state. NLP approaches have been applied as a form of clinical linguistics, identifying metrics such as lexical diversity, readability scores, sentence complexity, negation, uncertainty and degree of repetition as a means of identifying and even predicting specific mental health conditions (Conway et al., 2019, p. 213). However, Perkins (2011, p. 926) argues that identifying language ‘dysfunction’ and ‘atypicality’ when compared with ‘normal’ usage ‘cannot satisfactorily be accounted for in terms of a deficit in a language “module”’, and that ‘competence/ performance-type explanations are an unhelpful and even misleading way of characterizing these phenomena’. Our approach, then, is not to pursue the identification of ‘linguistic markers’, since as Hunt and Brookes (2020) assert, making any claims as to what (emotional) suffering looks like in relation to health and illness runs contrary to the diversity with which people talk about it. Our approach comes from a discipline that is firmly grounded in linguistic theory and founded on the recognition that language is used in context. A corpus linguistic approach capitalises on the speed and processing power of computers; however, it also raises important questions about how to identify, quantify and analyse features of language in the context in which they are used.

Corpus Linguistics Corpus linguistics refers to a set of procedures that allow us to process large datasets and make observations of patterns in how language is used, supporting claims about how people discuss experiences of health and illness, for example. We refer to our large dataset as a ‘corpus’ (pl. corpora), which is collected according to principled sampling procedures in order to be representative of a domain of communication and documented in a machine-readable format to allow quick calculations and searches using a computer. The emphasis on computational processing of large datasets in corpus linguistics affords researchers the opportunity to base their observations on more representative bodies of text and, thereby, make their findings more generalisable. Nevertheless, the emphasis on viewing language in its original context and the application of qualitative forms of analysis supports investigations of language that are sensitive to the ways in which language users construct their texts – such as forum posts – with an awareness of structure, sequence and their audience. Corpus linguists therefore caution against the decontextualised analysis of

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

12

Anxiety, Online Fora and This Study

language and while certain procedures, say, count individual words, this is regarded as a preliminary step in an inquiry that returns to the situated context in which those words appear. Applications of corpus-based approaches to different types of health communication have afforded insights that help us to understand how health professionals and lay communities alike report aspects of health and illness with a view to optimising healthcare outcomes. Focusing on the communication strategies of health professionals during consultations with patients, researchers have identified patterns in how consultants use interpersonal strategies (Thomas and Wilson, 1996) and how health professionals involve patients in decision-making (Skelton et al., 1999). Quantitative methods can identify general patterns, but these patterns exist in a complex context that can only partly be described quantitatively and so quantitative statements ‘should always be accompanied by detailed qualitative analysis’ (Skelton et al., 1999, p. 621). One of the fundamental procedures of corpus linguistics is keyness analysis, which helps to identify features that are particularly frequent in one dataset compared with another. Adolphs et al. (2004) used this approach to identify salient features in NHS Direct exchanges between professionals and patient callers, finding that in addition to a highly involved, interpersonal style (indicated, for example, in the regular use of the second-person pronoun, you), health professionals balanced direct instructions and imperatives (such as try, take and avoid) with vague language, which provided optionality for the caller and performed important politeness work. News media are also an important source of information regarding health issues and corpus linguistics has supported researchers in conducting longitudinal studies of health coverage. Price (2022) explored representations of mental illness in the UK press between 1984 and 2014 to consider their contribution to stigmatisation and found that such reports used identity-first forms (a schizophrenic) to refer to people with mental illness, more than person-first forms (a person with schizophrenia). Price (2022) also found that the press tended to represent the process of having mental illness as suffering, but firstperson accounts from people with mental illness are more likely to refer to experiencing mental illness. Hannaford (2017) similarly investigated UK press coverage between 1995 and 2014, which was examined alongside the UK National Attitudes to Mental Illness Survey (AMIS) (TNS BMRB, 2015). Hannaford (2017) reports an increase in destigmatising coverage of mental illness over the period, as well as a decline in coverage of people with mental illness as dangerous, which correlated with a decrease in negative attitudes towards people with mental illness among the public.

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Investigating the Language of Anxiety Disorders

13

Atkins and Harvey (2010) applied a keyness analysis (described in more detail later) to explore the lay perspective as conveyed through health enquiries submitted anonymously to a doctor-led health advice website. This approach supported them in identifying some of the common misconceptions about sexually transmitted infections and the online format seemed to facilitate an uninhibited discussion of sexual health issues. Harvey (2012) has investigated the same collection of adolescent health queries to explore questions and disclosures around depression. He reports two important recurring constructs: I am depressed and I have depression, which ‘encode different perspectives and meaning making with regard to the conceptualisation of depression, the former describing depressive experiences as a reaction to negative life events, the latter portraying depression as a pathology originating within the individual’ (Harvey, 2012, p. 349). Harvey (2012) thus argues that the language choices made by those submitting queries to the website reflect broader attitudes towards mental health that are informed by the language of ‘psychiatrization’ and the construction of sadness as a clinical problem. There are also studies investigating online forums using corpus linguistic methods, relating to various health concerns. Demmen et al. (2015) investigated an online support group for cancer and end of life care involving patients, family carers and healthcare professionals and reported a wide range of violence metaphors (battling cancer, for example) used to various effects, but with greater frequency in the online forum context, compared with face-to-face interactions. Kinloch and Jaworska (2020) explored the lived experience of postnatal depression (PND) through a comparative analysis of discourses about the condition produced by mothers in an online discussion forum, the medical profession and the UK print media. They were particularly interested in how mothers positioned themselves in relation to the social stigma cultivated in media discourses around PND and found that ‘secrecy’ – that is, hiding symptoms and experiences of PND – was a key theme in the data that could be directly linked to stigma. The studies reported here, which use corpus linguistic methods to investigate health communication in various contexts, each report one or more of a handful of techniques that have become recognised as the fundamentals of corpus linguistics (Brookes and McEnery, 2020) and which we rely on in the analyses reported in this book. One simple procedure for initiating a quantitative analysis is to extract frequency information, which is typically readily available through corpus analysis tools (software programs) in the form of wordlists. This tabulated presentation of the most frequent items (typically, words) in the corpus

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

14

Anxiety, Online Fora and This Study

can provide a very quick yet illustrative overview of a dataset and is often enabled for sequences of words, or word categories. However, in order to contextualise the raw frequencies, corpus linguists typically provide a reference point for comparison. This might be reported as a relative frequency: a normalised value that converts the actual number of occurrences to a standardised measure, such as x wordsper-million (wpm), in order to make it easier to compare the rate of occurrence of a feature in corpora of different sizes.2 The keyness approach mentioned earlier is an extension of this principle in that it is based on a comparison of the proportional frequency of a feature (e.g., a word) in two (or more) corpora and combined with a statistical test to determine if differences in the relative frequencies are statistically meaningful. Through identifying what is ‘key’ in one text compared with another, we begin to establish what is salient to the data we are investigating, as a matter or convention or an area of particular interest to communicators in that context. Conventionally, this baseline is determined from a larger reference corpus, though the selection of the reference data has implications for what emerges through our comparison. Our Anxiety Support forum data represents content that is not only characterised by the topic of anxiety disorders but also the mode, as a form of CMC. If we were to compare this to a corpus of general English (such as the BNC2014), the results would likely highlight features that are characteristic of online forms of communication, as distinct from spoken and written forms. As such, we can select a reference corpus that is more closely matched in terms of register, that is, one containing examples of online communication to ‘neutralise’ – or normalise – the frequent occurrence of features indicative of the online mode. In order to facilitate a comparison that tells us more about the nature of the forum and the topic of anxiety, we can refer to the enTenTen20 Corpus of the English Web (hereafter, the English Web 2020 corpus): a corpus of 36 billion words of ‘linguistically valuable web content’ collected between 2019 and 2021, including blogs and documents covering technology, sports, business and so on from a range of English-language domains (e.g., UK, US, Australia) (Jakubícˇek et al., 2013). We refer to the English Web 2020 corpus to consider how the Anxiety Support forum compares to general web-based English, though in later chapters we also divide the forum data into subcorpora in order to conduct statistical comparisons between parts of 2

For instance, if a feature occurs 100 times in a corpus of one million words (100 wpm), this is comparatively more often than occurring 150 times in a corpus of 10 million words (15 wpm).

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Investigating the Language of Anxiety Disorders

15

the data defined by contextual factors, namely whether the contributors identified as female or male (Chapter 5); as from the UK or the USA (Chapter 6); and how messages from different timepoints compare (Chapter 7). As such, we will be reporting the results of different keyness analyses as we investigate different segments and populations within our study of an online Anxiety Support forum. We have also stressed that to look at words in isolation offers only a restricted view of how language is being used and so an essential aspect of corpus linguistics is to look at language in context. Corpus analysis tools offer a range of ways through which we can investigate the relationships between words and patterns of word combinations. One such technique is called collocation, which highlights statistically meaningful word combinations in a corpus. This often involves identifying a relevant search term (which could itself be identified through frequency or keyness analysis) and then using a corpus analysis tool to identify words which more often occur in combination with the search term than without. This can highlight meaningful associations and comparisons between corpora from different communicative contexts. For example, Kinloch and Jaworska (2020) found that in an online forum, woman collocated with their search term PND but in media texts, the term sufferer was more likely to be used to describe someone experiencing PND. Techniques such as frequency, keyness and collocation analysis are often referred to as a ‘point of entry’ (Adolphs et al., 2004) or a ‘way in’ (Kinloch and Jaworska, 2020) to the data, typically in order to allow for more qualitative investigations. This qualitative stage of the analytical process is often informed by other language-based methods, such as discourse analysis, and requires more manual input from the researcher. A common feature of many corpus analysis tools is concordancing: a presentation format of the data which allows the researcher to observe sequential occurrences of a search term as a series of rows, with a snippet of the preceding and succeeding text either side. This is alternatively labelled a ‘key word in context (KWIC)’ view and offers a glimpse of the original text in each instance that is often sufficient for helping the researcher to discern patterns in how the term is used. Of course, for a more informed view, the researcher should familiarise themselves with the full text and concordance tools are often hyperlinked in a way that allows the researcher to select one of the occurrences and activate a view of the complete text (in our case a single forum post or the sequence of messages the post occurs in). The move to concordance lines is usually the point at which the researcher is tasked with demonstrating that they are a ‘socially- and

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

16

Anxiety, Online Fora and This Study

linguistically-informed human analyst’ (Baker et al., 2019, p. 224) in order to ‘address the subtler ways in which meaning is created’ (Baker et al., 2019, p. 223). Accordingly, McDonald and Woodward-Kron (2016) augmented their corpus-based investigation of online support groups concerned with bipolar disorder with systemic functional linguistics (SFL) as a theoretical framework, focusing on interpersonal and experiential meanings in their investigation of member roles and identities in the forum. Following Harvey’s (2012) observations of the formulations I am depressed and I have depression, McDonald and Woodward-Kron (2016, p. 169) use this framework to articulate their observations of how members of the bipolar disorder support forum foregrounded possession of the disorder (I have bipolar disorder) over an intensive attributive construction (I am bipolar). They explain that the process of ownership conveys a degree of control over their possessed condition (McDonald and Woodward-Kron, 2016). In the documentation of socially relevant themes, researchers might also draw on other approaches germane to the social sciences, such as content analysis, in order to bring together observations of comparable linguistic features. For example, Hunt and Brookes (2020, p. 88) explain their categorisation of keywords derived from a corpus of posts to a forum concerned with anorexia into themes that represent ‘central areas of meaning that characterize the forum users’ discussions of anorexia’. As a result, Hunt and Brookes (2020) are able to account for a larger proportion of their keyword list than would be possible if they simply took each word in turn, which are collated around themes such as ‘recovery’, ‘feelings and emotional responses’ and ‘forum-related’ aspects. We similarly set out not to simply describe the formal, linguistic features of the data but to consider how the language features identified through procedures of corpus analysis reflect more meaningful aspects of the lived experiences of the users of the forum. Thus, utilising corpus linguistics in combination with other (qualitative) approaches has afforded insights that direct us to larger patterns but also the local, contextualised usage of important terms, text composition and interpersonal aspects of the forum. Our approach therefore combines the computational identification of frequent and salient patterns via corpus linguistics with a close reading of text that takes into consideration context, via discourse analysis. Such a combination is sometimes referred to under the paradigm Corpus-Assisted Discourse Studies (CADS), as described by Partington et al. (2013). One aim of CADS is to avoid carrying out a politically motivated analysis (Partington et al., 2013, p. 339), such as those sometimes associated with Critical Discourse Studies (CDS), which characteristically focuses on cases of manipulative language and

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Online Forums

17

abuse of power. For the research in this book, while we largely align with the methodological techniques associated with CADS, we also feel that at times it is worth viewing the data through a more critical lens, especially if it articulates a discourse that might be seen to be impeding someone’s recovery; for example, that men should not talk about their feelings because it is seen as unmanly.

Online Forums In our review of the literature on applications of (corpus) linguistic approaches to experiences of healthcare, we have shown that online forums are one of many sites in which we can investigate discussions of health conditions and representations of those experiencing illness. Internet forums have emerged as a venue for individuals to come together, share experiences and provide mutual support (Eysenbach et al., 2004). They are often the first port of call when health issues emerge (Fox and Duggan, 2013), since they are typically free and devoted to specific health topics. Furthermore, from a psychological perspective, there is value in knowing that others have comparable experiences. Joinson (2003) describes a process of social comparison that is directed both downwards – whereby self-esteem derives from knowing that others are worse off than you – and upwards – in finding that there are others who can guide you. Indeed, the reported benefits of online support forums are typically characterised in terms of information and emotional support (Yip, 2020). Furthermore, online spaces may offer something that is not available to individuals in their offline world. The accessibility of online resources can mitigate the spatial, temporal and other institutional barriers of offline healthcare services. In addition, users of online forums have reported feeling more comfortable discussing sensitive and personal issues, particularly those subject to stigmatisation, in the relative anonymity afforded by the online context (Webb et al., 2008). This has been shown to be of particular importance in terms of engaging younger people in healthcare services, offering ‘a secure platform from which to ask awkward, sensitive or detailed questions without the fear of being judged or stigmatized’ (Harvey, 2012, p. 351). Forums are not the only type of online peer support available and researchers have also investigated how individuals with serious mental illness use social media to share their experiences and seek advice. The reported benefits, in relation to the various kinds of online peer support, include greater social connectedness, feelings of group belonging, gaining insights into important healthcare decisions that can promote healthcare-seeking behaviours and promotion of

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

18

Anxiety, Online Fora and This Study

treatment engagement (Naslund et al., 2016). Eysenbach et al. (2004, p. 5) have remarked that ‘virtual communities are in fact the single most important aspect of the web with the biggest impact on health outcomes’. The potential risks of online spaces, particularly if they are not moderated and/or do not involve quality information from health professionals, can include misleading information, hostile or derogatory comments from others and creating feelings of more uncertain about one’s mental health condition. However, Naslund et al. (2016) conclude that based on the evidence, the benefits of online peer-to-peer support outweigh the potential risks and they play an important role in motivating untreated and undiagnosed community members to seek professional help (Powell et al., 2003). Indeed, McDonald and Woodward-Kron (2016) observe that advice provided by veteran members to newcomers is often aligned with mainstream biomedical norms and research has shown that rather than operating in conflict with professional health advice, participation in online forums has led to users feeling better informed, having more confidence in their relationship with their physician, with better knowledge of the treatment options available, and gaining a greater sense of optimism about their prognosis (van Uden-Kraan et al., 2008). For the purposes of research, online support forums provide a readily accessible platform for text-based data that is, to a large extent, unmoderated by health professionals. They thereby provide the opportunity for us to investigate naturalistic, unsolicited language that principally conveys lay descriptions of, in our case, anxiety disorders. The influence of media and institutionalised discourse are, nevertheless, relevant in these accounts and Kinloch and Jaworska (2020) show that members of a forum related to postnatal depression (PND) draw on biomedical perspectives of PND. While there are criticisms of the reductionist portrayal of depression as a biological condition independent of cultural and social factors, the authors argue that it can help people ‘recognize PND as a real illness in need of treatment and potentially encourage them to seek medical attention’ (Kinloch and Jaworska, 2020, p. 95). This shows that any given discourse can have value in some instances and limitations in another, demonstrating that such discourses can be resources used to various effects. Furthermore, Schofield et al. (2020) show that the various discourses around anxiety disorders directly influence perceptions, contributing to the degree of ‘blame’, self-efficacy and, ultimately, stigma, associated with those who experience social anxiety disorder (SAD). Given that online forums are purportedly valued largely in terms of the informational and emotional support they offer, of key interest to us as researchers of health discourses are the ways in which members

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

HealthUnlocked: the Anxiety Support Forum

19

of the forum interact with one another and how they influence each other’s language when discussing experiences of anxiety. Kouper (2010) has shown not only that advice exchange is common among members of an online (motherhood) community but also that messages that solicit and provide advice have distinctive structural and pragmatic features. These often extend into longer units of language that follow a conventional story-telling structure (Lindholm, 2017). We can also observe how particular members assume certain identities, which may evolve over the course of their participation in the forum as their knowledge is established and their need for guidance from others diminishes. Indeed, Sillence (2010) identified a set of users within a cancer support group who collectively conveyed advicegiving as one of their key functions and had developed mechanisms for portraying their competence and trustworthiness. In addition to providing information and offering empathy, more established members also have a role to play in determining the conventions for how messages are formulated in the forum. McDonald and WoodwardKron (2016), for example, have demonstrated through lexicogrammatical and discourse-semantic choices how new members of a bipolar disorder online support group are socialised into health discourses (i.e., by ‘senior’ members), thus establishing what it means to communicate as a senior member as well as moderating the wider communicative practices of the forum. Ultimately, as Brookes (2020, p. 46) argues, there is clear value in analysing the representations of health illness that members of online support forums provide through their posts because they are ‘consumed, reproduced and challenged by other members of the support groups under study, and so have the potential to shape those other members’ own understandings and experiences of this health issue’.

HealthUnlocked: the Anxiety Support Forum The data analysed in this book comes from an online support forum, collected over a period of approximately nine years. The website that hosts the forum is managed by HealthUnlocked, a private company that: aims to transform individual health experiences into support, insight and understanding for others. We do this by enabling people to share personal health experiences and information online using our site (“Our Site”). In turn this provides support, aids self-management, and improves interactions with professionals, with the aim of improving day-to-day health and wellbeing. (https://support.healthunlocked.com/article/148-privacy)

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

20

Anxiety, Online Fora and This Study

The site hosts over 300 ‘communities’: distinct forums that are characterised by their focus on a particular health concern. Our data comes from one of these ‘communities’ labelled Anxiety Support, which is the largest of the communities explicitly marked as focusing on anxiety disorders.3 When members register for HealthUnlocked they are asked whether they are happy for their contributions to be used for research purposes. Thus, the data we obtained with permission from HealthUnlocked only comprises posts made by members who consented for their contributions to be used. Posters make use of usernames such as Charles365 rather than their real names. The data given to us by HealthUnlocked have been run through an automatic system to identify names and anonymise them, although this was not 100% effective and we have redacted names which were not anonymised along with any other identifying information, including usernames, when quoting any forum posts. The corpus comprises 294,082 comments from the period 20 March 2012 to 14 September 2020, which represents approximately 21 million words. There are 17,770 different contributors posting messages to the forum, who identify as being from 141 different countries around the world. The size of the dataset demonstrates how an approach supported by computer processes is suitable for attempting to account for so many posts and the coverage allows us to investigate longitudinal aspects of the dynamics of the forum and to explore different subsets of contributors according to characteristics such as age, gender and nationality. Much like many other online forums, members of the Anxiety Support forum can post messages either in response to contributions made by other members, or by initiating a new discussion thread. Messages are then presented as a chronological sequence of responses. The messages on the Anxiety Support forum are largely text-based, although they do include emoji and users can also post images and image macros overlain with text, which were removed from the data transferred to us. For the kinds of corpus procedures we have described earlier, the data needs to be machine-readable (McEnery and Hardie, 2012) and the inclusion of image content would necessitate a form of annotation to document salient features of the images in text. While researchers have demonstrated how a coding scheme can be applied to document information about images in a multimodal corpus analysis, such as Bednarek and Caple’s (2017) investigation of newsworthiness in news texts, there is no standard form of annotation 3

HealthUnlocked also hosts an Anxiety and Depression Support forum and a Living with Anxiety forum.

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

HealthUnlocked: the Anxiety Support Forum

21

that can readily be applied across datasets and which can capture the multitudinous variety of what can be represented in graphical format, which is particularly difficult when we consider both the denotative elements (what can be described as literally represented) and the connotative elements (the interpretation of what is represented). Furthermore, for us to have incorporated a record of such images, we would have had to have access to them and to evaluate and code them. This was not available to us, so while these are a feature of the forum, they do not appear in the data and, subsequently, our analysis. Hunt and Brookes (2020, p. 70) discuss the loss of graphicon material in their construction of a corpora based on online forums concerned with eating disorders and determine that this material performed ‘a largely supplementary function to the linguistic exchange of information in the fora, often repeating visually what is explicit in the adjacent text rather than conveying new information’. They also acknowledge that graphicons more evidently relate to the negotiation of interpersonal relationships online, which was not a research priority for their work (Hunt and Brookes, 2020) and Zappavigna (2012, p. 101) similarly states that memes ‘are deployed for social bonding rather than for sharing information’. These interpersonal functions are relevant to our exploration of the Anxiety Support forum, however, they were not available to us once the data was converted to text by HealthUnlocked. What we can comment on, however, are modifications to orthography that similarly operate in interpersonal ways, such as abbreviations (lol), elongation (thaaaanks) and vocal spellings (wot). With a dataset involving participants from a range of countries, we can also expect orthographic inconsistency as a result of different spelling conventions (e.g., humor/humour). This has implications for the automated word counts that are the basis for many corpus analysis procedures and there are tools that have been developed to navigate spelling variations according to historical or social norms. The Variant Detector (VARD) software tool, for example, was developed as a pre-processing tool to regularise variant spellings in a corpus prior to other linguistic processing (Baron and Rayson, 2008). The tool enables the researcher to collate and count these variants, while also allowing them to view and, thereby, study those variations. Nevertheless, with a corpus of approximately 21 million words, manual processing of candidate variants would still be required to account for all the possible variations. In a sense, people who do not spell words correctly are likely to have their contributions downplayed in the analysis. So a concordance analysis of how people use the word anxiety (which occurred 147,850 times) will miss the 144 cases of

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

22

Anxiety, Online Fora and This Study

anxity, 59 instances of anxioty and 40 cases of anxiey in the corpus. On reflection, we have not corrected mistakes as the amount of spelling variation was quite small and does not impact on the typicality of patterns that were found. The Anxiety Support forum is facilitated by the USA-based men’s cancer survivor support charity Malecare and its executive director serves as a moderator for the forum. Among its community guidelines, the Anxiety Support forum states that it ‘is not a substitute for 1-to-1 medical consultations or acute care’ (https://healthunlocked.com/anx ietysupport/about), echoing HealthUnlocked’s own policy that any content on the site is ‘never a substitute for professional medical advice’, that members should ‘always speak to a doctor or other health practitioner about your condition and/or treatment or changes to your condition and/or treatment’ and, ultimately, ‘Never delay seeking advice or dialling emergency services because of something that you have read on Our Site’ (https://support.healthunlocked.com/article/1 47-terms). A similar message is pinned alongside the discussion threads in which members take part. The community guidelines also model how members should formulate their messages, such as using ‘For me, this worked’ rather than ‘You should do this’ (https://healthunlocked.com/anxietysupport/ab out). This shows that community moderators recognise the significance of language used to proffer advice with varying degrees of directness, which we will be discussing in our own work. It also shows that alongside concerns for the quality of health information exchanged on the site, moderators are concerned with the communicative style adopted by users in their exchanges. Ordinary members also have the capacity to moderate the content that they see. In addition to replying to messages, users can ‘Like’ a post, save it to create a personal archive, or report it if they feel it is in breach of the community standards. It is the responsibility of the community moderators to deal with reported posts, although the HealthUnlocked team also manage posts that do not conform to their Terms of Service. Though we are not privy to the messages that have been removed – nor can we know how many that is – the functions for reporting, the establishing of community standards and the roles of moderators remind us that online support forums are policed by various stakeholders and that this can have implications for the content that we, and users of the forum, subsequently see. The ‘disinhibition’ of online spaces (Suler, 2004) that facilitates personal disclosures at the same time can encourage users to abandon politeness concerns and the potential for inflammatory or abusive content in such spaces has been documented (Hardaker, 2010).

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

HealthUnlocked: the Anxiety Support Forum

23

When we take this alongside the highly sensitive personal disclosures that arguably constitute the ‘core’ content of a forum concerned with a health issue such as anxiety disorders, there are important ethical concerns to consider when we want to explore this kind of data. Townsend and Wallace (2016) outline four key areas of concern when conducting research online, which we will briefly discuss here: private versus public; anonymity; informed consent; and risk of harm. Online spaces often make it difficult to determine whether content is public or private, and the implication for research is that with private content there is a greater need to inform participants of your work and to get their approval, by way of consent, before you begin. In order to access HealthUnlocked, users sign up and create a profile, which then allows them to access any one of the 300+ communities hosted on the site. Non-members have a very restricted view of content, that is, there is arguably enough of a preview for them to get a sense of how the site operates and what members discuss in order to make the determination whether they will become members. Nevertheless, they cannot view full posts or threads. In this sense, the data are not public. However, as a private company, HealthUnlocked stipulates in its terms of service that it works – and shares its content – with research partners. Our access to the data is the result of such a partnership. The data are anonymised, in order to protect the identities of those who use the site (which they do with a self-assigned username), and members have the capacity to manage their own settings and opt out of datasharing practice. This means that the data as discussed in this work are anonymised and that there are some contributions that are absent, on the basis that some users elected not to consent to their contributions being used for research. One of the concerns expressed by members of an online forum in relation to privacy and research is that the ‘meaning’ of a post is lost when taken out of context (Golder et al., 2017) and this has raised questions about researchers’ capacity to understand the communicative practices and norms of the forum (or other situation) they are observing. In response, researchers have often adopted an observeras-participant role (Mackenzie, 2017), taking an ethnographic approach that involves familiarising themselves with the communicative environment and participating as a member. This supports a more informed, qualitative approach and the types of ‘thick’ description associated with ethnographic research (Geertz, 1973). We do not make any such claims in our analysis of the Anxiety Support forum: our observations come principally from our investigation of this particular dataset as a corpus and we do not purport to have expertise regarding anxiety disorders. Nevertheless, the corpus approach does

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

24

Anxiety, Online Fora and This Study

offer an evidence-base for our observations, in that we report patterns of language use that are determined by their frequency in these data, which does come from individuals with personal experience and lay expertise. With respect to anonymity, the corpus approach also minimises the potential for ‘recoverability’. Since our observations largely come from aggregated data, they are not tied to any particular individual’s words. While we stress the importance of analysing occurrences in context and, subsequently, do reproduce specific examples, we have endeavoured to redact any identifying information that was not already anonymised in the data transfer from HealthUnlocked. Even for those with access to HealthUnlocked (and the Anxiety Support forum, specifically), the search function for posts is not calibrated in a way that it will find exact matches for search phrases, rather it will recover messages that broadly relate to the search terms. This is an advantage for protecting the identities of members, in that any extended quotes from the data in this work are not directly recoverable through the site itself and so contributors can remain anonymous. The scale of the data does present a challenge for the issue of informed consent. HealthUnlocked, for instance, is not in a position to delineate all or any potential research partners in their Terms of Service, so members are faced with an all-or-nothing approach to agreeing to be included in research. Without the specific research project to refer to, participants are also left unaware of what exactly is involved in such research. For corpus linguists, there are practical challenges in providing information to (often) thousands of participants and subsequently collecting informed consent. When it comes to online support forums, decisions regarding informed consent should also be balanced with concerns for the risk of harm (Elgesem, 2015). Posed with a similar challenge, Hunt and Brookes (2020, p. 75) reason that ‘imposing on the fora to request informed consent from a large number of contributors would risk disrupting the fora and undermining their primary role as supportive, recovery-oriented communities, thereby affecting the research participants and wider forum communities in a negative way’. With the measures in place that define membership to the forum, we believe that participants have sufficient control over information about them, which is managed via their own disclosures on the site and the anonymisation measures imposed by HealthUnlocked in making the data available. Participants also have control over what personal information they provide about themselves through their user profile. When they register, members are given the opportunity to pick one of the pre-defined categories for gender (Female, Male, Other) and ethnicity (White/

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

HealthUnlocked: the Anxiety Support Forum

25

Caucasian; Latino/Hispanic; Black/African/Caribbean; South Asian; East Asian; Middle Eastern; Mixed/Multiple ethnic groups; Other ethnic group), select the country where they live from a pre-defined list of options, provide their month and year of birth (from which their age is calculated), as well as provide a short bio. In each case, the member also has the option of leaving the category unselected/incomplete, and in 46.70% of cases, users did not indicate their gender (accounting for 31.54% of posts to the forum). The 26.80% of users who did not list a country of residence provided 17.96% of posts, 55.31% of users did not disclose their age (contributing 44.42% of posts) and 86.78% of users did not disclose their ethnicity (providing 83.64% of posts). Given how this information overlaps, it was only in the case of 25471 (8.66%) posts that the information about the poster was missing in all four categories. Based on the information that was available, we subsequently conducted analyses relating to age, gender and country of residence, but not ethnicity. When members register, they are also assigned a unique, alphanumeric User ID. This allows us to take into account the contributions of individual user profiles and to evaluate the distribution of a linguistic feature of interest, that is, in terms of its use across a number of different participants. However, one thing we must acknowledge is the possibility that an individual can create multiple profiles and this is even mentioned in the content of the forum in a case where one member claims that another user is the person behind a number of profiles that they have been involved in unfriendly interactions with. We, like other members of the forum, do not have the information to determine either the uniqueness of the profile or the veracity of the information relating to age, gender, ethnicity and age. As such, our observations are offered with the caveat that this is information that the user has selected about themselves, rather than making any claims based on any objective reality. One further metadata category that does not require user selection and input is the timestamp for the post, which enables us to investigate patterns in text features comparing year-to-year, or month-to-month for example and this is one of the dimensions we discuss in Chapter 7. The actions taken to facilitate a corpus analysis of the data and to ensure that participants are treated ethically means that we cannot discuss a ‘complete’ experience of the Anxiety Support forum. There are graphical features of posts that have not been recorded in our corpus, some users opted out of inclusion in research, members potentially reported posts which may have subsequently been removed and there is also a direct message function in the forum whereby members can send private messages to each other, which was not included in the

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

26

Anxiety, Online Fora and This Study

data. Nevertheless, we have investigated approximately 21 million words of forum data from over 17,000 participants, with a view to identifying patterns in how members of the Anxiety Support forum describe their experiences of anxiety and how they cultivate a community of peers based on shared experiences. We now offer an overview of the remaining content of this book, demonstrating the different aspects of the forum we have explored in our work.

Overview of the Book In the following chapter, our analysis begins by asking ‘What are the key ways that posters use language to conceptualise anxiety?’ We use the corpus analysis tool Sketch Engine to consider how the term anxiety compares to other conditions by examining how forum posters construct related concepts; for example, depression, fear, stress, panic and worry. We use the same software to provide a detailed Word Sketch of anxiety and its use in the forum, looking at its occurrence in different grammatical patterns. This analysis identified four clines in terms of how anxiety is discursively constructed. In Chapter 3 we delve deeper into forum posters’ descriptions of anxiety by focusing on how they describe their lived experience of anxiety, what they understand causes their anxiety and how they best believe that their anxiety can be resolved. We also consider patient narratives around their anxiety. This chapter provides an overview of the linguistic content of the forum by carrying out a keyness analysis of the online corpus to identify words and phrases that are statistically salient in forum posts. These terms are placed into thematic categories and a representative set is analysed to illustrate different aspects of discussion around anxiety. The analysis in this chapter has a comparative aspect as we compare the language used by people when creating a new topic to post about, as opposed to language which occurs when people reply to an existing topic. New topics often contain introductions, narratives and descriptions of problems and feelings whereas the replies tend to be focused more on giving advice and support. In addition to considering keywords and phrases, the analysis looks at longer recurring phrases, as well as emoji and emoticons. Chapter 4 continues the focus on the interactive and online affordances of the forum by looking at the ways that posters respond to each other’s posts. First, we ask, what kind of language characterises an initial post which receives numerous responses and how does this differ from posts which receive no responses at all. We then introduce a recently conceived framework for coding interactions in terms of

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

Overview of the Book

27

discourse units and apply it to a sample of our forum data, asking what language is typical of each discourse unit type. We then look at how different discourse units are typically combined within a single post and how discourse units work in sequences of responses. So, for example, if someone posts a message which has the function of writing about their feelings, what kinds of messages are they likely to get in response? In Chapter 5 we make use of the demographically tagged nature of the forum posts by comparing and contrasting posts made by participants identifying as female and male, respectively. While 31.20% of posts were made by posters who did not specify their sex, 52.02% were made by posters who identified as female and 16.71% were made by male posters. These figures are congruent with data on prevalence of anxiety by sex, which tends to indicate that women are more likely than men to be diagnosed with anxiety, although we note that these figures probably do not give accurate cases due to the fact that many people do not report anxiety, for various reasons. We examine male and female keywords in the corpus, finding that men are more likely to use problem-solving language that focuses on explanations for anxiety and strategies for resolving it. On the other hand, women are more likely to use affiliative language to express empathy, sympathy and encouragement to others. The chapter also examines gendered discourses relating to anxiety by considering representations around words such as man, woman, macho and feminine. Our analysis finds that men are viewed as having additional problems relating to anxiety due to societal pressures to ‘man up’ and not talk about mental health issues or emotions. Women’s experiences of anxiety are more often linked to relationship problems or experiences of abuse, as well as the burden of caring for families. Chapter 6 continues the theme of demographic variation by comparing posts from the two countries in which the highest proportion of posters identified as residing. Within the forum 72.78% of posts were made by either people based in the UK or the USA. An analysis of keyword differences indicates numerous differences which point not only to spelling (counseling) and lexical choices (brilliant) but also to ways that anxiety is understood. For example, American posters are far more likely to refer to a range of anti-anxiety medications (Lexapro, Klonopin, Xanax), positioning anxiety resolution as a form of consumer choice that that can be managed via the purchase of the right medication. On the other hand, UK key terms are more likely to reference how their anxiety is managed by the National Health Service that advocates various therapies, although this can also result in delays to treatment.

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

28

Anxiety, Online Fora and This Study

Chapter 7 has time as its theme, taking advantage of the fact that our corpus contains posts made over a nine-year period, along with the demographic information we have about patient age. We consider diachronic aspects of the forum in three ways. First, we look at how language has changed over time, focusing on changes in anxiety discourses. For example, there appears to be increasing focus over time on describing the experience of anxiety in terms of how it feels and its effect on the body, along with more references to tests, medication and side effects. On the other hand, posters refer less to other people over time in their posts and use affiliative language less often. Such trends may be linked to the presence or absence of different types of posters at different points, and the analysis in this chapter links back to the findings in Chapters 5 and 6. We then consider how the age of posters impacts on the ways they write about language, dividing the corpus into age-graded sub-sections (e.g., 20s, 30s). We compare linguistic differences across these age groups, seeking to identify how language use reflects different understandings or representations of anxiety in relationship to age. Finally, we consider the ‘journey’ that posters go on, comparing posters at different stages of their relationship to the forum. By collecting people’s first, twentieth, fortieth, sixtieth and final posts we can trace how posting behaviour ‘evolves’ over time – with initial posts often taking the form of narratives and seeking help, while more seasoned posters tend to offer different forms of guidance, taking on the role of ‘expert’. The analysis of the final posts considers the extent to which people provide explanations or offer a sense of narrative ‘closure’ when they leave the group. The concluding chapter of the book summarises the main findings from the preceding chapters, bringing them together to establish overall patterns and trends in online discourses of anxiety. These representations are then related to the contexts in which they are situated as well as their implications for our understanding of mental health in wider society. The chapter also critically reflects on the approach we took, the questions that emerged as a result of engaging with the corpus of forum posts and potential extensions to our study. Although the subject of this book is anxiety, the analysis also acts as an exemplum of how the study of language can be applied to a very practical need, namely the analysis of a large amount of text from an online forum which focuses on a particular topic. Many of the methods that we outline in the book could be used to study language use around other health conditions and even for forum data which do not relate to health, we believe that the techniques we describe, such as concordancing, Word Sketches and keywords, could still be gainfully employed.

https://doi.org/10.1017/9781009250139.002 Published online by Cambridge University Press

2

Sketching Anxiety

Introduction Our analysis begins with a consideration of the word anxiety, which appears in the name of the forum we are examining. It occurs 146,874 times in the corpus and is the 25th most frequent word in it, with the top 24 words all being from closed-class grammatical classes (pronouns such as I, conjunctions such as but, articles such as the and prepositions such as of). Therefore, anxiety is the top lexical word in the corpus. It is also the top keyword when the corpus is compared against the English Web 2020 corpus (a 38 billion-word corpus of internet English collected between 2019 and 2021), a keyword being a word which appears in one corpus statistically significantly more often when compared against a second corpus, often one which acts as a ‘reference’ for general language use. Both intuitively, and statistically then, it makes sense to start with the word anxiety. In some of the later chapters in the book we split the forum into sections in order to compare differences between users based on their sex, location and age. However, in this chapter we consider the whole corpus as a single dataset in order to ask how forum posters represent anxiety through language. We make use of an online corpus tool called Sketch Engine, which can provide summaries of the most typical and distinctive linguistic contexts that a word appears in. For example, Sketch Engine (Kilgarriff et al., 2014) can identify the adjectives that people use to modify anxiety (e.g., in phrases such as ‘I have bad anxiety’), presenting them in order of frequency. This helps us to spot and group together repeated patterns, which enables the identification of more general kinds of representation. We begin the chapter with a discussion of how the meanings of words can be understood through analysis of these kinds of repeated patterns, then take a slight detour from corpus linguistics to consider how anxiety has been defined in medical literature. After that we use Sketch Engine to identify words in the corpus which occur in similar 29

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

30

Sketching Anxiety

contexts, having the closest matching collocates. Some of these words are used in the subsequent analysis sections in order to outline distinctive uses of anxiety. Then, after a more detailed description of the Word Sketch function of Sketch Engine, the bulk of the analysis is concerned with a summary of the findings that were derived from the Word Sketch of anxiety. We identified eight sets of linguistic patterns that were associated with the word, and they suggest different ways that people who use the forum relate to their condition or make sense of it. These conceptualisations work as pairs, in that each one has an oppositional representation, so we discuss them together, giving illustrative examples. Finally, the chapter concludes with a reflection on the potential impacts that these conceptualisations might have.

Meaning by Association We have established in the previous chapter that, as Kinloch and Jaworska (2020, p. 75) assert, ‘paying close attention to language choices and studying their use in discourse produced by lay people can offer deeper insights into the ways in which patients conceptualize, negotiate and navigate the experience of illness’. Moreover, we adopt the view that repeated lexical choices not only constitute the means by which a phenomenon – such as health, illness and, in this case, anxiety – is reified according to various discourses, but also reflect choices that selectively represent an experience, namely that these choices carry implicit assumptions and, thereby, the reality represented is ideologically constructed (Halliday, 2003; Galasin´ski and Ziółkowska, 2020). Understanding the fundamental meaning of words is important when different stakeholders (health professionals, patients, government ministers) can influence the healthcare experience. For example, Galasin´ski and Ziółkowska (2020) investigated contested definitions of the word suicide and critically discuss the ways in which the human actors and the processes involved, as well as intent, are variously marginalised or made central. They stress the importance of standardised terminology for the purposes of diagnosis, risk-assessment and risk-management. Thus, it is important that when patients and health practitioners are discussing – in our case – anxiety, they can be confident that they are referring to essentially the same thing, or they are at least aware of the different understandings. Linguists have long been interested not only in the semantic meaning of words in themselves, but also in the words that are used alongside a chosen term, as a reflection of the habitual or customary uses and associations of that word (Firth, 1968). That is to say, the consistent

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Meaning by Association

31

combination of particular lexical items indicates ‘the associations and connotations they have, and therefore the assumptions which they embody’ (Stubbs, 1996, p. 172). Corpus linguistics is well suited to identifying repeated lexical choices, particularly in that it tends to involve large datasets in which such repetitions can be identified through quick processing and because there is the opportunity for a greater number of examples to be recorded (compared with small-scale manual analysis of a few texts). Furthermore, there are procedures in corpus analysis that have formalised the identification of systematic linguistic representations in more broadly objective and quantifiable ways. The principle of collocation recognises the syntagmatic ‘attraction’ between lexical items (Firth, 1968) and is formally identified in corpus linguistics through statistical measures that indicate which words tend to occur in combination. It involves establishing parameters by which one word is identified as occurring alongside another, such as within a set span (e.g., occurring within five words before or after), with sufficient regularity (a minimum number of times) and distributed across a minimum number of different texts or used by a minimum number of different contributors. Through collocation analysis, researchers have gained insights into the semantic and conceptual associations carried by various healthand illness-related terms. For example, Brookes (2020) investigated online support groups for diabetes and found that words co-occurring with insulin frequently referred to the practice of restricting it: not taking, stopping, skipping and so on, as well as references to weight. Through this analysis, Brookes (2020) was able to highlight the prevalence of discussion relating to diabulimia in the forums, as contributors associated restricting insulin with weight loss, and also a more nuanced picture of how practices of insulin restriction were understood by members of the forum. Brookes (2020) reports that members problematised the straightforward association of insulin with weight gain and challenged the practices of insulin restriction for weight management, citing the associated dangers and risks. Furthermore, Brookes (2020) identified an association between insulin restriction and autonomous diabetes management, which he contextualised within a broader neoliberal model of public health that emphasises individual responsibility. Ultimately, this investigation of talk around insulin on online diabetes support forums revealed some of the overlapping discourses that inform the perspectives that are negotiated in these spaces by those with lived experience. Understanding how these discourses influence self-management practices, particularly with chronic health conditions, is important for navigating issues of

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

32

Sketching Anxiety

compliance with medical advice and avoidance of potentially harmful behaviours. Investigations into collocation have also shown that certain words or phrases frequently co-occur with a range of items that have in common a particular attitudinal meaning (Xiao and McEnery, 2006). For instance, Stubbs (1995) showed that the verb cause typically co-occurs with something that is undesirable, such as trouble or death. The meaning interaction between a search term and its collocates can be described as a semantic prosody, where there is a tendency for collocates to denote a particular attitude or evaluation. Similarly, we might find that the collocates of a word tend to belong to a particular semantic set. Partington (2004), for example, found that maximisers such as utterly, totally and entirely typically have collocates that indicate absence or a change of state (e.g., oblivious, meaningless and destroyed). In these instances, collocates can vary in evaluation (i.e., positive or negative) but they share some semantic feature and this patterning of collocates is referred to as semantic preference. Extending our analysis of linguistic patterning in this way can support us in understanding the finer distinctions between anxiety and related terms, as they are used in the Anxiety Support forum.

The Meaning of Anxiety With respect to ‘anxiety disorders’, the DSM-5 (APA, 2013, p. 189) describes a range of conditions that are collectively characterised by ‘excessive fear and anxiety correlated with behavioural alterations’. The authors distinguish between fear and anxiety as follows: Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ, with fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors, and anxiety more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors. (APA, 2013, p. 189; italics in original)

As the description continues, there are references to distress, worry, panic and various anxiety disorders are alternatively labelled as phobias (e.g., social anxiety disorder is also known as social phobia). Evidently, there are related terms that are used to describe what is fundamentally an emotional response and how this manifests as physical symptoms, such as restlessness, muscle tension and sleep disturbance, as well as avoidance behaviours. Anxiety disorders are

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

The Meaning of Anxiety

33

differentiated not in terms of the emotional or physical experience, but rather the ‘types of objects or situations that induce fear, anxiety, or avoidance behaviour, and the associated cognitive ideation’ (APA, 2013, p. 189). The specification, therefore, of a type of anxiety disorder relies on the identification of the source of the perceived threat. There is, however, the implication that there is a threshold for severity in terms of distinguishing anxiety disorders from a normative fear response and it is the clinician who determines whether the fear or anxiety is ‘excessive’, ‘taking cultural contextual factors into account’ (APA, 2013, p. 189). We are advised that panic attack may be used as a ‘descriptive specifier for any anxiety disorder’, but also that panic attacks function as a marker and prognostic factor for severity of diagnosis ‘across an array of disorders, including, but not limited to the anxiety disorders’ (APA, 2013, p. 190). Furthermore, ‘Each anxiety disorder is diagnosed only when the symptoms are not attributable to the physiological effects of a substance/medication or to another medical condition or are not better explained by another mental disorder’ (APA, 2013, p. 190). The fact that diagnosis requires an assessment of what is ‘excessive’ and that this is contextualised according to individual circumstances and culture demonstrates some of the difficulty with describing experiences of anxiety in a way that denotes pathology and subsequently is treated with the appropriate seriousness and treatment. Brookes (2020) has shown that although diabulimia is not a recognised medical condition according to the DSM-5 (APA, 2013), its existence as a term demonstrates its value to people who experience it and who seek advice about it online.1 The potential for ‘psychologising’ descriptions of emotional experiences is explored by Harvey (2012, p. 372) in a study of adolescents seeking advice through an online health support website, with the finding that adopting a psychologising approach to symptom presentation may serve to legitimise queries to the site and to ‘give form to, and help to make sense of, a set of inexplicably complex and chaotic symptoms’. However, Harvey (2012) warns that contributors appear to overextend a clinical label of depression to experiences that might otherwise be discussed as more normalised feelings of emotional distress and that this absolves them of responsibility for their personal problems. As such, distinguishing those instances that can be managed at the interpersonal level from those that warrant clinical support is partly contingent upon the ways in which those lived experiences are 1

Diabulimia is a portmanteau of the words ‘diabetes’ and ‘bulimia’ and refers to a practice whereby people with type 1 diabetes reduce their insulin intake as a way to control their body weight.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

34

Sketching Anxiety

described. This is all the more significant in the absence of an established medical perspective in terms of the potential for how lay descriptions shape others’ understanding of the experience, as argued by Brookes (2020) with respect to posts made to online diabetes support groups. The description for anxiety disorders in the DSM-5 (APA, 2013) involves various terms relating to fear, distress, panic and so on. In addition to these overlapping emotional states, anxiety disorders are highly comorbid with depressive and bipolar disorders. Survey data collected by the World Health Organization showed that 45.7% of individuals with a lifetime major depressive disorder had a lifetime history of one or more anxiety disorders (Kessler et al., 2015). Similarly, 41.6% of individuals with 12-month major depression also had one or more anxiety disorders over the same period (Kessler et al., 2015). In the DSM-5, depressive disorders include disruptive mood dysregulation, major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, depressive disorder induced by substances/drugs and depressive disorder due to other medical conditions. The common characteristic of these conditions is the presence of sad, empty, or irritable mood, which together with specific cognitive and somatic symptoms leads to significant distress or impairment in functioning (APA, 2013). Research has also shown that across a wide variety of symptoms and disorders, anxiety and depression had bidirectional relationships with one another (Jacobson and Newman, 2017). Anxiety disorders generally precede the presentation of major depressive disorders (Kessler and Wang, 2008) and a European community-based study showed that social phobia was associated with a 5.7-fold increased risk of developing major depressive disorders (Ohayon and Schatzberg, 2010). Dold et al. (2017) found that generalised anxiety disorder (GAD) occurred the most frequently with major depressive disorder (compared with other anxiety disorders), was reported by individuals with the most severe depressive symptoms, and was associated with poorer treatment response. Indeed, Coplan et al. (2015) argue that the treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. This highlights a need to urgently attend to experiences of comorbidity involving anxiety and depression – particularly GAD – in order to improve treatment outcomes for those severely affected by the disorders. In addition, this high rate of comorbidity shows that it can be extremely difficult not only to describe anxiety and depression independently, but also to recognise their co-occurrence. In the

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

The Meaning of Anxiety

35

introduction to the DSM-5 (APA, 2013, p. 6), the authors acknowledge that ‘the boundaries between disorders are more porous than originally perceived’. Thus, it is of interest to explore how those with lived experience of one or more anxiety disorder, with or without an associated depressive disorder, position and describe those experiences in relation to one another. Given the challenges with diagnosing such disorders and understanding how they interact, there is potentially much to be gained from the point of view of those with lived experience, including the ways in which they adopt or negotiate medicalised discourses. A linguistic investigation into semantic meaning can provide insights into the subtle differences in how seemingly related words are used that can bring to light a better understanding of the associations they carry. For example, Halliday (1976) showed that while powerful and strong have similar denotational meanings, they are not always interchangeable; tea is more often described as strong rather than powerful, whereas for cars, the inverse is true. Ultimately, as Xiao and McEnery (2006, p. 108) conclude, ‘synonymous words are not collocationally interchangeable’ and collocation analysis can help us to make visible the differences in the patterns for how they are used. Conversely, collocation analysis can also direct us to nearsynonymous words, on the basis that they tend to occupy a similar syntagmatic position or are used in comparable semantic contexts. The corpus analysis tool Sketch Engine, for example, has a thesaurus function, which draws on the theory of distributional semantics to identify synonyms on the basis that they share similar collocates. It generates a list of lexical items, ranked according to the largest proportion of shared collocates. For instance, if we refer to the English Web 2020 corpus, the tool identifies the following synonyms for anxiety: depression, worry, fear, emotion, stress, anger, confusion, frustration, grief and illness. Table 2.1 shows their frequency in the English Web 2020 corpus, compared with 1,117,241 instances of anxiety, and the score indicates the proportion of shared collocates. The thesaurus function indicates that there is a high degree of similarity in the words that are used alongside these terms, compared with anxiety. That these terms generally relate to negative emotions is notable, in that it raises questions about the boundaries between ‘ordinary’ feelings and pathology in the ways that Harvey (2012) has discussed in relation to depression. In the Anxiety Support forum, we can anticipate that members would be more focused – compared with a general population – on the diagnosis of anxiety as a recognised disorder. Nevertheless, references to non-pathological feelings of

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

36

Sketching Anxiety

Table 2.1 Synonyms for anxiety derived from the English Web 2020 corpus Rank

Word

Frequency

Score

1 2 3 4 5 6 7 8 9 10

depression worry fear emotion stress anger confusion frustration grief illness

1,163,138 493,552 2,706,374 1,432,641 2,068,069 838,846 828,180 515,293 404,644 1,477,071

0.472 0.449 0.438 0.415 0.414 0.412 0.411 0.407 0.393 0.391

anxiety are of relevance, particularly if contributors are critically discussing the criteria and thresholds for diagnosis. So while the analysis in the following sections focuses on the term anxiety, the Sketch Engine thesaurus provides a set of related terms that we can also explore in order to home in on the language uses that make anxiety distinctive, compared with its closest relations. What we set out to investigate is the distinctions in how anxiety and related terms are used in the more specialised collection of texts from the Anxiety Support forum and, ultimately, how the words used alongside these terms direct us to differences in associations that give us a better understanding of what these terms mean for people with experiences of anxiety disorders.

Word Sketch Our collocational analysis was supported by the Word Sketch function in Sketch Engine (Kilgarriff et al., 2014). Word Sketch identifies words which commonly occur with the search term, according to particular grammatical relationships. These grammatical relations support us in determining how something is defined, how it relates to other objects and people and how it is involved in various actions. For example, when searching for a noun such as table, typical formulations might include modifiers of table (dining, picnic, coffee), nouns modified by table (tennis, top, lamp, cloth), verbs with table as object (turn, book, set, reserve) and verbs with table as subject (list, summarise, show, contain). These examples of verb patterns show that when table

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

37

operates as the grammatical object, it is more likely to relate to meals (booking and setting), but when it is the subject, it is more likely to be a way of presenting information in a document (summarising and containing). The Word Sketch is performed at the level of lemma, which means that it incorporates all the inflected forms of a word; that is, a search for the lemma of the verb catch would also include catches, catching and caught. This also means that anxiety and depression as nouns are distinct from the adjectives anxious and depressed as well as the verb form; for example, ‘it depresses me’. Associated words are identified and ranked according to a statistical measure of logDice, which like most association measures for collocation, indicates the typicality of a combination of words (the search term and the collocate), relative to the frequency of the search term in the data. Since it operates on a standardised scale (0–14), logDice allows us to assess the strength of collocation according to a theoretical maximum (Rychlý, 2008; Gablasova et al., 2017). We applied a minimum logDice score of 3.8 and a minimum frequency threshold of ten occurrences in order to focus on a manageable set of collocates that we could explore manually and that would provide sufficient data to investigate the uses of anxiety and related terms. Researchers have applied the Word Sketch tool to investigate representations of various groups of people and phenomena in order to uncover ideological aspects of the use of particular labelling terms. For example, Pearce (2008) explored the lemmas man and woman in a corpus of general British English and found that collocates of man not only highlighted physical power and labour (able-bodied, stocky, dig, haul, build, conquer) but also crime and deviancy (armed, convicted, assault, fight, burgle). Woman, on the other hand, was often the grammatical object of those actions (of men), possessing dependency, inferiority and subordination, for example, as well as defined in terms of marital/reproductive status and sexual orientation (celibate, married, heterosexual). Similarly, Baker et al. (2013) performed a Word Sketch of Muslim in the UK press and found that representations frequently denoted conflict (extremist, terrorist, fundamentalist) as well as referring to different ways of categorising Muslim people according to aspects of religion (cleric, faith, preacher), culture (dress, teaching, attitude) and as a national entity (population, state, leader). In an investigation of representations of mental illness in the UK press, Price (2022, p. 134) pursued the Word Sketch identification of the syntactic frame ‘[mental health and]’ and found a prevalence of the term well(-)being. Price (2022) argues that the prevalence of wellbeing is necessitated by the tendency to discuss mental health in terms

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

38

Sketching Anxiety

of problems, that is, that referring to mental health is, in itself, not sufficient to denote wellness. Price’s (2022) collocation analysis shows that references to mental health in this study of the UK press typically involve problems, conditions and issues, indicating that mental health more often refers – paradoxically – to mental illness. The Word Sketch supports a more sophisticated picture of collocational patterns than merely considering pairs of words together and through these grammatical relations, we can more readily see how one lexical option is systematically preferred over another in the same syntagmatic position; for example, ‘people suffer with mental illness’, compared with ‘people experience mental illness’ (Price, 2022). Even though the Word Sketch organises collocates according to these grammatical relations, researchers are still often confronted with a large number of results to explore. As such, it is common for analysts to manually categorise collocates (typically, those that function in the same formulation, i.e., modifiers of the search term) according to relevant topics. This helps researchers to incorporate a greater number of collocates into their analysis, in pursuit of the principle of ‘total accountability’ (McEnery and Hardie, 2012) whereby we offer a comprehensive account of the different representations captured in the corpus. Kinloch and Jaworska (2020, p. 85), for example, categorised the collocate terms of postnatal depression (PND) according to the themes Experience (suffer, have, get, experience), Identification (diagnose), Management (help), Medical label/descriptor (severe, depression, bad), Individual/social actor (woman, I, who), Explanation (cause, if, might) and Grammatical (with, after, from), which allowed them to report ‘dominant discourses’ around PND in their data (Kinloch and Jaworska, 2020, p. 81). From our analysis we identified eight ways that forum posters characterised anxiety as a concept, particularly in terms of how it related to their own experience. These eight ways can be considered as four pairs, with each one having an oppositional representation. However, there are also overlaps between some of the representations, and in the following section we have tried to minimise discussion where this occurs, to avoid repetition.

Medicalising The most common representation we found was one which viewed anxiety through a medicalising lens. Conrad (2007) describes medicalisation as the process of taking what have been previously seen as nonmedical problems and converting them into illnesses and disorders. Good (1994) has noted how adherence to faith-based religion began to

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

39

give way to evidence-based science, which was underway in Europe during the Reformation period of the sixteenth century and became increasingly dominant during the Enlightenment period of the seventeenth and eighteenth centuries. Bourke (2005) points out that in earlier times, priests would have been more commonly consulted for anxiety, whereas in contemporary times, it is family doctors who are sought. Littlewood (2002, p. 1) has suggested that in Western countries, distress has been medicalised, seen as coming from outside with a cause, pattern and possible cure. Medicalisation can be viewed as related to power; for example, Showalter (1987) has discussed how women who wanted to divorce their husbands or campaign for the vote were sometimes diagnosed with ‘hysteria’ which classed them as in need of medical control. The medical model is perhaps the most frequently used way of representing anxiety in the forum, indicating how it is widely accepted as a ‘common-sense’ or taken-for-granted way of understanding the concept. A key example of the medicalisation of anxiety is in the form of the word itself. Anxiety is a singular common noun (the plural form anxieties is much less common in the forum, occurring only 843 times). However, there is a related adjectival form, anxious, which occurs 18,217 times, being eight times less frequent that anxiety. To describe oneself as anxious is to imply a non-medicalised state, similar to possessing a (usually non-constant) trait such as being happy, afraid, grateful, proud and delighted – words which strongly collocate with I am in the English Web 2020 corpus. Anxious is therefore akin to a feeling, while anxiety is more suggestive of a long-term state. Table 2.2 shows the different patterns around anxiety which were suggestive of a medicalising representation. By, far, the most common linguistic indication of the medicalising representation of anxiety in the forum is through the phrase have anxiety, which occurred 10,309 times. Have usually precedes a past tense verb (e.g., I have walked) but it can also precede a noun phrase to denote possession or a state of being (e.g., I have mixed feelings). In the English Web 2020 corpus have precedes medical conditions such as diabetes, AIDS, flu and toothache, which thus positions anxiety in a similar way. When you have anxiety my doctor told me your senses heighten.

One phrasing involves the preposition with; for example, being diagnosed with anxiety or describing someone as a person or patient with anxiety. The language surrounding the latter cases echoes wordings that have been used to describe other conditions in a responsive way. For example, Dilmitis et al. (2012) have argued that language should

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Anxiety Treatments

Anxiety Condition

VERB with anxiety VERB from anxiety NOUN with anxiety

Anxiety Patient anxiety is (a/an) NOUN VERB anxiety

Anxiety NOUN

disorder (2913), state (153), episode (94), condition (56), diagnosis (28), illness (23), bout (15), relapse (13) website (34), centre (76), workbook (26), clinic (24), therapist (22), doctor (21), app (18), video (13), class (12), med (383), medication (313), medicine (69), pill (65), tablet (55), drug (37), management (54), treatment (31), relief (30), control (26), program (24), help (24), technique (15) sufferer (700), patient (30), brain (15), mind (13), hormone (11) illness (76), condition (32), disorder (25), disease (18), side effect (11) have (10309), suffer (673), manage (357), treat (239), cure (108), diagnose (49), heal (18) diagnose (422), suffer (1753) suffer (2529) people (488), person (40), patient (24), sick (28), ill (27)

Table 2.2 Medicalising representation of anxiety

Word Sketch

41

put people first rather than an illness or condition. They argue that ‘people living with HIV’ should be used as opposed to ‘infected people’, which puts the virus first. Similarly, Lynn (2017) argues that language such as AIDS patients or HIV positive women stigmatises and dehumanises people, reducing them to a diagnosis. This peoplefirst use of language also occurs in the Anxiety Support forum. People with anxiety should not be treated differently.

However, in the forum there are more cases where people-first language is not used; for example, anxiety sufferer, anxiety patient. The following excerpt is an interesting example of medicalisation as the poster claims that anxiety is not understood by the medical community, thus implying that there is not enough medicalisation of anxiety. The problem is we have became doctors by choice because the medical community can’t come to grip’s with what we as anxiety patients go through until it happens to them??

