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    Psychological discourses on gender, ethnicity, and socioeconomic status : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2001) Patel, Asmita
    The present study was concerned with how the discourses used in cognitive behaviour therapy (CBT), theory and practice construct the identity categories of gender, ethnicity and socioeconomic status (SES). This study also focused on whether CBT practitioners view CBT as a psychotherapy that is designed and aimed more toward obtaining individual client change and adaptation to distress than focusing on social causation of client distress and social change awareness. The research aims were executed using both Potter and Wetherell's (1987) approach to discourse analysis and a feminist poststructuralist framework. Ten clinical psychologists, participated. They were interviewed about the identity categories of gender, ethnicity and SES in relation to CBT theory and practice. An open ended unstructured approach to interviewing was undertaken. Transcripts from the interviews were analyzed. Analysis resulted in the identification of three main discourses: the assessment discourse, the individual practitioner discourse and the empowerment advocacy discourse. Overall analysis of the discourses revealed how they acted to construct CBT as a beneficial psychotherapy to use with clients from ethnic minority groups, low socioeconomic groups and for women, despite the overall consensus that CBT is not specifically designed to assess the effect of gender, ethnicity and SES factors. Analysis of transcripts also revealed that participants view CBT as psychotherapy that is designed more toward obtaining individual client change, though participants stated that CBT has the potential to design social change initiatives. The key issues arising from the findings are discussed and some general conclusions are presented. Limitations and future directions for research are also discussed.
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    A right to a risk filled life : understanding and analysis of the risk discourse for consumers in mental health : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Social Policy at Massey University
    (Massey University, 2008) Phillips, Ross
    This thesis documents the perspective and discourse of risk for eleven people who identify as someone with lived experiences of mental illness and mental health service use. The thesis followed a participatory methodology and involved consumers in both formulating and conducting the research. Following qualitative research methods some key findings included that there was a correlation between increased exposures to risk during increased acute unwellness; increased exposure to risk because of service use; that the people interviewed wished to have some control and self-responsibility in managing risks, that life was full of risk and that this was quite usual; and importantly, that risk was experienced as a stigmatizing phenomena for the participants. The stigma of risk was such that participants had to develop significant coping strategies to manage others perceptions and deal with the experience of having normal behaviours and emotions considered by others as abnormal and risky. The thesis makes recommendations for consumers, services and mental health service staff and for policy makers. Many of the recommendations consider how understandings of risk and approaches to risk management could alter or increase consumer safety and wellbeing. The thesis additionally includes an analysis of the participatory process that was followed with recommendations made encouraging an increased frequency and strengthened quality of consumer participation in research.
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    Out of sight, out of mind : an exploration of the sexuality experiences of women with enduring mental illness : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University
    (Massey University, 2008) Davison, Joanna
    This thesis explores the sexuality experiences of women with enduring mental illness. Sexuality is a complex and important aspect of a person's health and well-being. Yet, health professionals seem generally reluctant to discuss sexuality related issues, and few research studies have explored the sexuality of women with enduring mental illness. The aim of this research was to gain a deeper understanding about these women's sexuality experiences, including how they would like health professionals to address this aspect of their lives. Eight women were interviewed individually, and then together as a focus group. Working from a feminist theoretical perspective, the interview transcripts were analysed thematically. All the women considered their sexuality an essential component of their identity. However, powerful interlocking systems controlled and influenced how the women expressed their sexuality, often marginalising, and positioning them as 'Other'. The women's experiences highlight the need for mental health professionals to recognise that sexuality is an important aspect of a person's care and recovery. Mental health professionals need to offer services that enable women with enduring mental illness to openly discuss their sexuality.
