There has been intense investment in mental health resources and treatments over the last few decades in Australia. This includes the establishment of initiatives such as the Black Dog Institute, the headspace National Youth Mental Health Initiative (a good program, which I helped evaluate), and recently a multi-sector initiative aimed at ‘Creating Mentally health Workplaces’.
Despite these efforts, however, the expenditure on and costs of mental health issues continue to rise, and the prevalence of anxiety issues in our society remains high. Anthony Jorm, at the University of Melbourne, estimates that around 15% of Australians suffer from an anxiety disorder, but many Australians don’t understand these issues, can’t recognise the symptoms, and tend to dismiss them as ‘everyday worries’. This serves both to downplay the severity and impact of anxiety issues on the national psyche, but also – importantly – obscure the social basis to such emotions. A similar story applies to the experience of loneliness. As Adrian Franklin finds, loneliness is endemic in Australia.
There are numerous sociological explanations behind ingrained, or rising, anxiety and loneliness in our society. Certain groups are at greater risk of loneliness than others – older men for example – but sociologists such as Anthony Giddens and Zigmund Bauman point out the atomising affect of late modernity, where human relations become more individualised, and we become less invested in keeping our groups and connections together. And we are not helped by the way we structure our modern lives. Work is increasingly temporary and fractious, sending us off to all sorts of places, to work all sorts of hours, with increasing precarity. Our cities continue to sprawl into suburban ‘exopolises’, lacking natural social centres within which people can connect and socialise. And our media changes, becoming supposedly more ‘social’, but with uncertain consequences in terms of the exact impact it has on our face-to-face interaction.
The exact alchemy of factors that entrench anxiety and loneliness in modern society is unclear. However, the need to examine these factors sociologically is paramount. Do we need more expenditure on mental health services? Or is this just a Band-Aid solution? Do we instead need to examine, recognise, and cost options for making deeper, structural changes to our social, urban and media environments that impact our sense of sociability and security, and our feelings of anxiety, isolation and loneliness?
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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