Whispering and Yelling: Unfurling the Rhetorical Advocacy Continuum through Mental Health Social Change Communication

Public Relations, FFST, and Issues

Rhetorical interpretations of PR provide a crucial bedrock of social change and public interest perspectives by unveiling how collectives use persuasion to influence sociopolitical realms, offer positions, and discursively frame issues (Heath, 2006). While early theorizing around PR tended to focus on management perspectives and an organizational unit of analysis, such as helping organizations segment publics (Grunig & Repper, 1992), rhetorical efforts emphasized the discipline’s role in society (Heath et al., 2021). Furthermore, traditional PR theories tended to privilege corporate perspectives, though rhetorical and critical scholarship have theorized about non-profit and social movement actors in promoting and advancing societal discourse (Heath & Waymer, 2009; Wolf, 2018). In addition to evaluating campaign and message-level materials, rhetoric can illuminate PR’s function within the mass mediated marketplace of ideas (Ihlen, 2016). For this study, I work from a definition of PR that incorporates its rhetorical nature and has mass communication significance – PR is a communicative and relational process by which collectives create, embed, and share arguments and discursive meaning in societal deliberative arenas (Edwards, 2016; Heath, 2006).

FFST builds from these rhetorical groundings to posit that productive societal processes rely on discourses and systems that balance specific interests with collective benefit (Heath, 2006). PR work has wide-reaching societal implications (Anderson & Guo, 2021; Logan, 2018) and makes complex issues digestible for public consumption (Edwards, 2018; Len-Ríos, 2023). It unearths how societies manage uncertainty through multivocality within the discourse ecosystem, acknowledging journalism, marketing, government communication, and other crucial processes (Heath, 2006; D.K. Williams et al., 2022). For example, PR spokespeople, from corporations, government, or advocacy organizations, shape news coverage to manage acceptability of or resistance to issues such as child immigrant detention (Len-Ríos, 2023). Thus, PR is not intrinsically good or bad for society or its deliberations, but serves as a tool to garner awareness, influence interpretations, and publicize debate.

FFST’s various propositions incorporate ethical responsibility, cultural context, and strategic approach to ground discourse’s interaction with collective values and shared decision-making (Heath, 2006, 2018; Logan, 2018). Heath (2006) presented reflective management, corporate responsibility, power resource management, community as conflicting and conjoining, communitas and corporatas, collective voice (i.e. organizational communication), responsible advocacy, and narrative for enlightened choice as FFST premises. Given the social change and issues-based focus of this study, collective voice is an appropriate focus. This proposition argues:

Society is a complex of collectivities engaged in variously constructive dialogue and power resource distribution through meeting socially constructed and shared norm-based expectations whereby individuals seek to make enlightened choices in the face of risk, uncertainty, and reward/cost ambiguity. (Heath, 2006, p. 107)

Such a theoretical argument positions advocacy and activism as crucial for new ideas to spur societal advancement and enact democratic processes (Heath, 2018).

Participants

At the time of our interview, most social change communicators were between 46 and 65 years old (22) and many had or were pursuing advanced degrees (26). Within this sample, advocates identified in the following ways: men (10); women (28); White (33), Black or African American (4) and Asian or Asian American (1). I assigned participants pseudonyms to protect their identities. Participants often had diverse backgrounds that complemented their social change communication efforts (e.g. policy, law, social work) and sometimes upheld distinct discourses about mental health (treatment, survivors/consumers, or recovery). For instance, participants from large national or state-based advocacy organizations often aligned with a treatment discourse, while peer-run organizations and coalitions often shared consumer/survivor interpretations. However, participant reflections did not always fit neatly into any one discourse. To protect confidentiality, I do not share specific organization names alongside participant reflections or information. Some examples of organizations include National Alliance on Mental Illness, Mental Health America, MindFreedom International, trade associations, and state-based advocacy organizations. Please see Table 1 for pseudonyms, region, years of experience range, and organization type for all 38 participants. Information is offered in larger categories or ranges to avoid identification.

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Table 1.

Participant Pseudonyms and Demographics.

