Matt+Donovan

Sophie Miller

N8309043 Matt Donovan



**“Our Lady of Sorrows” **

“Why my mother chopped off her hair, followed me to the school bus stop that morning in second grade, I didn’t know.”

“Or why she bent down sobbing //don’t let go of my hand //. How long did we stand by the 7-11? Other kids hushed, watching.”

“When the bus clunked to a stop I climbed on first, grabbed a seat in back, my mother outside, hand curled on my window, her face a blur as the bus jerked away.”

“The kid beside me punched my arm. //Who was that man with you // //<span style="font-family: 'Arial','sans-serif'; font-size: 15.3333px;">crying so hard?” //

<span style="display: block; font-family: 'Arial','sans-serif'; text-align: center;">“I said I didn’t know. <span style="display: block; font-family: 'Arial','sans-serif'; text-align: center;">Three times I swore //I don’t know him.”//

<span style="font-family: 'Arial','sans-serif';">This image and poem are used to promote a play performed by Michael Mack <span style="font-family: 'Arial','sans-serif';">titled ‘Hearing <span class="char-title-of-work" style="font-family: 'Arial','sans-serif';"> Voices (Speaking in Tongues)’ <span style="font-family: 'Arial','sans-serif';">. Michael Mack was a young child when his mother was first diagnosed with schizophrenia. Mack’s play is a multi-character monolog that has evolved from a sequence of poems including the one above. These poems form a lyric memoir of Mack and his family navigating the life-changing reality of mental illness. This poem describes the feelings of Mack and the response of himself and others to his mother’s behaviour as he waits at a bus stop one morning on his way to school. The picture depicts a child like drawing on crumpled paper of an adult and child holding hands

//<span style="font-family: 'Arial','sans-serif';">Public Health Issue //

<span style="font-family: 'Arial','sans-serif';">This artefact relates to the issue of mental health illness in Australia, and more specifically the stigma suffered by those with mental illness and also their families. Whilst there has been increasing investment in mental health services and resources in Australia over recent decades, existing societal attitudes means that many people suffering mental illness remain doubly challenged. Not only do they suffer the disability and struggle with the symptoms of their disease, they and their families also suffer the discrimination and prejudice that result from misconceptions about mental illness. The resulting stress and social isolation endured by individuals and their families in turn contributes to worsening mental health outcomes, ultimately increasing this burden of disease.

//<span style="font-family: 'Arial','sans-serif';">Literature review //

<span style="font-family: 'Arial','sans-serif';">The importance of this issue is evident when reviewing data provided by the Australian Bureau of Statistics, indicating one in five Australians aged 16-85 years experienced a mental disorder in 2007 and nearly one in two had experienced a mental disorder at some point in their lives (ABS 2009). The main cause of premature death amongst people with a mental illness is suicide, with more than 10% of suicides occurring within the first 10 years of diagnosis (SANE, 2008). Additionally, there are significant economic costs to the nation, estimated to be approximately $20 billion annually which includes the cost of treatment as well as lost productivity and decreased labour force participation. In 2003, mental disorders were identified as the leading cause of healthy years of life lost due to disability (ABS 2009). Moreover the World Health Organisation predicts that by 2020 depression will contribute the largest share of the burden of disease in the developing world and the second largest worldwide (Australian Institute of Health & Welfare 2001).

<span style="font-family: 'Arial','sans-serif';">In the Middle Ages people believed that mental illness was a result of not being morally strong, and those affected were examples of the weakness of mankind. Unfortunately these cultural perceptions of people with mental illness being weak and/or dangerous and violent persist today with researchers suggesting this leads to prejudicial behaviour toward those affected (Overton & Medina 2008).

<span style="font-family: 'Arial','sans-serif';">In exploring the issue of mental illness, researchers and theorists have conducted numerous studies in an attempt to understand the factors involved in the formation of stigmatising attitudes, the effect of those attitudes on people with mental illness and implications for treatment and service delivery. Research has shown that stigma appears to be widely endorsed in the Western world, is less evident in Asian & African countries and is considered almost non-existent in Islamic societies, although the reason for this variation has not been established (Corrigan & Watson 2002). A 2004 study by SANE Australia found that 80% of consumers and carers surveyed reported experiencing stigma over the previous two-year period (SANE Australia 2004).Research suggests having a good social network is considered to act as a buffer against stress, reduce illness and have a positive effect on general wellbeing. Conversely social isolation can make it significantly harder for people with mental illness to recover or cope with their mental health problems and increases the risk of suicide (Elisha & Hocking 2005).

