Social Perspectives on Mental Distress – causes or contributory factors

Duration: 15.32 mins 

Speakers: 

Interviewer, Colin Burbridge 

Dr Jerry Tew, Institute of Applied Social Studies, University of Birmingham  

Hello, I’m Colin Burbridge. I’m a mental health service user and I’m also a working in the mental health field.  I’d like to introduce you to Jerry Tew. Jerry, from your perspective, what do you see as causing or contributing towards mental distress? 

I think from a social perspective there are probably four key areas that we can see how social factors may contribute to people’s distress. I think it’s important to start with the fact that everybody is different and people react to different stresses in different ways.  The first area that I’d like to cover is what we might call ‘difficult personal experiences’ and these may include losing perhaps a parent or a primary care giver early on in life, it might be going through periods of instability, insecurity. It might be, obviously it’s very hard to define what we mean by ‘neglect’, but I think that that is meaningful for some people.   And then there are more prominent experiences that we might call trauma or abuse and these may be one-offs or they may be sustained experiences.  The more powerless and the more vulnerable we are in terms of our life circumstances, the more likely these experiences are to have a long term impact in terms of how we make relationships and the sort of patterns that we have in the future, and if we have experiences that threaten our sense of who we are and how we relate to other people, then that means that in subsequent situations we may choose to withdraw, back off, or fall into the patterns that might feel like repeating the same sort of abuse or victimisation.  And that sort of thing affects our resilience, our ability to deal with the knocks of later life if we haven’t got the ability to make good, supportive, mutual sort of relationships with others.  The second area that I’d like to look at is where broader experiences of, broader social experiences, discrimination, perhaps to do with our race, our gender, can have a particular impact on our mental health and I think we now know pretty clearly from the research – if we start with racism – that it is actually racism that is a contributory factor. 

Yes. 

To start with people are saying ‘ah well, it’s the experience of migration and the social dislocation and so on’ and then we find that the second generation, people who came from the Caribbean, are actually having a worse time in terms of their mental health than the generation that came over.  So it’s not about the immigration experience. We’ve also got some very interesting data from studies in South London which show that if you’re black in a relatively prosperous, good sort of area of South London, compared to being in Brixton, you’re actually more likely to be admitted to psychiatric hospital than actually being a place where you stand out and may be subjected to more everyday racism rather than being in a rather rough and ready place but where you’re accepted.  It’s actually being black in a posh suburb that is worse for your mental health.  If we look at poverty overall, there’s a lot of indicators that link poverty and deprivation with poor mental health and to some extent it’s chicken and egg, that it seems that being brought up in deprived circumstances can lead to poor mental health outcomes, probably due to having fewer resources again to deal with the knocks that life throws at you. It can tend to lead to lower levels of educational achievement, it may mean that you’ve got other things which mean that you haven’t got the same access to resources that other people might have, to deal with the same sort of situations.  But more recent research has been to tease out the fact that it’s not absolutely deprivation, but relative deprivation, that makes the difference. It’s actually that sense of social injustice. That seems to be the thing that in some way eats away at people most and is most damaging to their mental health. 

And it’s very much a society thing isn’t it really? 

Mm. 

Yes, it’s quite endemic certainly. Are there any other things that.. 

I think the other big area is issues around gender and this is actually quite complex but research is suggesting that while we know that overall women are more likely to experience mental distress than men, it tends to be women who are either most conforming to or most rejecting off, gender stereotypes. They are the ones who seem to be suffering most. If we look at men, things seem to be changing quite a bit.  Overall men’s mental health experience is getting relatively worse if we look at hospital inpatient statistics, rates of compulsory admissions and so on, which suggests – but we haven’t got that good research to back this up – that men are finding living up to the sort of masculinities that we’re supposed to be living up to now, increasingly problematic. Or at least some men are finding that and that is causing particular stress and breakdowns for men.  I think for both women and men, the experience of society’s reactions if we are gay, lesbian or bisexual, takes this to the extreme. It’s meaning that we’re falling off the edge a bit in terms of the sort of femininities or the sort of masculinities that we’re supposed to be living up to and while on the face of it there’s been a fantastic social revolution over the last 20 years in terms of attitudes and practices, I don’t think it’s gone away and the evidence is from, particularly I suppose, younger people who are coming out as gay or lesbian. The stories that they’re telling are ones where that is still questions of identity, questions of acceptance and so on. They’re still huge issues for them and I think we’ve also got to remember that the mental health system may also be contributing inadvertently, or even overtly, to that sort of thing because up until the early 90s, the mental health system was still defining homosexuality as a mental disorder. 

Yes.  Are there any other points you can think of, Jerry? 