Pseudonym	Region	Organization scope/type	Years in mental health advocacy
Adam	West	National/Int.	25+
Betty	Southeast	State-based	5–10
Blair	Southeast	Not specified (diagnosis specific)	20–25
Brittany	West	National (local chapter)	0–5
Carmen	Midwest	State-based	10–15
Caroline	Northeast	State-based	20
Cassandra	Midwest	State-based (coalition)	0–5
Darci	Southeast	Not specified	5–10
Emma	West	State-based	25+
Fiona	West	National (local chapter)	25+
Fred	Northeast	Not specified (peer-run)	25+
Hazel	West	State-based	10–15
Jasmine	Northeast	Community-based (local)	10–15
Josh	Northeast	National (local chapter)	10–15
Josie	Northeast	National (local chapter)	5–10
Joy	Northeast	National/Int.	25+
Leila	West	State-based (coalition)	15–20
Liam	West	National (local chapter)	5–10
Lori	West	National (local chapter)	25+
Marissa	Northeast	National (issue specific)	5–10
Mark	West	State-based	15–20
May	Northeast	State-based (coalition)	25+
Nancy	West	National (local chapter)	5–10
Natasha	Northeast	Local (peer-run)	15–20
Olivia	West	State-based (local, peer-run)	15–20
Paul	Northeast	National (peer-run)	10–15
Phil	Northeast	National (constituent specific)	0–5
Priscilla	Northeast	Local/state (constituent specific)	5–10
Rachel	Midwest	State-based (coalition)	20
Sadie	Northeast	Local (peer-run)	10–15
Sally	Midwest	Local (service organization)	0–5
Sami	Northeast	State-based/local	15–20
Stella	West	State-based	0–5
Terry	Southeast	Not specified (constituent-based)	0–5
Timothy	West	Not specified (constituent-based)	5–10
Vickie	West	National (local chapter)	0–5
William	Midwest	State-based	0–5
Yvonne	Southeast	National	0–5

Analysis

I used an interpretive qualitative lens to complement rhetorical theory as it assumes that participants and researchers create meaning together and values participant insight (Hesse-Biber, 2017). An interpretive lens posits that social, political, and cultural realities influence our individual lived experiences (Tracy, 2013). I used speech-to-text AI (non-generative) to create rough drafts of transcripts. I edited each transcript while listening to the recording again and engaged in an exploratory coding and note-taking process. One interviewee chose not to be recorded, so I took detailed notes instead. I coded in an inductive, iterative fashion to understand participant responses and apply them to the research purposes (Tracy, 2013), which necessitated revisiting transcripts and audio multiple times to derive relationships between labels. I focused on answering the research question, allowed the data to guide me, and aspired to uphold participant voices. I wrote memos to reflect on each interview as well as coding/analysis. I also engaged with reflexivity exercises offered by Hesse-Biber (2017, p. 45) to consider how my perspectives and priorities may influence my interpretation of the data. For instance, I thought about how my experiences with mental illness representations and mental health campaigns influenced my beliefs and attitudes about mental health advocacy. Furthermore, the process of writing, whether through memos, thought exercises, or various drafts of this manuscript, constituted an integral step of research, rather than simply a mechanism for the research output (Mitchell & Clark, 2021).

Synonymous or Hierarchical Distinctions? The Advocacy Umbrella

Some participants described advocacy and activism as interlocking pieces of a whole and, thus, may see these rhetorical approaches as synonymous. For instance, Terry shared, “I probably, like most people, use them interchangeably,” though if he had to distinguish, he conceptualized activism as “maybe activism is advocacy in action, like boots on the ground, doing the work, if you will.” Josh worked for a local chapter of a large national advocacy organization. He explained that he saw them as synonymous and clarified activism’s official definition as “vigorous campaigning” to note “that’s exactly what we do. We call it advocacy but you know, you could also call it activism.” He noted that activism sometimes carries a negative connotation which aligned with other participants, such as Hazel and Nancy, who explained activism as associated with aggressiveness. Darci believed advocacy and activism were “one and the same” but, most importantly, should intend to seek better circumstances for people.

