'Nothing+Fits,+I+Have+Nothing'+-+Social+Support+in+Mental+Illness

Name: Chloe Ashton Student Number: n8309388 Tutor: Katie Page



**//"Breathe in deep,// ** **//A sea of desperate dreams.// **  **//I have no mouth,// **  **//and I must scream."// **

This artefact represents the subconscious mind of Christina, an 18-year-old Brisbane student who has experienced an array of mental illnesses which first occurred at an early age. These illnesses included major depression, Obsessive Compulsive Disorder (OCD) and anxiety disorders. In the seven years that I have known her, I have come to love her quirky passions for ancient history and biology, her Scottish humour and her heart of gold. In the mind-map above, there is an abstract display of song lyrics, chemical equations, personal feelings and even extracts of ancient history funerary practices. Interestingly, Christina has no recollection of penning these thoughts.

="Nothing Fits, I Have Nothing" - Social Support in Mental Health. =

//__So, What's the Issue?__//

For much of the twentieth century, a lack of mental health education resulted in the general public believing that crime and violent behaviour were characteristics of all mental illness (Francis, et al., 2004; Jorm, Christensen & Griffiths, 2005). These negative attributes had a detrimental effect on community perceptions and in turn, had an unfavourable impact on those who suffered from mental illnesses (Francis, et al., 2004). Despite Beck and Greenberg (1974 as cited in Davies, 2003) recognising that individuals with depression have pessimistic views not only of themselves but also of the world and the future, society continuously ostracised, ridiculed and ignored these individuals who seemed to not conform to collective norms due to their mental illnesses. At the turn of the century, acceptance of mental health has only slightly improved within the Australian society (Jorm, Christensen & Griffiths, 2006); however there remains a distinct inequality in social support for those who suffer a mental illness and those who do not. This lack of social support is influenced by societal beliefs. Therefore, in this analysis, social support systems required for mental illness suffers will be examined, complemented by Christina's cultural artefact which depicts an on-going war with not only the world, but also her own mind.

//__Okay, What Does the Literature Say?__//

This is the unfortunate reality: a prognostic report was produced for the World Health Organisation in 1996, detailing global mortality rates and the burden from disease which may occur between 2002 and 2030. Depression was predicted to have one of the highest non-communicable disease rates by 2020 (World Bank & Harvard School of Public Health, 1996). In Australia, forty-five per cent of the respondents to the National Survey of Mental Health and Wellbeing in 2007 had experienced a mental illness in their lifetime; equating to just over seven million Australians aged between 16 and 85 (Australian Institute of Health and Welfare, 2010). The Australian Government injected $4.1 billion into the mental health care system in 2006, which will bring much needed funds to a suffering system. It will be the upgrades to facilities, professional training and state of the art technologies that will quickly consume the governmental funds. When estimating expenditure required for the mental health care system, economists have failed to include one other important point: negative societal perceptions should also be considered in the estimation of mental illness expenditure (Wolff, 2007). Mental illnesses can stem from many factors, including biological predisposition and sociological events. Bullying, the loss of a family member and even economic stability can trigger depression or anxiety which can dangerously escalate (Davies, 2003). Moreover, despite society having the potential to incite ill health, mental illness maintains its negative connotations. Such prejudiced views were seen in populations that lacked secondary and tertiary education as well as exposure to mental illness in their social networks (Jorm, et al., 2005). On the contrary, tertiary educated populations were not immune to viewing mental illness negatively. The damning “Not for Service” report from the Mental Health Council of Australia highlighted the lack of dignity and respect received from health professionals during consultations with family, friends, carers and patients (Mental Health Council of Australia, 2005).

Self-sufficiency, such as an income from employment, is quintessential to improve ill health, and a lack of autonomy due to lack of employment or lack of assistance in the employment can lead to feelings of rejection, isolation and humiliation (Stroschein 2006; Davies, 2003; McNair, Highet, Hickey & Davenport, 2002). While companies continue to source workers from overseas which SANE Research (2008) condemns, especially when persons with histories of mental illnesses are rejected. Many people who have a mental illness are, in fact, capable of working in a number of fields. It is due to outright discrimination whereby work-place bullying, insufficient support, reduction in hours and unfair dismissal are common occurrences for mental illness sufferers (Huxley & Thornicroft, 2003).

