Experiences of otherness among students
diagnosed with depression and/or anxiety disorder
Senior researcher, Ph.D
National Institute for Health and Welfare. Mental Health Unit
P.O. Box 30, FI-00271 Helsinki, Finland
National Institute for Health and Welfare, Equality and Inclusion Unit
P.O. Box 30, FI-00271 Helsinki, Finland
Research professor, Ph.D
Social Insurance Institution, Research department
PL 450, 00250 Helsinki, Finland
Research manager, Ph.D
National Institute for Health and Welfare, Ageing, Disability and Functioning Unit
P.O. Box 30, FI-00271 Helsinki, Finland
Appelqvist-Schmidlechner K, Wessman J, Tuulio-Henriksson J, & Luoma ML.(2016)
Experiences of otherness among students diagnosed with depression and/or anxiety disorder.
International Journal of Psychosocial Rehabilitation. Vol 20 (2) 39-54
Kaija Appelqvist-Schmidlechner, PhD, Senior researcher
National Institute for Health and Welfare
P.O. Box 30, FI-00271 Helsinki, Finland
Conflicts of interest: The authors declare that they have no conflict of interest.
Funding: The study was funded by the Social Insurance Institution of Finland
Introduction. People with mental disorders sometimes experience that they are perceived as abnormal or different.
The study aimed at investigating the experiences of otherness among
students diagnosed with depression and/or anxiety disorder who
participated in a psychosocial rehabilitation program.
The data were gathered with focus groups by interviewing eight groups
of students (n=47) aged 16−25 years diagnosed with depression and/or
anxiety disorder who participated in a rehabilitation program during
themes were discovered related to the sense of otherness: 1) Carnival
of depression, 2) Stereotypes, 3) Shame, 4) Ethos of self management,
5) Overabundance of help, 6) Minimisation and lack of understanding,
and 7) Power of peer support.
Sense of otherness is related to stigma experiences which may carry
both negative and positive meanings. Health care professionals should
be aware of the power of peer support and humour among young adults
with mental disorders.
KEYWORDS: depression, young people, otherness, stigma, peer support
in adolescence or in young adulthood may severely impair psychological,
social and occupational development indicating a broad, lasting
tendency toward psychosocial problems in later life (Kessler et al.
1995).The prevalence of depression increases significantly during the
transition from childhood to adolescence (Lewinsohn et al. 1994, Hankin
2009), with the highest incidence at ages 15 to18 (Hankin et al. 1998).
The continuity to adulthood is very common (Hankin et al. 1998; Kessler
et al. 2012). Lifetime prevalence of major depressive disorder of
children in early adulthood varies between follow-up studies of
community samples from 23 to 43 per cent (Merikangas et al.
2009). In the WHO Mental Health Survey, the average 12-month
prevalence of major depressive episode in developed countries was 7 %
among young adults (18‒34 years) and of these, only 48 % reported
receiving some kind of treatment (Kessler et al. 2010).
suffering from mental disorders are sometimes affected by the
experience of being perceived as abnormal or different (Leavey 2005;
Moses 2009). The term "otherness" is well established and central to
sociological analyses of how majority and minority identities are
constructed. The dictionary defines "otherness" as "being or feeling
different in appearance or character from what is familiar, expected,
or generally accepted (Cambridge Advanced Learner’s Dictionary &
Thesaurus © Cambridge University Press). According to Bauman (1990),
the notion of otherness is central to the way in which societies
establish identity categories. These social categories shape our ideas
about who we think we are and the groups to which we belong. They
represent an established social order - hierarchy where certain groups
are established as being superior to other groups. Ideas of similarity
or difference are central to the way in which we achieve a sense of
identity and social belonging. In the view of Bauman, identities are
set up as dichotomies, for example, illness represents the opposite of
the norm or the ideal of health. (Bauman 1990.)
sciences, the term otherness has been applied rarely. The focus of
research interest has rather been on stigma and stigma experiences,
which can be seen as a marker of otherness. Stigma is a social
construction that defines individuals in terms of a distinguishing
characteristic of mark and, as a consequence, devalues them (Crocker et
al. 1998). Goffman (1963) describes stigma as a process by which the
reaction of others spoils normal identity. The concept of stigma is a
power-dependent phenomenon which consists of labeling, stereotyping,
cognitive separation, emotional reactions, loss of status and
discrimination (Link & Phelan 2001). Due to this process, stigma
can be seen as a meaningful indicator of otherness.