Caroline acknowledged that the relationship between the two approaches is context dependent when she clarified, “I don’t think it [activism] has to be [different from advocacy]. I you know, I think that that varies according to kind of organizational mission and personal values.” Natasha explained them as both working toward similar visions, if adhering to the inherent social justice aims:

I see advocacy and activism as really tied into that unrepresented or underrepresented voice and the power differentials and pushing back on those who have power and some people who are out there calling themselves advocates are very much on the power side.

Emma also described that advocacy is sometimes co-opted by industry and corporate interest, which can muddy the otherwise people-first and community-focused nature of advocacy and activism. While participants sometimes continued their statements with reflections on their potential distinctions, their experiences with advocacy and activism outlined overlapping persuasive activities for change that are difficult to distinguish, or ideally synonymous, when used for genuine, emancipatory purposes.

Advocacy was also described as a broader approach, or umbrella, in which activism falls under. As Paul explained from his experience leading a peer-focused organization, “I guess you could argue that activism is a form of advocacy. But I would say not all advocacy is activism.” Similarly, May thought out loud, “I think they’re related. I think activism – that’s actually interesting. I’m just thinking, is advocacy, a form of activism or vice versa? I think activism may be a form of advocacy more than vice versa.” Josie and Leila offered interpretations that aligned with advocacy as an umbrella term, too. Leila acknowledged the subjective nature of describing these approaches, “Well I think that they, they are not, you know, mutually exclusive. I think that within advocacy you have calls to action. And, so I think that that, to me is, it’s [activism] more action oriented.” Adam specified activism as “visible, concrete expressions of advocacy.”

Advocacy and activism’s synonymous uses, and the rhetorical choices they represent, imply that there may be a benefit in not “splitting hairs” between them. However, their interchangeability may also symbolize an underlying labeling strategy to avoid a radical connotation (of activism) or a co-opted by power connotation (for advocacy) in different contexts or for different audiences. Advocacy as a broader orientation that includes activism as a specific form further illuminates reasons for conflation between the two, as umbrella terms may be used to signify an overarching phenomenon in place of more narrow ones. In its macro meaning, advocacy is often positioned as an overarching attempt to garner public support and aligns with FFST’s versions of submitting arguments, facts, and values to a metaphorical arena where discourses compete (Heath et al., 2021). Despite these interpretations about interchangeability or perhaps advocacy as an umbrella term, interviews also illuminated some important distinctions that extend strategic nuances.

Advocacy Outcomes or Activist Spirit? Formality, Passion, and Flexibility

Another interpretation that complicated the relationship between the approaches included advocacy as centered on systems procedures and outcomes whereas activism includes an underlying spirit of civic engagement. For instance, activism presents arguments about social change visions while advocacy served as the “nuts and bolts” of systems change, as Yvonne recounted from her position at a national advocacy organization. Hazel described advocacy as putting a solution forward and going through a process of “give and take.” Nancy suggested that advocacy could be used at individual or organizational levels for gradual systems change while activism represented political movements. Liam expanded on these sentiments to assert that his advocacy work benefited from activists drawing attention to social injustices, but that his work provided closure through solutions. He explained:

I think advocacy is focused, theoretically at least, more on a solution. Here’s the problem. Here’s the fix. I think activism stops short of that. I think activism is – here’s the problem. Isn’t this awful? Something should be done. What is that something?

After commenting on the sometimes-synonymous nature of advocacy and activism and differences across organizational mission, Caroline had a related reflection. She labeled her organization’s work as more advocacy-based or “analytical” than activism in that it conducts and shares research:

So for example, we might develop a white paper and testify before the legislature about what would be best practice but we know that that’s really only going to make a difference if we’re partnering with other organizations that have a network of grassroots activists who can call their legislators and say “this is really important.”

Timothy and Mark also noted that advocacy requires specific solutions or outcomes, while activism emphasizes civic engagement or attention to issues.

Liam concluded that he could avoid participating in activist initiatives to “preserve” his advocacy role and relationships. May avoided civil disobedience efforts, which often align with activism, because of her background in law. Olivia explained how the social change demeanor of activism reflects an individual’s orientation to injustice:

I think advocacy can happen in many different places. But I think by the time you hit activism, it is like inherent in who you are. So, I don’t just speak about, up about mental health and substance misuse injustices, I speak up about the social injustices that lead to people experiencing more mental trauma, mental health and substance misuse.