Anxiety is also frequently followed by words which characterise it as a medical phenomenon. One collocate that might have been expected to occur is clinical, which we found as a collocate of depression in the forum (70 cases), however, the phrase clinical anxiety never occurred in the forum. Instead, the most common medicalising phrase was anxiety disorder (2,913 cases) with less frequent references to anxiety diagnosis (28), anxiety relapse (13), anxiety condition (56), anxiety episode (94) and anxiety bout (15). Anxiety disorder is the most frequent due to its appearance in two named anxiety-related disorders which appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): generalised anxiety disorder and social anxiety disorder. Hello all I’m new to this group and I was just recently diagnosed with generalized anxiety disorder and depression.

People in the forum also label anxiety as a medical condition; for example, using the phrasing anxiety is a/an . . . illness (63), condition (32), disorder (25) or disease (11). Anxiety is a true disorder and shouldn’t be dismissed. You must learn to live with a chronic and debilitating disease just as one does with MS or Hepatitis or AIDS because anxiety is a chronic debilitating disease.

There are smaller numbers of cases where people argue the opposite; for example, in seven cases people argue that anxiety is not a disease.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

42

Sketching Anxiety Anxiety is not a disease, may be an illness at best (nervous illness) but not a disease. Anxiety is not a disease but rather a sympton(s). Anxiety is not a disease. It’s a disorder inflicted, unwittingly, by the sufferer themselves.

However, these cases which reject the representation of anxiety as a disease still refer to a medicalising discourse in that they instead view anxiety as an illness, symptom or disorder. Similarly, people who argue that anxiety is not an illness, often simply use a different medicalising term rather than rejecting the medicalising discourse. Anxiety is NOT a mental illness, it is a physical disease. One thing keep in your mind that Anxiety is not an illness, it is a condition.

If anxiety is viewed as some sort of medical condition, then an accompanying set of representations view it as something that can be diagnosed, treated, managed or even cured or healed. Posters tend to use treat and manage to advocate medication or therapy as options. Propanolol is a very good medication for treating anxiety. Many manage anxiety without drugs, it depends on which way is suitable for each person.

However, cure tends to be used in a more complex way; about half of the time posters believe they can be cured or claimed to have been cured, while the other half argue that a cure is not possible. As I said earlier, acceptance of the symptoms you dislike (fear) so much will cure anxiety. Unfortunately propranolol can’t cure anxiety, its merely a tool to help the body reach a state of calm.

Heal is used less frequently than cure and treat and tends to be associated with less well-established treatments. I stumbled on a book that I purchased the other day called ‘Play it away’ by Charlie Hoehn it’s a book on a young man who had really bad anxiety and overcame it by having fun every single day! He healed his own anxiety and depression in weeks!!

Patterns involving noun phrases also indicate the medicalising view that anxiety can be treated in various ways; for example, through pharmacological intervention (anxiety medication), therapy (anxiety therapist) or other forms of support (anxiety website, anxiety class).

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

43

Normalising While the medicalising representation of anxiety is dominant in the forum, there are other ways of framing anxiety that are nonmedicalising, one of which we refer to as normalising. On very rare occasions, posters explicitly reject medicalisation. I love the way they have invented modern medical terms like social anxiety for terms like shyness. Another one is health anxiety instead of hypochondria.

The Word Sketch analysis found that normalisation tended to occur in ways which involve representations around what anxiety is or is not (Table 2.3). This can involve the use of a somewhat informal, colloquial language, where anxiety is (usually) characterised negatively as problematic, but it is labelled in a vague or even dismissive way; for example, a thing, stuff, crap or shit as opposed to being a syndrome, disorder or illness. I have suffered all my life with insomnia even before this anxiety thing. It sure doesn’t take long to get sick of this anxiety crap.

Normalisation also occurs with explicit rejection of terms such as disease or illness, whereby anxiety is instead characterised as a state of mind or learned behaviour. Anxiety is not disease! It is just state of mind!! And remember, anxiety is not an illness, it is learned behaviour, and bad thought processes that you have trained yourself over the years.

Anxiety is also described as part of the human makeup, part of life, or part of everyone, as the following post, where anxiety is represented as an aspect of all humanity. I am accepting that anxiety is part of every single person in this world, it’s part of our make up, part of who we are. If we didn’t have anxiety and worry about certain things we would not be human.

Table 2.3 Normalising representation of anxiety anxiety NOUN anxiety is (a) NOUN anxiety is not (a) NOUN anxiety is (a) ADJECTIVE

thing (140), stuff (40), crap (15), shit (12) part (12), habit (14) disease (4), illness (5), disorder (1) normal (34)

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

44

Sketching Anxiety

Terms such as normal anxiety may appear to be part of the normalising representation but they are used in a slightly more complicated way, with posters making a distinction between normal anxiety and the anxiety that they experience, which they view as not normal, and thus cause for concern. I turn away from anyone who puts the word “just” in front of anxiety. It’s like minimizing it. There’s the normal anxiety that many people feel and then there is chronic ANXIETY they we live with everyday. They are not alike.

Instead, the phrase anxiety is (a) normal, tends to be more typical of normalisation. Anxiety is normal amongst adults, cos there are many pressures to deal with... . .. When you understand that anxiety is a normal human response to a perceived threat that usually isn’t real, it loses it’s power. It is maladaptive behavior that you have developed, for what ever reason, to stressful events.

At times, medicalisation and normalisation can appear to be intertwined. In the following example, a poster describes a treatment plan for anxiety, which suggests a medicalisation model, although the plan advocates normalisation of anxiety. (These details are from Treatment Plans and Interventions for Depression and Anxiety Disorders by X L. X and X X Holland.) There are a few steps you can take that may be helpful and here are some coping statements that might be useful. 1 – Normalize your anxiety: Anxiety is normal. Everyone has anxiety. Anxiety shows that I am alert. Anxiety may be biologically programmed (this may be the “right response at the wrong time”- there is no danger that I have to escape from).

The representation of anxiety as normal is therefore sometimes used strategically, as part of therapeutic programmes that reframe anxiety as a form of biological programming that has gone awry.

Catastrophising The second pair of representations around anxiety on the forum are related to its extent and effect on the person experiencing it. Table 2.4 indicates that many posters describe their anxiety using superlative language (severe, major, extreme, intense, acute, massive, biggest, super, excess), emphasising that their problem is serious. Some

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

45

Table 2.4 Catastrophising representation of anxiety ADJECTIVE anxiety

Strength

severe (1,309), more (793), high (451), extreme (357), much (290), major (159), intense (104), heightened (83), acute (67), extra (59), serious (55), massive (31), further (31), great (29), most (26), strong (26), biggest (19), huge (15), additional (16), heavy (15), deep (15), super (14), excess (13) Length constant (225), chronic (164), daily (61), long term (38), prolonged (17), ongoing (14), everyday (12) Negativity bad (1,347), terrible (252), horrible (241), awful (120), crippling (87), debilitating (63), crazy (41), bloody (38), damn (31), dreaded (29), horrendous (21), horrid (19), dreadful (15), horrific (15), nasty (15) NOUN anxiety attack (2,840), sufferer (700) VERB with anxiety suffer (1,753), struggle (480) VERB from anxiety suffer (2,529) VERB anxiety suffer (673), heighten (95), worsen (57), raise (36), add (33), exacerbate (31), prompt (25), spike (23), hate (196), wish (67), fear (56), blame (37) anxiety VERB kick (246), hit (213), suck (196), ruin (102), attack (91), trigger (78), flare (66), strike (33), kill (33), cripple (28), drain (28), rob (24), push (22), destroy (21), increase (55), worsen (50), magnify (33), rise (29), grow (28), heighten (27), escalate (25), thrive (22)

posters explain that their reason for joining the forum is due to an intensification of their anxiety. Just joined today as have been having severe anxiety for 3 weeks but suffering from it since i was 14

The experience of anxiety is also described as constant (chronic, daily, ongoing, everyday, constant, long-term, prolonged). I am going through constant anxiety, feeling sick every day to the point where I feel like I am going to throw up but I never do Never able to get back to sleep, then spend 2 hrs in a constant state of extreme anxiety

Terms such as constant and perpetual represent anxiety starkly, as never-ending, whereas in the preceding second excerpt, the poster notes how they are never able to get back to sleep.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

46

Sketching Anxiety

Anxiety is also described in strongly negative terms (bad, terrible, horrible, awful, crippling, debilitating, horrendous, horrid, dreadful, horrific, nasty). Posters describe how they are unable to leave their home or bed due to crippling anxiety, which suggests that the term is not always used metaphorically. One aspect of this representation which is metaphorical though is the use of descriptors such as high, heightened, sky-high, gone up and through the roof which position worsening anxiety as ascending. The problem is now my anxiety is sky high and I am struggling to cope.

This metaphor can be contrasted with McMullen and Conway’s (2002) categorisation of representations of depression, which involve darkness (‘like a black cloud’), weight (‘weighing me down’), captor (‘I feel trapped’) and descent (‘I feel down’). Similarly, Charteris-Black (2012) has also noted that depression can be characterised in terms of containment and restraint (‘in a pit’, ‘pour out’), while Semino (2008) reports that the metaphorical domains most used by people talking about depression were ‘up/ down’, ‘enclosed space’, ‘journey’ and depression as a ‘physical entity’. Across these studies, the metaphorical framing of depression as descent is typically the most common. Thus, anxiety is a metaphorical opposite of depression, in that the worse it is, the more likely it will be represented as moving upwards. Another way of representing anxiety as extremely bad is by using the term anxiety attack. Attack is a nominalisation of the verb process to attack, which indicates that anxiety is represented as attacking the person who experiences anxiety. Other types of attack in the corpus include panic attack (15,879 occurrences), heart attack (3,896) and asthma attack (72). Within the English Web 2020, heart and panic attacks are also relatively frequent, although other forms of attacks imply an external attack, carried out by others; for example, terrorist, cyber, bomb, rocket, air, enemy, nuclear, drone, phishing, ransomware, chemical. The prosody of attack therefore implies that anxiety is akin to a separate force, attacking an individual. just came off a 10hour flight a few hours ago, had an anxiety attack on and off the whole journey causing back and chest pains, feel extremely light headed almost as im unreal

The term is used uncritically, although one poster questions the usefulness of the term panic attack. I think the term panic attack is not very accurate either. The very mention of the word can also send some people into a tailspin when

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

47

in a sensitised state. I prefer to call them energy surges because that is all that is happening.

Posters also describe hating anxiety or write that they wouldn’t wish it on anyone else, as a way of emphasising how terrible their experience is. I can’t deal with this no more feeling like I can’t breathe I hate this anxiety it’s ruined my life!!!!!!! Nobody in their right minds would want this. I dont wish this evil anxiety on my worst enemy!! But if people could just feel what this is like for 1 hour or feel just one panic attack they would never doubt us ever again.

The word form suffer occurs in various constructions; for example, suffer from anxiety, suffer/struggle with anxiety, suffer anxiety, and additional posters describe themselves and others as anxiety sufferers. Hey guys I been suffering from anxiety for ever it has taken things I love in my life things I can’t do now at 43

Compared to other ways of describing anxiety (I have anxiety, I have been experiencing anxiety, I feel anxious), the verbs suffer and struggle place emphasis more firmly on negative aspects. Of the words we examined related to anxiety (see Table 2.1), only illness tends to also occur with verb forms of suffer. In contrast, the terms anger, confusion, frustration and grief, indicating feelings and emotion, were not ‘suffered’ and, thereby, did not carry the same associations of illness, suggesting that suffer also indicates a medicalising representation as well as a catastrophising one. Finally, anxiety is also characterised as carrying out actions which aim to hurt or diminish the person who has anxiety: ruin, strike, cripple, drain. These constructions are discussed in more detail in the following sections, which consider the anthropomorphising representation of anxiety. Catastrophising stems from a perception that a situation is worse than it is or will result in much worse consequences. Chan et al. (2015) found that catastrophising was a positive predictor of anxiety among adolescents. Some representations of anxiety may not be viewed necessarily as helpful in terms of decreasing symptoms, while others may be helpful for some people but not others. However, there seems to be more general acceptance among health practitioners that catastrophising exacerbates anxiety, resulting in increased suffering. It is important to emphasise that the kinds of language use described here are not cases of people with anxiety exaggerating or lying about how they feel – one characteristic of catastrophising is a lack of awareness that it is happening. It is also not the case that every case of language use

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

48

Sketching Anxiety

associated with Table 2.4 should be seen as unhelpful. For example, a claim such as ‘My anxiety has become worse over the last six months’ is useful in terms of understanding someone’s history of anxiety. However, the potential negative effect of representing anxiety as negative and through the use of the more hyperbolic uses of language in Table 2.4 is worth taking into consideration.

Minimising In contrast, another representation of anxiety attempts to minimise its effects (Table 2.5).

Table 2.5 Minimising representation of anxiety ADJECTIVE anxiety

anxiety is ADJECTIVE anxiety is not ADJECTIVE anxiety VERB

less (85), mild (84), little (84), low (34), slight (25), bit (16), moderate (13), good old (18), just (390), only (81), plain (16), same (78), old (66), classic (63), usual (22), typical (21), common (20), stupid (63) manageable (18), common (54), mild (13) harmful (2), bad (33), life threatening (6)

play (363), tell (167), act (72), talk (71), trick (46), mess (39), say (54), scare (29), bother (25), exaggerate (23), convince (21) VERB anxiety help (601), overcome (443), accept (447), understand (440), control (405), manage (357), fight (316), reduce (303), treat (239), ease (170), beat (166), stop (151), calm (135), handle (126), relieve (113), cure (108), battle (80), lessen (72), take (194), address (68), face (69), conquer (60), tackle (51), end (50), combat (48), eliminate (48), lower (48), leave (42), avoid (33), ignore (33), alleviate (32), attack (32), shake (32), fix (30), improve (30), turn (30), challenge (24), decrease (24), forget (24), defeat (20), prevent (20), resolve (17), embrace (17), remove (17), suppress (14), deal (14), explain, (74), see (114), find (109), notice (65), describe (34) VERB with anxiety deal (1,298), live (329), cope (328) VERB from anxiety recover (186) ADJECTIVE from free (65) anxiety NOUN from recovery (60), relief (58), freedom (22) anxiety

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

49

This can be done through adjectives which characterise the amount as low, slight or moderate. Posters describe having a bit of anxiety, a little anxiety, or less anxiety than that which they had previously experienced. These kinds of representations are often used by posters who are responding to other people’s posts, as a form of support. Hi Im so glad you having a good time and finding things to ignore those little anxiety niggles

Rather than focusing on the amount of anxiety, some posters attempt to minimise its importance, referring to it as just anxiety or only anxiety. But I have been copeing better just realise its just anxiety When they come try to label them as “just anxiety” and do deep breathing exercises

Another set of descriptors classify anxiety as something that is recognisable (classic, common, typical) and thus manageable, as opposed to something unknown and untreatable. Again, this is classic anxiety – misleading and fooling us into thinking we have serious illness You’re in the right place, it sounds like you’re having typical anxiety

The following post is an excerpt from a response to another poster who has asked the forum about whether their experience of their heart racing should be checked out. The poster responds in a somewhat chiding way, positioning their initial poster’s experience as ‘just the same old anxiety’. By characterising it as something familiar, the poster attempts to minimise its effect. It’s not fair to sound the alarm with other people and to post questions about your heart when it’s just the same old anxiety that you choose to do nothing about. You need to remain silent every time your heart acts up like it has, no posting for help, no describing it and making people think you’re having a heart attack, nothing.

Another way of minimising anxiety is to refer to it as irrational and therefore not needing to be taken seriously (e.g., stupid or crazy). Remember it’s just stupid anxiety and it will not harm us I also have an anxiety med I only take about 3–4 times a year when crazy anxiety raises it’s ugly head – to nip it in the bud and remind myself I am in charge.

A less frequent representation in this category is to characterise anxiety as something that is not negative.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

50

Sketching Anxiety Do not think about your anxiety do not think about your issues instead embrace them. I have come to face the fact that anxiety is not a bad thing at all.

Other forms of this representation involve noting how it attempts to trick people into taking it seriously or characterising it as a paper tiger, a term which is a literal translation of the Chinese phrase zhilaohu. Mao Zedong, Chairman of the Chinese Communist Party, regularly used the phrase to dismiss American imperialism in the 1940s and 1950s. Hi lovely, what you are feeling is adrenaline and anxiety tricking you into thinking these things. However we have to be brave and expose anxiety for the paper tiger that it is by trying not to be afraid of our symptoms.

Additionally, rather than characterising one’s experience of anxiety as involving suffering, there is focus on dealing with, overcoming, accepting, reducing, coping with, living with, recovering from or managing anxiety. There are important differences here – recovery suggests a complete cessation of symptoms while management indicates that anxiety is not cured or resolved but that it can be controlled. However, all of these verbs are indicative of a mindset which focuses on the possibility that the situation can be improved. I believe that once you recover from anxiety the symptoms such as exaggerated fear of death will pass. After my fear of tablets I went to CBT a therapy and although found it very hard work, I can finally say that learning to manage my anxiety when it flares up I’m now positive about my future

Not all cases of minimisation are evaluated as successful. Some posters write about how their attempts at minimising anxiety can conflict with other thoughts. it really does freak me out keep telling myself its only anxiety but then when it comes i think how can anxiety possibly feel like this its as if your world is falling in around you i hate it so much and just want to go back to being myself again

However, what is most notable about the catastrophising and minimising representations is how they are split between posts that are advice-seeking and those that are advice-giving, respectively, suggesting that the former representation is more associated with those who are struggling with anxiety while the latter representation tends to be from people who believe they can offer insights and help, based on either their own experiences or through information-gathering.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

51

Table 2.6 Anthropomorphising representation of anxiety anxiety NOUN anxiety is a NOUN anxiety is not a NOUN TITLE anxiety anxiety VERB

VERB + anxiety

bully (87), monster (36), demon (27), beast (13) beast (31), devil (30), bitch (22), culprit (17), enemy (17), liar (16), bully (15), monster (13), trickster (9), demon (9), tiger (8), fraud (9) friend (10) Mr (34), Miss (1), Mrs (1) cause (1,710), make (1,246), affect (273), try (249), hit (213), give (179), stop (114), create (109), bring (97), control (94), work (85), want (83), run (67), build (61), put (53), drive (45), like (48), let (45), produce (42), rule (43), provoke (40), need (46), love (40), lead (39), change (35), effect (29), mean (25), decide (23), send (21), prevent (21), rear (58), follow (36), take (641), suck (196), ruin (102), attack (91), feed (79), throw (47), hold (33), cripple (28), wake (26), rob (24), push (22), destroy (21), play (363), tell (167), think (120), act (72), talk (71), know (64), trick (46), mess (39), say (54), scare (29), bother (25), wait (24), exaggerate (23), convince (21), win (61), wear (29), beat (28), overwhelm (25), thrive (22) fight (316), beat (166), battle (80), conquer (60), tackle (51), combat (48), attack (32), challenge (24)

Anthropomorphising In this representation, anxiety is cast as a living being, often a human, but sometimes an animal or a supernatural entity (Table 2.6). What these more specific representations have in common, though, is that anxiety is afforded agency of its own, so it is frequently described as carrying out actions or having goals. This kind of representation appears to be more specific to anxiety than depression, although we did find cases where fear was anthropomorphised with posters writing about how fear was their worst, real, true or arch enemy. We have included titles like Mr in this category, as they were used in order to personify anxiety as a familiar entity. I bet tomorrow is not as bad as you think ~just Mr Anxiety playing nasty tricks on you and making you fear the worst ~been there done that and got the t shirt lol

In these kinds of personifications, anxiety is almost always represented as male – across the whole corpus there is only one mention of Mrs

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

52

Sketching Anxiety

Anxiety and one of Miss Anxiety, which the poster characterises as being a partner in an abusive relationship. Miss Anxiety is my narcissistic life partner who is always fighting with me, bullying me and torturing me, but at the same time she loves me so much that she never leaves me alone.

Similarly, Mr Anxiety is described as a ‘lifelong companion’. Mr Anxiety does NOT have to be your lifelong companion – you can give him the heave-ho.

Another way that anxiety is anthropomorphised is by referring to it as a fantasy entity (beast, devil, monster, demon), a malign human (bitch, culprit, enemy, liar, bully, trickster, fraud), or, less commonly, a vicious animal (tiger), although as described earlier, the tiger is always described as a toothless tiger or a paper tiger, with posters characterising it as only appearing vicious. Anxiety is a beast that takes no prisoners, just when we feel we are doing well it sneaks up on us and bang were back at square one. anxiety is a liar, it whispers in our ear and makes us believe we have all sorts of serious illnesses when we have nothing of the kind.

Similar to the minimising representations, many of these kinds of anthropomorphising representations occur in advice-giving posts. The more we struggle, the more the anxiety bully fights us back sometimes with different symptoms in order to alarm us.

An important aspect of the anthropomorphising representation is that anxiety is shown to be carrying out actions or causing things to happen. Anxiety causes our system to go into over drive

Anxiety is also described as having conscious thoughts and desires, deciding, wanting and loving things. Although love appears to be a positive word, it is used to describe anxiety as desiring negative outcomes for the person experiencing it. My anxiety loves to find new ways to scare me. Anxiety never wants us to get too comfortable with ourselves and so it waits for the right opportunity and hits us with another reminder that it is in control.

Similarly, verbs such as give, work and create characterise anxiety as causing unwanted symptoms.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

53

Do you think it might be the anxiety giving you these thoughts no answers but a local physio told me it was my anxiety working over time my anxiety creates a fever like temperature in my head which make’s me truly think something wrong happened upstairs

A related set of verbs involve representations of anxiety as a manipulative entity which mentally abuses people. There’s absolutely no reason to believe you have cancer X, that’s your anxiety talking, don’t listen to it. What I’ve noticed though, is if I do accept that it’s anxiety messing with me I have a really good day!

In this category anxiety is described as playing tricks, scaring and exaggerating. It is also described as waiting for its chance to cause trouble. as soon as you stop taking the meds the anxiety is still there waiting to play games with your head.

Additionally, anxiety is assigned as the experiencer of the negative thought processes as opposed to the person who experiences anxiety. That is your anxiety thinking negative thoughts.

A less common set of verbs involves descriptions of anxiety as beating the poster. These verbs often occur with negation where posters exhort one another or themselves not to let anxiety beat them. Anxiety well never win unless you let it. sometimes it’s hard, but I’m not going to let this monster called anxiety beat me.

Other verbs in this representation describe anxiety as moving (creep, follow). I would say it’s your health anxiety following you to the gym. Been fine all day come tea time felt anxiety creeping up on me.

Finally, we have included a set of verbs which position anxiety as the patient of an action. Posters talk about challenging, combatting, battling and beating anxiety. These kinds of verbs could be seen as a subset of minimising representation verbs, although we note how they are different from instances where posters talk about curing or managing anxiety. Instead, they cast resolution of anxiety in terms of beating an opponent. In the following excerpt, the poster acknowledges the metaphorical nature of the representation by putting the word weapons in quote marks.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

54

Sketching Anxiety As you know, there is no secret recipe for dealing with loss and tragedy, but providing yourself with an assortment of “weapons” to combat the anxiety is your best bet to defeat it!!

Viewing anxiety as a living being can be seen as a management strategy for some posters. Chen et al. (2019) have described a study where individuals who were instructed to anthropomorphise sadness or happiness reported less experience of that emotion afterwards. They argue that the reduction of emotion occurs because anthropomorphic thinking increases the perceived distance between the self and the emotion, which results in a sense of detachment.

Abstracting On the other hand, anxiety can be viewed in a variety of ways that constitute it as an abstract state or entity (e.g., something which has no concrete state). We have already encountered some of the words in Table 2.7 before. For example, calling anxiety a disorder is also a form of medicalisation, while describing it as a nightmare is a form of catastrophisation. However, other words in the table suggest different perspectives. For example, some posters represent anxiety as an experience, journey or story, which frames it as part of a person’s life narrative. the anxiety journey is sometimes 1 step forward 2 steps back. We became friends up here and shared our anxiety experiences and now friends in the real world. I’m hoping I may get a little comfort or relief by pouring out my, probably, uninteresting anxiety story

A less frequent category of words describe anxiety in terms of a negative and repetitive experience, using terms such as cycle, loop and spiral, a set of characterisations which are linked to acknowledging that the catastrophising representation can result in increased anxiety. so i dont know wether you notice . . .. that there is a pattern here . . .. the anxiety cycle. one fear leading to another and another.. . . .. you have the TRIGGER––≫FEAR–––-≫STRESS––––≫WORRY–––≫ ANXIETY–––-≫PANIC ATTACK–––≫TRIGGER. on going cycle of anxiety disorder.

Anxiety trap works in a similar way. try focusing your attention on other things that can help you overcome the anxiety trap

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

55

Table 2.7 Anxiety as an abstract entity anxiety NOUN

anxiety is (a) NOUN

anxiety VERB

VERB anxiety

disorder (2,913), issue (757), problem (398), thing (195), state (153), condition (56), stuff (40), side (33), part (33), journey (27), diagnosis (28), illness (23), experience (22), situation (21), bout (15), story (15), crap (14), struggle (14), relapse (13), shit (11), cycle (131), loop (38), spiral (25), trap (10) illness (76), problem (46), condition (32), issue (32), paradox (25), disorder (25), disease (18), habit (14), pain (28), hell (22), nightmare (19), game (15), circle (12), battle (10), trigger (11), bluff (10), trick (8), cycle (8), feeling (71), fear (71), thought (21), stress (13), reaction (12), emotion (12), response (10), thing (225), something (81), part (64), way (35), step (19), state (15), form (10) kick (246), subside (69), flare (66), increase (55), worsen (50), strike (33), kill (33), magnify (33), exacerbate (31), rise (29), grow (28), drain (28) escalate (25), reduce (24), spike (23), decrease (22) experience (536), feel (817), fuel (95), lessen (72), raise (36), add (33), alleviate (32), fix (30), heighten (27), decrease (24)

In this category we have also included words which involve increasing anxiety such as heighten, worsen, raise, escalate, add, exacerbate and spike. Again, these verbs are often used in explanatory contexts. The more we focus on our bodily functions it can heighten your anxiety and make you feel worse.

Escalate is used in the English Web 2020 corpus to refer to abstract phenomena such as tension, violence, conflict, war, crisis, confrontation, and dispute. The anxiety just escalates it by a million percent.

Subside also has a semantic prosody for abstract entities. In the English Web 2020 corpus, things that subside include laughter, pain, swelling, anger, fever, storms, floods and fighting. I know when my anxiety subsides the symptoms will too.

Additionally, anxiety is represented as abstract negative phenomena; for example, as a repetitive process (circle, cycle), a place (hell), a bad dream (nightmare) or a contest (battle, game). I know that anxiety is hell because I suffer from it too.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

56

Sketching Anxiety I just want to tell you that anxiety is a vicious circle that keeps you feeling bad as long as you feed it. Anxiety is a game, it plays tricks on you, once you understand the gist of it, expose yourself, accept it

Coming somewhere between the abstracting and anthropomorphising representations of anxiety is a much smaller third set, which frames anxiety as a non-living object. For example, there are verb metaphors such as fix and fuel which cast anxiety as something akin to a machine. The fact that the medical profession only masks symptoms and has no conclusive understanding of the brain, basically means that you are paying for someone who has about as much chance as fixing anxiety as a plumber!! I keep googling symptoms too which is fuelling my anxiety.

Other verbs also imply non-living agents that are typically associated with natural, human-made or abstract phenomena, as magnify indicates. Anxiety magnifies all our fears tenfold

In the English Web 2020 corpus, things that magnify are objects created by humans: eyepieces, microscopes, glasses, mirrors and telescopes. Finally, there are another set of verbs, often denoting physical violence, which characterise anxiety even more negatively as an entity which physically abuses the sufferer. It is difficult to categorise these verbs as referring to an abstract, living or non-living entity as they tend to occur in general language use in a wide range of contexts. Some of these verbs are used in metaphorical ways to describe anxiety as appearing or worsening (e.g., kick in, flare, strike). These verbs can index natural phenomena, for example, in the English Web 2020 corpus, strike tends to be associated with lightning or earthquakes although there are also references to human-made objects (bullet, missile, car) or abstract concepts (tragedy, disaster) striking. sometimes anxiety strikes out of the blue for no reason it’s not long before anxiety soon kicks in and wrecks everything again!

The abstract representations of anxiety can involve both metaphorical and non-metaphorical cases and can encompass medicalising and catastrophising representations as well as also being those used in supportive or explanatory posts aimed at helping others to understand or cope with anxiety. This representation thus appears to be the most versatile and varied in terms of both its forms and its functions.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

57

Owning We now move to the final two representations, which consider the question ‘Is anxiety part of the person experiencing it or is it a separate entity?’ A common way of doing this is to refer to having anxiety, which we have also classed as a medicalising representation. However, a related phrase involves the choice not to use the word anxiety but to instead use the adjectival form signified through phrases such as anxious person. I am a very anxious person, I do tend to think the worst and worry about my health when something doesn’t feel right.

Additionally, when people used terms such as anxiety brain or anxiety mind, they are labelling part of themselves as possessing or having the quality of anxiety. Anxiety brain feels weird, like its vibrating and wants to shut down.

There are also phrases which feature a noun followed by with anxiety (e.g., person with anxiety), which have been seen earlier as part of the medicalising representation. The phrase have anxiety also implies that anxiety is part of oneself. However, the most typical way of signifying that anxiety is part of oneself is through use of possessive personal pronouns, of which my is by far the most frequent (Table 2.8). I had a flair up over christmas and new year with my anxiety and the awful symptoms

First-person pronoun use has been associated with other mental health conditions, most notably, depression. Zimmermann et al. (2017) carried out a longitudinal study of 29 patients with clinical depression, reporting that they did not find a significant association between depressive symptoms and first-person pronoun use. However, firstperson pronoun use did predict depressive symptoms approximately eight months later and this was largely due to use of two types of pronouns: objective pronouns (me) and possessive (my). Tackman et al. (2019) found that while there was a small but reliable correlation between depression and first-person singular pronouns, this did not include possessive pronouns. These studies do not necessarily focus on the phrase my depression though, but instead consider all uses of my, which suggests depressed people may use more self-centred language overall. With a phrase such as my anxiety, the emphasis is on characterising the mental health condition as belonging to the person experiencing it. Hunt (2013) examined a corpus of posts from the forum

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

58

Sketching Anxiety

Table 2.8 Owning representation of anxiety PRONOUN anxiety anxiety NOUN NOUN with anxiety VERB anxiety

my (18,604), our (854), your (6,510), their (414), her (128), his (94) brain (15), mind (13), hormone (11) people (488), person (40), patient (24), sick (28), ill (27) have (10,309)

depressonline.net, finding that when people use my depression they are more likely to discuss its impact upon their personal relationships, whereas when they use the depression, they focus more on the effects that depression has on them personally. He also found that posters who used the term my depression were more likely to claim to be experiencing relief from mental illness and hypothesises that this might be because these people are coming to terms with their condition. The top 20 collocates of my anxiety in the corpus are worse, has, bad, depression, started, is, high, makes, through, because, levels, made, when, with, control, making, attacks, due, caused and panic. The collocates indicate a focus on the extent of someone’s anxiety (e.g., levels), how it causes or co-occurs with other mental health conditions (panic, attacks, depression) and how bad it is (worse, bad, high, through – which normally occurs in metaphorical phrases such as my anxiety is through the roof). There are also collocates which indicate efforts to understand what causes anxiety and how anxiety causes other conditions (makes, made, control, due, caused). Illustrative examples are shown in the following: We had dreadful noisy neighbours and my anxiety was through the roof every weekend and bank holiday due to loud music, drinking and shouting My anxiety and panic attacks have become a lot worse and I’m starting to get to the point where I can’t cope with it any longer.

There appears to be some overlap then between characterising anxiety as part of oneself while describing particularly bad experiences.

Distancing Finally, there is a representation of anxiety as being separate from the person experiencing it. The anthropomorphising examples listed in earlier parts of this chapter could be seen as a subset of this

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Word Sketch

59

Table 2.9 Distancing representation of anxiety DETERMINER anxiety anxiety NOUN anxiety is a NOUN

anxiety is not a NOUN TITLE anxiety

the (10,239), this (2,011) attack (2,840), bully (87), monster (36), demon (27), beast (13) beast (31), devil (30), bitch (22), culprit (17), enemy (17), liar (16), bully (15), monster (13), trickster (9), demon (9), tiger (8), fraud (9) friend (10) Mr (34), Miss (1), Mrs (1)

representation (e.g., anxiety monster), and to avoid repetition we focus here on cases which involve use of a determiner (Table 2.9). The most frequent form of distancing representation in Table 2.9 involves the word the. I really do find that the anxiety is now more under control

However, a related (but less frequent) modifier is this. i had an accident and broke two vertabre in my back my back is now manageable with physio but this anxiety has floored me

The top 20 collocates of the anxiety are causing, forum, welcome, depression, worse, cycle, part, makes, control, symptoms, attacks, comes, away, keeps, causes, itself, panic, because, let and caused. Eight of these collocates overlap with the top ones for my anxiety (worse, depression, makes, control, because, attacks, caused, panic). Two of the others (welcome, forum) are the result of responses to posts where members refer to the Anxiety Support forum, so do not really indicate cases where people refer to having anxiety. Welcome to the Anxiety Forum. You have come to the right place to get support and understanding of what you are going through.

The collocate comes describes the onset or return of the anxiety and there is also focus on whether the anxiety will go away. The following two examples therefore represent anxiety as an unwelcome visitor, as opposed to something which is an integral part of someone’s identity. You can’t avoid the anxiety once it comes in so why fight it. Is that really too much to ask for the anxiety to go away so I can relax and sleep.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

60

Sketching Anxiety

While the anxiety does have one collocate that indicates the severity of anxiety (worse), on the whole there are fewer of these kinds of collocates, compared with those for my anxiety. We should also note that references to my anxiety tend to be more common in initial posts (1,492.45 per million words), which can often involve cases where people are describing problems or requesting help as opposed to uses of my anxiety in responses to posts (702.76 per million words) which more likely involve posters providing support. As shown in Table 2.10, the phrases the anxiety and your anxiety are more likely to be found in the responses to posts. Uses of the anxiety with collocates such as cycle, causing, causes and part tend to involve explanations or reassurances, which are more typical of responses to posts, rather than initial posts. I’ve been told to try floating through the anxiety and just accecpting it. I guess that’s how you break the anxiety cycle. The fear of going insane is all part of the anxiety illness and I would suggest we have all had it. It might be an idea to have a talk with your doctor so that you can feel reassured that it is the anxiety causing your symptoms.

Hunt and Harvey (2015) note that on a forum relating to eating disorders, uses of possessive phrases such as my ED are much less common than phrases such as the ED, indicating that posters usually discuss eating disorders as a condition which is distinct from the individual. However, this does not seem to be the case with discussions around anxiety, where my anxiety is more frequent than the/this anxiety. In terms of framing, as with anthropomorphism, viewing anxiety as something separate from the person experiencing it may increase a sense of detachment between the self and the feeling, which could be helpful in terms of decreasing perceptions of anxiety’s effects. We note how the people who used my anxiety were more likely to refer to its worsening levels, suggesting that, to an extent, catastrophisation was occurring when people characterised anxiety as part of themselves. Table 2.10 References to DETERMINER + anxiety according to post type

Initial posts Follow-up posts

my anxiety

the anxiety

your anxiety

7,661 (1,492.45) 8,182 (702.76)

1,835 (357.48) 6,229 (535.02)

407 (79.28) 4,547 (390.55)

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

Conclusion

61

Conclusion Our analysis showed a wide range of different ways that people on the Anxiety Support forum could linguistically represent anxiety. These ways included whether anxiety was viewed as medical condition or a normal part of life, whether it was seen as terrible or slight, whether it was characterised as living or abstract, and finally, whether it was part of a person or separate from them. These representations overlapped to different degrees; for example, referring to anxiety as a living entity would imply it is separate from the person who experiences it, while referring to anxiety as a medical condition is also likely to imply it is an abstract entity. Importantly, we do not want to give the impression that individuals referred to these representations in consistent ways over time or even within the same post. Different representations could be combined together, as in the following post where anxiety is initially described as an abstract concept (hell) but then is implied to have agency (take over my life). Panic and anxiety is definitely hell, but I know that it won’t take over my life forever.

It was not the aim of this chapter to evaluate some representations as more ‘helpful’ than others in terms of enabling to people to manage or resolve anxiety. This would require research that is beyond the scope of this book. Furthermore, on the basis of the linguistic studies we examined for other conditions such as depression, it is usually the case that there are trends but that findings are not absolute – not everyone who views anxiety as a separate entity from them may find this beneficial. Instead, we want to indicate the variety of ways that people on the Anxiety Support forum understand anxiety. Medical practitioners and people who experience anxiety may find that awareness of these different representations can offer insights by considering which ones (if any), they tend to use themselves and which ones they were not cognisant of. Medical practitioners might want to listen for these representations in the speech of their patients, which could help in terms of enabling the practitioner to match the patients’ own framings or identify uses of language which result in representations that may not help a patient to effectively manage their anxiety. Additionally, people with anxiety may want to consider the extent to which their feelings about anxiety might change, depending on the ways that they characterise their anxiety. We will encounter these characterisations again, at various points in the book, but in the following chapter, we take a more holistic perspective of language use in the forum, to consider keywords and what they can further tell us about people’s lived experiences of anxiety.

https://doi.org/10.1017/9781009250139.003 Published online by Cambridge University Press

3

The Lived Experience

Introduction Having focused on references to anxiety in the previous chapter, we now offer an examination of the wider Anxiety Support forum as a type of computer-mediated communication (CMC), in order to identify the topics and forms of expression that are prevalent in online discussions of experiences of anxiety. We apply keyness analysis to the investigation of words and fixed phrases, as an exploratory, datadriven approach to identifying what it is that members of the forum choose to discuss. Through this analysis, we obtain a sense of what participants expect from the forum: in terms of both the kinds of support they seek from other members and the nature of the exchanges they have with them, as we identify interactional norms. In this way, we offer a summary of how the lived experience of anxiety is represented in the forum, as well as a view of the lived experience of the Anxiety Support forum itself.

Online Forums as Computer-Mediated Communication The internet has become a key resource for providing health information and health-anxious individuals are particularly likely to use online resources to satisfy their health information needs (Baumgartner and Hartmann, 2011). Users have had to learn to navigate the myriad sources of health support and information that have emerged online in the form of webpages, blogs, social media, online forums and so on (Sillence et al., 2007) and digital tools also allow users to track personal health information related to, for example, heart rate, sleep patterns and ovulation through mobile apps (Bach and Wenz, 2020). The development of ‘eHealth’ reflects broader trends in the evolution of digital and online technologies that have progressed from unidirectional repositories of information to participatory, collaborative spaces for open exchange, changing the way that individuals 62

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Online Forums as Computer Mediated Communication

63

communicate, and contributing to addressing the health inequalities that manifest from uneven access to traditional health services and institutions (Chou et al., 2013). As such, investigations of how users generate their own content and communicate their own experiences through computer technologies can help us to develop tools and provide more targeted information to facilitate better health outcomes. The late 1990s saw the emergence of studies of CMC in earnest, as the availability of home computers and the growth of the World Wide Web brought huge numbers of users to spaces where their interactions with others were interposed by a computer screen, or a mobile phone (Herring, 2008). Linguistics research at this point was preoccupied with defining ‘Netspeak’, setting out to position CMC on a continuum between spoken and written language and focusing on the textual features that distinguished forms of CMC from communication in other contexts, such as the use of acronyms (brb – be right back), homophones (2 for to/too, r for are), emoticons (:), :-P) and later, emoji ( , ). However, as Crystal (2001, p. 48) concluded, ‘Netspeak is identical to neither speech nor writing, but selectively and adaptively displays properties of both.’ This consideration of structural features is one of the domains of research that has typified linguistic interest in CMC, which Herring (2008) positions alongside: • classification research concerned with modes and genres of online communication; • discourse patterns, including interactional turn-taking, politeness, dialect; • internet behaviour in terms of identity, community, power; • language ecologies – for example, the multilingual Web, the spread of English. One of the factors that has forced researchers to expand their investigations into CMC is the range of modes and platforms that – even in the 1990s – could be distinguished within the broad scope of CMC, including email, blogs, instant messaging, SMS texts, social media and virtual worlds. Each of these modes has their own structural characteristics that inevitably shape the textual features that we are likely to observe. Continued interest in finding the boundaries between these digital arenas has led to the recognition that there is a great deal of ‘hybridization’ and multifunctionality in CMC texts, whether conceptualised as genres that are defined by conventional organisational features (Thurlow and Poff, 2013) or registers that are defined by situational characteristics and examined for linguistic indicators of such characteristics (Biber and Egbert, 2018).

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

64

The Lived Experience

One of the legacies of the positioning of CMC in relation to spoken and written language is to view online communication in terms of what it is lacking; for example, the resources that we have at our disposal in face-to-face communication that are not possible in spaces such as online forums. For instance, we can refer to nonverbal (e.g., facial expressions), auditory (e.g., intonation, volume) and tactile (e.g., a hand on the shoulder) signals when we speak to someone face to face. Of course, these are variously available depending on the type of CMC, with facial expressions and prosodic aspects discernible in video conferencing, for example. Textual features of CMC such as emoticons/emoji, non-standard orthography (whaaaat?) and stylised metacommentary (*checks notes*) have, nevertheless, been described as compensatory, in lieu of paralinguistic features (as discussed by Bieswanger, 2013). However, this view diminishes the creative and ludic aspects of what are highly flexible features of CMC and other, iconic aspects of CMC, such as memes, hyperlinks and GIFs are near-impossible to replicate in other modes of communication. Furthermore, researchers have stressed that such resources are multifaceted and continually adapted in CMC towards new meanings and functions (e.g., Thurlow and Poff, 2013). Dresner and Herring (2010) stress that emoticons have multiple functions beyond their association with conveying emotion, most notably as illocutionary force indicators, prompting recipients to interpret a message as ironic, or playful. While micro-linguistic features such as emoticons, non-standard spelling, abbreviation and non-standard punctuation have long been held as characteristic of CMC, Bieswanger (2013, p. 478) makes the point that variation in the use of such features occurs ‘according to the language and script used, the mode of CMC employed, and other useand user-related factors’. In this way, we can consider online forums as fundamentally different from email, social media and SMS text messaging. Furthermore, even within sub-genres of CMC, there is heterogeneity; Bieswanger and Intemann (2011) found that on average 2% of the words across English-language online forums were emoticons, but that this varied across individual discussions from an average of 0.3% in one forum, to 3.1% in another. They ultimately conclude that there is no such thing as a language of online discussion forums (Bieswanger and Intemann, 2011). Instead, studies of online forums are arguably better served to evaluate them in terms of their specific topic focus and in relation to the membership of their respective communities. Hunt and Brookes (2020, p. 63) agree, stating that forum posts ‘must be understood as contributions to online communities that have established norms and expectations for communicating about illness’. Indeed, HealthUnlocked

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Online Forums as Computer Mediated Communication

65

provides explicit guidance to users about the manner in which they articulate their recommendations, with the example ‘“For me, this worked . . . ” rather than “You should do this . . . ”’ (https://healthun locked.com/anxietysupport/about). Less explicitly, contributions from established and regular posters offer a model to novice members of what is germane and appropriate to the forum. As Hunt and Brookes (2020, p. 63) assert, ‘Expectations based on existing interactions in an online community and an individual member’s status within it can therefore play a role in the ways in which support group members linguistically frame their messages’, in order to show to other members that they belong. Corpus linguistics, which is predicated on identifying patterns of language use, is therefore a fitting approach through which to uncover the regular vocabulary and formulations which contribute to the linguistic fingerprint of the Anxiety Support forum. In Chapter 1, we established that online support forums are characterised in terms of the information and emotional support they offer (Yip, 2020), that members report benefits according to group belonging and social connectedness (Naslund et al., 2016) and that many users of online forums feel more comfortable discussing sensitive and personal issues in online spaces that afford them relative anonymity (Webb et al., 2008). Linguistic investigations of online health forums have highlighted aspects that are more typical of the platform when compared with other modes of communication, such as members constructing their identity through diagnosis, advice-seeking and advice-giving (Stommel and Lamerichs, 2014). Discussions in online forums are reported to be characterised by ‘problem’ messages, discussing issues with diagnosis or medication for example, and disclosing personal troubles is an important component in the enactment of social support (Goldsmith, 2004). It is argued that the communicative context of internet forums encourages people with mental health concerns to offer sensitive self-disclosures ‘with a level of candour that would be unlikely in more inhibiting offline settings’ (Hunt and Brookes, 2020, p. 62), however, with advice-seeking and advice-giving there are found to be varying degrees of directness (Stommel and Lamerichs, 2014). Yip (2020, p. 1216), for instance, found that 70% of thread openers in forums for dealing with anxiety and depression requested support but in indirect means, such as through self-disclosure. This demonstrates the multifunctionality of such communicative acts, which encourage social connectedness in their frankness – that is, by providing intimate personal details – but also through their invitation for reciprocity and wisdom. Tied to this kind of problem-solution exchange are concerns for credibility and legitimacy, which can be established through accounts of long-standing membership to the forum, of a history of interactions

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

66

The Lived Experience

with medical professionals or a knowledge of treatments, for example (Galegher et al., 1998). There is a concern, however, that users’ commitments to demonstrating membership subsequently limit the range of perspectives communicated in online forum spaces, that contributors are encouraged to not only express but, indeed, even hold the ‘right’ point of view. Weber (2011), for instance, found that senior members of a sexual abuse support group reformulated or recast new members’ posts to bring them into alignment with normative values. Newcomers to an online support group for those recovering from eating disorders who had reported previously belonging to a pro-anorexia community were obliged to disavow that ideology as a precondition for membership (Stommel and Koole, 2010). McDonald and Woodward-Kron (2016) show that the socialisation into a bipolar disorder support forum community and the moderation of views expressed in that forum can be evidenced in lexicogrammatical and discourse-semantic choices, modelled by senior members and adopted by new members. As such, we investigate textual features with the aim of understanding what it means to be a participant in the Anxiety Support forum, as a platform for discussing experiences of anxiety, as well as a type of CMC. In addition to textual units such as abbreviations, hyperlinks and emoji characters, we can also ask questions about the structure of texts composed in asynchronous modes such as online forums. Compared with the often quick exchange of short turns in spoken conversation, users of online forums may deliberate longer on the content and structure of their posts as they strive to optimise the meaning of their communication and elicit multiple responses, albeit staggered over longer stretches of time. Furthermore, Stommel and Lamerichs (2014, p. 201) observe that asking and advice-giving are ‘sequentially related’ and that the interactional aspects of a discussion thread are important for understanding how communicative goals are achieved and negotiated with other members. We will discuss these structural and sequential aspects of the forum posts more in Chapter 4. In this chapter, we are first and foremost concerned with harnessing a view of how the content of the Anxiety Support forum, as seen through recurrent lexical items, reflects what it is like for participants, in terms of the topics they discuss and the ways in which they formulate their messages to one another. Guiding our discussion of recurrent features are the following questions: • What do recurring features of posts tell us about why members participate in the forum and what they set out to discuss? • What do patterns of language tell us about how lived experiences of anxiety are typically articulated in the context of this forum?

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Keyness

67

Before we report our observations of the Anxiety Support forum data, we will briefly introduce and outline the methodological concepts and procedures that we have applied to identify recurrent linguistic patterns. We begin with a discussion of one of the fundamental principles of corpus linguistic analysis, ‘keyness’, which provides the basis on which we identified not only the findings reported here but also in later chapters as we consider how patterns in language use relate to different groups of contributors at different stages of the life of the forum (Chapters 5–7).

Keyness The notion of keyness is often described in relation to ‘aboutness’ (Gabrielatos, 2018), in that the procedure is generally designed to highlight features that are indicative of both the topic and the style of the content of a corpus, telling you what it is ‘about’. As we will demonstrate in this chapter, keyness can be applied not only to lexical items, but also to any feature of a text for which we can determine frequency. However, for simplicity, we will briefly summarise the procedure for keyness analysis in terms of keywords. Scott (1997, p. 236) reports that a keyword may be defined as ‘a word that occurs with unusual frequency in a given text’ and that, crucially, we are interested in unusual frequency, by comparison with an established norm. As discussed in Chapter 1, the selection of a reference corpus has implications for what emerges from the analysis and we have selected the English Web 2020 for comparison in order to establish a norm for web-based English, thus foregrounding the distinct – principally topical – features of the Anxiety Support forum. Once a reference corpus is selected, keyness is determined through a comparison of the relative frequencies of select features (e.g., words) and corpus linguists typically establish a threshold for what is unusual according to a frequency or statistical measure. Scott (1997) writes that the calculation of keyness is done using the chisquared statistic and this has historically been computed in the form of Log Likelihood (Dunning, 1993). However, as Gabrielatos (2018) discusses, there is a range of metrics available for determining keyness, each of which attends to a different aspect of the quantification of the difference – and by implication, similarity – between the two relative frequencies. The Log Likelihood calculation, for example, determines statistical significance, that is, that we have sufficient evidence, by way of the size of the corpus and the number of occurrences, to confidently assert that the observed differences are not

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

68

The Lived Experience

down to chance. We can also apply effect size measures to determine the magnitude of the difference between relative frequencies, which can be combined with a measure of statistical significance to establish a level of confidence in those results. We applied the Simple maths calculation (the default measure in the corpus analysis tool Sketch Engine) to determine keyness, adjusting the smoothing parameter to prioritise higher frequency words (k=100) (Kilgarriff, 2009). This is a fairly accessible measure, which provides an indication of how many times more frequent an item appears in one corpus compared with another. We also wanted to ensure that the features we investigate can reasonably be considered to be representative of the corpus as a whole and so we have excluded words for which 50% of occurrences come from one poster. These keyness parameters have also been applied in subsequent chapters, unless otherwise stated.

N-grams Our analysis begins with a discussion of keywords. However, what also emerged through our investigation was the importance of multiword phrases that occurred repeatedly in posts to the Anxiety Support forum. Linguistic interest in repeated sequences of words is captured in the concept of ‘n-grams’, which uses the mathematical notation n to indicate an unspecified number of elements in a string of lexical items. In other words, we can search for repeated strings of two (2-grams), three (3-grams), four (4-grams) or more words. Investigations of n-grams have helped linguists to demonstrate that much of language is phraseological, that speakers have numerous ready-made constructs at their disposal, which they frequently utilise, and that readers process these frequently repeated strings more quickly (Underwood et al., 2004). N-gram analysis has been shown to be effective in offering a bottom-up approach to distinguishing (sub)genres of English, with 3-grams highlighting differences between spoken and written language, as well as distinguishing academic writing from creative writing (Gries et al., 2011). For example, Biber (2009) has shown that I don’t know why and the way in which are characteristic of informal spoken conversation and academic writing respectively, and that corpus analysis tools are effective for identifying n-grams (or ‘lexical bundles’) as indicative of the communicative goals and conventions of categories of text types. As such, we report key n-grams from the Anxiety Support forum, as determined by their unusually high frequency when compared with the English Web 2020 corpus.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

69

Emoticons and Emoji We discuss emoticons (comprising text characters such as :)) and emoji (pictograms such as ) separately from keywords and key n-grams, since their semantic and pragmatic meaning is arguably more flexible, depending on how they are combined with other characters or lexical items. Gawne and McCulloch (2019), for example, discuss the illustrative (Coffee? ), metaphoric (Stay strong! ), deictic ( This is perfect), emphatic ‘beat’ (WHAT ARE YOU DOING) and illocutionary (That was fun ) functions of emoji, which cannot readily be discerned from looking at the individual emoji character. We report our observations of frequently occurring emoticons, discussed in relation to how they were used by different categories of contributor to the forum. Studies have observed, for instance, that females produce emoji and emoticons more frequently than males while younger users post more emotions than older users (discussed in Herring and Dainas, 2020). While emoticons are associated with CMC, Frehner (2008) observed a higher relative frequency of emoticons in SMS texts (4.88 per 1,000 words) compared with emails (3.18 per 1,000 words), indicating that their use differs according to the type of CMC and providing a point of comparison for what we observed in the Anxiety Support forum.

What Do Members of the Anxiety Support Forum Set Out to Discuss? Keywords and Key Terms We divided the Anxiety Support forum data into two categories of messages: Main posts and Replies. This split was based on observations that Main posts (i.e., posts that initiate a discussion thread) were characterised by agenda/topic-setting, while Replies (i.e., the subsequent responses in a discussion thread) appeared to function very differently, based on their adoption of the ideas and experiences established in the Main post. Other research has made similar observations; for example, Collins (2019) found differences in self-initiated posts and replies in an online learning discussion forum, with more expressions of affiliation in replies to existing posts. There were 42,239 Main posts in the data, constituting 14.36% of contributions and 5,133,149 words. Correspondingly, there were 251,843 Replies (85.64% of posts), containing 15,902,860 words. Establishing these sub-corpora and comparing each with the English Web 2020 corpus allowed us to identify similarities and differences in the prevalent terms of each message type and determine which patterns were

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

70

The Lived Experience

characteristic of the Anxiety Support forum overall. The corpus analysis tool we used, Sketch Engine, offers the capacity to identify terms as well as individual words, capturing modified noun phrases such as anxiety attack or shortness of breath. These are distinct from n-grams, in that they represent singular objects and concepts, whereas n-grams are typically not complete or isolated structural units (Biber, 2009). For both the Main posts sub-corpus and the Reply post sub-corpus we derived a list of the top 100 keywords and the top 100 key terms. We examined occurrences of each of the key items in their original context to determine their prevailing semantic meaning. There were 113 items that were key for both Main posts and Replies, meaning that there were 87 keywords and key terms for Main posts that did not appear in the top 100 lists for Replies and, equally, 87 key items that appeared only in our lists for Replies. We were able to categorise both the similar and the distinct key items to our thematic groupings, indicating that even when the precise terms differed, the key items for Main posts and Replies related to a restricted number of semantically related concepts. We discuss the similarities and differences in those terms according to our thematic categories, which were as follows: • • • • • • • • • •

health issues and symptoms time persons and things medical tests, remedies and coping strategies feelings and emotion; cognition forum relations personal circumstances body parts and processes negative and positive evaluation; minimal and maximal auxiliary and modal verbs; lexical verbs.

These categories broadly reflect a focus on the physical manifestations of anxiety, which is reported in terms of various timeframes, affecting different parts of the body and disrupting natural bodily processes, such as sleep. Furthermore, there are frequent disclosures concerning the interaction with health professionals as members seek diagnosis and treatment and forum members are also invited to give their perspectives on identifying and coping with anxiety disorders. We begin by looking at the keywords and terms we categorised as relating to Health issues and symptoms, which are presented in Table 3.1 along with their frequencies. The key words and terms are shown in order of keyness score. For example, the first keyword, anxiety, occurs 44,511 times in the Main posts, or 8,671.28 times

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Health issues and symptoms

anxiety (44,511), panic (10,836), panic attack (6,427), symptoms (7,936), pain (7,459), sick (4,409), attack (6,370), depression (4,011), attacks (4,690), dizzy (2,919), tired (3,167), pains (2,660), health anxiety (2,078), chest pain (1,780), dizziness (1,687), suffer (2,106), heart attack (1,516), side effect (1,470), anxiety attack (1,152), physical symptom (771), anxiety symptom (728), anxiety disorder (715), shortness of breath (603), bad anxiety (571), severe anxiety (540), social anxiety (533), heart palpitation (525), mental health (717), panic disorder (478), head pressure (410), brain tumor (406), acid reflux (377), symptom of anxiety (312), sharp pain (272), heart problem (267), brain tumour (258), racing heart (251), back pain (263), other symptom (248), stomach pain (233), blood clot (238), burning sensation (229), health issue (261), new symptom (205), dizzy spell (198), sore throat (204), first panic (198), brain fog (197), anxiety issue (192), arm pain (187), first panic attack (185), heart race (184), tension headache (177), fast heart (174), heart racing (173), shooting pain (172)

Main posts

anxiety (109,907), symptoms (28,024), panic (20,396), pain (14,119), panic attack (10,723), depression (8,580), attacks (8,573), attack (10,544), suffer (6,086), sick (5,737), side effect (6,427), health anxiety (4,558), heart attack (2,689), chest pain (2,384), anxiety disorder (2,285), physical symptom (2,065), symptom of anxiety (1,701), anxiety symptom (1,685), anxiety attack (1,674), mental health (2,056), same symptom (1,074), acid reflux (907), heart palpitation (793), severe anxiety (782), panic disorder (775), health issue (888), other symptom (774), head pressure (726), shortness of breath (741), social anxiety (717), bad anxiety (664), anxiety issue (541), heart problem (540), racing heart (508), tension headache (504), health problem (609), brain tumor (487), mental illness (589)

Replies

Table 3.1 Keywords and key terms relating to Health issues and symptoms

72

The Lived Experience

per million words. In the English Web 2020 corpus, anxiety occurs 948,900 times or 26.96 times per million words. In other words, anxiety occurs 321 times as often in the Main posts compared to the English Web 2020 corpus. Compare this to the keyword for the Main posts, suffer, which occurs 28.13 times per million words in the English Web 2020 corpus and 41.02 times per million words in the Main posts – or 1.45 times as often. Comparing those key items in the Main posts with those in the Replies, we find that 35 were key for both, indicating a continued focus in the discussion threads on anxiety disorder, panic attack and physical symptom, for example, with commonly cited symptoms including chest pain, heart palpitation, head pressure and shortness of breath. A further 20 key items referring to symptoms appeared in the key lists for Main posts only, though these were often alternative expressions of similar experiences; for example, fast heart and heart racing, brain fog and dizziness. Ultimately, Main posts featured a greater range and specification of ways of expressing symptoms that were nevertheless acknowledged and referred to in Replies. When the same key terms describing symptoms appeared in Replies, members would often emphasise that these are widely recognised symptoms of anxiety and/or that they had personal experience of them. Furthermore, these were often a direct response to requests in the Main posts for indications that others in the forum could relate to what the original poster was experiencing. This is also reflected in the key term same symptom, which was key for Replies only, as contributors emphasised ‘sameness’ in their responses, reassuring the original poster that their experience is comparable with that of others. Another key term, mental illness, also appeared in our key lists for Replies but not for Main posts, reflecting a range of positions regarding the validity and categorisation of anxiety as a mental illness, particularly in relation to physical illness. For instance, contributors lament the wider social recognition and acceptance of serious mental illness: Would a person with pneumonia feel guilty, of course not. We have been brought up to believe that physical illness is fine but mental illness. Oh no! im also very aware that mental illness is just not measurable in the same way as physical, there isnt enough knowledge, science if you will, in regards to mental health. I believe the public are not getting the support they require because the metal health profession just isnt there yet.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

73

Furthermore, in response to the assertion that social anxiety is a very natural feeling and should not be classes [sic] as a mental illness with drugs to treat it, others in the forum were explicit in reiterating the legitimacy of such conditions as distinct from more ‘ordinary’ experiences of, for example, shyness: Social anxiety disorder is, in fact, a recognised medical condition with diagnostic guidelines and treatment options. Whilst we take your point that perhaps for many in the past, they were merely described as being shy, if you speak to someone with Social Anxiety Disorder they will tell you it is so much more than that.

To some extent, this reflects the medicalising and normalising discourses we reported in Chapter 2, with evidence that in the Anxiety Support forum, there is more of an impetus for acknowledging the validity and seriousness of members’ experiences. The next largest category, in terms of number of keywords and key terms, captured references to Time, as shown in Table 3.2.

