| Life is given once, when a child comes to this | | | | both were unwilling to give and receive support. In |
| world she/ he has many dreams in her eyes. | | | | addition she had a supportive friend but |
| None of them has thought about the stressors, | | | | unfortunately she left her after marriage. In her |
| but they are faced towards many stressors in | | | | adulthood when she got married, she highly |
| life. There dreams break when they realizes that | | | | needed her husband's support because she was |
| the social support which was their coping is no | | | | passing through a role transition but again this |
| more with them. This is happening in the below | | | | support fade away by her husband death and she |
| mentioned scenario. | | | | was left alone with the responsibility of two |
| Scenario: | | | | young children. Some times there was a need but |
| My patient was 59 years old female with | | | | there was no positive supports identified and if it |
| schizophrenia. Patient had this disease from last 17 | | | | was identified than they were unwilling to provide |
| years. The symptoms patient had on admission | | | | support, this leaded to absence of supportive |
| was: ghabrahat, and crying spells. Patient her self | | | | social net work. |
| don't know the reason of crying spells, patient | | | | Social support is required at every age of life, |
| said when ever she is alone some where she | | | | social support and social network shows positive |
| feels like crying and she is unable to rule out the | | | | effect on health and well being (Taylor, Seeman |
| reason. Patient lives in an extended family with | | | | & Gurung, 2003. If I see my patient scenario |
| her son, daughter in law, and grand daughter. She | | | | through life span I see that: |
| is a widow her husband died when she was 26 | | | | In childhood and teenage: |
| years old; patient had a supporting relationship | | | | At this stage children are looking forward to their |
| with him. After her husband's death she was all | | | | parents for support, the support which is provided |
| alone to raise her children. Patient faced plenty of | | | | in childhood develops self esteem, confidence and |
| difficulties in rearing them, and at that time no in | | | | sense of belonging. My patient belonged to a poor |
| laws helped her. Before marriage patient was living | | | | family where their priority was food so, parents |
| in a poor family with her parents, 4 sisters and | | | | were busy in earning and no support was |
| one brother. Patient has studied up till metric. | | | | provided to children. According to Chatters, |
| After this she was working in home and helping | | | | Krause and Shaw (2004) "early parental support is |
| her mother. Patient said there was no support | | | | believe to be linked to the development of |
| provided in childhood because every body was | | | | current supportive social relationship, a sense of |
| busy to earn in order to fulfill living needs. Patient | | | | personal control, and a sense of |
| had only one best friend with whom she shared | | | | self-worth….early parental support is |
| every thing but now she is married and living in | | | | strongly related to both mental and physical health |
| other country. Now patient is not sharing her | | | | outcomes". |
| feelings to any one as she said she do not feel | | | | In adolescence: |
| like sharing to any one. | | | | In adolescent age, my patient only had a friend |
| Introduction: | | | | whom she was considering supportive because |
| Looking at my patient' scenario I feel she had | | | | she was always there to listen her. Patient's friend |
| multiple factors which led her to mental illness | | | | got married and she was alone in this world |
| these were; poverty, lack of parental attention in | | | | despite of having a family. Friend had an important |
| childhood and teenage, unavailability of supportive | | | | place in my patient's life. According to a research |
| person, loss of husband, suppression of own | | | | conducted by Perese and Wolf (2005) "friend |
| feelings due to role transition, and social stigma. | | | | provides a sense of security and belonging that |
| These all factors have evolved lack of social | | | | buffers the stressors of life lack of friends was |
| support in patient's life. According to Perese & | | | | reported in one-third of the general population". |
| Wolf "Social support is the subjective measure of | | | | In young adulthood: |
| the emotional values that a person receives from | | | | A time came when my patient got married. It |
| his or her social network- the individual or group | | | | was a change in her life and she was highly |
| with whom the person is in contact" (p. 593). | | | | needing a support to get adjusted in new life, she |
| Social net work communicates love and affection | | | | got support from her husband and she got 2 kid |
| to them who are in their network. Though patient | | | | and she entered into a new role transition "a |
| has a social network (family) despite of them she | | | | mother" .Unfortunately her husband died and she |
| feels alone. Weiss says as cited by Perese and | | | | never received that support which was needed |