Jasmine, who worked for a local, community-based organization, said:

I think of advocacy as more formal at times and at times professionalized set of activities, although it doesn’t have to be whereas activism I think, can take forms that, you know, in terms of public protest and certain kinds of performance-like activities as well as certain kinds of confrontations that can happen on a grassroots level that isn’t always easy to pull off if you’re representing an organization.

Joy mentioned that “permission” is needed for many advocacy actions, such as assisting people in obtaining benefits or resources, implying a degree of officiality expected within structured, formal contexts. She continued, “but activism really is about issues, positions and laws that are unjust. And you are doing activism to make people aware and to eventually change it.”

Passion and emotion also drove distinctions between the two rhetorical approaches, emphasizing connotations of aggressiveness that often accompany activism and expectations of subtly related to advocacy. Brittany described advocacy as a “whisper” (suggesting conscientiousness, subtleness) and activism as a “yell” (suggesting disturbance) to describe how she balances the two. She stated, “so your approach as a PR person has to be flexible. There’s sometimes you yell and there’s sometimes you whisper.” She mentioned that the mental health stigma of a particular context and her identity as someone who has experienced a diagnosis informed her approach to oscillating between whispering (advocacy) and yelling (activism). Olivia also mentioned the tension she navigates, having come from a recovery background into a treatment-based context, “I’m less so now joining protests and marches mostly because my colleague and I agreed that like every day, in a certain way, I’m protesting and I’m having to do it very subtly. Very nuanced, ‘have you considered this?’”

These reflections relate to extant research about advocacy and activism as within and external of systems approaches, respectively (Choi, 2025; Zoller, 2005). Advocacy requires professionalization, formality, and rules to propose and facilitate institutional change. Passion and emotion are required for activism that disrupts unjust systems (Martin, 2007), such as when consumer/survivor efforts disrupt treatment, or even recovery, interpretations. These findings also explain scholarship that describes activism as more militant or combative to accentuate the moderate nature of other collectives and highlight compromise as palatable for institutions (Derville, 2005; Stokes & Rubin, 2010). For instance, Liam and Caroline explained how grassroots activism may be necessary to apply external pressure when working within prevailing treatment discourses and systems. Social change communicators not only make intentional decisions about which rhetorical approach to utilize based on a risk assessment of confrontation versus compromise, but they also consider how both work together within the broader orientation of advocacy to shape discourses in different realms (institutional and sociocultural). In that sense, these participants conveyed the two rhetorical approaches as sometimes synergistic and make decisions to blend or avoid one or the other depending on their circumstances and audiences.

Taken alongside reflections about interchangeability and advocacy as an umbrella term, the findings thus far point to two distinct understandings: (a) a macro-level, overarching advocacy that describes putting forth a position in a social change context (Heath et al., 2021); and (b) a narrower, more specific, solution-based advocacy that seeks changes within systems and is more clearly distinguishable from activism (Zoller, 2005). Activism, rather, is a version of civic engagement and visible dissent for sociocultural changemaking (Adi, 2019). In addition to the overlapping and distinct versions of advocacy and activism as rhetorical approaches, participants also noted lobbying and community organizing as central to these discussions.

Expanding Approaches: Lobbying and Community Organizing

Discussions about advocacy, activism, and their differences also brought about the rhetorical efforts of lobbying and community organizing. Lobbying was explained as a highly formal and regulated persuasive approach, and community organizing as a citizen-driven mobilization strategy related to both systems advocacy and activism.