Table 3.2 Keywords and key terms in the category Time Main posts Time started (7,734), weeks (5,250), anymore (2,486), night (6,638), constantly (2,453), ago (5,417), morning (4,223), day (14,406), sometimes (4,607), months (5,549), today (7,230), stop (4,428), now (19,824), last night (1,676), few days (1,322), few months (876), few weeks (845), last week (800), long time (673), other day (438), couple of days (368), next day (441), next week (409), last year (905), first time (817), last few days (258), couple of weeks (277), day today (243), last couple (265), last time (340), few times (278), past week (245), few hours (275), few years (477), past few days (215), past couple (219), couple of months (211), middle of the night (193)

Replies few days (2,188), last night (1,946), few weeks (1,719), long time (2,059), many times (1,464), few months (1,362), other day (853), many years (1,432), few times (722), next day (909), next week (855), couple of weeks (632), next time (739), couple of days (555), long term (862), sometimes (16,046)

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

74

The Lived Experience

The use of these terms provides temporal structure to the ‘anxiety narratives’ that appeared in both Main posts and Replies, with 12 key items appearing in both sets of lists as ways of approximating time periods; for example, couple of days, few months, long time. There were 26 key items in this category, however, that appeared as key for Main posts but not Replies and which placed an emphasis on past events, both long-term (couple of months, few years, weeks) and more immediate (last few days, now, past week, today). These comparative time frames enable contributors (of Main posts) to contextualise a more acute and severe experience of anxiety within a more longstanding history, adding legitimacy to their perspective on anxiety disorders – because of their lived experience – as well as their assessments of the developed intensity of the more recent experience that means that they don’t know what to do anymore. This also accounts for why they are now reaching out to the forum. There were four items that appeared in the key lists for Replies but not Main posts, which similarly functioned to establish legitimacy, though more often in relation to advice-giving. For instance, references to many times and many years attest to contributors’ long-standing experiences navigating anxiety and exercising tried-and-tested coping strategies. Even your monthly cycle can be upset by this condition. I have known it happen many times.

While authors of Main posts oriented towards the past to outline their history of anxiety, the prevalence of next time and long term reflect the future-oriented content of Replies, as contributors offer suggestions as to what the original poster could try on the next occasion of, for instance, a panic attack or a consultation with a health professional, as well as contemplating what are more long term solutions and benefits of, for example, treatment options. Next time say “hello fear so your back to visit” . . .. . .note the word “visit” Anti-depressants supposed to help in the long term but again can have side effects.

In Table 3.3, we present the composite key items of the next category, which includes references to various persons and things. It is important to note that the prevalence of the terms Im and Ive can, to some degree, be accounted for in the formatting of apostrophes, though the nonapostrophe forms do appear in both the Anxiety Support forum data and our reference corpus. Nevertheless, we checked the relative frequencies for the more conventional I’m and I’ve, finding that while both forms were more frequent in Main posts and Replies compared

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

75

Table 3.3 Keywords and key terms relating to Persons and things

Persons and things

Main posts

Replies

Im (9,501), my (114,255), I (341,223), anyone (14,574), myself (9,613), me (52,486), Ive (2,717), else (7,331), everyone (5,980), something (9,716), everything (5,047), anything (5,008), other people (583), only thing (365), same thing (392)

same thing (3,169), other people (1,947), lot of people (1,162), other thing (1,367), only thing (1,173), many people (1,781), anxiety sufferer (613), right thing (732), first thing (807), only way (788), Im (14,760), I (747,246), me (116,701), myself (20,577), yourself (20,049), u (14,244), my (181,030), you (447,708), your (152,732), something (27,752), thing (20,576), things (27,927), Ive (4,576)

with the English Web 2020 corpus, they were particularly frequent in Main posts (with Simple maths scores of 15.19 for I’m and 10.31 for I’ve) compared with Replies (8.24 for I’m, 5.55 for I’ve). The frequency and range of first-person references (I, Im, Ive, me, my, myself) in both Main posts and Replies reflects the focus on individual perspectives, as authors of Main posts outline the specifics of their personal circumstances, for which they seek guidance, and respondents reciprocate with the sharing of personal experiences in Replies to demonstrate affiliation and legitimise advice-giving. The prominence of second-person forms (you, your, u, yourself) in Replies also demonstrates that respondents adopted what was described in the Main post as the topic of the discussion and sought to orient their perspective around the author of the Main post’s situation, specifically. The term only thing was key for both Main posts and Replies and showed that members of the forum could empathise with the struggle of having limited treatment options for what was often a personalised experience of anxiety, that is, the only thing that helps me. What was more apparent in Replies, however, were references to where respondents had found motivation – for example, the only thing that keeps me going – offering encouragement to those who sought alternatives to their limited coping strategies. The items that were key only for Main posts also reflect contributors’ openness to unspecified possibilities,

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

76

The Lived Experience

looking for anyone and anything else through which to relate their experiences, and in the Replies, members oblige by asserting that a lot of people/many people experience something comparable to what is described in the Main post, thereby contributing to the normalising representation of anxiety discussed in the previous chapter. Similarly, references to the same thing and other people tended to appear in queries in Main posts (Has anyone else had the same thing?), but more likely as affirmative responses in Replies (Yes I have had the same thing). Further encouragement is found in Replies through references to the right thing, supporting the actions of the author of the Main post – including coming to the forum – and reassuring them that they are the best judge of what is the right thing for you. Respondents are definitive in their encouragement, asserting, for example, that the only way to get the better of this thing is not to give up. Nevertheless, references to the other thing show that respondents strive to provide the options that original posters have sought, drawing from their own knowledge and experience (the other thing I would suggest) and prioritising what is likely to be the first thing in a series of actions: First thing I would do is go & see your GP. The next category, which we have labelled Medical tests, remedies and coping strategies, attests to the involvement of health professionals in members’ experiences of anxiety, as they navigate diagnosis and treatment, including managing the side effects of medications. The key items categorised under this theme are shown in Table 3.4. There was a greater number of key items in Replies, compared with Main posts, reflecting an orientation towards suggesting coping strategies and remedies. Appearing in both Main posts and Replies were references to doctor(s) and blood tests/blood work, as well as meds, anti depressant, beta blocker and deep breath, providing an indication of some of the more routine aspects of how the physical symptoms associated with anxiety are tested and treated. As we observed in relation to references to persons (anyone else?), the authors of Main posts appear to be looking for indications of what is ‘normal’, with respect to prescribed medications and their side effects, for example, as well as generally seeking advice. In response, we found 17 key items that appeared in the lists for Replies only, which introduced further details relating to coping strategies (breathing exercise, breathing technique, deep breathing, self help, relax) as well as more formal treatment options (CBT, support group, therapist, therapy) including medication (medication, low dose) and testing (GP, CT scan). Members of the forum were open to a range of pharmacological, therapeutic and relaxation solutions, providing personal recommendations of what helps/has helped them and endorsing the good

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

77

Table 3.4 Keywords and key terms relating to Medical tests, remedies and coping strategies

Medical tests, remedies and coping strategies

Main posts

Replies

doctor (4,907), meds (2,518), medications (2,845), doctors (2,764), help (13,692), advice (3,624), blood test (987), blood work (499), deep breath (327), beta blocker (258), anti depressant (233)

deep breathing (2,080), blood test (1,748), deep breath (1,599), self help (1,125), beta blocker (1,043), blood work (751), breathing exercise (742), anti depressant (732), low dose (708), CT scan (589), doing something (661), good advice (562), breathing technique (501), support group (537), doctor (23,563), meds (13,205), medication (12,401), helps (15,131), GP (8,779), help (44,336), doctors (7,976), relax (6,166), CBT (4,859), therapist (4,844), helped (8,931), therapy (7,025)

advice of others in the forum. This openness was also reflected in the encouragement to be pro-active and try doing something, even if that is only to distract the addressee from their anxiety. A key term found in Replies but not Main posts was support group, reflecting the value that members place on being able to talk with others who can relate to the lived experience of anxiety disorders. Contributors referred to the forum itself as a support group, alongside references to in-person groups (is there a support group in your area?) and alternative online spaces that focused on more nuanced aspects of anxiety disorders, such as dealing with grief, or a support group specifically for people under the age of 18. The endorsement of these alternative spaces further indicates that members consider the opportunity to talk with others with comparable lived experience a valuable option for coping with anxiety. Table 3.5 comprises keywords and key terms in the categories of Feelings & emotion and Cognition, demonstrating how participants expressed evaluation with respect to the many facets of their anxiety experiences and what they feel like.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

78

The Lived Experience

Table 3.5 Keywords and key terms in the categories Feelings & emotion and Cognition

Feelings & emotion

Cognition

Main posts

Replies

feel (34,805), feeling (18,565), like (36,189), panic (10,836), scared (7,039), anxious (6,173), felt (7,819), feels (5,168), fear (4,968), worried (3,460), worry (3,105), stress (2,942), worrying (1,910), feelings (2,402), hate (2,348), afraid (2,013), weird feeling (395), horrible feeling (178) thoughts (4,564), thinking (5,095), know (17,591), negative thought (384), intrusive thought (263)

bad feeling (725), horrible feeling (555), feel (79,775), feeling (37,204), panic (20,396), anxious (12,605), fear (16,870), worry (12,160), scared (7,799), stress (10,209), feelings (8,324), calm (6,650), glad (7,105), felt (11,870), feels (6,898), like (76,821), scary (4,706) negative thought (1,438), peace of mind (812), intrusive thought (479), anxious thought (464), positive thought (465), thoughts (13,735), know (58,236), think (48,498), mind (20,576), thinking (12,168)

In both Main posts and Replies there is explicit acknowledgement of the negative emotional states associated with anxiety, including feeling anxious, fear, panic, scared, stress and worry, as well more generally a horrible feeling. In addition, we observed the related terms afraid, hate, worried, worrying, negative thought, intrusive thought and weird feeling in Main posts, as contributors emphasised the unusualness and concerning aspects of what they have been experiencing. The expression bad feeling – which was more characteristic of Replies – also appeared to acknowledge the negative experiences described in Main posts, but rather than focus on the ‘weirdness’, respondents encouraged acceptance, thereby contributing to the normalising discourse we have observed through other features. Nothing terrible is going to happen to you if you leave home. So just accept the bad feeling and just go outside any way. But you must accept

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

79

the bad feeling calmly and with the minimum of fear you can. Say: “To Hell with you agoraphobia, you’re not going to stop me going out.

Furthermore, where authors of Main posts referred to an intrusive thought, there were more often references to anxious thought in Replies, as respondents were more definitive in attributing this part of the experience to an anxiety disorder. The prominence of the terms calm and peace of mind in Replies reflects how it is often positioned in contrast to – and the antidote to – anxiety, as original posters are encouraged to try to stay calm and offered suggestions as to what brings them peace of mind. In the Replies, we also find a contrastive emphasis from the negativity of anxiety disorders on positive thought and particularly the positive emotion of being glad. This appeared as advice, for members to Find a positive thought to counterbalance the negative and respondents themselves highlighted successes in other participants’ experiences (Glad you managed to go out with your friends today). Contributors also expressed comfort in finding others who can relate (glad to know I’m not the only one), again demonstrating the value of being able to find people who can relate to your own experience, which was also explicitly marked in the next category of key items, Forum relations. The composite items of the category Forum relations are presented in Table 3.6, which shows that a greater number of these keywords and key terms were found in the Replies in the forum. The only items that appeared in the key lists for both types of messages were hello and hi, demonstrating that greetings were a regular feature of the forum. We also found the term good morning as a key feature of Main posts and the term hope everyone would also tend to appear at the beginning of a message, as contributors set a positive and affiliative tone (hope everyone is having a good day). The prevalence of lol in Replies also indicates a light-hearted tone, even after disclosure, relating to personal struggle: Every little pain in arms or chest I immediately think heart attack lol.

The Main post key term first post indicates how common it is in the forum to provide an introductory message and the inclusion of this term offers some justification for the subsequent structure and content, which typically includes a recap of the poster’s personal history with anxiety and an expression of their expectations. In these kinds of introductory Main posts, we also find the following terms: long story, as contributors apologise for the length of their message or look to summarise the key points (long story short); can anyone, which often precedes help, advise or relate, for example; and thanks

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

80

The Lived Experience

Table 3.6 Keywords and key terms relating to Forum relations

Forum relations

Main posts

Replies

hi (7,162), hello (2,596), hope everyone (330), can anyone (250), long story (223), thanks in advance (203), first post (187), good morning (190)

good luck (6,997), big hug (868), kind words (851), good idea (1,183), good night (706), thanks for the reply (509), hi (36,671), xx (18,876), xxx (13,761), hope (35,260), thank (25,929), sorry (14,609), lol (10,270), yes (20,717), luck (9,916), thanks (17,756), alone (12,560), maybe (14,584), hello (6,811), too (20,237, sounds (8,906), reply (6,254), wish (8,833)

in advance, as contributors anticipate responses to their request. The prevalence of maybe in Replies shows how members of the forum oblige in this request for advice, offering mitigated suggestions and thereby showing a preference for providing optionality, as opposed to being too prescriptive. The key terms found towards the end of Main posts contrast with the routine closings indicated for Replies, with examples including big hug, good luck, good night and the conventions for sign-offs, which include xx and xxx: hope you had a good day love big hug :) xx

In this example, we can also see how hope and big hug are used to show affiliation and the keywords alone, sorry and wish function in similar ways, with contributors reassuring other members you are not alone, expressing that they are sorry to hear you’re having such a bad time and wish you well. With respect to the keyword too, we distinguished its meaning as ‘also’ from other functions (e.g., indicating degree and included in the Maximal category, see Table 3.9) in recognition that this was another way in which members demonstrated shared experience (me too). The use of sounds in it sounds like was a very simple way in which participants could show receipt and acknowledgement of what the original poster had discussed, which could be reformulated through

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

81

Table 3.7 Keywords and key terms relating to Personal circumstances

Personal circumstances

Main posts

Replies

normal (5,535), bed (2,855), new job (365), whole life (196)

same way (1,622), same problem (713), new job (602), same boat (510), normal (11,584)

the alternative perspective of the respondent (Sounds like you’re doing brilliantly), or even offer confirmation: Yes this sounds like anxiety. Some of the key items for Replies reflect additional contributions, including the original poster’s response to Replies as demonstrated in the terms thanks for the reply/kind words and contributors generally evaluating suggestions as a good idea. Relatability was also expressed, in Replies in particular, through the key items we categorised as relating to Personal circumstances, which are presented in Table 3.7. For authors of Main posts, this reflected participants’ reconsideration of what is ‘normal’. For instance, they express a desire to get back to normal, that they are unable to do normal things and wonder if what they are experiencing is normal. This break from the ‘normal’ is also indicated in that anxiety has affected my whole life and one routine behaviour that symbolises this normal life and which has been disrupted is going to or getting out of bed. In response, other members of the forum emphasise normality without being dismissive (It’s totally normal but very unpleasant) and by providing sameness (I feel the same way, I have the same problem, I’ve been in the same boat). References to a new job in Main posts show that this is often used as an indicator of wellness and recovery (I see my new job as a breakthrough on the road to recovery), which anxiety threatens to jeopardise (I’m scared I will get dizzy and have anxiety and just not have enough energy for my new job), although the disruption or pursuit of a new job can itself be a source of anxiety. In Replies, members express understanding (Starting a new job can be a stressful time for most people) and offer a more celebratory perspective (Congratulations on your new job!), further demonstrating the sympathy and positivity of Replies that we have observed in relation to other categories. Related to the discussion of physical symptoms, there were a number of keywords and key terms that related to Body parts and processes, which are presented in Table 3.8.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

82

The Lived Experience

Table 3.8 Keywords and key terms in the category Body parts and processes

Body parts & processes

Main posts

Replies

chest (6,263), sleep (7,423), heart (11,540), stomach (3,198), head (8,063), breath (2,534), throat (2,201), breathing (2,253), woke (2,000), wake (2,301), brain (3,095), blood (3,909), heart rate (1,098), blood pressure (966), left side (592), left arm (380), right side (430), heart beat (342), whole body (269)

blood pressure (2,531), heart rate (2,196), nervous system (1,974), heart beat (639), left side (589), sleep (15,799), breathing (9,742), heart (21,399), chest (7,807), stomach (5,223), brain (7,888)

The key items that appeared for both Main posts and Replies show that anxiety is consistently reported as manifesting in the brain, stomach, chest, heart and blood pressure, disrupting the ordinary bodily processes of sleep and breathing. There are a greater number of key items relating to this category in Main posts, though they refer to approximately the same body parts or systems (blood, breath, head, left arm, right side, throat), with the keywords wake and woke reiterating the disruptive effect of anxiety on sleep. Key for Replies were references to the nervous system, which present as a kind of elaboration on how anxiety disorders manifest in physical symptoms throughout the body, providing an underlying structure through which digestive (stomach, throat), cardiovascular (heart, blood), pulmonary (breathing), cerebral (brain) and somnial (sleep) processes can be affected. This is also the basis on which certain treatments – such as vitamins – are recommended in that if they help the nervous system, they will in turn help with symptoms affecting different parts of the body. In Chapter 2 we discussed our observations of Catastrophising and Minimising discourses in relation to anxiety and these are, to some extent, reflected in the key item categories Negative evaluation, Positive evaluation, Minimal and Maximal, which are presented in Table 3.9. Comparing the keywords and key terms that appear in Main posts and Replies, we find matching expressions of negativity (bad, bad day, horrible, worse, bad time, awful) and difficulty (hard time, hard), as well as the term vicious circle in Replies, demonstrating an

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

83

Table 3.9 Keywords and key terms in the categories Negative evaluation, Positive evaluation, Minimal and Maximal Main posts

Replies

Negative evaluation

bad (9,881), worse (5,387), weird (3,443), horrible (2,055), crazy (2,348), wrong (3,729), bad day (540), hard time (371)

Positive evaluation

ok (3,017), good day (905)

Minimal

just (33,777), little bit (422), little thing (244) really (16,985), so (40,750)

bad day (1,538), hard time (785), vicious circle (609), bad time (469), worse (14,633), bad (22,261), horrible (6,215), hard (17,158), awful (4,860) good day (2,499), good thing (1,243), ok (11,586), better (35,107), good (45,245) little bit (1,092), small step (464), just (87,446) really (39,843), too (13,491), so (113,684)

Maximal

understanding of the accumulative effects of feeling anxious about having anxiety, for example. However, our key lists indicate that authors of Main posts more explicitly express the abnormality of their experience, as shown in the keywords weird, crazy and wrong, which are not represented in the key items for Replies. Indeed, in our discussion of the Personal circumstances category, we showed how respondents more readily describe experiences of anxiety as normal. As with other categories, we also find more evidence of positivity in Replies, compared with Main posts, with more explicit acknowledgement of what is considered a good thing and of when other contributors report feeling better. What we find in both Main posts and Replies are hopeful expressions on behalf of other members that they are ok, feel better and have a good day. Positivity was subject to minimisation in Main posts, as contributors refer to a little bit of positivity or inspiration, or feeling a little bit more relaxed, better or stronger, for example. This contrasts with the maximal (really, so) negative effects that even the slightest prompt can have: Every little thing pushes me off edge.

In this way, the problem of anxiety is maximised, in terms of both severity and how many potential triggers there are, since while the triggers themselves are minimal, they are ubiquitous. In the Replies,

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

84

The Lived Experience

there is a sense that members have established provisional thresholds for the extent or amount of negativity they can tolerate in that there are frequent references to too, through which they refer to worrying too much, to dosages being too much and to general behaviours which can become problematic when practised too much. Subsequently, they encourage others to adopt a critical view and to intervene when something becomes ‘too much’. This also contributed to the solution-oriented focus of Replies, in contrast with a problemoriented representation in Main posts. Minimisation is also evident in how respondents present recommendations for such solutions as a small step towards living well with anxiety, which can serve to manage expectations about the potential for recovery. We can also consider this a kind of face-saving, as respondents avoid overstating the utility of their advice and we find the obverse in Main posts, as contributors minimise the imposition of what they are asking of other members and present their desire as reasonable. For example: Just wondering how everyone copes the best with anxiety I just want to feel normal again

The final categories of key items capture Auxiliary & modal verbs and Lexical verbs, which are shown in Table 3.10. Generally, terms in these categories are highly multifunctional and cannot readily be summarised, given the range of uses that they have. Nevertheless, their keyness attests to their use at a higher-than-usual rate and we can see how they contribute to some of the topical patterns discussed earlier. The prevalence of having in Main posts, for example, captures references to posters presently having or historically been having panic Table 3.10 Keywords and key terms in the categories Auxiliary & modal verbs and Lexical verbs Main posts

Replies

Auxiliary & modal verbs

am (24,009), can’t (10,361), dont (3,531), cant (2,827), having (9,367)

Lexical verbs

going (15,987), getting (7,619), got (9,571), go (13,953), get (22,649), went (6,979), trying (4,649)

I dont (1,514), I cant (732), am (48,004), dont (10,054), do (118,867), doing (16,126) try (36,614), get (81,586), going (40,239), go (43,515), take (46,033), keep (21,162), taking (14,939)

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

85

attacks, breathing problems, palpitations and so on as they outline their personal experience of anxiety. In the key items (I) dont and (I) cant we observe the same issue of formatting apostrophes as we discussed in relation to Im and Ive, though the standard form of can’t also appeared in our keyword lists for Main posts. Looking at the use of these terms in context, we once again find a focus on problems in Main posts, as contributors express the ways in which they are inhibited: I dont know, I dont sleep, I cant do it anymore. In the Replies, we also find personal disclosures of limitations as a result of anxiety alongside expressions of sympathy (I cant begin to imagine what you’re going through), as well as ‘solutions’ in terms of the adjustments that members have made to minimise the effects of anxiety: I dont drink caffeine anymore and if I go to the sauna then I dont get panic attacks anymore. This focus on solutions is also evident in the forms try/trying. In Main posts, the present continuous and perfect progressive use of I am trying/I have been trying aligns with the poster’s narrative descriptions of the struggles that have led them to their present moment, reaching out to the forum. In Replies, the use of the present habitual I try suggests a course of action that the poster returns to, as a proven coping strategy, thereby implying advice: I try and breathe and distract myself as best I can

The imperative is also more often found in Replies, such as Try and stay positive n take deep breaths, as well as in instances of keep – that is, calm, in touch, thinking positive – and take (care, your time, a deep breath). A keyness analysis that highlighted prevalent words and terms in Main posts and Replies, respectively, has enabled us to observe prominent themes in the data and the categories we have discussed broadly represent the foremost topics of the Anxiety Support forum. Members of the forum showed an impetus, particularly in Replies, to emphasise the legitimacy and normalcy of anxiety, offering reassurance and advice to those who have come to the forum detailing their struggles with anxiety. We have shown that members of the forum seek and offer affiliation and understanding, and that while those creating Main posts appear to be preoccupied with the negative and problematic aspects of their lived experience, they are met with positivity and guidance from other members. The function of querying key terms was particularly useful for identifying concepts such as panic attack and expressions such as good idea, same problem and right thing, which would have been more difficult to discern based on individual words. It was this observation that encouraged us to look at longer phrases in the data and to consider regular articulations of topics and communicative functions in the forum, which we did by examining key n-grams.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

86

The Lived Experience

Key N-Grams Studies of n-grams (alternatively labelled ‘lexical bundles’) have shown that they usually do not represent a complete structural unit and often bridge two phrases or clauses (Biber, 2009). Furthermore, there is typically overlap between shorter n-grams (3-grams, 4-grams), which combine to form longer strings. As such, in Main posts we find the key 4-grams I was going to (681) and felt like I was (459), which were occasionally combined to form felt like I was going to (136). Subsequently, while our investigation also considered key 3-grams, 4-grams and 5-grams, we have focused our attention on key 6-grams in this discussion, since they generally incorporated what we observed in shorter strings. In comparing key n-grams from Main posts and Replies, we established a relative frequency threshold of 15 wordsper-million (wpm), on the basis that it would generate a manageable number of examples to discuss. In the Main posts data, this was approximate to a raw frequency of 88 and the resultant key n-grams are provided in Table 3.11. We can see from Table 3.11 that some 6-grams overlapped (e.g., felt like I was going to/going to have a heart attack) and n-grams were also combined within posts. In the abridged version of the following Main post, we see that the participant summarises their concern in the heading of the post (I don’t know what to do) before describing their experience (I woke up in the middle of the light [sic]) in terms of physical symptoms and how they tried to make sense of it (I thought I was going to pass out). In the rest of their post, they report their experience of seeking professional help and treatment, leading up to this message to reach out to the forum: Title: I don’t know what to do anymore. Anxiety, Stress, Depression. Very Lightheaded 24/7 I suffer from extreme anxiety, stress & depression. When I was 16 I woke up in the middle of the light brain fogged, dizzy, lightheaded, very anxious and panicky and had alot of outter body experiences. [. . .] I started panicking every single night even having to call my wife home cause I thought I was going to pass out on a nightly basis. this went on for months and I tried controlling them with NO LUCK at all.

This example reiterates how key items in the forum data highlight what participants seek through their messages, the ways of reporting experiences of anxiety and their motivations for reaching out at this moment. This corresponds with Bates’ (2021) observations of

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

87

Table 3.11 Key 6-grams in Main posts Rank

6-gram

Occurrences in Main posts

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

I don’t know what to do in the middle of the night felt like I was going to as long as I can remember going to have a heart attack I was having a heart attack for as long as I can up in the middle of the all I want to do is I was going to pass out I thought I was going to I felt like I was going

593 178 136 120 118 113 102 101 96 95 95 89

advice-seeking in online forums in which participants express having lower epistemic status (i.e., in need of knowledge or ideas from other members), perform relational work by introducing themselves and providing autobiographical information, which in turn provides justification, often by way of a present crisis, for requests for participants’ input. Our observations of key n-grams indicate how these aspects are formulated in the Anxiety Support forum. The n-gram I don’t know what to do expresses a need for help that indirectly encourages advice-giving from other members of the forum and was often followed by an explicit request (Please help me). This shows that it is common for participants to come to the forum when they are uncertain: when they are lacking ideas or the information to navigate their experiences with anxiety. Furthermore, 28.13% of instances of the n-gram came from participants aged 20 to 29, suggesting a ‘junior’ status in relation to anxiety. In 119 instances, the n-gram was followed by anymore/any more, suggesting that the poster had previously been working their way through their experience but had just recently encountered a problem that tested the limits of their own understanding or capacity to find a solution. Indeed, other key n-grams establish that participants have had some kind of experience of anxiety for as long as I can/as long as I can remember and there are often details of long-term problems and efforts to combat issues of anxiety, attesting to the poster’s efforts in trying to deal with the problem themselves. The severity of such experiences is reflected in the various n-grams that describe the physical sensation and impact: I felt like I was going to/going

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

88

The Lived Experience

to have a heart attack/I was having a heart attack/I was going to pass out. Contributors would also describe feeling such as they were going crazy, mad or to lose my mind. As such, they describe experiences that corroborate posters’ accounts of a ‘crisis’, for which they are seeking support or explanation. These anxiety encounters could mark the beginning of a narrative that subsequently involved medical tests, diagnosis, treatment and so on or a problematic turn in an otherwise consistent series of events, of which the contributor has better comprehension. The key n-grams up in the middle of the/in the middle of the night echo our observations of anxiety reported in terms of sleep disturbances and these depictions minimise the agency of the person experiencing them, since they are at rest. In other words, the individual is not engaging in any particular anxiety-inducing activity, rather anxiety can be activated even when the individual is asleep. Subsequently, authors of Main posts spoke of their desperation, expressed in the key n-gram all I want to do is, which prefaced desires such as go back to work and normalise my life a bit, or get on and do my job. Our investigation of n-grams in Replies similarly focused on 6-grams, with the same relative frequency threshold of 15 wpm. We observed similar overlap for key n-grams (including 3-, 4- and 5-grams), in that the key 6-grams shown in Table 3.12 can be summarised according to a handful of phrases. Furthermore, Replies tended to be shorter than Main posts and the n-grams we observed were more likely to offer ‘complete’ expressions that could be taken at face value. In other words, they expressed unambiguous sentiments, the meaning of which was not subject to change based on the context of the forum post in which it appeared. Based on key 6-grams, Replies can be characterised in terms of showing affiliation and reciprocity, suggesting that members of the Anxiety Support forum respond in kind when authors of Main posts share personal anxiety narratives and seek support. In the first instance, the key n-grams i know exactly how you feel and you are not on your own explicitly denote shared experience, which we have seen is often directly requested in Main posts. In 54.19% of cases, this was written by someone identifying as Female (in 12.56% of cases, Male). The key 6-grams light at the end of the/at the end of the tunnel served a similar function in that authors of Main posts often implored other members for signs of hope – there were 87 instances of light at the end of the tunnel in Main posts. Whether prompted by the matching phrases or otherwise, respondents are unequivocal in affirming the light at the end of the tunnel, alongside empathetic disclosures that they too had struggled to be optimistic about coping with anxiety. In addition, we see reciprocal personal narratives as respondents describe their own ‘crisis’ moment

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

What Do Members of the Anxiety Support Forum

89

Table 3.12 Key 6-grams in Replies Rank

6-gram

Occurrences in Reply posts

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.

thank you so much for your i hope you feel better soon us know how you get on let us know how you get i know exactly how you feel i wish you all the best at the end of the tunnel light at the end of the us no how you go on let us no how you go Hope and Help For Your Nerves in the middle of the night at the end of the day let me know how you get me know how you get on you so much for your reply hope you have a good day you are not on your own thank you for your kind words i was having a heart attack and let us know how you

679 503 500 498 411 318 281 276 260 258 258 256 256 237 235 230 215 205 205 200 200

using the key n-gram (I thought/felt like) I was having a heart attack. As with Main posts, these could equally mark the onset of their experiences with anxiety, or a more recent episode that indicates that they are still facing those types of challenges. Similarly, respondents would refer to waking up in the middle of the night to show their shared experience of sleep disturbances, however, in Replies, this more often preceded suggestions for how to deal with that aspect of anxiety disorders. when you wake up in the middle of the night feeling anxious just drink a cup of green tea This happens to me in the middle of the night so I’ve been keeping a heat pad in my bed.

There are further indications of advice-giving in Replies, in the key n-gram at the end of the day, for example, marking the articulation of a considered point of view that spoke of the poster’s wisdom.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

90

The Lived Experience At the end of the day worrying about it isn’t going to make it go away At the end of the day, it should be your call about what medication you are on

As a summative statement, it often appeared after a more detailed description of personal experience, coping strategies and treatment options. Again, we could say that this type of response is requested in Main posts by people who otherwise don’t know what to do. Another recommendation is indicated in the key 6-gram Hope and Help For Your Nerves, which refers to the title of a popular self-help book by Dr Claire Weekes and its alternative title, Self Help For Your Nerves, also appeared 196 times in Replies. This specific book was recommended by 72 different users (although one specific user was responsible for 117 (44.49%) mentions), among other resources and coping strategies. There is clear evidence that members of the forum look to facilitate dialogue, beyond a simple problem-solution exchange. The key n-grams thank you so much for your/you so much for your reply and thank you for your kind words predominantly indicate that authors of Main posts return to acknowledge other participants’ replies, which are described as advice, help, lovely comments and support and so on. Less often, this would be a comment on the original post itself, indicating that advice is more commonly found in Replies than Main posts. Seven of the key 6-grams represent some part or version of the phrase let us know how you get on, a clear indication that respondents in the forum are receptive to the personal stories of other members and encouraging of further contributions. The anticipation of further developments reflects the narrative structure observed in Main posts, by which posters position themselves at some kind of crisis moment that has prompted them to seek advice. Subsequently, respondents express a vested interest in knowing that the poster was able to navigate this challenge and/or that their advice was successful: Let us know how you get on with the further tests. If you do try it let us know how you get on with it.

Even when a respondent might not relate to the specific experiences described in a Main post, there were other expressions of empathy, notably I hope you feel better soon, I wish you all the best and hope you have a good day. Like the phrase let us know how you get on, these typically appeared as a kind of sign-off to a Reply, punctuating the message with a strong affiliative statement.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Emoticons and Emoji

91

Emoticons and Emoji The final part of our analysis in this chapter concerns the use of emoticons and emoji. We found 59,757 occurrences of precisely 200 different characters in the Anxiety Support forum corpus, appearing in 14.25% of posts and used by 24.51% of contributors. Compared with the English Web 2020 corpus, emoticons and emoji were underused in the Anxiety Support forum and none of the individual characters reached our threshold for keyness. The relative frequency of emoticons and emoji (2.53 per 1,000 words) was also lower than that observed by Frehner (2008) in SMS texts (4.88 per 1,000 words) and emails (3.18 per 1,000 words). While their general use was not notably frequent in the Anxiety Support forum, we observed that emoticons and emoji were a key feature of Replies (3,116 occurrences per million words) compared with Main posts (1,481 occurrences per million words). Based on the observations we have made so far of keywords and key n-grams and taking the use of emoticons at its broadest function (Dresner and Herring, 2010), this finding would attest to the affiliative nature of Replies. The most frequently used characters for Main posts and Replies, respectively, are shown in Table 3.13. The prevalence of smiley emoticons – having a resemblance to facial expressions – would suggest that users are largely using these characters to provide some indication of affective states, strengthening the valence of the message as it is communicated in text (Jaeger et al., 2019), for example, or softening the impact of potentially negative messages (Skovholt et al., 2014). Table 3.13 Frequent emoticons and emoji in Main posts and Replies Main posts

Replies

Character

Occurrences Posts Users Character

Occurrences Posts

:( :) :-) :-( :/

2,648 2,013 612 483 415 157 109 100 91 87 82

21,134 9,625 4,125 2,237 1,421 1,315 1,145 978 875 763 1,313

:D ;) :’(

2,053 1,463 418 390 366 135 83 79 84 74 72

855 542 101 137 165 78 28 47 41 49 40

:) :-) :( :D ;) :-D :/ ;-) :-(

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Users

17,462 2,088 6,525 399 3,752 1,043 1,756 127 1,103 316 1,158 211 1,046 250 777 34 827 307 693 90 1,106 248

92

The Lived Experience

Our keyness analysis pointed to more prevalent use of negative emotion characters in Main posts and more positive characters in Replies. The emoticons :(, :-(, :/ and :’ (were key for Main posts and the following were key for Replies: :), :-), :D, ;), :-D, , and ;-). These results are consistent with our observations of the ‘problem’ nature of Main posts and more positive tone of Replies in the forum. In 390 (19.00%) Main posts that featured the emoticon :(, this punctuated the Title for the message, establishing a negative tone for the post. For example: Worst iv been for ages :( Why is this happening to me :( Great . . . :(

These instances demonstrate that contributors have been prompted to post on the basis of a recent (re)emergence of a particularly bad experience associated with anxiety, looking for explanations and advice, as well as the use of emoticons to indicate, in this case, the ironic use of ‘great’. If we consider the full content of Main posts, there are frequent references to help (325 instances), please (185) and advice (64) alongside this emoticon, as well as explicit references to corresponding emotional states such as scared (162), panic (89) and hate (54). In comparison, in Replies :( more often appears alongside expressions of sympathy; for example, sorry to hear you’re feeling crappy too :(. We observed similar patterns for the comparable characters :-(, :/, :’ (and . We found that preferences for form of comparable emoticons/emoji were associated with different types of contributor. For example, in 32.10% of messages featuring :-(, the contributor reported as being from the UK and in 5.61% they reported being from the USA, compared with instances of :( where 25.40% of messages came from the UK and 15.99% came from members based in the USA. Furthermore, users aged 20 to 34 contributed 39.28% of messages featuring :( but only 15.64% of messages featuring :-(. The :-( form was potentially favoured by older participants, with members aged 40 to 49 contributing 14.91% of messages with this emoticon but only 5.17% of posts featuring :(. The proportion of messages contributed by female and male posters was comparable between :( and :-(. The more explicitly positive characters :), :-), :D, ;), :-D, , (:, :) and ;-) were key for Replies and often appeared alongside the kinds of supportive statements we have observed as more strongly associated with Replies: Good idea! Let me know how it goes :)

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Emoticons and Emoji

93

Im glad you had a great day!! Lets keep going !! hope you can see that light at the end of the tunnel ;)

Indeed, here we can see how the characters combine with key items we have discussed already in this chapter, as well as how the repetition of emoji can more emphatically convey the sentiment being expressed. Similarly in Main posts, where the use of such positive smileys was relatively less frequent, it appeared alongside the kinds of affiliative statement we have seen at the start of such messages (Hope you’re all okay ) and the pre-emptive thanks that tend to appear at the end (Thank you for your advice :)). Certain characters appeared to be more adaptable to a range of functions. For example, was used to express positivity, empathy, as an abstract representation of love or an iconic representation of the human heart: his post makes me happy!! It brightened my day!! Thank you!!!!! I get you. I understand. You are not alone. I

my boyfriend

It’s the adrenaline! Don’t worry it won’t be your up with the anxiety.take care don’t panic xx

your heart rate goes

Only when the icon stood in for a lexical item (‘love’, ‘heart’) would it appear in the middle of a clause, that is, in the appropriate syntactical position. When performing other functions, it would more typically occur at phrasal or sentence boundaries much like punctuation marks, as has been observed across various CMC contexts (Dresner and Herring, 2010; Skovholt et al., 2014). When we looked at the distribution of emoticons and emoji in relation to different kinds of contributor, we found that, collectively, these characters were key for posts written by female members (3,089 wpm) compared with male posters (1,072 wpm) and that of the 4,356 users who posted messages with at least one emoticon or emoji character, 48.71% identified as female (13.66% identified as male). Since emoticons were also more frequent in Replies, the prevalence of female members among posts with emoticons may in part be a result of a higher proportion of female members posting Replies. Of the participants who used emoticons and emoji and disclosed their age, 35.67% were in their 20s and 39.42% were aged between 30 and 39, with significantly lower frequencies for participants aged 40+. These findings, indicating higher usage among women and by younger people, are consistent with previous

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

94

The Lived Experience

findings (Prada et al., 2018). This raises questions about the different roles that participants carry out in the forum and how they manifest in different communicative strategies. For instance, we have reported findings that suggest that younger participants express not knowing what to do, so are more senior members of the forum offering advice? If they are not in a position to impart wisdom, are less senior members opting to express affiliation and empathy (with or without emoticons)? In the chapters that follow, we focus more on the interactive dynamics of discussion threads, including the range of response types documented in the forum and the contributions of different types of participants.

Conclusion We set out in this chapter to conduct an exploratory analysis of the Anxiety Support forum, to identify prominent themes and to consider the manner of expression used in this online space, as a form of CMC. The themes we identified based on keywords and key terms pointed to a focus on symptoms and personal anxiety narratives, indicating that in Main posts members set out to introduce themselves and give other members sufficient information about their circumstances in order to offer reassurance and advice. The key items for Replies also reflected a focus on symptoms and personal stories, but more significantly demonstrated some of the coping strategies recommended by other members of the forum, alongside expressions of affiliation and sympathy. The use of emoticons reflected a relatively informal tone, particularly in Replies, and a heightened sense of affective expression. Consistent with the findings of Stommel and Lamerichs (2014), the agenda-setting (Main) posts in this online forum were characterised by ‘problems’, which was evident not only in keywords and terms but also key n-grams and emoticons associated with negative emotions. Replies were notably more positive, expressing optimism and empathy and encouraging further dialogue (let us know how you get on). While the Main posts sometimes evidenced features linked to catastrophisation, the Replies tended more towards a normalisation representation of anxiety. That these patterns were shown to be consistent across the forum and evidenced in different units of analysis attests to the shared understanding among participants of why people come to the forum. We saw a pattern of behaviours by which new members – or members experiencing ‘crisis’ moments – outlined their situation to the forum and respondents were accommodating in their focus on that individual’s case, drawing on their own individual stories as a show of solidarity and as the basis for advice-giving. There was an imperative

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

Conclusion

95

among authors of Main posts to show that they had made attempts to navigate their own challenges, but that the current crisis has pushed them over the limit of what they had the capacity to deal with on their own. As such, they positioned other members of the forum as more knowledgeable and potentially able to offer the wisdom of their experience. In addition to highlighting the different sentiments and communicative functions of Main posts versus Replies, our key n-gram analysis has indicated that there is a general structure to forum posts, with introductory Main posts often beginning with well wishes for other members (hope everyone is having a good day) and closing with an invitation (Has anyone else had the same thing?) and/or pre-emptive thanks (thanks in advance); and in Replies, expressions of sympathy are foregrounded (sorry to hear you’re having such a bad time) and respondents often close on an optimistic tone (I hope you feel better soon), inviting further dialogue (let us know how you get on). In the next chapter, we turn our attention to these structural aspects, as well as the sequencing of posts as discussions unfold in the forum.

https://doi.org/10.1017/9781009250139.004 Published online by Cambridge University Press

4

Creating a Community

Introduction We have seen in Chapter 3 that members of the Anxiety Support forum endeavour to share personal stories, seek to find people who can relate to and advise on their situation and show affiliation with their peers. In this chapter, we consider the differences between posts that receive replies and those that do not, highlighting a small number of users whose contributions appear misaligned with the more typical communicative purposes of the forum. We then focus on the structure of forum posts and the sequencing of discussion threads to consider the interactional dynamics of how different communicative purposes are realised in the forum and how members create a dialogue that pursues particular communicative goals. We look at the frequency and manner of responses with a view to understanding how the composition of forum posts can facilitate successful and supportive interactions with other members. In order to track the articulation of the communicative purposes of forum posts, we apply a coding scheme for functional discourse units (Egbert et al., 2021). Based on nine codes which indicate the particular purpose of a stretch of interactive text – for example, giving advice, recounting past events or expressing disagreement – the scheme was originally developed for use with spoken conversation and so we reflect on our application of the scheme to online forum data. Orienting our discussion around those codes, we report: a) what kind of language is typical of each functional discourse unit; b) the ways that discourse units are combined in initial posts and responses; and c) typical patterns of interaction. This allows us to observe how members communicate in this online space and what other members respond to, thereby indicating what is considered appropriate to the Anxiety Support forum.

96

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Forum Interactions

97

Forum Interactions In Chapter 3, we saw evidence in the regular forms of expression of some of the documented aspects of online support groups previously reported in the literature (e.g., Stommel and Lamerichs, 2014), such as the construction of illness identities (anxiety sufferers), advice-seeking (I don’t know what to do) and the establishment of shared experiences and consensual views about anxiety disorders (does anyone else feel like this, you are not alone). Correspondingly, online peer forums are recognised as a valuable resource, alongside consultations with medical professionals, for example, in the wider provision of resources that support shared decision-making (Elwyn et al., 2010). The regularity with which these dimensions are referenced attests to some of the celebrated characteristics of online spaces for fostering communities that empower individuals through information exchange, emotional and social support, access to others in similar situations and the sense of autonomy that is enabled when individuals have the capacity to pursue resources outside of traditional health institutions (Armstrong et al., 2012). However, there are also potential challenges with online communities – enabled to some extent by the absence of the kinds of regulation found in institutional spaces – that can lead to disagreements, criticism and aggression that can compound users’ stress and anxiety (Armstrong et al., 2012). Like many of the communicative purposes we discuss in this chapter, disagreement and, more broadly, conflict can occur at varying degrees of magnitude and explicitness. Shum and Lee (2013), for example, found as many as 11 types of disagreement in internet forums popular among users from Hong Kong. Conflict, however, is not intrinsically a problem for online interactions; Black (2008, p. 1) states that difference is ‘essential for good problem analysis’ and that ‘groups that insulate themselves from disagreement and diversity are likely to make bad decisions’, suggesting that some forms of disagreement/conflict are an important part of the deliberative process. Argumentation strategies in online discussion groups have been shown to often include stories and different kinds of evidence, including personal experience (Black, 2008), much like we have observed in terms of supportive responses in the forum. Given that personal experience can both support and challenge the perspectives of other members of the forum, we can learn more about how participants in the forum draw on various resources and construct their posts by looking at how they function in the context of the discussion thread.

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

98

Creating a Community

Replies in the Anxiety Support Forum When we consider the frequency and distribution of replies across the Anxiety Support forum, we find that it is quite uneven and that most posts receive a small number of responses. Figure 4.1 shows that 3,005 (7.11%) Main posts did not receive any replies and that the number of direct replies to the Main post was typically small, with 18,033 (42.69%) of Main posts receiving either one or two replies. The highest number of direct replies to a Main post was 184, discussing the topic of sleep disturbances. This discussion thread amassed 314 contributions in all, posted over a long period between August 2014 and November 2019. The largest discussion thread, which contained 586 different messages posted over the course of June to September 2019, was similarly prompted by anxiety related to sleep disturbances, however, it involved a much more rapid and sustained exchange between two members (in particular), resembling a spoken conversation or instant messaging interaction. Furthermore, the participants explicitly mention the technical problems arising from loading a discussion thread this large, prompting them to start anew with another thread. Both examples attest to the continuity of dialogue and support in the forum, in contrasting timeframes, demonstrating that the platform supports users in engaging with an archive of posts from long-standing members, as well as in having near-immediate conversations with their peers.

10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

Replies

Figure 4.1 Number of Main posts according to number of direct replies

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

20 21+

Replies in the Anxiety Support Forum

99

We considered if there were any differences in the content of posts that received zero replies, compared with those that received (1+) replies. However, wordlists showed that the most frequently used tokens for each sub-corpora were similar and used to a comparable degree, in terms of relative frequency. This suggests that the ‘success’ of a post, in terms of eliciting responses, was not based simply on the content at the level of specific lexical items. Nevertheless, a keyness comparison did highlight that posts that elicited replies more typically featured terms that conveyed severity and urgency, as well as attending to the interpersonal dynamics of the forum (see Table 4.1). For Main posts that received at least one response, references to cancer and tumor, for instance, reflect an aspect of health anxiety in which many contributors are concerned that they have cancer and

Table 4.1 Keywords for Main posts that elicited replies compared with Main posts with zero replies Main posts which received 1+ replies

Main posts which received zero replies

cancer (1,650), dying (1,652), tumor (553), lightheaded (710), xx (1,155), crying (1,254), abit, (313), xxx (977), dizziness (1,509), symptom (1,099), er (963), mum (1,153), massive (357), seriously (645), sorry (1,600), die (2,342), 24/7 (524), bed (2,689), waiting (1,038), anymore (2,320), terrified (1,048), ears (758), legs (1,354), pains (2,502), tomorrow (1,369), hospital (1,686), tight (1,062), lonely (357), illness (877), fed (596), edge (493), nurse (328), constantly (2,341), shaking (996), kids (1,169), hubby (321), stroke (360), awful (1,336), doctors (2,610), pins (311), nobody (329), cope (1,552), she’s (658), picture (231), miserable (268), live (2,135), palpitations (1,209), husband (1,285), extremely (951), scared (6,628)

UK (49), our (258), mg (107), resistance (19), danger (28), wound (25), grounding (16), Etizolam (15), condition (62), medicine (69), system (57), message (46), services (22), depersonalisation (20), VOC (14), smoking (47), your (649), nap (30), double (26), serum (14), drug (46), root (23), free (83), website (36), role (22), liked (21), yourself (89), using (55), us (169), shares (13), thus (20), price (14), u (136), email (24), video (25), Cymbalta (19), experience (174), lead (35), learn (47), interested (28), power (28), Amsterdam (12), devil (15), habit (27), asthma (32), certain (63), order (35), effective (20), recommend (28), meditation (36)

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

100

Creating a Community

a comparable concern is reflected in references to dying. Others have a confirmed diagnosis or personal experience with cancer (i.e., through a relative, such as mum) and have questions about its interaction with anxiety. Taken with references to potential symptoms (lightheaded, dizziness, symptoms, pains, shaking, stroke, pins, palpitations), these messages indicate a preoccupation with diagnosis: understanding what constitutes an anxiety disorder and if the poster’s experience of it is ‘normal’. The severity of the poster’s experience is indicated in strongly evaluative terms such as massive, seriously, 24/7, constantly, awful, miserable and extremely and the desperation felt by posters expressed in not knowing how to cope anymore and being fed (up). As discussed in Chapter 3, the sense of having exhausted their options is one of the motivations for members joining the forum, in order to seek advice and understanding from others. That these aspects of posts feature prevalently in messages that get replies suggests that this is accepted as a purpose of the forum. The presence of xx and xxx attests to the kind of forum relations discussed in Chapter 3, as posters sign off their messages with well wishes such as take care, as well as thanks in advance. Kouper (2010) observed a prevalence of pre-emptive thanking in such contexts and this may encourage other forum members to respond, since they are already ‘indebted’. Posters also show their consideration for other members in the use of sorry; for example sorry to go on. The combination of the urgent issue and the interpersonal work carried out in Main posts could encourage replies, however, these features are not entirely absent from posts with zero replies, so we would caution against the suggestion that simply including these terms will ensure responses. We found that we were discounting a large number of keywords generated from posts that received zero replies on the basis that it was individual users who were providing the majority of instances and this pointed us to a shortlist of users with a particularly high rate for no-response Main posts. Table 4.2 highlights four cases in which members posted a minimum of 15 Main posts with at least 40% of those with no responses. We briefly review their posts to consider if their approach was unconducive to eliciting responses. The first of these forum members, renamed UserID#e27ef6 through anonymisation, tended to post platitudes, offering non-specific advice that arguably discouraged dialogue, in that they were written as matter-of-fact ‘truths’. For example: Every tomorrow has two handles. We can take hold of it with the handle (UserID#e27ef6) of anxiety or the handle of faith.

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Replies in the Anxiety Support Forum

101

Table 4.2 Forum members with a high rate of Main posts receiving zero replies

UserID

Age

Country Gender

Main Ethnicity posts

e27ef6

60

USA

Male

None

15

8 (53.33%)

d5804d

25

USA

Female

Black

19

10 (52.63%)

7522a1

None

UK

None

None

36

16 (44.44%)

ec06d4

45

UK

Male

None

21

9 (42.86%)

The fears we don’t face become our limits.

Main posts with no replies

(UserID#e27ef6)

Never be ashamed of a scar. It simply means you were stronger than whatever tried to hurt you. (UserID#e27ef6)

This type of advice is quite abstract and unsolicited, running counter to other trends we have observed in the Anxiety Support forum of members outlining their personal struggles and requesting advice from members they perceive to have wisdom from lived experience. The matter-of-fact nature of these statements also means that they are not ‘dialogically expansive’ (Martin and White, 2005), that is, they do not encourage the expression of alternative points of view. Ultimately, they do not give the impression of someone who is looking for input from the forum on their personal circumstance, which may account for why this was not forthcoming. Posts from UserID#d5804d that received zero replies similarly offered recommendations, specifically in the form of social media resources such as YouTube videos and Instagram profiles. This type of contribution arguably does not necessitate feedback, and if it did, it would probably be directed towards the creator of the resources, rather than the poster of the message. Furthermore, these recommendations include hyperlinks, which if other members do follow, take them away from the Anxiety Support forum, thereby disrupting any potential for dialogue at that moment. One of the community guidelines discourages members from using the forum for commercial or personal promotion (https://healthunlocked.com/anxietysupport/ about) and while this would not preclude the sharing of links and resources to third parties, posts that function only in this way may be perceived as contrary to the fundamental aims of the forum.

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

102

Creating a Community

UserID#7522a1 presents a potentially similar divergence from the more commonly occupied roles of members on the forum in that they are a self-proclaimed representative of the charity organisation AnxietyUK (and as shown in Table 4.1, UK is a keyword of the Main posts that received zero replies). Between March 2012 and May 2013, UserID#7222a1 posted 36 Main posts and 102 posts overall that highlighted the work of AnxietyUK, including inviting members to participate in surveys, alongside the dissemination of pertinent news stories relating to mental health issues more generally. Given that this individual participates in this forum in a professional capacity, they stand out from other members who are forthcoming with very personal issues. Furthermore, the style in which the posts are written is distinct; whether they are reporting news events or inviting survey responses, the posts read differently to the personal narratives and expressions of affiliation that we have already observed as more typical of the forum. This activity again could be seen as misaligned with the community guidelines and this, along with the low level of response, may account for why the user stopped posting after about a year. Our final example of a contributor with a high rate of Main posts without replies demonstrated a different kind of violation, in that on multiple occasions they appeared to post replies as new discussions, that is, Main posts. For instance, the following message appears to be directed at a specific member of the forum: Mite be the pills giveing you this do you get it even more whan you take (UserID#ec06d4) them

The offer of an explanation suggests that UserID#ec06d4 is responding to a specific problem outlined in another post and the question constitutes further inquiry into this specific issue, though since it is not linked to a prior message (i.e., as a Reply), it is not clear who the intended recipient is and if they are likely to see the message. Furthermore, without the context of the preceding message, other users may struggle to know how to respond and this, in turn, likely accounts for why it received zero replies. These brief case studies have highlighted different ways in which members behave contrary to the wider conventions of the forum, whether by communicating in platitudes, promotion or failing to post as a continuous thread. In our analysis of discourse units, we identify recurring sequences of communicative functions, thereby highlighting more conventional ways of interacting, which we discuss in terms of communicative purposes and response types.

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Documenting Forum Interactions

103

Documenting Forum Interactions The different motivations for participating in an online forum can manifest in various communicative strategies. For instance, when investigating a forum for support with eating disorders, Eichhorn (2008) found that seeking different kinds of support (informational, tangible, esteem, emotional and networking) was linked with different communicative strategies such as using self-deprecating comments, issuing requests for information and providing statements of personal success. While Eichhorn (2008) coded the support type for each post, it was clear that an individual message could function in multiple ways, offering more than one type of support, for example, or both offering and eliciting support. This has implications for documenting communicative purposes – which we discuss later – but nevertheless, demonstrates that we can point to specific content to evidence support in the forum. Stommel and Lamerichs (2014) argue that in addition to conveying social actions in posts, participants in a forum orient to their ‘sequential implicativeness’ (using the term introduced by Schegloff and Sacks, 1967), not only creating a space in which a response can be anticipated, but also providing cues as to the manner of the response. We can draw on the description of adjacency pairs by Schegloff and Sacks (1967) and the notion of a ‘preferred’ response to articulate how the formulation of a message encourages members to respond in particular ways; for example, greetings encourage reciprocal greetings, questions encourage answers, offers are typically met with acceptance. The completion of these two-part exchanges, however, relies on the first part being recognised by the respondent, since it can be signalled with different levels of explicitness. While directness may serve to maximise clarity, there are interpersonal motivations for taking a less direct approach (Kouper, 2010; Locher, 2013). Advice-seeking, for instance, can manifest in ‘low contingent’ questions (Vayreda and Antaki, 2009) that minimise the impetus on other forum members to respond. The non-specificity of a general request for help gives the other participants options regarding whether and how they respond, in comparison to more focused requests on specific topics. Similarly, posters can indicate a preference for descriptive rather than evaluative responses by asking, for example, what happened?, as opposed to what should I do? (Veen et al., 2010). This range of directness is also observed in advice-giving, with stories of personal experiences variously functioning to provide the legitimacy to give direct advice, or as indirect advice in themselves (Veen et al., 2010). While the reporting of the personal experience implies relevance, there is more scope for the

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

104

Creating a Community

addressee (i.e., the advice-seeker) to find the parallels with their own experience and thereby determine if and what is advisory. This also highlights the fact that communicative goals – such as deciding on treatment options – can be realised through different communicative purposes; for example, retelling past experiences or deliberating on the pros and cons of what is available (Biber et al., 2021). In light of the options available for different interactional objectives, Stommel and Lamerichs (2014, p. 201) emphasise that asking and giving advice, for example, are ‘sequentially related’. Furthermore, Waring (2007) has observed that if participants are looking for advice, they are more likely to interpret a post as such, even if it is not explicitly marked in the message. Advice may be offered in the absence of a clear request and, likewise, descriptions of personal experiences might only be considered to be advice following an explicit request. This, again, highlights that the realisation of a communicative goal may be contingent upon the ‘right’ response and the capacity for the responder to infer a communicative objective in the original post. It was this consideration for the ways in which communicative goals are coconstructed that directed us towards coding the Anxiety Support forum data through the documentation of functional discourse units. In prior research, we find different approaches to documenting the ways that online forum participants signal their intent through particular linguistic features. Armstrong et al. (2012, p. 351), for instance, conducted a thematic discourse analysis with the aim of uncovering underlying ideas, assumptions and conceptualisations behind identityconstruction and the normative social processes of an online diabetes forum. Locher (2013) carried out a content analysis of response letters generated by the online advice column Lucy Answers in terms of ‘discursive moves’. This allowed Locher (2013) to categorise different advice-giving strategies in terms of their directness, as well as observing how these operated sequentially. Other studies have shown that advice-giving is often accompanied by content designed to perform certain ‘relational work’ in order to mitigate the potential offence caused by telling others what to do (Bates, 2021). McDonald and Woodward-Kron (2016, p. 164) observed that what they call ‘unmodulated imperatives’ are used by veteran members when the instruction relates to social support (e.g., take care of yourself) as compared with when the advice involves some concerted effort on the part of the addressee, which is more likely to be modalised (e.g., you should consider) and accompanied by an explanation. Short personal stories can simultaneously function to create affiliation and authority, as well as offer advice indirectly (Armstrong et al., 2012). This begins to show how elements combine in an online forum post to

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Documenting Forum Interactions

105

achieve multiple objectives (e.g., provide advice while maintaining a good relationship) though it can be difficult to separate out these objectives in relation to specific content. Fu et al. (2016) developed a coding scheme to describe discourse patterns in an online educational forum, which supported them in investigating collaborative learning and knowledge building. However, their coding scheme involved 43 codes developed iteratively from the dataset, which could be ‘overlapping, nested, or embedded within one another’ (Fu et al., 2016, p. 449). This degree of overlap demonstrates that participants can switch between communicative purposes over the course of an interaction or even potentially within an utterance. As Egbert et al. (2021, p. 720) observe, ‘interlocutors may move from one communicative goal to another many times in a single conversation’. We are interested not only in how participants construct their own posts towards particular communicative ends, but also how the interplay between different communicative objectives can extend across posts in a discussion thread, as it is co-constructed by multiple participants. We can draw on principles of Conversation Analysis to capture interactional aspects of online forum data in terms of turn-taking, sequence organisation, repair, and opening sequences (Meredith, 2019). However, in addition to focusing on online content at the micro-level, there has also been interest in higher-level coherent units of talk that occur in conversation, namely ‘discourse units’ (Biber et al., 2021). Discourse units are understood to be natural, selfcontained and functional units in interaction (Egbert et al., 2021) in that they are produced in naturally occurring interactions and their beginnings and endings can be marked out in the text. With respect to being ‘functional’, Egbert et al. (2021, citing Biber, 1995, p. 137) refer to linguistic features and units that ‘both perform discourse tasks and reflect aspects of the communicative situation and production circumstances’. Our investigation of discourse units (DUs) in the Anxiety Support forum uses a pre-existing coding framework, the development of which is described in Egbert et al. (2021) with a demonstration of its application to transcripts of spoken conversational data in Biber et al. (2021). In these works, a discourse unit (DU) is defined as: 1. Coherent for its overarching communicative goal, which is both the primary objective of a DU and the task that the interlocutors are doing with language in the DU. This goal is typically coupled with a single topic or theme. Each DU has one communicative goal (e.g., complaining about annoying co-workers; making plans

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

106

Creating a Community

for buying Christmas gifts). There is an open-ended set of specific communicative goals, and these are not coded or labeled in our framework. 2. Characterized by one or more communicative purposes, where a communicative purpose is a finite set of actions that serve to help accomplish the communicative goal of a DU. Communicative purposes are coded in our framework. A DU may rely on one or more communicative purposes. When present, communicative purposes are coded on a scale from 1 to 3. 3. Recognizably self-contained: A DU has an identifiable beginning and end. 4. Length requirement: A DU has a minimum of five utterances or 100 words. (Egbert et al., 2021, p. 725; emphasis in original) The first point highlights that the possibilities for communicative goals are boundless and so it is not practical, or desirable, to try to come up with a typology for the many things interlocutors may choose to discuss. These are distinguished from communicative purposes, for which Egbert et al. (2021) have developed a taxonomy comprising nine types, which we outline below. In recognition of the multifunctionality of a discourse unit, the team developed an additional scale (0–3) that allowed them to distinguish a single dominant communicative purpose (coded 3), alongside an unspecified number of less prominent purposes (coded 1 or 2). Thus, we can record not only the frequency and distribution of communicative purposes in the data, but also report which purposes tend to be realised in the same discourse unit and which purposes tend to be combined in contiguous discourse units, including how certain types of original post prompt particular kinds of replies. The inclusion of a minimum length threshold relates to one of the key challenges of Egbert et al.’s (2021) work (with further details reported in Biber et al., 2021) developing the coding framework: segmentation, that is, the separation of discrete units prior to characterising them according to a restricted of codes or types. Multiple coders were used to evaluate how consistently speech events were identified in conversational data, with moderate success, which highlighted that one of the fundamental considerations for this segmentation process was granularity, that is, the extent to which a string of utterances could be split into further distinct units. This led Egbert et al. (2021) to establish a minimal threshold for length – five utterances or 100 words – which they state was fairly arbitrary, but practical in terms of achieving consistency in segmentation. One of the fundamental aspects of our adaptation of the coding framework related to the criterion for length

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Documenting Forum Interactions

107

and, ultimately, establishing the boundaries of a functional unit. In some aspects, online forum data are more clearly delineated in that posts have clear boundaries and it is not possible for ‘turns’ to overlap. This has implications for how posts are constructed, in that multiple objectives might be pursued in one message and even manifest in a hierarchical structure, with participants punctuating the message with their priority aim, in the form of an explicit request for help, for example. Furthermore, the poster can anticipate (even encourage) multiple responses to the same prompt, which can be generated at any point after the message is posted. Additionally, in spoken conversation, responses rely heavily on a chronological sequence, in that they tend to be immediate, as a continuation of the current topic of discussion and the present communicative goal. In asynchronous communication, such as online forums, a response to a specific post does not necessarily need to be the next chronological contribution and, indeed, the layout of the discussion on the website is often designed to visually demonstrate how posts relate to one another, giving respondents the option to reply to specific posts at any position in the thread. However, Bieswanger (2016) problematises the asynchronous/synchronous distinction and argues that while it is possible for participants to provide more considered and, potentially, crafted responses in asynchronous modes, the development of an ‘always online’ culture means that users of asynchronous online spaces can still exchange near-instantaneous messages that can, in turn, operate more like response turns in spoken conversation. Indeed, observations of conversational repair (Meredith, 2019) attest to the speed at which participants produce unplanned responses, so we should be cautious about overstating the degree of planning behind contributions to the forum. Nevertheless, with a more flexible timeline in which to offer a response, there is arguably a greater scope for generating texts of various lengths in an online forum and optionality in terms of whether multiple communicative goals are pursued in one post or over the course of separate messages. Based on early observations of the forum data, which demonstrated that posts could be quite brief (e.g., You should go to Gp as soon as possible), we decided to forego a minimum requirement for length, which was conducive to consistent segmentation between coders. Table 4.3 presents the nine discourse unit types and their codes, which are used to characterise different communicative purposes as described in Egbert et al. (2021, pp. 730–731).

