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