How do the media amplify the challenges for people in maintaining their mental health? The Social Amplification of Risk - Dolphyn Pty Ltd
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How do the media amplify the challenges for people
in maintaining their mental health?
The Social Amplification of Risk
February 2016
Prepared by:
Robert Sams
Dolphyn Pty Limited
Contact:
Phone: +612 424 037 112
Email: robert@dolphyn.com.au
Web: www.dolphyn.com.au
Post: PO Box 994 Newcastle, NSW 2300How do the media amplify the challenges for people in maintaining their mental health? There is much discussion and reporting of concern by the Australian media about mental health1. The influence of the media on societies discussion of, and decisions about mental health, including on social policy development, is significant2. Key messages in the mainstream media when reporting on, and depicting the topic are often3 centred on ‘helping’ individuals either maintain, or improve their mental health. This essay will demonstrate that the discourse of reporting on mental health by the mainstream media is of a ‘problem to be fixed’ (‘reductionist’4). It is this reductionist discourse that may amplify the challenges5 faced by individuals in maintaining their mental health and the organising of the mental health industry. A study of a small sample of media reports on, and portrayals in the media of, RUOK6, a popular mental health promotion program in Australia, will be used as a case study to verify this thesis. The study reveals that the coverage predominately 1 As reported by Pirkis et. al. (2008) and noted on the MindFrame website; “The Media Monitoring Project tracked reporting of suicide and mental illness in the Australian media over a 12 month period, from September 2006 to August 2007. This was a follow-up study, comparing the original 12 month monitoring period in 2000/01. The research found that the overall volume of media items had increased dramatically from 17,151 in 2000/01 to 42,013 in 2006/07.” http://himh.clients.squiz.net/mindframe/for-media/reporting-suicide/evidence-and-research/media-monitoring-studies as accessed on 26.12.2015 2 As noted by Meurk et. all (2015, p.162) “A recent survey by Head, Ferguson, Cherney, and Boreham (2014) of Australian public servants found, for example, that, while just over 50% rated ‘news media’ as an important or very important source of information in decision-making, over 90% rated ‘the internet’ as an important or very important way of obtaining research information. 3 This essay will demonstrate this point through an exploration of evidence of recent media reports in Australia by using a small sample of reports about a mental health promotion program in Australia, RUOK. 4 A term that will be defined and is discussed at length extensively within this essay. 5 Note, that the concept of ‘challenges’ faced by people in maintaining mental health are discussed at length within the body of this essay, including an overview of what the challenges are and why they are challenging. 6 https://www.ruok.org.au Robert Sams - February 2016 www.dolphyn.com.au 2
How do the media amplify the challenges for people in maintaining their mental health? promotes ‘techniques’7 that lead to a ‘reductionist’8 approach to either maintaining mental health or ‘fixing’ mental health problems. The essay will address four key questions; what is mental health and why may it be challenging to maintain? Why is the reductionist discourse so attractive and why may promoting ‘techniques’ as part of a reductionist approach to maintaining mental health be problematic? How may the media, through seeking to ‘help’ people deal with the challenges of mental health, in doing so, often promote a reductionist approach that is fixated on fixing? Finally, how may individuals, society and the media approach things differently in dealing with mental health? That is, what is a different way forward? The RUOK Day study is included to provide first hand evidence of how the media portray and report on mental health. Specifically, the study will examine how the RUOK message is framed and portrayed in the media and the hence how the priming effects9 of the messages and semiotics may serve to amplify the challenges of maintaining mental health, while at the same time attenuating the complex nature of mental health and support industry. To begin, the essay will now provide a definition and meaning for mental health. 7 Ellul (1964, p. vi) refers to ‘Technique’ as “By technique (their italics), for example, he means far more than machine technology. Technique refers to any complex of standardized means for attaining a predetermined result. This, it converts spontaneous and unreflective behaviour into behaviour that is deliberate and rationalized” 8 For example, the very question of RUOK, which will be explored throughout this essay is a closed question that requires a ‘minimalist’ answer of yes no, which does not necessarily achieve its stated aim of creating meaningful conversations (as noted later in this essay). 9 “Priming refers to the passive, subtle, and unobtrusive activation of relevant mental representations by external, environmental stimuli, such that people are not and do not become aware of the influence exerted by those stimuli” (Moskowitz 2009, p. 128) Robert Sams - February 2016 www.dolphyn.com.au 3
How do the media amplify the challenges for people in maintaining their mental health?
There are a significant number of definitions available for ‘mental health’10. This
essay adopts two of these definitions for the purpose of providing a clear meaning up
front to assist the reader as they progress through this essay. One is provided by the
World Health Organisation (WHO) and the other by Headspace11.
WHO (2014) define mental health as;
Mental health is a state of well-being in which an individual realizes his or her
own abilities, can cope with the normal stresses of life, can work productively
and is able to make a contribution to his or her community.
http://www.who.int/mediacentre/factsheets/fs220/en/
(as accessed on 12 December 2015)
Headspace12 (2015) builds on the WHO definition through the addition of “good
emotional and social wellbeing and the capacity to cope with change and
challenges.”
At this point it is important to highlight two central aspects of both definitions that will
assist in understanding how and why the media may quickly adopt a reductionist
approach when representing mental health.