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Code

adv

con

des

fel

fto

fut

Label

Giving advice and instructions

Engaging in conflict

Describing or explaining: timeneutral

Sharing feelings and opinions

Figuring things out

Describing or explaining the future

An explanation to justify a speaker’s preference for an item of clothing.

A description of the difference between two products.

A debate over which key on a key ring fits which door in a house.

One speaker helping another to navigate a website to order tickets by giving step-by-step instructions during the process.

Example

Descriptions or speculations about future events and intentions, including those that are planned and those that are more hypothetical.

(continued)

Two speakers sharing their plans for life after graduation from university.

Discussion aimed at exploring or considering options or Attempts to understand and explain the recent behaviour of a mutual acquaintance. plans, including discussion about how things work and what the best solution to a problem may be.

Discussion about feelings, opinions, and beliefs, including the airing of grievances and the sharing of personal perspectives.

Descriptions or explanations about facts, information, people or events where time (past or future) is either irrelevant or unspecified.

Includes disagreement of any type, including light-hearted debate as well as more serious quarrelling.

Occurs when one speaker offers directions, advice or suggestions to another speaker.

Description

Table 4.3 The nine types of communicative purposes

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

jok

pas

sdc

Joking around

Describing or explaining the past

Situation-dependent commentary

Occurs when speakers in a conversation are commenting on people or objects that are present, or events that are occurring in their shared situational context.

Narrative stories about true events from the past or other references to people or events from the past.

Conversation that is intended to be humorous, including both light-hearted and darker humour. It also includes good-humoured banter, teasing and flirting.

Commentary on the unsafe driving practices of another driver at the petrol station where they are waiting for their turn at the pump.

A speaker telling stories from a favourite vacation.

A hyperbolic comparison between a bad tasting pie and sawdust.

110

Creating a Community

In addition, Egbert et al. (2021) used the notation ‘ndu’ to mark out content as a ‘non-functional’ speech event if it did not appear to orient towards a clear communicative purpose or, in their case, meet the minimum length requirement for a discourse unit. It was not feasible to apply the framework to the entire Anxiety Support forum data, given the micro-level analysis involved in the coding, which needs to be carried out by hand. Rather, we identified a sample through the random selection of one discussion thread from each calendar month of the data. Covering the period March 2012 to September 2020, this amounted to 103 discussion threads, comprising 822 individual posts. This sample was divided evenly between two coders to read each post in its original context and apply the coding framework. The coders then exchanged and reviewed the applied scheme for consistency. While it is often the case that applications of coding schemes report statistical measures of inter-coder reliability, Egbert et al. (2021, p. 727) explain that such procedures assume that the objects being rated have fixed boundaries and can be counted as discrete units. Given that segmentation was part of the coding process, there was no guarantee that coders would identify and characterise the same number of units and so quantitative measures of agreement would not accurately reflect the nature of the task. Following Egbert et al. (2021), we applied ‘plausibility checks’, which meant that it was not a requirement for independent coding to be identical, but rather the aim was ‘for independent coders, trained using the same framework, to make coding decisions that other trained coders would deem plausible’ (Egbert et al., 2021, p. 728) and this related to 1) discourse unit boundaries, 2) presence of communicative purposes and 3) communicative purpose degree. Feedback on plausibility showed very high agreement, with a small number of cases (approximately 20 for over 1,300 discourse units) raising issues that were mainly concerned with the inclusion of additional, non-dominant communicative purposes. As an example of how the coding was applied, the following Main post comment was coded as a single discourse unit, with the dominant communicative purpose discussion about feelings (fel) and a secondary purpose of discussion about considering options or solutions to a problem (fto, coded as ‘2’): Title: Citalopram 20mg how long does it take to work and how long do the side effects last for. I’ve just come to the end of my 8th week and the side effects are still with me. I suffer tiredness the best part of the day and just feel un motivated and feel really anxious. Do I keep going and hope for the best or do I go back to my gp. The thing is I get really anxious about

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Discourse Unit Patterns

111

taking medication as I worry that they won’t work and ill be back to square one. Please help.:( [fel=3, fto=2]

The contributor refers to feeling un motivated, really anxious and having worry and their message is a request for help (i.e., advice) regarding them continuing to take the anti-depressant medication Citalopram. Indeed, the element Please help is an example of an additional aspect of our coding, in which we marked explicit prompts for respondents to attend to a particular communicative purpose. In this instance, we understand the request for help to encourage replies that offer advice, and in the replies that followed this post, there were indeed seven different discourse units with an advice-giving (adv) component. The frequency and combination of codes observed when applied to the conversational data of the Spoken BNC2014 are reported in Biber et al. (2021) and we similarly offer observations of the frequency and distribution of these communicative purposes in the Anxiety Support forum. The framework for segmenting conversations into discourse units and annotating their communicative purpose is novel in its comprehensive and fine-grained treatment of conversational data. Our application of the coding framework to online forum data provided an opportunity to further test its validity, extending its use from general talk about a range of topics to a focused (though, potentially varied) online discussion of anxiety disorders.

Discourse Unit Patterns In this section we discuss each of the communicative purposes in terms of their frequency, combination with less-dominant purposes and, where applicable, regular lexical features. In the 822 posts of our sample of discussion threads, we identified 1,316 distinct discourse units (DUs). Eighteen DUs were coded as ‘ndu’, which means that they did not constitute one of the purposes of our coding scheme. This was typically because they were brief (e.g., thank you, or simply Yes) or did not convey meaning by way of a clause or sentence, such as posting a URL or a single noun phrase. We coded the DUs according to the prominence of their communicative purposes (3, 2, 1), though a DU might only have one (dominant) communicative purpose and therefore only receive a ‘3’ coding. In three instances, we did not code a 3-ranking purpose on the basis that the communicative purpose (giving advice in each case) was not direct; for

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

112

Creating a Community

example, There’s a book that might help . . . . Our coding of minor purposes was designed to represent their prominence, which means that a ‘1’ coding did not necessitate the inclusion of a ‘2’ coding and vice versa. For example, the following post was coded as a single DU, with the communicative purposes of Sharing feelings (fel=3) and Giving advice (adv=1), reflecting the communication of a personal perspective that indirectly conveys advice as a reply to someone struggling to sleep: If I can’t sleep I get up and do something, anything!!, its a distraction. [fel=3, adv=1]

Overall: • 680 (51.67%) DUs were coded as having just one communicative purpose • 564 (42.86%) DUs had two (ranked) purposes • 54 (4.10%) DUs conveyed three different purposes. Biber et al. (2021) found that 58% of their coded DUs combined two different communicative purposes (coded with a value of 2 or 3) and 11% combined three purposes. By comparison, our findings indicate a relative preference for DUs with just one major communicative purpose in the Anxiety Support forum. The most common communicative purposes, by ranking, are reported in Table 4.4. Table 4.4 shows that the most common communicative purpose observed was the expression of opinions and personal perspectives (fel), followed by explanations (des) and advice-giving (adv). There was Table 4.4 The occurrence of each communicative purpose according to their ranked prominence Coding

3

2

1

Total

Sharing feelings and opinions (fel)

405

208

28

641

Describing or explaining: time-neutral (des)

284

151

15

450

Giving advice and instructions (adv)

203

61

29

293

Situation-dependent commentary (sdc)

173

45

21

239

Figuring things out (fto)

94

27

5

126

Describing or explaining the past (pas)

63

30

15

108

Describing or explaining the future (fut)

63

25

7

95

Joking around (jok)

7

4

3

14

Engaging in conflict (con)

3

1

0

4

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Discourse Unit Patterns

113

minimal conflict communication (con) and joking (jok) in the forum interactions. This pattern held for DUs in which there was only one communicative purpose, with 216 DUs coded only as fel, 119 DUs coded solely as adv and 130 DUs featuring only des. Our findings showed that when it appeared, Figuring things out (fto) was the least likely code to be combined with other purposes, appearing independently in 44.44% of cases. In contrast, pas, characterised by the reporting of past events, featured as the single code in the lowest proportion of instances (25.00%), with anecdotes and details of recently passed events appearing alongside other purposes, such as explaining a situation (des), appending a personal perspective (fel), or establishing the legitimacy of past experience in order to offer advice (adv). In what follows, we offer some descriptive statistics and observations of the use and content of each respective communicative purpose of the coding scheme, beginning with the most frequently occurring. We also discuss the use of explicit prompts.

Sharing Feelings and Opinions (fel) The most commonly coded communicative purpose was fel, and in addition to 216 instances where it was the only purpose of a DU, fel was the dominant purpose in a further 189 DUs. Biber et al. (2021) observed that, as a pervasive feature of conversational interactions, over 10% of the DUs in their corpus had the dominant goal of expressing personal feelings/opinions. In our data, we coded fel as the dominant communicative purpose in 30.78% of DUs, demonstrating the overall prevalence of the expression of contributors’ feelings and evaluations in the Anxiety Support forum. The most frequent trigram in DUs coded as fel for the dominant communicative purpose was I feel like (26), attesting to the reporting of first-person experiences. However, we also observed the regular formulations I hope you, you feel better and sorry to hear, which further demonstrate the kinds of affiliative expression we discussed in Chapter 3. This reiterates that the forum is a space where participants not only convey their own feelings but also can expect reciprocity and empathy. Indeed, DUs with fel as the dominant communicative purpose contained the second-highest number of prompts (after Figuring things out), which often called for advice (Please help) or explanations (Is this normal?), as well as indications that others could relate to their personal perspective: Anyone else feel like this?

Describing or Explaining: Time-Neutral (des) The des communicative purpose demonstrates how members shared information and explanations, which were often supportive

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

114

Creating a Community

matter-of-fact statements such as you are not alone and you will get well again. Along with 130 instances where des was the only communicative purpose of a DU, there were 154 instances where it was coded as the dominant purpose alongside other purposes. This indicates that descriptions and explanations are often used to support other communicative aims, or vice versa, typically offering a personal perspective (fel, 98 instances) or advice (adv, 39 instances). Biber et al. (2021, p. 31) found that the codes Describing or explaining: time-neutral and Figuring things out are ‘closely related in their communicative priorities’ since they both involve conversational participants working together to try to describe or explain something. However, when des is the dominant communicative purpose, one participant takes a leading role in supplying information, whereas fto is more collaborative (Biber et al., 2021). As such, the forum context may account for the prevalence of des compared with fto, since participants post their messages without any real assurance that there will be further contributions (even if they request them). Subsequently, there may be a stronger imperative in forum posts to proffer explanations, rather than risk leaving things unresolved. We have also seen how participants often request information and explanations in Main posts, which arguably encourages more definitive – rather than speculative – responses.

Giving Advice and Instructions (adv) There were 87 DUs with adv as the dominant communicative purpose, in addition to the 119 instances where it was the only purpose. When adv was the dominant communicative purpose, the most common additional purposes were explanations (des in 54 instances) and personal perspectives (fel in 23 instances). This indicates that advice-givers add legitimacy to their recommendations through rationalisations or by demonstrating their expertise through experience. The seven most frequent bigrams in the content of DUs coded with adv as the dominant communicative purpose all contain you and show how contributors to the forum offer the addressee instruction with varying degrees of directness: if you (55), you are (45), you can (31), you have (26), that you (23), you will (22), you feel (21). These terms appear alongside other expressions that indicate the communicative purpose of the statement. For example, a suggestion: I suggest that you visit your doctor

Bigrams such as I would (20), try and (16), you need (15) and try to (14) also preface advice and demonstrate the different advice-giving strategies that can be managed through grammatical mood (e.g., the

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Discourse Unit Patterns

115

imperative try or subjunctive would) and modal verbs (would, need). Locher (2013) reminds us that alongside giving advice, participants may also be concerned with rapport-building and creating engagement and so may want to avoid appearing too ‘bossy’. Lower modality instructions (e.g., you can) provide more optionality compared with high modality statements (you need) and the use of the subjunctive mood creates a hypothetical situation where the advice-giver proposes what they would do, if they were in the addressee’s position, or if they were asked their opinion: If it was me I would go back to the GP to discuss your feelings I would recommend that you speak with your physician

This articulation can mitigate the presumption that the poster has authority over the addressee because they are referring to imagined scenarios. In contrast, ‘unmodulated imperatives’ (McDonald and Woodward-Kron, 2016) such as try meditation are typically favoured when the action is presumed to be of maximal benefit to the addressee (Aijmer, 2014) and such formulations are also less face-threatening when advice has been directly requested. This reiterates that the way in which advice is expressed is informed by the sequence of the interaction.

Situation-Dependent Commentary (sdc) The code sdc captured references to objects in the shared situational context, and alongside 95 DUs where sdc was the sole communicative purpose, there were also 78 DUs where it was the dominant purpose combined with other codes. The sdc code was most frequently combined with fel (52), as participants expressed opinions on whatever the shared reference was as the topic of discussion. DUs coded with sdc as the dominant communicative purpose typically appeared in replies (160 instances, 92.49%) and the shared situational context was often the forum or discussion itself, as shown in references to reply, message, kind words, here (i.e., the forum), this site or this forum. The following example demonstrates how the forum is conceptualised as a space in which members come and go, thereby facilitating asynchronous exchanges, and in which posters can reasonably expect a response: You can come on her any time of the day to post a question or blog. Even if there’s no-one around to answer you straight away, they’d be someone around eventually that’ll reply.

Participants might also introduce resources or tools for helping them cope with anxiety, which were subsequently evaluated by others in the

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

116

Creating a Community

discussion thread. Nevertheless, the prominence of the forum and replies as a shared reference highlights the significance of the discussion itself in why people come to the forum.

Figuring Things Out (fto) Fto was the sole communicative purpose of 56 DUs and also the dominant purpose of 38 multi-purpose DUs. As mentioned earlier, DUs coded as fto contained more prompts (40) than any other communicative purpose, which is reflected in that they featured a higher number of question marks (89) than any other DU type and that frequent bigrams in these DUs include if you (17), do you (15), have you (14) and are you (12). These features demonstrate the types of inquiry present in DUs that seek to ‘figure things out’, but also the contemplation of circumstances that would entail contingent responses. For example: A lot depends on your age. Are you still 17?

It appears that when contributors are able to anticipate the responses, the discussion of fto is supplemented by advice-giving (adv, nine instances). However, more often, the communicative purpose of fto is appended by explanations (des, 12 instances) or personal perspectives (fel, 11 instances), which offer the kinds of explanation and description that can support the addressee in determining for themselves whether the option being discussed is appropriate for them.

Describing or Explaining the Past (pas) While the code pas was the sole communicative purpose in 27 DUs, it appeared as the dominant communicative purpose alongside other codes in 36 DUs, indicating that the telling of past events often contributed to other goals, such as reporting a personal perspective in order to demonstrate expertise or convey a sense of shared experience. Indeed, in 30 of the instances of pas as the dominant communicative purpose, we also coded fel (as either 2 or 1). Although Biber et al. (2021, p. 28) found that coding pas in spoken interactions did not typically involve personal narratives (but simply the establishment of things that happened), in the Anxiety Support forum, contributors often included personal stories relating to their experiences of anxiety disorders, which could extend over long periods of their lives. Eight of the most frequent bigrams in DUs coded as pas attest to the past and past-continuous tense of statements in these posts, including I was (38), I had (24), I have (16), it was (13), I did (13), had to (13), had a (11) and have been (10). These constructs in turn reflect the selection

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Discourse Unit Patterns

117

of prior events made relevant to the current circumstances that contextualise a contributor’s perspective, either as the sequence of events that led them to seek help through the forum (more typically in Main posts) or that enables them to offer the wisdom of their experience (more often in Reply posts).

Describing or Explaining the Future (fut) The prospective nature of DUs coded as fut was reflected in the bigrams going to, I will and will get (e.g., better). The discussion of future events was primarily in relation to imminent scenarios that were a cause of anxiety for the poster, such as an appointment with the health services that involved testing (such as an MRI) or the discussion of treatment options. When fut was the dominant communicative purpose – alongside 32 instances when it was the single communicative purpose – it was combined with descriptions of feelings (fel) in 17 instances. While these anticipated events were often a source of stress, there were also references to evening plans, for example, that offered the contributor comfort and even certain healthcare interactions were discussed with optimism as posters hoped for progress towards coping well with anxiety. This optimism was also reflected in the supportive responses from other members. For example: Now you know you can do it, things will hopefully get better for you.

Joking Around (jok) There were very few instances of joking (jok) coded in the data, appearing as the singular communicative purpose in only five DUs and the dominant purpose in a further two (with the additional purpose of Sharing feelings and opinions). In seven other instances, jok was coded as a minor communicative purpose, using self-deprecation to attenuate negative feelings (fel), for example. The low occurrence of explicit humour in the forum attests to the serious nature of anxiety disorders, however, we found that once a humorous tone had been established, others were willing to join in, with six DUs involving the jok code featuring in one discussion thread. This thread involved a light-hearted discussion of the effects of menopause, with the humour generating a sense of solidarity in working through the discomforting symptoms. The relevant posts are represented in Table 4.5. The humour in this exchange allows the participants to highlight the ways in which they can relate to each other. The contributors discuss – to a somewhat farcical degree – the anticipated

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

DU

1/1

3/3

1/1

1/1

1/1

3/3

Post

130155584

130155608

130155621

130155640

130155731

130156306

des

X, hot flushes I keep you warm in the Winter, you end up with the windows open, fan on & kicking hubby out of bed, I said hubby, not Rod or Will-i-am, some how you manage to let them stop :D love [anonymised] xxx

fut

fel

Glad I’m not alone when “Mother Nature” comes calling! My bedroom fan is always on and the window is open even in the winter! It’s cloudy here as well,thought we were getting some sun today:(I’m not in a good mood tIy . . . Being a grumpy cow:)) have warned hubby and daughter that I’m menopausal!! They’re keeping their distance:)) !!! Be ok if I’m left alone for a bit. Off to mum in law for Sunday roast.xxx

Have a good evening, I’ve got to do battle with the 9 yr old to have his Sunday night bath! Xxx

jok

Oh Sorry X has gone missing, I am sure he will be back :D xxx

jok

fel

Im trying to look on the bright side and hope the hot flushes will keep me warm in the winter :D X xx

Oh well wont be needing my hot water bottle this year then, or could pitch tent in garden to cool down :D Not seen Rod for a while !! X xx

3

jok

–

jok

–

– sdc

–

–

jok

1

fel

jok

fut

2

Communicative purpose

Message content

Table 4.5 Sequence of DUs involving jok coding

Discourse Unit Patterns

119

effects of menopause alongside a call back to a discussion about celebrity crushes (Rod, Will-I-Am) as a way to pass on wisdom and express feelings about present situations. The switch to a nonserious tone is also an aspect in which the participants can convey shared understanding and this kind of alignment is also evident in the other instances of jok in the data.

Engaging in Conflict (con) Con was the dominant communicative purpose on only three occasions, indicating an absence of serious debate and even light-hearted quarrelling on the forum. In their application of the coding framework to the Spoken BNC2014, Biber et al. (2021) observed a low frequency of occurrence of the categories relating to giving advice (adv) and conflict (con), which they attribute to the fact that these are highly face-threatening speech activities and that participants engaging in informal conversations were unlikely to pursue these communicative purposes (particularly since they were being recorded). In the Anxiety Support forum, advice-seeking and advice-giving are shown to be fundamental to the interactions between members, though we can say that participants might be similarly reluctant to engage in conflict in order to minimise the potential for offending others. One of the reported characteristics across experiences of anxiety disorders is the avoidance of fearful situations and unpleasant emotions (Panayiotou et al., 2014). As such, members may be particularly conscientious about avoiding interactions that may seem confrontational or facethreatening. Two of the three instances of con coding came from the same discussion thread in which a contributor shared their story of taking their father to the emergency department with concerns that they might have Covid. The conflict arose as other members of the forum challenged this decision. The example in Table 4.6 shows that one reply consisted of three DUs, with the ‘conflict’ element combined with advice and flanked by explanatory statements. The con component of the message is indicated in the poster’s disagreement, expressed in the evaluative terms totally irresponsible and the instruction to get a grip. The subsequent DU provides justification for this participant’s point of view, further indicating the extent to which this is contrary to the poster’s position in that they would never and describing the addressee’s actions as pointless. The structure of the post, however, does demonstrate that the contributor prioritised other communicative purposes ahead of expressing disagreement. The first DU has the minor communicative purpose of

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

120

Creating a Community

Table 4.6 Coding of communicative purposes in a post containing conflict Communicative purpose DU

Message content

DU1

3

2

1

I think maintaining minor symptoms at home is des absolutely the right way of managing it or you would get everyone with a sore throat or hay-fever turning up at a and e and spreading the virus.

–

adv

DU2

Like [anonymised] has done and to go to work con that is Totally irresponsible, get a Grip.

adv

–

DU3

des people are dying because of the actions we all take or don’t take. I have anxiety, with underlying reason but would never put others at risk. We can be carrying the virus for 2 weeks without showing signs . . .. The test you had was pointless because you could have picked up the virus going to the hospital

–

fel

offering advice and does still appear to be motivated by finding solutions, which is more consistent with the wider patterns we have observed in the data. Similarly, the other instance of the con coding that appears in this same discussion thread is found in the third (and final) DU of the post, following an expression of empathy (Sorry you feel this way, and hope you feel better) and advice (Try to do something relaxing, and some deep breathing). The disagreement element is also supplemented with an explanation to support the poster’s contrary point of view: I also have to say I’m really disappointed to hear how you went to work for 2 hours. Do you work from home? The nurse specifically said do not leave the house and act like you have the virus. So many people go out and spread it to others, because they didn’t think they had it or knew [con=3, des=2] they had it but went out anyways.

The positioning of the con communicative purpose in the structure of the post suggests that in the very few instances where participants in the forum felt compelled (I have to say) to express disagreement, this is preceded by statements that attend to the more regular objectives of broadly showing support, or offering information and advice.

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Combinations of Discourse Units within Posts

121

Combinations of Discourse Units within Posts In this section, we discuss the combination of DUs within the boundaries of a given post. The posts in our data contained anything between one and nine DUs and each DU was coded for between one and three communicative purposes. The distribution of posts with multiple DUs is indicated in Table 4.7. Overall: • 519 (63.14%) posts operated as a single discourse unit. • 285 (34.67%) posts contained more than one discourse unit. • Although we coded 18 (2.19%) units as non-discourse units (ndu), these were not combined with other DUs, that is, they were full and complete posts that did not amount to any of the communicative purposes of the framework. While there did not seem to be a restriction on the length of posts to the forum, contributors did appear to favour limiting their posts to a smaller number of DUs. This can have implications for the clarity of the message and, subsequently, the number of responses it receives since if the communicative purpose(s) of the post are clear and not obfuscated among multiple objectives, respondents are more likely to recognise that communicative purpose and can respond in kind. Beginning with posts that were coded as having two DUs, we continue to observe that certain communicative purposes are more likely to be combined with others. Table 4.8 shows the different combinations of dominant (coded 3) communicative purposes in posts with two DUs and this tells us that expressions of opinions and personal perspectives (fel) were frequently followed by giving advice (adv), explaining (des) and figuring things out (fto) and preceded by descriptions of present situational objects (sdc). The sequential order does not strictly entail the relationship between the two communicative purposes, in that a contributor could use fel+des to report a personal experience (fel) that gives them licence to proffer an explanation (des), or alternatively, as an explanation of why they have the perspective/opinion that they do. Nevertheless, there are Table 4.7 Number of posts with different numbers of DUs Number of DUs in post Number of posts

1

2

3

4

5

6

7

8

9

ndu

519

157

78

34

10

2

1

1

2

18

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

122

Creating a Community

Table 4.8 Combinations of dominant communicative purposes in posts with two DUs ↓DU1 adv

DU2→

adv 1

con

des

fel

fto

fut

jok

pas

sdc

0

3

7

2

0

0

1

2

con

0

0

0

0

0

0

0

0

0

des

19

0

0

8

4

4

0

1

4

fel

13

0

11

2

10

3

0

0

8

fto

4

0

1

1

0

1

0

0

0

fut

0

0

0

0

0

0

0

1

1

jok

0

0

0

0

0

0

0

0

1

pas

3

0

4

6

0

1

0

0

1

sdc

3

1

4

14

1

3

0

0

1

some more intuitively logical sequences that appear to be supported by the distribution of these combined codes. For example, given how often we have observed participants seeking help, the combination des+adv would suggest that respondents provide some kind of explanation prior to a solution by way of advice. Similarly, having a mutual reference point (sdc) is established prior to offering some evaluation or perspective on it (fel). In posts with three discourse units, we regularly observed DUs with a single communicative purpose, such as fel (44), adv (21) or sdc (20). In other words, while these purposes combined with (two) other DUs in the posts, they were more singularly focused within the context of the DU. Table 4.9 shows combinations of dominant (score 3) communicative purposes across the three DUs in a post (although they do not necessarily indicate order of DU1, DU2, DU3), where x indicates one of the other remaining DU types. We continue to observe a prevalence of expressions of personal perspectives and opinions (fel), which is combined with advice (adv), observations of the shared context (sdc), explanations (des) and speculations about future events (fut). These combinations also reiterate the prevalence of advice-giving, which is supported by personal experience (fel) and reasoning by way of explanations (des). There were 51 posts that included four or more DUs. Even though DUs were coded for up to three communicative purposes, the highest number of purposes in one post was six (one instance), combining adv, des, fel, fut, pas and sdc. Thirty-nine (76.47%)

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Combinations of Discourse Units within Posts

123

Table 4.9 Frequent combinations of dominant (score 3) communicative purposes across the three DUs in a post DU

DU

DU Frequency

Sharing feelings and opinions (fel)

Giving advice and instructions (adv)

x

21

Sharing feelings and opinions (fel)

Situation-dependent commentary (sdc)

x

19

Sharing feelings and opinions (fel)

Describing or explaining: timeneutral (des)

x

18

Giving advice and instructions (adv)

Describing or explaining: timeneutral (des)

x

17

Sharing feelings and opinions (fel)

Describing or explaining the future (fut)

x

16

posts with four or more DUs featured no more than four communicative purposes, the most common of which were des (49 posts), fel (44) and adv (39). Across the whole coded sample, 28.89% of posts were coded as having only one communicative purpose and 89.43% of posts included no more than three purposes, irrespective of the number of DUs. We observed 88 different configurations for combinations of communicative purposes within a post. The most common combination was Describing or explaining (des) + Sharing feelings and opinions (fel), which, when we consider any possible additional purposes (e.g., adv+des+fel+sdc, des+fel+pas), occurred 238 times. The communicative purpose Giving advice and instructions (adv) appeared alongside the combination of des+fel 87 times, which more often would include further communicative purposes; for example, adv+des+fel+sdc+(x) (28). The combination adv+des occurred 160 times and often with fel (87 occurrences). Similarly, the combination adv+fel appeared 140 times, most commonly with des, with or without additional purposes (87). The code fel appeared with Situation-dependent commentary (sdc) 141 times and on 58 occasions, this also involved the communicative purpose des. In 38 posts, the combination of fel+sdc also involved giving advice (adv). Thus, despite the potential for a variety of combinations, posts to the Anxiety Support forum appear to be dominated by the communicative purposes of expressing opinions and personal perspectives (fel), providing explanations (des), advice-giving (adv) and, to a lesser

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

124

Creating a Community

extent, discussing objects – such as the forum – in the shared context (sdc). Furthermore, we have some indication of how these communicative posts are combined in a single post, to provide explanations for personal perspectives that support other members in evaluating the relevance of that perspective to them, for example, or to provide legitimation to advice-giving. In the next section, we consider how the communicative purposes established in Main posts encourage and are met with particular kinds of replies.

Sequences of Functional Discourse Units Given the multitude of various combinations of communicative purposes within DUs and, in turn, the combinations of DUs within a post, in our investigation of sequences of posts in a discussion thread, we prioritise those Main posts with a focus on a relatively restricted range of communicative purposes. Our observations also take into account the presence of explicit prompts and whether these determine the types of response in the thread. For instance, while a Main post may provide a backstory (i.e., Describing the past and/or Sharing feelings) and explanation (des) that legitimises the contributor’s membership to the forum and justifies their query, there may be a more explicit indication that they are looking for responses that provide explanations or advice (i.e., des or adv) as part of a problem-solution exchange. Our coded sample contained 103 Main posts, which included 158 DUs. Although the number of DUs within a Main post ranged from between one and eight, 48 (46.60%) contained just one DU and only eight (7.77%) contained 4+ DUs. We coded prompts in 62 Main posts, which always appeared in the last DU of the post. These typically requested ‘help’ or ‘advice’; for instance, one post with four DUs ends, Anyone have words of advise for me? We have grouped the Main posts in our coded sample based on the prevailing communicative purposes across the DUs in the post (among other purposes), which largely oriented around the purposes fel, fto, des and pas. However, we will also report our observations of the remaining discussion threads and how forum members responded to a Main post where there was no single dominant communicative purpose.

Discussion Threads Initiated by Sharing Feelings and Opinions (fel) We begin by focusing on discussion threads headed by Main posts characterised by the communicative purpose fel, which was the largest category, comprising 46 Main posts, 368 comments overall, and 567

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Sequences of Functional Discourse Units

125

Table 4.10 Coding of DUs and communicative purposes for a fel Main post Communicative purpose DU Message content

3

2

1

1/3

I’m so fucking scared I have one of these. . . .. I’ve des gotten head pressure for a month sticky and I get dull aching pains on both sides of my temples right and left and back of my head to and top of my head and it started literally May X????

fel

–

2/3

so I had a cat scan last year that was clear cause I had a concussion last year . . .. but it came back normal

pas

–

–

3/3

now Next step is getting an mri . . .. and I’m terrified . . . ..

fut

fel

–

(43.09%) of our coded DUs. Twelve Main posts in this group were coded as singularly exhibiting the communicative purpose of fel, for instance: Anyone else feel like they’re going insane or losing their minds. I feel [fel=3] like that quite often . . .. i feel like im not me

Such instances unequivocally focus on expressions of feeling and fel was typically the dominant communicative purpose (coded 3) for at least one of the DUs of the remaining posts in this category. However, an example of a Main post less decidedly focused on the communicative purpose of fel is presented in Table 4.10, demonstrating the outer limits of what was included in this grouping. The 46 Main posts characterised by the fel communicative purpose elicited 198 direct replies and 125 (63.13%) also included fel as a communicative purpose. Indeed, fel was the most common coding (163 instances) in direct replies to Main posts in this grouping, followed by Describing or explaining (des, 120), Giving advice (adv, 114) and Situation-dependent commentary (sdc, 55). However, we have discussed previously how DUs coded as fel were prevalent across the sample and the proportion of fel codes (approximately 30%) in discussion threads in this grouping is comparable with those in the fto, des and pas groupings, which are discussed later. This suggests that Main posts that discuss feelings, opinions and beliefs are no more likely to prompt

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

126

Creating a Community

further expression of personal perspectives in the replies than Main posts characterised by other communicative purposes. Indeed, in 19 (41.30%) cases of Main posts in the fel grouping, fel was present in 50.00% or fewer of the replies and the communicative purpose was not guaranteed, with three instances of replies absent of fel. Furthermore, even in cases where there was a more singular focus on fel in the Main post (i.e., with few or no other communicative purposes), replies varied in their expression of fel and other purposes. What appeared to be more influential to the nature of replies was the topic (e.g., anxiety itself, their relationship, social situations) on which the original poster expressed their views and whether respondents perceived the presence of negative feelings to be a problem in need of a solution, which could also be indicated in a prompt, such as a request for help. The inclusion of a prompt, which was recorded in 28 (60.87%) cases, did not necessarily lead to particular types of response. In one discussion thread, the author of the Main post includes a prompt that seeks an explanation to their experience of anxiety: Does anybody know any more about why anxiety can be patchy like this?

However, the eight replies all feature fel as the dominant communicative purpose, with explanations (coded des) only featuring as a secondary or tertiary purpose in four instances. Indeed, one reply begins, I’m not sure why this happens, but . . . . This indicates that respondents more readily responded to the expression of personal perspective and feelings, reciprocating with their own point of view, particularly when they did not have an explanation for the situation described in the Main post. Furthermore, the original poster is appreciative of replies that relate to their experience, even if they cannot provide an explanation: it’s always reassuring to hear that other people experience the same things.

This reiterates the value of affiliation and shared understanding in the forum, whether explanations are available or not. In other instances, the prompt does appear to have informed the type of response provided by other members. For example, one contributor asks What else could help me please in a Main post and one of the (two) replies is characterised by the communicative purpose Figuring things out (fto), as the respondent makes suggestions as to alternative coping strategies. Nevertheless, the author of the other response in this discussion thread focuses on conveying that they are experiencing similar struggles to the original poster and does not provide any suggestions for solutions. The nature of the response

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Sequences of Functional Discourse Units

127

shows that even when members do not – or cannot – respond to explicit prompts, they recognise the value of demonstrating empathy and shared experience. Our observations so far have been of direct replies to the Main post, but of course the discussion threads also included responses to other messages in the thread (including those from the original poster) and the Main post can set the tone for these, too. In one discussion thread, a member explains that they are new to the forum and outlines their experience of anxiety, saying that they are anxious, extremely emotional, feel sick, at my wits end and at a loss as to wot to do. Of 12 Reply posts, only one is a direct response to the Main post, and in fact, the thread can be summarised as two separate conversations with two other members, the first of which takes place over approximately 45 minutes on the same day and the second in the space of approximately 20 minutes the following day. Both conversations begin with an empathic response (I feel your pain; I do that too!) and facilitate further discussion of each member’s perspective on their experiences of anxiety. These exchanges do feature the communicative purposes of adv, des, fut and sdc, but most commonly feature fel. In this instance, the two respondents have demonstrated to the self-proclaimed new member that the forum is a platform in which members can express their feelings towards anxiety and find others with relatable experiences. Furthermore, they have shown that while there are considerations for advice and explanations, interactions can principally involve the expression of frustrations and descriptions of struggles with anxiety.

Discussion Threads Initiated by Figuring Things Out (fto) Eighteen discussion threads were included in our grouping of Main posts characterised by the communicative purpose fto, which included 177 comments overall and 310 (23.56%) of our coded DUs. We coded six Main posts in this group as featuring only fto as a communicative purpose. For example: Title: Lustrel Hi i just started these medicatons can any1 tell me if ther good 4 anxiety . . . im on 50 mg thls guys ther also known as sertraline [fto=3]

This communicative purpose demonstrates how participants can come to the forum to discuss treatment options, presumably on the basis that other members are likely to be familiar with the kinds of decisions with which a person experiencing anxiety is faced. That there is an issue to be figured out is often indicated in what we also coded as a prompt

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

128

Creating a Community

(can any1 tell me if ther good 4 anxiety) and 15 (83.33%) Main posts in this grouping included a prompt. In the 78 direct replies to Main posts in this grouping, there were 16 instances of DUs featuring fto as a communicative purpose, which could manifest as further inquiries to work towards an appropriate solution (What are your physical symptoms?), but more typically involved respondents discussing options that they had considered, evaluating their suitability for the short or long term. For example: There is always a solution to anxiety. We just need to find the best one for us. Not sure if you have tried talking to a pschologist but they might be able to get to the bottom of underlying causes. In the short term you could try a beta blocker like propanolol which [fto=3, adv=2] could take the edge off.

Or showing consideration for the original poster’s personal preferences: I’m not sure if there are any herbal tablets for anxiety. Maybe someone else would know better. There are Bach flower remedies that might help you if you don’t want to go the medication route straight away.

[fto=3, adv=2]

In such cases, there is further acknowledgement that there is wisdom in the forum and that other participants have expertise from their lived experience. Although posts characterised by discussions aimed at exploring options may prompt solutions in the form of advice and explanations, the most common communicative purpose coded in direct replies was Sharing feelings (fel, 70), followed by Describing or explaining (des, 55) and Giving advice (adv, 47), which appeared in comparable proportions to replies to Main posts characterised by fel. As discussed earlier, in DUs coded with fel, we find expressions of sympathy and shared suffering from other members of the forum: So sorry to hear you are feeling so bad. I know exactly how you feel because I feel the same way

There are also indications that even though Main posts in this grouping seem to seek advice and explanations, respondents have a preference for presenting their contributions as personal perspectives (fel), rather than more explicit advice-giving. Indeed, one contributor’s expression of feelings conveys their reluctance to assume the position of ‘expert’: I am kind off apprehensive about recommending something since i am not an expert on negative thoughts. The thing that comes to mind is . . .

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Sequences of Functional Discourse Units

129

Conveying personal feelings and experiences also allows contributors to incorporate explanations and justifications that relate to them, but can equally be informative to the original poster: I’m currently having CBT for emetophobia (fear of being sick) and the techniques that I’m learning are being quite helpful because its all about letting yourself feel the anxious feelings and thoughts and [fel=3, des=2] accepting them rather than trying to get rid of them.

Providing this kind of explanation can help others evaluate the merits of one course of action over another and presenting this as a personal perspective enables the contributor to avoid the face threat of implying that these are considerations that others in the forum do not know about or have not thought of. Indeed, in this instance, the poster positions themselves as someone who is ‘learning’ about these coping techniques. There are more direct examples of explanation of advice-giving, which account for the high frequencies of des and adv codes. Nevertheless, these are typically accompanied by some expression of personal perspective or feeling, either in the same DU or a DU in the same post. For example: Please don’t feel afraid, I have experienced the same feelings of thinking I’m going ‘insane’, it’s severe anxiety, you feel you are losing control, the physical effects can be overwhelming, I know. It is your bodies response to stress, that’s all. Please seek as advised by [anonymised] above. I’m thinking of you. [adv=3, fel=2, des=1]

This post demonstrates how personal experience is used to legitimise more direct advice, as well as showing sympathy with and emotional support for the original poster. The instructions (Please don’t feel afraid, Please seek [help]) offer maximal benefit to the recipient, in which case a more direct approach is more conventional (Aijmer, 2014).

Discussion Threads Initiated by Describing or Explaining: Time-Neutral (des) We identified 15 discussion threads where the Main post was characterised by an explanation, that is, coded as des. These threads incorporated 117 comments overall and 172 (13.07%) of our coded DUs. In our coded sample, the types of explanations offered by contributors in Main posts that were not oriented around past or future events tended to still relate to a personal perspective, which made it difficult to distinguish this code from fel. It was when this personal experience

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

130

Creating a Community

was presented as a more general truth that the des code was applied. For example, one contributor discusses sleep disruption: I just can’t seem to sleep at night. You lay in bed and watch the hours float by–you close your eyes, never really falling into true sleep–it’s as if you are on guard. You open your eyes every hour or so.

The deictic shift from ‘I’ to ‘you’ creates the impression that this is a more universal experience and, indeed, one of the replies to this post uses ‘we’ in continuation of this generalised experience: Yes everyday u see we cant sleep because we are not use to it yet we have to build a habit of sleeping early to fall asleep most of the anxiety [des=3] is stress from lack of sleep

However, it was much more common for respondents to adopt a personal perspective, using ‘I’, and once a topic of discussion had been established, the distinction between general explanations (des) and personal perspectives (fel) became clearer. If we consider the position the original poster is in, there are face threats associated with providing unsolicited explanations, since they imply that these are things that other members do not know. Furthermore, we have discussed previously that forum members were not responsive to the sharing of general truths in the form of platitudes (in the case of UserID#e27ef6). As such, it seems reasonable that the one topic that participants can initiate a discussion with, as a matter of explanation, is their own position on and experience of anxiety. Although explanations are ‘dialogically contractive’ (Martin and White, 2005), typically closing a conversation rather than opening up the dialogue, nine of the 15 Main posts in this grouping included a prompt, offering a signal to others as to how they might respond. For example, one poster introduces and explains a particular coping method, asking for others’ opinions on it. This then leads to a discussion in which the method becomes an object in the shared situational context, with eight sdc codes among the subsequent DUs. We once again observed that fel (44, 31.21%) was the most frequent communicative purpose coded in direct replies, followed by des (38, 26.95%) and adv (20, 14.18%). Since the Main posters have written from a position of ‘knowing’ – by offering explanations – it is arguably unsurprising to see relatively fewer instances of advice, compared with the other discussion threads reported so far. Given the comparability between DUs coded as des and fel codes, we find that adv codes appeared in these discussion threads when respondents perceived the explanation of a personal experience to constitute

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Sequences of Functional Discourse Units

131

a ‘problem’ to be solved and/or the original poster included a prompt (e.g., requesting help). With the tendency for Main posters to explain some aspect of their own experience, even if presented as more universal, this did lead to the sharing of personal stories in reciprocity, giving rise to a high number of fel codes. In the direct replies to Main posts in this grouping, we applied des codes to reports of rates of anxiety and associated symptoms, for example, as well as documented comorbidities and proven treatments, the latter of which would also be the subject of more direct recommendations (adv).

Discussion Threads Initiated by Describing or Explaining the Past (pas) We determined that six Main posts could be characterised in terms of their focus on the reporting of past events (pas) and the resulting discussion threads amounted to 51 comments overall and 77 (5.85%) of our coded DUs. In each of these cases, the Main post was a single DU, and in five cases, we coded pas=3 with fel=2 (the other case was coded pas=3, sdc=2). This indicates that the telling of past events typically includes personal evaluations or reflections of what has happened and suggests that the sharing of these experiences can have a cathartic effect, since in only two instances was a more explicit prompt included, either asking for help or to see if anyone has anything similar. We recorded only one instance of the pas code in direct replies, which most often featured fel (18, 27.27%), adv (18, 27.27%) and des (12, 18.18%) codes, as we have observed elsewhere. The stories shared in Main posts typically led to negative evaluations and feelings, and so replies included recommendations (adv) on how to process and navigate the challenges described, as well as comparable personal stories (fel) and explanations (des) relating to different aspects of anxiety. In one instance, the events of the original post were directly influenced by restrictive measures introduced in response to the Covid-19 pandemic and this initiated a discussion of members’ respective challenges accessing care and knowing how to go about their daily lives while respecting such measures. This discussion thread demonstrates that the forum can function to enable members to jointly navigate emergent challenges that may or may not intersect with their broader experience of anxiety.

Discussion Threads from Multi-Purpose Main Posts What remained from our sample was eight discussion threads initiated by Main posts that we could not characterise in terms of any one communicative purpose. Discussion threads in this grouping

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

132

Creating a Community

amounted to 48 comments overall and 87 (6.61%) of our coded DUs. In seven of these eight cases, the Main post comprised multiple DUs, attending to different communicative purposes. For instance, one contributor was concerned with an upcoming meeting with their psychologist which they anticipated would involve discussion of treatments and so was looking to discuss their options (fto) with members of the forum, as well as providing some background context for their experience of anxiety (pas) and expressing their trepidation (fel) about the coming meeting (fut). The inclusion of multiple communicative purposes did not appear to restrict the potential for replies, since each of the Main posts received responses and even led to the kind of backand-forth exchange similar to spoken conversation between participants. The elicitation of responses was facilitated in four instances by prompts calling for ‘help’ and ‘advice’ and adv was the joint most frequently occurring code among direct replies, with Describing or explaining (des, 11 occurrences), followed by Sharing feelings and opinions (fel, 10). The prominence of these three communicative purposes, which we have observed across the discussion threads, suggests that the forum overall can be characterised by the sharing of personal perspectives, the pursuit of explanations about different aspects of anxiety and the giving of advice, with only minor differences according to the communicative purpose of the Main post at the beginning of the discussion thread.

Discussion Our application of the functional discourse unit coding framework to the Anxiety Support forum was an extension of its development and use in the context of spoken conversations (Biber et al., 2021; Egbert et al., 2021). We found that members of the forum drew on personal stories, coded as pas, in a way that was reported as largely absent in the spoken conversational data analysed by Biber et al. (2021). The pas code was rarely the sole communicative purpose of DUs in the forum, however, as it was used alongside explanations or advice-giving to provide a context drawn from lived experience. We also observed a higher rate of explanations (in the code des) and solutions, which could be delivered as advice, indicating that members of the forum worked towards problem-solving. This could, to some extent, be determined by the mode, since there were no guarantees that an interactional response was forthcoming, so users may feel compelled to offer a provisional conclusion to the interaction, just in case. Indeed, we saw that even in the case of Figuring things out (fto), contributors

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

Conclusion

133

provided contingent explanations to possible scenarios (e.g., Are you still 17?), which in turn allow other readers to determine the applicability of such contributions to their own experiences. While there were indications that users of the forum capitalised on the asynchronous mode that allowed them to craft personal anxiety stories and pursue multiple communicative purposes, we did observe a tendency to restrict DUs to just one or two purposes (in 94.53% of instances) and to combine smaller numbers of DUs within posts. It is impossible to know how long contributors deliberated on the composition of their messages but there was a broad range in both the length of posts and the periods of time over which discussion threads took place, with some spanning years and others including near-immediate replies that reflected more of a dialogic exchange. The variable timeframes for forum discussions also reflect two of the key communicative objectives we observed in the forum data: as a resource to find general information and advice that could be evaluated by subsequent visitors for personal relevance; and the more direct, interpersonal work as members indicated to contributors that they were not alone in their struggle with anxiety. In both aspects, the prevalence of personal experience and perspective, indicated in the fel code, demonstrates how and why the forum offers an additional resource alongside institutional sources for seeking support and expertise. In the forum, such expertise is more likely borne of lived experience than medical training. Furthermore, queries to the forum could even be about how to navigate those interactions with professional health services, canvassing the forum for information and advice on how to prepare for a discussion of treatment options, based on the experience gained by other members of comparable encounters.

Conclusion Considerations for both personal and interpersonal experiences seem to have encouraged an indirect approach to communicative purposes such as advice-giving. The prevalence of the code fel indicated that participants relied on personal stories to provide examples of lived experiences that could be taken as instructive, or as legitimising their more explicit advice-giving, as well as a demonstration of shared experience. We did find examples of ‘unmodulated imperatives’ (McDonald and Woodward-Kron, 2016) and more direct advicegiving when it came to instructing other forum members how to take care of themselves. In Main posts, the expression of a personal struggle often pre-empted a direct request for help and while adv was one of our most common codes, it did not appear frequently in the posts that

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

134

Creating a Community

initiated discussion threads, indicating that forum members started a conversation seeking advice more often than giving it. The minimal presence of ‘conflict’ in the forum suggested a more collaborative and dialogic approach to problem-solving by way of ‘figuring things out’ (code fto). Once again, an indirect approach was favoured whereby personal perspectives and stories might be introduced to offer alternative points of view rather than expressions of explicit disagreement. We also investigated instances where users were not getting replies from other members, potentially highlighting a different kind of disagreement relating to the communicative norms of the forum. In these instances, potential violations were perceived: in the provision of unsolicited advice in the form of platitudes or the promotion of materials outside of the forum, for instance. We determined that getting replies was not simply a matter of using the ‘right’ words, although demonstrating urgency and some degree of desperation, as well as consideration for the interpersonal aspects of the forum did appear to encourage responses. Including a prompt was one way of indicating expectations about responses and these were more common in Main posts (62 posts) compared with Reply posts (48). We also found that these kinds of explicit prompts were more often found in posts from members identifying as female (61), compared with male (15) and in the next chapter, we will investigate the contributions of female and male participants in more detail. Nevertheless, even when there was a prompt – seeking explanations, for example – members of the forum still responded with personal perspectives when an explanation was not available. More broadly, when a prompt was not met with the expected response, expressions of sympathy and showing shared experience were still valued by respondents and original posters alike. Our analysis has provided a record and some quantification of the prevalence of such communicative purposes in this forum, capturing what is shown to be of most value to this community in the interactions they share in this online space.

https://doi.org/10.1017/9781009250139.005 Published online by Cambridge University Press

5

Sex and Gender

Introduction In this chapter we consider how language and discourses around anxiety relate to gender and sex, two terms which are sometimes used interchangeably. We make a distinction between the two, using sex to refer to biological and physiological characteristics and gender as relating to socially constructed characteristics. Sex is thus concerned with reproductive organs and hormones whereas gender would relate to social expectations about the kinds of roles, qualities and behaviours that are seen as appropriate (or not) for men and women. Such expectations can differ between societies and change over time, although they are often linked to sex. Gender is a crucial aspect in how people understand their own identities and their role in society as well as how they relate to others. We are thus interested in the part that gender plays in terms of helping people understand their experience of anxiety and, subsequently, the extent to which gendered discourses (in other words, what is viewed as common-sense knowledge relating to gender) are potentially helpful or problematic for individuals with anxiety. Our analysis involves two related strands. First, we compare distinct uses of language that men and women use in their postings, through the keywords technique. Second, we examine the ways that posters represent men and women in terms of expectations about them or the generalisations about their perceived qualities, particularly in reference to how this relates to the experience of anxiety.

Sex, Gender and Anxiety Disorders The World Health Organization estimates that there are 264 million people living with anxiety, with females being almost twice as likely to be diagnosed as having anxiety than males (4.6% compared to 2.6% at the global level) (World Health Organization, 2017). McLean and Anderson (2009) review a range of studies relating gender to fear and 135

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

136

Sex and Gender

anxiety, noting that even at age six, girls are twice as likely as boys to have experienced an anxiety disorder (Lewinsohn et al., 1998), and generalised anxiety disorder is six times as likely to occur with adolescent girls than boys (Bowen et al., 1990). Research on the antecedents of anxiety indicates a wide range of possible explanations for these apparent sex differences. For example, Barlow (2000) points to a non-specific genetic contribution towards anxiety disorders while anxiety in women seems to be exacerbated during the premenstrual phase (McLeod et al., 1993). Meanwhile, Taylor et al. (2000) have argued that evolutionary factors have resulted in women not developing the ‘fight-or-flight’ response in the same way as men (as that would compromise pregnancy), and instead women have developed a response to fear that they call ‘tend-and-befriend’. Other factors could include different coping strategies, gender-specific trauma (Kessler and McLeod, 1984), a sense of uncontrollability (Nolen-Hoeksema, 1990), tendency to ruminate (Nolen-Hoeksema and Jackson, 2001) or heightened sensitivity to social cues (Craske, 2003), all of which have been suggested as reasons for higher rates of female anxiety. Additionally, it has been argued that caregivers encourage gender-conforming behaviours; for example, parents consider withdrawal and inhibition to be less acceptable for boys compared with girls (Stevenson-Hinde and Shouldice, 1993). Socialisation may also contribute towards the higher numbers of women being diagnosed with anxiety. The higher prevalence of female diagnoses suggests that anxiety is more likely to be seen as an issue affecting women. However, these rates of diagnosis of anxiety disorders should not automatically lead us to assume that women are more likely to be anxious than men – it could be the case that men are less likely to acknowledge they have anxiety to others and subsequently seek medical help. One argument is that the social patterning of hegemonic masculinities – privileging practices such as self-reliance and restrictive emotionality – limits the expression of symptoms of anxiety in men, leading to under-diagnosis (Gough et al., 2021), a point which we will explore further in the data analysis of this forum. Courtenay (2000, p. 1388) notes that health-related beliefs can be understood ‘as a means of constructing or demonstrating gender’ and, subsequently, health behaviours ‘simultaneously define and enact representations of gender’. In particular, understandings of masculinities are based on the denial of vulnerability, with displays of self-reliance and strength being expected (Clark et al., 2018). Such characteristics can all be undermined by (mental) illness, including anxiety disorders, resulting in the view that ‘masculinities are defined against positive health behaviours and beliefs’ (Courtenay, 2000, p. 1389). As a result, numbing or escapist behaviours might be found in men who

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Sex, Gender and Anxiety Disorders

137

experience chronic low mood, as opposed to discussing distress with health professionals or support networks (Brownhill et al., 2005). With men primed to exhibit externalising symptoms and cover up internalising symptoms for fear of stigma (Smith et al., 2018), diagnosing anxiety in men is especially difficult. Furthermore, characteristics associated with stereotypical masculinity can exacerbate mental health problems. For example, Martin et al. (2006) note that participants who viewed muscularity as having many benefits reported greater levels of social physique anxiety than did men who viewed muscularity less positively. Similarly, Hammond (2012) found that higher restrictive emotionality was associated with more depressive symptoms among African American men aged 18 to 39 years and in relation to body image. It is with these findings in mind that we now turn to consider gender in the posts on the Anxiety Support forum. When posters created an account with HealthUnlocked, they were asked to provide information about themselves relating to their sex, age, ethnicity and country of residence. For sex, posters had a choice of identifying as Male, Female or Other, or they could choose not to provide an answer. Table 5.1 shows that almost half the people who created a profile (46.70%) did not provide information about their sex. Over half (52.55%) of all posts were made by people who identified as female and 15.86% were made by male posters. A search across the forum for terms such as trans, transgender, transwoman, transman, non-binary or genderqueer indicated one person who had selected the option Male when creating a profile and subsequently selfdescribes as a transgender male when posting messages. I am a 17 year-old transgender male, and I have suffered from anxiety for as long as I can remember. (Male)

While this was a single case, it serves to remind that people can interpret categories such as male and female as relating to the sex they identify with as opposed to the sex they were assigned at birth. It is important that gender-based research does not overlook cases where people explicitly do not identify as male or female and in this corpus 143 (0.05%) posts were made by those identifying as “Other”, contributing 7,617 words of posts. The amount of text in the corpus written by people who chose ‘Other’ is relatively small, meaning that it is difficult to identify patterns based on frequency of usage. Comparing these 143 posts against the rest of the corpus produced only five keywords in the top 100 which occurred at least 10 times: checked (10 occurrences), real (11), physical (12), depression (14) and sleep (24). Concordance analysis of these words indicates that these posters discussed concerns about lack of sleep or

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Contributors

6,918 2,536 18 8,298 17,770

Gender

Female Male Other Unspecified Total

38.93 14.27 0.10 46.70 100

% 154,544 466,44 143 92,751 294,082

Posts 52.55 15.86 0.05 31.54 100

%

22.34 18.39 7.94 11.18 16.55

Posts per contributor

Table 5.1 Breakdown of the Anxiety Support forum corpus according to gender categories

10,334,292 3,485,443 7,617 7,054,059 20,881,411

Total words

Male and Female Keywords

139

dying in their sleep, being diagnosed with both anxiety and depression, checking physical symptoms and considering whether their physical symptoms were real. We also read these 143 messages to see if there were cases where posters referred to sex or gender explicitly. However, no incidences of this were found. We could tentatively conclude that on this forum, people who chose the ‘Other’ option for sex do not discuss their anxiety in relation to gender or sex, although a more confident conclusion would be that there is not enough data to make generalisations. With just 18 people on the forum identifying their sex as ‘Other’ (0.1%), we would note that this group is likely to be under-represented, particularly when we consider a study by Bouman et al. (2017) which found that trans people had higher levels of anxiety symptoms compared with other people. There may be a range of reasons for this – perhaps people who do not identify as either male or female might be unwilling to go on-record about this aspect of their identity, even on an anonymous forum, or they may decide to seek support in contexts where they feel safer disclosing that information.

Male and Female Keywords Our analysis thus moves on to the ways that self-identified male and female posters use language in the Anxiety Support forum. In order to identify linguistic features that are particularly typical of men and women, we have employed the keywords technique, which produces lists of words that are statistically significantly more frequent in one (sub-)corpus when compared against another (see Chapter 3 for a more detailed description of this process). As in Chapter 3, we initially used a third reference corpus, the English Web 2020 corpus, comparing the male and female posts separately against it. This resulted in two keyword lists, although an analysis of the top 500 keywords in each list found that the vast majority occurred in both lists. This is an important finding, indicating that for much of the time, men and women use broadly similar language when posting to the forum. This is, overwhelmingly, the ‘big picture’ when it comes to sex differences in the corpus. The words we focus on in this chapter should therefore be seen as the exceptions to the rule. In order to focus on differences, we decided to carry out a direct keywords comparison of male and female posts, that is, using each one as the reference corpus to the other. We thus obtained the top 100 keywords for these two sub-corpora along with the top 100 key multiword terms (fixed sequences of words of at least two words in length such as panic attack). Table 5.2 shows the top 100 keywords and terms, with relevant frequencies shown in brackets.

