A world of difference.
Researchers at a Canadian University have found that an adolescent's self-concept influences whether they will be need an inpatient stay or be able to be treated in an outpatient clinic. In other words, how serious their illness might be.
Its not rocket science - or is it?
It sometimes seems like language is obfuscating our view of what is really going on in mental illness and in our minds. Language isn't always the best tool - or the right one, to convey our experiences of consciousness.
Drilling down and separating out concepts, especially something as apparently ineffable as identity, can seem banal and at times counter-productive - perhaps like pulling apart a daisy in order to study it more closely.
But how else can we conduct research that stands up to the rigours of evidence?
Just as in other disciplines it can be hard to reconcile academic debates with everyday clinical practice.
Of course, there are always those gifted researchers who can conduct research and have a real impact in their clinical work as well as being armed with the skills to popularise their research.
Working in a busy inpatient unit has taught me that people with serious mental illness are at heart, struggling with self - self-definition, self-worth, self-knowledge, self-esteem - the boundaries between self and others. Some of them are struggling with the idea of existence itself.
But are these just words, or do they actually have traction in a person's presentation - do they have meaning for how people are in the world and how we experience them, and more importantly, how they experience themselves?
To me, self-esteem is a popularised concept that doesn't really equate to the deep-seated existential issues faced by young people (and all of us) in creating, managing and sustaining our identity. Giving a child a prize for coming 7th isn't going to make a lasting difference in how they feel about themselves. As well-meaning as the self-esteem movement was or has been, it is still a problematic distraction from the reality of the emotional problems faced by teachers and students in classrooms. Pretending that the world can reward those who don't perform is unrealistic, but we should still help our children to understand that failure is a not necessarily a bad thing - and support them to keep trying.
Measuring someone's sense of self by finding out how highly they rank or esteem themselves doesn't really tell us a lot about the intricacy of our relationship to ourselves.
Our sense of self is a whole lot more complex than that - and perhaps - in the end ineffable.
"Self-esteem key to treating mental health"
February 20, 2018, University of Waterloo
Improving how mental health patients perceive themselves could be critical in treating them, according to a study from the University of Waterloo.
The study found that youth with psychiatric disorders currently receiving inpatient services reported lower self-concept, particularly global self-worth, compared to those receiving outpatient services.
"This was the first study that examined youth with psychiatric disorder by comparing what type of service they were receiving and whether that was associated with self-concept," said Mark Ferro, the Canada Research Chair in Youth Mental Health and an assistant professor in the Faculty of Applied Health Sciences at Waterloo. "We know that global self-worth is lower in the inpatient group and we know from other research that lower self-concept is a precursor to other more serious mental health problems."
The study examined 47 youth aged 8-17 years who were receiving inpatient and outpatient psychiatric services at McMaster's Children Hospital in Hamilton. The participants' self-concept was measured using the Self-Perception Profile for Children and Adolescents.
Self-concept might be an important aspect to consider when implementing treatment programs to improve the mental health of youth who are hospitalized.
"Because youths who are in the inpatient service have a lower self-concept, therapies within their overall treatment program aiming to improve self-worth might be worthwhile," Ferro said. "Interventions to improve an individual's self-concept or self-perception would be complementary to some of the more pressing needs within child and youth inpatient psychiatric services."
The study, which was undertaken by Ferro and Hamilton Health Sciences bursary student Chris Choi, was recently published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry.