Dealing with Societal Pressure and its Impact on Mental Health
In my clinical rotation I came across a 50 year old woman diagnosed with schizophrenia. She had a history of learning disability, jaundice and head trauma. For this purpose her mother took her to Pakistan for treatment due to inaccessibility to health facilities .Her mother stated that India’s environment towards girls is restricted, unsupportive and as they were socio economically not strong ,she was therefore unable to get her daughter treated.
Since childhood she was ignored by her family in all house chores and activities. She was deprived from going to school, unlike the rest of her siblings and therefore she started isolating herself from social gathering. Due to social stigma, her parents forced her to remain at home. Now she was admitted with complains of violent, aggressive behavior, crying, harming family members, hallucinations and self-talking. She lives with her mother who is her sole caretaker since her family members dislike her and pass nasty comments on her, further aggravating her symptoms. This scenario reflects how a poor social environment can lead towards mental illness and have a great impact on an individual’s health.
Social environment has been defined by Barnett and Casper (2010) as, “Human social environments encompass the immediate physical surroundings, social relationships, and cultural milieus within which defined groups of people function and interact”. This concept is significant to my patient’s case because human being is a social animal and no one can live without family and society, a person requires help and company to share her emotions, physical and psychological aspects but dissatisfaction from social environment affects mental health. Therefore a caring and respectful environment enhances the sense of satisfaction and well-being but weekend ties lead to mental illnesses.
To analyze the above scenario, impaired family support ultimately diminished her level of self-esteem and self-confidence to function well because of the guilty feeling of not being able to fulfill the demands of her family .Moreover,the social environment regulates how people and communities behave. Relationships, and education, occupation,built infrastructure, cultural practices and socio-economic conditions in which they live have a great impact on an individual.
In this case, the first leading cause was poverty which directly affects mental well being. Since her family was unable to cope with financial crisis, they had lack of access to health, education and basic services. Secondly, education and employment directly influences the social environment. In our Pakistani culture where women are deprived from their basic right ,they are more prone to have a low level of education which limits their capacity to solve family issues and lack of employment affects financial growth.
Thirdly,negative criticism from parent impactedhad a great impact on her self-image. She feels that she doesn’t possess any positive qualities in her personality. Lastly,the stigma attached with her mental illness created an immense pressure on her personality as it changed the perception of family members causing isolation and rejection from society .
According to DR Wasif of the Pakistan association for mental health (2006) “It is believed that in Karachi alone , 1.2 million people suffer from major psychiatric disorders and if those suffering from stress related disorder are included, the figure rises to three million.” Contributing to the high rate of mental illness in Pakistan are many factors such as poverty, inaccessibility to adequate health care, unemployment, lack of family support , rapidly changing cultural and social environment and the fragmentation of family system .
Humans learn from their environment. According to Bandura, A (2007) “Personality has interaction between three components: the environment, behavior, and one’s psychological processes”. Several researches have cited that growth and development occur through a process called experiential learning. They say that children have the capability to learn from their daily .
In the case mentioned above, the patient was constantly victimized by her family, leading to cognitive decline and eventually Schizophrenia.At individual level as a nurse, I first built trusting relationship with her by using therapeutic communication. As I started instructing her for hygiene care ,she followed simpler instructions so I used positive enforcement and acknowledgment to boost up her self-esteem. Furthermore, I used pictures to explore her feelings through which she ventilated by pointing those pictures.
As cited in Corkle(2008) “Adequate social support is associated with several psychological benefits, including increased self-esteem, feeling of empowerment, functioning, quality of life, and recovery, while the absence of social support appears related to greater psychiatric symptoms, poorer perception of overall health, and reduced potential for full community integration”.
As group strategy I involved my patient in drawing and coloring, and when she achieved acknowledgment and encouragement from us then she started encouraging other patients as well. I taught her family about medication regimens and dealing with psychiatric patients. Further awareness programs should be held for promoting social environment to community and family.
At an institutional level, the strategy should involve carrying out counseling and awareness sessions to promote mental health and aid the prevention of mental illnesses affected by the social environment. NGOs and government should take initiative for mental health promotion. Other interventions at group or institutional level that could be applied are family therapy, rational emotional behavior therapy (REBT) and interpersonal psychotherapy. Family therapy basically aims to improve family structure through motivation, behavioral change.
Through this paper I have learnt that social environment is very important. After reading several articles I was better able to understand the contributing factors.A positive support from family, friends and society help person to cope with stressful situation. The whole experience of working with the patient was challenging but full of learning. At first I thought that my interventions will not be helpful for the patient as these patients require long term treatment but the outcomes were surprising to me because they helped me to understand that even minor interventions can act as an element of improvement for them. I learned to integrate and make relations among the social determinants i-e positive environment and the society can help to decreasethe suffering of mental illness.
To conclude, the stigma, social isolation, low self-esteem, depression and mental disorder are all affected by our social environment so it is very important to engage the patients in everyday life ,which would act as a catalyst in their rehabilitation process. Furthermore, there are many gaps in the promotion of mental health as Hussain (2011) argues that“Culture may influence many aspects of mental health, including how individuals from a given culture manifest their symptoms, their style of coping, their family and community supports”. Therefore to combat the issue, strategy at individual, group and institutional, level can be helpful. In addition, health care professionals and whole community can help to overcome this issue.
Casper, M., & Barnett, E. (2011).definition of social environment. american journal of public health, 91(3).
Hussain, S. (2011, May 13). Need to evolve community-oriented mental health services
Bandura, A. (2007). social learning theory. journal of social psycology, 43, 3-4 retrieved fromhttp://www.learning-theories.com/social-learning-theory-bandura.html
Rutter, M. (2005).how the environment affect mental health. thebritish journal of psychiatry, 186, 4-6.
Wasif, S.A.(2005). Mental Health Services in Pakistan. Retrieved January 18, 2000,from:http://www.thesouthasian.org/archives/2005/mental_health_services_in_paki.html
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