Welcome to this open discussion forum around the themes of mental health and well-being in ‘The Bell Jar Rises’ paper.  You can download the paper here. We’d like to invite you to contribute your thoughts and comments on one (or more!) of the following themes related to the paper which interest you. We look forward to hearing from you.

The components of well-being – What are the common factors in the times you have felt content and happy in life? What factors do your clients think comprise a good life?

Objective versus subjective quality of life – Have you had experiences where you felt dissatisfied with life despite things going objectively well? Have you implemented any services for clients which have addressed objective measures, but have had little impact on the satisfaction of clients?

Structural versus cognitive social capital – Is it better to possess a few, close and trusting relationships, or possess several, less intimate relationships? In what ways can relationships between clients and the wider community be forged?

Purpose and meaning in life - How have you and your clients instilled a sense of purpose in life? In what ways can we find meaning in life?  

Autonomy and mastery – How important is being independent to you and your clients? In what ways can clients gain greater control over their everyday affairs?

Impact of mental illness – What are the largest barriers to improving well-being in service users with mental illness?  Do you value the same things in life as your clients or is there a noticeable difference?

Improving global well-being – Do you have any suggestions for increasing the well-being of service users with mental illness? In what ways may we overcome the problem of stigma? How can better communication between different service providers be facilitated?

I thought this was a very interesting paper but curiously undermined by the author's adherence to the outdated and evidence-light disease model of mental illness. The paper reads as if mental illness springs from nowhere, and then impacts on social capital etc. The diagram on p13, Fig 2, is intended to show 'the multiple effects of mental illness on the theoretical model of global wellbeing'; mental illness may have multiple effects on wellbeing, but it is actually damage across the domains of wellbeing that causes mental illness in the first place.

There is an overwhelming body of evidence for the psychosocial determinants of poor mental health. The diagram devised by Haran Sivapalan would be more useful if the paper recognised this, and then tried to describe how changing the environmental factors impacts on the potential for recovery of the person experiencing mental ill health. 

 

 

 

Hi Peter, thank you for your insightful comments regarding the paper.

It is definitely true that psychosocial factors have an important role in the aetiology of mental illness. I briefly mention the role of high expressed emotion i.e. large numbers of critical comments and emotional over-involvement by family members, in the relapse of clients with schizophrenia. There is also substantial evidence linking schizophrenia to living in an urban environment, being in a minority group and cannabis use.

The difficulty arises in teasing out cause and effect. Much of the evidence is from associational studies that do not connote causality. In the case of cannabis use, it is hard to determine whether cannabis use directly leads to psychotic disorders, or whether an underlying proclivity to psychotic disorders causes an individual to self-medicate with cannabis. Similarly, behaviours such as social withdrawal may be symptoms of schizophrenia, so we cannot be certain if social factors such as social isolation engender increased susceptibility to schizophrenia.

The current body of evidence suggests that mental illness has several contributing factors; genetic and environmental or ‘biological’ and ‘social.’ These all amplify the risk of suffering from an illness. Mental illness itself is a term that encompasses various conditions, each with different contributions from social factors.

Most of the quality of life literature has been based on ‘severe mental illness’ - namely schizophrenia, schizoaffective disorder and bipolar disorder. With regards to schizophrenia, the current opinion is that it is a ‘neurodevelopmental disorder’. Damage or ‘insults’ to the brain in the womb, at birth and in early life may cause the brain to develop abnormally and then cause symptoms in late adolescence of early adulthood when the brain undergoes structural changes.

As medicine, neuroscience and social sciences progress, we will hopefully reveal more about the complex causes of mental illness. 

It would be interesting to hear other comments on the paper.