Health & Medicine

Women on the web: A feminist'reading'of depression websites

Women on the web: A feminist'reading'of depression websites
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  Young, I., Gattuso, S & Fullagar, S. (2004). Women on the web: A feminist ‘reading’of depression prevention websites. In Whiteford, G. (Ed.) Qualitative Research asInterpretive Practice . Bathurst: Centre for Research into Professional PracticeLearning and Education, Charles Sturt University. WOMEN ON THE WEB:A FEMINIST ‘READING’ OF DEPRESSION WEBSITES  Ilena YoungSchool of Community Health, Faculty of HealthCharles Sturt UniversitySuzy GattusoSchool of Community Health, Faculty of HealthCharles Sturt UniversitySimone Fullagar School of Leisure Studies, Centre for Work, Leisure and Community ResearchGriffith University Abstract The focus of this paper is the use of a feminist interpretive approach, informed by material-discursive analyses to examine discourses on depression on Internet websites ondepression. The paper will cover why this approach was taken, how it was implemented,our findings and the challenges that we faced. A major strategy of the National Action Plan for Depression (Commonwealth Department of Health and Aged Care 2000) is the dissemination of health information aimed at the prevention of depression, and associated personal, social and economic costs. Theexperience of depression is highly gendered with women reporting higher rates than men(NSW Health 2002). The Internet is now a major source of health information, with one inthree regular Internet users seeking on-line information about health and medicalconditions (ACNielsen 2000). Within this wealth of web-based health information,depression now appears as a major topic of interest. This paper explores the constructionof information being made available about depression on selected Australian web-sites,through a feminist ‘reading’ that identifies how gender figures in (or is absent from)explanations of depression.Our interpretive practice is a critical reading of how websites circulate particular ‘stories’about depression. We deconstruct the health information provided to women who accessthe Internet. Our interpretive practice draws upon material-discursive analyses of women’sexperiences of depression (Stoppard 2000, Ussher 1999). We focus on the discursiveconstructions of these sites, examining how ideas about depression connect with women’slives and emotions. We examine the gaps and silences that open up the possibility of other, p1/16  subjugated knowledges that are based on different assumptions about emotional health,illness and women’s subjectivities. In this project we positioned ourselves as Internet users, and critically engaged with theweb-sites as ‘texts’, looking closely at each page as a text that constructed particular discourses about depression. In this reading we looked for ‘how’ meaning was produced ‘what was said and not said’. We engaged reflexively to consider how these discoursesspoke to us and about us as women – as feminine subjects who may or may not haveidentified as having depression when accessing the site.This approach enabled us to analyse how particular discourses and narratives about women and depression are constructed. In this way it raises awareness of how women’sknowledge of self, emotions and social life become ‘subjugated knowledge’ within thediscursive terrain of biomedicine and therapy. With these insights however, come thechallenges, and we acknowledge our engagement with these discourses from the position of being women ourselves, with inherent limitations of a white, middle class academic position. Yet, we also have a strength drawn from differences in age, sexuality and urban-rural histories. Challenges also come from the biomedical establishment, where expert knowledge is valued, and recognition is limited for any approach not based on certainkinds of evidence. We reply with the thought that we are challenging the nature of that evidence, questioning the inherent power relations in its production, relations that alsoshape all interpretive practice. In doing so we produce another voice that problematisesthe very practice of ‘reading’ health information and the web. This also creates a reflexivespace for researchers to recognise the interpretive practices that constitute knowledge in particular (gendered) ways. A reflexive approach to interpretive practice brings increased awareness and transparency, with consideration and respect for a multiplicity of voices,ending in a reading which is itself open to other readings.   