| Wolf (2005) "Loneliness is caused by not being | | | | by her husband. Gurung, Taylor and Seeman |
| alone but by being without some definite needed | | | | (2003) shares a functional-specific model, it |
| relationship or set of relationship". This quotation | | | | suggests that "individual requirement for specific |
| explains that only presence of social network is | | | | forms of support can be met only within certain |
| not valued, it should be supportive one other wise | | | | relationship. Even the same type of support is |
| one might feel lonely inspite of presence of many | | | | provided by different sources, its impact may not |
| people around. | | | | be the same". Still patient is lacking her husband's |
| In addition, lack of social support can be due to | | | | support and no one can cover it. |
| social stigma and this is the main reason that | | | | In middle adulthood: |
| mentally ill people's social network becomes | | | | In this stage she was unable to cope with |
| narrow. Chernomas and Clarke (ND) supports | | | | stressors alone but her role did not allowed her to |
| "over time, due to social stigma associated with | | | | share her feelings with others and she suppressed |
| serious mental illness, developing and maintaining | | | | it. Now patient is mentally ill, she still needs her |
| relationships can be difficult. A support system is | | | | family's support but no body is here for her |
| vital for people living with schizophrenia yet at the | | | | support. Her children are busy in their own life and |
| same time the illness places relationship at risk". | | | | patient personality is not allowing her to explore |
| Social support starts from the time of birth as | | | | social network. Gurung, Taylor and Seeman |
| parents shows bodily gestures, verbal and | | | | (2003) say, "Personal characteristics may be |
| nonverbal communication provides a sense of | | | | critical determinant of whether support transaction |
| security to the infant and it goes on through out | | | | increases or decreases over time". |
| the life. Chatters, Krause and Shaw shares that | | | | This analysis make it clear that through out the |
| "Individuals who receive a lack of support early in | | | | life span there were multiple factors patient was |
| life remain at an increased risk of experiencing | | | | going through and it lead to lack of support. |
| poor health later in life". In our daily lives we all | | | | Integration of Newman's model: |
| have social network which helps us in resolving | | | | Her model is showing the relation between stress |
| our problems. If one has lack of social support | | | | and coping and the impact. I have chosen this |
| than he/she might feel lonely. Perese and Wolf | | | | model because in my patient scenario she was |
| shares some causes of loneliness he says "among | | | | unable to cope with the stressors alone and that |
| the general population, loneliness is often related | | | | is why she got mentally ill. Betty Neuman is talking |
| to loss or disruption of relationships, lack of | | | | about three lines of defense which varies with |
| partner or a social network, poverty, lack of | | | | age and development. These lines of defense |
| transportation, problematic living situations, and | | | | prevent us from any life stressors; these could |
| lack of opportunity for social interaction" (p. 593). | | | | be loss, cultural change, stress and pain. The |
| These factors shared are present in my patient's | | | | stressors could be multiple; it could be of more |
| life. and its impact was that she felt she is all | | | | intensity and when a person is unable to cope |
| alone. It would best conclude if I would say that | | | | with the life stressors and if the coping is not |
| every point of an individual's life is closely | | | | appropriate than the lines of defense could be |
| interrelated to one an other, and outcomes of | | | | break and person can get physically or |
| lack of social support will decrease mental health | | | | psychologically ill. |
| promotion. | | | | Strategies to deal with the issue: |
| Significance of the issue in Pakistani context: | | | | Individual: |
| In our society mental illness is taken as a stigma | | | | At individual level I actively listened to the patient, |
| and still people are not clear about the causative | | | | I helped patient in identifying the supportive |
| factors of the disease, rather they are connecting | | | | person, I involved patient in different activities to |
| it with supernatural forces. Research done by Dr. | | | | improve her social network, I educated patient |
| Gadith in 1994-1996 about shamanic concepts and | | | | regarding need and importance of social support |
| mental illness, supports that people who visited | | | | and I tried my best to explore patient feelings. I |
| shamans were actually falling under mental illness | | | | planned education session after assessing my |
| according to DSM IV criteria however shamans | | | | patient. I planned my teaching according to my |
| said that these people were affected by jinn, | | | | patient's strength and weaknesses. In this |
| aseb, and evil magic. This research shows that | | | | teaching firstly I acknowledge patient's feelings |
| People living in our country do not believe in | | | | and I made her self to explore the reason of her |