Social inclusion was undefinied due to its many contexts, therefore in this analysis; social inclusion shall hereby be defined as a sense of belonging, involvement and communal conntectedness in social networks including friendships (Le Boutillier & Croucher, 2010). A result of a study by Brockman (1979, as cited in Eaton, 1986) highlighted the significant amount of social rejection conveyed when one was perceived as mentally ill. Three decades later and current sociology literature of mental illness retains a defined presence of stigmatisation, social isolation and exclusion (SANE Research, 2006; McNair, et al., 2003; Huxley & Thornicroft, 2007). This is especially an issue in young adults as mental health literacy in young adults is still relatively modest. Despite 26 per cent of young adults between the ages of 16 and 25 identified themselves as having experienced a mental illness in 2006 (Varlow, et al., 2009) and are being exposed to depression, substance abuse, anxiety disorders, personality disorders, bipolar disorders and eating disorders in friends and family, they remain disinclined to utilise professional help services (Hickie, Luscombe, Daveport & Highet, 2007). Reliance on peer support is the preferred method for adolescents and in one study, this was found to possibly impact on young adults and their quality of friendships. King and Terrance’s (2008) study displayed a positive correlation between attributes of close friendships and mental health status. It can be surmised that this correlation can be a result from reliance on unguided peer support which is sought as opposed to professional health services.

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">Currently, many non-governmental organisations are attempting to combat mental health issues, especially in young adults (Varlow, et al., 2009). //Beyondblue// and //headspace// endeavour to raise awareness of the prevalence of mental illnesses within diverse populations as well as the unjust discrimination projected through programs, campaigns and events. Church groups such as the Salvation Army provide spiritual support as well as non-denominational financial, employment opportunities, professional counselling, free basic medical care and housing assistance without discrimination (Salvation Army, 2011). With increasing focus on the importance of mental health, Australia was ranked third regarding the efforts that are taken to accept mental illness and the portrayal of mental illnesses in the media has become increasingly positive, which will have a direct impact on the beliefs of an individual (Gaebel, Ahrens & Schlamann, 2010; Francis, et al., 2004). Only in the past thirty years has psychiatry begun to theoretically conceptualise mental health (Vaillant, 2003). Corrigan (2000) identified four general methods which are used in mental health research: laboratory experiments, surveys, ethnography and linguistic analysis. However, these methodologies are not resistant to reliability and validity issues. For example, surveys rely on self-reporting, and this can result in invalid results unless the participant was diagnosed by a psychiatrist according to state law diagnostic criterion. Mental illness lacks a concrete definition as it encompasses many illnesses which differ in severity (Hawkins, 2010). This will continue to work against changing the literature to reflect positive attitudes of mental health.

//__ An Analysis of Society __// <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">The foundation of social support lies in Emile Durkheim's Suicide Theory (1897). It was proposed that concrete social structures with strict standards allowed for the ostracism of behaviours considered deviant (Cohen, Underwood & Gottlieb, 2000). Durkheim postulated that other networks should be established to allow for idiosyncratic groups. In his eyes, the world was a collective society, which did not allow for deviation of set norms and this had detrimental effects on the health and well-being of the population (Tomasi, 2000). When applied to modern society, the traditional negative views of mental illness are disappearing however inadequate social support is the causing the “suicide” of positive concepts toward mental health and those with mental illnesses. This can result in longer recovery time, lack of medication adherence, solidarity and a detrimental view on life.

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">When it was found in previous studies that social support was linked to positive psychological and physical health outcomes, House (1981) developed a model which described three forms of supporting behaviours (Cohen and Wills, 1985). Instrumental, informational and emotional support each represented different avenues of support that are required for positive psychological and physical health outcomes (Thoits, 1986; Corrigan, 2000). These behaviours have the ability to be implemented in many areas of society including health departments, social networks and individuals.

