SOC327 2017 Tut11 – Wed 1530

According to Beyond Blue, it is estimated that in 1 year, 1 million Australian adults will experience depression and 2 million will experience anxiety; that 45% of Australians will experience mental health problem in their lifetime; that; and that 1 in 4 women and 1 in 6 men will experience depression.

However, anxiety, depression and sadness are only some of the difficult (or what I would call primary) emotions associated with mental illness. Those who experience it also have to deal with the stigma associated with mental illness, and with a range of secondary emotions associated – disgust, embarrassment, guilt and shame – associated with the experience of stigma. Erving Goffman described stigma as a discrepancy between a virtual and an actual social identity, where a person is “reduced in our minds from a whole and usual person to a tainted, discounted one.” Whether at work, home, school or in public, having to hide one’s condition – or suffer the indignity of being treated as a ‘tainted’ person – only compounds the difficult emotional experience of managing a mental illness.

Kathy Charmaz provides a critical sociological perspective to the problem, in arguing that our society sets up standards of normal health – a ‘core’ of healthy images and spaces – and expects people to either commit to a clear core (be consistently healthy) or accept a marginalized position outside of this (with an internalized, stigmatized, and shameful identity), but not to ‘pretend’ health or ‘exaggerate’ one’s illness, as those with mental illness are often suspect of doing. Gillian Bendelow notes that the great rise in pharmacological treatments over previous decades and that the use of anti-depressants is seen as the more socially conventional and acceptable approach to the ‘treatment’ of mental illness. Evidence of this can be seen in the fact that Australia now ranks second in the world in anti-depressant prescriptions.

Are more anti-depressants the solution? Davey and Chan (2012) challenge their effectiveness, and suggest that they should be increasingly used only in combination with psychotherapeutic approaches. However, this approach still individualises the problem, and does little to look at the social conditions and the stigma that compounds the experience of mental illness. Perhaps its time to move the focus away from the ‘core’ and towards the periphery, and do more to end the stigma associated with mental illness, anxiety and depression?

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21 Comments

  1. Im not sure that moving away from the ‘core’ and looking at the periphery is the answer to destigmatizing mental health issues. By attempting to do this are we not risking normalising the impacts of mental health on society and furthermore pushing the stigma into hiding?

    I think we need to address all areas of mental health. Firstly the overmedicalization of children and the misdiagnosis of mental illness needs to be overhauled. Oyr doctors are under enromous presure to getting patients in and out as quick as possible and are often not receiving adequate training on medications they are supplying. Bendelow suggests that some doctors only receive product training from Pharma companies..room for bias?

    Perhaps, with more With more attention being paid to the core then maybe we can come to a better understanding as a society.

    While I believe the current ‘individualisation’ of mental health perpetuates stigma and primary feelings of guilt, shame and embarrassment. As a society we need to consider how we choose to view these feelings and how our social policies support the destigmatization of mental illness. We need to consider how our most vunerable citizens are viewed and treated by society.

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  2. Davey and Chan (2012) argue that when medications are prescribed to treat mental illnesses, they should be part of a broader treatment plan, or used in conjunction with psychotherapeutic approaches. However, the study and training required to practice psychotherapy is an extremely expensive and a highly selective process and as a consequence, most therapists tend to be “stereotypically white, highly educated and upper or middle class” (Bendelow, 2009, p.99). Bendelow (2009) argues that this can lead to feelings of pressure amongst mental illness sufferers to exhibit an acceptable level of articulation to receive viable psychotherapeutic treatment. Such a desire for acceptance and a heightened sensitivity to others’ perceptions are associated with feelings of embarrassment, as discussed in the lecture. A patients’ inclination to monitor, change, or hide some aspect of the self can be felt as an impact of the stigma often attached to mental illness or seeking help. The breaking down of stigmas which are so often attached to mental health problems is a large part of the solution in reducing the gap between the prevalence of mental illness and the level of treatment that is sought.

    Bendelow, G 2009, ‘Medical Responses to Emotional and Psychological Distress’, Health, Emotion and the Body, Polity, Cambridge, UK, pp. 80 – 104

    Davy, C 2012, ‘Antidepressants may not be as Effective as we thought, and shouldn’t be the only treatment for depression’, The Conversation

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  3. I don’t necessarily agree with moving the focus away from the ‘core’ and more in the periphery. I think attention should be based on both. The issues are at the core, with over-medicalisation, or using anti-depressants as a bandaid, as well as in the peripheral, with social stigma. Depression and anxiety are disorders, and each person experiences them differently, therefore they are essentially individualised. One patient may not need anti-depressants, and may benefit from an exercise routine, or frequent CBT therapy. Each person is different.

