Tag: Psychological Disorder

An Overview of Socioeconomic Status and Mental Health

Published on by Andrew Marshall1 Comment

Introduction

Numerous studies around the world have found a relationship between socioeconomic status and mental health.

There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model.

Social Causation

The social causation theory is an older theory with more evidence and research behind it. This hypothesis states that one’s socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, “members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder”. The excess stress that people with low SES experience could be inadequate health care, job insecurity, and poverty, which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. Thus, lower SES predisposes individuals to the development of a mental illness.

Research

The Faris and Dunham (1939), Hollingshead and Redlich (1958), and Midtown Manhattan (1962) studies are three of the most influential in the debate between social causation and downward drift. They lend important evidence to the linear correlation between mental illness and SES, more specifically that a low SES produces a mental illness. The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience. Issues that are not experienced in high SES, such as lack of housing, hunger, unemployment, etc., contribute to the psychological stress levels that can lead to the onset of mental illness. Additionally, while experiencing greater stress levels, there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder. The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses. However, the hypothesis of the social causation model is disputed by the downward drift model.

Faris and Dunham (1939)

Faris and Dunham analysed the prevalence of mental disorders, including schizophrenia, in different areas of Chicago. The researchers plotted the homes of patients preceding their admission to hospitals. They found a remarkable increase of cases from the outskirts of the city moving inwards to the centre. This reflected other rates of distributions, such as unemployment, poverty and family desertion. They also found that cases of schizophrenia were most pervasive in public housing neighbourhoods as well as communities with higher numbers of immigrants. This was one of the first empirical, evidence-based studies supporting social causation theory.

Hollingshead and Redlich (1958)

Hollingshead and Redlich conducted a study in New Haven, Connecticut, that was considered a major breakthrough in this field of research. The authors identified anyone who was hospitalised or in treatment for mental illness by looking at files from clinics, hospitals, and the like. They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups. Their results showed high disproportions of schizophrenia among the lowest social group. They also found that the lower people were on the scale of social class, the likelier they were to be admitted to a hospital for psychosis.

Midtown Manhattan Study (1962)

The study by Srole, Langer, Micheal, Opler, and Rennie, known as the Midtown Manhattan Study, has become a quintessential study in mental health. The main focus of the research was to “uncover [the] unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike”. The researchers managed to probe deep into the community to include subjects usually left out of such studies. The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class. When basing their results on parental SES, approximately 33% of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18% of the inhabitants in the highest SES showed these signs. When assessing the relationship based on personal SES, 47% of inhabitants in the lowest SES showed signs of weakening mental functions while only 13% of the highest SES demonstrated these symptoms. These findings remained the same for all ages and genders.

Downward Drift

In contrast to social causation, downward drift (also known as social selection) postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to “a drift down into or fail to rise out of lower SES groups”. This means that a person’s SES level is a consequence rather than a cause of weakening mental functions. The downward drift theory shows promise specifically for individuals with a diagnosis of schizophrenia.

Research

Weich and Lewis (1998)

The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7,725 adults who had developed mental illnesses. They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break.

Isohanni et al. (2001)

In the Isohanni et al. longitudinal study in Finland, the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29. The study followed the patients for 31 years and looked at how their illness affected their educational achievement. The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia, and other psychotic or non-psychotic diagnoses, to those of the same 1966 birth cohort who had received no psychiatric treatment. They found that individuals who were hospitalised at 22 years or younger (early onset) were more likely to only complete a basic level of education and remain stagnant.

Some patients were able to complete secondary education, but none advanced to tertiary education. Those who had not been hospitalised had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education, 62% and 26%, respectively. This study suggests that mental disorders, especially schizophrenia, impede educational achievement. The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness.

Wiersma, Giel, De Jong and Slooff (1983)

The researchers in the Wiersma, Giel, De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers. Researchers assessed both topic areas in the fathers as well as in the patients. In a two-year follow-up, the downward mobility in both education and occupation was greater than expected in the patients. Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis. Most of the individuals participating in the study had a lower SES than when they were born. This study also showed that the drift may begin with prodromal symptoms rather than at full onset.