| existence of mental illness. If people are not | | | | illness, she was able to identify the lack of support |
| aware of mental illness than how they will support | | | | system. I taught her to involve in social gathering |
| their family members who are mentally ill. | | | | and to talk with other patients and to share her |
| In a seminar titled 'Mental Health across the Life | | | | feelings with others. After giving this teaching I |
| Span' organized by Aga Khan University's Mental | | | | observed that my patient was involving in social |
| Health Research and Development Forum, Dr. | | | | activities. |
| Syed Haroon emphasized that family support | | | | Group |
| plays an important role in mentally ill patient's | | | | Support groups can be made for better coping. |
| health promotion. Yet there are live examples of | | | | Perese and Wolf (2005) say, "The primary goal of |
| patients who are left alone in Karwan-E-Hayat and | | | | a support is to increase members' coping ability in |
| in asylums by their family members because they | | | | the face of stress, to strengthen 'the central |
| are unable to deal with it and in addition, mental | | | | core' of individuals". Support groups will also give a |
| illness seems as a social stigma to them. | | | | sense of friendship. Moreover counseling sessions |
| An other study done by Dr. Niaz in (2001) on | | | | could be done to explore patient's feelings and to |
| Overview of women's mental health in Pakistan, | | | | help them. In addition, school plate forms can be |
| she shares, isolation and lack of social support are | | | | utilize to deliver teaching there for awareness To |
| the main psychological problems in older ages. She | | | | make a support group I will plan this strategy with |
| further stated that "At government level there | | | | the help of psychotherapist in identifying the same |
| are no community social support centers or day | | | | patients who are suffering form lack of social |
| care centers for children of working mothers". | | | | support. In implementation I will make them share |
| Psychiatrists have identified that mental illnesses | | | | their life experiences; this will help them learn |
| requires a great social support but unfortunately | | | | through each others experiences. To evaluate a |
| not the population nor government is interested in | | | | mini survey could be done to compare the social |
| doing some thing to increase support to people. | | | | support system before and after the involvement |
| All these researches show that how mental illness | | | | with support group. |
| is seen in our society and how much support is | | | | Institutional: |
| required, not only in illness but support is needed | | | | Institutionally health awareness sessions can be |
| by every one to be healthy. | | | | done to make people aware of life needs and |
| Critical analysis of the issue: | | | | importance of mental health promotion. Media can |
| There is a process of social support (refer | | | | be utilized for Speeches to convey our messages |
| appendix A) which includes; antecedents, types of | | | | to the government to resolve some psychosocial |
| social support and out comes. Antecedents include | | | | factors: poverty, lack of parental support. Some |
| a need (of social support), social network (family, | | | | steps should be done to improve poverty as this |
| friends, neighbors etc) and social climate. In this | | | | is the common factor for mental illnesses. Could |
| process first need is identified than emotional and | | | | work with NGO's to conduct different seminars |
| instrumental support is delivered through social | | | | for mental health promotion, this will enhance |
| network and when all parties combine together | | | | education level of the population and they them |
| than a social climate is made for each others | | | | selves will take step to overcome factors |
| need. After support is provided outcome appears | | | | responsible for mental illness. To plan a seminar at |
| in a form of mental health promotion. Need is | | | | institution level I would make a plan of what need |
| about identification of need of social support, | | | | to be discussed in this seminar, I will discuss the |
| willingness of receiving support, and willingness of | | | | target population with directorial level. In this |
| giving support in different circumstances (context | | | | seminar psychiatrists can be included for |
| specific). | | | | broadening the horizon of knowledge. After this I |
| If I relate this stage (need) with my patient than | | | | will make sure that on implementation media |
| in childhood, she needed her parents' support but | | | | coverage is there. To evaluate this, small research |
| they were not willing to give because they were | | | | could be done to see the prevalence of mental |
| busy in earning for food which was an optimal | | | | illness in the community. In addition, small |
| need for living at that time. In adolescent age, | | | | questionnaires can be used to compare the |
| patient developed a coping skill by being busy in | | | | knowledge level before and after the seminar. |
| house hold and at this time she and her parents | | | | |