    The issue is the grouping of those who are deemed mentally ill into a group that is seen as not functioning or are up to the same level as anybody else. Stigma is especially strong in the workplace. In my high school psychology class, we had a man come and talk to us who had bipolar disorder. This man was a principle of a well-renowned public primary school in Canberra. During one of his manic episodes, the school found out about his disorder, and asked him to step down. This is not because he couldn’t perform at his job, but because of the stigma from staff, but more from parents of the children, who mostly believed the kids were unsafe under his authority.

    It is for this reason i believe Kathy Charmaz’s sociological perspective is so accurate. Those stigmatised feel shame, and what is worse they may believe that they should be shameful. They then accept this marginalised position, where really, they should not need to. It is society that should be educated and ‘treated’ for this stigma. Maybe they should start doing Cognitive Behavioural Therapy on those people with such a construed mindset.

  4. I do not believe that more anti-depressants is the solution to the rise in Depression, Anxiety and Mental Health issues in Australia. I think that if medication is used in combination with psychotherapeutic approaches then they may be of some benefit initially, but not for the long term. Getting to the root of the problem and trying alternate treatments such as physical exercise, breathing techniques etc. is the best approach. Certainly on an individual case by case basis, there will be patients with a mental illness that may require permanent medication but I think for the majority of people we need to look beyond a quick fix.
    I think there has been real progress over the last few years in getting the word out about mental illness such as depression and anxiety which has removed much of the stigma that was once associated with these conditions. The more aware, we, as a society have become, about how common these illnesses are, the more likely people will come forward and ask for help rather than just suffer in silence. They will also feel less shameful and embarrassed in the process.
    We need to look at what is happening in contemporary society that has seen such an increase in these mental health conditions and address these problems. We need to ask “What is society doing differently today than say 50 years ago?” Or is it that more people will talk about it these days as opposed to earlier times when it was hidden so the true extent of how many people were suffering from conditions such as depression were never fully realised. A very complex problem with no quick fix.
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  5. The argument of moving towards the periphery of the problem is strong, as it will end the stigma of mental illness and encourage people suffering to seek the help that they need – but as we now know through the proliferation of pharmacological trends, would these people simply be ‘treated’ through more medicine, furthering the problem rather than fixing it? Most likely as the training of these professionals are concerned, this will be the case, unfortunately. As the previous tutorial’s question had asked, this would be the band-aid or quick fix solution again.

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  6. Whilst I believe providing solely anti-depressants is not the answer I agree with Davey and Chans (2012) primary argument circulating around medications being used within treatment, should be part of a broader treatment plan not the primary solution.

    For example, Wichers (2014, pp. 1349-1360) research using sampling methodology has contributed to the understanding of the macro-level development of disorders such as anxiety and depression. Wichers argues that the micro-level perspective can be used to identify the smallest building blocks underlying the onset and course of mental health. Psychopathology is a result interplay between micro individualized experiences and behavioural patterns over time. This study may help to conceptualize the nature of mental health disorders, and generate individualized insights useful for macro level treatment and diagnosis psychiatry.

    If an economical treatment plan such as Wichers suggests then a macro level treatment plan with in-built individualized treatment can be utilised. This concept both tackles the ‘core’ whilst allowing the individual to tackle the stigma of the discrepancy within their social identity.

    Wichers, M., 2014. The dynamic nature of depression: a new micro-level perspective of mental disorder that meets current challenges. Psychological medicine, 44(7), pp.1349-1360.