<span style="font-family: 'Arial','sans-serif';"> In 2001 Link & Phelan theorised that stigma is a 4 step process. Initially a person is labelled according to some socially relevant ‘difference’. Then there is an association made between the label and a stereotype (often negative such as dangerous and/or lazy). Thirdly is the separation of ‘us’ and ‘them’. Lastly there is an association with discrimination e.g. rejection, exclusion etc.

<span style="font-family: 'Arial','sans-serif';">Studies by Phelan & Basow (2007) and Feldman & Crandall (2007) involving undergraduate students support Link & Phelan’s theory & found labelling predicted increased negative stereotyping which led to increased discrimination and a desire for social distance from the supposed mentally ill person. Feldman & Crandall actually isolated three factors that were most likely to lead to stigmatisation and social rejection. These included perceptions that mentally ill people are dangerous, that they are responsible for their own illness and that mental illness is rare. The studies examined social rejection as an aspect of stigma as researchers believe it to be damaging, distressing and disruptive to the lives of those affected & a cause of potential harm (Johnstone 2001). The perception of personal responsibility is thought to result in anger, low levels of assistance and increased avoidance and punishment that is also felt by the families of those affected (Feldman & Crandall 2007).

<span style="font-family: 'Arial','sans-serif';">These findings are further supported by Reavley and Jorm (2011) who conducted a survey of Australian high school students (n=1804) based on a vignette of a young person with depression. A questionnaire was used to assess students’ personal and perceived stigma towards a depressed peer. Results revealed that of those who recognised depression, most were more likely to believe the person was sick rather than weak, but were more likely to believe the person was dangerous and/or unpredictable. Whilst these studies reflect similar societal attitudes, they are limited by their cross- sectional nature in that results can’t be generalised to the community in general as most participants were students. Also the use of self-report data may be affected by social desirability bias. Additionally the scenario & questionnaire format used may misrepresent actual behaviour & attitudes as they are not real-life situations

<span style="font-family: 'Arial','sans-serif';">Importantly research suggests stigmatisation resulting in social rejection may not only adversely affect quality of life, but may cause a person to feel socially disconnected and/or abnormal, which may act as a barrier to people seeking help. If help is even sought, stigmatisation can influence the efficacy of a person’s treatment (Overton & Medina 2008). This was evidenced in a study by Eisenberg et al (2009) that measured personal attitudes of students toward those who had received treatment for mental illness. Results indicated personally held stigmatising beliefs represented a significant barrier to seeking help for mental illness. This is supported by evidence that suggests only about a third of adolescents with anxiety or symptoms of depression seek appropriate help (Rickwood, Deane & Wilson 2007). Moreover when people do seek help, they may be faced with avoidance, coercive treatment, and attitudes of treatment providers that endorse segregation in institutions (Reavley & Jorm 2011).

<span style="font-family: 'Arial','sans-serif';">The sigma of mental illness also extends to families of those affected. Family stigma involves attitudes of blame, shame and contamination where family members are blamed for someone’s mental illness. This in turn may make the family member feel ashamed or less worthy resulting in social isolation from the community in general. For example some may perceive children of a person with a mental health illness as being contaminated in some way (Larson et.al.2008). This is as concerning for the sufferers themselves as well as their families given the suggestion that stigma may detrimentally affect a person’s self-esteem and personal identity which research suggests leads to increased mood and anxiety disorders resulting from distorted views of self. This combined with the fact that family members may also suffer social isolation, discrimination in employment and/or housing, and receive less public empathy and in turn assistance, means even those who support loved ones with mental illness may be at risk of developing a mental disorder as a result of stigmatisation (Larson et.al.2008).

//<span style="font-family: 'Arial','sans-serif';">Cultural & social analysis //

<span style="font-family: 'Arial','sans-serif';">In trying to understand and redress this public health issue, it is important to appreciate the cultural and social trends of the past and the future, and the problems and challenges they may generate. Theorist Emile Durkheim suggested our actions are influenced by underlying social influences such as culture, social norms, religion, family and economy (Van Krieken 2006). In particular Durkheim’s theory relates suicide to an individual’s degree of social support and their ability to cope with stress that arises as a result of rapid social change. He describes egoistic suicide as being a consequence of severe social isolation that is extremely stressful as individuals have no connectedness to other social entities (Willis et.al. 2002).

<span style="font-family: 'Arial','sans-serif';">Research surrounding stigmatisation and the degree of social isolation that follows lends support to this theory, as does public health data that reports people with mental illness are more at risk of adverse health, economic and social outcomes (ABS 2008). The Australian Productivity Commission found of six major health conditions, the mentally ill are the least likely to be employed. People with mental illness are overrepresented in homeless populations and in prisons, with up to 75% of the homeless & around 40% of prisoners experiencing mental illness (ABS 2008). The prevalence rates of mental illness are highest in adolescent years when those affected may be trying to establish occupations and are beginning to have families, thus involving personal, social and economic change (ABS 2008).

<span style="font-family: 'Arial','sans-serif';">Other theorists such as Beck 1992 also believed that during rapid social transition the lack of supportive organisations such as family & church means people are more obligated to depend solely on themselves (Willis et.al. 2007). Beck purports that where circumstances such as unemployment, & exposure to violence exist, a ‘risk’ society is realised, where people are more vulnerable to economic and personal stressors as they are left to solve their own problems. They may in turn may feel hopeless, have fewer coping skills and may increasingly suffer mental illness (Willis et.al 2007).

<span style="font-family: 'Arial','sans-serif';">Whilst the societies Durkheim studied were undergoing industrialisation, society today is considered post modern, where protective institutions such as the traditional family are ill defined, social cohesion is tenuous and economic fluctuation seems uncontrolled (Willis et.al 2007). Postmodernists suggest the emphasis on social structures and material relations does not apply to social life today. Instead Individualism is pervasive in the social life of western countries including Australia (Eckersley & Dear 2002).

<span style="font-family: 'Arial','sans-serif';">Changes in mass media & information technology in recent decades means the power of media is very dominant in postmodern society (Willis et.al 2002). In the absence of cultural and social foundations that negate stress such as families, religion & community, people often seek external agency such as mass media to guide their actions and provide reassurance in decision making (Willis et.al 2002). Unfortunately, the media often portrays people with mental illness as dangerous, violent and/or childlike social outcasts. The audience relates to the limited information they receive which amplifies the public disapproval of persons with mental illness (Overton & Medina). It is not unreasonable then, to suggest that in our society where representations of reality in media are considered real and our identity seems more defined by the car we drive and the mobile phone we use, those who suffer mental illness and/or are unemployed, homeless or economically disadvantaged are increasingly stigmatised and isolated in post modern society.

<span style="font-family: 'Arial','sans-serif';">On a positive note, post modernism means there are many and varied resources and information sites about mental illness available to people both electronically and through media advertising, This is very important as the negative personal perception of people with mental illness and the resulting stigmatisation appears to be inherent in existing social structures, such as the way resources are allocated, services are provided and the way the media portrays the mentally ill. For example, although $4.7 billion was spent on mental health services in 2006-07, mental health funding as a share of government spending has remained fairly unchanged for the last 15 years (ABS 2008).

<span style="font-family: 'Arial','sans-serif';">More recently there has been much progress in the area of education with organisations such as ‘Beyond Blue’ providing much needed information regarding illness such as depression and anxiety. Tools for clinician training are available that will hopefully remove some of the barriers to treatment services, and eliminate negative attitudes of service providers, employers and the public generally (Beyond Blue Australia). Moreover efforts need to be focused on strategies to prevent mental illness that particularly focus on those in society with identified risk factors such as the unemployed, economically disadvantaged and socially isolated. Additionally the education of those reporting mental illness and guidelines for mass media to use to ensure appropriate reporting of mental health topics and incidents should be instigated as soon as possible.

//<span style="font-family: 'Arial','sans-serif';">Analysis of Artefact and learning reflections //

<span style="font-family: 'Arial','sans-serif';">This Artefact represents the stigma associated with mental illness for a mother suffering schizophrenia and her son. The language used portrays confusion regarding his mother’s behaviour and the words “Other kids hushed, watching” suggest fear about what they didn’t understand and what they considered to be bizarre behaviour. Her bending down and sobbing ‘don’t let go of my hand’ reflects the loneliness and despair she felt, and her need for comfort and security. His eagerness to board the bus and his denial of his mother reflects the shame and embarrassment he felt and his fear of being stigmatised and socially outcast by his peers. His words also suggest a level of guilt for denying his mothers identity. The picture drawn by a child shows a mother and son standing tall with hands joining and represents the bond Mac has with his mother despite her mental illness. The crumpled paper suggests he may keep this picture with him to remind him of his love for his mother and their relationship as family despite their struggle against discrimination and rejection. <span style="font-family: 'Arial','sans-serif';">Whilst I understood the fact that those with mental illness may be loathe to share this information in case they were excluded by their peers, I previously had not realised the extent to which stigmatisation is so prevalent in society. I think it is only through people talking about their illness and having contact with others that attitudes will change and people will realise they have nothing to fear. However I have learnt just how difficult that might be given the negative perceptions that exist, and realise stigmatisation is as big a problem, if not more so, than mental illness itself.