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

disorder (1,804), illness (1,325), condition (707), symptoms (7,999), death (933), fast (1,185), beating (499), tension (837), heart attack (797), sleep apnea (105), general anxiety (102), chest pain (430), brain fog (125), heart disease (116), health anxiety (1,109), heart problem (86), heart failure (61), lung cancer (69), rapid heart (56), light headedness (49), cold turkey (139) first thing (231), long term (238), short term (166), last thing (96), same time (292), first place (105), eventually (928), gradually (133)

Persons and things wife (767), male (238), man (647), girlfriend (225), sufferers (314), guy (370), old male (100), year old male (74), anxiety sufferer (64), old man (38), self (1,766), those (2,809), itself (561)

Time

Health issues and symptoms

Male key items

Table 5.2 Male and female keywords and key terms

tomorrow (2,996), today (9,964), tonight (1,744), good day (1,330), last night (1,956), lovely day (234), next week (646), other day (601), last year (1,221), nice day (169), day today (334), day yesterday (144), single day (293), whole time (154), new day (168), day tomorrow (106), last week (915), next time (457), bad day (444), hard time (579), night time (266), sleep tonight (76), full time (245), young age (159) husband (2,844), boyfriend (1,310), daughter (2,574), mum (2,458), hubby (924), mom (1,832), baby (1,665), kids (2,377), children (1,720), son (2,026), sister (1,206), girl (1,073), partner (1,405), house (3,624), anxious person (211), little girl (187), old female (106), other half (145), year old female (78), little boy (106), I’m (13875), ur (1,681), she (16,166), (continued)

sick (5,237), racing heart (404), breast cancer (121), much anxiety (179), sore throat (233), low iron (81), allergic reaction (131), blood clot (204), tight band (80)

Female key items

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

thoughts (3,836) yeah (1,540), regards (441), cheers (257), mate (247)

Cognition Forum relations

muscle (905), pulse (156), BP (505), rate (931), blood pressure (766), heart rate (716), heart beat (127), human body (37)

feelings (2,838), fear (5,661)

Feelings and emotion

Personal circumstances Body parts and processes

fighting (1,148), cure (714), fight (1,226), beta blocker (132), deep breath (171), stress test (133), blood work (238)

Medical tests, remedies and coping strategies

pregnant (863), thyroid (1,071), hair (781), pregnancy (455), birth control (132), ugly head (113), upper back (125), iron (625) (continued)

xx (12,996), xxx (9,900), hun (2,653), :D (1,972), hugs (2,723), :) (15,057), (1,175), :( (3,888), oh (5,024), :-) (4,134), (641), hi (23,953), thankyou (1,635), thank (16,393), lol (6,476), xxxx (1,267), yes (12,439), sorry (9,176), wishing (1,011), okay (3,474), x (52,220), OMG (798), hope u (233), hope everyone (215) same way (920)

him (8,492), u (8,130), mine (3,552), he (20,244), iam (690), myself (15,798) counselling (1,396), yoga (724), bath (713), support (6,042), fresh air (259), rescue remedy (148), support group (261), good book (149), waiting list (208), hot bath (114), support system (96), vitamin D (266), CBT therapy (85), safe place (142), chamomile tea (155), small dose (135), new medication (125) love (11,017), crying (1,761), cry (1,831), glad (4,505), scared (7,737), hate (3,731), pleased (902), proud (1,037), upset (1,506), terrified (1,203), horrible feeling (310), awful feeling (154), u feel (121), I’m feeling (91), I’m glad (76)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Grammatical bin

Abstract nouns

Adjectives

Auxiliary and modal verbs Lexical verbs

Minimal Maximal

Negative evaluation Positive evaluation

practice (806), become (1,273), smoking (505), return (474), caused (1,194), begin (488), causes (1,022), based (370), becomes (189), learn (991), adding (236), doing anything (151) common (929), opposite (307), medical (926), strange (246), physical (596), real (1,426) problem (2,618), attitude (396), state (887), process (624), problems (2,217), tricks (330), nature (293), danger (276), power (429), knowledge (289), peace (835), reason (1526) by (7292), towards (157), instead (833), above (462), three (729)

little bit (275), less (1,196), simply (105)

only way (204), right way (60), important thing (75), good thing (178), only thing (264), right thing (128)

Male key items

Table 5.2 (continued)

cos (684), bc (592)

hard work (223), self esteem (247)

alone (8,457), well (24,489), hot (2,320)

sending (1,244), hoping (2,056), praying (804), want (14,780), taking care (163)

too (21,371), totally (2,503), definitely (3,467), big part (151), long way (218), am (36,110)

lovely (2,673), amazing (1,598), wonderful (1,269), beautiful (1,040), good idea (672), great idea (149), huge help (70)

awful (3,561), horrible (4,464)

Female key items

Male and Female Keywords

143

Although the forum consists of 17,770 different contributors, there is variation in the number of posts that people made. Between them, just over 400 people made half of the posts to the forum, while the top 10 posters contributed 9.78% of posts. To ensure that the keywords we identify are not the result of the writing style of a frequently posting individual, we have removed key items which were used 50% of the time by only one person. We have also removed key items which refer to poster’s usernames (most of these had been anonymised as x prior to receiving the forum data but a few had been left in). It should be noted that the keywords and terms in the table do not indicate words that are exclusively used by men or women only. For example, the male keyword, wife is used 767 times by men and 341 by women. As Table 5.1 indicates, female posts contain about three times as many words as male posts so, relatively speaking, the frequencies for wife come to 195.65 times per million words for male posters and 29.16 per million for female posters. In other words, men use wife 6.70 times more often than women. This is the male keyword with the largest relative difference. At the other end of the scale is the male keyword thoughts: 3,836 male uses and 8,277 female uses, which translates to 948.48 occurrences per million words for men and 707.80 times per million for women. Here, men only use the word 1.38 times more often than women. Keyness, therefore, is not an absolute measure but rather it shows trends. An initial stage in our analysis involved categorising the keywords into groups, a process which was carried out by hand and involved obtaining concordances of the words so we could identify how they were being used in the context of the original posts. This kind of categorisation is admittedly subjective as some words have multiple uses and could be put into more than one category. Additionally, the types of categories themselves could be made more specific or general. We have used the same categories that emerged from the analysis in Chapter 3 (see Tables 3.1–3.10), although we have included three additional categories (abstract nouns, adjectives and grammatical bin) to account for items which would have been difficult to classify otherwise. As we examined the keywords, we gradually began to consider them in terms of how they relate to a range of different aspects of anxiety. This has helped to provide an overall structure to the analysis in this chapter. Rather than simply starting at the top of each keyword list and working our way down, we discuss the keywords in groups, providing contrasts between male and female words in order to draw out a more interesting narrative. We found that analysing the keywords helped to address four questions:

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

144

• • • •

Sex and Gender

How do men and women understand their anxiety? How do they try to resolve it? How do they relate to the forum? How does anxiety relate to other aspects of their life?

We begin by addressing the first question.

How Do Men and Women Understand Their Anxiety? Anxious feelings often result in physical changes in the body, including raised heart rate, which can provoke further anxiety. Male posters are more likely to write about anxiety in terms of fear relating to dying from a heart attack, with their keywords including BP (blood pressure), pulse, fast and death and key terms such as chest pain, heart attack, heart beat, heart disease, heart failure, heart problem, heart rate and rapid heart. I’ve been to the ER countless times either from a thud in my chest or rapid heart beat, and then worrying about it just makes it worse and worse (Male)

Statistically, this makes sense – heart attacks are the leading cause of death for men in many countries, including the USA (Centers for Disease Control and Prevention, 2022) and the UK (Public Health England, 2017). Men are twice as likely to have a heart attack than women, although men are also more likely to survive a heart attack. Women are 50% more likely to die in the first year after having a heart attack compared with men, and they are almost twice as likely to have a second heart attack. Men are more likely to refer to symptoms of anxiety, along with fears of death, and they also acknowledge that these fears constitute health anxiety, whereas women talk about anxiety causing them to feel sick, a more general term with a wider range of meanings. Men also use keywords that characterise anxiety as an abstract entity, often using a medicalisation discourse. They refer to anxiety as a disorder, illness, condition or state, for example. After years of searching and suffering, I’ve found that a lot of what contributed to my anxiety disorder (panic attacks, depression, mood swings, physical ailments) was repressed anger, bitterness and trauma stemming from my childhood. (Male) So it was take the meds or continue down a path of suffering with the anxiety every day. I don’t think this type of illness is one that we can .. tough it out . . . by themselves . . . . (Male)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Male and Female Keywords

145

The people on anxiety uk share a common identity,we suffer from the condition of anxiety. (Male) also believe all our senses are heightened smell, sound, taste, sight this comes from being in a high anxiety state but that information can also be confusing and misunderstood in that state of mind. (Male)

These keywords characterise anxiety as something that happens to you, rather than something that is part of you. Similarly, a key term for men is anxiety sufferer. The idea of being someone who suffers from anxiety is in keeping with the understanding of anxiety as a disorder or illness. Being an anxiety sufferer you will tend to think about the issues more closely than someone without. (Male)

Female posters, on the other hand, are more likely to refer to themselves using the term anxious person. I’ve now accepted I’m an anxious person by nature and try to be open with people about it. (Female) What you are experiencing right now is very normal for the anxious person. We need to be in control but it is not always an easy request (Female)

The difference is that male posters are more likely to view anxiety as something that has appeared in their lives, similar to other healthrelated conditions, while women are more likely to view their anxiety as an essential characteristic of themselves – the first of the preceding posters says that she is an anxious person by nature and 29 out of the 213 female uses of anxious person involve use of the word always; for example, ‘I have always been an anxious person.’ Males only use anxious person 16 times and never say it is something they have always been. Considering proportional frequencies, as occurrences per million words, men use anxious person 4.08 times per million words whereas women us it 18.21 per million, so the difference is notable. Another keyword which indicates that male participants view anxiety as a non-permanent state is develop, which suggests that anxiety is something which can occur at a particular point in time. why the shame about having anxiety? Anybody can develop anxiety if life becomes too stressful for too long. (Male)

This understanding of one’s relationship with anxiety is potentially important. If we view it as a condition or state, then there is an

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

146

Sex and Gender

expectation that it is not an essential characteristic of your identity, it is something that can develop and eventually it may go away. However, if we describe ourselves as an anxious person, we are attributing anxiety to our nature, indicating that it might be more difficult to remove anxiety from our lives. Indeed, this brings us to keywords which answer the question – how do posters believe that they should try to resolve their anxiety?

How Do Men and Women Try to Resolve Their Anxiety? Three pertinent male keywords here are cure, fight and fighting. It stands to reason that if men are more likely to view anxiety as an illness or condition, then they are also more likely to consider it as something that can be cured. However, the 714 male uses of cure present a more complex picture than first imagined. While male posters do not reject the idea that anxiety can be cured, they often lament that a cure is not easy to come by. I have had anxiety for 15 years and having had CBT that finished earlier this year, I’m in a better position to deal with it now than I ever was before. It’s not a cure but it’s like a toolbox that you can dip into when you need it and can really help you get on with your life in the long term. (Male) The anxiety is coming from within so I believe the ‘cure’ has to come from within and from me with perhaps a bit of guidance. (Male) It would be great if there was an easy cure for anxiety, but if [anonymised] had discovered one, I felt it would have made the news. Wouldn’t he have won a Nobel prize, in fact? (Male)

Some male posters treat a cure as a benchmark to which various therapies or approaches can be compared. The first of the preceding posters, for instance, views CBT as not a cure but a toolbox that can help. The second poster puts the word cure in quotes, simultaneously giving it credence by mentioning the concept, while signifying distance from it. The third poster notes there is no easy cure, and this is an often-voiced opinion by male posters, with references to there being no miracle cure, quick cure, magic cure, instant cure, simple cure or overnight cure. However, these phrases do not fully dismiss the idea of a cure, instead it is implied to be the opposite of these things: something that will take time or will not be easy. Other male posters are more optimistic about a cure. Cure lies in facing the thoughts and feelings and being ok with them, not by adding more fear and trying to rid yourself of your symptoms (Male)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Male and Female Keywords

147

But we should keep an open mind and await evidence that therapies like yoga and meditation can indeed result in permanent cure. (Male)

Male posters express frustration at not being able to find a cure, listing numerous methods they have tried which did not result in one, although they do not appear to give up hope as the following poster intimates. I saw what pills has done to my brother he’s on loads and still no better, just slower. I am quite energetic and enjoy racing around and don’t want that to change,so I suppose I must find other ways to cure this anxiety. (Male)

Similarly, the male keywords fight and fighting indicate that men have a range of different stances towards anxiety. An analysis of 100 random cases of male uses of fight found that 41 of them related to cases where men urged others or themselves to fight their anxiety. its fab news you are going back to work, make sure you take every positive and hold on to it. Its well worth the fight, keep strong and beat anxiety. (Male) And thanks for telling me that I’ll be fine it boost my courage to fight this anxiety! :) (Male)

However, 22 cases argue the opposite, that fighting anxiety was counter-productive. Why do you combat it? The more you fight it the more you focus on it and increase the focus on it. I’ve had anxiety for quite sometime and really the only thing that has helped me get over it is by accepting that it is there and not changing my life to conform to it. (Male)

While there is disagreement in the way that men believe they should approach anxiety, even the men who believe you should not fight it seem to be advocating a solution (usually based around the idea of accepting anxiety) which results in its reduction. Indeed, even the preceding poster, who indicates a resistant position in not changing his life to conform to anxiety, still suggests a way of fighting anxiety, just one that is more covert. As part of a problem-solution view of anxiety, male posters are also more likely to use keywords such as caused, causes, reason, process, learn and knowledge, which related to understanding where anxiety comes from and the relationship between anxiety and other health issues.

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

148

Sex and Gender

Anxiety causes gastrointestinal upsets and in turn, that can make you feel bloated and cause pressure in the chest; chest pains, shoulder pain, and even jaw pain. (Male) There is a reason for people developing anxiety disorder – a cause, a trigger. (Male)

Process also tends to be concerned with recovery, occurring after the words healing, learning, recovery, gradual and slow. This process of getting better is often described as taking a long time. It probably took quite a while for your symptoms to develop, so it is not entirely unreasonable to expect this healing process might also take some time too!! (Male)

There is also reference to a learning process, with learn being another male keyword. Male posters urge each other to learn how to be comfortable in their own skin, to take care of themselves, to relax, to cope, to laugh again, to let go, to be OK with not feeling OK, to use breathing techniques and to beat anxiety. Similarly, male posters view knowledge as an important aspect of coping with anxiety. Male posters use phrases such as ‘knowledge is power’ or ‘knowledge is the key to recovery’. With anxiety and panic attacks, knowledge is one of the key components to coping with it. The more knowledge you have, the better you can cope. (Male)

Another aspect of the male focus on resolving anxiety is a sense that there are different approaches or methods but that some are right and others are not. This is indicated through male use of key terms such as good thing, only thing, last thing, right way, right thing and important thing. Good thing and important thing both occur more commonly in the form of giving advice, with the two adjectives used to mark the advice as worth taking. Last thing is used when advising people not to engage in certain activities. A good thing today I found is that when doing deep breathing focus on expanding your belly, not your upper chest. (Male) The most important thing you can do, if you feel anxious about your health is an appointment with your GP where you can discuss your concerns. (Male) Last thing you want to do is Google symptoms with bad anxiety it always looks alot worse than it is. (Male)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Male and Female Keywords

149

The phrase only thing is used mainly by male posters to indicate that they have only been able to think of a single solution to a problem, although in some cases they use it in the context of giving advice, where they suggest a single course of action or reason. The only thing i can think of is the possibility that maybe the medication works faster than CBT, however I do not know for sure. (Male) Everyone reacts to the different SSRIs in slightly different ways so I’m afraid that the only thing that you can do it give it the 4 weeks of potential therapeutic lag and see if it kicks in and if not try something else. (Male)

With right way, male posters refer to different approaches for dealing with anxiety, noting that there is a right way (which they can impart), so there is an implication that there is also a wrong way. The following poster sets up a hypothetical dialogue between himself and an imagined person with anxiety, asking a question and then answering it. I am not judging or criticising anyone for doing it because I did the very same things for a long time until I learnt how to cope with the symptoms the right way. What is the right way? The right way to recover from anxiety or any other fear based disorder is to do nothing. (Male)

These phrases sometimes blend advice with support. In an investigation of 100 random occurrences of right thing, this manifested as a male poster reassuring someone else that they did the right thing in 72 instances. It is not daft at all and going to your GPRS was the right thing to do. i have been referred the same as you. (Male)

The male keyword instead also functions as part of advice-giving, with posters using it as a way of signalling an alternative (and better) approach. Then, instead of thinking “I hope I don’t have a panic attack soon”, focus on the fact that every second is another opportunity for you to start ALL over again and have more of the amazing days I was talking about. (Male)

Moving on to female posters, rather than giving advice based on trying to understand the process of anxiety, there is more focus on recommending practices or items which have helped them to feel better, signified by key terms such as hot bath, fresh air, chamomile tea, good book, rescue remedy, safe place and vitamin D. Hot bAth and a good book to take your mind of things, give it a try, it works for me (Female)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

150

Sex and Gender

I used a safe place exercise which is probably a similar thing to anchoring. I used it when things were unbearable and it does work . . . (Female) I take Rescue Remedy (herbal remedy for anxiety), it is very effective. (Female)

In summary, one observed difference is that men tend to advocate understanding the processes behind anxiety, whereas women are more likely to suggest activities that will help to alleviate it.

How Do Men and Women Relate to the Forum? While the male key items tend to be more problem-solution focused, the female keywords and key terms are more based upon providing emotional support, encouragement or indicating that posters relate to one another’s problems. One set of female key items focuses on affiliation, tending to occur at the start or end of posts. This category includes responsive markers such as omg, which indicate the poster’s emotional reaction towards another person’s post. As a typical example of omg (an acronymised form of Oh My God), in response to a post where someone has complained about someone else removing their food, a female poster uses omg to indicate excitement that the poster is the same as her. OMG I am the same about stuff like the activia yoghurts, I would kick ass if anyone binned or ate my food! :O (Female)

Additionally, sorry, glad and pleased tend to involve expressive evaluations towards others’ posts, while same way is used to show that a poster identifies with another’s experience. I don’t know the answer but I’m sorry you are finding things tough xx (Female) Glad ur feeling carmer todayur already being positive xx (Female) I feel the exact same way as you.my symptoms are also constant with no respite. (Female)

Female posters are also more likely to express affection towards other posters, using keywords such as x,1 xx, xxx, xxxx, hun, hugs and love, as well as key terms such as lovely day and hope everyone. 1

Prior to us receiving the forum data, most of the names in the corpus had been identified via automatic means and anonymised, being converted to the letter x. The change of names to x results in a potential problem concerning its interpretation, particularly as some posters on the forum signed off their posts to use x to signify a kiss while others ended posts with their name. It was therefore not possible to confidently ascertain whether x referred to a kiss or a name. As x was a top 100 female keyword, we have included it in

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Male and Female Keywords

151

Eighty-seven out of 100 random cases of lovely day involve posters hoping that someone has a lovely day, while hope everyone occurs in similar constructions but is aimed at the whole forum. Hope everyone is ok today how are yal feeling??? (Female)

Female posters address others as hun and send them love and hugs. ahh thank you hun I hope you feel better soon love and hugs back to you (Female)

The keyword lol (an acronym for laughing out loud) tends to be used by posters to signify a humorous stance, which can have the aim of resolving ambiguity and thus avoiding potential conflict. I’ve suffered with agarophobia and social anxiety since my teens,I seem to be conquering my fears through throwing myself in at the deep and (not literally lol),so yeah I’m not doing too bad, I’m just missing a good friend (Female)

Finally, female posters have a more frequent and wider use of ASCIIbased emoticons, using combinations of punctuation characters like :), :-), :( and :D, as well as emoji which are made of a single glyph such as and . These characters are usually used in order to signify humour or to indicate an emotional response towards another poster. Oi cheeky back in the day David Essex was a megastar :D Went to see him quite a few times once the stalking did pay off and I walked into the bar of the hotel he was staying at and had my pic taken with him oh happy days (Female) Hope all goes well for you.

(Female)

Men employ a smaller number of affiliative keywords, some of which indicate a colloquial style. Agreement is indicated with informal yeah (women have the standard word yes as a keyword) while they use cheers (257 cases) and regards (441 cases) as sign-offs to their posts and refer to one another as mate (247 cases). However, the frequencies of these keywords are relatively low compared to the female affiliative keywords (e.g., xx is used 12,996 times by women), so while words such as cheers are a salient feature of male posts, they are also comparatively rare. Another set of female keywords relate to evaluation, with posters describing their feelings or attitudes, either negative (awful, horrible, alone, hate) or positive (wonderful, amazing, beautiful, Table 5.2. Since xx, xxx and xxxx are also female keywords, we would hypothesise that x as a kiss is very likely a female keyword too.

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

152

Sex and Gender

lovely). The latter set are reminiscent of Lakoff’s (1975) claim that women use ‘empty adjectives’, so-called because their apparent over-use renders them almost meaningless. Women tend to use these words to positively evaluate the forum itself (collocates of these words include group, community, site, support, post, comments), their partners (man, husband, boyfriend), children (boy, girl, baby, daughter, granddaughter) and holidays (Christmas, weekend, holiday). I hope you continue coming on the forum, we have a wonderful group of support and caring people who like yourself suffer from anxiety. (Female) There’s times I’ve felt like I was dying but I have a job, a house with my amazing, wonderful boyfriend, and responsibilities that I have to tend to. (Female)

The negative evaluative words often function as a way that female posters show support towards others, with collocates of these words such as must and sounds indicating that the poster is evaluating someone else’s experience. Ah it must be awful hun one of the many horrible things we have to go through on a daily basis, yes I think that’s why a lot of us had thought we have had MS at one time or another (Female)

In addition, these words are used to evaluate how anxiety, or symptoms related to it, feels. I suffered a lot from anxiety in the past, and I know that horrible feeling of dread (Female) Hate being like this, anyone else understand what am going through?? (Female)

Women are also more likely to refer to negative emotions when they discuss anxiety (key items include crying, cry, scared, upset, terrified, awful feeling and horrible feelings). There is sometimes an element of catastrophisation or maximising the impact of anxiety with these negative words relating to evaluation and feelings. This is also demonstrated in female key phrases such as single day and whole time, used to describe situations as constant. the whole time i was there i was panicing so bad i couldn’t stop shaking and trembling and the whole time i was wishing i never came. (Female)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Male and Female Keywords

153

I have the same symptoms every single day. (Female)

However, alternatively, women’s openness about the emotional impact of anxiety stands in contrast to male reluctance to discuss them. One male keyword, feelings, tends to be used vaguely, to intimate that men are experiencing emotions, or to refer to feelings of physical symptoms. anxiety can cause the weirdest feelings Although if you are so concerned with your feelings of heart attack etc and you are worried see your GP

How Does Anxiety Relate to Other Aspects of Posters’ Lives? While male posters focus on knowledge as a way of helping their anxiety, female posters stress the importance of support, referring to the support of the forum, their family organised groups and health practitioners. Each of these can be referred to as a support system. I’ve managed my anxiety up until now by having an amazing family support system (Female) Today I’m cutting out the coffee and tonight I’m going to an anxiety support group that I found near where I live, so just some small steps (Female)

Female posters use a range of keywords and phrases that refer to other people in their lives, usually family members such as husband, hubby, other half, boyfriend, partner, daughter, baby, children, kids, little boy, little girl, mum, mom, son and sister, as well as third-person pronouns such as him, he and she. Female posters thus tend to situate their experience of anxiety in relationship to those who are close to them, often expressing concern about how their condition has or might adversely affect them. I also think what if I never wake up and what will happen to my children. I know it is anxiety and anxious thoughts make my body tense. (Female) Whatever this is has completely ruined my life and me as a person. I try to not let my kids and husband see how bad this affects me but it’s just so hard. (Female)

In addition to referring to themselves as sufferers, male, self, man and guy, there are only two male keywords that refer to other people: wife

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

154

Sex and Gender

and girlfriend. Furthermore, there are qualitative differences in how wives and husbands are written about. For example, husbands collocates with supportive (31 occurrences), as female posters focus on the extent to which their husbands support them. My husband is super supportive, never complains and amazingly understanding, sometimes to the point that I feel as if he deserves better then to have to live this way. (Female) I’m at a loss. I can’t function day to day if I’m vomiting. My husband isn’t supportive at all. I just don’t know what to do . . .. (Female)

Another collocate of husband – poor – involves descriptions of longsuffering partners. My poor husband listens to me every morning same thing over and over even though I try to hold it in. (Female)

A smaller number of men (7) write about how their wives have been understanding of their anxiety, but also husbands tend to write about how their wives have impacted on their anxiety, with the collocate died being used to refer to mental health issues resulting from wives dying. When my wife died back in January this year everything seemed empty and pointless. (Male)

The female keywords mum and mom (which mainly indicate differences in American and British orthography) usually refer to the poster’s own mother but in about 10% of cases they are used to refer to the self. Nevertheless, as with words such as boyfriend or daughter, they also express a relationship: the poster identifies themselves in terms of the fact that they have children. I am a mum again to an 18 month old but I have never had anxiety before it has only been since she was 4 months old (Female)

The keywords that men use to refer to themselves are used as identity markers but do not tend to specify a relationship with another person. I felt totally useless as a man and i started self harming. (Male) Im a 26 yr old male whos been experiencing the EXACT same things you are. (Male)

Thus, a difference between male and female identity-based keywords is that men are more likely to consider themselves as a person in their own right – and focus on how their anxiety impacts on themselves,

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Discussion

155

whereas women are more likely to consider themselves (and their anxiety) in terms of their relationships to others.

Discussion It ought to be emphasised again that the differences in language use found here are not absolute but a matter of scale. While men, collectively speaking, are more likely to refer to their anxiety as an illness, not all men do this, and some women call their anxiety an illness. The keywords thus examine what happens if we look at language use that is most typically male and most typically female, but it should be borne in mind that this is in reality a small amount of language and most of the words and phrases in the forum are used with similar relative frequencies by men and women. Additionally, hardly any men frequently use all the male keywords mentioned in this chapter, with the same point applying to women with the female keywords. As such, the preceding descriptions cite a kind of amalgamation of several typical male and female linguistic features across hundreds of posters, rather than claiming that all (or even most) men combine these features together to create a distinct gender identity. Bearing those caveats in mind, what do the keywords tell us potentially about gendered differences? First, there are differences in the ways that men and women understand anxiety as it relates to themselves. Men are more likely to view it as a disorder or illness while women describe anxiety as a personal quality and identify as an anxious person. Subsequently, men view anxiety more in terms of curing or fighting it, and provide other posters with information and advice regarding the right way to do this. As Lindinger-Sternart (2015) notes, men value self-sufficiency when it comes to health-seeking behaviours. Female posters are more likely to offer suggestions for (nonmedical) techniques to alleviate anxiety, like taking a hot bath. They also consider the impact of anxiety on those around them, as well as considering other people as a potential source of support. For them the forum is a place where they can describe how anxiety makes them feel and where they can provide support to others in the form of encouragement and empathy, noting that they have had similar experiences. The differences noted here have been found with respect to other mental health forums. For example, when looking at a forum concerned with depression, Nimrod (2013, p. 432) found that ‘men are more likely to cope by seeking information, while women are more interested in discussing daily living with depression’. Other studies (e.g., Hausner et al., 2008; Mo et al., 2009) looking at gender differences in online support groups have found similar patterns.

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

156

Sex and Gender

It is not our intention to judge whether the male or female discourses on anxiety are most productive in terms of helping people to resolve or live with their situation. It could be argued that there are pros and cons associated with each. Men might feel hopeful that their anxiety can be resolved (although this may result in disappointment if it is not the case), and their focus on obtaining knowledge about the processes around anxiety suggests they do not feel as much need to rely on the support of others. On the other hand, women appear more concerned with social structures, meaning they are more likely to turn to others for help rather than bottling up problems. Someone who views anxiety as a personal trait might believe that it will never go away, although this may also result in a more realistic appraisal involving learning to manage or live with anxiety. An important point to make is that all these discourses around anxiety appear in the forum. Those who join the forum for information on coping strategies can find them, while those who want kindness and empathy are catered for too. Different strategies were identified broadly in relation to sex in these data. However, this raises another question: if men and women understand anxiety differently, what happens if your perception of anxiety is not typical of your sex? In the next section, we take a different perspective, focusing not on language used by men and women but language used about them.

Discourses of Gender In this analysis section we consider the whole corpus to look at the ways that posters refer to concepts relating to gender in order to identify gendered discourses (Sunderland, 2004) or ways of understanding gender that are viewed as common-sense. To do this we first identified a set of words which were likely to be used when such discourses are referenced. This involved a three-stage process. First, we used introspection to think of a set of gender-related words. We then consulted a thesaurus to identify further words and, finally, we added new words which were identified as a result of engaging with the corpus data. This produced the following set of words (frequencies are shown in brackets): bloke (100), blokes (17), blokey (0), boy (1,039), boys (504), chap (46), chaps (3), guy (1,337), guys (3,594), lad (106), laddish (0), lads (48), macho (10), machismo (0), male (602), males (29), man (2,464), man(-) like (0), manly (7), masculinities (0), masculinity (0), men (785) effeminate (0), female (623), females (42), feminine (16), femininities (0), femininity (1), girl (1,794), girls (727), girly (53), lady (960), lady(-) like (0), ladies (272), lass (17), lasses (3), woman (1,248), womanly (2), women (941)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Discourses of Gender

157

By reading expanded concordance lines of posts containing words in these lists, we identified the cases which referenced gender (references to masculinity or femininity or behaviours and expectations associated with identifying as a man or woman) as opposed to sex (references to being male or female). We then developed a categorisation system which grouped similar gendered representations together. The identification of representations involved examining adjectives used as descriptors of men or women, nouns that were used to label them and verbs that involved men or women as either carrying out actions or having actions carried out on them. Additionally, we considered other forms of language use including metaphors, implicatures and tautologies. Representations could, for example, involve assertions that men either do or do not possess certain qualities or should or should not possess them. The analysis in this section of the chapter involves more qualitative evaluation, compared with the earlier keyness analysis. Despite words such as man and woman being reasonably frequent, the majority of occurrences are not used in ways where expectations about gender can be ascertained. The data for this section comprises 138 expanded concordance lines, meaning it is too small to be able to make strong claims about which views of gender are popular and which are not. We have focused on cases where there is evidence of repetition, involving different people making a similar claim about some aspect of gender, as opposed to single cases. To begin the analysis in this section, we consider the variety of factors that are used to explain women’s experiences of anxiety. Unlike men, we found that women regularly categorised mental health issues, particularly anxiety, as at least partly influenced by biological sex, relating to hormones, monthly cycles and the menopause. Anxiety is therefore viewed as something that has the potential, at least, to constitute a part of what it is to be female. Another cause of anxiety can be hormonal – female hormones for instance – some women become anxious around the menopause. (Female) any women, myself included, experience an increase in anxiety around “that time”. (Female)

Another understanding of anxiety, however, is based more on social factors, with some women writing of their experiences of sexism and misogyny. This is sometimes viewed as contributing towards women’s anxiety and seen as something which makes women’s lives more difficult than they should be.

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

158

Sex and Gender

it’s very sad how women get treated online and no woman should have put up with immature people like the ones you described. (Female) In my 30s, I am still getting over my childhood – I’m female so his mysogeny hurt me deeply. (Female) I know some will disagree with the reality of Patriarchy and female subjugation (including in the USA), but I am not here to debate reality: all I will say to those people who still deny women’s oppression . . . ignorance is bliss. (Female)

The following post views anxiety as hormonal and criticises the British medical system for not acknowledging this, implying that women’s specific experiences of anxiety are overlooked and that they are simply treated the same as men. Posters also note how male doctors are dismissive of mental health issues and advise one another to see a female doctor. The tendency in the UK is to treat women as men disregarding how fluctuations of oestrogen and progesterone can affect your moods, and your health (Female) I do find female doctors generally better on mental health issues. (Female)

However, another set of posts appear to represent women as possessing various personality qualities (indecisiveness, vanity, jealousy, empathy) which make them more likely to experience anxiety. Such qualities do not seem to be viewed as biologically inherent in the same way as hormones, but they also do not seem to be attributed to societal structures either. i know it’s such a girly thing to be obsessed with our looks, glad i’m not alone. (Female) That is a big part of my anxiety, wether the decisions are big or small, I know a lot of women do this but I can’t even decide what to wear (Female) I also get very jealous when there are beautiful women on tv. Maybe my boyfriend would rather look at them than my flabby chubby self. I don’t know if this is a female thing. (Female) Its very common for us women to take on others pain and emotions and blame ourselves for it. (Female)

Most of these perceived traits, apart from empathy, are negative and while they represent women as more likely to experience

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Discourses of Gender

159

anxiety, other characteristics associated with being a woman are viewed as being likely to impact on women in terms of their management of anxiety. Women are seen as good communicators and able to be honest about how they are feeling. I think women, find it easier than men, to admit they are suffering, sometimes men can see it as a weakness, which it certainly isnt . . . maybe he feels that way (Female)

As a result, women are seen to value communication more than men, to the point where they are sometimes viewed as loquacious. i do believe that women need other women to talk with (Female) I do no women never stop talking & we are very good at saying how we feel & what we want (Female)

Perhaps contrary to the stereotype, some posters represent women as tough, as expressed in various metaphorical expressions (soldier on, machines, their rock). as woman we soldier on, but she may be worrying deep down (Female) All that hard work ur body is doing! We are machines us women! (Female) It is very hard on kids to see their mom unwell . . . they think of you as their rock. Sometimes we just cant be that for them. Your boyfriend may just feel helpless and not know what to do. We, as women, are always suppose to be strong and nurturing.. (Female)

However, other posters note concerns that their anxiety will be seen as a gendered example of a ‘helpless female’ and thus a sign of weakness and instability. I was angry that my husband was instructed to come, like I was the helpless female who couldn’t do it myself. (Female) he obviously thinks i’m being a bit of a wimp (I’m the only female engineer in the company) (Female)

The following poster identifies as male but worries how disclosing anxiety would result in him being seen as like a woman. I don’t have a fear of doctors, doctor offices or hospitals. I just fear talking about my mental state. I was worried I would be deemed weak, girly, feminine. That they would send me off, deem me mentally unstable, a danger to my self. (Male)

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

160

Sex and Gender

Men are generally viewed as less emotionally expressive than women. For example, one male poster advises a female poster who has been having problems with her husband, suggesting that she writes him a letter. He ends his post with the following sentence: I hope this helps in some way, i am a man and not good at touchy feely, good luck (Male)

Here the use of and can be interpreted not as a co-ordinating conjunction but as a subordinating conjunction, whereby the quality of not being ‘good at touchy feely’ is implied to be due to the fact that the poster is a man. Men also cite a pressure to be strong, and therefore silent. i cant talk to anyone close because i have to be the strong male type in the family and i dont want it to reflect on my son (Male)

With other posts, the connection between being male and emotionally inexperienced is made more explicit. Being a man the hardest is to allow yourself to have feelings . . .. .crying especially, followed closely by talking about your feelings to other people-it’s unnatural to me as I always used to keep things inside. (Male)

A female poster describes her male partner as a ‘typical cave man’, the result of which is that he is not able to provide support to her. last month he actually admited he cant be there for me emotionally, he is a typical cave man cant talk about his feelings, he said he got no one to help him, give him advice on how to cope with me (Female)

Other posters note how men differ from women in terms of not acknowledging problems, with the following poster being somewhat critical of what they see as a male response. i think quite often women tend to be the doer’s and organisers and often cope better, where men just put their heads down and hope it will just go away eventuallly or things will improve and the pressure will decrease (Sex unknown)

A view that men should be ‘strong and silent’ is seen as a barrier to men overcoming their problems. I know many men turn to drinking to hide their fears, problems and issues. (Female)

Other studies have found cases of boys and men ‘externalizing’ troubles, employing increasingly risky, dangerous or life-threatening behaviours such as excessive drinking, along with an externally directed physical release of emotional distress in the form of aggression,

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Discourses of Gender

161

violence and suicide that conforms with masculine ideals of a strong outer physical appearance (Brownhill et al., 2005; Smith et al., 2018). However, while some posters urge men to overcome concerns about not appearing masculine to talk about their fears and problems with others, others take a different perspective. Trust me heart is not as weak or vulnerable As we think about it. You are a man and be a man. Start workout, sweat yourself, say these stupid feelings to give you their best shot. Don’t surrender or yield before them. (Male)

On the surface, this poster appears to employ a tautological assertion ‘you are a man and be a man’, although this can be resolved if we interpret the two uses of man to have different meanings; for example, the first use referring to the biological status of being male, the second one referring to a gendered understanding of being a man (linked to notions of strength). The poster also uses metaphorical language which frames the experience of anxiety as a battle, urging the man not to surrender or yield before his feelings. He also is advised to confront the feelings, being told to give it ‘their best shot’. Similar sentiments are put forward in the following post which also takes the form of a ‘pep talk’ from one man to another, who has been experiencing symptoms of anxiety. I have faith in you mate deep down your a strong ass man who can work threw anything fight my friend fight with everything you have and always remember im here for you (Male)

For this poster, anxiety is seen as a battle which can be overcome if the person experiencing responds in a way that is associated with notions of hegemonic masculinity – subordinating a foe through physical strength and violent action. A salient use of this discourse of male strength is in the phrase man up. I’m on meds now and gettin reay bad side effects but I no I need to man up if I want my life back (Male) I accept the fact that I’m lightheaded and I just man up and not worry. If I get anxious I embrace the anxiety and show it im not scared. (Male)

However, an alternative discourse views anxiety as affecting both men and women, and that it is acceptable for men to acknowledge this. Me being well me i’ve injured myself a lot, bruised 1 rib and fractured another, had a rugby pole pierce my kneecap and so on and I don’t

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

162

Sex and Gender

care how less of a ‘man’ this makes me to the world, anxiety is the toughest thing I have ever faced. (Male)

This poster begins by positioning himself as a man who has experienced numerous physical injuries. He also implies that he plays rugby: a sport which involves players tackling one another for possession of the ball, thus requiring considerable physical strength and favouring players with large bodies. The poster thus establishes a set of masculine ‘credentials’, which help to off-set his subsequent description of how anxiety is the toughest thing he has ever faced and he does not care if that makes him less of a ‘man’ to the world. To an extent, by describing anxiety as tough, it is framed as a foe in a similar way to earlier posters who used the battle metaphor. However, the verb face suggests a different orientation to fight, and the poster’s use of quotes around the word man suggests a more critical perspective, one which challenges stereotypical notions of masculinity. At the same time though, not caring how much less of a ‘man’ his assertion makes him could be viewed as part of a more traditional masculine identity, one where other people’s opinions are seen as not relevant because men are self-assured enough not to require validation from others. A similar report involves one poster reporting something he had heard. Also I have been to the ER multiple times for panic attacks. I have had cat scans and mri’s all because of anxiety. The doctors told me that a panic attack can bring a grown man to his knees. (Male)

The fact that this piece of information is from not one but multiple doctors, helps to function as a legitimation strategy (an expert opinion), which helps to counter any criticisms that the assertion seems to be outlandish. The poster uses the pleonasm ‘grown man’ rather than simply ‘man’, a choice which emphasises the power of a panic attack as a symptom of anxiety. While this poster also stresses how anxiety can affect men, he focuses on a specific type of men: ‘grown’ men, which both counters the idea that men do not experience anxiety but also helps bring to mind the idea that, usually, men are tough. Other posters blame a ‘macho culture’ for making men’s experience of anxiety more difficult due to the fact that they feel unable to talk about it for fear of being perceived as weak and feminine. I struggle doing the most normal of things and I get the whole “man up” comments when I’m holding on to a wall struggling to breath it’s horrific. (Male) Having a breakdown in my early twenties was bad really rough because there was a macho culture and having bad nervres is a sign

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Discourses of Gender

163

of weakness. I know now trying to hide the fact made me feel much much worse I treid hiding in the bottle taking all kinds of drugs which just drove me more crackers. (Male)

In addition, a small number of posters try to challenge the ‘man up’ discourse, positively representing men who talk about their feelings or acknowledge their problems and characterising such men as ‘more of a man’, ‘a bigger man’ or ‘a real man’. The words bigger and more function as comparators, thus implying a scale of masculinity where men can be ranked, while real implies that some men are ‘fake’. What makes such a man ‘bigger’ is the capacity to admit to having qualities that are otherwise purported to be unexpected or undesirable in men, despite their universal occurrence. yet it takes a bigger man to admit they are struggling & I believe every man will at some stage in his life struggle even though they may not admit it (Sex Unknown)

The following poster says she is a woman and prefers a man with qualities that make him appear sensitive. Well I am not a man, but as a woman, I do understand that, is the job description been tough in that industry, but personally, I prefer a man that is sensitive & has feelings & a heart & it makes them more of a man, not I suppose that helps any (Female)

Another poster contrasts the kind of man who can open up about how he feels (‘a real man’) with those who cannot (‘a coward’). keep an open mind and allow it to rather than pushing it away which we tend to do because we feel so bad about ourselves It takes a real man to be able to post like you have & open up about how you feel not a coward a coward cannot admit to how they are feeling so I hope you will eventually realize that :-) (Sex Unknown)

Such posts recontextualise masculinity as not being about silently suffering or refusing to acknowledge problems but as being brave enough to talk about them. While this representation offers an alternative perspective of masculinity to those which urge men to ‘man up’ or that ‘strong is silent’, it also has some elements in common with them. First, having masculine qualities is still viewed as a good thing and central to a man’s identity. Second, masculinity is still defined in terms of traditional concepts such as strength and bravery, as well as being demonstrated via comparisons with other kinds of men. While such qualities are seen as being demonstrated in different ways (e.g., by talking about

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

164

Sex and Gender

problems), the overall discourse, that men should be strong, is still maintained.

Conclusion While overall, the vocabulary used by men and women in the Anxiety Support forum is quite similar, the analysis of keywords and terms identified notable differences in the ways that they understand their experience of anxiety. Men appear more likely to view anxiety as a potentially temporary state and seek knowledge about it so they can find the right ‘cure’. To an extent, the findings from the earlier keywords part of the chapter illustrate and explain the gendered discourses found in the second part of the chapter. Despite the fact that it is acknowledged that men’s experience of anxiety can be hampered by their reluctance to be seen as breaking gender norms, male understandings of anxiety are framed in language around fighting and terms such as ‘man up’. Even the counter-discourses which encourage men to seek help still maintain traditional views of masculinity by positioning such activities as even more masculine because they require bravery to go against the norm. Perhaps this strategy is understandable; it does not seek to threaten a man’s self-image but uses the logic of masculinity-equals-strength to encourage men to be strong enough to do something that is seen as weak. Advice which tells men to be more like women and seek help is unlikely to be effective, given that we have observed concerns from men about appearing feminine or ‘like a woman’. More broadly, even though posters discussed critically gender-based norms relating to responses to anxiety, alternatives nevertheless referred to aspects of traditional gendered discourses, showing how difficult they are to counter. We found fewer cases where women were concerned about not conforming to gendered expectations, although a small number of women felt that by talking about anxiety they would be dismissed by men as weak. Women are more likely to view their anxiety as a trait as opposed to an illness and they also discuss it more often as being influenced by hormones. Women are also seen as having personality characteristics which are likely to result in anxiety. Rather than primarily trying to seek understanding around the processes of anxiety, women tend to use the forum as a means of support and providing affiliation with other posters, as well as identifying cases of shared experience or activities that will alleviate anxiety. However, women’s perceived ability to communicate is also seen as a positive way that they can deal with anxiety, through use of different kinds of support networks, comprising either medical professionals, family and friends or online communities. Indeed, women’s postings position their

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

Conclusion

165

experience of anxiety in terms of how it impacts on those around them, whereas male posters tend to be more focused on how anxiety relates to them. We do not believe that there is a perfect, one-size-fits-all method of addressing anxiety but rather that there are a range of possible ways of understanding it, along with associated coping strategies, and individuals would be best advised to be made aware of them and given support (if required) so they can make an informed choice regarding which combination is most likely to benefit them. As this chapter has indicated, some understandings and coping strategies around anxiety are gendered, meaning that certain avenues might be more or less likely to be pursued than others, depending on how strongly aligned people feel towards notions of what is appropriate for their sex. This means that for some people, certain approaches or perspectives may feel offlimits. Perhaps the point that emerges most clearly from the latter half of the analysis is the difficulty that men feel in terms of opening up about anxiety and seeking help. On the other hand, perhaps some women could benefit from the more typically male strategies around information-seeking and viewing anxiety as something that does not have to be an essential or inevitable part of your personality. Some men might do better to think about how their anxiety impacts on those around them, whereas some women could perhaps be advised not to exacerbate their anxiety by becoming too concerned about its effect on friends and family. Balance is key. In terms of going forward, this chapter has identified different ways that anxiety is gendered and this could be helpful for both therapists and doctors, as well as for individuals with anxiety. It might be the case that programmes can be tailored in terms of what is likely to be seen as an appropriate strategy for the sex of the patient, or that individuals can be made aware of cases where their internalised gendered discourses might be influencing their understanding of anxiety in an unhelpful way or restricting their options for management. Ultimately, it is important to acknowledge the fact that anxiety is understood through a gendered lens and to consider the consequences this might have for treatment.

https://doi.org/10.1017/9781009250139.006 Published online by Cambridge University Press

6

Comparing Cultures

Introduction When users sign up for an account with HealthUnlocked they are asked a range of questions about aspects of their identity, including ‘Where do you live?’, prompting them to select a country from a drop-down menu. The Anxiety Support forum contains posts from 141 countries, although many countries are only represented by very small numbers of posts. Table 6.1 indicates that just two countries account for the majority of posts (72.60%) made to the forum – the UK and the USA. Although 26.80% of contributors did not provide their location, this accounted for a smaller contribution of posts (17.96%). People who said they were living in Australia and Canada contributed posts that amounted to over 2% of the total but no other countries had more than 1% representation. Half of the Australian posts were made by just seven posters (2.2%), while this figure was 19 (3.95%) for the Canadian posters. As a result, when we examined keyword lists for these two countries, the majority of keywords were of low frequency (63 of the top 100 Canadian keywords occurred fewer than 100 times, with the same figure for the Australian keywords), and many of them were the result of a single poster’s idiosyncratic language use. For the analysis in this chapter, we focus on a comparison of the two countries that contributed the most posts, the UK and the USA. Based on a global survey of mental health conditions, Dattani et al. (2021) note that in 2017, 4.65% of the UK population had an anxiety disorder, whereas this figure was a little higher at 6.64% for the USA. The countries are linked in numerous ways. The first British settlement was established in the USA in 1607. America declared Independence from the UK in 1776 and despite this being a somewhat acrimonious split, since then, relations have been reasonably friendly, with the two countries being allies in numerous wars as well as co-operating in terms of sharing intelligence, economic investment and trends in fashion and music. 166

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Introduction

167

Table 6.1 Contributions to the Anxiety Support forum by country Country

Posts

%

Contributors

%

United Kingdom United States None Australia Canada Others

114,876 98,642 52,805 6,877 6,599 14,246

39.06 33.54 17.96 2.34 2.24 4.81

5,885 5,016 4,763 318 480 1,280

33.12 28.23 26.80 1.79 2.70 7.34

Both countries have English as the dominant language, speaking national varieties which are largely intelligible, although mainly distinguishable through lexical and orthographic differences. In 1806, Noah Webster introduced the Compendious Dictionary of the English Language, advocating for a standardised American English orthography that was designed to resolve some of the inconsistencies of British English spelling arising from competing rules derived from Latin, Norse, French and Greek. Not all of Webster’s recommendations were taken up, but several were adopted, including replacing -our- with -or-, -ise- with -ize-, -cewith -se- and -re- with -er-. These rules thus render colour, realise, defence and theatre as color, realize, defense and theater. In addition, there are numerous lexical differences (usually involving nouns) which distinguish language use across a range of contexts; for example, railroad/railway, schedule/timetable, cookie/biscuit, sweater/jumper. In this chapter we are less interested in these relatively superficial linguistic differences but more concerned with cases which reveal a structural or cultural difference between the two countries. For example, British people are much more likely to use words such as king, prince and royal due to the fact that the UK has a monarchy and America does not. Additionally, some words indicate more subtle differences. For example, Baker (2017, p. 197) noted that a general corpus of written American English in 2006 contained more references to words relating to danger such as risk, unsafe, peril and dangerous, when compared against an equivalent corpus of British English. Many of these words occurred in news articles, indicating that American news reporting tends to be more focused on issues around risk, which might be used strategically as a way of encouraging readers to engage with such stories. Other differences can occur at the stylistic level, although they can also indicate deeper facets of a cultural sensibility. For example, British people tend to use more adverbs of degree,

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

168

Comparing Cultures

particularly words such as rather, reasonably and quite, and phrases such as to an extent and to a point (Baker, 2017, p. 183) while Leech et al. (2009) have noted that British people are more likely to use modal verbs (e.g., can, could), indicating that they can often appear to use language in a more measured or indirect way compared with Americans. Our analysis in this chapter thus focuses on words and phrases that are used with significantly different frequencies between American and British posters which reveal something about how cultural discourses contribute towards understandings of anxiety.

Cultural Keywords The following analysis focuses on differences by comparing the two sets of posts directly against one another, taking the top 100 keywords and top 100 key multi-word terms for each country. These are shown in Table 6.2 with usernames and items that are mostly used by a single poster removed. We used the same categorisation system as in Chapter 2, with two additional categories to capture spelling differences: some which can be clearly linked as alternatives – for example, mom/mum, anyways/anyway, tumor/tumour, round/around; and lexical differences – for example, store/shop, vacation/holiday. As with the equivalent table for sex differences in the previous chapter, the keywords indicate tendencies towards difference rather than absolute differences. For example, the strongest American keyword, Xanax, occurs 2,323 times in American posts (350.46 times per million words) and only 132 times (15.48 times per million words) in British ones, meaning that it is used 22.63 times as much by Americans. The weakest American keyword, focus, occurs 2,178 times (328.59 times per million words) in American posts and 1,650 times (193.58 times per million words) in British ones, so is used only 1.69 times as much by Americans. We have supplemented the keyness analysis with consideration of concordance lines containing words which directly refer to national identity (British, Britain, Britishness, UK, U.K., United Kingdom, America, American, Americans, the US, U.S., the states, United States). An examination of these terms was useful in identifying cases where posters went on-record about their own cultures, helping to provide additional insights which in some cases, further explained the existence of some of the keywords. Our analysis focuses on the following four questions: • How do American and British posters characterise their anxiety? • Are causes of anxiety believed to be cultural, and if so, how?

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Time

Health issues and symptoms

British key items

(continued)

ill (3,314), suffered (2,458), illness (2,655), suffer shortness (752), hurts (952), tightness (688), tingling (4,274), suffering (3,377), unwell (601), mental (939), lightheaded (798), anxiety attack (713), head illness (367), low mood (128), horrible feeling pressure (523), panic attack (2,826), chest pain (880), (299), health anxiety (2,528), tight chest (176), panic disorder (455), acid reflux (540), heart attack chest infection (81), low self (101), serious illness (1,343), impending doom (199), sleep apnea (174), (103), self harm (119), low self esteem (92) first panic (231), first panic attack (215), severe anxiety (516), much anxiety (164), anxiety level (120), neck pain (159), gonna die (163), chest tightness (138), weird feeling (212), blurry vision (140), bad anxiety (460), trouble breathing (95), cold turkey (216), tunnel vision (89), brain fog (209), morning anxiety (120), sinus infection (116), stress level (83), thinking something (113), heart racing (210), high blood (222), panic mode (130), off balance (171), high blood pressure (209) finally (1,858), everyday (2,538), lately (1,395), hard moment (4,427), wen (712), Christmas (1,045), bad day (466), good day (989), last year (891), last time (575), great day (251), first time (745), past couple week (891), bad day (466), next week (609), bad (163), past year (155), past week (162), past month (108) time (216), long term (488), new year (199), day today (293), first place (229), day yesterday (131), full time (223), last night (1,455), short while (88), next year (109), bad patch (69), bad night (92)

American key items

Table 6.2 American and British keywords and key terms

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Feelings and emotion

Medical tests, remedies and coping strategies

Persons and things

British key items

(continued)

partner (1,608), them (23,566), hubby (703), iv (1,447), ur (2,211), ive (3,885), u r (141), other half (165), little boy (135), anxiety sufferer (131), only person (171) GP (6,516), tablets (2,457), counselling (1,831), Xanax (2,323), ER (2,256), Zoloft (1,746), Lexapro CBT (3,699), Citalopram (1,820), Diazepam (1,457), medicine (1,708), Klonopin (785), EKG (787), (1,383), Sertraline (1,950), tablet (954), book Ativan (920), therapist (3,052), med (1,337), (3,562), bloods (562), ECG (786), mindfulness psychiatrist (1,387), cardiologist (864), pill (1,013), (1,022), garden (581), docs (916), health team Paxil (473), Buspar (438), benzos (515), medications (154), mental health team (146), blood test (608), (1,282), mg (1474), meds (6,377), neurologist (570), talking therapy (179), rescue remedy (150), crisis Prozac (855), CT (704), Celexa (367), blood work team (117), hot water (184), behavioural therapy (876), deep breathing (1,437), stress test (301), (108), eye test (108), hot water bottle (113), emergency room (271), physical therapy (179), urgent cognitive behavioural therapy (102), water bottle care (172), support group (216), eye doctor (128), cat (126), taking Citalopram (80) scan (104), primary care (99), new doctor (120), sleep study (93), deep breath (302), support system (91), health history (84), beta blocker (233), good therapist (92), regular doctor (75), CT scan (126), primary doctor (72), talk therapy (84), holter monitor (82), anxiety medication (116), self talk (76), hot shower (66), service dog (61) afraid (3080) fed (840), mad (1,185)

I’m (7,965)

American key items

Table 6.2 (continued)

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

insurance (569), pray (1,483), God (3,493), praying (942), prayers (540), forum (1,895), same thing (1,596), same way (926), same issue (116), anyone experience (85), exact same way (88), same feeling (118), health insurance (70), exact thing (71) muscles (1,897), breathe (2,206), body (8,235), neck (2,612), heart (13,088), vision (1,365), breathing (5,111), asleep (1,558), breath (3,063), pressure (3,742), sensation (1,288), heart rate (1,286), blood pressure (1,393), birth control (131), right side (315), rib cage (123), chest wall (107), upper back (111), blood sugar (187), heart beat (207), left side (184) crazy (3,611), sucks (1,337)

Personal circumstances

awesome (537), only thing (547)

almost (3,222), little bit (556)

Negative evaluation Positive evaluation

Minimal

Body parts and processes

okay (3,063), ugh (727), smh (416), blessed day (76)

Forum relations

(continued)

awful (3,557), rubbish (546), vicious circle (515), awful thing (92), quick fix (177) lovely (2,634), nice (3,942), brilliant (757), useful (715), honest (1,259), good idea (603), right thing (316), great help (158), good advice (284), only way (430), important thing (156), nice feeling (81)

mental health (1,744)

:D (998), xxx (6,327), hun (2,752), x (60,644), xxxx (1,509), xx (11,371), thankyou (1,775), hi (21,467), hello (4,756), regards (947), pleased (753), hugs (2,113), wishes (1,702), ha (907), thanks (9,937), hiya (554), love (7,514), good luck (3,223), lovely day (141), hope u (248), nice day (146), big hug (155), hope everyone (194) UK (1,360), NHS (858), waiting list (281), new job (431), sick note (74)

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Lexical differences

Orthographical differences

Grammatical bin

Abstract nouns

Adjectives

Auxiliary and modal verbs Lexical verbs

Maximal

British key items

dealing (2,019), figure (879), hang (1,207), quit (818), managed (1,401), cope (2,925), reply (3,481), chat handle (999), fall (1,447), use (3,810), freak (662), (1,383), speak (1,832), sorted (649), carry happens (2,705), focus (2,178), taking care (167), (1,160), sat (1,008), accept (3,838), manage smoking weed (128) (1,365), doing nothing (177) deep (3,365), weird (3,198), fast (2,083), healthy (1,733), right (9,879) issue (1,911), issues (3,657) recovery (2,371), site (2,949), hard work (223), self esteem (231), other side (242) idk (1,475), bc (732), w (519) etc (3,387), cos (984), although (2,854), which (17,304), n (1,910) mum (3,003), realise (1,357), round (1,617), whilst mom (1,993), gotten (1,361), realize (1,109), (1,140), realised (738), learnt (561), anyway derealization (705), awhile (671), thru (802), tumor (2,344), counsellor (647), tumour (615), brain (781), learned (1,141), counselor (578), tumour (440), going round (143), way round (77) depersonalization (570), gonna (1,904), realized (591), counseling (570), wanna (1,000), laying (659), kinda (834), anyways (477), brain tumor (459) store (784), high school (238), grocery store (121) holiday (1,171)

quite (4,111), bit (7,396), nearly (1,217), abit (600), sort (1949) super (1,163), freaking (853), truly (1,282), entire (489), loads (1,194), lots (2,978) whole life (238), single day (228), entire life (121) must (3,713)

American key items

Table 6.2 (continued)

Cultural Keywords

173

• How do American and British posters relate to the forum? • What ways of managing their anxiety distinguish American and British posters? We will begin by addressing the first of these questions.

How Do American and British Posters Characterise Their Anxiety? Both British and American posters refer to the physical symptoms accompanying anxiety, although this tends to be described differently. British posters use the key term health anxiety, which refers to a wide range of symptoms without giving much detail. However, American posters tend to describe the physical symptoms that are related to anxiety in more detail, including shortness of breath, tingling sensation, pressure, feeling lightheaded, chest tightness, blurry vision, chest pain, acid reflux, sleep apnea, neck pain, trouble breathing, tunnel vision, head pressure, brain fog and heart racing. These symptoms, along with others, are often listed together, and attributed to anxiety. Head pressure, faintness, dizziness, numbness/difficulty moving my facial muscles and extremities, tremors, weakness, brain fog, trouble enunciating things, hot flashes, blurred vision, trouble walking/ driving . . .. (US)

Additionally, American posters refer to specific body parts or regions: right side, left side, rib cage, chest wall, upper back, neck and heart as being affected by symptoms. I also get this tingling on the right side of my head, tingling in my face (US) For the past couple of weeks I’ve been having odd pressure under my right rib cage . (US) For myself, it’s always had to do with chest wall muscle tightness from stress or over exertion of the muscles. (US)

American posters therefore provide much more detail in terms of labelling the sensations and symptoms that relate to anxiety. They are concerned about high blood pressure and the possibility of having a heart attack, and indeed, the word attack is used to refer to both their anxiety and their symptoms, alongside the key terms anxiety attack and panic attack. My hands are shaking because I feel like I am going to have a full blown anxiety attack. (US)

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

174

Comparing Cultures

I had my first panic attack on a plane last month and it’s been down hill ever since. (US)

In order to understand the prosody of [NOUN]+attack, it is helpful to consider other kinds of nouns which tend to occur in this construction. In the English Web 2020 corpus, the [NOUN] is frequently terrorist, terror, bomb, cyber, nuclear, missile or chemical, indicating that [NOUN]+attack evokes the idea of deliberate violence carried out by a hostile entity. In cases such as heart attack or anxiety attack, there is no external agent who carries out the attack, and the role of the heart or anxiety as either the cause or recipient of the attack is somewhat ambiguous. Is anxiety carrying out the attack or the one being attacked? Looking at other words such as bomb or terrorist in this construction, the noun seems primed to function as the source of the attack so perhaps anxiety is being represented linguistically as attacking the person. This does not seem to be the case for heart attack though, where it is the heart which experiences the attack. What is worth emphasising is that anxiety attack represents anxiety in an extremely violent and distressing way. The British keywords suffer, suffered and suffering represent anxiety as a negative experience and the key term anxiety sufferer provides an identity label for some British people with anxiety. I know I suffer from anxiety (and very badly from health anxiety) and try to accept this how I am. (UK) I’m a anxiety sufferer for most of my life but then really bad in the last year and half. (UK)

In the British National Corpus (1994), collocates of suffer include problems, consequences, damage, pain and loss. While suffer also has a very negative discourse prosody, it does not contain the same implication of violence as the word attack does. Another set of British keywords describe anxiety as an illness, the sensation of feeling ill, the process of becoming ill, or as causing illness (ill, illness, unwell). In the third example that follows, anxiety is also metaphorically cleaned up, positing illness as something like dirt or mess. I went on holiday with my cousin last week and was really ill with anxiety all week until i landed at Gatwick (UK) anxiety has a way of making us feel exhausted, and unwell (UK) Most people won’t talk about it, but anxiety is a real illness, and like most illnesses can be cleaned up. (UK)

General words such as ill and unwell indicate that British posters are less likely to refer to specific sets of physical symptoms, and indeed we

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Cultural Keywords

175

find that they tend to describe their experience of anxiety using the evaluative adjective bad, pairing it with a time-related noun: bad day, bad time, bad patch. I’m still having a bad time been like it all day shaking worrying crying? terrifying thoughts (UK)

These terms are sometimes used by posters to reassure others that their feelings are temporary. I don’t know much about you, so can’t make any comments on what is making you so anxious, but I do know what it’s like when you are having a really bad day. It will pass. Honest. Try to look beyond the bad patch and be reassured that it will get better. (UK)

This minimalisation appears to be in contrast with American posters who focus more on describing how their feelings and symptoms have lasted for a long time: entire life, whole life, (every) single day. I wanna know why and how this is anxiety!!!! I go thru hell every single day . . . (US) I just turned 59 and looking back I have had anxiety my entire life, at least as far back as I can recall. (US) I have bad panic attacks out of nowhere, I’ve had anxiety almost my whole life but it never was this bad. No I literally feel like I might be dying, I’m at the ER like every month (US)

Various cultural commentators have noted that British people – and in particular, English people – have a tendency to lessen the impact of negative statements or views. For example, Mikes (1984) claims that understatement is a way of life for the English while Fox (2004, pp. 67–8) refers to the English as having an unwritten ‘Understatement Rule’ which ‘comes naturally, because it is deeply engrained in our culture, part of the English psyche’. In contrast, American key phrases such as entire life and anxiety attack appear more emphatic and are reminiscent of the study mentioned earlier in this chapter, which noted how American news reports tend to focus on stories about danger.