Firstly, mental health is an important part of overall well-being that includes, in
addition to mental health, the physical, biological, spiritual and psychological health of
10 For example a Google search on the definition of ‘mental health’ retrieves 145,000,000 responses.
https://www.google.com.au/search?client=safari&rls=en&q=Definition+of+mental+health&ie=UTF-8&oe=UTF-
8&gfe_rd=cr&ei=oAaDVrjpBcbN8Ae7zpOYCA
11 headspace is the National Youth Mental Health Foundation providing early intervention mental health services to 12-25 year
olds. See http://headspace.org.au/about-us/ as accessed on 19.12.2015
12 “Good mental health is about being able to work and study to your full potential, cope with day-to-day life stresses, be
involved in your community, and live your life in a free and satisfying way. A person who has good mental health has good
emotional and social wellbeing and the capacity to cope with change and challenges” http://headspace.org.au/get-info/what-is-
mental-health/ (as accessed on 12 December 2015)
Robert Sams - February 2016 www.dolphyn.com.au 4How do the media amplify the challenges for people in maintaining their mental health? a person. Secondly, ‘good’ mental health includes making contributions to, and being involved in community and society and is essential for individuals to have meaning and purpose13. These two points emphasize that mental health is a complex and intertwined mix of a variety of factors that need to exist together, cohesively and holistically, in order for well-being to be maintained. The media use the method of reductionism in trying to simplify and make these complex aspects easier to understand. For further guidance on the complex nature of well-being, including mental health, we can turn to the field of positive psychology14 that considers both a eudaimonic15 explanation of well-being, in addition to the simplistic hedonic16 explanation. An understanding of these two aspects17 of well-being and mental health are critical to this essay as it will argue, that one way the media may amplify the challenges of maintaining mental health is through a focus on ‘fixing the parts’ (‘reductionism’), rather than seeking to understand the complexities associated with an eudaimonic approach to mental health. The ‘fixing’ approach fits neatly with the hedonic definition of well-being, where we simply strive for more pleasure and less pain. 13 This point is further explain in this essay in the discussion on positive psychology 14 Martin Seligman who is the author of books such as Authentic Happiness and Flourish founded the field of Positive Psychology. In Flourish (2001, p. 5-30), Seligman provides an introduction to his theory of ‘happiness’, which he describes as a critical aspect of well-being, taken from the study of positive psychology and outlines three elements for ‘happiness’ including a) positive emotion, feeling and comfort; b) ‘flow’ using Csikszentminalyi’s (2002) model, and c) meaning 15 This approach adopts Self-Determination Theory to conceptualise happiness (Keyes et al., 2002; Deci & Ryan, 2000). Self determination theory suggests that happiness is related to fulfillment in the areas of autonomy and competence. – taken from http://www.counsellingconnection.com/index.php/2010/08/30/happiness-and-positive-psychology/ as accessed on 19.12.2015 16 Hedonic well-being is based on the notion that increased pleasure and decreased pain leads to happiness. Hedonic concepts are based on the notion of subjective well-being. Subjective well-being is a scientific term that is commonly used to denote the ‘happy or good life’. – taken from http://www.counsellingconnection.com/index.php/2010/08/30/happiness-and- positive-psychology/ as accessed on 19.12.2015 17 That is hedonic and eudaimonic Robert Sams - February 2016 www.dolphyn.com.au 5
How do the media amplify the challenges for people in maintaining their mental health? Contrastingly, an understanding of mental health that accepts that people are not components to break down and fix, rather that people should be understood holistically, and that maintaining mental health is about finding purpose, meaning, ‘flow’, and living in community with others, is the definition of mental health proposed in this essay. Poor mental health can lead to mental illnesses such as anxiety18 and depression19, both of which create challenges for people as individuals, communities and society20. While this essay does not allow for an exhaustive review of the challenges associated with mental health it will provide a brief explanation of some of the challenges and why people may be faced with them. One challenging factor for individuals is the reductionist discourse of the mainstream media in Australia when reporting on and portraying mental health. While this aspect will be examined in more detail later in this essay, the point to make at this point is in relation to challenges associated with the increased volume of reporting21 on mental health, and the discourse of the media representation of mental health, this alone creates it’s challenges for people. 18 The American Psychiatric Association in the DSM5 (2013, p.155) notes in relation to anxiety disorders “Include disorders that share features of excessive fear and anxiety ad related behavioural disturbances. Fear (their italics) is the emotional response to real or perceived imminent threat, whereas anxiety (their italics) is anticipation of future threat.” 19 The American Psychiatric Association in the DSM5 (2013, p.155) notes in relation to depressive disorders “The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function.” 20 “Mental health and substance use disorders cost Australian workplaces over $11 billion every year in absenteeism, reduced productivity, and compensation claims, across all industries.” (ABC ‘Mental As’ Website - http://www.abc.net.au/mentalas/ as accessed on 30.12.2015) 21 Pirkis et. al. (2008, p.9) note that “The overall volume of media items increased dramatically from 17,151 in 2000/01 to 42,013 in 2006/07.” Robert Sams - February 2016 www.dolphyn.com.au 6
How do the media amplify the challenges for people in maintaining their mental health?
Another aspect that outlines the challenges in dealing with mental health is the
complex nature in which problems with mental health may arise within a person. To
highlight this, (Young, 2012) when referring to ‘Alimentary Thinking’ with the head,
heart and gut notes;
”Stress leads to the gut to increase production of ghrelin, a hormone that, as
well as making you feel more hungry, reduces anxiety and depression”.
(Young, 2012, p.41)
In this example, Young (2012) outlines the link between the physiological,
psychological and biological nature of mental illness22, and how all of these factors
need to be considered as working ‘together’, rather than in isolation (‘reductionist’), in
order to maintain mental health.
In concluding this short review of the challenges of maintaining mental health,
perhaps the greatest challenge is how individuals, communities and society consider
mental health. If the definition is the simplistic ‘hedonic’ definition, this will amplify
simplistic approaches hence, reductionism. An understanding of ‘eudaimonic’ well-
being requires a more complex, higher level, discussion and understanding of factors
such as transcendence, fulfilment and of a virtuous life23, all factors that require
critical thinking, deep assessment and time, none of which are synonymous with
reductionist methods.
In order to begin to delve into why reductionist methods are so attractive for
individuals and society, particularly to the media, it is first useful to understand why it
is that humans find it difficult to cope with, and accept pain and suffering. Explicitly
22 In this case, stress
23 All factors that are discussed later in this essay
Robert Sams - February 2016 www.dolphyn.com.au 7How do the media amplify the challenges for people in maintaining their mental health?
why are humans drawn to ‘fixing’ and trying to eliminate pain and suffering, rather
than accepting that it is part of what it means to ‘be’ as a human and further, it is an
essential part of how we learn, mature and grow?
This question is not an easy one to answer, and perhaps there is no answer for it,
however Kushner (2007) explores it when she poses;
It may be that instead of giving us a friendly world that would never challenge
us and therefore never make us strong, God gave us a world that would
inevitably break our hearts, and compensated for that by planting in our souls
the gift of resilience.
(Kushner 2007, p.55)
When one is in the midst of pain and suffering and experiencing all of the feelings
and emotions that go with pain, it may be difficult to understand that experiencing the
pain is necessary for learning, maturing and importantly as Kushner notes,
developing resilience.
Pain and suffering in the context of mental health may be experienced when people
are going through a period of grief. This grief may be following the loss of family or a
friend, the loss of a relationship or the loss of meaning and purpose in life. While the
ideal approach may be to tap into a quick fix and a ready made solution, recovering
from a loss, that is, maintaining mental health, following a period of grief is often
difficult, complex and may take time.
Kubler-Ross (2014) provides a framework for people to work through such grief and
grieving, and while she has been able to simplify this process down to five key stages
of “denial, anger, bargaining, depression and acceptance” (Kubler-Ross 2014, p.7),
each stage is not described as a step by step process instead, Kubler-Ross (2014,
Robert Sams - February 2016 www.dolphyn.com.au 8How do the media amplify the challenges for people in maintaining their mental health?
p.22) outlines that each stage may be difficult and it may not be developmental, but
rather can jump in stages. For example when referring to depression and suggesting
that it “can be dealt with in a paradoxical way”24.
Suggesting that people “experience depression”, and “allow the sadness and
emptiness to cleanse you” is outlining a process that is not clear-cut and
unequivocal, instead, is it implying that at times, life through a period of grief may be
disordered, confusing and challenging. Humans struggle to deal with ambiguity and
‘messy’ situations, such as grief and depression, and instead would prefer there to be
simple solutions where problems could be fixed. This is why reductionism is so
attractive to humans, it offers fixes, solutions and most importantly, simple answers
to complex questions and challenges, such as maintaining mental health.
What is reductionism and what else makes it seductive to humans?
Dekker (2011) in Drift Into Failure (Chapter Three) provides a useful history and
analysis of how the seduction of the reductionist approach is enacted in the risk and
safety industry worldwide. Dekker (2011) notes that:
Newton and Descartes’ ideas have pretty much set the agenda for how we, in
the West, think about science, about truth, about cause and effect. And how we
think about accidents, about their causes, and what we should do to prevent
them. Today these effects have become so ingrained, so subtle, so invisible, so
transparent, so taken for granted, that we might not even be aware that much of
24 “As tough as it is, depression can be dealt with in a paradoxical way. See it as a visitor, perhaps an unwelcome one, but one
who is visiting whether you like it or not. Make a place for your guest. Invite your depression to pull up a chair with you in front of
the fire, and sit with it, without looking for a way to escape. Allow the sadness and emptiness to cleanse you and help you
explore your loss in its entirety. When you allow yourself to experience depression, it will leave as soon as it has served its
purpose in your loss. As you grow stronger, it may return from time to time, but that is how grief works.” (Kubler-Ross 2014,
p.22)
Robert Sams - February 2016 www.dolphyn.com.au 9How do the media amplify the challenges for people in maintaining their mental health?
the language we speak, and much of the thinking and work we do in safety and
accident prevention, is modelled after their ideas.
(Dekker 2011, p. 53)
A reductionist approach that is based on Newton and Descartes assumes
simplistically, that once problem parts and symptoms can be identified, then
conditions may be cured or fixed. In relation to mental health in organisations, the
focus is mainly on the body and mind25, with limited understanding or attention paid to
‘spirit’.
This approach means that mental health concerns are often dealt with in isolation
(‘reductionist’) and treated as a cognitive and medical problem rather than accepting
the importance of social and spiritual aspects26.
Aghadiuno (2010, p.4) describes that “The contradictions and dilemmas generated by
being reductionist are endless” and it is these contradictions and dilemmas that
society, and importantly in the context of this essay, the media, struggle to
understand and deal with in relation to mental health. In part, this may be brought
about by the predilection for societies and individuals, to focus on objectivity, clarity
25 See for example how this is enacted in practice by reviewing how the Employee Assistance Professional (EAP) Association
of Australasia (http://www.eapaa.org.au) refers to EAP programs. Specifically, the use of words such as ‘intervention’ to
describe it’s services and focuses on mental wellbeing and psychological health, appears to do this in isolation of the ’body’ and
‘spirit’. Introducing an EAP program is reflective of the ‘reductionist’ approach that organisations implement in order to ‘manage ‘
mental health.
26 (WHO, 2013 p. 7) explain how paying attention to matters beyond just mind and body are critical in dealing with mental
health; “Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage
one's thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and
environmental factors such as national policies, social protection, living standards, working conditions, and community social
supports. Exposure to adversity at a young age is an established preventable risk factor for mental disorders.”
