By Natalie Hendry (firstname.lastname@example.org)
In this post I outline some of my early thinking in relation to my PhD research project, which explores how young people experiencing mental illness understand wellbeing through technology. Though I am a media and communications PhD student with a background in education, and experience in public health, I am increasingly drawn to sociological ideas and theories to help make sense of the ways digital media and health intersect in young people’s lives. I completed my confirmation last October and am now developing my methods and the ethics applications required across multiple research sites including the university, hospitals and health services. More details about my PhD research project are available here.
I discuss an instance from before my PhD that guides my current thinking in relation to young people’s use of visual social media. The example stems from a time I was working as a teacher in a Victorian adolescent psychiatric unit. I use this story to help me unpack some of the conceptual gaps in understandings of youth wellbeing and mental health. This is definitely a work in progress, and I welcome feedback and comments (and yes, that’s a recommendation for other students to submit half-baked thinking to select audiences. The TASA Youth folk would love you for it.) The vignette that follows has been altered to protect my former student. She did allow me permission to use the example, but did not want her name or a pseudonym attached.
Visuality and checking-in to sensory experiences
I hand out iPads to two students. One is visibly exhausted and enforces, “I don’t want to talk about it”. I open up the Garageband app before I pass her the iPad – it helped in a previous session – but she closes the app and audibly sighs. I’ve got it wrong again, I think. Wi-fi isn’t accessible for proxy server access to banned sites so she will be okay, no Facebook or Whatsapp as distraction. I leave her at the beanbag for some space without surveillance. There’s only fifteen minutes before class finishes. At lunch I check the devices’ batteries and start to pack them away. For hers, I open the menu to see what apps she used, and find the Camera icon flip up. The Photo Album shows over 30 selfies.
I ask her later if she was bored, and reassure her that I didn’t mind her self-imaging but that I had to delete them. “You know how it is, the iPads are in class sets, your privacy post-discharge is important.” She shrugs, “It’s the meds. My face. I feel puffy but I kinda look like me, just without make up and not much sleep. Not what I thought I’d look like.” The selfies were to check-in about how she felt her face looked. Something more than a glance in a mirror.
One year later I am still struck by a desire to make sense of this story without resorting to psychology or to flip open the DSM-5 to try to make sense of her self-representation. Sure, pharmacological treatment can change a person’s physical appearance or how they feel they look, but treatment is experienced beyond the individual and their biological body. Instead I want to think through this moment in a number of ways: to argue for an increased focus on visuality in the social sciences, and to disrupt neatly bound definitions of the mediated affordances of technology. An increased focus of visuality in sociology is warranted particularly in relation to digital media and health systems where emotion and affect are often silenced or made invisible.
Visuality in the transformation of the invisibility of mental illness
I’ve been drawn to an idea from the start of my project, that the visuality of social media affords young people the opportunity to make the invisibilities of their mental illness experiences visible. Making the invisible, visible, has become a key theme and aim for my project. Like so many others who have drawn on this phrase, I use it to assert that visibility offers the potential to transform social, political or economical disadvantage. Without drawing too heavily on earlier Utopian discourses about the potential of technology or the Internet, being seen is important for those whose presence is often ignored, ridiculed, feared or disciplined. For those enduring mental illness, responding to cultural stereotypes of the “psycho”, the “mad”, the “insane” or the “crazy” is not only a personal struggle. It is not only the despair and pain present in one’s interior life, but is also the pain enacted within the public sphere, in each public moment at the shops or school for example, or interactions across policy, legislation, media and institutions.
The experience of mental ill-health has a history of invisibility, with shame and fear attached to drive it further away from a potentially welcoming and empathetic public. Reading diagnostic criteria critically, the DSM-5 outlines depression to be a social, or perhaps anti-social type of social, experience of life – isolation, social withdrawal, anhedonia, dyssomnia, detachment, alienation; each psychiatric term providing medical legitimacy to historically and culturally determined observations of behaviour; a disciplinary strategy reminiscent of Foucault’s history of madness. This isn’t new to sociology, that medicine is a system of power. Many others have done this offered eloquent critiques of medicine and psychiatry that are respectful to those who rely psychiatric support in the face of deep suffering. My point instead is to seek out other ways of thinking about mental health that also question its social construction. This desire to expand Foucault and other’s social theories of mental illness is reinforced by Cvetkovich in her book Depression: a public feeling. In seeking “forms of testimony” to explain depression, she asks for “one that doesn’t reduce lived experience to a list of symptoms, one that provides a forum for feelings that, despite a widespread therapeutic culture, still haven’t gone public enough” (2012:15). Public representations of recovery in visual social media may work to those ends.