Are Causes of Anxiety Believed to Be Cultural, and If So, How? We begin this section by considering an American key term: smoking weed. Recreational use of cannabis (sometimes informally referred to as weed) is legal in 18 states in the USA, and another 13 states have decriminalised its use (Hartman, 2021), with medical use of cannabis being legal with a doctor’s recommendation in 36 states (NCSL,

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

176

Comparing Cultures

2021). Usage in the USA varies widely by state, with the District of Columbia having the highest rate (27.42%) and South Dakota having the lowest (11.13%) (Elfein, 2021). In the UK, cannabis is a Class B drug and it is illegal to grow, distribute or sell it. Despite this, 7.8% of people in England and Wales aged 16 to 59 years had used cannabis at least once in a year (Office for National Statistics, 2020a). Cannabis is thus less frequently used in the UK, and even those who do use it may be unwilling to write about it on an online forum, which helps to explain why smoking weed is a key phrase for the USA. Low amounts of cannabis have been reported as decreasing anxiety, although higher doses seem to increase it (Childs et al., 2017). The majority of American posters who write about smoking weed tend to view cannabis as a contributing factor towards their anxiety. Even before I experienced anxiety, I had 2 diff attacks from smoking weed. And everyone I know with anxiety now, cannot smoke anymore. It calms most people down, but not people w anx – in my experience. (US)

However, a smaller number of American posters indicate that cannabis has helped their mental health. i know ive not been perfect i drink beer on occasionally i know ive told you i would cutt down . . .. and smoking weed but its helped me alot please for give me for my sin (US)

Putting keywords aside for the moment, what other cultural factors do posters cite when they refer to their own countries? Our investigation of terms specifically indexing UK/US nationality also revealed certain cultural factors related to experiences of anxiety. For example, a few posters are critical of the food that is available in America, citing it as a possible contribution towards their mental health. I’ve been thinking that carbs may be bad for me as they affect my mood. I get a rush when they hit my system then I crash when they are through it. I have an extremely busy life and in the US, convenient foods are filled with yuk and carbs. (US) In America we have the easiest opportunity in the world to ruin our bodies with the food available to us, that even the “healthy” stuff needs to be put under a microscope. (US) I find that nine times out of ten a particular supplement does not work, but when I keep searching, I find one that helps. So you have to keep trying to find a cure. There are basics that you need to do in any case. Nutrition is the key. Everyone in America is malnourished. (US)

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Cultural Keywords

177

It is also believed that in the USA a cultural mindset which values productivity in its citizens can also contribute towards anxiety. I’m in this place for many reasons. The biggest stressor is feelings of incompetence. I’ve been decommissioned from having a job (injury). Now, I cannot support myself which is just a truly terrible place to be in. Poverty can be very uncomfortable and the way in which America equates having a “job” to being a contributing/productive human being is just so toxic for anyone experiencing some sort of serious life set-back (US)

Another poster refers to the political climate as contributing towards anxiety. I am in U.S. And I can’t help but wonder if the current political climate of hate and drama that exists here doesn’t exacerbate anxiety and depression. It is impossible to get away from the trauma. It is like you are always on high alert, waiting for the next horrendous mass shooting or climate tragedy. (US)

On the other hand, in Britain, a ‘stiff upper lip’ attitude is cited as hampering good mental health, with the following post similar to some of those discussed in the previous chapter in which contributors criticised traditional male attitudes around seeking help. Unfortunately there is still a stigma around mental health. Add to that the British stiff upper lip, pull your socks up, everything will be all right tomorrow attitude and you have quite a time bomb. (UK)

The attitude described in this post could also help to explain the British tendency towards understatement (i.e., use of phrases such as bad patch). The social anthropologist Kate Fox (2004, p. 401) has also described English interactions as characterised by awkwardness or social dis-ease and one poster blames British culture for anxiety, describing it as unsociable and socially awkward, with interaction needing to be fuelled by alcohol. I have a hypothesis that in the UK we don’t have a very sociable culture and that this contributes to the number of people in UK society with anxiety disorders . . . [. . .] In the UK, I find people are quite socially awquard when compared to the Spanish, Italians and French. That a lot of interaction depends on the consumption of alcohol. That people talk at others, rather than actually conversing. I find the culture here has become very show-offy and we are, as a country, getting further and further away from our authentic selves. (UK)

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

178

Comparing Cultures

MacRae et al. (2005) carried out personality tests on 12,000 students from 51 cultures, finding that extroversion was actually higher in the UK than in the USA, while Schmitt et al. (2007) analysed 17,000 people from 56 nations, finding that Americans were very slightly more extroverted than the British. Data from millions of participants who took a free online Myers–Briggs personality test at the website 16Personalities showed that British participants were slightly more introverted than extroverted (+0.33%), although this trend was actually a little more pronounced for Americans (+0.4%) (16 Personalities, 2022). Quantitatively, then, there is little evidence that Britons are less sociable than Americans, although extroversion does not necessarily correlate with social ease. We are on firmer ground if we acknowledge the culture stereotype of the ‘British reserve’ as something which contributes towards an understanding of why British people experience anxiety, and why they may be less forthcoming in terms of discussing details of their symptoms. Another theme which emerged from British posts were complaints about the inclement weather. Most regions in the UK experience around 1,200–1,600 hours of sunshine annually, whereas for the USA this figure is 2,000–3,500+ hours (Engel, 2014). The following contributor notes how seasonal affective disorder (SAD) makes their anxiety worse. SAD is linked to reduced exposure to sunlight, which is believed to affect the hypothalamus, resulting in higher levels of melatonin, lower levels of serotonin and disruption to the body’s internal clock. Suffering with anxiety all year round sucks! Though the ramp up with the start of Fall/Autumn and SAD kicking in makes it suck more! I live in the UK so sunshine does not happen much. (UK)

The UK is also known for its fluctuating and often unpredictable weather due to the fact that it is located under an area where five main air masses meet. This perhaps explains why the British are renowned for talking about the weather, with a Census-wide poll of 2,000 people showing that 42% believed that this was one of the most typical British traits (the next highest was drinking tea at 39%, then queuing at 35%) (Sansome, 2019). The following poster notes how Britain’s changing weather exacerbates her anxiety. So I live in the UK where its almost always cold and rainy, especially around this time of the year, however today was relatively sunny and really quite warm for us. For some reason it’s started to totally freak me out. I can’t handle change at all and the thought of warm weather, no school with summer holidays, sun cream, the

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Cultural Keywords

179

beach etc etc has all started to totally cause me to panic and I have no idea why? (UK)

We do not wish to argue that the reasons for anxiety given in this section are necessarily accurate reflections of cultural differences, rather, we note that these are beliefs about differences, which people use to make sense of their anxiety. This distinction is small but important.

How Do American and British Posters Relate to the Forum? To a large extent, both American and British posters use the forum for similar reasons, relating their own anxiety histories and symptoms as well as providing advice and support to others. However, through the keyness analysis, we identified some differences. For example, American posters use the key term anyone experience, which tends to occur in queries about shared experiences, based on descriptions of symptoms or side effects of medication. Whenever I ask people if their heart pounds after they drink heavy and they say no, my anxiety shoots through the roof smh.. Does anyone experience this? (US) ive been on my medication for 8wks now and wanted to know does anyone experience constipation on their antidepressant. (US)

As well as trying to identify posters with similar experiences, Americans also note when their experiences are comparable to others by using key phrases such as exact same way, exact thing, same thing, same way, same issue and same feeling. I have the exact same thing. I understand your frustration and pain. Everyday life is hard and sometimes I don’t feel like I have ax handle on it. (US) I have the same feeling! My head is always heavy :/ (US)

American posters show solidarity with other posters by identifying shared autobiographical elements, sometimes offering advice regarding ways that they dealt with a symptom or providing an empathic response. You have sleep apnea I had the same exact thing. I got my sleep machine now I’m fine. Just got to try and relax. I know it’s hard I had anxiety for 15 years u kind of learn to deal with it although still can’t fly of go fishing terrified of things I did every day. (US)

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

180

Comparing Cultures

British posters are less likely to identify shared experiences, using a different set of key terms to express affiliation and support towards other posters. Some of these terms follow formal politeness conventions. For example, they are more likely to use a set of greetings which occur at the start of messages: hi, hiya and hello. Hiya never feel ashamed of what you are anxiety is not a thing I’d wish on anybody (UK)

British posts are also more likely to end with a formal acknowledgement of farewell, consisting of key terms such as regards, good luck, have a good/lovely day, hugs, big hug, best wishes or a string of ‘x’s which represent kisses. Hope things start to look up for you soon, best wishes (UK) Try 2 stay as calm as u can. kindest regards [NAME]. (UK) I hope you re ok now and again Im really sorry u had to go through this. big hug xxx (UK)

Love is also a keyword for British posters. As this word can be used in a variety of ways, we carried out a qualitative investigation. In a random sample of 100 British occurrences of love, we found that 10 were used as a term of endearment to refer to another poster; for example, ‘Don’t be so hard on yourself love’. A further 57 cases were used as an affectionate sign-off to a message and the remaining 33 occurred as a verb; for example, ‘I love the theatre!’. By comparison, in a random sample of 100 American occurrences of love, only seven were used to refer to someone, nine occurred as part of a sign-off and the other 84 were verb cases. Not only then is love a British keyword, but it is also much more likely to be used to display affection towards another poster. The British keyword hun (a shortened form of honey) is also used in a similar way to the noun use of love (in the previous chapter we saw that this and some of the other affiliative keywords discussed in this section tended to be used more by female posters than males). In addition, British posters are more likely to formally express gratitude by using the keywords thankyou and thanks. Thanks hun I’m glad you can relate. (UK)

Pleased also functions as a British affiliative keyword. Investigation of a random sample of 100 cases of pleased showed that in 79 instances, posters used the word as part of an expression of happiness towards another poster.

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Cultural Keywords

181

I am pleased you are getting relief from your symptoms. (UK)

It was not possible to conduct a comparable study of American uses of pleased, since there was only 20 occurrences (British people used it 753 times). Only one of the American occurrences of pleased was used to express happiness towards another poster. Another key term, hope everyone, tended to be used by British posters towards all members of the forum. Hope everyone is fine and anxiety isn’t causing you grief or worry. (UK)

In addition, the British keyword :D is used to represent a laughing face emoji. about the doctor fear if I find someone a bit scary can help to imagine them sat on toilet :D (UK)

Therefore, while both American and British posters use the forum to express affiliation and support, there appear to be somewhat culturally typically ways of going about this. Americans are more likely to seek and show consensus regarding their experiences of anxiety whereas British people are more likely to use formal markers and routine expressions that indicate greetings, partings, gratitude and humour.

What Ways of Managing Their Anxiety Distinguish American and British Posters? American posters are more likely to use key items relating to religion: God, pray, prayers, praying and blessed day. Posters advise others to pray to God for help, describe how their prayers have helped them with anxiety and pray on behalf of other members of the forum. I don’t know if you are a Christian or not but if you are, please seek counseling from your pastor. Pray and ask God for help. He hears you and loves you. (US) I had been so neglectful of praying and knowing to always pray and have faith and soon as this anxiety came and knocked me down I went crawling to God which I’m glad it happened so I can never forget ever again to keep God in my life and pray always no matter if I’m doing good or bad. (US) Woke up still a little down but I am believing we all will feel better an praying we will be delivered from fear an anxious thoughts x have a blessed day because we are blessed we woke up this morning! (US)

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

182

Comparing Cultures

Rosmarin et al. (2009) have indicated that for North Americans, general religiousness, religious practices such as prayer and positive core religious beliefs are associated with lower levels of worry, trait anxiety and depressive symptoms. For some, belief in a higher power can help to alleviate anxiety, particularly during distressing times. Additionally, effects on the brain during prayer have also been linked to reduced anxiety. For example, a brain scan study of long-term meditators by Newberg et al. (2010), which included Tibetan Buddhist and Franciscan nuns, found that they had more activity in their frontal-lobe areas, which may help people feel calmer and better able to deal with stressors. Around 63% of British people describe themselves as having a religion (European Commission, 2019), compared with 74% in the USA (Pew Research Centre, 2019). The difference between these figures is not enormous, although claiming to have a religion and the extent to which it is practised can vary. A better marker of religious practice would perhaps be weekly church attendance, which was 36% in the USA and 8% in the UK (Pew Research Centre, 2018). Religious language does not always explicitly reference religion, due to idiomatic expressions that can be used as general vocatives or expletives; for example, oh my God, a god-awful place or God bless. An examination of 100 random American instances of God found that 71 were explicit, on-record references to God while the rest were idiomatic expressions. For an equal-sized British sample, 26 cases were on-record references to God and the other 74 were idiomatic. As such, not only do Americans refer to God more often (480.84 times per million words vs 174.2 per million British instances), when they do so, it occurs in a more explicitly religious way. Additionally, while none of the American sample of 100 cases involved Americans questioning the presence of God, this occurred in three instances in the British sample, as in the following case, which is a response to a poster who advised talking to God. Talking to God doesn’t help if you don’t believe in God, which I don’t. (UK)

When British posters do try to counter attempts by others to draw on religious beliefs for support, they generally do it in a respectful way. I’m afraid I’m very much an atheist but I respect everyone’s right to their beliefs. One of my best friends is a Christian with very strong religious beliefs and she and I have debated the subject for hours. I used to have a very strong dislike of religion but having seen that for some people it brings comfort I can see some value in it. (UK)

As mentioned in Chapter 1, the medical model of treatment for anxiety often involves talking therapies, prescription medicine or a combination

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Cultural Keywords

183

of the two. It is therefore interesting to consider the key items in Table 6.2 that relate to medication in some way. Among the American key items, we observe a number of brand name medications: Xanax, Zoloft, Lexapro, Klonopin, Ativan, Paxil, Buspar, Prozac and Celexa, as well as more general terms such as benzos (which refer to a class of drugs called Benzodiazepines), medicine, medications, med, meds, pill and mg (which refers to dosage in milligrams). In 1997, the Food and Drug Administration in the USA relaxed its rules on advertising prescription drugs, resulting in adverts for anti-anxiety drugs regularly appearing in breaks between television programmes (only the USA and New Zealand allow such direct-to-consumer advertising). American posters engage in more discussion of the medication(s) they are taking and outlining their experiences of being on different doses, as well as giving medicationrelated advice to each other. My doctor has prescribed me Xanax and Ativan. I use the Ativan on a “as needed” basis for sleep only and it works out for me. (US) DO NOT STOP TAKING THE SERTALINE. The logical step would be to increase the dosage to 150 mg. You have given the 100 mg plenty of time to work! (US)

American contributors also convey a sense of ‘shopping around’, as they try to find a medication (or combination of medications) that will work for them. I’ve been on different medications Prozac, Zoloft, and now lexapro (US) 21/2mg klonopin 30mg buspar and 60mg of cymbalta for 5 years with a couple changes I have 0.5 xanax and I have tried both of the other meds I can’t take depresent they make me worse but the Xanax where a life saver when I was really bad (US)

American key terms also include beta blocker, anxiety medication and cold turkey (slang for when someone suddenly stops taking a drug). I have been taking Lexapro for about 15 years now. I started slowly, braking the pill in half I started with 5, 10, and now 20 . . . I have tried the cold turkey thing, but had very bad withdrawal symptoms. Just give the meds some time. (US)

The number of British key terms that refer to medications is rather smaller, with just three being keywords: Citalopram, Diazepam and Sertraline as well as tablet and tablets (which is possibly a form of lexical variation related to American pill). Britain has different regulations to the USA regarding prescription drugs. For example, Xanax is not available through the National Health Service in the UK due to concerns about its

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

184

Comparing Cultures

strength and fast-acting nature (Knight, 2019). However, an American keyword that does not appear to have a British equivalent is medicine, which seems to imply that something will cure you or make you well, while words such as tablet or pill are more neutral terms which do not incorporate an expectation of their effects. There is not one day that goes by without me feeling like my head is going to explode my whole feels like im off balance, been to every doctor, Ive been put on anxiety medicine (US) I am still on 20 mgs a day Valium, and over the years have had many different my tablets, bjut last 7 years have been on Cipralex, which has put on weight and I hate it (UK)

Another difference between the American and British contexts involves access to anxiety medication. In both countries such medication is prescribed by a doctor, although in the UK prescriptions are at a standard rate (and free for people in Scotland, Wales and Northern Ireland, those aged under 16 or over 60, pregnant women, recent mothers, those with specified medical conditions, physical disabilities, war pensions, people who are National Health Service in-patients, people on Income Support, Jobseeker’s Allowance or Universal Credit). In 2023, the cost of a prescription was £9.35 an item (which could constitute a monthly supply of an anti-anxiety medication). Medication in the UK is thus relatively inexpensive through the National Health Service, which is funded by National Insurance contributions as a form of general taxation. Several British posters acknowledge its importance, with the second of the following posters comparing the health systems of the two countries together. Us British don’t know how lucky we are to HAve a NHS serviceand moan at paying £7:50 for a months supply, lol. (UK) The National Health Service has the 100% support of all British people, life without it would be inconceivable. The NHS was started in 1948 by the socialist government: this is why some elements in the United States disparagingly refer to it as “communist medicine”. I have never understood why the U.S., the richest and most powerful country in the world, does not have something similar in place and it is depressing to hear American friends are denied access to basic medical care because they have reached the limit on their insurance or can’t afford proper insurance (UK)

In the USA, medication is more expensive, with the average American spending around $1,200 a year on prescription drugs: more than any other high-income country (Blumberg, 2019). Kamal et al. (2019) note

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Cultural Keywords

185

that around a quarter of Americans find it difficult to afford prescription drugs due to their high cost. Rajkumar (2020) describes the high cost of medication in the USA as being due to a combination of factors: the existence of monopolies, the seriousness of a disease, the high cost of developing drugs and the lobbying power of pharmaceutical companies. This helps to explain why a key term for Americans is health insurance, with posters noting their difficulties in terms of access to medication or other forms of treatment due to a lack of insurance. So ive been trying to handle my anxiety and my issues day by day . . . But i have been having issues with health insurance and i cant continue to see my Therapist and get my meds. So ive been cold Turkey for about 2 months now. (US) It’s a travesty – living here in the USA where some of the most advanced health care exists – yet it’s only truly accessible to those who have the best health insurance. The difference between “Gold Plans” (if you can afford it or if it’s provided by your employer) and medicaid managed plans (such as mine) is like heaven and hell. I think an entirely new classification of anxiety is being created – you could call it “health access anxiety.” (US)

While access to different forms of treatment for anxiety is generally less expensive for British posters, the reliance on the NHS results in the key term waiting list, particularly for therapy, with CBT (cognitive behavioural therapy) being the therapy that people most often mention they have to wait for. I am on a hugely long waiting list at the moment for CBT with the NHS (UK)

NHS waiting lists are described as too long, never-ending, endless, crazy, unbelievable and agonising, although some posters urge others that it is worth the wait. The waiting list might be long, but if this is a long standing issue in your life, it might be worth staying on the waiting list for CBT. (UK)

During the period under analysis, the UK was led by a Conservative– Liberal Democrat coalition, up until 2015, when the Conservatives gained a majority. Since 2010, the government pursued a policy of austerity, resulting in spending cuts. While the NHS budget actually rose by an average of 1.4% a year between 2009 and 2019, it has been argued that this is not enough to deal with a growing and ageing population, and it is less than half of the 3.7% average annual rise since the NHS was established (The King’s Fund, 2022). Several British posters are critical of the extent of NHS funding, referring to it as cuts.

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

186

Comparing Cultures

in today’s world (are you in the UK?), then the NHS have been changing their ‘ranges’ and they’re no longer anywhere near ‘normal’ compared to what they were 18 months ago ~ when they’d have treated you ‘before’ all the NHS cuts began, and in fact insisted you have certain levels ~ now they’re not! (UK)

The key terms also indicate different ways that the two sets of posters write about medical practitioners, with good therapist appearing among the key items in US posts. In keeping with the neoliberal context of healthcare-seeking in the USA, Americans stress the importance of finding a good therapist and seek advice on the forum for recommendations. I would definitely recommend you find a good therapist who specifically treats anxiety disorder to work with and help you sort things out. (US) Can someone offer a good therapist or psychiatrist in the NYC/Jersey City area? (US)

Americans also use the key term new doctor, which echoes the ‘shopping around’ sentiment mentioned earlier and relates to trying out different medications. I found a new doctor today and he gave me 2 prescription one is xanax and the other zoloft (US) Get a second opinion. Go to a new doctor. Get a fresh pair of eyes to look at you. That’s what I did. (US) I have an appointment this Friday with a new doctor who I am hoping will listen to me and care unlike my old doctor. (US)

Healthcare in America is thus characterised more in terms of capitalist discourse, where the person with anxiety is seen as the consumer, the healthcare practitioner provides a service and the medication or talking therapy is a product – as long as you are able to pay. I am in the US. The doctors here are really crappy. I scheduled a third opinion for Tues hopefully this one goes for it. (US)

In the UK, patients tend not to frame their experience of anxiety in terms of being able to exercise choices or make changes if they feel they are not happy with their treatment. Instead, British people with anxiety tend to talk about how they are advised not by a single person who they can choose but by a team, who are all employed by the NHS. This results in the key terms mental health team and crisis team. British people with anxiety are assigned to these teams if they seek help; these teams can consist of different mental health specialists including

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Cultural Keywords

187

psychiatrists, psychologists, psychiatric nurses, social workers and occupational therapists. Posters appear to have mixed views on these teams: tge only reassurances I ever trust are those from my mental health team (UK) Our mental health team are understaffed and constantly changing roles so it’s a stressful time. (UK) I suffer from extreme anxiety i have started to see the crisis team who are great. (UK) I’ve had the Crisis Team visiting and to be perfectly honest the service they provide isn’t up to very much. Their first action (reaction?) is to remove my medication which, quite frankly is a desultory move. (UK)

Finally, British posters use three keywords that indicate their attitude towards anxiety: manage, cope and carry (which occurs 80% of the time in the phrase carry on). As with the earlier reference to the British ‘stiff upper lip’, these verbs indicate what could be seen as a particularly British worldview towards adversity. In my experience, nice people care, therefore they suffer – that’s not weakness! In fact, we;re often stronger, because we suffer more, but still carry on! (UK) There is not much hope of us getting better, if we don’t think positive and stay strong. You know that saying.. ‘Keep calm and carry on’ that’s exactly what we must do. It’s not easy, I know, but we must have faith in ourselves. :) (UK) Whatever happens, hun, you will cope as best you can. (UK) i think its something that will always be with me so i need to manage it as best i can. (UK)

The British characteristic of ‘carrying on’ can perhaps be traced to what is referred to the Blitz Spirit. During World War II, British people endured nightly bombing attacks from Nazi Germany, particularly during 1940 to 1941 when the Luftwaffe dropped bombs on London and other strategic cities across the UK. Although the stress of the war resulted in a range of physical and mental ailments, many people acclimatised to the bombings, referring to raids as if they were weather; for example, by stating that an evening was ‘very blitzy’ (Mackay, 2002, p. 261). Similarly, the author Nancy Mitford related how her maid Gladys, on hearing an air raid siren after a two-year respite, said, ‘Isn’t it a treat to hear them again!’ (BBC Radio, 1958). During the war, rates of suicide

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

188

Comparing Cultures

and drunkenness declined and, overall, morale remained high. ‘Keep Calm and Carry On’ was a propaganda slogan created by the British Ministry of Information in 1939 at the start of World War II. Around 2.45 million posters containing the slogan were printed, but they were pulped and recycled to deal with a paper shortage. In 2000, a copy of the poster was found and then reproduced on a range of products (t-shirts, rugs, beer tankards, biscuit tins) resulting in the phrase becoming well known and seen as a distinctly British way of dealing with adversity. Even before the discovery of the poster, the term carry on has had long-standing significance in Britain due to the Carry On film series, consisting of 31 comedy films, mostly produced in the 1960s and 1970s, which used a regular group of actors and featured British characters in different contexts (e.g., Carry on Abroad, Carry on Up the Jungle). ‘Carrying on’ implies enduring hardship, putting up with a difficult situation and getting by as best you can, often with cheerfulness or good humour. It does not suggest solving a problem but simply living with it. Overy (2013) argues that the British government under-played the psychological and physical effects of the bombings, instead focusing on stories of British resolve as a form of propaganda. Nevertheless, the myth of the Blitz Spirit appears to be firmly rooted in the British consciousness and is manifested in the stoical responses indicated by manage, cope and carry. Three related American keywords are handle, dealing and figure, all of which appear to express a more pro-active approach to anxiety, compared with the passive acceptance and endurance-related sentiments of carrying on. Anyways yeah, I handle my anxiety without meds..they did nothing for me & the withdrawals were crazy, I wouldn’t wish that on my enemy . It was ridiculous. (US) I just turned 16 this past week and I have been dealing with the very same anxiety disorder since I was 9. (US) My doctors say it’s nothing physical they ran many tests for my stomach they say its all anxiety caused by my ocd so i guess I have to figure out how to get that under control. (US)

Finally, we should note that Table 6.2 contains some keywords and terms that were also found in the previous chapter when we compared male and female language. Table 6.3 indicates these intersectional key terms. This table indicates that the affiliative keywords such as xxx, hun and hugs are more likely to be used by British women while their American counterparts stress the importance of a support group or support

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

Conclusion

189

Table 6.3 Key terms that intersect country and sex US

UK

Female mom, okay, praying, bc, I’m, same way, hard time, taking care, support group, single day, birth control, much anxiety, support system, upper back

Male

x, :D, xxx, mum, hun, lovely, counselling, xxxx, xx, thankyou, partner, hi, cos, awful, ur, pleased, hugs, hubby, love, good day, last year, waiting list, last week, bad day, good idea, next week, other half, lovely day, hard work, rescue remedy, hope u, nice day, little boy, horrible feeling, day today, self esteem, hope everyone, day yesterday, full time, last night fast, blood work, heart rate, stress illness, regards, long term, only test, blood pressure, chest pain, way, anxiety sufferer, first place, heart attack, sleep apnea, little important thing, health anxiety bit, deep breath, cold turkey, only thing, brain fog, beta blocker, heart beat

system. References to heart problems seem to be more the province of American men, while British men appear to be the ones who use markers of importance (only way, first place, important thing) with their advice. Table 6.3 thus reveals that not all keywords are equally distributed across a particular identity group, but some may be the result of intersectional identities.

Conclusion We found evidence that people view cultural characteristics as playing a part in anxiety – such as the British stiff upper lip or sense of social awkwardness – although reference to published research did not always appear to confirm that these characteristics were actually particularly marked. Nevertheless, the belief in a cultural identity is likely to influence some individuals’ reactions to a condition such as anxiety. The vast majority of British posters would not have experienced being bombed during the World Wars yet the view of the British as exhibiting the Blitz Spirit (even though some historians have argued it was over-stated) provides twenty-first-century Britons with a ‘Carry On’ blueprint for coping with a range of problems, including anxiety. Anderson’s (1983) notion of

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

190

Comparing Cultures

the ‘imagined community’ is perhaps salient: the idea of a nation as a socially constructed community, imagined by people who perceive themselves as part of that group. Such communities were made possible due to print capitalism, which began with the process of printing books and pamphlets, allowing a common discourse to emerge. It is interesting to see that in an online context, which facilitates participation from members based in various nations, the sense of imagined communities continues to be upheld, and indeed, one aspect of this is in the discussion of perceived cultural traits which are sometimes made all the more salient through comparisons against other cultures. Some of the differences we refer to in this chapter can be more easily explained due to real-life systemic factors. Differing healthcare systems position Americans as customers who are expected to pay for service, subsequently creating expectations of good service; while the British are patient – in the sense of both the noun and the adjective – that is, more used to having to wait in line for their turn. Additionally, legalisation of cannabis in the USA provides a potential explanatory factor for some cases of anxiety, while its illegality in the UK means that as a potential source of relief from anxiety (or a cause of it), it is risky and/or inaccessible. Knowledge about cultural factors can have the potential to be empowering, particularly if an individual feels that a certain mindset is not helpful for them personally. We note, for example, how Americans were more likely to use somewhat dramatising phrases such as anxiety attack and entire life, while British people talked about going through a bad patch and carrying on. Learning about stoicism may help some posters to manage better, although on the other hand, the persistence of Americans to get a second or third opinion from doctors, or to keep trying different medications, might be an approach that some British people could benefit from. Of course, knowing about the opportunities to deal with anxiety that are available in other cultures may result in frustration, particularly because most of us cannot simply relocate to a place with a healthcare system that is more suitable for us. With that said, both British and American people complained about their own systems, and so acknowledging the aphorism ‘the grass is always greener’ might help to allay cultural envy to an extent. Other differences outlined in this chapter are more difficult to explain – the American propensity to comment on and seek out consensus for symptoms, for example. Whatever the underlying reasons for the differences, the fact remains that the techniques used in this chapter have drawn them out, indicating that, to an extent, understandings of anxiety are culturally flavoured and that the success or failure of individuals in responding to their condition can be dependent on the country that they are born in.

https://doi.org/10.1017/9781009250139.007 Published online by Cambridge University Press

7

Time

Introduction In this chapter we consider the effects of change over time on language use in the Anxiety Support forum. Bearing in mind that the corpus consists of almost nine complete years’ worth of data, we wanted to consider whether particular events in the outside world impacted on what posters discussed at various points. More generally, we wanted to gain a better understanding of how discussion relating to anxiety developed over time. Corpus studies of diachronic change are reasonably plentiful, including for example, research on language change using the Brown family, which consist of written reference corpora sampled from 1931, 1961, 1991/2 and 2006 (Leech et al., 2009; Baker, 2017). Such studies have focused on orthographic, grammatical, semantic, lexical and pragmatic change over time, noting how written English has become more densified (more information packed into less space), informal (mirroring a colloquial style) and democratic (avoiding language that is seen as face-threatening or maintaining inequalities). Examples of these three trends would be, respectively, the decline of noun phrases containing of in favour of shorter genitive constructions (e.g., the hand of the king vs the king’s hand), increased use of first- and second-person pronouns such as you and I and avoidance of titles such as Mr, Mrs and Miss. Other forms of diachronic corpus research have been focused more on specific registers of language. For example, Rey (2001) built corpora of dialogue from scripts of the long-running television series Star Trek from 1966 to 1999, examining frequencies of lexical items used by male and female speakers. She found that over time women used less ‘involved’ speech, whereas the opposite was true for men. Brookes and Baker (2021) examined a 10-year corpus of British news articles about obesity, finding that over time there was an increasing focus on personal responsibility and scientific research when discussing obesity, as opposed to articles about the role of politics, business and social inequality. 191

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

192

Time

However, there are other pertinent ways of thinking about the passage of time in the forum which are linked to the identities of posters themselves. The first would be to consider that posts in the forum have been tagged for age (for posters who provided such information about themselves when they created a profile), in the same way that they were tagged for sex and location. This allows us to compare language use by different age groups to see whether there are agegraded differences. Research of this kind has been carried out on reference corpora such as the British National Corpus; for example, McEnery (2005) showed how adolescents and young adults used a higher proportion of swear words than other age groups. A corpus study of patient feedback by Baker et al. (2019) found that younger people tended to complain more about staff rudeness and not being taken seriously, whereas older patients used negativisers such as never and not to construct themselves as ‘expert patients’; for example, ‘At 50 years old I have never experienced anything like it!’. In the Anxiety Support forum corpus, we can consider how posters in different age groups orient to anxiety, to other members and what they describe as causing or alleviating their anxiety. A third way of conceptualising time is to consider individual posters and their participation in the forum over the collected data period. Some participants only posted one or two messages, whereas others posted hundreds. Using this kind of information, we consider the ‘journey’ that participants go on, from their first post to their last, and what such a journey could typically look like. For example, do posters assume different roles as they become a more established member of the forum? What kinds of language distinguish newer members from older ones? And are there distinctive forms of language which provide clues that someone is never intending to post again? This is an area where there is less existing work to draw on and we hope that the exploratory analysis in the penultimate section of this chapter inspires others to take these methods further. We begin, however, by considering the first of the preceding ways of considering time – by looking at changes across the whole forum over the nineyear period.

Comparing Years The first message in the corpus, entitled ‘Agoraphobia’, was posted at 16.54 on 20 March 2012. We can not be sure that this is the first ever message posted to the Anxiety Support forum, since some of the replies included in the data correspond with earlier discussion threads. The last message in the corpus was posted approximately eight years and

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Years

193

7000 6000 5000 4000 3000 2000 1000

2012–03 2012–06 2012–09 2012–12 2013–03 2013–06 2013–09 2013–12 2014–03 2014–06 2014–09 2014–12 2015–03 2015–06 2015–09 2015–12 2016–03 2016–06 2016–09 2016–12 2017–03 2017–06 2017–09 2017–12 2018–03 2018–06 2018–09 2018–12 2019–03 2019–06 2019–09 2019–12 2020–03 2020–06 2020–09

0

UK

US

Other

Figure 7.1 Frequency of posts over time (months)

eight months later at 2.08am on 6 October 2020 as a response to another contributor who had posted about gagging while excited: ‘I’m so glad I’m not the only one to have this as well. Thanks for sharing this.’ The forum continues to operate and we are aware that this is not the last message posted to the forum, nor to many of the discussion threads included in our corpus. Figure 7.1 shows the number of posts per month over time. There was considerable fluctuation with an initial peak in April 2013, then a fall until 2014–15. This was followed by another rise in posts and a high peak in September 2017, then a reasonably steep fall-off, a slight recovery in May 2019 and then another decline. A pertinent question is whether external events in the world influenced people’s experience of anxiety, particularly events that took place in the UK or the USA, which is where 72.60% of the posters claimed to be from (also indicated in Figure 7.1). On 23 June 2016, the UK and Gibraltar voted on whether to remain in or leave the European Union, with the result, unexpectedly, being 51.89% to leave. Later that year on 8 November, the 58th presidential election in the USA took place, resulting in Republican Donald Trump defeating the Democratic candidate Hillary Clinton, despite losing the popular vote. Both events were seen as controversial and caused widespread consternation. However, they do not seem to have been the subject of much discussion on the Anxiety Support forum. Brexit (which refers to the British vote to leave the EU) only occurred three times across the whole forum, whereas Trump was mentioned 20 times.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

194

Time

In order to identify possible events that we might not have considered, we decided to compile a list of annual keywords. To achieve this, we compared each year against a sub-corpus consisting of all the other years; for example, we compared 2012 against 2013 to 2020 and repeated this for every year in succession. Unlike the analysis in Chapters 3, 5 and 6, we have not considered key multi-word terms in this chapter as we are splitting the corpus into a higher number of sub-corpora, meaning that frequencies are lower. The frequencies of multi-word terms are generally lower than the frequencies of words, which means that the former are less likely to reveal patterns that we can confidently generalise in this chapter. Table 7.1 shows the top 50 keywords for each of the nine years of the corpus, with frequencies in brackets (usernames have been removed). Table 7.1 Annual keywords Year

Keywords

2012

CBT (760), hi (2,976), wishes (409), Christmas (311), GP (889), blog (207), site (587), blogs (123), citalopram (316), people (2,136), although (449), as (6,059), blessings (107), best (1,267), tablets (324), not (6,804), illness (401), NHS (170), work (1,748), the (23,968), herbal (133), difficult (411), realise (195), them (2,510) xxx (9,920), love (7,485), lol (4,074), xx (5,725), hugs (1,920), lovely (2,007), xxxx (1,338), well (9,727), no (10,472), site (2,180), she (6,691), hope (8,484), hi (9,285), blog (693), GP (2,926), here (6,389), wiv (351), good (10,554), we (12,218), nice (2,239), mum (1,434), he (7,832), done (4,021), her (4,563), as (20,482), hubby (627), xxxxx (458), pleased (673), oh (2,075) hi (7,378), xx (3,907), hope (5,140), love (2,850), headspace (256), vomiting (353), lovely (889), thanks (2,667), GP (1,529), good (5,550), knitting (121), mindfulness (345), thankyou (457), welcome (614), she (3,132), posting (336), morning (1,385), CBT (810), site (832), xxxx (399), pleased (286), weekend (387), post (1,219) I (97,657), head (2,489), feel (11,545), hello (1,259), please (1,800), also (4,322), floaters (145), symptoms (3,795), help (5,844), like (10,961), pressure (1,116), eyes (710), weird (925), healthy (521), Dr (729), anxiety (14,306), my (27,323), ha (250), problems (1,152), eye (465), B12 (210), die (745), feels (1,310), problem (1,225) I (198,225), ah (701), it (86,707), like (22,392), neck (1,504), care (3,398), feel (22,214), because (9,451), pain (4,650), anxiety (28,645), my (54,647), scared (3,266), doctor (5,956), head (4,349), numbness (446), symptoms (7,209), pains (1,570), and (109,950), weak (824), chest (2,976), vitamin (600), hello (2,069), feels (2,607), something (7,402), (continued)

2013

2014

2015

2016

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Years

195

Table 7.1 (continued) Year

2017

2018

2019

2020

Keywords God (1,570), B12 (389), burning (546), doctors (2,342), pray (606), just (22,609), fatigue (382), die (1,408) anxiety (36,020), forum (1,445), heart (8,799), weed (542), sensitised (534), symptoms (9,201), idk (806), and (134,693), yeah (1,729), nervous (1,976), fear (5,723), book (1,997), smh (257), recover (923), or (21,221), system (1,394), fast (1,365), crazy (1,957), it (99,847), magnesium (934), your (36,168), chest (3,591), doctor (7,028), fake (272), smoked (227), because (10,874), that (53,712), like (25,580) CBD (382), its (8,330), anxiety (19,938), disorder (1,076), sensitised (296), and (73,481), Weekes (229), resources (176), of (32,842), lexapro (427), by (4,339), trees (111), thoughts (2,613), heart (4,468), fighting (553), your (19,953), those (1,796), respite (104), Claire (164), sensitized (124), fake (168) Zoloft (909), CBD (313), Ativan (395), antidepressants (411), Lexapro (476), dose (979), mg (595), withdrawal (330), taper (149), tapering (123), definitely (982), ER (554), issues (1,236), SSRIs (130), benzos (197), benzo (170), increase (333), SSRI (233), unbalanced (111), side (1,965), drug (470), brain (1,479), also (4,813), did (4,952), symptoms (4,276), for (22,214) virus (349), breath (508), safe (282), rate (290), shortness (152), fever (93), mask (64), health (935), heart (1,565), high (430), cough (122), throat (335), dose (348), pregabalin (61), stay (502), withdrawal (130), weeks (812), palpitations (259), media (57), IDK (160), pneumonia (43), precautions (23), Mirtazapine (109), mg (216), care (724)

For this part of the analysis, we have not removed keywords which were due to a small number of prolific posters using a particular word often, as we wanted to gain an overall impression of the topics or forms of language that were encountered at different points across the timespan. In some cases, it appears that a small number of prolific posters influenced discussion in a particular year; for example, one poster made numerous references to Dr Claire Weekes’ self-help books in 2018 (Claire, Weekes) while another consistently referred to tapering off medication (taper, tapering) in 2019. Other keywords are indicative of stylistic features of particular posters. For example, in 2016, the keyword ah was mainly attributable to one poster who posted 1,969 messages between December 2015 and June 2017. Some keywords do seem to be more linked to developments outside the forum. For example, the words blog and blogs were keywords in 2012, collectively mentioned 330 times. In the early days of the forum,

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

196

Time

posters were more likely to recommend anxiety-based blogs to one another, particularly those created by Health Unlocked members. Hello, thanks for the link to the site! I’m going to have a look too! Sounds like you’ve really been through it :(hope you find readin the blogs on here as useful as I have! I never knew so many people suffered from anxiety until I came on here! X (2012)

However, by 2020 there were only five mentions of blog(s), perhaps due to other forms of support becoming available. For example, in 2014, the keyword headspace refers to an online company who specialise in meditation. Founded in 2010, they initially operated through their website, but in 2012, a Headspace app was launched, becoming particularly popular among Anxiety Support forum members in 2014. I tend to do my headspace first thing in the morning set me up for the day ahead. (2014)

The final year, 2020, stands out as referring to a global event: the COVID-19 pandemic, which resulted in lockdowns in many countries around the world as well as high numbers of deaths and hospitalisations. Keywords specific to 2020 such as virus, fever and masks refer to COVID-19, with concordance analyses indicating that this was the only global-wide topic across the corpus which significantly impacted on the discussion in the forum. One reason for this is that in 2020, COVID-19 was a new disease which resulted in a range of symptoms, some of which were similar to the physical symptoms caused by anxiety. I think even more people are dealing with shortness of breath because of the virus it being listed as a symptom so we’re all thinking it and getting anxious and getting physical symptoms. It’s so annoying (2020)

Additionally, some people on the forum related how fear of COVID19 meant that it was more difficult for them to seek medical help for their anxiety. It’s just hard to go see my gp as of this corona virus, yeh a scan of the heart would deffo put my mind at rest thanks a lot (2020)

Some people with anxiety on the forum had an intense fear of dying, so the possibility of being exposed to COVID-19 or having symptoms resulting from catching COVID-19 resulted in increased anxiety. just dont wanna die from this virus and get it. and i been waking up with the sore throat also late it goes away when i drink something but then it comes back again ugh. (2020)

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Changing Themes over Time

197

While Brexit and Trump’s election caused anxiety to large numbers of people, these events did not immediately or directly impact on their lives in the same way as COVID-19, where lockdowns meant that businesses closed, livelihoods were lost, people had to stay indoors for long periods of time, children could not attend school and elderly family members could not be visited. I’m driving my family nuts. I don’t want anyone near my kids or myself. We literally stay in the house. I go to work and lock my office door to avoid contact. (2020)

In short, the impact of Brexit and of Trump’s election was not as direct and immediate as COVID-19. Additionally, while COVID-19 was a devastating event for the entire world, Brexit and Trump’s election were more contentious, with many people in the UK and the USA, respectively, voting for them. Writing about political events on a largely anonymous forum runs the risk of encountering disagreement from others, which is likely to exacerbate anxiety. As such, although members of the forum barely mentioned these two topics, we would hypothesise that this is because people avoided writing about them, rather than not being affected by them.

Changing Themes over Time The analysis in the preceding section focuses on lexical items which were most typical of a particular year. A limitation of the keywords procedure is that it is not suited to identifying more gradual changes over time, particularly those that might involve combinations of words which together constitute a theme. In order to identify these kinds of changes, we considered the most frequent 1,000 words across the whole corpus. Many of these words were grammatical words such as of, the and at, so did not denote a particular theme. However, it was possible to assign 20% of the top 1,000 words into 12 categories by examining concordances of the words and using a bottom-up categorisation scheme to identify themes. These themes are shown in Table 7.2. Many of the themes identify a topic (e.g., medication or symptoms), although others relate to functions of language (e.g., affiliative or evaluative language). We plotted the relative frequencies of the words in each category for each year, generating a trendline and calculating gradient and R2 scores for each category. The gradient indicates the slope of the chart: a high positive number indicates a strong increase in relative frequency over time whereas a high negative number indicates a strong decrease in relative frequency over time.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

198

Time

Table 7.2 Categories of frequent words in the corpus Category

Words in category

Body

heart, head, body, chest, blood, brain, 617.1 stomach, neck, eyes, throat, muscles, legs, eye, muscle, hands, ear, mouth, arm, ears, arms, thyroid, feet 402.62 symptoms, panic, pain, attack, attacks, sick, tired, dizzy, pains, die, symptom, dizziness, headaches, palpitations, tension, racing, headache, nausea, sensation, tight, crying, vision, sensations, shaking, acid, tingling, sore, burning, faint, hurts, tense 274.35 meds, medication, dose, prescribed, tablets, Xanax, mg, Sertraline, Zoloft, drug, medicine, drugs, Citalopram, medications, pills, med, pill, Lexapro test, tests, checked, results, scan, MRI 140.2 doctor, doctors, GP, Dr, doc, psychiatrist 107.27 therapy, accept, CBT, therapist, nerves, 52.05 acceptance, counselling God, pray 30.133 time, day, days, night, week, year, morning, 23.933 hours, month, everyday, constantly, daily, yesterday, hour, minutes, lately, tonight, 24, early, minute, evening, future, weekend, nights, Christmas recover, recovery 18.233 relax, exercise, meditation, magnesium, tea, 16.95 music, relaxation, vitamin, relaxing -141.58 friends, friend, husband, mum, kids, daughter, son, dad, children, mom, parents, baby, mother, partner, sister, boyfriend -166.72 good, bad, worse, wrong, horrible, nice, worst, weird, crazy, awful, scary, helpful, lovely, terrible, severe, important, strange, amazing, funny, wonderful, annoying -1100.1 hi, thank, thanks, xx, xxx, lol, hello, yeah, agree, hugs, welcome, hun, wishes, bless, thankyou, wow, :), :-), :(, :D

Symptom

Medication

Test Doctor Therapy Religion Time

Recovery Other Coping Social Actors

Evaluation

Affiliative

Gradient

R2 0.5857

0.3657

0.7802

0.7454 0.4949 0.0949 0.3673 0.0275

0.0874 0.0927 0.5863

0.734

0.4029

A number close to zero indicates that the relative frequency has remained reasonably stable. The R2 score is always a number between 0 and 1 and it indicates the extent to which there is strong correlation

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Changing Themes over Time

199

12000 10000 8000 6000 4000 2000 0 2012 Symptom

2013

2014 Body

2015

2016

Medication

2017

2018 Doctor

2019

2020

Test

Figure 7.2 Relative frequency of categories of terms increasing over time

(e.g., if we plot the points on a chart, do they fall in a straight line?). A score close to 1 indicates strong correlation whereas a score close to 0 indicates quite a bit of variation over time. Table 7.2 shows that the categories Body, Symptom, Medication, Test and Doctor have all high positive gradients (above 100), indicating that, relatively speaking, they have increased quite markedly over time. These categories are shown in Figure 7.2 for comparison. References to Symptom and Body were the most common and follow a similar trajectory: there is a slight drop from 2012 to 2013, then a rise until 2015 when the relative frequencies of words in these two categories stabilises, falling slightly for the remaining years. A hypothesis for these changes is that it is due to increasing numbers of American posters joining the forum in 2014. Considering the analysis in the previous chapter, we note that it tends to be American posters who are more likely to refer to medications and symptoms, particularly in relation to different body parts, and as Figure 7.1 indicates, there was a sharp increase in contributions from American posters in 2014. At the start of 2014 only 4.85% of posts were from Americans. This had risen to 27.67% by the end of 2014 and steadily increased in the following years, ranging between 43.93% and 57.96% across the months of 2017. However, when we examined non-US posts, we found that generally they also showed increases in the five categories shown in Figure 7.2. These increases appeared between 2012 and 2015, lagging slightly behind the American increases. This suggests that the American posters may have helped to focus the language of the whole forum in a particular direction. This

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

200

Time

appears to be one of the most significant changes to the forum and reflects the increased dominance over time of posts which discuss the relationship between anxiety and physical symptoms. My chest and heart tell me I’m having a heart attack, nearly every day. I know it’s not true, as those symptoms surfaced almost a year ago . . .. that is just my strongest, most persistent anxiety symptom. (2020)

Related to the topics of Body and Symptom are increases in discussion of the topics Medication, Doctor and Test between 2013 and 2015, although these are less dramatic. The use of terms in these categories is demonstrated in the following examples: I do still take klonopin for anxiety and panic attacks for years now with the best results of any of the anxiety type meds we’re familiar with. I’m prescribed 3, 1mg tabs a day as necessary. (2020) The palpitations and the dizziness have made my anxiety worse, my doctor is checking me out but I have a feeling it will end up being anxiety related. (2020) I’ve had them for 6 years now. I’ve done every test and I am waiting for results for a cardiac MRI. (2020)

Taken together, the five categories in Figure 7.2 indicate an increased sense of medicalisation of anxiety in the Anxiety Support forum. Other categories in Table 7.2 have either very small increases over time or decreases. Figure 7.3 shows the relative frequencies for five categories, of which four (Time, Evaluation, Social Actors, Other

20000 15000 10000 5000 0 2012

2013

2014

2015

2016

Affiliative

Evaluative

Social Actor

Time

2017

2018

2019

2020

Other Coping

Figure 7.3 Relative frequency of categories of terms decreasing or remaining stable over time

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

201

Coping) appear to be almost unchanging from year to year. The exception in Figure 7.3 is Affiliative, which shows a large increase between 2012 and 2013, then a decrease until 2015, followed by a more stable pattern. This appears to be largely due to the presence of one prolific poster who joined the group in December 2012 and posted a very high number of messages until she left in 2015, changing accounts several times. This poster had very high frequencies of affiliative words such as xxx, hun, lol, hi and thanks, which explains their spike in 2013 to 2014. The figure indicates how a single poster can make a major impact on the language of a forum. Two categories that are not shown in Figures 7.2 or 7.3 are Religion and Recovery. Both contain much lower relative frequencies than the other 10 categories and show slight increases over time although no clear linear pattern. The increase in the Religion category is again most likely due to the higher numbers of American posters who joined the forum in 2014 – as noted in the previous chapter, American keywords included God, pray, prayers and praying. There is therefore evidence for an increased medicalisation discourse around anxiety in the forum – references to medications doubled between 2013 and 2019 and references to tests more than tripled between 2012 and 2020. The reasons for this increase in medicalisation terms are most likely correlated with the changing demographic profile of members who brought with them a focus on physical symptoms associated with anxiety.

Comparing Age Numerous studies have pointed to age as an important factor in the experience of anxiety in terms of the degree of anxiety people experience and what they tend to be anxious about. Powers et al. (1992) note that undergraduates tend to have anxiety about social events and financial situations while Hunt et al. (2003) found that older adults worry more about world issues and familial concerns. Gould and Edelstein (2010) found that younger adults tend to report significantly higher amounts of trait and state anxiety symptoms than older adults. Similarly, in a comparison of two groups of adults, one consisting of students with a mean age of 20.1 years and the other of older people with a mean age 71.8 years, Mahoney et al. (2015) found that the younger group reported significantly higher levels of anxiety sensitivity (i.e., the tendency to fear body sensations associated with anxious arousal) and experiential avoidance (i.e., excessive negative evaluation of unwanted thoughts and feelings and efforts to control or escape them). On the other hand, the

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

202

Time

Table 7.3 Number of posts by age category Age

Posts

%

None (incl. 0) Under 20 20–29 30–39 40–49 50–59 60–69 70–79 80+

130,618 2,984 31,610 47,845 26,675 26,262 16,100 10,105 1,883

44.42 1.02 10.75 16.27 9.07 8.93 5.47 3.43 0.64

older group reported significantly higher levels of trait mindfulness, that is, being fully cognisant of thoughts and feelings without judgement or avoidance, thereby decreasing their distress levels. Gerolimatos and Edelstein (2012) have suggested that such a difference is likely to be due to older adults having better emotional regulation skills so they do not devote anxious attention to sensations that might exacerbate anxiety. Mahoney et al. (2015) add that this may be the result of life experience of the older group and higher likelihood of consultations with medical professionals. Table 7.3 shows the number of posts by age across the forum. Just over 44% of people did not give their age, so were not included in the analysis that follows. Only a small number of people claimed to be under 20 (1.02%) so there is not enough data for us to compare this group against other groups. Similarly, only 0.64% of people claimed to be 80 or over, and this included 1,061 posts from people who said they were 100 or over (including someone who said they were 244 years old). Therefore, we have not included people aged 80+ in the analysis. The analysis instead focuses on people aged between 20 and 79, which represents 53.92% of posts. We obtained top 100 keyword lists for each age group by comparing each group against sub-corpora consisting of the remaining age groups; for example, we compared posts made of people aged 20 to 29 against those aged 30 to 79. After removing usernames and keywords which were used at least 50% of the time by a single poster, this resulted in the keywords shown in Table 7.4. The very small number of keywords for people in their 70s is the outcome of one prolific poster who wrote 23.4% of the messages in this group. This poster tended to use language in

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

203

Table 7.4 Keywords by age group Age

Keywords

20s

(357), :( (1,770), idk (639), yeah (1,187), wanna, (584), boyfriend (591), scared (2,794), weird (1,423), gonna (902), guys (767), feels (2,098), die (1,192), thankyou (632), freaking (394), college (349), okay (1,219), haha (409), constantly (1,039), kinda (411), literally (627), im (3,733), sucks (471), anyone (2,939), crazy (2,939), pains (1,109), anymore (1,030), chest (2,226), like (17,099), hey (940), lately (582), super (381), really (8,179), sick (1,583), because (6,738), thank (4,387), hate (1,140), fine (1,835), currently (492), everything (2,587), worried (1,155), hurts (389), tips (321), wrong (1,739), mom (532), attack (2,517), recently (851), feel (15,799), extremely (408), head (2,873), arm (458), dying (731), my (41,269), school (659), want (4,001), just (16,741), pretty (803), seriously (375), whole (779), felt (2,714), makes (2,109), everyday (910), myself (4,249), cant (937), numb (328), left (1,153), asleep (548), honestly (459), me (22,574), sometimes (2,774), heart (4,508), else (2,024), I (145,339), since (2,205), ever (1,840), gotten (379), wake (940), almost (1,004), completely (756) :) (5,320), issue (959), allow (542), u (3,366), once (2,528), ur (752), headaches (1,022), ER (708), body (3,796), cycle (560), everyday (1,253), kids (911), dizzy (1,452), gotten (518), sensation (655), happen (1911), medication (3,118), afraid (1,352), coming (1,507), while (2,573), neck (1,085), stuck (567), truly (628), amazing (630), control (2,145), relax (1,511), mind (4,971), physical (1,521), issues (1,713), Xanax (711), start (3,281), therapist (1,176), knowing (799), negative (983) oh (1,075), Sertraline (401), its (4,253), lol (1,422), etc (666), CBT (736), hi (5,365), Dr (702), kids (540), awful (788), dad (427) OK (1,610), yes (2,450), wow (313), mum (498), counselling (307), ive (812), u (1,747), im (2,444), hugs (483), week (1,452), mine (682) totally (522), weak (369), maybe (1,698), due (732), lots (544), sounds (1,029), too (4,232), partner (321), doc (451), obviously (218), ya (170), chat (276), ur (376), tingling (217), fight (506), mg (337), work (3,066), yep (133), sweats (99), il (94), cardiac (86), sadly (105), Christmas (228) Mr (367), B12 (392), deficiency (227), xx (2,694), hey (441), menopause (163), wont (252), cant (629), thats (438), n (401), love (2,581), post (1,159), daughter (590), advise (270), anorexia (80), listen (524), welcome (586), members (190), apps (119), website (242), care (1,757), lovely (631), headed (179), vomiting (116), youve (82), psychologist (157), talking (712), Zoloft (229), hug (179), look (1,469), thankyou (257), gym (168), results (377), might (1,247), sufferers (137), ok (1,575), son (512), please (1,421), hang (327), hi (5,663), alcohol (253), ptsd (168), foods (164), link (175), check (605), meditation (414), treatment (362), videos (119), information (240), done (1,764), happy (continued)

30s

40s

50s

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

204

Time

Table 7.4 (continued) Age

60s

70s

Keywords (928), lots (688), keep (2,534), sick (744), enjoy (609), youtube (160), money (253), hope (4,349), fluids (73), comfortable (148), chat (303), dogs (151), checked (473), yoga (147), Xanax (319), dont (834), mental (623), busy (426) regards (311), wishes (394), site (749), xxxx (304), love (1,753), Venlafaxine (147), GP (1,002), evening (304), Klonopin (161), bless (328), pleased (178), husband (464), perhaps (252), counselling (261), posting (208), luck (871), lots (451), antidepressant (128), problems (826), local (172), son (335), helpful (399), UK (185), Zopiclone (85), daughter (389), very (3,231), wonderful (229), ill (482), difficult (446), early (271), addictive (118), support (916), exercises (180), lady (121), although (415), Mirtazapine (122), mgs (65), programme (70), compassion (65), gradually (125), garden (101), however (477), hi (3,525), GAD (149), mg (263), such (678), depression (944), prescribe (113), am (5,113), dose (457), cope (419), best (1,461), treatment (222), certainly (232), lovely (325), contact (142), big (541), fully (155), bus (92), thyroid (180), age (266), diabetic (62), wife (152), grandson (54), migraine (112), mornings (120), increase (149), anti-depressants (65), found (822), particularly (95), problem (780), who (1,688), children (250), xxxxx (76), useful (110), are (9,051), dogs (102), wonder (223), increased (126), relaxation (239), counsellor (103), counseling (94), mindfulness (172) GP (872), nausea (336), problems (817), medications (292), problem (817), many (1,475), certainly (253)

a highly repetitive way, which meant that the majority of the top 100 keywords for this age group were the result of that single poster. While this poster’s language would have provided numerous interesting keywords to examine (such as their tendency to refer to blips and glitches in people’s nervous systems), we cannot generalise their language use more widely to people in their 70s. As a result, the majority of the analysis that follows will focus on the 20s to 60s groups.