  7. People feel that having a mental illness is an equivalent to being psychologically mental. However, this is not the case. Many people suffer from depression, anxiety and several other mental illnesses. Most people commit suicide as they have nobody to talk to about what they are feeling and hence the taboo and social stigma around mental illness needs to be removed. People should not only be taught how to identify a mental illness, they should also be taught to be open minded and accept people who are suffering from Mental Illness. As Dr. Patulny’s tweet states, doctors and psychologists are the most unfortunate as they have no one to express their feelings too, if they are suffering from a mental illness.
    Bendelow (2009) states the different medications that have been designed for mental illnesses, but the article also highlights how doctors still cannot accurately identify all the different types of mental illnesses today. Moreover, the concerning part of a mental illness is that it is not regarded with equal importance to a physical illness. Several doctors tend to try different doses and medications with their patients, which can result in horrible side effects like strokes. Most people do not wish to speak of their mental illness at a work place or in schools, children do not share their thoughts as they feel the will be bullied. As Charmaz (2013) outlines “marginalisation of chronically ill people may begin with and unpredictability of bodily and mental functioning that influences everything they do.” Doctors advise people who are suffering from depression or who have other mental illnesses, to lead stress free lives by doing yoga and other breathing exercises, however this only irritates the patient even more as their body is responding in a different manner to the exercises that they do.

  8. I think there is certainly a huge stigma when it comes to mental health especially in school or work conditions. Someone who is applying for a position would generally never disclose the fact that they are suffering from a mental health condition as they would have fear or being rejected by the employer, this places a huge emphasis that mental health is a negative or even dangerous condition; when realistically most individuals will feel a sense of depressive symptoms if not be diagnosed with a condition, so why the stigma if 45% of the Australian population could potentially be exposed?
    Antidepressants and anti psychotics can sometimes be a helpful solution to mental health disorders; but i feel it is only needed in server cases or when treating people with chemical imbalances such as people suffering with schizophrenia, bipolar etc..
    Personally i think more education and awareness is needed in schools and workplaces across Australia such as having presentations to educate people who are unsure of what disorders there are, who depression/anxiety effects, how to get help, letting people know there is always someone to talk to and that mental illness is a common and curable thing with time and practice and participating in group or individual practices such as mindfulness and stress/anxiety reducing activities.

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  9. Throughout Australia there is an overwhelming proportion of the population who is increasingly experiencing mental health problems. Mental health problems influence the primary emotions of depression, anxiety and sadness. Whilst also influencing secondary emotions of disgust, embarrassment, guilt and shame through stigmatised experiences within social settings by having mental health issues. In this way, people with mental health issues become othered within society, as they do not fit the core ideal of the population who sees “Health is the norm” (Charmaz 2008, p.8). This effect is representative within Charmaz’s depiction of Marilyn Raymer who “…had to prove that she had the wherewithal to claim the right- and the capability- to participate” within society (Charmaz 2008, p.9). Due to Marilyn’s internal health problems and stigmas associated with her condition, she was unable to participate within society, as she constantly had to prove her normalcy. Solutions to mental health problems are also a large problem within modernity, as there is greater dependence to “…prescribe drugs to treat mild to moderate conditions dominated by anxiety states and depression” (Bendelow 2009, p.89). This reliance on pharmaceuticals to treat mental health problems is a short-term fix to an issue that is impacted by social conditions. In taking this stance, possible productive solutions in decreasing the level of mental health problems experienced may include; counselling services, support within social ties, less dependency on pharmaceuticals drugs as the primary solution, and to diminish social stigma for those who experience mental health problems.

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  10. I think in order to dissolve the stigma associated towards mental health, there needs to be some sort of investment in effective advertising for mental health issues. With depression being one of the most noticeable mental health issues, it is apparent that the other mental health issues don’t really have the same noticeability from within society.

    Bendelow (2009) sums it up in a very accurate way, and that is that doctors these days are still not fully able to understand the full complexities of the individual, and this leads to a lack in being able to identify the actual mental health issues an individual may hold.

    With my personal experiences regarding a close friend, I’ve personally seen the effect stigma can have on an individual, when people don’t fully grasp the emotional effect it takes on the individual with the issue. It’s deconstructive and can cause an individual to become isolative and highly depressed, which in turn can also lead into a worsening of the mental health. Seeing as though health is such an important factor, and part of our individual needs, I feel like more must be done in an effort to counteract the stigma placed upon mental health issues.

  11. Whilst it is evident that social stigma plays a massive role in how individuals experience mental health issues (shame, guilt, embarrassment), the sole concentration on the social aspects (stigma) of mental illness will not remove all the problems people are experiencing. I believe that yes we need to work at breaking down the stigma that is still associated with mental illness, however, there still needs to be a focus on the individual. Mental health issues are experienced differently from person to person, and I believe that shifting away from an individualised basis will ultimately have a detrimental impact.