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    Exploring the relationship between mental health professionals and family caregivers, who care for 18-30 year olds, diagnosed with a serious mental illness, in two district healthe board areas of NZ : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Rehabilitation at Massey University
    (Massey University, 2004) Nicholls, Elizabeth A
    Despite compelling evidence of benefits for mentally ill family members when there is a working relationship between mental health professionals (MHPs) and family caregivers (FCGs), international and New Zealand literature has continued to reveal that the relationship is fraught with difficulties. Although there have been a number of international studies exploring the relationship from the family caregiver perspective there have been few international studies and no New Zealand studies conducted that have explored the MHPs perspective of this relationship. Therefore the purpose of this research was to explore this relationship from the FCG's perspective and the MHP's perspective. In-depth interviews were conducted with six FCGs and seven MHPs, one of whom was also a FCG, from two North Island District Health Board areas. Four MHP themes and five FCG themes were identified which highlight a significant chasm that exists between the MHP's intention to build a relationship with the FCG, and the FCG's experience of the nature of this relationship. These findings are discussed and recommendations are made to bridge this chasm for the benefit of FCGs and MHPs, but ultimately the person with the mental illness.
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    Gender and lunacy : a study of women patients at the Auckland Lunatic Asylum, 1870-1910 : a thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in history at Massey University
    (Massey University, 1990) Labrum, Bronwyn
    This is a study of the experience of the insane in nineteenth century New Zealand and it examines in detail a sample of 45 women and 15 men who were admitted to the Auckland Lunatic Asylum between 1870 and 1910. Based on patient casenotes, reports by asylum officials, newspaper accounts, and drawing on recent overseas historical literature about insanity, the thesis analyses why these patients were labelled insane, what that process involved, and the techniques adopted to treat the mentally ill. Throughout it emphasises the socially-constructed nature of mental illness and aims to determine the extent to which gender was a factor in the processes of detection and incarceration. Although the focus is primarily on women, men are included as it is argued that gender is a comparative tool of analysis. The study concludes that committal and treatment were all heavily influenced by gender in varying degrees. However it also argues that examining gender does not tell the whole story. Complex pressures all played their role. These included notions of propriety, social and familial conflict, economic distress, material conditions and race.
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    A Tongan talanoa about conceptualisations, constructions and understandings of mental illness : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Albany, Auckland, New Zealand
    (Massey University, 2014) Vaka, Sione Lavenita
    The New Zealand Mental Health Survey, Te Rau Hinengaro (Oakley-Browne, Wells, & Scott, 2006), reported that Tongan people have high prevalence rates of mental illness, do not utilise mental health services, and the risks of mental illnesses were different between Tongan people born in Tonga and those who were born in New Zealand. The risks were higher for those who were born in Aotearoa New Zealand (A/NZ). The overall aim of this research is to explore the meaning of mental illness for Tongan people in A/NZ, and the research question is, what is the meaning of mental illness for Tongan people in A/NZ? The Tongan cultural framework talanoa was used as a conceptual framework to inform this research and also as a method for collecting the data. Using talanoa engaged this research in the circular and collective ideologies of Tongan people. Tongan cultural contexts are used to strengthen this engagement and the collection of data, and Tongan concepts are used to discuss the findings. Thematic analysis was utilised to analyse the data. These Tongan concepts construct (tufunga) mental illness from Tongan perspectives and interpretations. This research found that Tongans in New Zealand perceive and interpret mental illness in three ways: through traditional Tongan interpretations, through Western and biomedical influences, and also through an intersection of Tongan interpretations and Western/ biomedical influences. These interpretations are presented as themes. These themes were tufunga faka-Tonga (Tongan constructions of mental distress); tufunga faka-paiōsaikosōsiolo (biopsychosocial constructions of mental distress), and the tufunga fepaki mo e fetaulaki he vaha‘a ‘o e tufunga faka-paiōsaikosōsiolo mo e tufunga faka-Tonga (intersections between biopsychosocial and Tongan constructions of mental distress). The research findings, therefore, highlight challenges associated with applying a biomedical linear, individually focused Western mental health system to a traditional Tongan, circular, and collective community in A/NZ.
