Disease mongering, overdiagnosis, and media practices: a critical discourse analysis of sluggish cognitive tempo (SCT) and the motivational deficiency disorder (MoDeD) spoof

1.1 Background

A few years after Canadian health policy researcher Alan Cassels had introduced a fake disease (“Adolescent Motivational Deficiency Disorder” or AMDD) in a Canadian Broadcasting Corporation (CBC) radio documentary (Cassels 2008), Australian academic and journalist Ray Moynihan created his version of the spoof, which involved fake textual artefacts of different kinds.^[1] It started out as an April Fool’s prank, an article published in the British Medical Journal (“Scientists find new disease: Motivational deficiency disorder”, Moynihan 2006), which was followed by a hoax video (“A New Epidemic?”, Burne 2006).

Although the name of the scholar responsible for identifying MoDeD (Dr. “Leth Argos”) and of the drug used for its treatment (“Indolebant”) were clearly fictitious and humorous, and although Moynihan himself revealed that the BMJ post was an April Fool’s prank a few hours after its publication, the spoof generated a lot of interest as major media outlets reported the news of the “discovery” of the disease, often missing the joke (Mirsky 2006). A comment on the spoof article (“MoDeD – not new but re-discovered”) was immediately sent to the BMJ (Head 2006) to confute the assumption that Dr. Argos was the first to research the illness, and the link to Moynihan’s prank was shared online by users who thought it was a genuine scientific communication. It is conceivable that, in spite of its author’s attempts to signal that MoDeD was not a real ailment, his adherence to the conventions of popularising genres made his text credible for most readers.

The success of the spoof (which still generates feedback such as the video tribute “Motivational Deficiency Disorder”, posted on YouTube by comedian John Lawrenson in 2021 (Lawrenson 2021), i.e., 15 years after the appearance of the BMJ article) arguably has to do not only with its believability and humour, but also with the relevance of the topic it addresses. The MoDeD hoax was devised within the medical community with the intent of raising awareness on the increasing practice of “disease mongering”, a pejorative term designating the pathologisation of statuses once only described as “problematic”.

4.1 Linguistic and communicative strategies

The dataset analysed here reveals a significant repertoire of linguistic features that accompany the popularisation of specialised knowledge. These can be divided into surface techniques and those that work on a cognitive level (Garzone 2020: 162–165). The former perform an explanatory function, making specialised terminology more widely comprehensible by employing more familiar lexis from the general word stock, principally in definitions, and by substituting dense specialised phraseology, usually with reformulations of varying length and greater syntactic simplicity.

New medical disorders are regularly announced by technical terms and a preference for information-packed pre- and post-modified noun phrases as opposed to verbal structures. Additionally, definitions are frequently formed by incorporating words derived from the classical languages. The present data is no exception. Thus, we find in the Wikipedia text:

This tendency is parodied in the Moynihan article:

The authentic journalist is less inclined to indulge in this kind of usage, opting, instead, for a mixture of inserted and direct citation of Dr. Barkley:

Every new disorder worthy of the name is heralded with its relevant initialism or acronym, which are at the same time characteristic of the opacity of specialised discourse for the layman. It is also in evidence here. Scholars have accounted for this convention by referring to the extreme compression favoured by specialised discourse, in which the priority is to cram as much factual information into peer-to-peer-specialised communication. As Garzone (2020: 52) has noted, initialisms “contribute to realising the ideal economy and concision that is typical of specialised communication.” These densely packed denominations have to be unpacked for the lay reader by definitions in the appropriate register. The first line of the SCT Wikipedia entry provides a textbook example:

The Moynihan spoof imitates this technique of tagging the abbreviation on to the full designation:

In this case the denomination takes place through an acronym, itself a form of word play that mocks the very disorder it names. “Moded” is a slang word, defined by the Urban Dictionary (2022) as “being most properly used when someone has vehemently defended a position and been proven wrong”.

