Download BrattonScierra_ProposalDraft2_070116

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Running Head: MENTAL HEALTH COMMUNICATION AND SOCIAL MEDIA
The Effect of Social Support through Online Forums:
Erasing the Stigma of Mental Health Disorders
Scierra N. Bratton
Queens University of Charlotte
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Running Head: MENTAL HEALTH COMMUNICATION AND SOCIAL MEDIA
Abstract
In any given year, one in five adults in the United States will be diagnosed with a mental
disorder (Kitchener and Jorm, 2013, p.3). Within that same year, a national survey found that
19.6 percent of adults (18 or older) experience a mental disorder. The percentage may not
immediately alarm you, but the equivalent is 45.6 million people. Researchers are now working
to figure out what hinders and what helps individuals with these disorders. Meanwhile, increases
in social media use through the implementation of platforms such as Facebook, Twitter and
Instagram have created a global reach and easier access via mobile devices to engage, discuss
and connect. Research leans in two directions. On one end of the spectrum, researchers believe
that social media can be helpful in mental health recovery, while on the opposite end of the
spectrum the argument is that social media is a cause of increasing mental health issues. For
example, data from the Office for National Statistics suggests that children who spend more than
three hours a day on social media are twice as likely to suffer from mental health issues
(www.ons.gov.uk., 2016). On the other hand, studies show that children and adolescents should
decrease social media time, but it is increasingly difficult with devices such as cell phones and
tablets. These studies argue that a decrease in social media time equals a decrease in mental
health issues. These mobile devices allow for users to constantly stay connected without regard
for face-to-face interactions. However, McNeil (2013) suggests that social media has the
opportunity to provide an outlet for grief and pain, or an opportunity to receive social support
that may not otherwise exist. By participating in social media platforms, I believe that users are
able to freely and boldly ask for guidance and social support without the pressures of real life,
face-to-face social interaction.
Key words: health care communication ethics, mental health, stigma, social support,
social media, forums, digital propinquity, grief, pain, acceptance
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Mental Health Communication and the Role of Social Media
This project will study the impact of communication on mental health, specifically in
social media communities, to better understand how people use online forums to build social
support. Mental health disorders are serious issues that many face today. Some may not realize
that they have a disorder due to misdiagnosis or not being diagnosed at all. Furthermore, there is
typically a negative stigma placed on individuals who have been diagnosed, leaving many
hesitant to learn the facts. Those who live with mental illnesses typically recall feeling tainted or
“less than” (Yeshua-Katz and Martins, 2013, p. 500). Many times these individuals are labeled as
crazy, violent or even stupid, which makes those who have not been diagnosed hesitant to get
checked, for fear of falling into the stigma. As technology advances every day, so does the use of
social media as users have the ability to share what they want, whenever they want. Consumers
are avidly using online forums as a means of a virtual support group to connect with friends,
family, and strangers all over the world. The focus of this project is to discover if positive
communication takes place via forums in an effort to encourage social support and effective
communication about mental health. There are many studies that share research on social media
and the idea that it is a helpful tool in mental health recovery. This paper will take a deeper look
at how individuals’ usage of social media affects their communication, thereby, their well-being
including their mental health.
Today, social support extends further than the face-to-face communication scenario. The
Digital Propinquity Theory is defined as people who are online and are uniquely able to form
attachments and connections to others who they would possibly never “meet” otherwise
(McNeill, 2013, pp.5-6). The introduction of social media has changed the concept of
community by allowing users the ability to disregard the restrictions of time and space. Whether
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near or thousands of miles away, loved ones and strangers alike have endless ways to connect via
social media. McNeill (2013) explains that community has gradually expanded beyond
geographical borders, becoming a combination of real as well as virtual spaces with collective
and collected experiences being gained from these worlds (p. 7). With the advancement of
technology and the increase in social media use, studies are being conducted to see how
excessive this use is and how it is affecting users, mentally.
Through extensive research of health communication, I hope to discover how social
support through social media is utilized by individuals who live with mental health disorders. I
will look at how users are communicating and building relationships with others who have
mental health disorders if the communication assists users or hinders their attempts to gain social
support. The intended audience for this project is anyone who has a diagnosed mental health
disorder or anyone who has a loved one with a diagnosed mental health disorder. It is important
that the audience becomes more self-aware of how they are communicating with their loved ones
because once they are aware, they might be able to enhance how they communicate with them.