Introduction Depression is the leading cause of the non-fatal burden of disease for women in Australia(Australian Institute of Health & Welfare 1999)   with its highest incidence in the 18-24-year-old group (Commonwealth Department of Health & Aged C are 2000). As well asbeing a significant health issue depression is also an important economic issue. Treatingdepression is a major area of expenditure in health budgets. Prescriptions for anti-depressants rose 60% from 1990 to 1998, going from 5.1 million to 8.2 million (McManuset al 2000),   and continue to increase. Interpreting these figures is difficult. While they mayrepresent a real increase in rates of depression, they may also represent an increasedwillingness to diagnose depression and/or an increased willingness to prescribe suchmedication. From the latter perspective, this is part of a broader and deeper socio-culturalshift in what is seen to constitute the experience and diagnosis of the phenomenon calleddepression. This expansion of depression as a category of mental illness is thus also aprofoundly political issue that is being taken up within social, health and feminist debates(Fullagar & Gattuso 2002, Healy 1998, Stoppard 2000, Ussher 1991).In 2000 the Australian National Action Plan for Depression was established with aims todisseminate health information and promote new ways of ameliorating the personal, social p2/16  and economic costs associated with depression. To achieve this end there has been a focuson increasing the populations’ mental health literacy, which is broadly defined as theability to recognise mental health problems and seek professional (i.e. medical) help (Jorm2000). The powerful role of new media, such as the Internet, in disseminating mentalhealth information has also been recognised alongside women’s increasing use of the webfor health related purposes as they juggle multiple time demands and responsibilitiesrelating to work, leisure, family and health (Pandey, Hart & Tiwary, 2003). A number of specific Australian depression websites has also emerged with similar emphases(Christensen & Griffiths 2002, Christensen, Griffiths & Medway 2000).Walkerdine comments that the media is “the site of considerable importance in theproduction of subjectivity” (1997, p169). With an interest in how popular media textsmobilise meanings about depression for women we began a study of how women’smagazines and popular websites represented depression. In this paper we focus on ourreading of the depression websites, concluding with our reflections on interpretiveuncertainties relating to the representation of women’s ‘voices’ in our research. Ourmethodology is informed by a feminist, material-discursive analytic framework, in whichwe pursue a central aim of feminist research, “the ending of the invisibility and distortionof female experience” (Ussher 1999, p99). In using this approach we present feministinterpretive practice as inherently critical since “it centers and makes problematic women’sdiverse situations as well as the institutions that frame those situations” (Olesen 2003,p333). Women, Depression and the Web Pandey, Hart & Tiwary (2003) argue that women are increasingly turning to the Internet asa source of health information for prevention and direct health needs, and that this is partlydue to the time pressures associated with multiple gendered demands and responsibilities(as gatekeepers of family health). However, despite the fact that women are twice as likelyto be diagnosed with depression as men, with an earlier age of onset and longer, oftenrecurrent episodes (, NSW Health 2002), there has been little attentionpaid to the relationship between gender and depression on Australian websites. There is aparticular need to examine how websites are significant cultural sites in the representationof women's experience of emotional distress as depression.Our focus on the discursive construction of depression on websites does not deny theserious and debilitating effects of that experience which may come to be diagnosed asdepression on women’s lives. However, we approach the issue of why women experiencedepression from another vantage point – one that emphasises how we, as a society, come to‘know’ that certain emotional, embodied and profoundly social experiences are a mentalillness, drawing on a rationalist scientific schema where experiences can be defined,classified and ordered. In doing so we draw upon a material-discursive approach that isalso feminist in that it seeks to render visible the gendered nature of representations of depression for women. If we are to develop health promotion strategies and informationthat support women’s emotional wellbeing and addresses the growing diagnosis of depression, then we need to examine how gender is positioned within current approaches. p3/16  We need, therefore, to examine health information on websites not only in terms of evidence-based 'quality', but also the gendered construction of depression as a personal,social or medical problem with attendant solutions (Lloyd & Hawe 2003). Such an analysisexplores how ‘depressive’ identities and meanings are constructed and gendered inparticular ways through health information that is generally presented as a neutral orhelpful discourse. Drawing upon Foucault’s (1980) discursive analysis we foreground theworkings of power/knowledge relations as they produce the very language (metaphors,stories, symbolism) used to create meaning about women’s emotional lives – theirsubjectivities. This is a very different approach to those studies that have evaluated thequality of health information on depression websites in relation to an evidenced base thatprivileges particular kinds of expert knowledge and standardised methods (Christensen &Griffiths 2002, Christensen, Griffiths & Medway 