and its effects are commonly distinguished into two forms: public and
self-stigma (Corrigan & Watson 2002). Public stigma refers to
stigmatizing perceptions among the general population whereas
self-stigma occurs when people with mental illness self-label
themselves as someone who is socially unacceptable. According to
Corrigan et al. (2009), self-stigma comprises three steps: awareness of
the stereotype, agreement with it, and applying it to themselves. As a
result of this process, people suffer reduced self-esteem and
self-efficacy. Label avoidance has been seen as a third level of stigma
(Ben-Zeev et al. 2010). This is the case when people with mental health
problems avoid seeking help from mental health services because they do
not want to be categorized as a "mentally ill person" or they do not
want to face the prejudice and discrimination that the label entails.
is one of the main reasons why individuals with mental illnesses
hesitate in seeking mental health services (Chen-Fang et al. 2005,
Schomerus & Angermeyer 2008, Bowers et al. 2013). Studies have
shown that only about half of young people with mental health problems
had used mental health services (Aalto-Setälä et al. 2002; Sourander et
al. 2004; Biddle et al. 2006; Kessler et al. 2010).
Self-stigmatization, particularly, has been seen as an important
mechanism decreasing the willingness to seek psychiatric help (Corrigan
2004; Cheng-Fang et al. 2005; Schomerus et al. 2009). Moreover, fear of
negative attitudes among peers towards people with mental disorder in
general may hinder young people with mental problems to seek help (Rose
et al. 2007). Stigma has also been seen as a barrier to recovery from
mental illness (Link et al. 2001) as it may harm self-esteem among
individuals with mental health challenges.
Secrecy, shame and
limited social interaction are often related with having mental health
problems among adults (Link et al. 1989). However, less is known about
experiences of otherness among young adults diagnosed with a
psychiatric diagnosis. Knowledge on this area is crucial as these
aspects have an impact on the quality of life, help seeking behavior
and recovery (Link et al. 2001; Ceng-Fang et al. 2005; Schomerus et al.
2009; Ben-Zeev et al. 2010; Bowers et al. 2013). In this study, we set
out to investigate the experiences of otherness among young adults with
depression and/or anxiety disorder. Study participants were students
with these diagnoses who participated in a psychosocial rehabilitation
Materials and methods
study was a part of a larger evaluation study in which feasibility,
perceived impact and benefits of the OPI rehabilitation program for
students with depression and/or anxiety disorder were investigated
(Appelqvist-Schmidlechner et al. 2015). The project was implemented and
funded by the Social Insurance Institution of Finland (Kela) and the
study was conducted by the National Institute for Health and Welfare,
in co-operation with Kela.
The OPI program is an outpatient
group rehabilitation program that enables young people to attend
psychiatric rehabilitation alongside vocational education. The target
group comprised students aged 16‒25 years studying in vocational
schools who had a diagnosis of depression and/or anxiety disorder. The
rehabilitation program represented a recovery based approach (Anthony
1993) to support students with mental health challenges to cope with
their life situation and to accomplish their studies. The program
consisted of 18 group sessions and 6 one-to-one sessions. The length of
the program was 18 months including a 6 month follow up period. The
program was cognitive-behavioral-therapy -oriented with
solution-focused approach and led by two counselors. Two service
providers offered altogether 8 courses during 2011‒2013, each course
had a maximum number of 12 participants. Referrals to the program were
mostly made by the school health service, school social workers or
community health services. Collaboration with the school - particularly
with school social worker and school health service - played an
important role in the OPI program. Besides screening for potential
participants, they served as a link between the school and
rehabilitation providing dialog and consultation between these two
parties, in collaboration with the client. (Appelqvist-Schmidlechner et
In investigating the program, both quantitative and
qualitative research methods were used. The study on the feasibility
and outcomes of the OPI program showed positive outcomes in quality of
life, learning capacities and severity of depression among program
participants (Appelqvist-Schmidlechner et al. 2015) The present study
is based on the qualitative data collected in focus groups of program
participants. Focus group was chosen as a method as it enables the
uncovering of the unique cultural beliefs, values and motivations that
affect one's health behavior and well-being (Krueger & Casey
Recruitment and participant selection
80 students participated in the OPI program and were invited to
participate in the OPI evaluation study that has been described in
detail previously (Appelqvist-Schmidlechner et al. 2015). Written
informed consent and obtained parental consent - in the cases of
participants under 18 years old - was received from 70 participant. All
of them were invited to take part in one focus group session to be
organized in the end of the rehabilitation. Information about the study
and the purpose of the focus group was provided. Of the 70
participants, 23 did not attend the focus group for various reasons.