    In regards to more anti-depressants being the solution, I maintain that once again it needs to be judged on a person-to-person basis. The article by Davey and Chan (2012) argues that medication should only be used in very specific cases, and in conjecture with other treatment methods. Whilst this perspective does individualise the treatment of mental health to a degree, I do not believe that it is individualised enough. For the experience of friends I know that medication is a significant factor in their recovery from depression. I believe that the exploration of other treatment methods is important, because once again mental health and the suitable treatments vary from case to case. However, the rising notion that exercise in itself can stop depression is a treatment method that is contributing to the stigma behind mental health issues and is potentially dangerous. Once again whilst exercise is proven to contribute to the reduction of mental health problems, it needs to be judged by a health care professional and the individual themselves. In some instances the use of exercise as an anti-depressant can actually contribute to the development of further mental health issues (e.g. anorexia) and fail to resolve the initial problem. This is why I believe we need to be extremely careful when criticising the use of anti-depressants or encouraging individuals to try exercise in place of treatment, as in doing so are we not just contributing to the stigma further?
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  12. Stigma surrounding mental illness is highly prevalent in our society. The most troubling thing is that as stigma causes the mentally ill person to feel embarrassment and shame, they are less likely to come forward and seek help. Instead the embarrassment, shame and the anxiety about having a mental illness that stigma produces further debilitates their mental health.

    Charmaz’s (2008) analysis of how marginalisation occurs is spot on. I agree that our society has a ‘core’ healthy image that everyone is measured against. I think this core image is clarified through social media and advertising as mostly ‘healthy’ images are circulated and everyday problems and struggles as well as common feelings of anxiety or depression are disguised and hidden. Social media could also be a way in which we are ‘assessed’ as being in the core or not.

    Having a mental illness does not define who you are, it is there but it is not your whole life if proper treatment is being sought. Benedelow (2009) raises an important point about the tendency to treat mental illness with drugs. This treatment holds to the view that mental illness is biological and thus can be treated pharmacologically. While being biologically predisposed to a mental illness is a factor, this view misses the root social problems that cause mental illness in many people. Aiming to end the stigma surrounding illness and challenging the ‘core’ healthy image could create a more inclusive and loving society that is dedicated to the wellbeing of all individuals.

    S327UOW17 #Tut11 #Wed1530

  13. To look away at the individual and look towards the larger implication of mental health for society as a whole is an interesting approach.
    The stigma surrounding mental health will surely be impacted upon in a more inclusive and effective way when moving the spotlight away from the individual’s efforts. The individualising of mental health enables negative emotions like guilt and shame as the experiences of being mentally unwell are pathologized.

    Goffman outlines the damaging forces of stigma, for example when looking at its various forms. This stigma needs to be dismantled as it perpetuates a cycle of blame and prejudice towards the people who have mental health concerns rather than actually helping them.

  14. More anti-depressant are not the solution. I don’t necessarily agree with the focus moving away from the ‘core’ and towards to periphery. Doing more the end the stigma associated with mental illness, anxiety and depression is key to making people more aware of the possibilities of having a mental illness and allowing people to feel as though they can talk about their illness and function as a normal member of society with it.

    I think it is important that we create a safe environment where people are able to openly discuss all forms of mental health and associated issues and difficulties without being judge or afraid. We need to stop pharmaceutical companies from reaping so much profit from the pushing of their drugs so people are actually only prescribed medication when they actually need it.

    Mental illness affects society as a whole, whether you suffer from it yourself or know someone who does everyone is affected to some extent. Having more open discussion and creating more awareness of what mental illness is, what it entails, and that it isn’t always associated with bad/aggressive behaviour is essential for the de-stigmatisation of mental illness.

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  15. In contemporary society, there is a trend to hide particular illnesses due to the social stigma attached. Mental illness is one key example of this particular social phenomenon. Often there are two main avenues that may be adopted;

    1. The individual can put on a ‘brave face’ and pretend everything is ok; or
    2. The individual can communicate that they have a mental illness and risk becoming, as Charmaz argues, the ‘marginalised other’.