The goal of this project is to shed light on how online forums might have the ability to erase the
stigma on mental health.
For this inquiry project literature review, I will focus on how social support via social
media communication might optimistically affect individuals living with mental health disorders.
I will discuss the stigma on mental health, the digital propinquity theory, health care
communication ethics, and responsiveness for health care communication. By analyzing social
media presence, I will hope to understand how individuals might competently utilize social
media platforms as a positive means of social support. The final outcome of this project will be a
thesis.
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Running Head: MENTAL HEALTH COMMUNICATION AND SOCIAL MEDIA
Literature Review
Defining Mental Health
In the Mental Health First Aid USA manual (2013), mental health is discussed on a
continuum that ranges from having good mental health to having mental disorders. Someone
who feels in control of their emotions with exceptional cognitive functioning and has positive
interactions with others is considered an individual with good mental health. Those who embody
these characteristics tend to perform well at work, in school, and in family and other social
relationships. The authors of the manual define a mental disorder, or mental illness, as “a
diagnosable illness that affects a person’s thinking, emotional state, and behavior and disrupts
the person’s ability to work or carry out other daily activities and engage in satisfying personal
relationships” (Kitchener and Jorm, 2013, p. 2). A few common mental health disorders include:
anxiety disorders, major depressive disorder, substance use disorder, bipolar disorders, eating
disorders, and schizophrenia.
Historical Context
In the early history of mental illness, many cultures believed it was a form of religious
punishment or demonic possession (uniteforsight.org, 2012). Ancient Egyptian, Indian, Greek,
and Roman writings categorized mental illness as a religious or personal problem. In the fifth
century B.C., Hippocrates, a pioneer in treating mentally ill people, focused on changing a
mentally ill patient’s environment or occupation or administering medications. During the
Middle Ages, the mentally ill were believed to be possessed and these negative attitudes
continued into the eighteenth century in the United States. This negativity lead to the
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stigmatization of mental illness and unhygienic (as well as often degrading) confinement of
mentally ill individuals (uniteforsight.org, 2012). This same stigma on mental health still lurks
today still with dark portrayals and a negative attitude towards individuals living with mental
health disorders.
Stigma
As the use of social media expands, it is becoming increasingly important to understand
that although there are risks, users are also able to utilize these platforms for recovery and to
challenge the stigma. Today, individuals with mental health illnesses are using social media for
peer support, shared learning, and to decrease their feelings of isolation. While mental health
patients are recognizing this positive impact, I believe it is important for mental health
practitioners to be able to increasingly gain an understanding so that they can provide the proper
support and care. Betton and Tomlinson (2013) write that “practitioners in health are slowly
waking up to the potential of social media as a tool to facilitate and promote the social inclusion
of individuals living with mental health problems” (p. 57). The authors explain that social media
not only provides a space for people with similar experiences to connect, but it has the potential
to reduce isolation. These platforms promote engagement in peer support and can create a
positive outlook for individuals experiencing mental health issues.
The term stigma is composed of a double perspective known as discredited and
discreditable stigma. Discredited stigma is when the individual assumes his or her differentness
is already known or is visible and discreditable stigma is when he or she assumes it is neither
known by those present nor immediately perceived by them (Yeshua-Katz and Martins, 2013, p.
500). Individuals who do not have a solid social support system offline might turn to online
support groups to fill the void of social and psychological needs. This can assist in compensation
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for the lack of those resources in real life allowing these stigmatized individuals the benefits of
joining a group of others who are similar.
Some benefits include: feeling less isolated and different, disclosing a long secret part of
oneself, sharing one’s own experiences and learning from others, and gaining emotional and
motivational support (Yeshua-Katz and Martins, 2013, p. 501). Some communication issues that
stem from stigma include: expressing feelings of hopelessness, change in normal emotional
behavior, increase in substance abuse, withdrawing from family, friends and society, anxiety,
agitation, trouble sleeping or excessive sleeping, and dramatic changes in mood (Kitchener and
Jorm, 2013, p. 106). One way to avoid or help soothe these issues is by utilizing the concept of
interpersonal communication.