Debate

Many researchers argue against the downward drift model, because unlike its counterpart, “it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance”. Mirowsky and Ross discuss in their book, Social Causes of Psychological Distress, that stress frequently stems from lack of control, or the feeling of lack of control, over one’s life. Those in lower SES have a minimal sense of control over the events that occur in their lives.

They argue that lack of control does not only stem from jobs with low income, but that “minority status also lowers the sense of control, partly because of lower education, income, and unemployment, and partly because any given level of achievement requires greater effort and provides fewer opportunities”. The arguments posed in their book support social causation since such high stress levels are involved. Although both models can be existing, they do not need to be mutually exclusive, researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia.

Implications for schizophrenia

Although social causation can explain some forms of mental illnesses, downward drift “has the greatest empirical support and is one of the cardinal features of schizophrenia”. The downward drift theory is more applicable to schizophrenia for a number of reasons. There are varying degrees of the disease, but once a psychotic break is experienced, the person often cannot function at the same level as before. This impairment affects all areas of life—education, occupation, social and family connections, etc. Due to the many challenges, patients will likely drift to a lower SES because they are unable to keep up with previous standards.

Another reason why the downward drift theory is preferred is that, unlike other mental illnesses such as depression, once someone is diagnosed with schizophrenia they have the diagnosis for life. While symptoms may not be constant, “individuals with this diagnosis often experience cycles of remission and relapse throughout their lives”.

This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease. There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because “it often starts in early adult life and becomes chronic”. Patients will usually function at a lower level once the illness has manifested itself. Even with the help of antipsychotic medication and psycho-social support, most patients will still experience some symptoms making moving up out of a lower SES nearly impossible.

Another possible explanation discussed in literature regarding the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness. Individuals with mental illness are often treated differently, usually negatively, by their community. Although great strides have been made, mental illness is often unfavourably stigmatised. As Livingston explains, “stigma can produce a negative spiraling effect on the life course of people with mental illnesses, which tends to create…a decline in social class”.

Individuals who develop schizophrenia cannot function at the level they are used to, and “are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses.” The complete exclusion they experience helps to maintain their new lower status, preventing any upward mobility. The downward drift theory may be mainly applicable to schizophrenia; however, it may also apply to other mental illnesses since each is accompanied by a negative stigma.

While it can be hard to maintain status once the schizophrenia appears, some individuals are able to resist a downward drift, particularly if they start out at a higher SES. For example, if a person is from a high SES, they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status. It is also important for those with schizophrenia to have a strong network of friends and family because friends and family may notice signs of the illness before full onset. For example, individuals that are married show less of a drift downwards than those who are not. Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Socioeconomic_status_and_mental_health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Boredom Boreout Syndrome?

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Introduction

Boredom boreout syndrome is a psychological disorder that causes physical illness, mainly caused by mental underload at the workplace due to lack of either adequate quantitative or qualitative workload. One reason for boreout could be that the initial job description does not match the actual work.

This theory was first expounded in 2007 in Diagnose Boreout, a book by Peter Werder and Philippe Rothlin, two Swiss business consultants.

Symptoms and Consequences

Symptoms of the bore-out syndrome are described by the Frankfurt psychotherapist Wolfgang Merkle as similar to the burnout syndrome. These include depression, listlessness and insomnia, but also tinnitus, susceptibility to infection, stomach upset, headache and dizziness.

The consequences of boreout for employees are numerous both psychologically and physically and more or less serious. On the psychological level, boredom, dissatisfaction, and permanent frustration gradually lead the victim of a boreout into a vicious circle. They gradually lose the will to act at the professional level and at the personal level. To the loss of self-esteem is added the constant anxiety of being discovered. The boreout victim lives with the constant fear that their supervisor, colleagues, or friends will discover their inactivity and duplicity. The confrontation with and enduring the unsatisfactory situation leads to further stress that paralyses and strains. Being constantly confronted with the emptiness of their professional life and their apparent uselessness in society, the employee may experience significant stress. The suffering all the more accentuated because it cannot be shared and if it is, is not understood. This is also the reason that this syndrome is relatively unknown:

This has to do with the fact that everyone prefers to have disorders that are socially considered. Someone who says, ‘I have so much to do, my God, the job is banging up at work’, is much more respected than someone who says he’s bored, has no responsibilities, and that’s what gets him done. Everyone says: ‘I want to trade with you, that’s great! Interview: Wolfgang Merkle Frankfurter Allgemeinen Zeitung, 2010.

This can lead to serious mental disorders such as personality destruction or even depression or suicide. Boreout is also a trigger for physical diseases such as certain types of epilepsy caused by stress or exhaustion, severe sleep disorders, hand and voice tremors, shingles, and ulcers.

On the physical side, according to the British “Bored to death” study, employees who are bored at work are two to three times more likely to be victims of cardiovascular events than those whose employment is stimulating. The permanent anxiety in which the employee lives exhausts him/her physically. Fatigue is constant despite physical inactivity. Boreout can lead to eating disorders such as untimely nibbling or loss of appetite. Some people may use alcohol or drugs to overcome their discomfort and thus develop a harmful addiction.

Elements

According to Peter Werder and Philippe Rothlin, the absence of meaningful tasks, rather than the presence of stress, is many workers’ chief problem. Ruth Stock-Homburg defines boreout as a negative psychological state with low work-related arousal.

Boreout has been studied in terms of its key dimensions. In their practitioners book, Werder and Rothlin suggest elements: boredom, lack of challenge, and lack of interest. These authors disagree with the common perceptions that a demotivated employee is lazy; instead, they claim that the employee has lost interest in work tasks. Those suffering from boreout are “dissatisfied with their professional situation” in that they are frustrated at being prevented, by institutional mechanisms or obstacles as opposed to by their own lack of aptitude, from fulfilling their potential (as by using their skills, knowledge, and abilities to contribute to their company’s development) and/or from receiving official recognition for their efforts.

Relying on empirical data from service employees, Stock-Homburg identifies three components of boreout: job boredom, crisis of meaning and crisis of growth, which arise from a loss of resources due to a lack of challenges.

Peter Werder and Philippe Rothlin suggest that the reason for researchers’ and employers’ overlooking the magnitude of boreout-related problems is that they are underreported because revealing them exposes a worker to the risk of social stigma and adverse economic effects (By the same token, many managers and co-workers consider an employee’s level of workplace stress to be indicative of that employee’s status in the workplace).

There are several reasons boreout might occur. The authors note that boreout is unlikely to occur in many non-office jobs where the employee must focus on finishing a specific task (e.g. a surgeon) or helping people in need (e.g. a childcare worker or nanny). In terms of group processes, it may well be that the boss or certain forceful or ambitious individuals with the team take all the interesting work leaving only a little of the most boring tasks for the others. Alternatively, the structure of the organization may simply promote this inefficiency. Of course, few if any employees (even among those who would prefer to leave) want to be fired or laid off, so the vast majority are unwilling and unlikely to call attention to the dispensable nature of their role.

As such, even if an employee has very little work to do or would only expect to be given qualitative inadequate work, they give the appearance of “looking busy” (e.g. ensuring that a work-related document is open on one’s computer, covering one’s desk with file folders, and carrying briefcases (whether empty or loaded) from work to one’s home and vice versa).

Coping Strategies

The symptoms of boreout lead employees to adopt coping or work-avoidance strategies that create the appearance that they are already under stress, suggesting to management both that they are heavily “in demand” as workers and that they should not be given additional work: “The boreout sufferer’s aim is to look busy, to not be given any new work by the boss and, certainly, not to lose the job.”

Boreout strategies include:

  • Stretching work strategy: This involves drawing out tasks so they take much longer than necessary. For example, if an employee’s sole assignment during a work week is a report that takes three work days, the employee will “stretch” this three days of work over the entire work week. Stretching strategies vary from employee to employee. Some employees may do the entire report in the first three days, and then spend the remaining days surfing the Internet, planning their holiday, browsing online shopping websites, sending personal e-mails, and so on (all the while ensuring that their workstation is filled with the evidence of “hard work”, by having work documents ready to be switched-to on the screen). Alternatively, some employees may “stretch” the work over the entire work week by breaking up the process with a number of pauses to send personal e-mails, go outside for a cigarette, get a coffee, chat with friends in other parts of the company, or even go to the washroom for a 10-minute nap.
  • Pseudo-commitment strategy: The pretence of commitment to the job by attending work and sitting at the desk, sometimes after work hours. As well, demotivated employees may stay at their desks to eat their lunch to give the impression that they are working through the lunch hour; in fact, they may be sending personal e-mails or reading online articles unrelated to work. An employee who spends the afternoon on personal phone calls may learn how to mask this by sounding serious and professional during their responses, to give the impression that it is a work-related call. For example, if a bureaucrat is chatting with a friend to set up a dinner date, when the friend suggests a time, the bureaucrat can respond that “we can probably fit that meeting time in.”