What Causes Anxiety for Posters of Different Age Groups? Some keywords indicate subjects that are more relevant to life-stage, with people in their 20s using the words school, college, university and

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

205

boyfriend more than other groups. They relate to how their anxiety has impacted on their education and romantic relationships. I didn’t return to College early this month because I could not handle the pressure, considering I’m going through so much (20s) I was so miserable I was having so many pains and my mind would race and whenever I would just think of my boyfriend and my anxiety would get so so high that I thought I had to end it to make it go away (but it won’t it will come back with every relationship). (20s)

Those in their 30s and 40s mention the keyword kids, with these groups being most likely to have young children living with them. Hello I’ve had anxiety today but been stressfull. Kids playing up, my dogs won’t stop barking, done house work twice and it needs doing again (30s)

People in their 40s use a few keywords that relate to other people who are connected to them: partner, mum, dad. Elderly parents provide a present-day source of anxiety for people in this age group, who also write about how parental behaviours and choices might have impacted on their ability to cope with anxiety. I am worried about my mum who isn’t too well. She will be 80 this month, I am an only child so there isn’t really anyone else to help out. (40s) My dad was amazing but my mum was like your dad .. Even when my knees were dislocating and the pain was so bad she would grab my hair drag me to the bus stop and tell me school was more important (40s)

People in their 50s use the keyword money to refer to anxiety over financial difficulties. I have servere money worries at the moment and it is making me totally depressed anxious and unable to sleep and . . . anyone who says money can’t make you happy I have to disagree with (50s)

This group are more likely to refer to their son or daughter, terms which do not necessarily imply young children as kids does. my daughter is very sad a d I’m not there to put my arm round her – her partner is ill and can’t be fixed – sorry to burden you with my anxiety (50s)

Those in their 60s also use son and daughter as keywords, as well as children and grandson. I’m helping to bring up my 14 week old grandson with my daughter (long story) and I find my anxiety has increased. (60s)

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

206

Time

Older people tend to spend less time in deep sleep and wake more often during the night and some people in their 60s appear to have particular struggles with anxiety upon waking, signified by the keywords early and mornings. Wake up early stomach rumbling but the very thought of eating makes me feel sick. I know it’s anxiety and I am on meds but still the same. (60s)

How Do Posters of Different Age Groups Characterise Their Anxiety? Posters in their 20s use a set of keywords which suggest an all-ornothing perspective. Some of these keywords are more suggestive of stylistic choice (e.g., densification realised by combining two words into one – everyday, anymore), others are more clearly indicative of distinct worldview: literally, really, constantly, everything, extremely, seriously, completely, super, whole. i just remember being in his car and it cold outside and just feeling like a little mouse in a trap. thats literally what i am, a little mouse and the world is the trap and i want out (20s) I constantly check my body in a mirror I have no clue how many times a day (20s) Anyway I guess my biggest complaint is that I am afraid of EVERYTHING right now, and I mean everything. (20s) Right now my stomach is completely destroyed because of anxiety and I can only eat bland food. (20s) My whole body hurts and I become totally incapable of having any sort of thought process within 10 minutes of getting up. I feel completely numb. (20s)

A question arises as to whether these kinds of words are typical of how people in their 20s use language generally, or whether they are more distinctive of situations where they talk about anxiety. To address this, we examined two other corpora containing spoken British English. The Spoken BNC2014 contains 11 million words of informal speech recorded in 2014 which is tagged for speaker information, including age. In this corpus, collective relative frequencies of the preceding nine keywords were obtained. The age groups used in this corpus are delineated differently (0–14, 15–24, 25–34 and so on), so we cannot isolate people in their 20s, although the group with the highest frequency of these words is the 15–24 group, with use of the terms decreasing as age categories increase.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

207

In order to consider whether older speakers have other ways of expressing hyperbole, we examined words with the part-of-speech tag JJT, indicating superlative adjectives such as biggest in the BNC2014. It was the 25–34 group that had the highest frequency of these terms, with the 15–24 group using them second most. We also looked at the top 100 words in the BNC2014 which received the tag RR (general adverb) and identified 10 which tended to be used to express all-or-nothing perspectives: always, never, definitely, absolutely, especially, totally, particularly, certainly, clearly and perfectly. Again, it was the 25–34 age group which used them the most, so we can more widely link these kinds of words as being more strongly associated with the language use of people in their 20s. Another question to consider is whether this is a current phenomenon – is it something distinctive about people in their 20s who are living in the 2010s, or is it something that people in their 20s have always done? We would need to consider a much larger set of corpora to fully do justice to this question, although one corpus we can consult is the Spoken BNC1994, which contains recorded conversations from 1994. Again, the results look similar (see Figure 7.4), with the 15–24 group using the hyperbolic keywords the most, with decreasing use in older people. We should also note that for all age groups, the equivalent figures are around double in 2014 compared with 1994. The results indicate, therefore, that there is evidence both for younger people using more hyperbolic language and for language use becoming more hyperbolic for everyone in the 20-year period between 1994 and 2014. Returning to the Anxiety Support forum data, people in their 20s also use a high number of keywords which indicate negative evaluation or reference to negative concepts: sucks, crazy, weird, freaking, hate, pains, sick, worried, hurts, wrong, attack, die, dying, scared, scares and the sad face emoticon :(. And the dreams make no sense at all or they’re about what gives me anxiety then I’ll wake up in the middle of the night scared and thinking I’m gonna die. (20s) Ugh I hate It I cant even enjoy going out i HATE anxiety (20s) I am just so scared . . . Uhhhhhhh : (: (: (: (Does anybody know if you can get some form of tranquilizer from the doctors or MH professionals? I seriously need something! (20s)

With respect to pains, Baker et al. (2017, p. 184) found that in a British corpus of patient feedback to the National Health Service,

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

208

Time

7000 1994

2014

6000 5000 4000 3000 2000 1000 0 15–24

25–34

35–44

45–59

60+

Figure 7.4 Combined relative frequencies per million words of literally, really, constantly, everything, extremely, seriously, completely, super and whole in spoken corpora

the word pains was used significantly more by men than women. In the Anxiety Support forum data, male posters were also more likely to use the term, with a relative frequency of 335.17 times per million words, compared with 239.7 times per million words by female posters. When we focus specifically on the 20–29 age group however, the rates of use are much more comparable, with 8,342.29 occurrences per million words for female speakers and 8,896.28 times per million words for male speakers. This suggests that we can associate the term more with the age group, rather than aspects of gender. As pain can be a count or non-count noun, the choice of referring to the plural form pains as opposed to pain suggests a desire for emphasis, highlighting the transient intensity in contrast to a more enduring state. On boxing day I went out with a few mates to town and all of a sudden I got off the bus walked around for 5 mins and then I felt really bad chest pains that lingered for about 15 mins (20s)

In contrast, older age groups use a more moderated form of language. For example, the next age group up (30s) use the more euphemisticsounding words issue and issues to refer to a range of phenomena, including anxiety. Knowing your past focus on health issues, it sounds like an anxiety issue. (30s)

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

209

The 30s age group also offers explanations for anxiety; for example, by referring to it as consisting of a cycle, whereby anxiety is seen as producing physical symptoms which result in increased anxiety. The thinking and worrying are reinforcing the cycle. Anxiety can cause so many symptoms – this is definitely one of the many I’ve experienced. (30s)

People in their 30s write more often about controlling their anxiety (or it controlling them), anthropomorphising it through use of the keyword allow. 4 months ago I felt like my heart stopped and started again. This made me panic and spin my anxiety out of control. (30s) As I see it the drug im taking helps control the anxiety just as a drug would for any illness/condition. (30s) Anxiety will suck u dry if you allow it you have got to want control over your life your so young embrace your youth and do n’t let anxiety destroy it. (30s)

The 40s group used the word fight relatively more frequently than other age groups, although an examination of its uses in context suggests a range of positions. Some posters conceptualise dealing with anxiety as a fight. Keep the fight, we are all behind you, learning to deal with anxiety is the key, we will always be in recovery, that is part of us. (40s)

Others talk about the difficulty of trying to fight anxiety or argue that irrational fears shouldn’t be fought. I feel like iam fighting a losing war with this anxiety I fight evey day to have a good day but it just don’t happen (40s) It is a very scary thing when it happens as all the symptoms are very real but it’s our body fighting something . . . a fear . . .. but as it’s an irrational fear there’s nothing to fight. (40s)

The range of uses of fight suggests that the concept of fighting anxiety is both important and a source of contestation for this age group, whereas other groups do not have the same tendency to refer to whether anxiety should be fought (or not). People in their 60s favour the word cope, which suggests a different set of expectations around resolving anxiety. I have to go and see my GP in the next day or so, but how do I cope with the fear and anxiety? (60s)

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

210

Time

This group, along with people in their 70s, also use problem and problems relatively more frequently than others. While problem is indicative of something negative, its strongest collocates in the English Web 2020 corpus include solve, solving, solved, solution, fix, address, resolve and facing. The word problem therefore has a discourse prosody which indicates something that has the capacity to be solved. This is unlike the word issue (which as noted earlier, was key for people in their 30s), whose collocates have a discourse prosody for importance (important, key, major, serious, critical) and acknowledgement (address, raise, discuss, facing) rather than resolution. You are already staring from a good place – you know the problem and you are actively seeking solutions. (60s)

The 60s group is the only one to have age as a keyword, a word which sometimes occurs in autobiographical statements such as ‘I left school many moons ago at the age of 15.’ However, some posters in their 60s use age to refer to expectations that older people should not experience anxiety. I’m being told is grow up and act my age now I’m 61 and don’t seem to able to get out of this hole I’m in (60s)

What Ways of Managing Their Anxiety Distinguish Posters of Different Age Groups? No relevant keywords for the 20s and 70s age groups were found, so this section focuses on the 30s to 60s groups. People in their 30s (and above) use keywords which suggest different ways of focusing on, resolving or living with anxiety that most commonly involve medicalisation of anxiety: ER, medication, Xanax and therapist. Since your symptoms are so wide spread it might be a good idea to have your doctor check you out. Seeing a therapist and going on medication for a short time might help break this cycle you are in. (30s)

People in their 40s also use keywords which suggest medicalisation, although these are based on talking therapies: counselling, session, CBT. It’s finally starting to happen, next Thursday afternoon I got my first counselling session but I am nervous about it. (40s)

Compared to the 30s and 40s groups, the 50s age group has fewer keywords that indicate a medicalisation discourse, although two

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

211

forms of medication (Xanax and Zoloft) are key, as is the term psychologist. Instead, people in the 50s group recommend obtaining information from the internet as a way of dealing with anxiety (apps, website, link, videos, information, youtube). I get really bad anxiety and when I feel scared I listen to the self hypnosis videos on youtube. (50s) There are some great meditation apps. (50s)

They also describe a number of non-medical ways that they have found helpful, particularly those involving training or exercising the mind and body: gym, yoga and meditation. Change the thought process away from that by doing some yoga or mindfulness. Play some music. (50s)

Additionally, this group suggest distraction techniques as a way of coping with anxiety, through the use of the keyword busy. Try to keep busy and hang in there, it will pass (50s)

This group also advocates focusing on positive aspects of life and taking pleasure in small things, signalled through the use of the keyword enjoy and more specifically, dogs. I try and live in the moment . . .. one day at a time, no pressure . . . enjoy that particular day. (50s) I play my cello, I find a fiddly or a new piece of music and play til my arms ache. Or I get outside, walk the dogs or faff in the garden (50s)

Another aspect of people in their 50s is a focus on diet and nourishment, signified via keywords such as B12, deficiency, alcohol, foods and fluids. I’ve cut way back on processed foods, snacks and chocolate and feel so much better for doing that. (50s) Alcohol increase anxiety and makes the symptoms the next day worse. (50s) Hope your feeling a little better and if not have visited or made an appointment with your doctor. Try and have plenty of fluids to keep yourself hydrated. (50s)

Compared with people in their 30s and 40s, those in their 50s appear more in favour of non-medical solutions based on self-sufficiency, rather than taking medication or seeking therapies or counselling.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

212

Time

People in their 60s also mention everyday pleasures (garden, dogs) and refer to relaxation, mindfulness and (breathing) exercises as ways of reducing anxiety. However, they also use a relatively high number of keywords relating to medication: Venlafaxine, Klonopin, Zopiclone, Mirtazapine, antidepressant, anti-depressants, addictive, mg, mgs, prescribe, dose. The 60s keywords increase and increased usually refer to increasing the dose of medication. I am determined not to increase my dose today of Zopiclone but it will be very hard. (60s)

The 60s group also advocates support and counselling, indicating that there is no single outstanding way of managing anxiety that makes this group distinct from others.

How Do Posters of Different Age Groups Relate to the Forum? People in their 20s use a higher proportion of first-person pronouns than other posters, with keywords being I, me, myself, my. These words tend to involve narrations of people’s own experiences, as opposed to posts which are directed towards responding to others. I’m tired of feeling the way I do. I always fear there is something seriously wrong with my body. I don’t feel myself and haven’t. People keep telling me it will get better, but it doesn’t and it feels like it won’t. I can’t deal with anxiety and keep my life together. I’m falling apart, mentally and emotionally. (20s)

The 20s keyword tips tends to position these posters as seeking advice from others. Do you have any tips for me that maybe you used to help you overcome the anxiety? (20s)

People in their 30s use two keywords which involve second-person pronouns, u and ur, although these are more likely to indicate use of non-standard language as opposed to a greater propensity to address posts towards others, as the more frequent words you, your and you’re are not keywords for this group (or any age group). People in their 30s use the smiley face emoticon :) more than other posters as a way of indicating humour or support. Sooo, keep that celery near by. Apparently, you found a healthy snack with benefits . . .. :) (30s)

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

213

remember we are all anxiety sufferers here and our experience means we can help each other out! :) (30s)

A higher number of interpersonal keywords were used by people in their 40s (oh, lol, hi, OK, yes, wow, hugs and mate) and 50s (xx, hey, love, welcome, hug, thankyou, ok, please, hi), signalling a more responsive mode of interaction, which is often based around signalling acknowledgement, support and agreement as well as indicating when posters are joking or find something funny. Some 50s keywords tended to occur as part of supportive or affiliative statements; for example, hang in there, happy birthday/Christmas, lots of hugs/love, keep talking, hope this helps/you feel better. Hi [NAME], yes I have felt exactly the same for about 6 months! (40s) Wow, thats sounds extremely interesting. (40s) Welcome to the site I hope it goes well at the docs. (50s)

The 40s group use a range of adverb keywords (totally, too, sadly, maybe, obviously), of which only totally appears to express a strong stance about something, appearing similar to 20s keywords such as extremely, completely and constantly. However, while people in their 20s use this adverb to describe how bad their anxiety is, people in their 40s use totally to signal agreement towards other posters, with its top four collocates being relate, understand, agree and sympathise. I totally understand where you are coming from, if you need to cry then let it out! (40s)

The adverb too is also often used by this group to indicate agreement, in phrases such as ‘Yes, I get this too.’ Another adverb, sadly tends to be used to express sympathy or sorrow when relating to other people’s problems, while maybe indicates hedging and tends to occur with suggestions to others that they should ask for help. Sadly feeling like that is a normal or rather I see it as a normal part of anxiety (40s) Would you maybe think of going back to the doctor to get some help for your anxiety symptoms? (40s)

Finally, obviously, is usually used by people in their 40s when giving support or advice, as a way of indicating that the poster takes the other person’s condition seriously, as in the first of the following examples. In the second example, obviously is used by the poster to express what is seen as common knowledge (meds can help) but then goes on to offer

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

214

Time

a different perspective (exercise is a treatment for dealing with anxiety), which by extension is implied to be non-obvious. I couldn’t help but feel my heart go out to you. Agoraphobia is obviously a completely crippling condition. (40s) There are obviously many meds that can help but so many all natural ways of dealing with anxiety. One of the best treatments is exercise. (40s)

In a similar way, people in their 60s use the keywords perhaps, although and however as ways of presenting an alternative perspective. I know you can get those liquids, milkshakes, soups and juices that have all the vitamins and minerals etc the body needs. You also need to discuss your anxiety, however, perhaps get the above sorted first. (60s) Inside, you know that although you feel you are going to die, you survived and eventually you will get stronger, learn coping strategies, be able to manage again. (60s)

In contrast to those in their 20s, older posters tend to use keywords which express positive evaluation. People in their 50s use lovely, happy and comfortable while those in their 60s use helpful, useful, wonderful and lovely. These words are typically used when giving advice (e.g., by describing what people find helpful or useful) or support (e.g., by telling someone they are doing a wonderful job). I find my friends are very helpful and writing my feelings helps me to stand back from them a bit (60s)

The 60s age group also uses a range of interpersonal keywords, although these tend to be less responsive ones such as wow and oh and instead involve more formal discourse routines such as greetings (hi, evening) and sign-offs (regards, best, wishes, lots, love, xxxx, xxxxx, bless, big). Evening all Sorry I have not been on earlier but have had visitors. (60s) Sending big hugs and positive thoughts. (60s)

We might want to ask why younger people use more emphatic language to describe their anxiety. One reason could be that due to their age, some younger people might struggle to be heard. For example, Baker et al. (2017) found that young people were more likely to complain that doctors did not take them seriously. When people feel they are not heard, then they might respond by ‘turning up the volume’, or in this case, by using stronger language. It could also be hypothesised that younger people are perhaps more likely to experience stronger feelings

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

215

of anxiety due to physiological changes. High levels of estrogen amplify the brain’s stress response, and this tends to peak for women in their 20s. Testosterone levels in men tend to peak around age 18–19, and while high testosterone is not associated with higher levels of anxiety, it has been linked to increased neural activity to emotional stimuli, such as negative faces (Hermans et al., 2008). Stress hormones such as cortisol and adrenaline are released when people are in danger, helping the body to initiate a fight-or-flight response. However, if an experience triggers release of these hormones when there is no immediate danger (such as receiving a stressful work email), this can result in excess levels of cortisol and adrenaline, which can exacerbate feelings of anxiety. Cortisol levels tend to be higher in young people, gradually declining across the 20s and 30s, being relatively stable in the 40s and 50s and increasing thereafter (Moffat et al., 2020). Young people’s forceful descriptions of anxiety could therefore be reflective of the strong emotional responses that their hormonal levels are causing. Another factor could be level of experience. Older people who experience anxiety have had more time to seek support and information or to try a range of different techniques that might help to reduce or manage their anxiety. Our analysis indicated that younger people in the forum were more likely to be seeking advice while those who were older were more likely to offer advice. As a result, the young people who join the forum may be those who have fewer resources for coping with anxiety, and therefore are more likely to have a troubling experience of it, which might help to explain their language around it. While young people used more emphatic language in the two general corpora of spoken English that we examined, we also point to the fact that all age groups are using more of this kind of language in 2014, compared with 1994. This could be linked to societal changes, particularly around the way that information is framed. A major difference in language use between these two years is the growth of the internet. In 1994, only 1% of the UK population was online, while this figure was 91.6% in 2014 (Data Commons, 2022). Access to other sources of information have also increased over this period; for example, numbers of television channels, streaming entertainment services such as Netflix and the presence of 24-hour-a-day news channels. There are increasing numbers of voices vying for attention and so louder messages which present strong opinions are likely to be successful in ever more crowded communication spaces. Online, hyperbole is often used in relation to the term clickbait, where headlines such as ‘This simple copywriting technique will blow your mind’ are used to provoke strong emotional responses to ensure that people click on links (Weaver, 2019). Indeed, we found in Chapter 4 that posts

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

216

Time

which tended to receive higher numbers of replies also contained strongly evaluative language and references to emotive topics such as cancer and death. People in their 20s have grown up as digital natives and are likely to have experienced more exposure to this kind of hyperbolic online language in their short lives, relative to older people. Linked to this phenomenon of linguistic change is a hypothesis that life is more stressful for young people in the 2010s, compared with the 1990s. Twenge (2019) showed that between 2005 and 2017, young American adults experienced a significant rise in serious psychological distress, depression and suicide. Another study in 2018 of American college students found a 10% increase of incidences of anxiety or depression, compared with when the same survey had been carried out in 2013 (American College Health Association, 2018). In the UK, which has the highest number of forum contributors, median and mean household incomes have risen between 1994 and 2014 (Office for National Statistics, 2020b) but it was more expensive to buy a house in the 2010s,1 and since 1998, university students have had to pay tuition fees, which in 2023 stand at £9,250 a year. Being a generation who have always been online could also play a role in increased levels of anxiety. For example, online bullying can mean that younger people do not feel safe, even in their own bedrooms, while the tendency for people to document their positive experiences on social media can result in a phenomenon called FOMO (Fear of Missing Out), which is associated with worsening depression, anxiety and a lowered quality of life (Elhai et al., 2020). Another theory claims that young people are less resilient than they have been in the past, with studies indicating that over time, young people have lower levels of psychological health and optimism and higher narcissism and neuroticism (Stewart and Bernhardt, 2010; Scollon and Diener, 2006). Lukianoff and Haidt (2018) suggest that over-protective parenting styles have reduced children’s exposure to challenge and stressors and led to an increased tendency to engage in ‘black-and-white thinking’. Linked to the reasons for younger people’s more emphatic characterisations of anxiety, another set of questions relate to how this should be interpreted. If someone regularly characterises their experiences using superlatives such as extremely, constantly, really and completely, how easy is it to take their language at face value, compared with someone 1

In the UK, the average house price, adjusted for inflation in 1994 was £110,003 and £225,514 in 2014 (Nationwide) www.allagents.co.uk/house-prices-adjusted/. The equivalent figures for the USA were $130,000 in 1994 and $285,775 in 2014 (Fred®) https://fred.stlouisfed.org/series/MSPUS.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Comparing Age

217

who uses these words rarely? People might be tempted to take a strong claim more seriously from someone who hardly ever makes such claims. But then, how would someone who regularly makes strong claims be able to convey the seriousness of an even stronger claim? We do not advocate that young people’s claims about anxiety are not taken seriously, although the research in this chapter indicates that young people’s perceptions of their anxiety, as evidenced by their language use, could be seen as a form of catastrophisation, which is not generally viewed as conducive to anxiety resolution. We also note differences in ways that anxiety was characterised among age groups, with older posters more likely to write about problems (which imply solutions), and younger ones calling them issues (which are to be addressed rather than solved). People in their 30s wrote about controlling anxiety, whereas those in the 40s wrote about fighting it. There appears to be an age-graded difference then, in terms of older people orienting to anxiety as something that can be fought or solved, whereas younger posters seem to view anxiety as an ongoing issue that may never go away but can be controlled. While there was evidence of medicalisation for all age groups, this appeared to be stronger for those in the 30s and 40s, who advocated medication and talking therapies, respectively. Older posters, particularly those in their 50s, appeared to recommend a range of approaches to anxiety which did not involve pharmacological intervention or therapy but were more based around aspects of lifestyle. They advocated keeping busy, enjoying life, exercise, meditation and making changes to one’s diet. Recent research has noted that in the UK context at least, there has been a rise in medical prescriptions for anxiety between 2003 and 2018, particularly for young adults (Archer et al., 2022). These researchers hypothesise that the increases may be the result of better detection of anxiety in young adults but also caution that ‘some prescribing is not based on robust evidence of effectiveness, may contradict guidelines, and there is limited evidence on the overall impact associated with taking anti-depressants long term. As such, there may be unintended harm’ (Archer et al., 2022, p. 1). As with the previous chapter, we note that some of the keywords in the age-related table have been encountered in earlier analysis chapters. Table 7.5 indicates how the age-related keywords intersect with both sex and location. The table indicates further how keywords are not necessarily associated with a single aspect of identity. Note, for example, how the words problem and problems are key for both older people and men, whereas young Americans are distinguished by their wider range of non-standard or colloquial keywords (gonna, kinda, sucks, idk)

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

oh, lol, hi, kids, awful, yes, mum, u, hugs, mine, too, partner, ur

physical

fight

sufferers

regards, problems, gradually, wife, problem

problems, problem

30s

40s

50s

60s

70s

thankyou

UK

idk, weird, gonna, freaking, okay, kinda, sucks, crazy, lately, super, hurts, mom, everyday, asleep, heart, gotten, almost issue, ER, body, everyday, gotten, sensation, afraid, neck, truly, issues, Xanax, therapist tingling, mg

US

Sertraline, etc, CBT, hi, mum, ive, hugs, totally, lots, chat xx, love, daughter, lovely, thankyou, xx, n, love, lovely, thankyou, Zoloft, hang, Xanax son, hi, sick, yoga hi, lots, chat xxxx, love, pleased, husband, regards, wishes, site, xxxx, Klonopin, mg, counseling counselling, son, daughter, love, wonderful, support, hi, am, lovely, GP, pleased, counselling, thyroid, children lots, UK, ill, although, hi, cope, lovely, useful, counsellor GP medications

:), u, ur, kids, amazing

yeah

, :(, scared, thankyou, okay, sick, thank, hate, mom, want, myself

Female

20s

Male

Table 7.5 Age-related keywords intersecting with sex and location

The Journey from First to Last Post

219

compared with their British counterparts. It is older British women who seem to be responsible for many of the affiliative keywords (hi, hugs, love, lovely, thankyou, xx, xxxx).

The Journey from First to Last Post There were 17,770 unique posters who contributed to the corpus. However, the majority of people only contributed a small amount of text. A third of people (5,894) only made a single posting, and 78.9% of all people who posted only made between 1 and 10 posts. This figure goes up to 87.2% for people who made between 1 and 20 posts. The distribution of users according to how many messages they posted (up to 20 posts) is shown in Figure 7.5. We end the analysis in this chapter by considering the ‘journey’ that people go on, from making an initial post, to becoming a more established member of a community, to then leaving the forum. During this journey, in what ways does their language use change? To answer this question, we compared the language of posters at different points across their journey. First, we collected the 17,770 first posts that people made, and compared them against the rest of the corpus to identify keywords. We then did this for the 20th, 40th, 60th and final posts. For final posts we only considered posters who had made at least 60 posts, and we did not consider final posts that occurred in 2020 (the final year in the corpus), as it is possible that people would continue to post to the group past the point where our data collection ended. To rule out

6000 5000 4000 3000 2000 1000 0

1

2

3

4

5

6

7

8

9 10 11 12 13 14 15 16 17 18 19 20

Figure 7.5 The number of contributors who made between 1 and 20 posts

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

220

Time

Table 7.6 Keywords associated with different stages of posting Post

Keywords

1st

recently (1,390), diagnosed (953), old (1,807), suffered (946), year (2,548), constantly (1,185), started (3,827), anyone (3,420), years (5,185), attacks (2,393), since (2,859), social (655), months (2,744), suffering (1,262), new (2,405), ago (2,760), severe (816), male (231), appreciated (339), almost (1,258), constant (845), can’t (3,739), depression (2,067), sick (1,700), month (1,083), currently (566), past (1,576), female (222), joined (275), experiencing (640), school (823), extreme (360), similar (797), die (1,045), dying (766), extremely (475), attack (2,562), am (10,815), convinced (472), prescribed (638), came (1,436), sensation (543), dizzy (1,099), my (43,208), gotten (420), asleep (613), head (3,050), name (511), ER (540), began (305) u (207), sister (32), behavior (13), function (24), ur (49), mindfulness (27), chemical (13), learning (29), dog (31), smell (14), balance (33), techniques (30), panicky (19), diet (30), improve (19), mess (22), monitor (21), traumatic (13), brain (120), blood (129), guy (20), journey (21), docs (22), meditation (47), girlfriend (12), doses (11), positive (103), chat (29), awful (70), reassure (16), most (158), rescue (11), less (60), meditate (11), realize (24), thru (18), bc (15), research (21), doc (46), assured (10), hence (10), kidney (10), urine (10), train (14), multiple (14), mg (37) Google (48), u (115), water (41), lump (14), ya (14), voice (12), trip (15), free (36), peace (27), Paxil (10), otherwise (13), heat (12), stick (15), listen (31), frustrated (10), pretty (38), memory (12), id (11), drinks (10), med (19), ear (22), bath (12), fatigue (12), therapy (53), area (19), information (14), coping (16) mindfulness (20), ten (10), group (20), nice (42), peace (21), ended (14), somewhere (12), sucks (12), slowly (20), plus (14), tense (11), exercises (10) university (13), accommodation (10), useful (10), offer (12), simply (11), drink (26), finding (15), yours (11), group (15), emotions (10), mg (15), certain (14), learned (11), write (14), mri (10), mad (10), happens (25), experience (30)

20th

40th

60th

Last

idiosyncratic or unrepresentative cases, we removed keywords that had a frequency below 10. The keywords are shown in Table 7.6. It should be borne in mind that the majority of people who post an initial message to the board will not go on to post a 20th message, and as such, the keywords are based on considerably less data as we work down the table. Correspondingly, while first posts amount to 2,212,827 words, the

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

The Journey from First to Last Post

221

20th posts consist of just 168,725 words. Nevertheless, we should not devalue the impact that long-term posters have on the group – they may be in the minority but the sheer volume of posts that they make can mean that they disproportionately affect the kinds of language and views that other posters encounter on the forum. Owing to the lower frequencies, in comparison to the previous keywords analyses in this book, we can be less confident about generalising the findings. First posts tend to contain elements of personal history, with people describing themselves as new or having just joined the forum and giving information about their name, age (old, years) and sex (male, female). Hi everyone i am new here my name is x i am male from egypt 28 years and i think i have anxiety since i was 16. (1st post)

These posters are likely to provide details about how long they have experienced anxiety or related issues (recently, year, started, years, since, months, ago, month, currently, past, began). Posters are also likely to report a diagnosis (diagnosed) or medical prescription (prescribed), or visits to emergency services (ER) as well as labelling different kinds of mental health conditions (panic attacks, depression, social anxiety) and characterising their symptoms (dizzy, sick, fear of dying). They describe their anxiety or related symptoms in very negative terms (suffered, suffering, constant, constantly, extreme, extremely, attacks, severe), which in part legitimises their participation in the forum, as well as their search for advice or confirmation (anyone, appreciated, similar). Does anyone know how I can get my life back? Be greatly appreciated. (1st post)

At the 20th post, the amount of negative language has reduced somewhat, although posters use the word awful, to either refer to their own state, or to show sympathy towards others. I’m currently going through this, going on 5 months. It’s absolutely awful. (20th post) Hi that’s awful that your psychiatrist just told you to stop taking them. (20th post)

The keyword positive indicates another way that posters try to provide support, advice or encouragement, as well as suggesting a different stance towards anxiety.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

222

Time

Keep on talking on this blog, its surprising how much positive you can feel after writing or even answering peoples questions. (20th post) Please think positive thoughts.. you can do it (20th post)

These posters are more likely to refer to wider aspects of their lives which go beyond their own symptoms (sister, girlfriend, dog). My friends are more sympathetic than my own sister is and it bothers me to know that! (20th post)

They are also more likely to recommend calming methods such as mindfulness, meditation, meditate and techniques to others. Mindfulness meditation is the best way to go because it teaches you to look at your thoughts from an outside perspective without judging them. (20th post)

These posters are more likely to view themselves as being on a journey, which involves research or learning how to improve. Other verbs related to this are realize and train. I am still learning to improve what I use and add in a new technique occasionally as well. (20th post) Learning what works for you is a very personal journey but you sound like you know exactly what I mean (20th post) mornings are the hardest I have found, but am beginning to realize it’s just a false thought. (20th post) Read up on brain research, and read up on ways you can train your mind to work In your favor. (20th post)

The keywords reassure and assured are used as emphasis by these posters to be supportive of others. Hi, I can reassure that you definetly are not alone. (20th post) Please don’t worry and be assured it is only built up anxiety that is doing this and it takes a while for you nervous system to calm down only AFTER you stop thinking and worrying. (20th post)

For the 40th posts, the keyword Google involves discussions which evaluate (usually negatively) the effectiveness of using the internet search engine Google to diagnose symptoms. We’ve all been where you are. Convinced we have deadly diseases that we really don’t, no matter what the doctor says. That’s why Dr Google is

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

The Journey from First to Last Post

223

the number one thing NOT to do. The internet is not a doctor and can’t diagnose anything. (40th post)

Other keywords involve specific pieces of advice which are not based on medication or therapy; for example, drinking water but not caffeinated drinks, using heat pads for sore muscles or taking a bath. The keywords listen and voice refer to advice to use music, podcasts or guided meditations, but compared to the 20th posts, there are references to a much wider range of coping mechanisms. I listen to mind calming music too which helps me massively to relax. (40th post) I find comfort in doctor weekes voice and advice. (40th post) Going out is my coping mechanism even if I do not feel like it or nervous, or apprehensive. (40th post)

In contrast with the 1st posts which talk about suffering or 20th posts which conceptualise anxiety as awful, by the 40th post, people write about being frustrated with their anxiety. I get anxiety over anything and everything. I’ll be feeling fine and it’s as if my body’s not happy that way do it makes me freak. I’m just frustrated and it makes me mad at myself. (40th post)

Also, while content in 20th posts describes the experience of anxiety as journey, in the 40th posts we start to see references to what the end of the journey might look like: peace or being free of anxiety. I have been free of anxiety for the last year now an off medication lexapro since February. (40th post) Hope you can find a little peace today. (40th post)

The small set of keywords used by people making their 60th post contain some words that have already been observed at earlier stages, such as mindfulness, exercises, peace, which suggests that posts start to become less distinctive after a certain point. The keyword slowly often involves quite specific advice regarding breathing. Breathe in for a count of 2 pause then breathe out slowly for 4. Do this about 10 times. (60th post)

This set of people are more likely to use the word group, which either refers to advice to join a group or to the Anxiety Support group itself.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

224

Time

If there is a buddhist meditation group then that is a good start but things like yoga are also related to practicing mindfulness (60th post) Talking is the best medication invented and it is free. Sharing our issues here in this group has been so wonderful for me. (60th post)

The word ended does not refer to people’s anxiety resolving as might be expected but instead tends to be used in personal narratives which involve the phrase ended up. I worked somewhere where this lady was really awful and nasty to me just because she was older and worked there longer. She wasnt really nice to anyone.. I ended up leaving my job because she was so rude. (60th post)

It was initially expected that the final posts would contain messages where posters said goodbye to others or provided reasons why they were leaving. Such posts did exist but they were in the minority. Well, I am off! It is time to bid you all goodbye in this forum and for me to leave. It is a good forum but I find it causing me more stress than easing it. Thanks everyone for your time and I declare freedom over all of you! (final post)

A handful of final posters noted that it had been a long time since their previous post, suggesting that to all intents and purposes they had already left the group. Their final post therefore seems to signal a nostalgic revisit, despite intentions to resume interaction with the group. Haven’t posted for months,time goes by so quickly.been difficult to cope with new job/transition (final post)

One final post was from a friend of the original poster who revealed that she had died. Thank you for your condolences and kind words about X. She loved this forum gave her the knowledge she was not alone on her struggle with anxiety and depression. Many on here gave her advice and I thank you for that (final post)

However, the majority of final posts contained no explicit indication that the poster was leaving, suggesting that even after at least 60 posts, when people stopped (regularly) posting to the forum, they did not announce their intention to others or formally say goodbye. This is perhaps due to the somewhat fluid and asynchronous nature of forum

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

The Journey from First to Last Post

225

interactions. Unlike a face-to-face conversation, which has a distinct end, perhaps some posters did not realise that they were writing their final post, or it is possible that they wanted to leave the door open to return at a later point. This goes some way to explaining why three of the final posts contained reassurances to other posters that the poster was always here. I had really bad health anxiety, I also suffered with a bit off depression but this was off the medication I was taking, I couldn’t leave my house . . . I’m out everyday enjoying life. If you need to talk I’m always here :) (final post)

The small number of keywords used by final posters revealed a couple of possible reasons why some posters decide to stop posting. For example, the keyword simply occasionally occurred in posts which expressed annoyance at others. Do . . . NOT . . . shout. You’ve just made my eyes bleed with all that uppercase nonsense. Apart from anything else, there is quite simply NO need for that type of ill-mannered silly behaviour. None. Period. Thanks. (final post) But I think I’m done with this site, simply because I’ve noticed the negativity I feel after it. (final post)

Similarly, the keyword yours was sometimes used by posters to refer to other people’s opinions. In the following examples both posters thank another person for their opinion but also indicate that they are not in full agreement while engaging in mitigation work (e.g., saying they respect the poster’s views or that they may well be right). Hi X, thank you for taking the time to explain things much clearer for me, its my problem to be honest, not yours. i dont mean offence at all, im just always interested in opinions and different topics. we all have to have Different ones dont we. im certainly not picking holes in what you believe, i would not do that, i completly respect your views. (final post) you have made yourself much clearer for me, thank you, you have provided me with a very clear opinion of yours. i dont think my mind will ever be settled, thus, you may well be right stde, as i do hold anger, (final post)

In a similar way, the keyword experience was used by final posters as a way of validating an opinion that they suspect may not be welcome. From my personal experience, your stubborness could be positive, or, self-defeating. (final post)

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

226

Time

Please get help to talk to your boyfriend about his problem and I know it is tough, but you have to let him know that it is make or break time because it is not fair on you or any future kids if he doesn’t want to get help. This is my opinion and experience, but as they say hindsight is a wonderful thing. (final post)

On the other hand, learned tended to be used in last posts in order to indicate that the poster had made progress (and was therefore less likely to need the support of the group). I’m back to my old self again, thank God! It was a rough 3 months for me. I’ve been going to therapy since January and have learned to just accept the anxiety and the symptoms. (final post) Some of the things I learned from schema therapy have really changed my outlook. (final post)

Earlier, we saw how learning (a verb which indicates the continuous or progressive tense) was a keyword for 20th posts, so it is interesting to see how the past tense form learned is a keyword for the final posts. At least for some long-time forum members, their final post indicates that their journey has ended positively. The analysis in the final section of this chapter indicates distinctive forms of language use by contributors at various stages of their involvement in the forum. Of course, the majority of posters do not engage with the forum by making 60 or even 20 posts, so the analysis here focuses more on a small set of people who do remain for a longer period and thereby can potentially have more influence on how the forum operates. The typical first poster provides autobiographical information, writes about their symptoms, often using catastrophising language and asks for help. For the 12% of posters who remain with the group long enough to make a 20th post, by this point they have assumed an advice-giving rather than advice-seeking role, providing sympathy, reassurance and advice to others. They talk more about wider aspects of their own lives and characterise their experience with anxiety as a journey. They are likely to suggest meditation or mindfulness techniques to others. For the 7% of posters who make a 40th post, advice is based on engaging in a wider range of lifestyle practices such as listening to music, taking hot baths and drinking the right fluids. Only 1 in 20 people contribute 60 or more posts to the forum. By this point they provide advice in terms of relating their own experiences as narratives or give specific details about different kinds of exercises. As long-term members, they are also more likely to provide positive evaluations of the forum. For those who leave the group, in their final posts a small number express annoyance at other

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

Conclusion

227

posters or indicate that they have made sufficient progress to not need the group anymore (a case of having learned as opposed to still learning), but generally there are few clues that a poster’s journey is over. The door is usually left open, even if the majority of posters will never return.

Conclusion This chapter has outlined three ways in which the concept of time can be used to analyse the language in the Anxiety Support forum, each providing a different picture. Change over time revealed that posters tended not to use the forum to express anxiety over worldwide events – with the exception being COVID-19 – although trends in technology (e.g., the declining popularity of blogs) did impact on the ways that forum members sought ways to address their anxiety. The comparison of the age of forum members revealed that younger posters (those in their 20s) had a clearly distinct way of writing, which tended to involve extremely negative representations of their anxiety while asking for advice. Older members tended to take advice-giving roles, using more affiliative and supportive language, although even here there were more subtle differences; for example, around viewing anxiety as an issue to be addressed (people in their 30s), to be fought (40s) or a problem to be solved (50s and 60s). Different ways of managing anxiety also appeared to be age-related, with younger posters favouring medication and therapy, while middle-aged contributors were more likely to suggest meditation or techniques involving distraction or relaxation. And finally, the analysis of the number of posts made by forum members showed a progression from a troubled first post, which typically sought advice, to longer-term members taking on supportive roles, characterising their experience as a journey which involves learning. While only a small number of people engaged with the forum long enough to make 60 posts or more, it is notable even among the long-standing members that few of them made formal goodbyes to the group. As the analysis throughout this book has indicated, the Anxiety Support forum has a range of social norms, some of which are clearly different from those which occur in face-toface contexts. One point that is worth reaffirming is how the longerterm posts referred to the value of the forum itself in helping them with their anxiety. It is with this in mind that we turn now to our concluding chapter.

https://doi.org/10.1017/9781009250139.008 Published online by Cambridge University Press

8

Conclusion

Introduction In this concluding chapter, we begin by reflecting on the research journey we undertook and its implications, considering the methodological issues which have impacted on our findings and unexpected problems that arose. We then summarise the main findings from our analyses, bringing them together to establish overall patterns and trends in online discourses of anxiety, focusing – in particular – on conceptualisations of anxiety and management strategies as well as considering the value of the forum for those who participated in it. Finally, we make suggestions for further research that could build on our findings.

Working with a Corpus of Forum Posts To a large extent, our study took a data-driven perspective in that we allowed the data to guide the analysis, rather than starting with an initial set of research questions. We knew, for example, that we should analyse linguistic patterns around the word anxiety, as that was the topic of the forum and a corpus analysis was not needed in order to tell us that. The interactive nature of the forum, whereby people posted replies to one another’s messages, was another way that the format of the corpus drove how we approached the analysis. From the outset, we knew that we would carry out some form of analysis which considered the sequencing and interaction between posts, hence the adoption of the discourse functions coding scheme in Chapter 4. Nevertheless, for the most part our investigation has been guided by features of the forum, in terms of recurring content and the different ways of categorising its participants. The original coding of the data enabled certain types of analysis to be carried out more easily than others. The forum posts had been categorised according to certain types of demographic information 228

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

Working with a Corpus of Forum Posts

229

that each poster was asked to provide, so this lent itself to forms of analysis which exploited those types of information – particularly sex, age and location. When posters created a profile, they were not asked about other types of demographic information such as sexuality, level of education, religion, social class or political beliefs, and subsequently, we were not able to consider these factors in the analysis. It might have been possible to carry out an analysis of cases where posters explicitly referred to these aspects of identity themselves, although most posters did not mention these characteristics, so the amount of data involved would have been very small and likely unrepresentative. Additionally, analysing a set of posts where people make an aspect of their identity salient is likely to produce different results from analysing posts where people hold an identity but do not mention it (see Baker and Brookes, 2022 for a comparison of such cases involving patient feedback). As well as being data-driven, the analysis was corpus-driven, in that, apart from Chapter 2 – in which we looked at a pre-chosen word (anxiety) – we did not know what features of the corpus we would analyse. The keywords technique, which was used in several chapters, drove us to focus on words or categories of words that we could not have predicted from the outset. This kind of approach ensures that researcher bias is kept in check as a wider set of (unexpected) patterns need to be accounted for. Differences such as the greater propensity for American posters to refer to religion or the British focus on carrying on and coping might not have been spotted had we employed a different methodological approach, say, based on close readings of posts. Subsequently, the analysis carried out in Chapters 5–7 did not begin with any specific research questions but, instead, the questions listed in those chapters emerged gradually, as we started to analyse the keywords we found and realised what they were being used to achieve by posters. In one aspect, the data collection part of our project was remarkably uncomplicated – the posts were provided by the owners of the forum as an Excel file with various kinds of meta-data (such as the date a post was made) and demographic information (such as sex of the poster) attached in different columns. It was relatively straightforward to transfer these data to the corpus analysis software Sketch Engine. However, the data was not perfect; we found that it contained a small but significant number of posts that were repetitions. From examining the timestamps of these repeat posts, it was possible that posters had attempted to post the same message more than once, perhaps due to a lag in their internet connection. Such repetitions unhelpfully inflated the frequencies of certain words and so they needed to be removed before analysis could begin.

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

230

Conclusion

Another issue with having a third-party provide the data was that we did not have full control over the way that it was encoded. Within the forum people have the facility to ‘like’ another person’s post and can see the number of likes that each post has already received. This information would have been potentially useful, in terms of helping us to identify the features of popular or unpopular posts. However, it was not included in the data transfer we received. Additionally, each forum member could upload an image which was displayed as their avatar when they posted. An investigation into how participants represent themselves using these image resources could provide further insights into the membership of the forum, however, these images were not included in the spreadsheet either. Furthermore, prior to us receiving the data, there appeared to have been a process of automatic anonymisation that replaced people’s names with the letter x. While anonymisation is an important part of the ethical considerations required for analyses of language corpora, particularly when involving sensitive topics, this resulted in several problems. First, it meant that it was difficult to distinguish when x was used by posters to signify a kiss or (much less frequently, the letter x), or when x was an anonymised artefact. Second, the anonymisation of names and the obscuration of this information meant that it was sometimes difficult to make sense of the forum interactions, particularly when contributors referred to one another within a post. Because participants adopted usernames, there was also an issue related to the fact that an individual could join the forum using multiple profiles, or even rejoin – which would generate a new user identifier – with the same username. In such cases it would have been helpful to be able to track these profiles and consider their relation to one another, particularly for prolific posters who were liable to impact on the kinds of keywords which emerged during the analysis. Finally, the anonymisation procedure did not appear to have been fully successful in that some usernames were not anonymised, particularly those which took lexical forms that could also represent other words, such as eve. Ultimately, some names appeared as distinct words whereas others were subsumed under the letter x. In our analysis, we removed people’s names from keyword lists, but we should acknowledge the minor skewing effect on all frequency-based analyses. Had names not been anonymised, the sheer variety and number of members of the forum mean that it is unlikely that our keyness analysis would have produced wildly different keywords, however, it may have altered the keywords that appeared around our cut-off points. The content of our corpus was also affected by the capacity for participants to opt out of the process of data-sharing, withholding

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

Working with a Corpus of Forum Posts

231

their consent for their contributions to be shared with researchers like us. It is important that potential participants in research are given this option, nevertheless, this did mean that some forum exchanges in our corpus were incomplete. Since we were reading full discussion threads through our analysis of interactive aspects of the forum in Chapter 4, we did have the opportunity to informally gauge the extent to which removed comments impacted the coherence of the data and this appeared to be minimal, nevertheless it still needs to be pointed out. The ethics of collecting interactional data raises interesting issues for corpus linguists and it should be accepted that such data may not be as complete, as say, a corpus of newspaper articles. Another feature of the data that was affected by the encoding for data transfer was the use of emoji, which we were interested in as a distinctive aspect of computer-mediated communication. Some emoji had only been partially encoded and this particularly impacted emoji characters that use a zero-width joiner to combine representations of a person’s skin tone and/or sex with other representations of various bodies and faces, for example. An emoji designed to represent a dancer character, indexing a female with black skin, for instance, would likely only be retained as a dancing character. This meant that we were not fully able to consider the range of ways that posters used emoji to represent themselves and other people around them. As we reported in Chapter 3, despite observing 200 different emoji and emoticon characters, they were used relatively infrequently in the forum data and so would not have been a central feature in our corpus-driven analyses. Nevertheless, a small number were used frequently enough for us to carry out analyses between sub-corpora, that is, posts from female contributors compared with posts from male contributors and offer some observations of their different functions in the Anxiety Support forum. The issue of prolific posters was one which emerged as we started to carry out our analysis, particularly in the chapters which examined sex and location. It transpired that some keywords were simply due to a particular contributor who had a distinctive writing style or idiolect, and as those chapters aimed to identify forms of language that were typical of a social group rather than an individual, we had to find a way to lessen the influence of such individuals. After experimenting with different techniques, we decided to remove keywords that occurred in the posts of a single contributor on more than half of the instances. This resulted in us including a very small number of ‘borderline’ keywords, which were just under this threshold, but this did not alter our overall findings. Our investigation of this forum data thus presented a number of unforeseen issues which impact on the extent to which we can be

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

232

Conclusion

confident of our findings or generalise them to the wider population. In terms of lessons learned, it is unlikely that we could have done things very differently to improve our results, but if we worked with a similar corpus – which we had the opportunity to encode ourselves – we would save time (and feelings of frustration) by taking these distinctive issues into account from the outset.

Conceptualising Anxiety In the early part of our analysis (Chapter 2), we identified language use which related to four dimensions that contributors to the forum used to characterise their anxiety. These involved: 1) the extent to which people viewed anxiety as a medical condition or as a normal aspect of human life; 2) whether a person catastrophised or minimised their experience of anxiety; 3) the view of anxiety as a living or abstract phenomenon; and 4) anxiety as internal or external to oneself. It is wiser to view these pairs as existing at extreme points on a cline rather than simple binary states as people do not necessarily represent anxiety in consistent ways over time. It is also unlikely that they are consciously aware of these dimensions and how they orient to them. The research in this book does not extend to being able to evaluate which characterisations are more likely to result in positive outcomes for people with anxiety, although we have noted other research which sees catastrophisation, for example, as a positive predictor of anxiety (Chan et al., 2015). For this and the other dimensions, individual preferences will likely be important for how they work towards recovery or living with their anxiety. For example, some people might find it helpful to view anxiety as a human or non-human avatar, prompting strategies aimed at diminishing its power, while others might find more use in seeing anxiety as a fundamental part of themselves, to be accepted and understood. In any case, we believe that raised awareness of how people make sense of their own anxiety could produce beneficial insights, particularly if used sensitively in therapeutical contexts. Indeed, in the context of psychosis, different kinds of relational therapies orient around managing the relationship that the person has with their illness and making use of the interpersonal skills they exercise with other people in their lives when, in this case anxiety, is personified (Craig et al., 2018). With this awareness that an individual might have a representation of their anxiety in mind that is informed by not only individual experience but also broader concepts in society, we note how gendered discourses impacted on people’s understandings of anxiety. The analysis in Chapter 5 showed that members of the forum acknowledge

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

Conceptualising Anxiety

233

that men face difficulties in talking about experiences of anxiety on the basis that this would be seen as unmasculine. Male orientations to anxiety were nevertheless complex and involved various kinds of identity management. Men in the forum urged one another to fight anxiety, a strategy that runs counter to the idea that by accepting anxiety it will be lessened. Women, on the other hand, were more likely to view anxiety as part of their identities, alongside views that women are more likely to be anxious due to hormone fluctuations or specific personality traits. Taken together, these views represent anxiety as inherently, even inevitably, female – a position which is problematic for both men and women. In Chapter 6, we saw how British posters had a somewhat phlegmatic attitude towards anxiety, as something to be coped with while they carry on, whereas Americans were more likely to refer to dealing pro-actively with or figuring out their anxiety. Here we do not want to position either view as the ‘best’ one, only to reiterate that expectations about anxiety can be culturally distinct and that this may have consequences for recovery outcomes. We also argue that norms associated with social conventions and the potential for confusion borne of the various explanatory models can both be particularly salient for a condition such as anxiety, where people’s self-talk and beliefs about the future are likely to strongly impact on anxiety levels. We observed, in our analysis of change of time (Chapter 7), that younger posters tended to use more emphatic language in their posts, which could be linked to the practice of catastrophising. There may be cases where emphatic language is beneficial; for example, to obtain attention and prompt action when in imminent danger. However, we also wondered whether such a perspective on anxiety could contribute towards further anxiety. Our analysis of general spoken corpora from both 1994 and 2014 indicated that over time everyone has increased their use of the types of emphatic language features that we identified in posts to the Anxiety Support forum and the evidence also indicates that the situation is becoming more marked in recent years. In any case, it is still younger people who use them the most. On the one hand, this relates to the experience itself, indicating that younger people tend to experience stronger reactions to situations and that they face particularly tough challenges or have fewer resources to cope with them. On the other hand, this relates to the manner of expression and it could be argued that we should not place as much stock on emphatic language when used by younger people – its frequent use may have dampened its intended meaning. Furthermore, this contrasts with a tendency among older people to communicate more euphemistically, limiting the capacity for them to be able to convey that their anxiety is

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

234

Conclusion

debilitating. More work is required to understand the implications of young people’s use of emphatic language, but we would also advise that counsellors and medical practitioners show awareness of the ways that people use language to orient to their anxiety, and that part of this should involve taking into account the typical language use of a particular age group.

Strategies Our analysis did not set out to identify the kinds of techniques that people agreed upon as successfully helping them to manage anxiety, as opposed to those which did not. This was because our focus was on language use as opposed to coping strategies, although there was inevitable overlap in that some aspects of coping featured in our linguistic analysis, such as in Chapter 3. Additionally, it would have been difficult to systematically identify and categorise different kinds of strategies and then quantify the extent to which people view them as successful. Similarly, when we examined the ways that people conceptualised anxiety, we did not want to evaluate them in terms of being conducive (or not) to effective management. Instead, we have tried to outline the range of perspectives and also note which ones are more typical of certain types of people. Our findings are best understood as summative of general trends in the data. For example, different elements of our analysis indicate that older people or those who have been posting in the forum for a long time might have perspectives to offer that are based on greater amounts of experience, as opposed to younger people or new posters. However, we should not assume that length of time that has passed since someone first experienced anxiety is necessarily going to perfectly correlate with one’s ability to manage the condition. For one reason or another, some people with long-standing anxiety may not have been able to adopt strategies that work for them. The results of our analysis in Chapter 7 also showed that older people and those who had a longer relationship with the forum tended to write more about the value of non-medicalised approaches to anxiety. These included engaging in enjoyable everyday activities such as gardening, walking the dog, doing yoga, or having a bath. In terms of implications, this does not mean that we should uncritically view such posters as ‘wiser’ than other posters who extol the benefits of medication or therapy; although an advantage of non-medical approaches is that they tend to be easier to engage with than talking therapies, and unlike medication they do not carry a risk of side effects or withdrawal symptoms.

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

The Value of the Forum

235

In terms of management strategies more generally, we note other differences which were related to aspects of identity or culture. Male posters tended to approach anxiety as a temporary illness that could be fought or cured through fact-based research. Female posters were more likely than men to see anxiety as a trait that could be managed by reaching out for emotional support and making use of a range of different family, friendship, online and medical networks. Consequently, women tended to look outwards, to consider how their anxiety impacted on others around them, whereas men were more likely to consider how anxiety affected their own lives. The differences expressed here are likely to be a function of social expectations about male and female behaviour as well as being influenced by biological differences such as hormone levels. With regard to location or culture, we noted how American posters were more likely to refer to religious beliefs as part of a coping strategy, while they also more fully embraced the medicalisation model of anxiety, believing that the right drugs would provide a solution and that this might require some shopping around. American posters also tended to focus on physical symptoms related to their anxiety, sought out others with similar experiences and used more emphatic language. In comparison, British posters seemed less certain that their anxiety could be fully resolved and instead used language that suggested a conceptualisation of anxiety as an illness that must be managed. They were also more likely to interact with others in supportive ways, using routinised politeness. It is less likely that biological factors can account for these differences, but more credible that they are related to societal structures and cultural values. We believe that awareness of how our identities and cultural contexts are likely to shape our understandings of anxiety are an important part of resolving it. By contrasting our understandings with those from other groups, we can obtain a better sense of the range of conceptualisations available and perhaps be more conscious about how we relate to anxiety ourselves. Awareness of alternative cultural understandings of anxiety or the ways that our relationship with anxiety is filtered through gendered expectations can potentially be empowering, although we also note that it can be difficult to ‘break out’ of the cultural discourses that we have internalised over a long period of time, that is, it may not be easy to shift from the view that you must fight anxiety to instead manage or accept it.

The Value of the Forum Our observations consistently demonstrated that contributors celebrated the forum, in terms of both the emotional support and empathy

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

236

Conclusion

that they received from other posters and their value in helping them learn about the physiological processes connected to anxiety and different techniques that people used to manage it. It is indicative that more critical views of the forum were not revealed directly through keyword lists but tended to be encountered accidentally as a by-product of other kinds of analysis. Chapter 4 indicated that there were relatively few incidences of conflict in the forum, however, we would hypothesise that because the forum is focused on experiences of anxiety, its users were particularly mindful to avoid conflict, handling potentially difficult situations carefully. Indeed, avoidance of fearful situations and unpleasant emotions is a reported feature of experiences across different anxiety disorders, which increases alongside more severe anxiety symptoms (Panayiotou et al., 2014) and members reported not only self-awareness of such avoidance strategies but also that avoiding conflict with people in their personal and professional lives was itself a source of anxiety. A report generated by the Institute of Mental Health on the views associated with online support groups for anxiety did reveal concerns about the negativity of being confronted with other people’s struggles with anxiety disorders (Machin et al., 2016), which could stop some people from engaging with such online spaces. As such, we do not take the relatively low incidence of disagreement to be indicative of online interactions more broadly. Through our analysis in Chapter 3, we found that many participants come to the forum when they have exhausted their options in the offline world and seek help from those whom they can reliably depend on having experience of anxiety disorders and treatments. Subsequently, although others in the forum do indeed share their own stories, we found that responses were characterised by empathy and encouragement, rather than negativity. Furthermore, respondents encouraged other members to provide updates, indicating that the forum facilitates the development of more enduring and supportive personal relationships. There were few cases of people announcing they were leaving the group due to the behaviour of others, and an analysis of people’s final posts indicated that even when a disagreement was likely to be the cause of someone leaving, they usually tried to be polite, up until the end. While some amount of friction can be necessary to enable ideas to be developed, we found that the main mode of interaction in the group was collaborative rather than antagonistic, with people more likely to share their views, give advice or engage in problem solving (see Chapter 4). Therefore, it could be argued that the forum could be upheld as a model for successful online interaction. To an extent, this may be due to the community guidelines that are featured on the main

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

The Value of the Forum

237

page of the Anxiety forum (each forum within HealthUnlocked has its own guidelines). These include instructions such as ‘Be kind, respectful, and understanding of one another. No spam, self promotion, or ad hominem remarks.’ There is also a Report facility, allowing users to alert moderators to posts that do not adhere to the guidelines. However, we did not have access to posts that had been removed by moderators, so we must acknowledge that our analysis perhaps paints a rosier picture than the reality. The procedures of our analysis are based on frequency and thereby allow us to remark upon the linguistic features and discourses that dominate the forum, which can have a potentially normalising effect on its users. We found, for example, in Chapter 4 that certain users who were not getting many replies deviated in some sense from the more common ways of interacting we observed in the forum and which we discussed in terms of both prevailing topics and forms of expression in Chapter 3. In addition to the community guidelines and response rates, new users can view the existing interactions as a model for what is appropriate and conventional for the forum and selfidentified newer members would often comment on how they had spent time reading others’ posts and interactions prior to introducing themselves. The practice of starting with a personal narrative was a pattern that was made visible through our analyses in Chapters 3 and 4, alongside the problem-solving structure and relational work of replies in the resulting discussion threads. Given such interactional patterns of behaviour, there may be concerns as to how alternative approaches are embraced by forum members and whether online spaces such as these normalise the articulation of expressions of anxiety. Nevertheless, the range of orientations observed in Chapter 2, along with the cultural-, gender- and age-related discourses identified in Chapters 5–7, suggests that there is indeed the opportunity to adopt a variety of discourses, as the user sees fit. The guidelines make it clear that the forum does not replace the relationship between posters and doctors or other healthcare professionals, and advise seeking professional help in situations where a poster feels confused or distressed. Indeed, we saw numerous posts where people were advised by members to go to their doctor or seek help outside the forum. The forum was not able to provide concrete treatment pathways, for example, in the form of therapy or medication, and the responses that posters received could be of varied quality and quantity. It is worth pointing out that 7.11% of initial posts received no replies at all, while 42.69% received one or two replies. Initial posts which used dramatising language (words such as constantly, nobody and truly) or discussed fears around life-threatening

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

238

Conclusion

symptoms (cancer, brain tumor, heart attack) tended to receive many more posts than those which referred to less-concerning symptoms such as sleeplessness, acid reflux or side effects of medication. The fact that the forum is online means that people from around the world can reply. While this offers an extremely wide range of perspectives or discourses around anxiety, it could also mean that sometimes the experiences or advice of others might not be as relatable or relevant; for example, if someone recommends a form of medication that is readily available in their country but not in others. Nevertheless, what we found in Chapter 3 is a willingness to adopt an individual member’s anxiety experience as the topic of discussion and a personalised approach to advice-giving, acknowledging that anxiety manifests differently for each person. Where the forum differs from a professional relationship is in terms of enabling anonymity, allowing people to identify others who are experiencing similar circumstances and hear their stories, and to offer and receive emotional support. There have been considerations for formalising the types of support provided in online forums, by offering guided peer interactions that adopt the principles of established talk therapies (O’Leary et al., 2018). Nevertheless, while the guided approach can help orient towards solutions and more personalised reflections, it can introduce pressure to focus on problems to be solved. Conversely, while the unguided approach might not always lead to meaningful personal reflections, it has been found to be pleasant and relaxing, providing opportunities to discuss special interests and distract participants from the stresses of everyday life (O’Leary et al., 2018). Arguably, we have seen both the problem solving and the relational aspects emerge in the Anxiety Support forum in an organic way, suggesting that members can and do pursue these kinds of goals when they choose to and, importantly, that they are likely to get both solution-based and empathic responses. One aspect of people’s final posts raises another issue about the value of online health forums; while some of the long-term posters characterised their experience with anxiety as a journey which involved learning, we did not find large numbers of posts where people presented themselves as having resolved their anxiety. Instead, the more typical pattern was that final posts indicated disrupted narratives. People are perhaps likely to post to a health-related forum when they are seeking answers or when they are feeling at a low point, but they might not always return to the group when their situation has improved. As a result, engaging with a health forum has the potential to be demotivating if people encounter a catalogue of misery with few success stories. Furthermore, most contributors did not discuss having

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

Future Directions

239

gone on a journey and their participation in the forum – as a contributor, at least – was often short-lived: 56% of posters only made between one and three posts to the forum, and only 12% went on to make more than 20 posts. Some members showed awareness of the potentially demotivating impact of the broader content of the forum, responding by explicitly labelling a post as a ‘positive’ experience to temper the wider struggles of participants generally. This awareness could also account for the more frequent kinds of encouraging statement found in responses (see Chapter 3). Nevertheless, the topics we reported in Chapter 3 show that anxiety is broadly discussed in terms of its physical and emotional impacts that manifest in symptoms and require long-term management. Given the breadth of experiences shared by members and the many different ways anxiety disorders can take effect, the wide range of anxiety resolution strategies appearing across forum posts may be confusing, resulting in people trying to move from one strategy to another or spending a lot of money on different products which are recommended as solutions. On the whole though, we view forums such as the one we examined as having value as long as those who engage with them recognise that they have both benefits and limits and set their expectations accordingly.