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">Instrumental support involves financial aid and home assistance (Cohen & Wills, 1985; Killbourne, McCarthy, Post, Welsh and Blow, 2007). This form of support is specific to the governmental health departments and non-for-profit organisations such as BlueCare and the Salvation Army. Instrumental supports given by these organisations are essential within society, as connectedness is enhanced between the mental illness sufferer, their friends, family and the community. Furthermore, additional assistance such as financial assistance to those who are either unable or who are out of work. When a community lacks instrumental support, those who experience mental illnesses experience increased feelings of solitude and isolation and thus may be hospitalised more frequently for longer durations (Killbourne, et al., 2007).

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">Informational support is defined as exchanging information which relates to personal experiences (Taylor, 1999 as cited in Stroschein, 2006). In the twenty-first century we have the ability to instantaneously communicate with someone who is in another town, city, and state or on the other side of the world. There is no doubt that the internet has the potential to enhance and diversify social interactions (Webb, Burns & Collin, 2008). People with similar personalities and issues tend to group in a setting where they are able to share their experiences without perceived judgement and in online forums, this type of support can be exchanged with the benefits of creating friendships (Schon, 2010) An advantageous factor that drives internet engagement in chat rooms is the premise of anonymity as websites that maintain obscurity are more favourable to those who suffer a mental illness (Leach, et al., 2007). The ability to exist within an online community and have the ability to control what information is released can be comforting to someone who may be judged by their mental illness. It also gives the chance to regain humility, individuality, identity and confidence to prepare to face the outside world comfortably. An initiative by the Centre for Mental Health Research at the Australian National University saw BlueBoards Chat forums go online, which provides a safe and secure space to discuss mental illnesses or issues surrounding this topic (Australian National University, 2011).

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">Emotional support has many definitions; however, in the context of social support, it is henceforth defined as a personal feeling of belonging, acceptance and unconditional love (Langford, Bowsher, Maloney & Lillis, 1997; Moss, 1973). Killbourne, et al., (2007) studied social support opportunities for veterans and discovered that patients diagnosed with a serious mental illness reported extremely low levels of social support across all dimensions; however, this was more evident in emotional support. Considering the ability to hold friendships is essential for healthy mental and physical health, it is absolutely vital that emotional support is provided for those who experience a mental illness (Caine, 2008). A lack of emotional support was also associated with higher rates of suicidal ideation and decreased cognitive functioning (Killbourne, et al., (2007). To increase emotional support in mental health, carers, family and friends should be made aware of the importance of this type of support. Many of these stakeholders may not know how to emotionally deal with someone who has a mental illness, therefore it is important that they can emotionally connect as opposed to simply “looking after” as the benefits are immensely positive.

<span style="font-family: tahoma,geneva,sans-serif; font-size: 90%;">In order to implement social support in the community, barriers will be encountered. Firstly, employment is highly sought by those with a mental illness; however employers were met with the consequence of providing ongoing encouragement and support to the employee and also the rest of the staff to remove barriers in stigmatisation (SANE Research, 2008). Incentive Incentives from employers may be involved as well as extra training to appropriately deal with this issue. Secondly, high use of technology could contribute towards further education of the general public. Currently, YouTube and Facebook advertise programs, foundations and products on sidebars and prior to video viewing. Public health experts need to collaborate with the wider media and educational experts, as research has shown that media and education combined have reduced stigmatisation, and this success can be attributed to positive views in media, which has an impact on societal views (Francis, et al., 2004; Jorm, Christensen & Griffiths, 2005). This method of education advertising could improve mental health literacy as technological advances have allowed access to social and news media in almost every part of the globe. Conversely, exuberant exposure to internet may promote further solitude, which would deter from receiving the intended message. It is important for these issues to be identified and combated as with the rates of mental illness on the rise, we need as much support as we can get.