Mental ill-health is also experienced a spatial phenomenon. As a concrete example, we can consider the changes over the last century in Australia and think about where treatment has taken place: the asylum, to deinstitutionalisation and community treatment, to outpatient clinics, and recently to new digital places of support, treatment and care in online forums, apps and platforms. Parr’s (2008:165) work in particular positions mental illness as a spatial social experience, arguing that “in the popular imaginary, then, ‘the mental patient’ evoked… categorisation as abnormal, outside, excluded.” To find spaces to be included, then, especially online, provides young people the opportunity to potentially transform invisibility and isolation, to something visible, present and inclusive. I highlight potentially transform here with some anxiety because my research focus – the visualisation of mental illness – evokes moral panic and trigger disclaimers especially when online content involves self-harm imagery or suicidal gestures. I admit I am relieved that my computer screen at Uni doesn’t face out to those passing by, not out of shame for my research topic, but knowing that images hold power and can evoke deep, unpredictable emotional responses.
Being attuned to these ethical issues has been the most challenging yet most satisfying element of my work. This has required me to think through a number of contradictions inherent in youth studies: that young people experiencing mental illness are both at risk (and require protection) and a source of risk (I need protocols to protect myself, or that publicly sharing young people’s work may provoke other’s distress); that young people are capable of talking about and reflecting on their lives, but also may struggle to communicate their lives in ways that are useful to researchers. I’ve undertaken a small study interviewing advocates and professionals working in youth mental health to explore these challenges and their practical indications, including investigating themes around disclosure, consent processes involving guardians and clinicians, and participatory inclusive methods. I will continue to work through these issues as my project evolves.
Although my aim is to explore the ways visually based connections through digital media are potentially transformative, I do not approach this as a simple equation. I am acutely aware that the images and their emotional and physical content have complex meanings and impacts. Cvetkovich’s (2012:2, 7) work suggests to me that my aim could possibly be “to depathologise negative feelings so that they can be seen as a possible resource for political action rather than as its antithesis,” to “think psychic and social life together”. To dig deep into the internet to find, understand and reflect the distressing, painful and despairing media moments, seems to have become my way of making the invisible, visible. Sifting through the visual representation of #mentalillness, #depression, #ana, #recovery or #suicide across sites, I find sometimes sad, sometimes productive, sometimes bored content that allows individuals to visually speak to, and against, limiting and grotesque tropes of emotional distress. If I want to make sense of the distressing or triggering visual content, I also need to also think about the every day ways young people use visual social media to represent their recovery journeys.
For some young people, their recovery journey involves a hospital admission to an adolescent psychiatric unit. In Victoria, there are a number of units admitting young people under 18 years and a handful that engage with those between 15 and 25 years. Each adolescent unit is attached to a government-funded school whose staff work closely with clinical staff to support young people’s education goals. Guidelines across hospital departments enforce that young people do not have access to personal digital devices, although for some units this typical risk management policy is being reconsidered. Young people had access to the internet at the school, which in my case, was a physically distinct building to the unit. (Of interest to this audience, a colleague at the school has completed a qualitative study exploring the “third space” of the classroom and how students at the school identify differently in the classroom compared to the unit. Please contact me for details.)
Selfies as OTT, excessive and narcissistic
Returning to my student, I wonder about her encounter with the iPad. I wonder if we can think of her selfie-taking as social, even if she had no wi-fi access and the images were deleted and not shared? I have explicitly interpreted my story alongside academic and popular interest in “selfie culture” as it reflects current selfie research but also extends how we perceive young people, and especially young women’s, selfie practices. (See Katie Warfield’s video for an overview of selfie research, including a history of the selfie, its inclusion in the dictionary and definition tensions.)
My student followed the norms of the conventional selfie: her face was the focus, she took multiple images (to choose the best one that met her intentions?), and she used the front facing camera. This is typical selfie practice as explained in more than enough newspaper articles (do you know what your teen is doing?!) and YouTube how-tos (including make up tips). That selfie practices are often regarded in mainstream media to be a waste of time, OTT (over the top) or excessive reveals social discomfort in consumer and bodily practices expected of young women in Australia. Predominant discourses surrounding selfies reinforce gendered scripts of young women as both vulnerable and risky; they are fragile souls who require “likes” for self-acceptance, but also narcissistic and out-of-control, requiring containment. See here and here for brief discussions about gender and selfies. Folks on tumblr have also linked selfie creation to Jones’ concept of feminist narcissism.
