The transitional period of adolescence can be a struggle for some, particularly within the fast paced industrialised societies of capitalist consumption. It can present itself as a fight for autonomy with much influence from others such as parents, peer groups and the media. The experiences of the child through his/her upbringing form their internal working model; the basis of their approach to how they make sense of the world and those in it. However the culture, location, financial status, and family ethics are all beyond the control of the lives of the young. The level of vulnerability to discrimination at the adolescent stage in the life course is heightened by the participation in platforms such as school, increased socialising outside of the family, social networks and media. As Erikson theorises, from ages 12 to 18 the child is at a stage of identity versus role confusion, awareness of the opinions of others awakens and the ability to contrast their life experience with that of others and the cultural norms begins. (Maclean & Harrison, 2011, p. 100).This realisation of difference can lead to a sense of inequality which, once recognised and understood, can result in stigmatisation and stereotyping, with the potential to lead to social exclusion. (Burke & Parker, 2007, pp. 11-12).
A social constructive perspective would suggest that the reality we live in is constructed by subjective understandings, producing these cultural norms. These effect the lives of all in the form of one size fits all expectations and dictats such as age, education, finance, marriage, employment, behaviour, language and so on. These expectations of “the norm” can put increasing pressure on individuals and deviance from them can provoke negative reactions from others. It is these negative reactions, alongside the construct of language used, that form the basis of stigma, discrimination and oppression. (Thompson & Thompson, 2008, pp. 259-260)
The media, and those within, have certainly played their part in tainting youth culture in a negative light. With the use of language seen in the tabloids such as “Asbos, chavs, hoodies, yobs, gangs” – the list goes on. It is of course not only the young that suffer discrimination from the media, the following account from somebody diagnosed with schizophrenia shares their opinion of the effect the media have on those with mental illness. After discussion of tabloid headlines such as “schizo’ butchers” they summarise: ‘The media and politicians have no idea of how much damage they do in their senseless reporting and twisted logic… of how they diminish the chances of recovery and prevent those suffering with mental illness from restoring their lives’. (Dominic, 2002, p. 21). It is the power of the mass media, the influence that the media and politicians hold, that guide the general opinions of society as a whole. This use of such negative portrayal and language creates labels of disadvantage and discrimination. This labelling process (Becker, 1963, Lemart, 1972) can push those affected to the fringes of society, with the readers of these tabloid articles frowning upon anyone perceived to fit the stereotypes, with the potential to encourage some to adopt the associated behaviours and live up to the label they have been assigned; (Payne, 2005, p. 170) a self-fulfilled prophecy. A diagnosis of a mental health condition can present life changing labels, some still consumed by taboo, difficult to discuss and to accept.
The process in receiving diagnosis and support can have the potential to discriminate and oppress in itself. The dominant discourse within mental health services is that of psychiatric diagnosis, this follows the oppressive and outdated medical model of disability. This approach, as described by Oliver, defines disability by focusing on individual impairment rather than recognising culture, society and environment as the disabling factors. In terms of mental health, although traditionally psychiatrists may recognise the economic and sociocultural input into individual circumstance, they continue to follow a medicalized approach to treatment through individual diagnosis and medication. (Thompson, 2012, p. 21). There is much cynicism surrounding the potential conflict of interest in the use of medication by psychiatrists; a biological fix or chemical cosh for a diagnosis based on interpretive judgment with little organic evidence to conclude. Curra speaks about the role of the corporate pharmaceutical industry in the medicalization process, of its power to invent disease and exaggerate symptoms, of the intense turf wars over seeking control of the “social deviances” that offer the most economic and political benefit. (Curra, 2011, p. 95). This is a cynical Marxist stance on capitalism but with the global pharmaceutical market valued at an ever increasing yearly rate of $300billion US dollars, (World Health Organisation, 2014) a sceptical view is entirely justified.
Alternatively the psychological discourse favours the more holistic therapeutic models, on the surface seemingly a more individual approach, however still conceptually weak in that these methods are also based upon value judgements in differentiating “abnormalities” against whatever is defined as “normality” within the profession. As Pollack (1999) once highlighted, these criteria used for diagnoses, the so called deviances from normative behaviours, are defined by adults so do they reflect or even understand the younger narrative? (Golightley, 2008, p. 79). As briefly discussed earlier, the ever changing pace that society is moving in is potentially closing the gap between what is perceived as normal and abnormal. As cultural norms and societal behaviours are forever evolving at a rapid rate, perhaps a more modern approach is required to mental health diagnosis. This potentially oppressive gap between services and young service users needs to be understood by those involved in supporting those entering the system. In a recent campaign document produced for the Department of Health, looking at discrimination around mental health in children and young people, those interviewed expressed their views over reaching out for help and support; fearful that they would not be taken seriously, accused of being attention seekers or of going through an adolescent phase. (Time for Change, 2014, p. 7). These opinions suggest a perceived lack of understanding and empathy for the young people facing mental health diagnosis. Previous research has also suggested that the apparent discriminatory attitudes of some of the professionals involved in the process, despite the current policies implemented to improve equality and tackle discrimination, have actually further contributed to the feelings of rejection, confusion and despair of some of the young people gaining access to mental health services. (Morrison, L’Heureux, 2001, p. 43).