The practice of defining the abbreviation is replicated in the “straight” news article in The Guardian:

In the context of popularisation such segments often require some form of explanation. Example 7 illustrates one of the ways in which this is done:

This is an instance of exemplification, typically, though, not always, signalled by markers like “such as”, “for example”, “for instance”. The technique works by illustrating a general proposition with specific concrete examples that are nearer widely shared experience. This technique is absent from the spoof. This is likely because the author intends the unexplained pseudoscientific-technical language to ridicule and criticise the tendency of medicalisation proponents to use language to “shock and awe” the lay public into submission and acceptance of their theories. However, a related strategy is present in the text of the news video, where we learn from Leth Argos:

Here the expert speaker provides concrete examples of what the more abstract and general terms mean. Paradoxically, as one would expect from parody and satire, the explanation is patently absurd, though the intention is to ridicule the categorical pronouncements made by proponents of highly debatable theories and discoveries. The Guardian journalist also provides concrete examples in more familiar language to illustrate the meaning of a more opaque, technical statement:

Exemplification may also entail quantification of the disorder.

While this kind of exemplification is absent in the spoof or the newspaper article (unless quoting directly from Barkley), it is particularly prominent in the Wikipedia SCT page, which is most closely associated with the proponent.

Some of these features are not without implications as regards ethical aspects of medicalisation. In the process of popularisation, not all specialised terminology, lexis and syntax is jettisoned. There is a considerable residue that is made accessible by all or some of the above techniques. Specialised terminology and the preponderance of noun phrases, things rather than actions, embodies the priority given to fact in specialised discourse. Redeployed like this in popularising discourse, they convey the impression that a disorder like SCT, for example, is an established and ascertained reality. This impression is consolidated by the presence of abbreviations – initialisms only becoming accepted usage within a community of specialised discourse once the full designation is sufficiently known and established to be regularly substituted by the abbreviated form. Their presence implies agreement rather than debate. It is a seal of approval, so to speak, or, as Woods (2006: 129) puts it:

the naming and labelling of objects, events or people … frequently leads to the establishment of assumptions and expectations about the character and nature of what has been named. This is evidenced in medical discourse.

This type of denomination is the very one used by the original proponent, lampooned by a serious critic of medicalization, and replicated by the journalist.

The consolidated “factuality” of the discourse of medicalization is further extended by the tendency to quantitative exemplification, a feature that will be returned to in Section 4.2. It is to be noted that the explanatory strategies used are preponderantly the surface ones as defined by Garzone (2020). Techniques that work on the cognitive plane, typically analogy in the form of simile or metaphor, are only minimally present, specifically in the Wikipedia text:

Explanation is the least used strategy in the SCT sub-dataset; conceivably, this points to an underlying concern with foregrounding the substantive aspect of the topic when proposing a new disorder.

4.2 The rhetoric of disease mongering, overdiagnosis, and medicalization

The analysis of the rhetorical strategies, carried out by means of a close reading of the texts, highlights how consistent the sub-datasets are at the meso-level of Fairclough’s (1992) model, too. Only one strategy, the use of impossible claims, occurs exclusively in the spoof (cf. examples 8 and 12).

Further rhetorical devices are shared by both sub-datasets, corroborating the hypothesis that the spoof and the “genuine” scientific texts rely on a comparable construction. For instance, The Guardian article, Wikipedia entries on SCT, the hoax video and BMJ feature about MoDeD establish the significance of the condition they describe in quantitative terms.^[6]

The emphasis on the absurdly high number of people affected by MoDeD (5 million in Australia at the time of writing) parodies the tendency to make claims for the pervasiveness of the condition, something which occurs in the example of straight journalism (14). However, this recurrent trait contributes to ensuring the article achieves “threshold” news value (Galtung and Ruge 1970), according to which only phenomena and events that involve large groups are “newsworthy”, i.e., these can be turned into news items and appear in media outlets. A related rhetorical strategy, deployed both by the authors of the spoof and by the scientific journalists covering SCT, is to emphasise the risks involved in underestimating the condition, that is, by failing to appreciate its quantitative importance:

A typical trait of popularising texts is personalization, that is the mention of the names of the scholars who made the discovery. So that the latter’s credibility can be enhanced, their position in their institutions is often underscored (details on previous academic work are not frequent, differently from the conventions of research articles; Hyland 2010). The personalization feature is present in both sub-datasets, where authoritative ‘coiners’ of the condition are identified and described on the basis of their (prestigious) roles:

However, worries about researchers’ connections with drug companies are also expressed, a characteristic press strategy that allows journalists to appear unbiased towards the content they are producing and aware of its possible critical implications:

In example (21), the existence of possible conflict of interest between Dr. Argos and Health Tech is rebutted by the scientist himself in a section of the video. The inclusion of his actual words in the form of direct speech makes it possible for the footage creator not to take responsibility for either the mention or the confutation of the doctor’s involvement with the pharmaceutical company.