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    The Janus influence and discovering a life : a study of people living with coexisting mental health and substance use disorders : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology at Massey University, Albany, New Zealand
    (Massey University, 2001) Warren, Helen Barbara
    This grounded study examines how people who are dually diagnosed with a major mental illness and substance use disorder 'recover' their lives from a past of 'intemperate insanity' and discover a world in a rich and productive present. Thirty participants, including consumers, staff and families, took part in the study. Additional slices of data were retrieved from the analysis of six 'policy' documents and 72 hours of participant observation. All data were constantly compared and analysed using Glaser's emergent approach to grounded theory. Research and literature on those with coexisting disorders has been dominated by the 'medical model' with a focus on assessment, diagnosis, treatment and rehabilitation both in addiction and mental health settings. Whilst these aspects of 'management' of coexisting disorders are important, this acute phase of intervention represents only a small fragment of a person's life. These people are not their disease, and the coexisting disorders are not the totality of their being. 'Discovering a life' was an emergent theme that formed the basic core category. Intemperate insanity, naked in Woolworths (the crisis), shedding the armour (recovery) and living without the armour (maintaining the change) and Janus' temple (service provision) formed the theoretical codes which made up the entity discovering a life. There also emerged a further 'natural division', a critical juncture essential to discovering a life - sobriety. Without sobriety, participants' lives took a different path which linked them back to a past of intemperate insanity. Literary images of the Roman God Janus are used as a metaphor throughout the thesis to elucidate aspects of the participants' lives. Janus was the God of endings and new beginnings, of youth and age, and is portrayed in historical texts with a double head, one looking backwards and the other forwards. It is this need to remind themselves of the past in order to imagine the future, a need to track the metaphorical trajectory from youth to age that informs the basis of 'wellness' in the present for my participants. Service provision in the mental health and alcohol and drug fields is aimed at early intervention, the acutely ill and early phase rehabilitation. There are clearly ways of analysing and approaching the 'illness' at this initial point of the continuum that are efficacious and cardinal to the ultimate well-being of the individual. What I am proposing here is not an alternative to this bio-psycho-social explication, but a second-level, substantive theory that offers an insight into the way a diversity of people with coexisting mental health and substance dependence disorders integrate their human imperfections into their lives. They have found a way of accepting, rather than transcending, the human condition. At the same time, this new paradigm has implications for the way we provide a service to people with coexisting disorders. Service providers are invited to participate in a way that shifts the emphasis of intervention from 'doing' (tasks and skills-related activities), to 'being' (with a focus on integrating coexisting disorders into identity of 'self'). A therapeutic emphasis on 'caring', not 'curing', creates an environment that allows consumers to realistically live rich and meaningful lives.
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    Acts of integration, expressions of faith : madness, death and ritual in Melanau ontology : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Anthropology at Massey University
    (Massey University, 2004) Appleton, Ann Lucille
    Longitudinal medical research studies undertaken on an international scale by the World Health Organisation continue to confirm a better prognosis for mental illness in traditional societies than in more technologically developed societies. While various associations have been drawn or hypothesised between specific cultural factors and a more favourable outcome, attention has also frequently been drawn to the methodological, analytic and diagnostic inadequacies of these studies. The work for this thesis was undertaken with these criticisms in mind and also in part as a counter to the perceived inadequacies of a solely bio-medical approach to psychopathology. The specific purpose of the research was to assess the role that culture plays in the construction and experience of both psychological well-being and psychopathology in a "traditional" society in Sarawak, Malaysia. There was an equal concern to ascertain and examine the ways in which explanations and understandings about identity, illness and wellness differ from current western models and approaches and how they are realised and lived out in the experience of individuals. The ethnographic data was collected during intensive participant-observation conducted over two years in the Mukah District of Sarawak, Malaysia, a region which has a long association with the Melanau ethnic group. Drawing on the ethnographic evidence, this thesis argues that psychopathological experiences (as psychological phenomena) embody characteristics that make it possible to identify them as culturally constructed artifacts. A theory is advanced which locates the source of psychopathology within the context of human being-in-the-world and which suggests that features of the mental illness experience such as chronicity and stigma are historically and culturally constructed within the illness concept itself. The argument draws on the theory and insights of existentialism, phenomenology. Turner's ritual theory, and Jung's concept of the shadow, extended to include a concept of the cultural shadow. It concludes that a failure to take account of the cultural dimensions of mental illness may also result in a failure to perceive not only the source of our psychopathologies but also a solution.