According to the program providers, some participants had dropped out
the program earlier, some had personal reasons not to attend the
session in this particular day and some were reluctant to participate
in the focus group. Altogether 47 students (38 females and 9 males)
participated in the focus group (5-7 participants in each focus
All study participants were students in two
different vocational schools in Finland (16-26 years, mean age 19, SD
2,15), all with diagnosed depression and/or anxiety disorder. The
anonymity of the participants was ensured for ethical reason. As a
result, name, age or demographic data about those who participated in
the focus group could not be collected.
groups of students aged 16‒25 years diagnosed with depression and/or
anxiety disorder who participated in the OPI program were interviewed
during 2011‒2013. The focus groups took place on the premises of the
service providers during the last group session. Each focus group was
facilitated by two female researchers (the first and second author);
one leading the interview and the other supporting the facilitator by
specifying questions about important issues, ensuring that all
questions were exhaustively discussed and making notes if necessary.
All interviews followed a similar structure with a primary focus to
collect experiences on participating in the OPI program. The structure
was developed by the first and second author and discussed within a
project team (including professionals from Kela and the National
Institute for Health and Welfare) providing support for the study. The
interview started with the clarification of the purpose of the focus
group, asking for permission to tape the interview, and then posing
questions based on the interview guide. Interviews were semi-structured
with following themes: Experiences of participating in the program,
feelings about starting the program and about telling other people
about it, perceived benefits and feasibility of the program, and
experiences of integrating rehabilitation and school. In spite of the
structured interview guide, the facilitators wanted to ensure the
natural flow of the discussion and to avoid controlling the discussion
too strictly. Consequently, despite of the fact that the primary focus
of the group discussion was not the sense of otherness, this theme was
very present and dominant in every group session, thus providing
interesting data related to the subject of the present study.
length of each focus group interview was from 40 minutes to 2 hours,
typically 60‒90 minutes. Following informed consent procedures, the
interviews were recorded with the permission of the respondents and
transcribed. The length of the recording was altogether 9 hours and 25
minutes (transcribed in 159 pages, single line spacing, font Times New
Roman 12). To ensure confidentiality, all identifying information was
removed and participants were assigned pseudonyms.
ethical approval for the study was granted by the ethics committee of
The Hospital District of Helsinki and Uusimaa and the National
Institute for Health and Welfare.
Written informed consent was
received from all study participants or their parents if the
participant was under 18 years. Information about the study and the
purpose of the focus group interview was provided.
researchers that facilitated the focus groups were working at the
National Institute for Health and Welfare in Finland as researchers and
had previous experiences with this study method and interviewing young
people. The researchers were not involved with planning or providing
the program. The anonymity of participants was ensured for ethical
Data analysis and reporting
content analysis (Braun & Clarke 2006) using an inductive approach
was used to analyze the transcripts. The purpose was to identify,
analyze and report patterns within the phenomenon of being labeled with
a psychiatric diagnosis. Relevant expressions (sentences/paragraphs)
for the aim of the study (sense of otherness) were identified and
divided into meaning units. The procedure included the following steps:
1) data familiarization, 2) generation of initial codes, 3) searching
for themes, 4) reviewing themes, and 5) defining and naming the themes.
The raw data were systematized by the first author into different
themes following the verification of the themes by the second author.
The authors discussed then the themes until they reached agreement. The
themes and examples of data extracts are presented in Table 1 and
quotes illustrating the themes in the text. As the students
participated in the focus group anonymously, the quotes are presented
without detailed labels specifying, for example, the age of the
participant at the end of each quotations.
data analysis discovered seven themes which were named as 1) Carnival
of depression, 2) Stereotypes, 3) Shame, 4) Ethos of self management,
5) Overabundance of help, 6) Minimisation and lack of understanding,
and 7) Power of peer support.