Counter-arguments denying the illness status of MoDeD and SCT are also present in the sub-datasets and are embedded in reported speech, another conventional element of scientific journalism. The statements of other scholars, i.e., other medical authorities, about the practice of attributing disease qualities to undesirable conditions are reproduced in the texts analysed. This practice appears as a “matter of concern” in both examples (23) and (24).

The tendency to medicalize and overdiagnose is worrying as it is construed as linked to possible “disease mongering”.

As already noted, the presence of counter-arguments, perplexities about possible conflicts of interest, and the fear of “disease mongering” introduce an element of balance and objectivity into the popularising mission of the media.

4.3 Discursive strategies

The third and final level of analysis traces three main, interrelated discursive strategies underpinning this particular case of medicalization discourse. In each type the strategy hinges on a series of related contrasts between entrenched ways of interpreting and defining human behaviour and a more scientific approach that sees it as a symptom of an underlying medical problem.^[7]

It is difficult to say which of the sub-strategies is the most prominent because they are often intertwined in the same segment of text; so they will be dealt with in the order they occur in the Wikipedia webpage, which has been, as previously pointed out, mainly curated by the proponent of SCT.

The first of this set of contrasts is that of the old with the new, or between once and now. Its importance is suggested by the cluster found at the very beginning of the text:

Each of these examples consolidates the impression that scientific knowledge is intrinsically an improvement on the understanding that preceded it. Thus in example (27), “past uncertainty”, “controversy” and “debate” are to be contrasted with present “certainty”, in which things have become “clear”. Similarly, example (28) foregrounds the limitations of previous understanding and stresses the way in which contemporary investigation fills in important gaps in existing knowledge.

Similar juxtapositions of old and new, then and now, are found in the video and in the newspaper article.

For all its humour, based on the incongruity between laziness and the rather grand scientific definition, as well as the paradoxical relief of discovering that one is actually ill, the text parodies the way the then-now pattern is used in medicalization discourse. Here, too, we see the past, “all my life”, a collocation often used with negative connotations of suffering or frustration, contrasted with a “now” that offers greater understanding. The next example takes this comparison even further:

In this case, the persistence of people in questioning the existence of a disease that has been established for over a century is framed as retrograde and perhaps wrong-headed while, true to its mission, research has now identified the real source of the problem. In each of these examples SCT is framed as the product of enlightenment and a testimony to the way in which science redresses the neglect of the past.

The next related group of contrasts emphasises the difference between illusion and reality, thus between a state of deception, misinterpretation and misunderstanding, on the one hand, and penetration and comprehension, on the other:

Each of the above extracts stresses the way in which, before the research in question, everyone (including the medical world) had been labouring under a misapprehension. The prevalent socially constructed reality (embodied by folk definitions like “aloofness”, “disinterest” or, more comically, “laziness”) is presented as a deceptive appearance by the new reality resulting from scientific investigation, which confidently asserts a new actuality (“in fact”) that contrasts with former misconceptions.

The final strand in these interconnected contrasts involves the association of what were formerly personality traits with pathologies.

It is notable that in each case vaguely defined behaviour like “dreaminess”, “mental fogginess”, “slow working speed”, “naughtiness”, “laziness”, characterised in day-to-day life and assessments by many gradations and degrees of intensity and protractedness, are crystallised into unambiguous, circumscribed terms by this strategy of juxtaposing: “symptoms”, “disorder”, “medical basis”.

All three orders of contrast analysed here, often within the space of a single sentence or clause, are concerned with transforming perception: old, limited knowledge is replaced with new, clear understanding; deceptive appearances give way to reliable factuality; fuzziness comes into sharp focus. This repertoire is used to alter readers’ perception of the condition under discussion. Moreover, the very ‘symptoms’ that are transformed in this medical account are aspects of what were once seen not merely as character traits but as instances of moral deviations like the “deadly sin of sloth” (“laziness”, “dreaminess”, “slow working speed”). Besides the persuasiveness implied in the contrast between the clarity of medical science with the obscurantism of traditional religion, there is also the attraction of release from the judgements and condemnations associated with the latter.