Framework of Social Change Advocacy: A Rhetorical Continuum of Approaches

The broad description of advocacy as an umbrella term, which I will call big “A” Advocacy as modeled after uppercase-lowercase frameworks for macro and micro relationships (e.g. Jian et al., 2008), describes a rhetorical discourse orientation toward social change. In the context of mental health, advocacy can signify the overarching efforts to improve conditions for people with mental illness and/or protect mental health for all citizens. Within this broad orientation, communicators may choose from a variety of approaches to achieve specific goals across institutional or sociocultural discourse spaces – activism, little “a” advocacy, lobbying and community organizing. Little “a” advocacy actions include the specific education and persuasion-based efforts within systems, which differ from activism’s focus on dismantling interlocking social injustices by using external, and often oppositional, tactics (Martin, 2007; McKeever et al., 2023). Additionally, lobbying and community organizing represent advocacy approaches that involve distinct but related persuasive realities. For instance, lobbying is highly regulated for social change organizations (both institutionally and culturally), and community organizing requires mass mobilization toward shared problems. These Advocacy/advocacy meanings are significant because they explain how advocacy and activism can be synonyms, hierarchical, and distinct all at once. Big “A” Advocacy also demonstrates how lobbying and community organizing seamlessly arise in conversations as each approach is not mutually exclusive but rather coexists. Table 2 provides specific definitions, key components, and examples of each Advocacy approach.

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Table 2.

Big “A” Advocacy Rhetorical Approaches with Definitions and Examples.

Advocacy approach	Definition/key components	Example activities
lobbying	Use of persuasion to directly influence decision-makers, and therefore, policies, legislation, and outcomes (can involve individual or mass efforts)	Host meetings or calls with legislators; offer briefings on policy or laws for decision-makers; organize lobby days for citizens to directly interact with legislators
	Often includes formality, expertise, and access though can involve grassroots initiatives
advocacy	Use of persuasion within systems to effect specific changes	Campaigns, workshops, or initiatives to educate community members, journalists, policymakers, and/or organizations; conduct and share research with government, media and/or community members; host trainings with corporations
	Often includes formal roles, solutions, systems outcomes, and compromise
community organizing	Use of persuasion to mobilize local or identity-based collectives to address shared problems	Host community meetings for social problems, mobilize community members to enact agency in decision-making, promote citizen participation in community events
	Often uses local resources and addresses shared problems (can be dissent-based or solutions-based)
activism	Use of persuasion to draw attention to overlapping injustices and social problems	Prepare protests, sit-ins, and civil disobedience events; facilitate boycotts to pressure corporations or government; attract media to garner attention
	Often uses unconventional, informal, and participatory means

Source. In addition to the findings and participant insights, these sources helped inform this table: Choi (2025); Choi and Boling (2026); Ihlen and Raknes (2020); Martin (2007); Morris et al. (2025); Ohmer and Brooks (2013); Staples (2012); Zoller (2005).

A continuum demonstrates how phenomena are inherently connected; distinct yet not mutually exclusive. In this case, the continuum represents the span of institutional to sociocultural influence that different rhetorical approaches can enact when offering ideas and shaping discourses through rhetoric. Different types of Advocacy are governed by different rhetorical rules and social expectations because they operate within different societal spaces. More formal expectations for lobbying and systems advocacy suggest closeness to traditional structures, such as government, health systems, or corporations. As the most institutionally direct, formal, and regulated version of Advocacy, lobbying generally includes relationships with legislators and other decision-makers to influence policy and systems outcomes (Choi & Boling, 2026; Ihlen & Raknes, 2020) and often requires deep embeddedness in and knowledge of conventions, though everyday citizens can submit their arguments in these spaces, too. Not necessarily addressing specific legislation, little “a” advocacy often still involves formal roles, politeness, resources, and knowledge of rules to achieve change (Zoller, 2005). For instance, advocacy may include a corporate or government educational briefing, or a community education campaign. Community organizing represents actions within local contexts to serve the immediate needs of citizens (Morris et al., 2025; Ohmer & Brooks, 2013) often existing between informal, oppositional activist approaches and formal little “a” advocacy means to succeed. Activism is the least direct avenue to decision-makers and institutions, but most direct in sociocultural influence, attempting to change institutions and systems externally, often through culture, political pressure, and public opinion (Martin, 2007; Zoller, 2005). Figure 1 presents a visual representation of the relationship between these social change approaches and continuum of institutional to sociocultural realms.

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Figure 1.

Continuum of social change rhetorical advocacy approaches.

