Project 99: Case Study – Lisa’s Story
This case study is one of a series which were developed as part of our Project 99 work. Through a variety of youth work contacts, we identified a number of young people who were able to provide some in-depth (anonymised) stories in a case study format. This gave us tremendous insights into experiences of mental health issues, use of digital technologies, and how these two might relate to each other. The other case studies and project outputs can be read on our Project 99 page.
Lisa is 22 year-old. She is working part time after graduating from University and moved out of her parents’ house. She previously struggled with depression and anxiety.
Mental Wellbeing Journey
In high school, Lisa studied intensely, which had a negative impact on her social life. She worked late most nights and was hard on herself if she ate unhealthy, which caused her anxiety despite being physically healthy and not underweight. Lisa was able to self-manage her difficulties in high school without seeking support.
“I was always afraid of going to the doctor in case they told me something was really wrong with me.”
A general feeling of unhappiness made her restless to leave school and home.
During her first years at University, Lisa enjoyed a healthier work balance and a large group of friends. In third year, she struggled to cope with increased workload and withdrew socially.Her frustration and lack of energy prevented her from enjoying any activity, which made her worry about her physical health.
Lisa remained positive and cheerful and her mental health problems were unnoticed. Her father, who also suffered from depression, recommended she saw a GP. She rebelled instantly against the idea but made an appointment after missing work deadlines and pressure built up. Her parents supported her during this difficult period. She was diagnosed with depression and received medication.
Six months later, Lisa felt healthy again and was able to stop her medication. Finding a job after graduation was difficult and she moved back with her parents. She became socially isolated, anxious and began to have daily panic attacks. She kept it hidden from her family – controlling her panic attacks through breathing techniques. She was terrified of seeing her GP in case something was wrong with her heart. Eventually, she found a self-diagnosis on an NHS website and online forums and felt relieved:
“They were just panic attacks! That was fine, I could handle that!”
Lisa went to live with a friend and started a part-time job. Her panic attacks stopped for a while but financial difficulties triggered them again.
“I didn’t tell anyone I was having panic attacks until my friend told me that she had started having them recently. That made it easy to tell her … then after that I told my mum and a few other friends … it was much easier to deal with then.”
By the time the appointment was scheduled, Lisa felt much stronger emotionally and she decided not to attend it. Although feeling healthier than ever, relationship difficulties made her feel low again. Realising there were issues not addressed, she said:
“I should have made that counselling appointment. The medication just made me feel I could handle things alone.”
Feeling healthier now, Lisa is still wrestling with the idea. She fears “opening up” but is aware that it may help her in the long run. She is extremely well supported by friends and family.
Digital Life
Lisa accesses the Internet through her laptop and does not have a smartphone. She prefers to call friends and family rather than text messages.
“We don’t have a TV in the flat, so our laptops are pretty much on all the time when we’re home so we can listen to music, the radio and watch DVDs or stuff on YouTube … There’s a few podcasts and shows that I listen to regularly for news, but mainly the news I get, and things I decide to read or watch are what other people post links to on Facebook. Or show me on YouTube.”
Facebook is always opened on her laptop. She follows her favourite celebrities on Twitter and uses Tumblr to browse and collect interesting images and quotes. She plays music on Spotify and YouTube all the time and likes compiling playlists.
When she was looking for a job, she would use social media for long periods of time for distraction, which in turn made her feel guilty and stressed.
“Sometimes, even though I should of been looking for a job, I would find myself spending ages procrastinating online; just scrolling Facebook and Tumblr, reading blog articles and watching stuff on YouTube. Its weird, I knew I was wasting so much time and looking at complete rubbish, but it was like I couldn’t stop and bring myself to do what I should have been doing.”
When she was socially isolated, she spent a lot of time browsing Facebook but posted very little, messaging friends only if they wrote first. This gave her the illusion of keeping in touch with friends.
“I got into bad habits when I moved back in with my parents. I was hardly going out and doing any real socialising at all, just talking to people on Facebook and reading their posts. The less I saw people, the less I wanted to, or the less I felt like I could.”
She realised this was contributing to her unhappiness and began to make an effort to socialise more as well as actively using her Facebook – sending messages to friends and instigating ‘chats’ rather than waiting to be spoken to.