Carnival of depression
was used as a method to deal with the condition of mental illness and
to cope with public stigma. The expressions related to this was named
as "Carnival of depression". A peer group with individuals in similar
condition set frames for this "carnival". Students were joking about
depression or depressed people in general, but they were also laughing
a lot at themselves, as the following citations from the interview show:
1: I was a little bit afraid to come in, in the middle of the session,
I thought fuck, there are at least ten totally strange people and I
have to come in. I am brought out there. Hey, here you have a new one.
And then they get one more weirdo.
Participant 2: Yippee! We got one depressed more!
Participant 1: Straight from Transylvania!
[laughing one’s head of]
Participant 3: Let’s put all the depressed here together, in the headquarters of depression.
Participant 2: Let’s dump them all there [laughing] (Focus group 4)
study participants very often saw mental illness and treatment of
mental disorders through culturally mediated stereotypes. Messages in
the media and in the television influenced their attitudes. Themes in
this category reflect how young people with a mental illness find
psychiatric rehabilitation and, more generally, people with mental
The study participants did not exactly know what
rehabilitation actually means. Images about mental health problems and
rehabilitation came from stereotypes presented in films and media.
However, they could not relate themselves with these stereotypes,
as illustrated in the following quotes and examples of discussion:
I heard the word ”psychiatric rehabilitation” I thought a while what it
means and how it sounds and I thought I will be locked up in a hospital
and I will be there in a room with soft walls with five other people
wearing a straitjacket.
And I told her (school
health nurse) that I don’t know if I want to participate in this
rehabilitation program. Because it felt like I am going to sit in a
closed ward and have to explain why I feel myself a little bit
depressed." (Female, focus group 6)
Participant 1: I
think the word psychiatric rehabilitation is totally wrong to use. For
people in our age it sounds like you are about to be locked up in a
closed ward ....
Participant 2: For me, all drug addicts and alcoholics came to mind. (Focus group 4)
Participant 1: And I thought, hmmmm... rehabilitation...well well...,
Participant 2: You will be banded in your bed...
Participant 3: Look at these pictures, what do they tell to you...?
Participant 1. Do you hear voices? Do you feel something wringing your head?
[laughing] (Focus group 4)
were often concerned with the attitudes of peers or relatives about
their condition. Many of them were ashamed and felt embarrassed about
having mental health problems and participating in the rehabilitation.
Worries about the reaction of peers were common. Telling about their
participation in a rehabilitation program was difficult for most of the
participants. It seemed that they protected their self-esteem by not
disclosing their illness to others.
I still worry that they think I’m weird because I have this diagnosis
and attend this kind of program..." (Female, focus group 1)
my friends could talk something like, what kind of a fucking whacko she
is, or something like that." (Female, focus group 8)
Some rather kept it as a secret, as illustrated in the quotation below.
definitely won’t tell to my friends that I participate in a psychiatric
rehabilitation program, that I’m in this kind of club for depressed
people." (Female, focus group 7)
of the students were afraid they would disappoint their parents by
telling about their condition. An example of discussion below describes
the feelings of some study participants.
1: It’s a little bit difficult to tell to your parents, suddenly you
have to tell them that your child is depressed. Well, what?
Participant 2: It feels like you disappoint them
Participant 3: Yes, I felt the same (Focus group 4)
some study participants reported being able to talk openly about their
illness with peers and relatives. These students had often relatives
who had a history of mental illness, which normalized their condition.
Ethos of self management
study participants had a strong ethos of self management. This is not
surprising considering the age of the study participants, being in the
middle of the transition phase to adulthood and independence. As most
of them lived no longer with their parents, they had the possibility to
conceal their condition. Some of them did not want to burden their
parents with their problems, as is shown in the following citation:
"This is my problem. They don’t have to stress about it." (Female, focus group 4)
did not want to burden their friends and class mates with their mental
health challenges, either. Many had this uncomfortable feeling like
they would only ruin other's mood by telling about own bad feelings.
Consequently, some of them tried to hide their bad feelings behind a
"fake happy face".
Participant 1: That terrible embarrassment among other people if they heard about such problems.