Robert Sams - February 2016 www.dolphyn.com.au 10How do the media amplify the challenges for people in maintaining their mental health? and perfection, while in reality societies and individuals are regularly faced with ambiguity and subjectiveness, hence the contradictions. Because of this, society seeks clarity by breaking down the sum of the parts with the aim of ‘reducing’ equivocality (‘reductionist’). However in doing this, often fail to understand people as a whole, which means that these approaches have limited impact27. The essay will now provide supporting evidence to demonstrate how the media, through adopting a ‘helping’ and reductionist discourse, amplify the challenges of maintaining mental health. The study by Sams (2015c) provides a simple case study of RUOK to exemplify to the reporting on, and portrayal of the program, and specifically how the program was promoted for RUOK Day in 201528. As an introduction to the RUOK Day case study and to provide a context for the reporting of mental health in the media and how such reporting may ‘amplify’ or ‘attenuate’ messages, a short introduction on the topic of ‘social amplification’ as it relates to the media is provided before the case study is presented. To begin, it is useful to firstly consider what role the media plays in society in relation to providing and portraying information about mental health. As Nawková et. al. 27 See for example the case studies included in this essay where the media aim to reduce mental health down to simple steps, yet according to Lifeline (2015) in their 2014/15 Annual Report, the rate of suicide in Australia continues to rise (evidence). “While our lifesaving services, research and training programs have saved countless lives over the years, there is still much to do; sadly, suicide remains the leading cause of death for Australians aged between 15 and 441”. Lifeline Annual Report as accessed at https://www.lifeline.org.au/About-Lifeline/Publications-Library#promotional_materials on 31.12.2015 28 This is the one day per year that is set aside to promote the RUOK message, see https://www.ruok.org.au/newsroom/details/2015/09/22/today-is-the-day-to-ask-r-u-ok accessed on 01.01.2015 Robert Sams - February 2016 www.dolphyn.com.au 11
How do the media amplify the challenges for people in maintaining their mental health? (2012) highlight29, the media have a significant and influential role in how messages are broadcast about mental health. Further, Francis and Perkins et. al. (2005) in their detailed study of reporting on mental health by the media30 confirms that reporting was either about “policies and programs” or “symptoms and treatment”. This demonstrates when reporting on mental health that the media target fixing and treating (‘reductionism’). While this approach and information can be useful, a critical point to understand in reviewing the RUOK case study is that the media provides little discussion or understanding on the important role that grief and depression (Kubler-Ross, 2014) play in learning, growing and maturing31. Instead, mental health is mostly portrayed as a problem that must be fixed or treated, and preferably not left for too long in doing so. 29 “Broadcast and printed media are considered to be the public’s primary source of information regarding mental health=illness (e.g., Anderson, 2003; Hannigan, 1999; Philo et al., 1994). Numerous studies have documented an association between negative media portrayals of people with mental illness and the public’s negative attitudes (e.g., Angermeyer & Matschinger, 1996; Philo, 1996; Wahl, 1992; Wahl & Lefkowits, 1989) and have concluded that stigmatizing presentations have a direct negative effect on individuals living with mental illness (Grinfeld, 1998) and on social policies (Cutcliffe & Hannigan, 2001; Olstead, 2002; Rose, 1998).” Nawková et. al. (2012, p.23) 30 This study describes Australian media portrayal of mental illnesses, focusing on depression. A random sample of 1,123 items was selected for analysis from a pool of 13,389 nonfictional media items about mental illness collected between March 2000 and February 2001. Depression was portrayed more frequently than other mental illnesses. Items about depression, eating disorders, and substance use disorders most commonly described policies or programs, whereas items about schizophrenia most frequently portrayed individuals or symptoms and treatment. A minority of items about depression presented information about symptoms, causes, treatment, or prognosis. Francis and Perkins et. al. (2005, p.283). 31 As outlined earlier in this essay Robert Sams - February 2016 www.dolphyn.com.au 12
How do the media amplify the challenges for people in maintaining their mental health? Finally, in order to understand how a reductionist discourse32 amplifies the challenges for people in maintaining their mental health, it is essential to be aware of how the communication of mental health messages33 impact on our unconscious mind in relation to decision-making34. It is the unconscious messages, through framing and priming that are critical in understanding how people make decisions and judgments. A demonstration of how framing and priming of messages about the RUOK program is included in the case study. So how may the reporting and portrayal of stories about mental health in the media ‘amplify’ the challenges faced by people in maintaining their mental health? Slovic (2010) outlines a valuable model to consider how amplification may occur when messages are portrayed through the media in what is know as the Social Amplification of Risk Framework (SARF)35. While this model refers to the amplification of risk in general, in the context of this essay, risk is considered as the challenges in maintaining mental health. 32 Of ‘fixing’, ‘treating’ and ‘solving’ 33 For example through the media 34 As noted by Postman (2006), such messages go beyond the text used in such communication and include symbols and metaphors; “A message denotes a specific, concrete statement about the world. But the forms of our media, including the symbols through which they permit conversation, do not make such statements. They are rather like metaphors, working by unobtrusive but powerful implication to enforce their special definitions of reality. What is peculiar about such interpositions of media is that their role in directing what we will see or know is so rarely noticed. A person who reads a book or who watches television or who glances at his watch is not usually interested in how his mind is organized and controlled by these events, still less in what idea of the world is suggested by a book, television, or a watch.” (2005, p.11) 35 Kasperson et. al (1989, p. 131) note; “Social amplification of risk, in our usage, denotes the phenomenon by which information processes, institutional structures, social group behaviour, and individual responses share the experience of risk, thereby contributing to or reducing the risk consequences.” Robert Sams - February 2016 www.dolphyn.com.au 13