    Both options have serious consequences. For example, by opting to hide an illness the individual avoids seeking help, and thus the opportunity to feel, and possibly, get better. Furthermore, there are also dire consequences attached to ignoring a mental illness such as; self-harm, harm of others, or even suicide. On the other hand, if the person acknowledges their illness then there is the real risk that they will be labelled as ‘too sick to cope’, or as ‘faking it’, or exaggerating their condition. These things in themselves can further exasperate the symptoms of the illness.

    I argue, as does Charmaz, that as a society we need to start to address this issue at the periphery rather than always focusing on the core. We need to address the feelings of who we term as ‘normal’ and ask why they have these feelings towards those with mental illnesses in the first place. Therefore, we need to focus on the feelings of the so called ‘normal’ and move away from always looking at attempting to ‘fix’ the ‘other’.

    Questions we can ask are; Why is doubt and judgement placed on those you have a mental illness? What can we do to address mental illnesses in the workplace? Although we have begun to break down this stigma in society by such campaigns as ‘Are you OK day,’ we need to turn our focus to asking why isn’t it ok to talk about mental health? Also, we must extend this social address on stigma to include the experiences of people with all forms of disability; ‘albeit visible,’ or invisible disabilities.

    *Note watch last video from 37 min 32 sec.

    #S327UOW17 #Tut11 #Wed1530

  16. In contemporary society, there is a trend to hide particular illnesses due to the social stigma attached. Mental illness is one key example of this particular social phenomenon. Often there are two main avenues that may be adopted;

    1. The individual can put on a ‘brave face’ and pretend everything is ok; or
    2. The individual can communicate that they have a mental illness and risk becoming, as Charmaz argues, the ‘marginalised other’.

    Both options have serious consequences. For example, by opting to hide an illness the individual avoids seeking help, and thus the opportunity to feel, and possibly, get better. Furthermore, there are also dire consequences attached to ignoring a mental illness such as; self-harm, harm of others, or even suicide. On the other hand, if the person acknowledges their illness then there is the real risk that they will be labelled as ‘too sick to cope’, or as ‘faking it’, or exaggerating their condition. These things in themselves can further exasperate the symptoms of the illness.

    I argue, as does Charmaz, that as a society we need to start to address this issue at the periphery rather than always focusing on the core. We need to address the feelings of who we term as ‘normal’ and ask why they have these feelings towards those with mental illnesses in the first place. Therefore, we need to focus on the feelings of the so called ‘normal’ and move away from always looking at attempting to ‘fix’ the ‘other’.

    Questions we can ask are; Why is doubt and judgement placed on those you have a mental illness? What can we do to address mental illnesses in the workplace? Although we have begun to break down this stigma in society by such campaigns as ‘Are you OK day,’ we need to turn our focus to asking why isn’t it ok to talk about mental health? Also, we must extend this social address on stigma to include the experiences of people with all forms of disability; ‘albeit visible,’ or invisible disabilities.

    *Note watch last video from 37 min 32 sec.

    #S327UOW17 #Tut11 #Wed1530

  17. With large numbers of Australians suffering from mental health issues, it is understandable when disclosing these issues that an individual begins to experience secondary emotions associated with stigma. Goffman (1963) accurately defines stigma “an attribute that is deeply discrediting” and the belief that a “person with stigma is not quite human” (Goffman, 1963, as cited by LeBel, 2012, p.90). With this perception associated with stigma, it understandable that individuals with mental health issues endure feelings embarrassment, guilt, shame etc., regardless of the context/environment they’re in. Hence, an individual’s decision to conceal their condition avoids the manifestation of these emotions (stemming from perceptions of stigma). Charmaz (2008) highlights the complex position in which society projects ‘core’ notions of normal health, and definable “barriers and boundaries” (Charmaz, 2008, p.11). When individuals do not fit within the core of normal health, they become marginalised, in which they obtain a “problematic status in society” (Charmaz, 2008, p.11). Charmaz continues to highlight that these marginalised individuals are aware of this status, and continue to compare themselves with the unobtainable core, until committing to the marginalised position – evoking a shameful identity.

    As pointed out by Bendelow (2009), the rapid medicalisation of mental illness has witnessed pharmaceuticals being prescribed to individuals with mental health issues, opposed conventional therapy. Hence, the new norm of pharmaceutical treatment has positioned Australia as one of the largest prescribers of anti-depressants in the world (Davey, 2016). However, as contended in the study by Davey and Chanen (2016), this go-to treatment method is not the effective in treating individuals with mental illness and advocating for the combination of pharmaceuticals and conventional therapy (Davey, 2016). Although this individualised the complex nature of this problem, there is not a universal way to deal with each individual and each mental health issue.