Consequences for Employees

Consequences of boreout for employees include dissatisfaction, fatigue as well as ennui and low self-esteem. The paradox of boreout is that despite hating the situation, employees feel unable to ask for more challenging tasks, to raise the situation with superiors or even look for a new job. The authors do, however, propose a solution: first, one must analyse one’s personal job situation, then look for a solution within the company and finally if that does not help, look for a new job. If all else fails, turning to friends, family, or other co-workers for support can be extremely beneficial until any of the previously listed options become viable.

Consequences for Businesses

Stock-Homburg empirically investigated the impact of the three boreout dimensions among service employees – showing that a crisis of meaning as well as a crisis of growth had a negative impact on the innovative work behaviour. Another study showed that boreout negatively affects customer orientation of service employees.

Prammer studied a variety of boreout effects on businesses:

  • Whereabouts of dissatisfied employees, who do not work because they have internally terminated, cost the company money.
  • If employees actively quit internally, they can damage the operation by demonstrating their ability to mentally restore the employment contract.
  • The qualification of the employee is not recognised (the company can not use its potential).
  • The qualified employee changes jobs (and takes their experience), which can endanger entire business locations.
  • As long as a recession continues, the affected employee remains in the company and leaves the company at the appropriate opportunity. In-house, a problem of distribution of work orders arises.
  • Tabooing causes real problems to go undetected.
  • Whole generations of employees are lost (because they have no opportunity to fully realise their potential).

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Boreout >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Smile Mask Syndrome?

Published on by Andrew Marshall1 Comment

Introduction

Smile mask syndrome (Japanese: スマイル仮面症候群, Hepburn: sumairu kamen shōkōgun), abbreviated SMS, is a psychological disorder proposed by professor Makoto Natsume of Osaka Shoin Women’s University, in which subjects develop depression and physical illness as a result of prolonged, unnatural smiling.

Refer to Honne and Tatemae.

Background

Natsume proposed the disorder after counselling students from the university in his practice and noticing that a number of students had spent so much time faking their smiles that they were unaware that they were smiling even while relating stressful or upsetting experiences to him. Natsume attributes this to the great importance placed on smiling in the Japanese service industry, particularly for young women.

Smiling is an important skill for Japanese women working in the service industry. Almost all service industry companies in Japan require their female staff to smile for long periods of time. Natsume says that his female patients often talk about the importance of smiling when the topic of the conversation is on their workplace. He relates examples of patients saying that they felt their smile had a large effect on whether they were hired or not, and that their superiors had stressed the effect that good smiles had on customers. According to Natsume, this atmosphere sometimes causes women to smile unnaturally for so long that they start to suppress their real emotions and become depressed.

Japanese author Tomomi Fujiwara notes that the demand for a common smile in the workplace emerged in Japan around the 1980s, and blames the cultural changes wrought by the Tokyo Disneyland, opened in 1983, for popularising the demand for an obligatory smile in the workplace.

The smile mask syndrome has also been identified in Korea. Korean writer Bae Woo-ri noted that smiling gives one a competitive advantage over the others, and has become a necessary attribute of many employees, just like a “neat uniform”. Yoon-Do-rahm, a psychology counsellor, compared the current society, which is full of smile-masks, to a clown show; both are characterised by plentiful, yet empty and fake, smiles.

Smile mask syndrome can cause physical problems as well as mental ones. Natsume relates that many of his patients developed muscle aches and headaches as a result of prolonged smiling, and says that these are similar to the symptoms of repetitive strain injury.