Yeah, I think there’s one other key area that we know something about which is experience of family dynamics and communication patterns. This is something that goes right back to people like R.D. Lang and the communication theorists in the States, Gregory Bates and the people that he worked with. What they suggested was that there are certain forms of communication – emotional and the actual way that people communicate in families – that can be very hard to handle and make sense of.  More recently that’s been taken up in a different context with work that’s been called ‘expressed emotion’ which I think is a rather unhelpful term and I’ll come back to that in a moment.  Basically what that is saying is if somebody is subjected to communication from people that they’re pretty close to and dependent on, which is either emotionally intrusive, is hostile, particularly if that hostility is rather covert. It’s the sort of the nice smile but what’s underneath the nice smile is not very clear. 

Yes. 

That, if somebody’d has already had a breakdown, particularly a schizophrenic breakdown, and goes back to a family where that sort of thing is going on where there may be conflicting communication patterns or expectations from different family members, they’ve a much, much higher chance of having a relapse and going back into hospital.  What we’re also getting evidence of is it’s not just about relapse, it’s also about first breakdown as well, are similar patterns. There’s a very interesting Finnish study which was supposed to be showing how it was all down to genetics, which actually found that genetics played virtually no part in it, but different family dynamics and family experiences was a main predictor of, within the cohort that they studied, who suffered a breakdown and who didn’t suffer a breakdown. 

That’s a really interesting point, Jerry. Are there any other points that you can think of? 

The final one is probably the one that’s most obvious to most people, which is social transitions, that we know that particular issues like divorce and redundancy are very likely to have major impacts on us and I think what we need to look at is what is the impact that it does have and why does that impact for some people mean that it presents a change in our mental health?  What goes with a job and what goes with a long term relationship is a whole set of identities and social roles and networks and connections. So I think what we’re talking about is actually the person and the particular job are important but this other stuff is probably at least as important, if not more so, in understanding why these sorts of things tip us over the edge.  Interestingly, the other things like actually forming a new relationship which seems all joyous and positive, again that can be – a big one obviously, having a baby – supposed to be all joyous but it certainly does dislocate an awful lot of who we think we are, who our friends are, where our networks are, where our support is – a whole question of identities and place in the world can change enormously at that time and we know that that is a time when quite commonly people experience mental distress. 

Jerry, what do you see is potentially relevant within a person’s history and what also do you see as potentially relevant within a person’s current situation? 

Broadly speaking I think it’s the same factors that play a role in both.  So a past experience of loss or abuse can increase our vulnerability. A current experience of loss or abuse can be the thing that tips us over the edge. What I think is particularly important in terms of understanding mental health experiences is what I call the ‘triple whammy’ which is - a social model of disability has been really  helpful in understanding how, for a lot of people with disabilities, it’s not the impairment itself that reduces their life opportunities and causes them most of the problem, it is the attitudes and practices of mainstream society and that is what the disabled people’s movement has struggled against in terms of fighting for legislation and so on.  Where it gets that bit more complicated for people with mental distress is this reaction from society, which in terms of people’s mental distress, can be absolutely over the top and extreme in terms of demonising people, having public protests and this every day media coverage, the stigmatisation, the attitudes there.  Well that is remarkably similar to the sort of discrimination and oppression that we were talking about earlier on that can actually be creating people’s vulnerabilities. So if you’re a wheelchair user, society’s reactions to your wheelchair use are highly frustrating but they may not actually make your mobility problem worse.  If you’ve got an issue around mental distress then society’s reactions can actually make the very thing that you’re trying to struggle with, ten times worse. Hence ‘triple whammy’. 

They compound it don’t they? 

Mm. 

Is this same or different for more common experiences, say for instance depression or for more unusual experiences, for instance schizophrenia, hearing voices? 

It’s quite an interesting question and I don’t think we know the answer to this fully. Some of the early work tried to relate particular sorts of experiences to particular forms of mental distress. So the expressed emotion work was done in relation to people with schizophrenia, people who hear voices. Some of the stuff around loss and separation was linked to depression and some of the stuff around abuse and trauma, particularly looking at things like self-harming, eating disorders and so on.  What’s tended to happen as the research has progressed is that there seems to be more and more overlap. It may still be true that for something like self-harm it’s more likely to be a pointer to previous experiences of trauma or abuse, but a lot of people who hear voices who have ‘psychotic type experiences’, they may experience trauma.  Alternatively, they may not and it may come from one of the other factors. So there seems to be a lot of human variability here, that different of us will react to the same things in different ways and end up with what seems really quite different presentations of distress, but it may be the same underlying issue that’s behind it. 

We’re all unique people and we all react to things in a unique way. 

Mm, absolutely, yes. 

END OF RECORDING