Interpersonal communication is described as the relational function of communication.
According to Goffman, these “interpersonal rituals” reflect on one’s “abilities to send, receive
and interpret messages that influence their self-images, relationships and the giving and
receiving of social support” (Query and James, 1989, p.170). This explains individual’s varying
abilities to communicate supportively with others and elicit social support during crises such as a
mental breakdown. There are five components of interpersonal communication competence;
affiliation/support, social relaxation, empathy, behavioral flexibility and interaction management.
Affiliation/support allows people to feel connected and build an attachment or relationship with
others while also providing the opportunity to give assistance in times of need, uncertainty, or
triumph. Social relaxation allows a space for enjoyment in order to halt feelings of nervousness
or worry. The ability to understand and share feelings of others describes the empathy
component. Behavioral flexibility refers to the adaptive change in behavior in response to one’s
communication environment. If ongoing behavior, including inactivity, is stopped or modified
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then a new behavior is initiated. Finally, interaction management is a component assisting in
improving skills such as productivity, handling conflict, personal improvement and teaching
positive models of behavior.
All of these components can be highlighted in social media forum use. Furthermore,
interpersonal communication competence has three consistently identified dimensions in which
the above mentioned components fall into. They are cognitive dimension, affective dimension
and behavioral dimension. First, the cognitive dimension refers to the ability to receive, process,
and send information along a continuum of social-to-task dimensions. Secondly, the affective
dimension looks at the use of human communication to create, maintain, and terminate
relationships. Finally, the behavioral dimension addresses how job-related information is
communicated to one another (Query and James, 1989, p.171). These three dimensions provide
insight into how interpersonal communication is categorized when studying individual’s
interactions. Through practice of interpersonal communication, individuals are able to find
closeness and comfort through asking questions and giving or receiving feedback. Stigma has the
ability to change over time as new ways are discovered to discuss and become transparent about
mental health. This communication should include those who are living with mental health
disorders not only because they have first-hand knowledge, but because open communication
provides an opportunity to cope as well.
Digital Propinquity Theory
Through use of social media, users build a sense of attachment to networks and groups,
also known as projected communities. These projected communities cause the digital propinquity
effect, which is defined as a closeness inhibited by digital means (McNeill, 2013, p.5). An
example of digital propinquity could be communicating in a forum on Facebook that focuses on
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support for individuals living with a mental health disorder. The concept of digital propinquity
creates a strong sense of connection and attachment that these individuals may not physically
receive.
One example of this concept includes a recent Twitter rant by singer, songwriter, actress,
and model Demi Lovato. Just after midnight on May 5, 2016, Lovato sent a series of tweets to
her almost 36 million followers discussing her displeasure about the negative attitude still seen
towards individuals with mental disorders. One of the tweets received over 20 thousand retweets
(etonline.com, 2016). I believe this shows how social media forums allows its users to connect
and share information efficiently. This means that Twitter’s platform might be a conduit for
digital propinquity by allowing those who follow Lovato to feel a sense of closeness and provide
social support to others by retweeting or loving the tweet. Since people connected on Twitter see
retweets and reactions to tweets as being loved, social support might be produced. As a public
figure, Lovato has a following that allows for increased visibility of her social media platforms,
thus possibly increasing her influence on others, including those with mental health disorders.
Celebrities are not the only ones who use Twitter and other social media as a platform to
provide digital propinquity. A writer for NursingTimes.net (2013) shared an example of the need
for support on social media when there is no one around. In the example, a mother tweeted “my
daughter is having a bad panic attack, we r using paper bag but I can’t seem to settle her? She is
so scared its horrible any advice?” (NursingTimes.net, 2013). The website shared that although
the mother tweeted at 11:20 p.m., several nurses began retweeting her message and offering
advice. The website also said that the mother later used Twitter to thank the community for their
support and reported that people were checking on them days later. According to
NursingTimes.net (2013), “This is where social media comes into its own: it provides an outlet
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Running Head: MENTAL HEALTH COMMUNICATION AND SOCIAL MEDIA
for grief and pain, or an opportunity to get support that may not otherwise exist – maybe it’s 3am
and someone is in need of support, but doesn’t want to disturb their family or friends, or maybe
they feel desperately alone but feel they can’t face people in the offline world”. Perhaps the
flipside of utilizing social media as a means to isolate oneself from the physical world is to seek
guidance and advice from those other than the ones you would otherwise see face-to-face.