This lack of understanding of the power imbalance between professionals and service users is far from the expected standards of the health and social care sector and quite the opposite of the empowering approach required. As stipulated within the Health & Care Professions Council (HCPC) standards of proficiency, professionals must be able to recognise and manage power dynamics within relationships alongside reflection of the impact of inequality, disadvantage and discrimination and to challenge and address this impact. (HCPC, p. 9) The health care profession is governed by an imbalance of power; from the power of statute law in addition to the procedures, policies and ingrained cultures of governing agencies and other professionals. The disempowerment faced by those diagnosed with a mental health condition can be a complex challenge for practitioners, one which requires a systemic approach to allow space and time for people to develop lost stories, empowering them to understand their own narratives. Without this chance, practice can become oppressive as we impose our own views and agenda without encouragement for people to adjust to any destructive narrative and find their own hope. (Reimers, 2000, p.188)
The use of theory to provide a framework for practice requires a critically reflective position, no single theory can possibly summarise the complexities of an individual and their circumstance. They can however offer a knowledge base of researched societal trends that can be used to guide understanding and improve upon offered support. They also offer a broader perspective on the role of society and the impact of this upon the individual, and vice versa. Giddens approach is that theories are interdependent and mutually reinforce one another, (Cunningham & Cunningham, 2008, p. 26) his concept of structuration could also be applied to society and its reliance on individuals to create and maintain it. Mullally speaks of the obstacles faced by oppressed groups and how these effect their capacity to fully participate within society. (Burke & Dalrymple, 2009, p. 265) This inability to participate potentially impinges on the function of society, however it is society and its function that create these obstacles through discrimination and disadvantage.
Burke, B, Darymple, J. (2009). Critical intervention and empowerment. Adams, R, Dominelli, L, Payne, M (Eds.). Social Work: themes, issues and critical debates. (pp. 261 – 271. 3rd edition). Hampshire: Palgrave Macmillan.
Burke, P, and Parker, J. (2007). Social Work and Disadvantage: Addressing the Roots of Stigma through Association. London: Jessica Kingsley Publishers. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=180456&site=eds-live&ebv=EB&ppid=pp_11
Cunningham, J, Cunningham, S. (2008). Sociology and Social Work. Wiltshire: Cromwell Press.
Curra, J. (2011).The Relativity of Deviance. California: Sage Publications. Retrieved from web: http://search.ebscohost.com/login.aspx?direct=true&db=e000tww&AN=467137&site=eds-live&ebv=EB&ppid=pp_95
Dominic, S. (2002). Stigma Stories. Ramsey, R. Page, A. Goodman. T, Hart. D. (Ed.) Changing Minds: our lives and mental illness. (pp. 3-22). Gaskell: London.
Golightley, M. (2008). Social Work and Mental Health. Exeter: Learning Matters. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=e000tww&AN=411663&site=eds-live&ebv=EB&ppid=pp_79
HCPC. (2012) Standards of proficiency: Social Workers in England. London.
Morrison, L. and L’Heureux, J. (2001) Suicide and gay/lesbian/bisexual youth: Implications for clinicians. Journal of Adolescence 24, 39–49. Retrieved from http://pendientedemigracion.ucm.es/info/rqtr/biblioteca/Violencia%20gltb/suicide%20in%20gltb%20youth%20implications%20for%20clinicians.pdf
Payne, M. (2005). Modern Social Work Theory. 3rd Edition. Hampshire: Palgrave.
Reimers, S. (2000). Commentary from a practitioner perspective. Gordon, R. (Ed.) Developing reflective practice: Making sense of social work in a world of change. (pp. 187-190). Bristol: The Policy Press.
Time to Change. (2014). Children and young people’s programme development. Summary of research and insights. Retrieved from http://www.time-to-change.org.uk/sites/default/files/TTC%20CYP%20Report%20FINAL.pdf
Thompson, N and Thompson, S. (2008). The Social Work Companion. Hampshire: Palgrave Macmillan.
World Health Organisation (2014): Trade, foreign policy, diplomacy and Health; Pharmaceutical industry. Retrieved from http://www.who.int/trade/glossary/story073/en/
Find out more about ASLI Project Development and Social Justice Administrator Becky Saunders
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