  18. The lecture for this topic discussed the emotions and stigmas associated with mental illnesses. When thinking about what could be done to end the stigma associated with mental illness, Charmaz highlights how people are viewed when they have a mental illness. The stigma revolves around the misconception that people with mental illnesses are “lazy… don’t want to do anything” and are “not productive” (Charmaz 2008, p. 12).

    Bendelow notes that there has been a rapid increase in doses and the response has been unbalanced in terms of control and care (Bendelow 2009, p. 86). Rather than focusing solely on developing and distributing more anti-depressants, there needs to be a stronger focus on the de-stigmatisation and working out the causes behind the mental illnesses themselves.

    Bendelow, G 2009, ‘Medical responses to emotional and psychological distress’, in Health, Emotion and the Body, Polity, Cambridge, UK, pp. 80-104.

    Charmaz, K 2008, ‘Views from the Margins: Voices, Silences, and Suffering’, Qualitative Research in Psychology, vol. 5, no. 1, pp. 7-18.

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  19. I think there is definitely a problem with anti-depressants in our society. More prescriptions are not the answer but telling those that are regularly taking some form of anti-depression that they are using an ‘quick-fix’ is also insensitive. Medication can be an important treatment for individual’s and can help people function (at least in the way that it is socially acceptable). Medication can be a short term tool till other therapies are accessible. They are also long term tools for some individuals in combination with psychological treatment. This combination, Davey and Chan (2012) argue, is the most effective method.

    Secondary emotions also play a part, the shame and stigma associated with mental illness. So our society individualizes mental illnesses. It is something most people deal with hidden as they feel the pressure of social stigma, especially in work settings. I think this individualization has a lot to do with why many people with mental illness continue to use medication as long term treatment rather than see psychologists regularly.

    The most dangerous part of anti-depressants is that pharmaceutical companies are profiting enormously from the rise in reported depression and anxiety in our society. Similar to the situation with antibiotics, this profit is playing a factor in research. As mentioned in the lecture there has been underreporting of ‘negative’ trials in academic research.
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  20. An accurate representation of stigma was explored by Goffman (1963), describing it as “deeply discrediting”, this is further connected to certain mental health issues where stigma is mostly inevitable when it comes to these illnesses. Many complex feelings are associated with the stigma surrounding mental health issues, which in turn can complicate and exacerbate the emotions already being felt. Feelings such as shame and embarrassment are common emotions interrelated with mental illnesses, which in turn can lead to individuals not opening up about how they are feeling, resulting in detrimental effects. As noted in Davey (2016), Australia has become the largest prescribers of anti-depressive medication, which is extremely significant as it is almost seen as a band-aid solution and ultimately can lead to those effected not seeking professional help once prescribed this medication. This issue is multiplex and further exploration into this is needed.

  21. The increase in mental health issues over the last decade raises and interesting question. Has there been in an increase in those experiencing mental illness? Or, has there been a process of normalisation by which more individual’s are being profiled as having disorders where these emotions may have been once experienced without such a name.

    I believe the answer is yes to both. Mental health issues have been de-stigmatised just enough that more individual’s are seeking help for their problems and more people are discussing them. As it’s only a new development that we are becoming more open about these things and emotions are no longer being expected to be private, there is not yet a socially systemised way in which we can signify and differentiate the severity of certain conditions. When two individuals both say they are suffering from anxiety, where one of their conditions is so severe that they are unable to leave their house while the other is able to function quite well in daily activities, there is a cloaking situation that occurs. This may be the reason that stigma surrounding mental illness still exists.

    However, there has certainly been an increase in mental health issues being experienced by people and I believe this is as a result of our modern lifestyle. We are trained to work fast and hard, to work long hours, to need instant gratification and be afraid of commitment and failure. At the same time we are not trained to value community, to be able to make informed decisions in the face of an over-abundance of choice and to strive for contentedness instead of ‘happiness’. These stressors of an increasingly technologically reliant and capitalistic society I believe are fuelling problems in mental health and within the spirit of our economic system, it is seen as easier to deal with problems that already exist instead of taking the preventative path.

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