Continuum Relevance Across Advocacy Contexts

This study specifically addresses mental health as a socially contested and often stigmatized issue in the United States. It is specific to a social change and public interest context and would likely not transfer well to for-profit scenarios. However, this framework overlaps with international contexts related to mental health. Mental health social change is a global endeavor, and global organizations are taking on related approaches to those offered in this study. For instance, Saha (2021) outlined a blend of institutional and sociocultural advocacy priorities for India that overlap with this research. Many global organizations also navigate similar tensions of mental health for all and specific services for those with mental illnesses as well as balancing treatment, recovery, and consumer/survivor framings and solutions (Beresford, & Rose, 2023; Crowe, 2022; Saha, 2021; Saraceno & Caldas de Almeida, 2022). Thus, this study’s clarification of rhetorical approaches may apply to other countries with similar political and discursive processes (e.g. Western Europe or Australia) or may apply to other countries when adapted to varied cultural and institutional structures.

Furthermore, the rhetorical advocacy continuum illuminates other issues throughout PR and mass communication, particularly those that are complex, stigmatized, and controversial (Madden, 2019). For example, pregnancy loss awareness advocates and activists have navigated overlapping institutional (i.e. governmental, laws, organizational policy) and sociocultural change (i.e. addressing taboo) alongside tensions between medical expertise and lived experience (Aghazadeh, 2024). Other issues that involve stigma and controversy, such as AIDS, education, or gun violence, also show diverse influences that span governmental and citizen-led advocacy to influence media, culture, and decision-making (Choi, 2025; Madden & Beykont, 2025; McKeever, 2021). As the U.S. and other societies continue to face polarization around a host of social issues, many different disciplines and professions in mass communication also benefit from clearer conceptualizations of these approaches. For instance, how media outlets and journalists conceptualize, label, and frame these approaches matter tremendously in their societal and discursive effects (McCluskey & Kim, 2012; Willems, 2024; D. K. Williams et al., 2022).

Limitations, Future Research, and Conclusion

One major limitation of this study includes the lack of diverse participants according to race, gender identity, and education. I was the only researcher for this project, which means findings and implications are bounded by my biases and experiences. This study privileges U.S. views as I am, and participants were, embedded in this context. Furthermore, this project assumes a social justice orientation of activism and advocacy, which may not represent causes such as pro-life/anti-abortion, anti-vaccine, or other movements (della Porta, 2023). Interviews were also conducted before COVID-19 shutdowns. While this could be a limitation in some ways, it may also serve as a strength in providing a more stable, enduring perspective less influenced by one particular crisis.

Future research should consider how different identity factors (such as race, gender, sexual orientation) and lived experiences influence philosophies and discourses within social issues advocacy. Studies that detail emotion could illuminate more about resilience in the contexts of social change and build from important theoretical work at the intersection of issues and adversity (Anderson & Guo, 2021; Madden, 2019; Madden & Beykont, 2025). Future studies can also help refine and test the relationships between the advocacy approaches offered in the continuum by building from and connecting to existing scales, categories (McKeever et al., 2023), and related policy contexts (Choi & Boling, 2026).

While important research has begun to disentangle advocacy and activism (Choi, 2025; McKeever et al., 2023), they have remained conflated as they exist in a discursive societal milieu. Mental health, like many controversial social issues, inspires a variety of voices in competition for societal understanding and decision-making. Through interviews with 38 mental health social change communicators, I offered firsthand accounts of the persuasive realities of advocacy and activism, which also uncovered lobbying and community organizing as distinct yet overlapping persuasive approaches to change. These communicators serve as rhetors who make decisions about when, how, and why to apply persuasive approaches and are intimately aware of their political and sociocultural consequences. In interpreting their responses, this study situated their lived experiences within extant PR and mass communication literature.

The major contribution of this study is the rhetorical continuum that seeks to disentangle advocacy and activism, while offering nuance about social change persuasion. It also presents discourses as rhetorical artifacts that influence symbolic and policy outcomes for society (Foust & Alvarado, 2018). This continuum serves as a framework for social change advocacy contexts and can help structure investigations in PR and mass communication research while also illuminating the everyday work of advocates and activists. In mass mediated society, where traditional and social media outlets are constantly exposing people to arguments about collective issues, interrogating their persuasive tenets are key to unpacking deliberative consequence.