Personal accounts of crisis should be used to build mental health policy and practice.
Thursday, 31 August, 2023
Listen to the(opens in a new window)podcast
Dr Emma Farrell (pictured) is a chartered psychologist, author and senior interdisciplinary researcher in the School of Education at University College Dublin. A founding member of Jigsaw, the National Centre for Youth Mental Health, her book, '(opens in a new window)Making Sense of Mental Health, a Practical Approach through Lived Experience',is available now.
For her PhD, Dr Emma Farrell conducted in-depth interviews with 27 university students who experienced a mental health crisis, piecing together their lives from the origin of their distress through their lowest moments to eventual recovery.
“If I was to pick out the thing that struck me most from the years I spent doing this work, it would be just how willing people were to tell their stories,” she says. “Just how much they valued and appreciated the opportunity to come in and sit down and tell their own story in their own words, knowing that I wasn't going to stop them or direct them or curtail them. There's so few places in our lives and in the world in which we can be ourselves and tell our story.”
When she herself was a student, Dr Farrell observed how textbooks about mental health focused on data and statistics, with people’s direct experiences mentioned only in supporting anecdotes.
“I just felt that all the knowledge, insight and evidence that is in people's experiences and their stories was not only not being captured but it wasn't being valued. It wasn't really being seen for what it is, which is essential evidence, knowledge and wisdom. We almost didn't have a way of dealing with it or listening to it or incorporating it into things like policy or into practice.”
The goal for her PhD, which forms the basis of her book, was, she says, to “try and bridge that gap. To see stories and people's experiences for what they are, which is really important evidence and knowledge that we should be using to build policy and practice and to form the basis of how we think about, talk about and respond to mental health”.
Making Sense of Mental Healthis a compelling examination of the various ways in which 27 individuals’ lives were interrupted by crisis and how they coped. Participants, who ranged in age from 19 to 48, had been diagnosed with a variety of illnesses, from eating disorders to suicidal ideation; depression to psychosis.
While writing that “individual people are as unique as their life stories”, Dr Farrell still identifies four stages used by all participants to plot these crisis stories: the pre-narrative stage, or lead-up; the crisis or interruption itself; the narrative wreckage afterwards, when the storyline of their lives up to that point lay in tatters; and the road to recovery.
These detailed and candid first-person accounts are expertly weaved throughout the book and form a fascinating excavation of human crisis, sense-making and repair.
There are many illuminating moments. Perfectionism emerges as one of the strongest and most pervasive difficulties, mentioned by 17 of the 27 participants. This often came down to a fear of not living up to expectations, Dr Farrell observes.
“Expectation is something that weighs on a lot of people and if it's a heavy weight, it can really deeply impact us. It must be hard to be well and healthy and flourish in the world when you're constantly carrying or negotiating that weight of expectation. That sense of, ‘I am only worthwhile or I'm only good enough if I get top marks or if I'm the best at sport or I have the most friends’ - or whatever the particular marker is. It was something that really came through in the young people I worked with.”
She adds that this sense of pressure, “more often than not”, came from the individuals themselves, rather than from other people.
Another common theme was negative school experiences, particularly bullying.
Dr Farrell feels that bullying is mitigated when we understand and implement the conditions for kindness.
“Can we just give each other a bit of space, cut each other a bit of slack and recognise we are all human, and try to be kind? But it's much easier to be kind if we are safe and secure in ourselves, if we feel comfortable and accepted and if we don't feel judged or bullied or harassed in our own worlds.”
Remarkably, many participants said there was “no reason” for their crisis.
“That was very interesting to me. It kind of reflects how we think about most things in our society; in other words, if there's a problem, there must be a cause and effect and then there must be a solution. But I think mental health is one of those things that really brings us face to face with our humanity and the fact that sometimes it isn't as simple as a cause, effect, solution.”
It is also fascinating that participants could speak of “upsides” to their crisis, such as identifying and attending to important needs in their lives.
“I think there is so much to learn from these experiences,” says Dr Farrell, adding that crises “fundamentally change” people.
“I think most of us are just trotting through life and we don't have to encounter these really essential questions about life and death and how we live, how our society is structured and how we find a way of being in the world that is healthy. I think in doing that and in figuring that out, we learn something really important.”
The many ways in which participants found meaning in the midst of crisis is both insightful and potentially instructive.
“I don't think we do enough to learn from people's experiences and learn from what people have learned themselves through having to face these sorts of difficulties.”
Listen to the(opens in a new window)podcast