//__ How Does that Relate to the Artefact? __// <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">Have you ever felt defenceless against your thoughts? Have you ever been constantly bombarded with nonsensical imagery and emotion so vivid that you can’t sleep? The constant bombarding of intensely fragmented and capricious thoughts is experienced by Christina on a daily basis. Christina's subconscious mind mapped out her inner emotions onto a blank page through song lyrics, calorimetric equations, excerpts of fiction, history and chemistry literature, chemical equations and her thoughts on previous experiences. There are particularly emotionally evoking sentences, such as:

**<span style="color: gray; font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">//“Breathe in deep, a sea of desperate dreams. I have no mouth and I must scream.”// ** <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">These lyrics can symbolise how difficult it is for Christina to verbally speak up about her feelings. She believes that she has no voice and is desperately dreaming however feels suffocated or silenced. This may be because she doesn't have anyone to disclose or feels as if she can't explain her feelings. Many people with mental illnesses may experience the feeling of being silenced.

**<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">//“ Only those who are worthy reach perfection” // ** **<span style="color: gray; font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">//“Nothing fits. I have nothing.”// ** **<span style="color: gray; font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">//It's bad enough, no need to make it worse.”// ** **<span style="color: gray; font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">//“It won't make you interesting. Don't bother.”// ** <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">With these words accompany a desperate want for perfect, or to fit in. Lacking confidence, however, Christina may simply not want to make a fuss about it as she believes that she isn't of value to those around her. A loss of importance, belonging and identity are experienced by everyone at least once throughout their life, and while a mental illness may not form from it, it is still vitally important that a community and as individuals, we support each other in every way possible for positive health outcomes. <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 90%;">This analysis on social support has revealed an ignorant side to humanity. When reading through research papers, it has brought me to the full realisation that these participants who reveal their disastrous encounters with a broken health care system are not just statistics, but real human beings. Human beings who are being brandished with labels when all they need is love and support to get them through the tough times. Knowing Christina personally, it has been tough to try and comprehend how she felt the night that she wrote all these emotions on the page. Although I probably never will feel like that in my life, I know that isn't important. What is important is that Christina knows that I will continue to love her and support her, even her radical plan to resurrect dinosaurs in 30 years.

<span style="color: black; font-family: Tahoma,Geneva,sans-serif; font-size: 80%;">Reference List

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<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 80%;">Reflections <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 80%;">1. Mental Health - Anxiety and Depression. Are We Making it Worse? http://healthculturesociety.wikispaces.com/Mental+Health+-+Anxiety+and+Depression%2C+are+we+making+it+worse%3F

=Yes, we are definitely making it worse.=

The song that you chose was very fitting to the concept of mental health. :) In your literature review, you did really well in exploring what can cause and exacerbate mental illnesses and how society can play a large role in how mental illness is seen and that in fact, we are most definitely making it worse. It was interesting to read that as Australia is an individualist country, this can work against us in suicidal rates. It is quite frightening that a celebrated characteristic such as being an individual can have severe consequences. Your analysis of the song complements the lyrics and paints a very distressing picture of how people with mental illnesses much feel. You've done a very good job overall. :)

2. Australians - Unsatisfied with Sex in the Classroom http://healthculturesociety.wikispaces.com/Australians+-+Unsatisfied+with+sex+in+the+classroom =Nice job!= You've done a wonderful job with this assignment. As you touched on, homosexual safe sex practice advocation is rarely seen in the media. This is utterly barbaric and there is absolutely no reason for this ignorance. Another point is the recent "Ripnroll" safe sex campaign which caused a lot of controversey in Brisbane? The statistics that you presented were quite confronting, however it is the reality, and unless we change the way we teach safe sex practices, everything will spiral out of control. Also, I agree with you in that sex education in schools is extremely poor. The extent of my sex education was a 30 minute lesson whereby a young female teacher sat awkwardly for 27 minutes and then took 3 minutes to show us how to put a condom on a whiteboard maker. It was pathetic, really.. Very well done! :)