How do the media amplify the challenges for people in maintaining their mental health? Effectively what Slovic suggests is that certain factors in reporting may either amplify, that is heighten the effect of, or attenuate, that is dampen the effect of, messages that it portrays36. Two key elements of the SARF model are stigma37 and what Slovic (2010) refers to as a “signals38”. Slovic (2010, p.138) explains that “amplification stations” that may amplify or attenuate signals39 may include for example “reporters and the mass media”. In progressing this idea further, Imison and Chapman (2012), refer to signals in another way, as ‘events’40 or ‘cues’. Events are examples of signals in in the SARF model and it can be events, such as the RUOK Day that the media use to amplify or 36 A simple explanation of this is ‘what is said and what is not said’ in the media will impact on people’s reactions to stories in the media 37 Flynn et. al. (2004) refer to stigma as “ something that is to be shunned or avoided not just because it is dangerous, but because it overturns or destroys a positive condition, signalling that what was or should be something good is now marked as blemished or tainted. (Flynn et. al 2014, preface) 38 Slovic (2010) notes that; “Kasperson (1988) argue that such signals are subject to predictable transformations as they filter through various social and individual amplification stations. Such transformations can increase or decrease the volume of information about an event, heighten the salience of certain aspects of a message or reinterpret and elaborate the availability symbols and images, thereby leading to particular interpretations and responses by other participants in the social system. Slovic (2010, p. 318) 39 For example about stigma’s associated with mental health 40 Events become news when they possess characteristics deemed ‘newsworthy’. Among commonly- accepted criteria of newsworthiness in overseas coverage are the resonance of an event with media consumers’ sense of cultural familiarity and existing beliefs, the rarity of the event and the extent to which it can be personalised (Galtung & Ruge, 1965) cited in Imison and Chapman (2012, p. 3) Robert Sams - February 2016 www.dolphyn.com.au 14
How do the media amplify the challenges for people in maintaining their mental health? attenuate messages about mental health. This will now be examined through the case study41. The discourse analysis study by Sams (2015c) included a review of 50 separate reports or portrayals of the 2015 RUOK campaign across a broad spectrum of media including websites, newspapers and television. Amongst these were the RUOK website, the RUOK Facebook page, reports from the Daily Telegraph, News.com, Channel Nine and seven news reports42. Eight individual case studies are included in this essay along with an interview with the mother of a person who has suffered life long challenges with mental health. The summary in this essay is a representation of the broad findings of the study by Sams (2015c). Case Study Number One – A Review of the RUOK Website43 An obvious starting point to begin a review of how a reductionist approach is in place is to start with the name ‘RUOK’. Using such a simplistic name suggests that all that is needed to understand the complex issues44 of mental health is to ask “are you ok?”, ‘reduces’ a multifaceted topic to a simplistic question. 41 This essay does not allow for a thorough review of the impact and affect that the media may have in amplifying the challenges associated with mental health so a small number of media reports and portrayals from a more detailed studied conducted by Sams (2015c) of the RUOK for 2015 is provided. 42 An important point to note is that many media agencies across different media channels are linked and associated with each other. For example, “All major newspapers are owned either by News Limited, a subsidiary of News Corporation, or Fairfax Media.” (source; https://en.wikipedia.org/wiki/Media_of_Australia as accessed on 19.12.2015) - The impact of this is that messages are often reinforced through various different channels only serving to make understanding the ‘truth’ even more challenging for people especially when these channels appear completely independent of each other 43 https://www.ruok.org.au 44 As discussed earlier in this essay including the multi-faced make-up on well-being including mental health Robert Sams - February 2016 www.dolphyn.com.au 15
How do the media amplify the challenges for people in maintaining their mental health?
Such simplistic messages are repeated throughout the RUOK website45 where there
is also a constant undertone of reducing the stigma46 of mental health through
encouraging conversations. However this message maybe problematic as Muerk et.
al. (2015) explains;
Focusing on stigma may inadvertently individualise the causes of mental illness
and distract attention away from the other roles of the social environment in
contributing to mental illness: for example, a dysfunctional immediate social
environment or structural socioeconomic inequalities. If the tole of the social
environment is reduced to focus on stigma alone, society and governments may
feel less obligated to find effective solutions to social causes of mental illnesses
or to provide social support to this with mental illness who need it.
(Muerk et. al. 2015, p.166)
This provides a paradoxical situation where on the one hand promoting conversation
and relationships may provide for healthy relationships and reduces the stigma
associated with mental illnesses, at the same time; they may enhance the very thing
that they are aiming to reduce. This is one reason why a reductionist approach to
complex challenges is problematic.
45 For example with this message; a) “If your gut says something’s not quite right with someone, chances are that they might
need a bit of extra support from the people around them. They might be acting a bit differently, seem to have a lot on their plate,
or simply aren’t themselves. Don’t ignore those signs but instead take some time to start a conversation.” And this message b)
“One of the great things about asking “are you ok?” is you don’t have to know the answers to a mate’s problems. Nor do you
have to be ok yourself. Or feel particularly strong. As long as you feel up to listening, not judging and just talking through stuff
you have found useful in the past, you’ve everything it takes to have a meaningful conversation to support a mate in need.”
Source: http://wwwruok.org.au as accessed on 31.12.2015
46 The challenges of discourses that focus on stigma are explained by Muerk (2015); “The discourses that frame media
campaigns for improving mental health through de-stigmatisation can unintentionally support a rationale for state disinvestment
in mental health services, socially based treatments or social welfare. (Muerk et. al. 2015, p.166)
”
Robert Sams - February 2016 www.dolphyn.com.au 16How do the media amplify the challenges for people in maintaining their mental health?
Case Study Number Two – A Review of the RUOK Facebook Page47
The following message appears in the About Us section of the RUOK Facebook
page;
R U OK? wants to inspire all people to ask 'are you ok?' to support anyone
struggling with life. Visit ruok.org.au Our mission is to create a world where all
people are connected and are protected from suicide.
