De-tabooing depression and anxiety in old age
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Kate Burridge, Monash University |
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Réka Benczes, Corvinus University of Budapest |
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Mia Lindgren, University of Tasmania |
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Lilla Szabó, Corvinus University of Budapest |
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Sarah Fishlock, Monash University |
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Keith Allan, Monash University Questions and comments about this page/project should be emailed to Keith |
This research is supported under Australian Research Council's Discovery Projects funding scheme, project number DP210101197.
There has been plenty of medical research on depression and anxiety in Australia, and while language has been identified as highly relevant for recovery, little is known of how people express their experiences associated with these illnesses. The research gap is even wider for the worst affected in the population – older adults. Because these illnesses are shrouded in taboo, symptoms often go undetected. Our aim is to uncover how older Australians talk about and understand mental wellbeing and to raise awareness of these debilitating conditions via new media. The research will facilitate communication about mental well-being and also celebrate the lives and stories of older Australians – an integral but vulnerable segment of society.
Many older Australians suffer from late-onset depression and anxiety, but little is known about these conditions due to a lack of research and the stigma surrounding these illnesses. Instead of talking openly about their mental health, older adults often camouflage their language when expressing how they feel. The fallout from this behaviour is potentially disastrous – symptoms go undetected and treatment does not come in time. Yet health and illness are not solely physiological conditions; they are also sociocultural concepts that can best be captured by examining the language we use to describe them. The aim of the research is threefold: to uncover how older Australians talk about and understand mental wellbeing; to raise public awareness of these debilitating conditions via new media such as podcasting; and to suggest language strategies for clinical and nursing professionals working in aged care. By lifting the taboo around late-onset depression and anxiety, the project ultimately seeks to help older Australians lead happier and healthier lives.
We are pursuing four integrated objectives:
Depression and anxiety are different conditions, but often co-occur; over half of those with depression also suffer from anxiety. Symptoms often overlap: sleep problems, trouble concentrating, fatigue, irritability and mood swings are conditions indicative of both, and people experiencing these symptoms typically do not distinguish between them. As the current research focuses on the language used in the community at large, rather than the medical profession in particular, it embraces terminology for both conditions.
Depression and anxiety are sensitive subjects, one of society's taboos. Thus, the words and expressions used to talk about depression and anxiety are often euphemistic and generally draw on figurative (i.e. non-literal) language. There is a strong reliance on metaphors and, implicitly, metonymies to achieve the displacement effect associated with euphemistic expressions. Consider even the established term depression, motivated by an underlying metaphor of sad is down (in its literal sense referring to an action of lowering something or pressing something down). In fact, figurativity seems to be the norm: even the everyday expression be in a bad mood implies the conceptualization of sadness or gloominess as some kind of a container.
Cognitive linguistics has been especially successful in the description and analysis of figurative language use, founded on the tenet that language and thought is non-literal, and metaphor and metonymy is integral to human cognition (i.e., it is based upon metaphorical and metonymical conceptualisations). What this implies is that abstract meaning is based upon and constituted by essentially more figurative meaning. Accordingly, in the cognitive linguistic view, abstract concepts are understood mostly via more concrete entities, more specifically via metaphorical and metonymical projections. These metaphorical and metonymical projections or mappings are manifested in language, in the various figurative expressions that we use when talking about abstract concepts. For instance, we can understand the abstract target domain of sadness by a number of different, more concrete source domains, such as darkness (e.g., be in a dark mood), insanity (e.g., be insane with grief) or a fluid in a container (e.g., be filled with sorrow), etc.
It has been shown in a number of studies that metaphor can be used effectively in shaping mental illness communication and in removing its negative image. It has been demonstrated that the use of visual metaphors in health communication messages, based on the common metaphorical conceptualization of mental illness as a barrier, encouraged help-seeking behaviour among American college students. Furthermore, metaphor can itself become a tool by which a therapeutic alliance can be forged. It has been employed within psychotherapy for decades to bring about a positive change in the therapeutic process. Previous research suggests that considerable discrepancies exist between patients and health practitioners when it comes to the metaphorical and metonymic conceptualizations of illnesses, which might further hinder the diagnosis of depression among older adults. The medical profession does not always take the metaphorical language of people suffering from mental illness seriously, considering it "inferior" as compared to official clinical parlance. This negligence results in the loss of evidence of how people understand their condition.
The data come from a variety of sources, including interviews with both older adults and relevant health care professionals, newspaper articles and illness narratives. So, who are these older adults? There is, of course, no precise onset to old age, but it is appropriate to name it as 60, on the basis that 60 years of age is the earliest eligibility for a (state/territory) government Seniors Card. In alignment with the overall aims of the project, the methodology follows four distinct stages, as elaborated below.
All data will be closely examined to identify all expressions related to late-onset depression and anxiety. The expressions will then be categorised and tagged (as euphemism, idiom, metaphor, metonymy, etc.) for recovery and interpretation; the database will be freely accessible for other researchers as well (following registration). The analysis will also record the year(s) in which the expressions are used in order to allow for a potential diachronic perspective. This corpus will be supplemented by the life satisfaction survey. The proposed project is a study of how older Australians think about life by examining the metaphors they use. This study will be based on a representative survey of the older Australian population, to include both (a) urban and rural cohorts; and (b) individuals living independently and in aged care facilities. One of the primary aims of this survey will be to compare and contrast life conceptualizations of older adults along these distinctions (urban vs. rural; aged care resident vs. non-resident). Data will be collected via an online survey method, which will then be subjected to a cognitive semantic analysis.
This stage involves the identification and analysis of how the linguistic data reflect conceptualizations surrounding late-onset depression and anxiety. We will follow our tested method of cognitive linguistic analysis, specifically approaches such as the Metaphor Identification Procedure routinely employed for the detection of metaphorical usage in language, and cognitive discourse analysis.
A podcast series comprising five episodes will be developed using the recorded in-depth interviews with 30 older Australians and 10 health professionals. This involves transcribing interviews, scripting episodes around themes generated during earlier analyses, editing interviews, recording on-location ambience, collecting music segments for the podcasts, creating podcast jingles and opening soundtrack and finally scripting and recording voiceover links. The podcast presenter will be sourced within the older community at U3A. The podcast production also involves online publication and distribution processes, social media development and community engagement to attract podcast audiences. The podcast series will be produced following a constructive journalism approach which focuses presenting positive ways to engage with issues identified in the episode. This approach emphasises importance of making first-person experiences heard and the presentation of multifocal perspectives on potential solutions.
Podcast development involves the recording, editing, production, podcast publication and dissemination and evaluation using focus groups at two public listening sessions with U3A members, examining the suitability and effectiveness of the podcast formats and technologies in discussing mental health and wellbeing in older populations in Australia.
In the final stage of the project, main findings will be publicized and made available for presentational purposes (potentially also training) in the form of public talks (e.g., University of the Third Age talks and lectures; these are open to the general public) and talks/workshops for clinical and nursing professionals (e.g., the seminar series at the Monash Ageing Research Centre; a roundtable discussion planned for Year 3 with members of the Academic Unit of Geriatric Medicine at Monash University). Podcasts will be generally available via the project's website, and to the around 300 Australian U3A groups via U3A online.