By participating in social media platforms, users are able to freely and boldly ask for
guidance and support without the pressures of real life social interaction. The users who respond
and provide the support gain a sense of increase in their self-worth and self-esteem by assisting
others. NursingTimes.net (2013) exclaims that “knowing you’ve helped someone is a wonderful
feeling and can be a real boost to mental well-being. We aren’t just limited to new kinds of social
media, there’s a wealth of forums out there on all kinds of topics aimed at specific
demographics”. One of these topics is mental health and there are many boards and forums for
people with various conditions that are moderated by volunteers to ensure people who use them
remain safe. Although social media is not recommended as a replacement for therapy, it can
beneficially compliment treatment. It allows for individuals to show their independence as well
as boost self-efficiency and self-esteem as a method of recovery. The digital propinquity theory
is achieved when positive and effective communication takes place and responsiveness is
achieved.
I will discuss even more examples further in the project as I look at psychcentral.com.
Psych Central’s website provides a wealth of information for anyone living with a mental health
disorder or anyone who just wants to become more educated on the topic. For this project, I will
place primary focus on the forums section of the website. There are over 400,000 members and
over 425,000 threads throughout the forum. With over 5 million posts within the forum, I will
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Running Head: MENTAL HEALTH COMMUNICATION AND SOCIAL MEDIA
select the most applicable threads within a given time period that discuss topics such as stigma,
social support, and provide examples of digital propinquity. Exploring these posts will allow for
identification of positive communication and relationship building communication online.
Research shows that positive communication and relationship building communication
are key to creating an engaging and proactive space in online forums. With sixty percent of
American adults and eighty percent of Internet users seeking health information online, they are
no longer simply passive consumers of the content they seek. Internet users have become active
producers as well, with social networking sites increasingly being used for venues of exchange
of health-related information and advice Hether, Murphy and Valente, 2014, p. 1424). Attitude
and behavior are crucial aspects of position communication and relationship building
communication as it relates to social media use. Attitude is typically open minded and nonjudgmental in forums for mental health discussion providing a sense of closeness, acceptance,
and tolerance. Behavior tends to mirror attitude based on the connections made and increase in
comfort levels, creating a space for valid questions, advice, information, and social support. It is
hypothesized that trust in social media and the perception of social support are positively
associated with health outcomes (Hether et al, 2014, p. 1433).
The foundation of health care is caring which includes sympathetic response to those who
suffer. In Communication ethics literacy: Dialogue and difference, authors define responsiveness
as the responsibility that meets the call of the Other, even when the call is unwanted (Arnett,
Fritz, and Bell, 2009, p. 191). Typically, an individual who is actively participating in social
media for purpose of social support is also actively seeking responsiveness from their
connections online. Health care communication ethics is more than what happens to us. Rather it
is in our response. Viktor Frankl’s notion of final freedom is a central idea to health care
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communication ethics. In other words, when it seems you have reached a dead end, with no
options, our final freedom is the key to unlocking what seems impossible. “The importance of
response emerges from a pragmatic realization – when there is no longer an easy answer given to
us, we must find a creative response that breaks free of our demand for options no longer
available (Arnett et al, 2009, p. 195). This outlet of responsiveness is available to all through
social media anytime, anywhere.
Research question: How is social media used as a means of social support on mental health
forums?
Method
This study will consist of a textual analysis of digital media conversations on a forum
focused on topics surrounding mental health. The purpose of analyzing these text conversations
will be to explore how use of online forums provides social support for individuals living with
mental health disorders. The study will focus on one digital media forum:
1. psychcentral.com
This digital media forum was chosen because it offers information at no cost, open areas online
for individuals to discuss amongst one another various mental health issues and provides the
opportunity to receive social support. I believe this website will provide data that I can use to
answer my research question.