Participant 2: Depression is still a kind of taboo...(Focus group 2)
Overabundance of help
coded as "Overabundance of help " include negative perceptions directed
toward peers and friends who were too keen to offer help. Many had
faced overabundance of help, which was experienced as annoying by some
study participants. The following are illustrations of these themes.
"So many think they are like Jesus ... I can heal you. Just talk to me". (Female, focus group 4)
"One friend of mine talked to me like I was 5 years old. That was so annoying." (Female, focus group 4)
Students didn’t want to be treated as special cases by friends or teachers because of fear of stigma.
then somebody in the class, in front of the class, asked me if I’m ok
and if I manage. And by doing that she made me look even more weirdo ".
(Female, focus group 7)
Students didn’t want
other people to pity them. They wanted to be handled like other
students, despite their diagnosis. They wanted teachers to take their
diagnosis into account, but they didn’t want to be treated as a special
"I have sent my
teacher an e-mail and told that I want you to take this into account,
but I don’t want any special treatment or pity. I don’t want to turn
this into a big issue." (Female, focus group 2)
Minimisation and lack of understanding
of the overabundance of help experienced by some study participants,
many reported experiences of other people minimizing their condition,
or lack of being understood by others. They reported having been
misunderstood by teachers and peers, as well as by professionals. Some
felt, that even mental health professionals did not take their
condition seriously. The following citations present experiences with
the public health care.
got this feeling that they minimised my condition. Then I started to
cry uncontrollably and yelled them that fuck, I feel bad!" (Female,
focus group 4)
told me that my condition is too good. Should I have a rope around my
neck before they understand? I’m not suicidal and I don’t want to be
like that. I just want to have somebody to talk with. When I’m sitting
all day long alone in my apartment staring at walls, well, it can’t be
that normal. (Female, focus group 4)
numerous professionals providing help in the past, some of the study
participants were tired to explain their condition and tell their story
over and over again. They felt that peers, teachers and even
psychiatric and mental health nurses could not really understand them
despite their education and many years of working experience. Some of
the study participants had a strong feeling of being misunderstood by
all without the same condition.
then as I talked with a nurse, I don’t think she really understood,
even though she had studied this for ten years and more. But I think
she can’t REALLY understand me." (female, focus group 6)
Power of peer support
theme reflects how the students with mental disorder felt a sense of
belonging when interacting with others with similar condition. Group
members were bonded through sharing a common problem. It was a relief
for many to realize that others experience the same problems and are
struggling, too. They felt connected, sharing a common problem and
getting peer support. One main benefit of the group-based
rehabilitation was the opportunity to laugh and cry together. Nobody
needed to hide their bad feelings, but everybody had also the
permission to laugh.
so cool that even if we talk about rough things and cry together and
something like that, but after a coffee break we can have fun and laugh
together. I mean, you don’t have to be sad all day, even if you...if
you have just handled very deep stuff and talked about rough issues."
(Female, focus group 2)
In groups with a good
group cohesion, students had the experience of being understood by
others, they were able to talk confidentially and openly. They felt
more connected and less alone, reducing feelings of isolation.
also...you are not alone with this issue. And...well...it has been so
good to talk with these people. They understand how you feel." (female,
focus group 1)
Table 1. Themes
Examples of data extract
Carnivalisation of depression
Joking about depression in general
Joking about depressed people
Joking about oneself as a depressed
Joking about taking part in a
my uncle is a nutcase"
"...Let’s put all the depressed
here together, in the headquarters of depression..."
"...Straight from Transylvania..."
"... And then they get one more
Stereotypic images of depression and
Stereotypic images of psychiatric
(people with mental health problems) walk in the street and mutter..."
"For people in our age it sounds
like you are about to be locked up in a closed ward ...".
Shame in telling about one's depression
Fear to disappoint the parents
Worries about the reaction and attitudes
"I definitely won’t tell to my
friends that I participate in a psychiatric rehabilitation program, that I’m
in this kind of club for depressed people."
"It feels like you disappoint
have the feeling that my brother may think, that what...is my sister ok? Is
she allowed to be among the people? Should she be locked up somewhere?"
Ethos of self management
Unwillingness to burden other (parents,
Willingness to manage alone
(friends) get embarrassed when I talk about my problems or about issues we
are talking here. Then I got this feeling, I don't want to bother
them..."Otherwise the feeling of others will be ruined."