Source: https://www.facebook.com/ruokday/info/?tab=page_info as accessed
on 20.12.2015
This is a further demonstration of the simplistic message proposed by RUOK to the
complex challenges of maintaining mental health. Specifically, the message about
RUOK’s mission to “create a world where all people are connect and protected from
suicide” demonstrates a discourse of ‘helping’48 hence suggesting that that there is
no place in the message of RUOK to learn from the lessons of grief and pain as
noted by Kubler-Ross earlier in this essay. This is evidence of the reinforcement of
the reductionist discourse in the RUOK message.
Further specific evidence of this the reductionist and controlling discourse of RUOK
appears in the ‘conversation thread’ included at Appendix A. In this ‘conversation’, a
member of the conversation expressed concerns about how he had been previously
treated by police and the immediate response in the next thread by the
‘Administrator’ of the RUOK Facebook page was;
47 Refer to Appendix A
48 For example through the use of the word “protected”
Robert Sams - February 2016 www.dolphyn.com.au 17How do the media amplify the challenges for people in maintaining their mental health?
Given that we had no other way to ensure that you were safe, we had little
choice but to contact 000. Many police have been trained to sensitively and
responsibly support people in a suicidal crisis.
Source: https://www.facebook.com/ruokday/info/?tab=page_info as accessed
on 20.12.2015
Of particular interest in this post is the language used, “to ensure that you were safe,
we are left with little choice but to call 000”. This is direct evidence that the RUOK
program seeks to control individuals49 and further demonstrates that there is no place
in the message of RUOK for understanding of pain and suffering, rather a desire to
‘reduce’ or eliminate it. An alternative to adopting ‘reductionist’ methods, is adopting
a more humble inquiry50, rather than moving quickly to ‘fixing’.
Case Study Number Three – An Example Campaign on the RUOK Website
The poster included at Appendix B was posted on the RUOK website. It is noted
from the language used; that the message espoused by RUOK has an agenda that
suggests that they don’t think people suffering from mental health challenges are well
so they are going to make it their business to find out what is causing their pain,
presumably for the purposes of ‘reducing’ it. The discourse51 of this language is one
of fixing and controlling, not one of understanding or empathy.
The essay will now turn its attention to how the RUOK program is portrayed in media
other than it’s own website and Facebook page.
49 In this case by contacting the Police
50 See Schein (2013)
51 That is, the power exhibited through the use of language
Robert Sams - February 2016 www.dolphyn.com.au 18How do the media amplify the challenges for people in maintaining their mental health? Case Study Number Four – A Report on News.com website52 This story on News.com is of Tyson who overcome suicidal thoughts and went on to live a life with great well-being. This is typical of stories portrayed on popular mental health websites53 that outline how people have overcome feelings of pain, anxiety and depression and ‘chose’ against the decision to take their own life through suicide. This type of reporting, of heroism as a signal,54 may serve to amplify to those with a mental illness that their situation may be worse than they thought because they do not exhibit the ‘heroic’ powers demonstrated through the examples identified. This also provided evidence of how the media may attenuate, through what is not said. In all of the cases sited, the stories of recovery were portrayed positively and did not disclose the many personal challenges and set-backs that the people in the stories may have experienced. Case Study Number Five – A Report on Daily Telegraph website55 The article promoting RUOK’s 2015 concluded with; 52 http://www.news.com.au/lifestyle/health/health-problems/open-dialogue-about-depression-is-one-of-the-most-important- conversations-society-can-have/news-story/2a208694e396f4d483f18dc2d97471ea - as accessed on 17.12.2015 53 For example see Mary’s story - https://www.beyondblue.org.au/get-involved/make-a-donation/support-service-christmas- appeal - as accessed on 17.12.2015 and Rachel’s story - https://www.lifeline.org.au/makingspiritsbright - as accessed on 17.12.2015 54 Signal; as defined by Slovic (2010) earlier in this essay 55 Article from the Daily Telegraph article headed RU OK The Question That Could Save Your Life dated 31.08.2015 source: http://www.dailytelegraph.com.au/news/national/ruok-the-question-that-could-save-a-life/story-fnjj6010-1227505297406 - as accessed on 12.12.2015 Robert Sams - February 2016 www.dolphyn.com.au 19
How do the media amplify the challenges for people in maintaining their mental health?
Campaign director Rebecca Lewis said today’s event, which involves Health
Minister Michael Ferguson and House of Assembly Speaker Elise Archer, is an
opportunity for anyone to have meaningful conversations, with coffee and cup
cakes thrown in.
source: http://www.dailytelegraph.com.au/news/national/ruok-the-question-that-
could-save-a-life/story-fnjj6010-1227505297406 - as accessed on 12.12.2015
The trajectory of a statement that concludes with “meaningful conversations with
coffee and cup cakes thrown in”, is that this is simply a marketing and promotional
campaign. Any serious effort to have ‘meaningful conversations’ would not be framed
in a way that would include “coffee and cup cakes thrown in”.
Case Study Number Six – A Report on News.com website
News.com on 10.09.201556 describes that; “depression is a silent, devastating
menace that all too many people endure alone. And often the first time those close to
them learn about it, it can be too late”. This is further evidence that the discourse
associated with reporting on mental health is that it is a demon that must be fixed and
vanished. Through the description as a “devastating menace”, it again reinforces that
there is no place for learning, maturing or growing from mental health challenges.
56 http://www.news.com.au/lifestyle/health/mind/why-people-suffering-from-mental-health-issues-struggle-with-r-u-ok-
day/news-story/ce235dbbd6300a9e12154eed678a7d73 - as accessed on 17.12.2015
Robert Sams - February 2016 www.dolphyn.com.au 20How do the media amplify the challenges for people in maintaining their mental health?