Future Directions An analysis is never really complete; there is always more that could be done, with new questions raised as a result of engaging with existing ones. As we have noted earlier, the format of the data we received meant that a few restrictions were placed on what we could analyse. We have discussed how emoji were not always fully rendered in the version of the data we received and there is a wider issue relating to the absence of images from our corpus. When people post a message to HealthUnlocked they can also attach pictures if they wish to. Direct observation of the forum suggests that this facility is not used frequently, but we did identify references to pictures in people’s messages. Some pictures appeared to involve people exhibiting medical symptoms, others were of pets or people’s homes, and others offered relaxing images or inspirational messages. However, as such images were not included with the data we received, we cannot comment on how images contributed towards people’s representations of anxiety and in what contexts they were used. An extended analysis could therefore integrate these multimodal aspects more systematically, although would require a different approach to data collection.

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

240

Conclusion

Another area which could have involved more detail relates to the demographic information we used to make comparisons. In Chapters 5, 6 and 7 we considered sex, location and age, respectively. We had also initially intended to compare ethnic groups, however, while forum members were asked to indicate their ethnicity when they created a profile, 86.78% of users included in our data did not provide such information. This figure for missing information was particularly high compared with equivalent figures for sex (46.70%), country (26.80%) and age (55.31%). Among those that did provide information about ethnicity, 10.47% of contributors identified themselves as White, yet the next highest category – Black – comprised just 0.69% of contributors, meaning that there was little data to allow meaningful comparisons of sub-corpora. It is, nevertheless, worth revisiting the forum at a later date, when more data may be available overall, and when perhaps more people have indicated their ethnicity. In Chapter 6, we only compared British and American forum users, as they contributed 72.60% of the forum posts. The next largest category of contributors was those who did not provide any information about their country of residence (17.96% of posts), leaving 9.48% of posts that came from named countries other than the USA or UK. As these posts covered 139 countries, our attempts at keyword comparisons to find language distinctive of a particular country did not produce much, simply because there was comparatively little data. One option for building larger sub-corpora would have been to categorise posts according to wider geo-political regions – for example, by grouping posts from countries in the Middle East or Asia – although would require careful consideration for how these groupings were indicative of cultural groups in order to facilitate a discussion of how cultural differences inform how people talk about anxiety. Researchers interested in the (linguistic representations of) lived experiences of anxiety can extend the analyses we have presented in this book beyond the Anxiety Support forum. HealthUnlocked contains another forum called Anxiety and Depression Support, which would offer a logical comparison to the forum we examined. Additionally, considering other forums that cover mental health conditions would be useful in terms of identifying aspects of language relating to anxiety that is unique or aspects which are used to talk about mental illness more generally. Do people use the same kind of representations around depression or eating disorders for example? Moving away from HealthUnlocked, it would be interesting to consider other forums that deal specifically with anxiety. For example, the website Reddit has a community called Anxiety Disorders (r/Anxiety) and it is worth considering how different forums approach issues such

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

Concluding Remarks

241

as moderation, the kinds of posting guidelines that they have and how different levels of anonymity impact on interactions and the kinds of information that people post. Reddit also has a wider range of forums to cover specific types of anxiety, that is, social anxiety, health anxiety, anxiety and panic disorders, and such divisions could offer another form of comparison. The analytical procedures we have discussed in this book can readily be applied to data collected in such contexts. Finally, in Chapter 2 we identified four dimensions relating to how anxiety could be viewed, each with two ‘states’; for example, medicalisation vs normalisation. These four dimensions do not occur in isolation but each one contributes towards an overall matrix, interacting with other dimensions, and potentially resulting in 16 combinations. More work could be done to consider the interactions between dimensions – are all 16 combinations generally used by forum members or are some more common than others? We would also suggest that our findings regarding the various conceptualisations of anxiety could be used to inform studies intended to evaluate their effectiveness in terms of anxiety resolution, or the strategies that are best suited to the different ways we can conceptualise anxiety.

Concluding Remarks One aim of writing the book was to foreground the role of language in how people orient towards conceptualisations of anxiety and how language use can reflect a diverse, interacting set of cultural backgrounds. We want to underline the importance of broadening the scope of research on anxiety; recent trends suggests that if anything, it is an area of mental health that is likely to increase in coming years. The ways that we understand anxiety therefore have the potential to dramatically impact on our collective well-being and happiness. We view this book as contributing towards ongoing efforts to better understand anxiety by engaging with the voices and reports of those who experience it. We also hope that it inspires further research which considers anxiety from a linguistic, discourse or corpus-assisted perspective. There is still a great deal of work to be done.

https://doi.org/10.1017/9781009250139.009 Published online by Cambridge University Press

References

16 Personalities (2022). World Personality Map. www.16personalities.com/ country-profiles/global/world#global Adolphs, S., Brown, B., Carter, R., Crawford, P. and Sahota, O. (2004). Applied clinical linguistics: Corpus linguistics in health care settings. Journal of Applied Linguistics, 1(1), 9-28. https://doi.org/10.1558/japl.v1.i1.9 Aijmer, K. (2014). Conversational Routines in English: Convention and Creativity, 2nd ed. Routledge. Al-Mosaiwi, M. and Johnstone, T. (2018). In an absolute state: Elevated use of absolutist words is a marker specific to anxiety, depression, and suicidal ideation. Clinical Psychological Science, 6, 529–542. https://doi.org/10.1177/ 2167702617747074 Alonso, J., Buron, A., Rojas-Farreras, S., de Graaf, R., Haro, J. M., de Girolamo, G., Bruffaerts, R., Kovess, V., Matschinger, H. and Vilagut, G. (2009) Perceived stigma among individuals with common mental disorders. Journal of Affective Disorders, 118(1–3), 180–186. https://doi.org/10.1016/j .jad.2009.02.006 Alonso, J., Lepine, J. P. and the ESEMeD/MHEDEA 2000 Scientific Committee. (2007). Overview of key data from the European Study of the Epidemiology of Mental Disorders (ESEMeD). The Journal of Clinical Psychiatry, 68(suppl2), 3–9. American College Health Association. (2018). National College Health Assessment II: Reference Group Executive Summary Fall 2018. www.acha.o rg/documents/ncha/NCHA-II_Fall_2018_Reference_Group_Executive_Summ ary.pdf American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5TM, 5th ed. American Psychiatric Publishing. Anderson, B. (1983). Imagined Communities. Verso. Archer, C., MacNeill, S. J., Mars, B., Turner, K., Kessler, D. and Wiles, N. (2022). Rise in prescribing for anxiety in UK primary care between 2003 and 2018: A population-based cohort study using Clinical Practice Research Datalink. British Journal of General Practice 72(720), e511–e518. https://doi.org/10 .3399/BJGP.2021.0561 Armstrong, N., Koteyko, N. and Powell, J. (2012). ‘Oh dear, should I really be saying that on here?’: Issues of identity and authority in an online diabetes

242

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

243

community. Health, 16(4), 347–365. https://doi.org/10.1177%2F136345931 1425514 A-Tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. and Emmelkamp, P. M. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/ 10.1159/000365764 Atkins, S. and Harvey, K. (2010). How to use corpus linguistics in the study of health communication. In M. McCarthy and A. O’Keeffe (eds.) The Routledge Handbook of Corpus Linguistics (pp. 605–619). Routledge. Bach, R. L. and Wenz, A. (2020). Studying health-related internet and mobile device use using web logs and smartphone records. PLoS ONE, 15(6), e0234663. https://doi.org/10.1371/journal.pone.0234663 Baker, P. (2017). American and British English: Divided by a Common Language. Cambridge University Press. Baker, P. and Brookes, G. (2022). Analysing Language, Sex and Age in a Corpus of Patient Feedback: A Comparison of Approaches. Cambridge University Press. Baker, P., Brookes, G. and Evans, C. (2019). The Language of Patient Feedback: A Corpus Linguistic Study of Online Health Communication. Routledge. Baker, P., Gabrielatos, C. and McEnery, T. (2013). Sketching Muslims: A corpus driven analysis of representations around the word ‘Muslim’ in the British press 1998–2009. Applied Linguistics, 34(3), 255–278. https://doi.org/10.1093/ applin/ams048 Bandelow, B., Michaelis, S. and Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. https:// dx.doi.org/10.31887%2FDCNS.2017.19.2%2Fbbandelow Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55(11), 1247–1263. https://doi.org/10.1037//0003-066x.55.11.1247 Baron, A. and Rayson, P. (2008). VARD2: A tool for dealing with spelling variation in historical corpora. Paper presented at Postgraduate Conference in Corpus Linguistics, Aston University, Birmingham. www.research.lancs.ac.uk/portal/ services/downloadRegister/463187/BaronRaysonAston2008.pdf Bates, C. F. (2021). Mitigation in discourse: Social, cognitive and affective motivations when exchanging advice. Journal of Pragmatics, 173, 119–133. https://doi.org/10.1016/j.pragma.2020.12.008 Baumgartner, S. E. and Hartmann, T. (2011). The role of health anxiety in online health information search. Cyberpsychology, Behavior and Social Networking, 14(10), 613–618. https://doi.org/10.1089/cyber.2010.0425 BBC Radio. (1958). These Foolish Things, broadcast 14 July. www.bbc.co.uk/ archive/these-foolish-things/zmcvmfr Bednarek, M. and Caple, H. (2017). The Discourse of News Values: How News Organizations Create Newsworthiness. Oxford University Press.

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

244

References

Biber, D. (1995). Dimensions of Register Variation: A Cross-Linguistic Comparison. Cambridge University Press. Biber, D. (2009). A corpus-driven approach to formulaic language in English multi-word patterns in speech and writing. International Journal of Corpus Linguistics, 14(3), 275–311. https://doi.org/10.1075/ijcl.14.3.08bib Biber, D. and Egbert, J. (2018). Register Variation Online. Cambridge University Press. Biber, D., Egbert, J., Keller, D. and Wizner, S. (2021). Towards a taxonomy of conversational discourse types: An empirical corpus-based analysis. Journal of Pragmatics, 171, 20–35. https://doi.org/10.1016/j.pragma.2020.09.018 Bieswanger, M. (2013). Micro-linguistic structural features of computermediated communication. In S. Herring, D. Stein and T. Virtanen (eds.) Pragmatics of Computer-Mediated Communication (pp. 463–486). De Gruyter. Bieswanger, M. (2016). Electronically-mediated Englishes: Synchronicity revisited. In L. Squires (ed.) English in Computer-Mediated Communication (pp. 281–300). De Gruyter. Bieswanger, M. and Intemann, F. (2011). Patterns and variation in the language use in English-based discussion forums. In M. Luginbühl and D. Perrin (eds.) Muster und Variation: Medienlinguistische Perspektiven auf Textproduktion und Text (pp. 157–187). Peter Lang. Black, L. (2008). Listening to the city: Difference, identity, and storytelling in online deliberative groups. Journal of Public Deliberation, 5(1), article 4, 1–35. https://doi.org/10.16997/jdd.76 Blumberg, Y. (2019). Here’s why many prescription drugs in the US cost so much – and it’s not innovation or improvement. CNBC. www.cnbc.com/201 9/01/10/why-prescription-drugs-in-the-us-cost-so-much.html Bouman, W. P., Claes, L., Brewin, N., Crawford, J. R., Millet, N., FernandezAranda, F. and Arcelus, J. (2017). Transgender and anxiety: A comparative study between transgender people and the general population. International Journal of Transgenderism, 18(1), 16–26. https://doi.org/10.1080/15532739 .2016.1258352 Bourke, J. (2005). Fear: A Cultural History. Virago Press. Bowen, R. C., Offord, D. R. and Boyle, M. H. (1990). The prevalence of overanxious disorder and separation anxiety disorder: Results from the Ontario Child Health Study. Journal of the American Academy of Child and Adolescent Psychiatry, 29(5), 753–758. https://doi.org/10.1097/00004583199009000-00013 Brookes, G. (2020). Corpus linguistics in illness and healthcare contexts: A case study of diabulimia support groups. In Z. Demjén (ed.) Applying Linguistics in Illness and Healthcare Contexts (pp. 44–72). Bloomsbury. Brookes, G. and Baker, P. (2021). Obesity in the News: Language and Representation in the Press. Cambridge University Press. Brookes, G. and McEnery, T. (2020). Corpus linguistics. In S. Adolphs and D. Knight (eds.) The Routledge Handbook of English Language and Digital Humanities (pp. 378–404). Routledge.

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

245

Brownhill, S., Wilhelm, K., Barclay, L. and Schmeid, V. (2005). ‘Big build’: Hidden depression in men. Australian and New Zealand Journal of Psychiatry, 39, 921–931. https://doi.org/10.1080/j.1440-1614.2005.01665 Capps, L. and Ochs, E. (1997). Constructing Panic: The Discourse of Agoraphobia. Harvard University Press. Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. and Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety, 35(6), 502–514. https://doi.org/10.1002/da.22728 Centres for Disease Control and Prevention. (2022). Men and heart disease. www .cdc.gov/heartdisease/men.htm Chan, S. M., Chan, S. K. and Kwok, W. W. (2015). Ruminative and catastrophizing cognitive styles mediate the association between daily hassles and high anxiety in Hong Kong adolescents. Child Psychiatry and Human Development, 46, 57–66. https://doi.org/10.1007/s10578-014-0451-9 Charteris-Black, J. (2012). Shattering the Bell Jar: Metaphor, gender, and depression. Metaphor and Symbol, 27(3), 199–216. https://doi.org/10.1080/ 10926488.2012.665796 Chen, F., Chen, R. P. and Yang, L. (2019). When sadness comes alive, will it be less painful? The effects of anthropomorphic thinking on sadness regulation and consumption. Journal of Consumer Psychology, 30(2), 277–295. https://doi .org/10.1002/jcpy.1137 Childs, E., Lutz, J. A. and de Wit, H. (2017). Dose-related effects of delta-9-THC on emotional responses to acute psychosocial stress. Drug and Alcohol Dependence, 177, 136–144. https://doi.org/10.1016/j.drugalcdep.2017 .03.030 Chou, W. Y., Prestin, A., Lyons, C. and Wen, K. Y. (2013). Web 2.0 for health promotion: Reviewing the current evidence. American Journal of Public Health, 103(1), e9–e18. https://doi.org/10.2105/AJPH.2012.301071 Clark, L. H., Hudson, J. L., Dunstan, D. A. and Clark, G. I. (2018). Barriers and facilitating factors to help-seeking for symptoms of clinical anxiety in adolescent males. Australian Journal of Psychology, 70(3), 225–234. https:// doi.org/10.1111/ajpy.12191 Collins, L. C. (2019). Corpus Linguistics for Online Communication. Routledge. Conrad, P. (2007). The Medicalization of Society. John Hopkins University Press. Conway, M., Hu, M. and Chapman, W. W. (2019). Recent advances in using natural language processing to address public health research questions using social media and consumer generated data. Yearbook of Medical Informatics, 28(1), 208–217. https://doi.org/10.1055/s-0039-1677918 Coplan, J. D., Aaronson, C. A., Panthangi, V. and Kim, Y. (2015). Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World Journal of Psychiatry, 5(4), 366–378. http://dx.doi.org/10 .5498/wjp.v5.i4.366 Courtenay, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science and Medicine, 50(10), 1385–1401. https://doi.org/10.1016/s0277-9536(99)00390-1

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

246

References

Craig, T. K. J., Rus-Calafell, M., Ward, T., Leff, J. P., Huckvale, M., Howarth, E., Emsley, R. and Garety, P. A. (2018). AVATAR therapy for auditory verbal hallucinations in people with psychosis: A single-blind, randomised control trial. The Lancet Psychiatry, 5(1), 31–40. https://doi.org/10.1016/S2215-036 6(17)30427-3 Craske, M. G. (2003). The Origins of Phobias and Anxiety Disorders: Why More Women Than Men. Elsevier Science. Crocq, M.-A. (2015). A history of anxiety: From Hippocrates to DSM. Dialogues in Clinical Neuroscience, 17(3), 319–325. https://dx.doi.org/10.31887%2FD CNS.2015.17.3%2Fmacrocq Crystal, D. (2001). Language and the Internet. Cambridge University Press. Data Commons. (2022). United Kingdom. https://datacommons.org/place/country/ GBR?utm_medium=explore&mprop=count&popt=Person&cpv=isInternetUser %2CTrue&hl=en Dattani, S., Ritchie, H. and Roser, M. (2021). Mental Health. Our World In Data. https://ourworldindata.org/mental-health. Demmen, J. E., Semino, E., Demjén, Z., Koller, V., Hardie, A., Rayson, P. and Payne, S. (2015). A computer-assisted study of the use of violence metaphors for cancer and end of life by patients, family carers and health professionals. International Journal of Corpus Linguistics, 20(2), 205–231. https://doi.org/ 10.1075/ijcl.20.2.03dem Dilmitis, S., Edwards, O., Hull, B., Margolese, S., Mason, N., Namiba, A., Nyambe, M., Paxton, S., Petretti, S., Ross, G. V., Welbourn, A. and Zakowics, A. (2012). Language, identity and HIV: Why do we keep talking about the responsible and responsive use of language? Language matters. Journal of the International AIDS Society, 15(Suppl 2), 17990. https://doi .org/10.7448/IAS.15.4.17990 Dold, M., Bartova, L., Souery, D., Mendlewicz, J., Serretti, A., Porcelli, S., Zohar, J., Montgomery, S. and Kasper, S. (2017). Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders – results from a European multicenter study. Journal of Psychiatric Research, 91, 1–13. https://doi.org/10.1016/j.jpsychires.2017 .02.020 Domhardt, M., Geßlein, H., von Rezori, R. E. and Baumeister, H. (2019). Internetand mobile-based interventions for anxiety disorders: A meta-analytic review of intervention components. Depression and Anxiety, 36(3), 213–224. https://doi .org/10.1002/da.22860 Dresner, E. and Herring, S. C. (2010). Functions of the non-verbal in CMC: Emoticons and illocutionary force. Communication Theory, 20(3), 249–268. https://doi.org/10.1111/j.1468-2885.2010.01362.x Dunning, T. (1993). Accurate methods for the statistics of surprise and coincidence. Computational Linguistics, 19(1), 61–74. https://dl.acm.org/doi/ 10.5555/972450.972454 Egbert, J., Wizner, S., Keller, D., Biber, D., McEnery, T. and Baker, P. (2021). Identifying and describing functional discourse units in the BNC Spoken 2014. Text & Talk, 41(5–6), 715–737. https://doi.org/10.1515/text-2020-0053

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

247

Eichhorn, K. C. (2008). Soliciting and providing social support over the Internet: An investigation of online eating disorder support groups. Journal of Computer-Mediated Communication, 14(1), 67–78. https://doi.org/10.1111/j .1083-6101.2008.01431.x Elfein, J. (2021). Marijuana use among U.S. adults within the past year 2018– 2019 by state. Statista. www.statista.com/statistics/723822/cannabis-usewithin-one-year-us-adults/. Elgesem, D. (2015). Consent and information – ethical considerations when conducting research on social media. In H. Fossheim and H. Ingierd (eds.) Internet Research Ethics (pp. 14–34). Cappelen Damm Akademisk. Elhai, J. D., Yang, H., Fang, J., Bai, X. and Hall, B. J. (2020). Depression and anxiety symptoms are related to problematic smartphone use severity in Chinese young adults: Fear of missing out as a mediator. Addictive Behaviors, 101, 105962. https://doi.org/10.1016/j.addbeh.2019.04.020 Elwyn, G., Frosch, D., Volandes, A. E., Edwards, A. and Montori, V. M. (2010). Investing in deliberation: A definition and classification of decision support interventions for people facing difficult health decisions. Medical Decision Making, 30(6), 701–711. https://doi.org/10.1177%2F0272989X 10386231 Engel, P. (2014). Map: Here’s where you should move if you want the most sunshine. Business Insider. 2 June. www.businessinsider.com/map-here-arethe-parts-of-the-us-that-get-the-most-sunshine-2014-6?r=US&IR=T European Commission. (2019). Discrimination in the European Union. Eurobarometer. https://europa.eu/eurobarometer/surveys/detail/2251. Eysenbach, G., Powell, J., Englesakis, M., Rizo, C. and Stern, A. (2004). Health related virtual communities and electronic support groups: Systematic review of the effects of online peer to peer interactions. BMJ, 328,1166. https://doi.org /10.1136/bmj.328.7449.1166 Firth, J. (1968). A Synopsis of Linguistic Theory, 1930–55. In F. R. Palmer (ed.) Selected Papers of J. R. Firth (1952–59) (pp. 168–205). Longmans. Fox, K. (2004). Watching the English. Hodder and Stoughton. Fox, S. and Duggan, M. (2013). Health online 2013. Pew Research Center. http:// pewintemet.org/Reports/2013/Health-online.aspx Frehner, C. (2008). Email – SMS – MMS: The Linguistic Creativity of Asynchronous Discourse in the New Media Age. Peter Lang. Fu, E. L. F., van Aalst, J. and Chan, C. K. K. (2016). Toward a classification of discourse patterns in asynchronous online discussions. International Journal of Computer-Supported Collaborative Learning, 11, 441–478. https://doi.org/10 .1007/s11412-016-9245-3 Gablasova, D., Brezina, V. and McEnery, T. (2017). Collocations in corpus-based language learning research: Identifying, comparing, and interpreting the evidence. Language Learning, 67(S1), 155–179. https://doi.org/10.1111/lang .12225 Gabrielatos, C. (2018). Keyness analysis: Nature, metrics and techniques. In C. Taylor and A. Marchi (eds.) Corpus Approaches to Discourse: A Critical Review (pp. 225–258). Routledge.

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

248

References

Galasin´ski, D. and Ziółkowska, J. (2020). A moment outside time: A critical discourse analytic perspective on dominant constructions of suicide. In Z. Demjén (ed.) Applying Linguistics in Illness and Healthcare Contexts (pp. 349–371). Bloomsbury. http://dx.doi.org/10.5040/9781350057685.0023 Galegher, J., Sproull, L. and Kiesler, S. (1998). Legitimacy, authority, and community in electronic support groups. Written Communication, 15(4), 493–530. https://doi.org/10.1177%2F0741088398015004003 Gawne, L. and McCulloch, G. (2019). Emoji as digital gestures. Language@Internet, 17. www.languageatinternet.org/articles/2019/gawne. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388, 1545–1602. https://doi .org/10.1016/S0140-6736(16)31678-6 Geertz, C. (1973). Thick description: Toward an interpretive theory of culture. In Interpretations of Cultures: Selected Essays (pp. 3–30). Basic Books. Georgaca, E. (2014). Discourse analytic research on mental distress: A critical overview. Journal of Mental Health, 23(2), 55–61. https://doi.org/10.3109/ 09638237.2012.734648 Gerolimatos, L. A. and Edelstein, B. A. (2012). Anxiety-related constructs mediate the relation between age and health anxiety. Aging & Mental Health, 16(8), 975–982. https://doi.org/10.1080/13607863.2012.688192 Golder, S., Ahmed, S., Norman, G. and Booth, A. (2017). Attitudes towards the ethics of using social media: A systematic review. Journal of Medical Internet Research, 19(6), e195. https://doi.org/10.2196/jmir.7082 Goldsmith, D. J. (2004). Communicating Social Support. Cambridge University Press. Good, B. (1994). How medicine constructs its objects. In B. Good (ed.) Medicine, Rationality and Experience (pp. 65-87). Cambridge University Press. Gough, B., Robertson, S. and Luck, H. (2021). Engendered expressions of anxiety: Men’s emotional communications with women and other men. Frontiers in Psychology, 6, 697356. https://doi.org/10.3389/fsco.2021.697356 Gould, C. E. and Edelstein, B. A. (2010). Worry, emotion control, and anxiety control in older and young adults. Journal of Anxiety Disorders, 24(7), 759–766. https://doi.org/10.1016/j.janxdis.2010.05.009 Gries, S. Th., Newman, J. and Shaoul, C. (2011). N-grams and the clustering of registers. ELR Journal, 5 (1). http://ejournals.org.uk/ELR/article/2011/1. Haase, M. (2021). When words speak for themselves: An examination of linguistic correlates of anxiety and depression. Thesis. Kent State University. http://rave .ohiolink.edu/etdc/view?acc_num=ksuhonors1620659259937997 Halliday, M. A. K. (1976). System and Function in Language. Oxford University Press. Halliday, M. A. K. (2003). Language and the order of nature. In J. Webster (ed.) On Language and Linguistics. Volume 3 in the Collected Works of M.A.K. Halliday (pp. 116–138). Continuum.

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

249

Hammond, W. P. (2012). Taking it like a man: Masculine role norms as moderators of the racial discrimination-depressive symptoms association among African American men. American Journal of Public Health, 102 (Suppl 2), S232–41. https://dx.doi.org/10.2105%2FAJPH.2011.300485 Hannaford, E. D. (2017). The press and public on mental health: A corpus linguistic analysis of UK newspaper coverage of mental illness (1995–2014), compared with the UK National Attitudes to Mental Illness. MPhil(R) thesis. University of Glasgow. http://theses.gla.ac.uk/9016/ Hardaker, C. (2010). Trolling in asynchronous computer-mediated communication: From user discussions to academic definitions. Journal of Politeness Research, 6, 215e242. http://dx.doi.org/10.1515/JPLR.2010.011 Hartman, M. (2021). Cannabis overview. National Conference of State Legislatures. www.ncsl.org/research/civil-and-criminal-justice/marijuanaoverview.aspx Harvey, K. (2012). Disclosures of depression: Using corpus linguistic methods to examine young people’s online health concerns. International Journal of Corpus Linguistics, 17(3), 349–379. https://doi.org/10.1075/ijcl.17.3.03har Hausner, H., Hajak, G. and Spiessl, H. (2008). Gender differences in help-seeking behavior on two internet forums for individuals with self-reported depression. Gender Medicine, 5(2), 181–185. https://doi.org/10.1016/j.genm.2008.05.008 Hayes, S. C., Strosahl, K. D. and Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. 2nd ed. Guilford Press. Hermans, E. J., Ramsey, N. F. and van Honk, J. (2008). Exogenous testosterone enhances responsiveness to social threat in the neural circuitry of social aggression in humans. Biological Psychiatry, 63(3), 263–270. https://doi.org/ 10.1016/j.biopsych.2007.05.013 Herring, S. C. (2008). Language and the internet. In W. Donsbach (ed.) International Encyclopedia of Communication (pp. 2640–2645). Blackwell. https://doi.org/10.1002/9781405186407.wbiecl005 Herring, S. and Dainas, A. (2017). ‘Nice picture comment!’ Graphicons in Facebook comment threads. Proceedings of the Fiftieth Hawaii International Conference in System Sciences. 4–7 January. Los Alamitos, California, pp. 2185–2194. Herring, S. C. and Dainas, A. (2020). Gender and age influence on interpretation of emoji functions. ACM Transactions on Social Computing, 3(2), 1–26. https://doi.org/10.1145/3375629 Hunt, D. (2013). Anorexia nervosa, depression and medicalisation: a corpusbased study of patients and professionals. PhD thesis. University of Nottingham. Hunt, D. and Brookes, G. (2020). Corpus, Discourse and Mental Health. Bloomsbury. Hunt, D. and Harvey, K. (2015). Health communication and corpus linguistics: Using corpus tools to analyse eating disorder discourse online. In P. Baker and T. McEnery (eds.) Corpora and Discourse: Integrating Discourse and Corpora (pp. 134–154). Palgrave.

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

250

References

Hunt, S., Wisocki, P. and Yanko, J. (2003). Worry and use of coping strategies among older and younger adults. Journal of Anxiety Disorders, 17(5), 547–560. https://doi.org/10.1016/S0887-6185(02)00229-3 Jacobson, N. C. and Newman, M. G. (2017). Anxiety and depression as bidirectional risk factors for one another: A meta-analysis of longitudinal studies. Psychological Bulletin, 143(11), 1155–1200. http://dx.doi.org/10 .1037/bul0000111 Jaeger, S. R., Roigard, C. M., Jin, D., Vidal, L. and Ares, G. (2019). Valence, arousal and sentiment meanings of 33 facial emoji: Insights for the use of emoji in consumer research. Food Research International, 119, 895–907. https://doi .org/10.1016/j.foodres.2018.10.074 Jakubícˇek, M., Kilgarriff, A., Kovárˇ, V., Rychlý, P., and Suchomel, V. (2013). The TenTen corpus family. Proceedings of the 7th International Corpus Linguistics Conference CL 2013, pp. 125–127. Lancaster University. Joinson, A. N. (2003). Understanding the Psychology of Internet Behaviour: Virtual Worlds, Real Lives. Palgrave Macmillan. Kamal, R., Cox, C. and McDermott, D. (2019). What are the recent and forecasted trends in prescription drug spending? Health System Tracker. www .healthsystemtracker.org/chart-collection/recent-forecasted-trends-prescriptiondrug-spending/ Kessler, R. C. and McLeod, J. D. (1984). Sex differences in vulnerability to undesirable life events. American Sociological Review, 49(5), 620–631. https:// doi.org/10.2307/2095420 Kessler, R. C. and Wang, P. S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115–129. https://doi.org/10.1146/annurev.publhealth.29.020907 .090847 Kessler, R. C., Sampson, N. A., Berglund, P., Gruber, M. J., Al-Hamzawi, A., Andrade, L., Bunting, B., Demyttenaere, K., Florescu, S., de Girolamo, G., Gureje, O., He, Y., Hu, C., Huang, Y., Karam, E., Kovess-Masfety, V., Lee, S., Levinson, D., Medina Mora, M. E., Moskalewicz, J., Nakamura, Y., NavarroMateu, F., Oakley Browne, M. A., Piazza, M., Posada-Villa, J., Slade, T., Ten Have, M., Torres, Y., Vilagut, G., Xavier, M., Zarkov, Z., Shahly, V. and Wilcox, M. A. (2015). Anxious and non-anxious major depressive disorder in the World Health Organization world mental health surveys. Epidemiology and Psychiatric Sciences, 24(3), 210–226. https://doi.org/10.1017/S2045796 015000189 Kilgarriff, A. (2009). Simple maths for keywords. In M. Mahlberg, V. GonzálezDíaz and C. Smith (eds.) Proceedings of the Corpus Linguistics Conference, CL2009. University of Liverpool. http://ucrel.lancs.ac.uk/publications/ CL2009/171_FullPaper.doc Kilgarriff, A., Baisa, V., Bušta, J., Jakubícˇek, M., Kovárˇ, V., Michelfeit, J., Rychlý, P. and Suchomel, V. (2014). The Sketch Engine: Ten years on. Lexicography, 1, 7–36. https://doi.org/10.1007/s40607-014-0009-9 The King’s Fund. (2022). The NHS budget and how it has changed. www .kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

251

Kinloch, K. and Jaworska, S. (2020). Using a comparative corpus-assisted approach to study health and illness discourses across domains: The case of postnatal depression (PND) in lay, medical and media texts. In Z. Demjén (ed.) Applying linguistics in Illness and Healthcare Contexts (pp. 73–98). Bloomsbury. Knight, N. (2019). Xanax: what you need to know. GQ. 18 January. www .gq-magazine.co.uk/article/xanax-what-you-need-to-know Konnopka, A. and König, H. (2020). Economic burden of anxiety disorders: A systematic review and meta-analysis. PharmacoEconomics, 38, 25–37. https://doi.org/10.1007/s40273-019-00849-7 Kouper, I. (2010). The pragmatics of peer advice in a LiveJournal community. Language@Internet, 7, 1–21. www.languageatinternet.org/articles/2010/ 2464. Lakoff, R. (1975). Language and Woman’s Place. Harper and Row. Leech, G., Hundt, M., Mair, C. and Smith, N. (2009). Change in Contemporary English: A Grammatical Study. Cambridge University Press. Lewinsohn, P. M., Gotlib, I. H., Lewinsohn, M., Seeley, J. R. and Allen, N. B. (1998). Gender differences in anxiety disorders and anxiety symptoms in adolescents. Journal of Abnormal Psychology, 107(1), 109–117. https://doi .org/10.1037/0021-843X.107.1.109 Lindholm, L. (2017). ‘So now I’m panic attack free!’: Response stories in a peer-topeer online advice forum on pregnancy and parenting. Linguistik Online, 87 (8). https://doi.org/10.13092/lo.87.4171 Lindinger-Sternart, S. (2015). Help-seeking behaviours of men for mental health and the impact of diverse cultural backgrounds. International Journal of Social Science Studies, 3(1), 1–6. http://dx.doi.org/10.11114/ijs ss.v3il.519 Littlewood, R. (2002). Pathologies of the West: An Anthropology of Mental Illness in Europe and America. Cornell University Press. Locher, M. (2013). Internet advice. In S. Herring, D. Stein and T. Virtanen (eds.) Pragmatics of Computer-Mediated Communication (pp. 339–362). De Gruyter. Lukianoff, G. and Haidt, J. (2018). The Coddling of the American Mind: How Good Intentions and Bad Ideas are Setting Up a Generation for Failure. Penguin Books. Lynn V. A. (2017). Language and HIV communication. HIV/AIDS (Auckland, N. Z.), 9, 183–185. https://doi.org/10.2147/HIV.S148193 Lyons, M., Deniz Aksayli, N. and Bewer, G. (2018). Mental distress and language use: Linguistic analysis of discussion forum posts. Computers in Human Behavior, 87, 207–211. https://doi.org/10.1016/j.chb.2018.05.035 Machin, K., Thomson, L., Hare-Duke, L. and Lambert, M. (2016). Exploratory research study of peer support provision for people with anxiety. Anxiety UK. www.anxietyuk.org.uk/get-involved/research-area/katharine-and-harold-fisheranxiety-research-fund/. Mackay, R. (2002). Half the Battle: Civilian Morale in Britain during the Second World War. Manchester University Press.

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

252

References

Mackenzie, J. (2017). Identifying informational norms in Mumsnet Talk: A reflexive-linguistic approach to internet research ethics. Applied Linguistics Review, 8(2–3), 293–314. https://doi.org/10.1515/applirev-2016-1042 Mahoney, C. T., Segal, D. L., Coolidge, F. L. (2015). Anxiety sensitivity, experiential avoidance, and mindfulness among younger and older adults: Age differences in risk factors for anxiety symptoms. The International Journal of Aging and Human Development, 81(4), 217–240. https://doi.org/10 .1177/0091415015621309 Martin, J. J., Kliber, A., Hodges Kulinna, P. and Fahlman, M. (2006). Social physique anxiety and muscularity and appearance cognitions in college men. Sex Roles, 55, 151–158. https://doi.org/10.1007/s11199-006-9069-0 Martin, J. R. and White, P. R. R. (2005). The Language of Evaluation: Appraisal in English. Palgrave Macmillan. McCrae, R. R., Terracciano, A. and Personality Profiles of Cultures Project. (2005). Personality profiles of cultures: Aggregate personality traits. Journal of Personality and Social Psychology, 89(3), 407–425. https://doi.org/10.1037/ 0022-3514.89.3.407 McDonald, D. and Woodward-Kron, R. (2016). Member roles and identities in online support groups: Perspectives from corpus and systemic functional linguistics. Discourse & Communication, 10(2), 157–175. https://doi.org/10 .1177%2F1750481315615985 McEnery, T. (2005). Swearing in English: Bad Language, Purity and Power from 1586 to the Present. Routledge. https://doi.org/10.4324/9780203501443 McEnery, T. and Hardie, A. (2012). Corpus Linguistics: Method, Theory and Practice. Cambridge University Press. McLean, C. P. and Anderson, E. R. (2009). Brave men and timid women? A review of the gender differences in fear and anxiety. Clinical Psychology Review, 29 (6), 496–505. https://doi.org/10.1016/j.cpr.2009.05.003 McLeod, D. R., Hoehn-Saric, R., Foster, G. V. and Hipsley, P. A. (1993). The influence of premenstrual syndrome on ratings of anxiety in women with generalized anxiety disorder. Acta Psychiatrica Scandinavica, 88(4), 248–251. https://doi.org/10.1111/j.1600-0447.1993.tb03451.x McMullen, L. M. and Conway, J. B. (2002). Conventional metaphors for depression. In S. R. Fussell (ed.) The Verbal Communication of Emotions: Interdisciplinary Perspectives (pp. 167–181). Erlbaum. Meredith, J. (2019). Conversation analysis and online interaction. Research on Language and Social Interaction, 52(3), 241–256. https://doi.org/10.1080/08 351813.2019.1631040 Mikes, G. (1984). How to Be a Brit. Penguin. Mo, P. K., Malik, S. H. and Coulson, N. S. (2009). Gender differences in computer-mediated communication: A systematic literature review of online health-related support groups. Patient Education and Counseling, 75(1), 16–24. https://doi.org/10.1016/j.pec.2008.08.029 Moffat, S. D., An, Y., Resnick, S. M., Diamond, M. P. and Ferrucci, L. (2020). Longitudinal change in cortisol levels across the adult life span. The Journal of Gerontology, 75(2), 394–400. https://doi.org/10.1093/gerona/gly279

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

253

Naslund, J. A., Aschbrenner, K. A., Marsch, L. A. and Bartles, S. J. (2016). The future of mental health care: Peer-to-peer support and social media. Epidemiology and Psychiatric Sciences, 25, 113–122. https://doi.org/10.1017/ S2045796015001067 NCSL. (2021). State medical marijuana laws. National Conference of State Legislatures. www.ncsl.org/research/health/state-medical-marijuana-laws.aspx Newberg, A., Wintering, N., Waldman, M. R. and Amen, D. G. (2010). Cerebral blood flow differences between long-term meditators and non-meditators. Consciousness and Cognition, 19(4), 899–905. https://doi.org/10.1016/j .concog.2010.05.003 Nimrod, G. (2013). Online depression communities: Members’ interests and perceived benefits. Health Communication, 28(5), 425–434. https://doi.org/10 .1080/10410236.2012.691068 Nissling, L., Kraepelin, M., Kaldo, V., Hange, D., Larsson, A., Persson, M. and Weineland, S. (2021). Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized control trial. Internet Interventions, 26, 100456. https://doi.org/10.1016/j.invent.2021.100456 Nolen-Hoeksema, S. (1990). Sex Differences in Depression. Stanford University Press. Nolen-Hoeksema, S. and Jackson, B. (2001). Mediators of the gender difference in rumination. Psychology of Women Quarterly, 25(1), 37–47. https://doi.org/10 .1111%2F1471-6402.00005 O’Leary, K., Schueller, S. M., Wobbrock, J. O. and Pratt, W. (2018). ‘Suddenly, we got to become therapists for each other’: Designing peer support chats for mental health. CHI ’18: Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems. April. Paper No. 331, pp. 1–14. https://doi.org /10.1145/3173574.3173905 Office for National Statistics. (2020a). Drug misuse in England Wales: Year ending March 2020. www.ons.gov.uk/peoplepopulationandcommunity/ crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2020 Office for National Statistics. (2020b). Average household income, UK: financial year ending 2019. www.ons.gov.uk/peoplepopulationandcommunity/personaland householdfinances/incomeandwealth/bulletins/householddisposableincomeandi nequality/financialyearending2019 Ohayon, M. M. and Schatzberg, A. F. (2010). Social phobia and depression: Prevalence and comorbidity. Journal of Psychosomatic Research, 68(3), 235–243. https://doi.org/10.1016/j.jpsychores.2009.07.018 Overy, R. (2013). The Bombing War. Europe 1939–45. Allen Lane. Panayiotou, G., Karekla, M. and Mete, I. (2014). Dispositional coping in individuals with anxiety disorder symptomatology: Avoidance predicts distress. Journal of Contextual Behavioral Science, 3, 314–321. https://doi .org/10.1016/j.jcbs.2014.07.001 Partington, A. (2004). ‘Utterly content in each other’s company’: Semantic prosody and semantic preference. International Journal of Corpus Linguistics, 9(1), 131–156. https://doi.org/10.1075/ijcl.9.1.07par

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

254

References

Partington, A., Duguid, A. and Taylor, C. (2013). Patterns and Meanings in Discourse. John Benjamins. Pearce, M. (2008). Investigating the collocational behaviour of MAN and WOMAN in the BNC using Sketch Engine. Corpora, 3(1), 1–29. https://doi .org/10.3366/E174950320800004X Pennebaker, J. W. (2011). The Secret Life of Pronouns: What Our Words Say about Us. Bloomsbury. Perkins, M. R. (2011). Clinical linguistics: Its past, present and future. Clinical Linguistics & Phonetics, 25(11–12), 922–927. https://doi.org/10.3109/02699 206.2011.599471 Pew Research Center. (2018). The age gap in religion around the world. www .pewforum.org/2018/06/13/how-religious-commitment-varies-by-country-amongpeople-of-all-ages/. Pew Research Centre. (2019). In U.S., decline of Christianity continues at rapid pace. www.pewforum.org/2019/10/17/in-u-s-decline-of-christianity-continuesat-rapid-pace/. Powell, J., McCarthy, N. and Eysenbach, G. (2003). Cross-sectional survey of users of Internet depression communities. BMC Psychiatry, 3(19), 1–7. https:// doi.org/10.1186/1471-244X-3-19 Powers, C. B., Wisocki, P. A. and Whitbourne, S. K. (1992). Age differences and correlates of worrying in young and elderly adults. The Gerontologist, 32(1), 82–88. https://doi.org/10.1093/geront/32.1.82 Prada, M., Rodrigues, D. L., Garrido, M. V., Lopes, D., Cavalheiro, B. and Gaspar, R. (2018). Motives, frequency and attitudes toward emoji and emoticon use. Telematics and Informatics, 35, 1925–1934. https://doi.org/10 .1016/j.tele.2018.06.005 Price, H. (2022). The Language of Mental Illness: Corpus Linguistics and the Construction of Mental Illness in the Press. Cambridge University Press. Public Health England. (2017). Health Profile for England: 2017. Chapter 2: Major causes of death and how they have changed. www.gov.uk/government/ publications/health-profile-for-england/chapter-2-major-causes-of-death-andhow-they-have-changed Rajkumar, S. V. (2020). The high cost of prescription drugs: Causes and solutions. Blood Cancer Journal, 10(71), 1–5. https://doi.org/10.1038/s41408-020-0338-x Ramirez-Esparza, N., Chung, C. K., Kacewicz, E. and Pennebaker, J. W. (2008). The psychology of word use in depression forums in English and in Spanish: Testing two text analytic approaches. The International AAAI Conference on Web and Social Media. pp. 102–108. Association for the Advancement of Artificial Intelligence. www.aaai.org/Papers/ICWSM/2008/ICWSM08-020 .pdf Rethink Mental Illness. (2022). Anxiety Disorders version 6.1. www.rethink.org/ advice-and-information/about-mental-illness/learn-more-about-conditions/ anxiety-disorders/ Rey, J. M. (2001). Changing gender roles in popular culture: Dialogue in Star Trek episodes from 1966 to 1993. In S. Conrad and D. Biber (eds.) Variation in English: Multi-Dimensional Studies (pp. 138–156). Longman.

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

255

Riordan, M. A. and Kreuz, R. J. (2010). Cues in computer-mediated communication: A corpus analysis. Computers in Human Behaviour, 26(6), 1806–1817. http://dx.doi.org/10.1016/j.chb.2010.07.008 Rosmarin, D. H., Krumrei, E. J. and Andersson, G. (2009). Religion as a predictor of psychological distress in two religious communities. Cognitive Behaviour Therapy, 38(1), 54–64. https://psycnet.apa.org/doi/10.1080/16506070802477222 Rychlý, P. (2008). A lexicographer-friendly association score. In P. Sojka and A. Horák (eds.) Proceedings of Recent Advances in Slavonic Natural Language Processing, RASLAN 2008 (pp. 6–9). Masaryk University. https://nlp.fi.muni.cz/ raslan/2008/papers/13.pdf Sansome, J. (2019). Talking about the weather is the ‘most typical British trait’, a survey has found. Manchester Evening News. 8 March. www.manchesterevening news.co.uk/news/greater-manchester-news/talking-weather-most-typical-british15940259 Schegloff, E. and Sacks, H. (1967). Opening up closings. Semiotica, 8(4), 289–327. https://doi.org/10.1515/semi.1973.8.4.289 Schmitt, D. P., Allik J., McCrae, R. R. and Benet-Martinez, V. (2007). The geographical distribution of Big Five personality traits: Patterns and profiles of human self-description across 56 nations. Journal of Cross-Cultural Psychology, 38(2), 173–212. https://doi.org/10.1177%2F0022022106297299 Schofield, C. A., Abdul-Chani, M. and Gaudiano, B. A. (2020). Impact of causal explanations for social anxiety disorder on stigma and treatment perceptions. Journal of Mental Health, 29(1), 84–91. https://doi.org/10.1080/09638237 .2018.1487543 Scollon, C. N. and Diener, E. (2006). Love, work, and changes in extraversion and neuroticism over time. Journal of Personality and Social Psychology, 91(6), 1152–1165. https://doi.org/10.1037/0022-3514.91.6.1152 Scott, M. (1997). PC analysis of key words – and key key words. System, 25(2), 233–245. https://doi.org/10.1016/S0346-251X(97)00011-0 Semino, E. (2008). Metaphor in Discourse. Cambridge University Press. Shim, M., Mahaffey, B., Bleidistel, M. and Gonzalez, A. (2017). A scoping review of human-support factors in the context of Internet-based psychological interventions (IPIs) for depression and anxiety disorders. Clinical Psychology Review, 57, 129–140. http://dx.doi.org/10.1016/j.cpr.2017.09.003 Showalter, E. (1987). The Female Malady: Women, Madness, and English Culture, 1830–1980. Virago Press. Shum, W. and Lee, C. (2013). (Im)politeness and disagreement in two Hong Kong Internet discussion forums. Journal of Pragmatics, 50(1), 52–83. https://doi .org/10.1016/j.pragma.2013.01.010 Sik, D. (2021). From lay depression narratives to secular ritual healing: An online ethnography of mental health forums. Culture, Medicine, and Psychiatry, 45, 751–774. https://doi.org/10.1007/s11013-020-09702-5 Sillence, E. (2010). Seeking out very like-minded others: Exploring trust and advice issues in an online health support group. International Journal of Web Based Communities, 6(4), 376–394. http://dx.doi.org/10.1504/IJWBC .2010.035840

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

256

References

Sillence, E., Briggs, P., Harris, P. and Fishwick, L. (2007). Going online for health advice: Changes in usage and trust practices over the last five years. Interacting with Computers, 19(3), 397–406. https://doi.org/10.1016/j.intcom.2006.10 .002 Skelton, J., Murray, J. and Hobbs, F. (1999). Imprecision in medical communication: Study of a doctor talking to patients with serious illness. Journal of the Royal Society of Medicine, 92(12), 620–625. https://doi.org/10 .1177/014107689909201204 Skovholt, K., Grønning, A. and Kankaanranta, A. (2014). The communicative functions of emoticons in workplace e-mails: :-). Journal of ComputerMediated Communication, 19, 780–797. https://doi.org/10.1111/jcc4.12063 Slonim, T. (2014). Verbal behavior in individuals with Generalized Anxiety Disorder. Doctoral dissertation. City University of New York. https://academic works.cuny.edu/gc_etds/386/ Smith, D. T., Mouzon, D. M. and Elliott, M. (2018). Reviewing the assumptions about men’s mental health: An exploration of the gender binary. American Journal of Men’s Health, 12(1), 78–89. https://doi.org/10.1177/ 1557988316630953 Stevenson-Hinde, J. and Shouldice, A. (1993). Wariness to strangers: A behavior systems perspective revisited. In K. H. Rubin and J. B. Asendorpf (eds.) Social Withdrawal, Inhibition, and Shyness in Childhood (pp. 101–116). Lawrence Erlbaum. Stewart, K. D. and Bernhardt, P. C. (2010). Comparing millennials to pre-1987 students and with one another. North American Journal of Psychology, 12(3), 579–602. Stommel, W. and Koole, T. (2010). The online support group as a community: A micro-analysis of the interaction with a new member. Discourse Studies, 12(3), 357–378. https://doi.org/10.1177/1461445609358518 Stommel, W. and Lamerichs, J. (2014). Interaction in online support groups. In H. E. Hamilton and W. Y. S. Chou (eds.) The Routledge Handbook of Language and Health Communication (pp. 198–211). Routledge. Stubbs, M. (1995). Collocations and semantic profiles: On the cause of the trouble with quantitative methods. Function of Language, 2(1), 23–55. https://doi.org/ 10.1075/fol.2.1.03stu Stubbs, M. (1996). Text and Corpus Analysis. Blackwell. Suler, J. (2004). The online disinhibition effect. CyberPsychology & Behavior, 7 (3), 321–326. https://doi.org/10.1089/1094931041291295 Sunderland, J. (2004). Gendered Discourse. Palgrave Macmillan. https://doi.org/10 .1057/9780230505582 Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Edwards, T. S., Pennebaker, J. W. and Mehl, M. R. (2019). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology, 116(5), 817–834. https://doi.org/10.1037/pspp0000187 Tausczik, Y. R. and Pennebaker, J. W. (2010). The psychological meaning of words: LIWC and computerized text analysis methods. Journal of Language

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

References

257

and Social Psychology, 29(1), 24–54. https://doi.org/10.1177/0261927X 09351676 Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R. and Updegraff, J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107(3), 411–429. https://doi.org/10.1037/0033-295X.107.3.411 Thomas, J. and Wilson, A. (1996). Methodologies for studying a corpus of doctor–patient interaction. In J. Thomas and M. Short (eds.) Using Corpora for Language Research (pp. 181–207). Longman. Thurlow, C. and Poff, M. (2013). Text messaging. In S. Herring, D. Stein and T. Virtanen (eds.) Pragmatics of Computer-Mediated Communication (pp. 163–189). De Gruyter. TNS BMRB. (2015). Attitudes to mental illness: 2014 research report. Time to Change. www.time-to-change.org.uk/research-reports-publications/campaign Townsend, L. and Wallace, C. (2016). Social media research: A guide to ethics. University of Aberdeen. www.gla.ac.uk/media/Media_487729_smxx.pdf Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E. and Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology, 128(3), 185–199. https://doi.org/10.1037/abn0000410 Underwood, G., Schmitt, N. and Galpin, A. (2004). The eyes have it: An eyemovement study into the processing of formulaic sequences. In N. Schmitt (ed.) Formulaic Sequences: Acquisition, Processing, and Use (pp. 153–172). John Benjamins. https://doi.org/10.1075/lllt.9.09und Van Uden-Kraan, C. F., Drossaert, C. H., Taal, E., Seydel, E. R. and Van de Laar, M. A. (2008). Self-reported differences in empowerment between lurkers and posters in online patient support groups. Journal of Medical Internet Research, 10(2), e18. https://doi.org/10.2196/jmir.992 Vanheule, S., Desmet, M. and Meganck, R. (2009). What the heart thinks, the tongue speaks: A study on depression and lexical choice. Psychological Reports, 104(2), 473–481. https://doi.org/10.2466/pr0.104.2.473-481 Vayreda, A. and Antaki, C. (2009). Social support and unsolicited advice in a bipolar disorder online forum. Qualitative Health Research, 19(7), 931–942. https://doi.org/10.1177/1049732309338952 Veen, M., Te Molder, H., Gremmen, B. and Van Woerkum, C. (2010). Quitting is not an option: An analysis of online diet talk between celiac disease patients. Health, 14(1), 23–40. https://doi.org/10.1177%2F1363459309347478 Waring, H. Z. (2007). The multi-functionality of accounts in advice giving. Journal of Sociolinguistics, 11(3), 367–391. https://doi.org/10.1111/j.1467-9 841.2007.00328.x Weaver, B. (2019). Lies in copywriting. Hyperbole vs realism. copywritematters www.copywritematters.com/lies-copywriting-hyperbole-realism/ Webb, M., Burns, J. M. and Collin, P. (2008). Providing online support for young people with mental health difficulties: Challenges and opportunities explored. Early Intervention Psychiatry, 2(2), 108–113. https://doi.org/10.1111/j.17517893.2008.00066.x

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

258

References

Weber, H. L. (2011). Missed cues: How disputes can socialize virtual newcomers. Language@Internet, 8(5). http://nbn-resolving.de/urn:nbn:de:0009-7-31711 World Health Organization. (2017). Depression and Other Common Mental Disorders: Global Health Estimates. World Health Organization. Xiao, R. and McEnery, T. (2006). Collocation, semantic prosody, and near synonymy: A cross-linguistic perspective. Applied Linguistics, 27(1), 103–129. https://doi.org/10.1093/applin/ami045 Yip, J. W. C. (2020). Evaluating the communication of online social support: A mixed-methods analysis of structure and content. Health Communication, 35 (10), 1210–1218. https://doi.org/10.1080/10410236.2019.1623643 Zappavigna, M. (2012). Discourses of Twitter and Social Media. Continuum. Zimmermann, J., Brockmeyer, T., Hunn, M., Schauenburg, H. and Wolf, M. (2017). First-person pronoun use in spoken language as a predictor of future depressive symptoms: Preliminary evidence from a clinical sample of depressed patients. Clinical Psychology & Psychotherapy, 24(2), 384–391. https://doi .org/10.1002/cpp.2006

https://doi.org/10.1017/9781009250139.010 Published online by Cambridge University Press

Index

abstracting, 54–56 adjectives, 29, 37, 49, 143, 148, 152, 157, 175, 190, 207 adverbs, 7, 167, 207, 213 advice, 50, 66, 77, 79, 80, 84, 85, 90, 100, 103, 119, 124, 128, 132, 133, 148, 215, 223 advice-giving, 18, 19, 22, 52, 65, 74, 75, 89, 104, 112, 114–115, 122, 123, 129, 149, 226 advice-seeking, 33, 65, 87, 100, 103, 111, 212 affiliation, 79, 80, 88, 150, 180, 181 age group, 92, 93, 192, 201, 202, 204–217, 233 anonymisation, 20, 23, 24, 230 anonymity, 6, 8, 23, 24, 65, 238, 241 anthropomorphising, 51–54, 58, 209 anxiety disorders, 3, 32–33, 136, diagnosis, 4, 33, 35, 65, 76, 100, 136 medication, 42, 76, 179, 183–184 symptoms, 3, 32, 72, 100, 144, 173 therapy, 4, 42, 185, 186, 237 apostrophes, 74, 85 asynchronous communication, 66, 107, 115, 133, 224 Baker, P., 16, 37, 167, 192, 207, 214, 229 Biber, D., 63, 68, 70, 86, 104, 105, 111, 112, 113, 114, 116, 119 biomedical perspective, 6, 18 bipolar disorder, 16, 19, 34, 66 BNC 1994, 207 BNC 2014, 14, 111, 119, 206, 207 Brexit, 193 British National Corpus, 174 Brookes, G., 19, 31, 33, 34, 191 Brown corpora, 191

cannabis, 175, 190 capitalism, 186, 190 Carry On films, 188 catastrophisation, 44–48, 50, 54, 56, 82, 94, 152, 217, 226, 232 closings, 80, 95, 100, 130 Cognitive Behavioural Therapy (CBT), 5, 185 collocation, 15, 31–32, 35, 37 colloquial language, 43, 151, 191, 217 computational linguistics, 9 computer-mediated communication, 8, 62, 63–64 concordance, 15, 21, 137, 157, 168, 197 conflict, 97, 119–120, 134 conjunctions, 29, 160 consent, 20, 23, 24, 231 content analysis, 16, 104 Conversation Analysis, 105 corpus linguistics, 11, 31, 65, 229 Corpus-Assisted Discourse Studies (CADS), 16, 241 COVID-19, 119, 131, 196–197, 227 depression, 4, 6, 9, 13, 18, 34, 46, 57, 137, 155, 216 determiner, 59 disclosures, 13, 22, 24, 65, 70, 79, 85, 88 discourse, 7–8, 16, 18 discourse prosody, 174, 210 discourse unit, 105–110 distancing, 58–60 Egbert, J., 63, 96, 105, 106, 107, 132 emoji, 9, 69, 91, 151, 231 emoticons, 26, 63, 64, 69, 91–94, 212, 231 emotional support, 17, 18, 65, 97, 103, 129, 150, 235, 238

259

https://doi.org/10.1017/9781009250139.011 Published online by Cambridge University Press

260

Index

empathy, 19, 27, 75, 88, 90, 93, 94, 113, 120, 127, 155, 156, 158, 179, 235, 236, 238 emphatic language, 69, 93, 175, 214, 215, 233 English Web 2020 corpus, 14, 29, 35, 39, 46, 55, 56, 67, 68, 69, 72, 75, 91, 139, 174, 210 ethics, 23, 25, 230, 231 ethnicity, 24, 25, 137, 240 ethnography, 23 euphemism, 208, 233 evaluation, 32, 70, 77, 82, 113, 122, 131, 150, 151, 157, 201, 207, 214, 216, 226 expectations, 65, 79, 84, 135, 146, 157, 164, 184, 190, 209, 233, 235, 239 expertise, 6, 8, 24, 114, 116, 128, 133 fear, 32 frequency, 13, 29, 197, 237 gender, 24, 93, 135, 136, 156–164, 245 guidelines, 22, 101, 102, 217, 236–237, 241 Harvey, K., 13, 16, 17, 33, 35 healthcare services, 5, 17, HealthUnlocked, 19–20, 22, 24, 166, 239, 240 humour, 117, 151, 213 images, 8, 20–21, 230, 239 imagined community, 190 imperatives, 12, 85, 104, 115, 133 keyness, 12, 14, 29, 67 KWIC. See concordance legitimation, 33, 65, 74, 103, 113, 114, 124, 129, 133, 162, 221 lemma, 37 lived experience, 2, 6, 8, 13, 16, 26, 31, 33, 35, 61, 62, 74, 77, 85, 101, 128, 133, 240 LIWC, 9 masculinity, 136–137, 163, medicalising, 38–42, 44, 54, 73, 144, 201, 210, meta-data, 25, 229 metaphor, 46, 53, 56, 159, 161

minimising, 48–50, 53, 82 modality, 7, 70, 84, 104, 115, 168 narrative, 6, 26, 28, 54, 74, 85, 88, 90, 116, 143, 212, 224, 226, 237, 238 national culture, 167, 168, 175–179, 182, 187, 235 National Health Service (NHS), 12, 27, 183, 184, 185, 186, 207 natural language processing, 9 n-grams, 68, 86 non-binary identities, 137–139 normalisation, 43–44, 73, 76, 78, 94 nouns, 37, 143, 157, 174 online forums, 6, 8, 17–19 orthography, 21, 64, 154, 167 panic attack, 7, 33, 46, 72, 74, 162, 221 paralinguistic features, 8, 64 person first language, 41 personality, 158, 178 pharmacotherapy, 5, 42 politeness, 22, 63, 115, 119, 180 prompts, 111, 113, 116, 124, 127, 132, 134 pronouns, 9, 10, 12, 57, 153, 191, 212, psychotherapy, 5 qualitative analysis, xiii, 11, 15, 16, 23, 157, 180 relationships, 21, 58, 153–155, 164, 197, 205, 235 religion, 38, 181–182 repair, 107 repetition, 31, 93, 157, 229 research questions, 66, 143, 168, 228, 229 seasonal affective disorder (SAD), 178 semantic prosody, 32, 55 sex, 135, 157, 161 sex differences, 69, 92, 135, 139–155, 160, 208, 233, 235 sexism, 157 Sketch Engine, 29–30, 35, 36, 68, 70, 229 social anxiety disorder (SAD), 3, 18, 32 social constructionist, 8 stigma, 5, 8, 12, 13, 17, 18, 41, 137 subjunctive, 115

https://doi.org/10.1017/9781009250139.011 Published online by Cambridge University Press

Index superlatives, 216 systemic functional linguistics, 16 tautology, 161 thanking, 81, 90, 93, 95, 100, 180, 201, 225 trans identities, 137–139

261

verbs, 7, 32, 36, 39, 46, 47, 50, 52, 55, 56, 70, 84, 115, 157, 162, 168, 180, 187, 222, 226

understatement, 175, 177

Word Sketch, 36–38 World Health Organization, 5, 34, 135 World War II, 188, 189

VARD, 21

zero replies, 100–102, 134

https://doi.org/10.1017/9781009250139.011 Published online by Cambridge University Press

https://doi.org/10.1017/9781009250139.011 Published online by Cambridge University Press