2000). Using a Material-Discursive Approach Material-discursive analysis has been taken up by feminist researchers such as Ussher(1991) and Stoppard (2000). This interpretive practice explores the power-knowledgerelations that produce particular truths about women’s identity, the nature of depression andprofessional ideas about cause, treatment and prevention of mental health problems. Thediscursive domain of culture is not, however, divorced from the material, the lived,embodied aspects of everyday life. In relation to depression this involves understandinghow women’s lives are shaped by their experiences of violence, poverty, work, caringresponsibilities, and so on that have embodied and emotional effects on the self. These areissues relating to the construction of women’s subjectivity, that is, how women come tothink and feel about themselves through the mediating work of culture and genderedrelations with others. We are interested in the potential of a material-discursive analysis tofacilitate transformations in the way we understand and produce knowledge aboutdepression with respect to professional practices, policy directions and mental healthpromotion strategies.We analysed selected websites from the position of being women ourselves who may beseeking information or support about depression. Acknowledging the limitations of ourwhite, middle class academic position as women we drew strength from our gendereddifferences with respect to age, sexuality and rural/urban histories, when analysing the waywebsites mobilised particular discourses and narratives about depression. We consideredwhat was said and, importantly, what was not said, the gaps and silences that point towardsother, subjugated knowledges with different explanations about women’s lives, bodies andsubjectivities.Our interpretive approach differs from hermeneutic traditions that presume meaning pre-exists language and resides within a subjective realm of experience. Rather, we develop adeconstructive 'reading' or critical engagement with depression websites as ‘texts’ thatdraw upon and produce particular discursive formations to explain cause, management andprevention. As critical readers we look closely at how each page mobilises particulardiscourses about depression (for example as a biomedical problem of chemical imbalancein the brain). In this way the practice of ‘reading’ texts emphases 'how' meaning isproduced in relation to 'what is said'. For example, do descriptions of depression draw upon p4/16  particular kinds of ‘expertise’ to legitimate their explanations of causality? We also think reflexively about how these discourses speak to, and about us, as women - as femininesubjects who have different knowledges of depression when accessing the site. Do theseexplanations of depression connect with our embodied and emotional experience of contemporary social life? What do they say and what do they not say? Searching the Web Our initial web search was conducted from the perspective of an Australian woman Internetuser wanting to access information about depression (and Australia), with no previous siterecommendations or guidance. Thirteen of the most popular and well known search engineswere used to search for “depression” and “depression and Australia”. The search enginesused were Ask Jeeves, All The Web, Alta Vista, Google, Inktomi, Lycos, MSN Search,Teoma, Wisenut, Yahoo, Web Wombat, Look Smart, and Go Eureka. Eight of these searchengines also offered a possibility to delimit the search by looking for sites from Australasiaor Oceania, leading to an additional, limited search for “depression” within these sites only.A total of 34 searches resulted, which all took place during the last week of February 2003.From each of these searches the top twenty sites were taken, all non-relevant sites weredeleted (e.g. dealing with economic depression) leaving a total of 516 sites relevant to thesubject in question. These sites were then ranked according to the number of times thatthey were found in these searches.The four most easily found sites were identified as Table 1 : Most easily found depression websitesSite Name No of timesfound Depression Site for Australians - your comprehensive depression resource(DepressioNet) 15Beyondblue: the national depression initiative 12Blue Pages depression information 11This exercise showed that a tremendous amount of information about depression isavailable on the Internet, and a total of 155 different sources of information were identified.These sources were diverse, ranging from government agencies to specialist NGO’s,religious organisations to the media, individuals to pharmaceutical companies. Thisdiversity illustrates how difficult it is for any one organisation or site to dominate aseemingly disorderly medium such as the Internet, where anyone can put up theinformation and content of their choice. From this observation it is tempting to assume thata wide range of information about depression is being made available, and that in thisdiversity a range of voices and emphases will be heard. Such assumptions are somethingwe question as a result of our analysis in this project. p5/16
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