The article also tells the story of Geoff57 and how he struggles with RUOK Day and
concludes with Geoff suggesting; “It seems like a hollow, token gesture and I suspect
it’s because they don’t really care.” This is further evidence of the risk of ‘reducing’
complex messages down to simplistic, marketing style programs may have on
individuals who deal with the challenges of mental health.
Case Study Number Seven – A Report on Daily Telegraph website
The Daily Telegraph on 22.09.201558 reported on the Pymble Ladies College –
‘Onsie’ promotion;
“We printed out some conversation starters to stick around the oval to get
conversation going,” she said. “Even though we didn’t beat the record, it was an
incentive to engage people .”
The discourse of this portrayal is of ‘quantity over quality’ in relation to conversations.
It would appear that the promotion of the RUOK program in this school was not about
“meaningful conversations” as promoted by RUOK, but rather the volume of
conversations measured by “beating the record”.
Case Study Number Eight – A Report on The Australian Newspaper website
57 “R U OK? Day has been poorly rolled out in Geoff’s workplace by the office social butterflies seeking yet another way to
break up the monotony of corporate life, with all the same grace and decorum as they would run the annual office Melbourne
Cub sweep.” Management and staff will mingle, make small talk and laugh as they ask ‘R U OK?’ like they do every year. And
Geoff will answer “yes” because why on earth would he open up about his psychological pain in this sort of setting? “Why don’t
they ask on one of the other 364 days of the year? It seems like a hollow, token gesture and I suspect it’s because they don’t
really care.” (http://www.dailytelegraph.com.au/search-results?q=RU+OK+Day as accessed on 17.12.2015
58 http://www.dailytelegraph.com.au/newslocal/north-shore/pymble-ladies-college-attempts-to-break-world-onesie-record-for-r-
u-ok-awareness-day/story-fngr8h9d-1227523020252 - as accessed on 17.12.2015
Robert Sams - February 2016 www.dolphyn.com.au 21How do the media amplify the challenges for people in maintaining their mental health? The Virgin Mobile campaign59 as reported as a news story in the Daily Telegraph on 11.09.2014 tells (or sells) the story of how Virgin Mobile “will give its customers free calls within Australia today as part of its biggest ever marketing overhaul aimed at making mobile phones — and Virgin’s relationship with its customers — more meaningful.” The discourse of this message is that Virgin is using the RUOK program as a tool to promote their mobile phone network. A key point to make is that the language and discourse is negative, there is not positive in depression and anxiety, no link to resilience, only harm – reinforces only the hedonic approach to wellbeing. In concluding the case study, it is critical to highlight that one of the key challenges and paradoxes in creating a very public program and campaign using a simplistic message and symbolism is that while more people become aware of what this message means, it also means that people dealing with the challenges of mental health may think that they are not doing so well because they hear the key messages so often. For example while RUOK has raised awareness about meaningful conversations, at the same time the example shared by Geoff in the Daily Telegraph story in some ways cheapens RUOK to a marketing program full of gimmicks. To conclude, and test the thesis proposed in this essay, an interview was conducted60 with the mother of a long-term sufferer of mental illness. This example provides evidence that the messages of ‘RUOK’ and similar program, offering seemingly simple fixes to complex problems may paradoxically and inadvertently create 59 See excerpt; “The offer is part of the telco’s partnership with R U OK? Day, which encourages people to reach out to others that may be struggling. It also kicks off the second phase of the telco’s “Making Mobile Better” marketing campaign, created by advertising agency Havas Worldwide, which raises awareness of trivial or annoying mobile phone behaviour and aims to give it more meaning.” Source: http://www.theaustralian.com.au/business/media/virgin-finds-meaning-in-mobile-on-ruok-day/news- story/a5bb625367adda1caf83424b21e37fa9 - as accessed on 17.12.2015 60 See Appendix C Robert Sams - February 2016 www.dolphyn.com.au 22
How do the media amplify the challenges for people in maintaining their mental health? additional challenges61 for people with mental illness when they see regular messages of ‘solutions’ and ‘fixes’, yet are not able to put these in place themselves. So given this, what is a different way forward? The essay will now offer suggestions for a ‘way forward’ in how dealing with the challenges of mental health may be dealt with from three different perspectives; a) the way forward for individuals who face challenges to mental health; b) for communities and society; and importantly in the context of this essay, c) for the media. Firstly, for individuals, as the essay has already established (Kubler-Ross 2014), building resilience and accepting pain, suffering and grief are factors that individuals may work through over time. Kubler-Ross’s (2014) five stages of dealing with grief and grieving provide a framework for individuals to progress through this. However it is acknowledged that this model only serves those who are experiencing, or have experienced pain, suffering and grief. As Seligman (2012, p.11-12) notes in his model for ‘authentic happiness’ there are three things individuals should strive for to improve wellbeing including; a) positive emotion, engagement and meaning; b) ‘flow’ and; c) happiness which is meaning and flourishing62. 61 Such as those highlighted in the interview (Appendix C) where the person suffering the mental illness now has a profound feeling of guilt 62 “The gold standard for measuring well-being is flourishing, and that the goal of positive psychology is to increase flourishing.” (Seligman 2012, p.13) Robert Sams - February 2016 www.dolphyn.com.au 23
How do the media amplify the challenges for people in maintaining their mental health?
Seligman (2012) notes;
People who have the most positive emotion, the most engagement, and the
most meaning in life are the happiest, and they have the most satisfaction.
(Seligman 2012, p.15)
In building on Seligman’s ideas, individuals may consider Aghadiuno, M. (2010, p. 5)
who describes; “a holistic perspective of health and illness takes in the physical,
emotional, social, cultural, psychological and spiritual dimensions of the person”. He
further notes (2010, p.14) that “Holism sees the people as part of a family, culture
and community and regards people as entities with physical psychological
sociocultural and spiritual aspects”
Spirituality is accepted in a more holistic approach to dealing with mental health.