" This is my problem. They don’t have
to stress about it."
Overabundance of help
Annoying friends offering help
Too many parties offering help
Turning one's condition to an too big
"One friend of mine talked to me
like I was 5 years old. That was so annoying."
this fuss over me, I sit there alone with all these people, parents, school
nurses and nearly the school cooks, too. Then you get the feeling, that
well...here you are..."
"And then somebody in the class,
in front of the class, asked me if I’m ok and if I manage. And by doing that
she made me look even more weirdo ".
Minimisation and lack of understanding
Lack of understanding
Minimisation of symptoms by others
Exhaustion to explain one's condition
"But I think she can’t REALLY
"...they minimised my condition."
am so tired to explain everybody about all this.."..." It's so tiring."
Power of peer support
Feeling of being understood
Sharing a common problem
Sharing different feelings
understand how you feel..."
"...you are not alone with this
"It’s so cool that even if we
talk about rough things and cry together and something like that, but after a
coffee break we can have fun and laugh together
study aimed to synthesize qualitative evidence related to experiences
of otherness among students diagnosed with depression and/or anxiety
disorder who participated in a psychosocial rehabilitation program. The
themes described here highlight and explain how study participants
experienced their illness, the reactions of other people to their
condition and taking part in a rehabilitation program with peers in
The present study showed that the sense of
otherness due to a psychiatric diagnosis is related to stigma
experiences, which may carry both negative and positive meanings (Link
& Phelan 2010). The study participants had faced sense of shame,
minimisation of their condition, lack of being understood by others and
inappropriate way of providing support. On the other hand, in groups
with peers with the same condition, they had experienced the
possibility to share common thoughts and problems, to laugh and to make
fun of themselves and to get peer support. The findings of the present
study were in line with those of the study by Kranke and Floersch
(2009), who interviewed adolescents with a mental health diagnosis and
described their experiences of stigma in schools, finding both negative
and positive meanings of stigma experiences.
In the present
study, the presence of self stigma and label avoidance was particularly
remarkable. Fear of social stigma strongly affected the student's
willingness to participate in the rehabilitation program. Many felt
embarrassed about having a mental health problem and they were worried
about other people's reactions. During adolescence and young adulthood,
concerns about opinions of others are common also among those without
mental health challenges. It is understandable that young people with
mental health problems experience these concerns even stronger. Young
people with mental health problems commonly feel stigmatized and
labeled experiencing multiple losses of identity, family, career
choices, and educational and social standing at worst (Leavey 2005;
Moses 2009). It is also known that they commonly are stigmatized by
peers without mental health problems (O'Driscoll 2012).
of the dominant presence of stigma experiences among study
participants, not every student in this study experienced fear of
stigma. Some study participants did not have difficulties to talk
openly about their illness with peers and relatives. Previous studies
have shown that stigma experiences among young people with mental
disorders are not necessarily that common. In the study of Moses
(2009), relatively low levels of stigma among adolescent recipients of
mental health treatment was shown. The authors stated this to be
related to the commonality of mental health symptoms during this age
period or increased knowledge about mental health problems and the
treatability of these problems. In the present study, those with
previous experiences with mental health problems in the family seemed
to face fewer difficulties with telling other people about their
The diagnosis of depression / anxiety disorder formed
a bond between the study participants, providing connection with others
in similar condition, sense of belonging and being understood as well
as peer support. Shared experiences of otherness deepened the social
cohesion. The strategy of forming friendships with others in similar
condition is called positive stigma avoidance strategy (Kranke &
Floersch 2009). This is a strategy of managing stigma by producing a
sense of belonging as well as normalizing behavior, feeling and
experience. Group-based interventions - like the OPI program - have the
opportunity to foster the group identity and to normalize the illness,
reducing stress and self-stigma and supporting the recovery (Corrigan
& Wassel 2005; Newbold et al. 2013). Further, group-based
interventions have the possibility to provide opportunities to create
and maintain friendships with individuals in similar condition. This is
important as in this age period young people commonly choose friends
based on similarity (Abound & Mendelson 1996).