Mental Wellbeing Insights
At risk groups
“I guess my problems started quite early on in high school. I was working too much and not socialising enough … I was pretty anxious about what I ate and how much I exercised. No one really noticed or thought it was a problem.”
Young people at risk of developing mental health difficulties often go unnoticed – early intervention, through the promotion and teaching of emotional literacy and self-awareness could prevent some problems from escalating.
Emotional barriers to support
“I didn’t want to tell anyone how bad I was feeling. I’m always pretty cheerful and in control when I’m with my friends … I didn’t want it to seem like there was something wrong with me … I guess I like seeming like I’m the strong one and that nothing gets to me.”
Pride, fear and guilt can make it difficult to seek help and reduce the impact of any support they do receive. Stigma and self-stigma are also factors.
Support beyond medication
“It really helped at the time; I felt much better … the medication just made me feel I could handle things on my own. But a little after I came off them I started to feel bad again, because I hadn’t really dealt with any of my issues.”
Medication alone is not really enough. Long-term wellbeing requires emotional and whole-person support in addition to the treatment of the physical side. This is true for all levels of severity; not simply the most acute or long-term conditions.
Self referral
“It took a lot of building up for me to ring up for a counselling appointment …. the letter took so long to come that by time I felt better, so I didn’t ever book an appointment. I wish I had now, I think I still need it, but I don’t know if I’ll build up to it again.”
It is difficult for young people in a vulnerable and emotionally volatile state to effectively self-manage without prompts, and know what is best for themselves in long term.
Recovery as a non-linear process
“After I stopped taking the medication for anxiety I felt so much better. My life was much more sorted and back to normal. I thought that was it, but then a few months later I had a really low period again, it kind of took me by surprise.”
Recovery should never be explained in terms of a quick fix, or of a black and white distinction between ‘ill’ and ‘well’. Young people need to be prepared for setbacks and possibility of relapse, but with an emphasis on gradual progress.
Physical symptoms
“It was having the panic attacks start again; that made me go to the doctors. I was just having them so often, and even if I felt OK on a conscious level and wasn’t actually actively worrying about stuff, it was like my body couldn’t help itself. It was scary not having control.”
Many young people will often not seek or be given support until the physical manifestations or consequences of mental ill health begin to overwhelm them, or become obvious to others.
Self Diagnosis
“I always Googled my symptoms first to try and convince myself that I didn’t have some horrible disease!”
In some cases, self-diagnosis may prevent young people from seeking support. Instead, they attempt to tackle problems alone even when they aren’t fully capable. Self-diagnosis in this way is common; advice and support to self-manage beyond this must be just as readily available.
Emotional openness
This is key to emotional wellbeing. For young people reluctant to seek support, hearing the honest discussion of experiences of mental health from people within their immediate network can give them the courage they need in order to do so, or at least to voice their difficulties.
Digital Insights
Curating content
Increasingly, users tailor the way they consume news, information, entertainment and digital content. Young people are used to gathering content from wide variety of unofficial sources; most frequently via one another by sharing links and posts.
Social media and the arts
“One of my favourite things to do is to trawl the Internet for interesting photos and illustrations. Sometimes I share them on Facebook, but I mainly collect them on Tumblr and save them in a folder so I can look through them when I need a bit of a break.”
Social media plays an important role in the dissemination of the arts: music, film, photography etc. Special interest groups flourish. This may be positive for mental health to aid self-realisation and development. Artistic content may also be used as an imaginative and pervasive means of spreading information and enabling empathy.
Social media and deferral
Young people use social media as a distraction. This can be harmless and normal teenage behaviour; they may spend long hours on social media sites rather than tackle homework, for example. It enters more serious territory when feeding into the listlessness and inability to perform even simple daily tasks that can be a part of depression.
Social media and social isolation
Socialising online can be a lifeline for otherwise socially isolated individuals. However, if this begins to replace social interaction entirely, it can be damaging and prolong periods of reclusiveness.
Social media use patterns
“I can tell that my mental state isn’t at its best if I start spending too much time on Facebook … like, just scrolling through my news feed without actually commenting on anything or posting anything.”
A change in a young person’s use pattern will more than likely indicate a change in state of mind. This can be a point of discussion in monitoring a person’s mental wellbeing and emotional state.
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