Bennet and Shepherd (2012) note that spiritual beliefs are critical in dealing with
depression63.
63 Research in the role of spirituality in medical practice has risen markedly in recent years (Hibers et al., 2010) stemming
“
largely from research which has identified that assessing and supporting patients’ spiritual beliefs may have positive impacts on
mental health, especially depression (Koenig, 2008; Koeng et al., 2001; Seeman et al., 2003; Sims and Cook, 2009) cited in
Bennett, K. and Shepherd, J. (2012). as cited in Bennett, K. and Shepherd, J. 2012
”
Robert Sams - February 2016 www.dolphyn.com.au 24How do the media amplify the challenges for people in maintaining their mental health? Taking this further, Boniwell (2015) suggests, in relation to finding ‘meaning’, that this requires “dedication and commitment to something or somebody else by oneself” which she describes as ‘transcendence’64. It is finding meaning with others that links back to the definition of mental health established earlier in this essay where the WHO (2015) definition of well-being highlighted the critical aspect of being able “make a contribution to his or her community”65. So if well-being and maintaining good mental health requires individuals to contribute in community, what is required of communities in order for this to occur? To begin to understand this, we can turn to MacKay (2014) who, in his book, The Art of Belonging provides a narrative through non-fictional stories of how communities may ‘flourish’ together66. Mackay’s “we need communities and they need us”, suggests that, one is good for the other and they need to co-exist. However, Mackay 64 “Transcendence is related to dedication and commitment to something or somebody else but oneself. It is also strongly related to finding meaning in one's life and acting in accordance with this meaning. However, this meaning is necessarily related to transcending the personal (without losing oneself) for the sake of something larger than oneself (it can be children, meaningful work, the wider community, or a spiritual pathway). Transcendence thus leads to some external utility of one's life, through objective life results or virtuous living. Transcendence is a eudaimonic pathway to well-being that is independent of personal development (although undoubtedly both can co-exist). For example, a mother who dedicates her life to raising (rather than merely looking after) her children as fully functioning human beings may not have much time to devote to her own personal development.” Source; http://www.positivepsychology.org.uk/pp-theory/eudaimonia/34-the-concept-of-eudaimonic-well- being.html as accessed on 16 December 2015 65 http://www.who.int/mediacentre/factsheets/fs220/en/ (as accessed on 12 December 2015) 66 We rely on communities to support and sustain us, and if those communities are to survive and proposer, we must engage with them and nurture them. That’s the beautiful symmetry of human society; we need communities and they need us.(MacKay, 2014, p.1) Robert Sams - February 2016 www.dolphyn.com.au 25
How do the media amplify the challenges for people in maintaining their mental health? provides a caution67 of the paradox of living in community while at the same time having all of the desires, weaknesses and challenges as individuals. The key to successful communities is an understanding of the tension that exists between what Buber (2000) refers to as I-Thou68. Buber’s exploration of the dialectic of ‘self’ in existence in ‘community’ is important in considering how communities may support each other in maintaining mental health. Long (2013) takes Buber’s concepts and philosophy and put them into practice in the community that has been created at Sydney’s The Wayside Chapel69. ‘The Wayside’ is social service that provide support through ‘community’70 to those who have “fallen by the wayside”, that includes many who face challenges with mental health. 67 But the tension between our independence and our interdependence may be one of the most useful explanations of why we “ so often feel conflicted and confused about what we should do. We know we should treat each other respectfully and with kindness: after all, that’s the basis of any civil society. But sometimes we just want to get our own way, regardless of the negative impact of our behaviour on others.” (MacKay, 2014, p.1) 68 “When Thou is spoken, the speaker has not thing for this object. For where there is a thing there is another thing. Every It is bounded by others; It exits only through being bounded by others. But when Thou is spoken, there is no thing. Thou has no bounds.” (Buber, 2000, p.20) 69 http://www.thewaysidechapel.com 70 The Wayside aims to “creates a community where there is no ‘us and them’ by breaking down the barriers of judgement and providing a safe place where people from all walks of life are welcome just to ‘be’” Source; http://www.thewaysidechapel.com/about-us.php accessed on 09.12.2015 Robert Sams - February 2016 www.dolphyn.com.au 26
How do the media amplify the challenges for people in maintaining their mental health?
Long (2013), in extending Buber’s I-Thou philosophy suggests that:
When a meeting between two people truly takes place, when there is just you and
me and we are interacting in a very real and honest way, dropping agendas and
stepping into a wide open space where the air is fresh and competitors become
brothers and sisters and threats become people, this is when we come into life.
(Long 2013, p. 35)
If Long’s concept of ‘meeting’ were more readily adopted in “communities that we
need and they need us”, there would be more time for understanding the complex
nature of human relationships and in this understanding how we can contribute to
each others well-being and mental health. In this concept of ‘meeting’ there is no
desire to ‘fix’ and ‘mend’, just listen and ‘be’.
First hand evidence is included through a case study at Appendix D that provides an
account of how ‘being in community’ assisted a person suffering from anxiety.
Finally, we can turn to what the media can do differently in order to minimise the
amplification of challenges faced by those experiencing challenges with mental
health.
To begin, we can turn to Meurk (2015) who notes;
The cycles of mental health reform in Australia have been characterised as crisis-
driven and ‘ad-hoc’ (Whiteford, 2014; Whiteford, Harris and Diminic, 2013). Each
cycle of reform has been accompanied by a highly publicised mental health issue
which dominated Australian media coverage of mental health issues. Our
examination of the role media have played in mental health reform has been
prompted by this apparent pattern and a desire within the field for mental health
policy development to be better informed by research evidence that is applied in a
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