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    Comparing characteristics, practices and experiential skills of mental health practitioners in New Zealand and Singapore : implications for Chinese clients and cognitive behaviour therapy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Albany, New Zealand
    (Massey University, 2007) Foo, Koong Hean
    This study compared the characteristics, self-reported practices and experiential skills of mental health practitioners (MHPs) in New Zealand and Singapore with the aim of benefiting both nations in managing the mentally ill. A mixed-research design was used consisting of a mail questionnaire survey and a structured interview. For each country, mail questionnaires were sent to 300 MHPs, namely, counsellors, psychiatrists, psychologists, psychotherapists, and social workers, while structured interviews were held with 12 MHPs. Potential participants were drawn from available electronic or printed publications on counselling and psychotherapy services in both countries. Those drawn from individual listings of MHPs were systematically sampled, whereas those drawn from organisational listings of MHPs were sampled by way of estimation. Despite the relatively low response rates of 20% to 27% from the participants of the mail questionnaire, the major findings were supported and augmented by those from the structured interviews in the combined analysis of results. Results were categorised into personal, professional and practice characteristics of MHPs. Personal characteristics included demographic characteristics. Professional characteristics included training characteristics, primary job affiliation and use of Western therapy models and interventions. Practice characteristics were sub-divided into five categories: practice setting; diagnostic system and assessment procedures; client and caseload; gender/ethnic match; and experiential skills. Similarities in personal and demographic characteristics between MHPs of both New Zealand and Singapore were found with respect to gender, ethnicity, and language ability. Differences in these characteristics were found with respect to age range and religious affiliation. Similarities in professional characteristics between MHPs of both countries were found with respect to country of therapy training, qualification in therapy, number of years of supervised training received, and use of Western therapy models and interventions. Differences in these characteristics were found with respect to primary job affiliation, availability of clinical psychology programmes, years of experience in therapy, and registration of practice. Similarities in practice characteristics between MHPs of both countries were found with respect to relevance of therapy models, focus of practice, diagnostic system and use of assessment procedures, clients seen, clients' presenting problems, and gender/ethnic match. Differences in these characteristics were found with respect to preferences of therapy models, and average number of sessions per client. Similarities in experiential skills between MHPs of both countries were found with respect to handling of self-disclosure, religious or spiritual issues, and traditional healers. Implications for Chinese clients and cognitive behaviour therapy were discussed, as well as limitations of the study.
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    Depression, the internet and ethnography : a study of online support forums and the methodology used : a thesis presented in partial fulfilment of the requirements for a Master of Arts degree in Social Anthropology at Massey University, Albany Campus
    (Massey University, 2005) Hawkey, Michael Andrew
    Depression is one of the more common forms of mental illness experienced by people around the world. It is an illness which affects both men and women alike and does not target specific ages or nationalities. Depression is also an illness many suffer in solitude, often unable to pinpoint what exactly is wrong, rather identifying it as a “darkness” or sense of “numbness”. As we move into an age of growing technological changes, the Internet has become host to many forms of communities. These communities can be both modified versions of their offline original or whole new communities that did not exist to any great degree before the introduction of the internet. One such new form of online community are those designed for the support of peoples with depression and other mood disorders. Because of this growth in online communities and anthropology’s tradition of researching and understanding different groups of people, it is only appropriate that, as a discipline, it also moves online alongside these new communities. To do this, traditional field methods need to be reassessed and new potential problems and ethical dilemmas resolved. As online depression communities and internet ethnography are both relatively new fields of study, this thesis will examine the elements of both the online depression communities being studied, and the methods used in researching them. The reason I chose to research this topic is because, although depression as a subject has been covered many times before, and online community research is growing, there have been few studies undertaken on the two combined. In undertaking such research, this study will be of use for both academia and the public mental health sector. Academically, it provides us with an additional study venturing into online iii research and how to apply our tools within it. For the mental health sector, it provides an account as to how and why people with mental health issues deal with their problems, or at least begin to deal with them. This is important, as in the mental health sector many people with a mental illness may not reach out for help until in dire need. With the growth of online communities people may join earlier in their suffering and this knowledge could be of use for departments of mental health.