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Down but Not out in the Bush: Women's Experiences of Depression

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Down but Not out in the Bush: Women's Experiences of Depression DOWN BUT NOT OUT IN THE BUSH: WOMEN’S EXPERIENCES OF DEPRESSION IN RURAL NEW SOUTH WALES Stephanie Johnson Bachelor of Social Work Master of Social Work Supervisors Associate Professor Mark Brough Dr Rosalyn Darracott Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy School of Public Health and Social Work Faculty of Health Queensland University of Technology 2018 Keywords Depression Feminist Rural Support Women 2 Down But Not Out in the Bush: Women’s Experiences of Depression in Rural NSW Abstract Biomedical research reports that depression is twice as common in women as men (American Psychiatric Association, 2013; Piccinelli & Wilkinson, 2000). Rural women’s experiences of depression are of concern because of the barriers they face in accessing services and health care, due in part to factors such as isolation, violence, stigma, stoicism, and poverty (Alston et al., 2006). Despite numerous studies on depression, the literature contains only one mixed methods study and one qualitative study that address the topic of rural Australian women’s experiences of depression. This thesis argues that women’s experiences and experiential knowledge, as well as the challenges faced by women living in the bush, have not been adequately considered by previous research and that the accounts of these women are valid as a source of knowledge in their own right. Hearing from women about their lived experiences provides a rich source of information that may not be revealed without a qualitative study that begins and ends with the women as the central focus. The overall purpose of this study was to understand the lived experiences of women who were experiencing depression within the context of rural NSW. To do this, four broad objectives were developed: • to explore the women’s own understandings of the lived experience of depression and its causes; • to consider whether the experiences of women living in rural NSW may have affected or influenced their depression experiences and, if so, in which ways; • to identify what intervention/support options women chose, if any, and the reasons for their choices; and • to examine how these women coped with and recovered from their experiences of depression. The dominant discourse in health has been the biomedical model, which can be seen as politically conservative and individualistic in orientation. This thesis explains the positions of both biomedical and psychological perspectives, and expands upon the biomedical discourses by including other discourses such as feminist and social constructionist frameworks. This study does not necessarily endorse the biomedical diagnosis of depression as “truth” but instead Down But Not Out in the Bush: Women’s Experiences of Depression in Rural NSW 3 uses the term depression as an ever-evolving package of contested meanings. A critical starting point for this research is women’s own experiences and definitions of depression. Therefore, participants in the study may have received a biomedical diagnosis of depression, or the women themselves had defined their experiences as depression. While most had accessed professional help, this was not a requirement of participation in the study. There were 27 women who participated in the semistructured interviews, which were informed by qualitative methods using a feminist standpoint framework. Thematic analysis was employed to analyse the data from the interviews. Seven themes were identified from the data analysis: women’s understandings and explanations of depression, how depression disrupts everyday life, living in rural NSW with depression, abusive childhood experiences, grief and loss, accessing professional help and services, and accessing informal help and support. Drawing from these themes overall there was a sense that the women’s stories held multiple meanings of living with depression, and there was diversity in their understandings of their rural experiences, and how they coped with their depression experiences. The women used a variety of creative means to get assistance for their distress, and some rejected biomedical help. In the final analysis, the underlying premise of a possible lack of service provision in rural areas seemed to serve more as a distraction from the critical issues of violence, male privilege, and oppression that the women had experienced. The study found that difficult relationships, loss, and childhood abuse and violence had been a part of and had continued to impact many of the women’s lives. In fact, it seemed that depression may not have been an appropriate term for what many of the women were experiencing; instead, the findings suggest that the term depression as it is biomedically used may need to be challenged: What many of the women seemed actually to be experiencing was oppression rather than depression. 4 Down But Not Out in the Bush: Women’s Experiences of Depression in Rural NSW Table of Contents Keywords ............................................................................................................. 2 Abstract ................................................................................................................ 3 List of Figures ...................................................................................................... 9 List of Tables...................................................................................................... 10 List of Abbreviations.......................................................................................... 11 Statement of Original Authorship ...................................................................... 12 Acknowledgements ............................................................................................ 13 Chapter 1: Women’s Experiences of Depression ........................................14 Research Standpoint ........................................................................................... 15 Justification for the Study .................................................................................. 16 Purpose of the Study .......................................................................................... 17 Operational Definitions ...................................................................................... 17 Brief Description of Methods............................................................................. 18 Organisation of the Thesis ................................................................................. 19 Chapter 2: Approaches and Understandings of Depression......................21 Historical Understandings and Therapeutic Interventions of Depression.......... 21 Mental Health Service Delivery in Contemporary Australia ............................. 23 Explanatory Theories of Depression .................................................................. 25 Biomedical explanations. ........................................................................... 25 Critique of the biomedical model. .............................................................. 28 Psychological and psychosocial explanations. ........................................... 31 Critique of psychological and psychosocial explanations. ......................... 32 Intersectional feminism and social constructionist explanations. .............. 33 Intersectional feminism. ........................................................................ 34 Social constructionism. ......................................................................... 35 Down But Not Out in the Bush: Women’s Experiences of Depression in Rural NSW 5 Critique of feminist and social constructionist theories. ....................... 37 Summary ............................................................................................................ 38 Chapter 3: Literature Review.......................................................................39 International Literature Regarding Women’s Experiences of Depression ........ 40 Notions of self, intimate relationships, and gendered role expectations. ... 40 Loss, poverty, and family and life stressors. .............................................. 43 Abusive childhood experiences and violence. ........................................... 45 Australian Qualitative and Mixed Methods Studies on Women’s Depression .. 47 Summary ............................................................................................................ 51 Chapter 4: Rurality and Mental Wellbeing in Rural Australia ................52 Rural Australian Landscapes: The Impact of Place on Health .......................... 52 Health Status ...................................................................................................... 54 The Economy, Education, and Employment in Rural Australia ........................ 56 Rural Australian Culture, Values, and Community ........................................... 58 Social class structures. ................................................................................ 58 Help-seeking and the barriers to access help for rural women: Gossip, stigma, and anonymity. ........................................................................................... 59 Women and rural Australia. ....................................................................... 61 Power and violence. ................................................................................... 63 Summary ...........................................................................................................
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