participants used humor as a method in dealing with their mental
illness. They were making fun of themselves and the peer group set
frames for that. The "carnivalisation of depression" was perceived in
using stereotypes, playing the fool and in lots of laugh with peers in
similar condition. Previous studies have shown that the use of humor is
a common method in coping with stress and it can be seen as a coping
strategy, as a method to escape and/or avoid the reality (Crawford
& Caltabiano 2011; Wu & Chan 2013). The term "Carnivalisation"
is not found in the literature related to mental health issues, but it
describes the phenomenon observed in this study better than the common
term "humour" as it includes a stronger social aspect provided by the
peer group. It also includes elements like atmosphere through humour
and chaos, parody and personal satire, as described by Bakhtin (1968).
study also showed up that the students did not have adequate
information about mental disorders or psychiatric rehabilitation. Young
people do not necessarily understand the meaning of the terms used by
health care professionals or these terms may be experienced as
stigmatizing. The perceptions were formed by stereotypic pictures from
the media and television. It is known that media messages very often
influence perceptions and form stigmatizing attitudes toward people
with mental problems (Cutcliffe & Hannigan 2001; Kranke et al.
Strengths and limitations
strengths but also several limitations of the study that have to be
taken into account. The method used in this study fits for the purpose
of the study. Qualitative research has the possibility to lend relevant
insight into experiences of otherness as a young person with mental
disorder. Group settings can trigger people to talk about things that
they may not necessary talk about in individual interviews, enriching
the data with group experiences and interpretations. Focus groups are
seen as an ideal method for exploring people's own meanings and
understandings of health and illness (Wilkinson 1998). However, as the
sample was small, the results can not be generalized.
challenge in facilitating focus groups is to get every participant to
open up and engage in the discussion. Some were more dominant while
other needed encouragement to speak. On the whole, the atmosphere
during every focus group was open and friendly. Some groups were more
talkative than the others. This impression was confirmed also by the
counselors providing the program.
One weakness of the study is
the small number of males among the study participants. Participants of
the OPI program were mainly females and the voice of male students is
underrepresented in the study. It is also to note, that not every
participating in the feasibility study participated in the focus group
interview. It is difficult to estimate, how this might have biased the
results as the reasons for nonparticipating were various. Further, it
has to be taken into consideration that the study participants were
taking part in a group rehabilitation program. This has most likely had
an influence on the themes that came up in the analysis, especially
highlighting the meaning of peer support. The experiences of otherness
among those without the possibility to participate in this kind of
group-based rehabilitation program or those not having any kind of
treatment would differ from these findings. This could be an
interesting aim for future studies.
Implications for practice
present study highlighted many interesting and important aspects for
health care practitioners. First, as young people are known to be
reluctant to seek help for their mental health problems, it is
important to avoid minimisation of symptoms when dealing with a young
person with a mental health concern. On the other hand, young people do
not want to be handled like a person with a disability. Health care
professionals can contribute to the positive experiences among young
patients with mental illness with a person-centered approach, where the
patients and their concerns are taken seriously. Young people with
mental health problems want to be heard and respected like any other
Second, young people do not necessarily understand the
terms used by the health care system. Service providers and mental
health professionals have to pay more attention on how to reach those
young people in need for help and how to lower the threshold for
seeking help. Young people with mental disorders should be provided
with adequate information about services that are supplied. Besides
oral and written information, also an opportunity to visit the venue
and professionals providing the service is recommended. Within the OPI
program, this opportunity lowered the threshold to take part in the
Third, service providers should also be aware of the
power of peer support in planning and developing mental health services
for young people with mental illness. Connection with peers with
similar condition has the opportunity to normalize the experience of
the illness. This can have a positive impact on recovery. Further,
young people with mental disorders should be used as experts by
experience and be engaged in planning and developing mental health
programs for their own age group.
findings of the present study showed that the experiences of otherness
among young people with depression and/or anxiety disorder are related
to stigma experiences, which may carry both negative and positive
meanings. Negative meanings were related, most of all, to shame and
worries about the reaction of peers and relatives as well as to the
lack of being understood by others. The positive feelings came out in
interacting with peers in similar condition providing support,
understanding and sense of belonging. Humor was used as a coping method
of dealing with mental illness.
The present study provides a
better understanding of the social identity of young people receiving
support for mental health challenges, and it helps service providers to
pay more attention on how to reach those in need of help, how to lower
the threshold for seeking help and how young people with mental
disorders should be supported.
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