Selfies as excessive behaviour also recall definitions of mental illness as excessive behaviour: being too loud, too sleepy, too emotional, or too energetic. Thinking along these lines exposes the cultural limitations of psychiatric assessment. For example, grief is expressed differently across different communities and cultures, or how communities respond to men’s distress differently to women’s. Those who are “too sensitive” or “over reactive” are deemed to be on the outside, excluded because they extend or push expected behaviour.
Perhaps too, taking a selfie, even if it is not ultimately shared, does not mean that it wasn’t created with an anticipated social future. It is an image that someone else could understand and interpret, that she could potentially send to a friend to help clarify and reassure: Do I look weird? Do I look normal? How do I look? She employed typical visual characteristics of selfies (e.g. angles of lens, size of face to other elements) to check-in. In doing so, she was able to query her perception of the medication’s side effects in a way that did not require external clinical intervention or googling medical information. Perhaps, like selfies of vulnerable or marginalised young people across Tumblr or Instagram, her self-images may also depict an attempt to master or grasp some sense of control over social, political and economic environments where identities and experiences are invisible.
Immediacy, trust and emotional authenticity
I’m also curious if the immediacy of social media or digital devices also engenders relations with others or objects where trust is required to develop quickly. The student’s “excess” of self-images reinforced trust in the photographs and that what she was seeing was authentic. She was able to demonstrate that one image may not show her what she was looking for in that moment, a sort of ‘Doubting Thomas’ encounter of the digital kind. The affordances of the iPad reassured her that yes, her face did “kinda look like me” even if her tactile perceptions did not correlate to the images. She was not bound by limits of the number of film exposures an older camera might have, or the temporal distance from taking the images to having them developed. It was easier to trust in a device that provided immediate engagement with her self-image.
Trust often developed quickly between people including young people and their support teams on the unit. I thought of this as contagious intimacy on the unit as trust-building was accelerated as young people became ‘BFFs’ (best friends forever) quickly, their relationships facilitated by shared experience and reassurance that a peer “finally gets it.” At times this was interpreted as provocative behaviour as it increased the potential for disclosure burdening one friend (having to “manage” someone’s disclosure without setting up your own protective boundaries) or involved trust-building conversations where friends were more likely to agree with each others’ thoughts about personal themes rather than challenge them (to listen to something deeply personal and then feel obligated to reciprocate, or maintain their self-deprecating thinking rather than questioning it for fear of sabotaging the relationship).
In some ways this is similar to research into holiday or travel sexual health practices where YOLO (You Only Live Once) is the motivator of one’s behaviour, and someone (on a backpacking trip, perhaps) breaks the slow, mundane routine lived back at home in favour of sexually risky practices fuelled by excessive substance use and the physical promixity enabled by a backpacker lodge. Of course, studies also depict this as a consumer transaction structured by clubs and bars trying to make money, the spatial environments and the meanings attached to them (where it is and isn’t okay to publicly hook up) and culturally shared meanings attached to “growing up” that normalise certain ages as periods of transition before the eventual settling down where risk is regarded as irresponsible or juvenile. (Briggs, Tutenges, Armitage & Panchev, 2011; Ravert, 2009; Thomas, 2005; Tutenges, 2012). Breaking predictability of everyday life shifts perceptions of trust and risk of disclosure. I wonder how might we link work across health topics to understand the spatial dimensions of health behaviours and trust behaviours?
Rapidly established trust is interpreted as a risky phenomenon but shifting it beyond risk paradigms may uncover new ways of thinking about the role of trust. The often immediate onset of illness, including mental ill-health, disrupts typical tempos and rhythms of relationship building for young people, their families and communities. This is frequently a necessity; in crisis, people need to quickly trust people they may not typically trust. For my students, trust and feeling okay about disclosures about trauma or challenges may occur more rapidly because of the ephemerality of the relationships in the hospital. It was unlikely that I would become an ongoing presence in a young person’s life beyond their discharge, aside for a handful of school or service meetings. The hospital then became a transient place and the site of affective labour that allowed for different temporal and spatial norms unlike the young people’s lives outside the unit.
Beyond the vignette, the immediacy and digital-not-physical co-presence of social media requires different strategies to establish trust between services, devices and individuals. Distance between individuals in hospital relationships facilitated disclosure and trust, perhaps in the same way secret-sharing apps like Whisper or visually based platforms like Tumblr may afford emotional authenticity. Parr’s (2008) research into digital mental health support groups suggests that intimacy and trust was established and maintained by emotional closeness and experiences of friendship including reciprocity. The therapeutic alliances formed in these spaces had real impact and an affective element to them regardless of the ambiguous physical proximity of the group members. Lee and Cook’s (2014) recent paper is useful here too when thinking about digital immediacy in young people’s lives and suggests this dominates over privacy concerns.
Unlike Facebook, Tumblr doesn’t require public demographic data or potentially expose the history of your educational, employment or family life. Old school friends from years ago cannot friend request you because they saw you were added to a mutual friends’ list. Tumblr doesn’t tap into Baym’s “facebook as nation” metaphor, and perhaps offers more creative scope to present an emotionally authentic self (and more engagement with one’s less public fantasies it seems with users creating a second NSFW (not safe for work) blog of every sexual proclivity imaginable). Emotional authenticity shifts and perhaps becomes more visible as users have more control over the labour they engage in on Tumblr including the ambiguity of visualising their identities, interests, opinions, values and experiences. This is further afforded by private Tumblr blogs, that although need to be connected to a public blog, serve as highly controlled spaces. The audience for private Tumblr blogs is determined by who you share your password with, rather than how you turn on or off dynamic privacy settings.
Screenshot from Whisper app http://whisper.sh/
Affective labour and emplacing selfie practices
Returning to my student, perhaps she engaged in a different type of selfie labour because of the space she was in. Using an iPad in a classroom at a hospital school is quite different to using your own iPad in your bedroom or at a large school or on the tram. What you can and can’t do is socially and geographically afforded by location, and perhaps may be limited by place – access to wifi, the surveillance enacted by teachers required by the unit, or the apps available. The affective labour involved in taking multiple selfies was different to the labour involved in talking to someone about medication confusion or moving from a containing space. The device allowed her to check in with her sensory perceptions, and her experience of embodiment, but it did so in ways that were bound by social and the geographical.
Exploring the intersections of health and media includes thinking beyond the technological or social affordances of devices, apps, sites and digital media, to also include the sensual. Emplacing the student, as Pink and Hjorth (2012) may suggest, might offer a way to think through the “psychic and social live together” (Cvetkovich, 2012:7). Emplacing the student in the hospital classroom place might allow for a more nuanced concept of affordances, and too, a more nuanced concept of mental health. It may not be enough to disrupt stereotypes of mental illness or selfie culture but it is a start and motivates the early stages of my research.
*Alternatively titled: ‘pics or GTFO’ (get the f*** out) but this seems harsh, though I’m told it’s the more typical phrase.
Briggs, D., Tutenges, S., Armitage, R., & Panchev, D. (2011). Sexy substances and the substance of sex: findings from an ethnographic study in Ibiza, Spain. Drugs and Alcohol Today, 11(4), 173-187.
Cvetkovich, A. (2012) Depression: a public feeling. Durham, NC: Duke University Press.
Lee, A., & Cook, P.S. (2014) The conditions of exposure and immediacy: Internet surveillance and Generation Y. Journal of Sociology. Published online 27 March, 2014, doi: 10.1177/1440783314522870
Parr, H., & Davidson, J. (2008). Virtual trust: online emotional intimacies in mental health support. In J. Brownlie, A. Greene, & A. Howson (Eds.), Researching Trust and Health. Routledge. Retrieved from http://eprints.gla.ac.uk/45673/
Pink, S. & L. Hjorth (2012, accepted May 2012) ‘Emplaced Cartographies: Reconceptualising camera phone practices in an age of locative media’, Media International Australia, 145: 145-156.
Ravert, R. D. (2009). “You’re only young once”: Things college students report doing now before it is too late. Journal of Adolescent Research, 24(3), 376-396. doi: 10.1177/0743558409334254
Thomas, M. (2005). ‘What happens in Tenerife stays in Tenerife’: Understanding women’s sexual behaviour on holiday. Culture, Health & Sexuality, 7(6), 571-584. doi: 10.1080/13691050500256807
Tutenges, S. (2012). Nightlife tourism: A mixed methods study of young tourists at an international nightlife resort. Tourist Studies, 12(2), 131-150.