 * <span style="font-family: 'Arial','sans-serif';">References **

<span style="font-family: 'Arial','sans-serif';">Australian Bureau of Statistics. (2008). // [|2007 National Survey of Mental Health and Wellbeing: Summary of Results] (ABS cat. no. 4326.0), p. 21.// <span style="font-family: 'Arial','sans-serif';">Retrieved from []

<span style="font-family: 'Arial','sans-serif';">Australian Bureau of Statistics. (2009). //Australian Social Trends//, //March 2009: Mental Health// (ABS cat. no. 4102.0), p. 13-17. <span style="font-family: 'Arial','sans-serif';">Retrieved from [|www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4102.0March%202009] ?

<span style="font-family: 'Arial','sans-serif';">Australian Institute of Health and Welfare. (2001). //National Health Priority Areas Report on Mental health// <span style="font-family: 'Arial','sans-serif';">Retrieved from []

<span style="font-family: 'Arial','sans-serif';">Beyond Blue: The national depression initiative. Retrieved from www.beyondblue.org.au

<span style="font-family: 'Arial','sans-serif';">Corrigan,P. & Watson,A. (2002). Understanding the impact of stigma on people with mental illness //World Psychiatry 1:1 16-18.//

<span style="font-family: 'Arial','sans-serif';">Eckersley R. & Dear, K. (2002). Cultural correlates of youth suicide, //Social Science & Medicine,// vol. 55, no. 11, pp. 1891-1904//.// Retrieved from http://www.richardeckersley.com.au/attachments/SSM_youthsuicide_1.pdf

<span style="font-family: 'Arial','sans-serif';">Eisenberg, D., Downs, M., Golberstein, E. & Zivin, K. (2009). Stigma and Help Seeking for Mental Health Among College Students. //Medical Care Research and Review 66:5 522-537//

<span style="font-family: 'Arial','sans-serif';">Elisha,D & Hocking,B. (2005). Reducing Social Isolation in People with a Mental Illness: Views of Consumers and Carers. //Health Issues. 85:16-19.// Retrieved from <span style="font-family: 'Arial','sans-serif';">http://www.healthissuescentre.org.au/documents/items/2008/05/206501-upload-00001.pdf

<span style="font-family: 'Arial','sans-serif';">Feldman, D.B. & Crandall, C.S. (2007). Dimensions of Mental Illness Stigma: What About Mental Illness Causes Social Rejection? <span class="italic" style="font-family: 'Arial','sans-serif';">//Journal of Social and Clinical Psychology,// <span style="font-family: 'Arial','sans-serif';"> // 26 (2),// 137-154. Retrieved from Academic Research Library. (Document ID: 1241728931).

<span style="font-family: 'Arial','sans-serif';">Johnstone, M.J. (2001). Stigma, social justice and the rights of the mentally ill: Challenging the status quo. //Australian and New Zealand Journal of Mental Health Nursing, 10: 200–209//. doi: 10.1046/j.1440-0979.2001.00212.x

<span style="font-family: 'Arial','sans-serif';">Larson, J. E. & Corrigan, P. (2008). The Stigma of Families with Mental Illness. //Academic Psychiatry 32:2// 87-91

<span style="font-family: 'Arial','sans-serif';">Overton, S.L & Medina, S.L. (2008). The Stigma of Mental Illness. //Journal of Counselling and Development, 86, 2.// 143-149

<span style="font-family: 'Arial','sans-serif';">Phelan, J. E. & Basow, S. A. (2007), College Students' Attitudes toward Mental Illness: An Examination of the Stigma Process. //Journal of Applied Social Psychology, 37//: 2877–2902. doi: 10.1111/j.1559-1816.2007.00286.x

<span style="font-family: 'Arial','sans-serif';">Reavely, N. & Jorn, A. (2011). Depression stigma in Australian high school students. //Youth Studies Australia; v.30 n.2// p.33-40 Retrieved from http://search.informit.com.au.ezp01.library.qut.edu.au/fullText;dn=187373;res=AEIPT> ISSN: 1038-2569.

<span style="font-family: 'Arial','sans-serif';">Rickwood, D.J., Deane, F.P. & Wilson, C.J. (2007). When and how do young people seek professional help for mental health problems? //Medical Journal of Australia, v.187, n.7, S.35-9.// Retrieved from []

<span style="font-family: 'Arial','sans-serif';">Van Krieken, Robert, et al (2006) Sociology: themes and perspectives 3rd edition Chapter 1 Pearson, Frenchs Forest p.4-16

<span style="font-family: 'Arial','sans-serif';">Willis L.A., Coombs D.W., Cockerham.W.C. & Frison S.L. (2002) Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide. //Social Science & Medicine 55// 907-920