In 2008, Psych Central was recognized on TIME.com as one of the best websites for its
top mental health content and social media tools. TIME.com (2008) also recognized Psych
Central for its simple quizzes and the “Ask the Therapist” and prescription rating sections. After
reviewing the website, I found it “offers an array of in-depth content from news, book reviews,
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resource links, clinical trial overviews, and quizzes. From bipolar disorder to sexual disorders,
Psych Central is continually building upon its more than 13 years of serving the online
community” (Psych Central, 2008). Founder and publisher, Dr. John Grohol shared that the
website’s commitment is to providing people with trusted mental health information in an effort
to help reduce the stigma associated with it. I believe this website can be used as a self-help tool
that allows members to be a part of support groups. A positive impact of social media is the
ability to connect with others and gain support in a non-judgmental environment. Psych Central
(2008) announced that “each month more than 650,000 people visit Psych Central, to connect
with others, read about various mental health concerns, take assessment quizzes, and more”.
Sites that provide services and forums for social media users, such as Psych Central, may help to
break down the barriers of stigma often associated with mental health concerns by bringing
trusted resources to the Internet.
Procedure
A textual analysis will provide the opportunity to gather information about sense-making
practices, look at how similar or different the sense-making practices people use can be and
provide a better understanding of social support by examining limitations and possible
alternatives to stigma, isolation, grief, and pain (McKee, 2003, p. 14). For the purpose of this
study, I will focus solely on conversations for textual analysis to determine if there are benefits
of providing social support online. The conversations from forums are worthy of analysis
because the content provides insight and might reveal that online forums provede a positive
outlet that can often be overlooked as a benefit of social support. I will collect posts in the
Relationships and Communication forum to use as my data for this study.
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Sample
To conduct digital research, I chose the website psychcentral.com, the internet’s largest
and oldest independent mental health social network (psychcentral.com, 2016). Psych Central
provides a wealth of mental health information, emotional support, and advocacy to over seven
million people worldwide. Celebrating its twentieth year online and named one of the “50 Best
Websites of 2008”, one of Psych Central’s many features includes two online community forums
(psychcentral.com, 2016). I will focus my data collection to include conversations from April
2016 through May 2016 on the Relationships and Communication forum to determine if of
ongoing conversations online provide social support.
I will look closely at the Relationships and Communication forum which includes 237
threads from April 1 to May 31 which include a varying numbers of replies, from hundreds to
thousands. The goal will be to determine the number of posts that appear to be written with the
intention of seeking social support. For example, one post’s subject line is “Feeling so alone”. I
will read through all of the replies to examine how other users respond in an effort to comfort the
initial poster and provide advice on coping with feelings of isolation. I will highlight the best
replies in research and throw out any duplicate replies. Criteria for highlighting selected posts
and replies will include recurring words and phrases that may be interpreted in thematic findings.
Data Analysis
Selected texts will be analyzed using several components. First, each text will be
examined by deciphering whether or not a particular mental health disorder was defined or
described. For example, whether or not the text generally discussed mental health or if a specific
disorder was articulated or a lens implied on any individual disorder. Was the information within
the conversation clearly and thoroughly given and supported by the author? Furthermore, within
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each conversation (or thread), what are the responses provided to the initial post? Are the
conversations more negative or positive? What might the continuous conversations provide to
fellow authors and readers? Is there a method of support and coping provided? I will identify key
words and phrases used within the conversations related to mental health will include symptoms,
challenges, stigma, coping, care, and support. From this, I hope to determine the implications of
social support. Owen (1984) discusses thematic interpretation techniques including recurrence,
repetition, and forcefulness (p.275). From the analyses of these themes, I should complete the
goal of this study, which is to discover how online forums are utilized. Are they a means of
social support?
Challenges and Limitations
The purpose of this study is to gain an insight into the communication barriers of
individuals living with mental health disorders. The study might have data limitations because it
is being collected from sources who are not healthcare professionals. The data will be focused
more on personal experience and suggestions as opposed to science or research based
information. Therefore, the data collected will be provided on a case-by-case basis. Also,
different individuals will have experienced different issues, side effects, and outcomes which
could affect the outcome of the data. Researcher bias may be another limitation, as I will be the
only person interpreting the themes. A challenge may also be the amount of data collected.
However, this study will attempt to shed light on the possible benefits of utilizing online forums
as a means of social support by looking at the themes throughout posts, and their replies in the
Relationship and Communication thread on Psych Central’s website.
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