Life work experience degree

Little is known about the day-to-day experience of people with mental illness. The research that has been conducted has characterized the lives of people with severe and persistent mental illness (SPMI) as largely solitary and little meaningful activity. In addition, mood states of boredom and anxiety have been implicated in the functioning of clients with mental illness in community treatment settings. The purpose of this study was to examine the daily life of people with SPMI and identify if challenge/skill qualities of activity were related to mood states of boredom and anxiety. Subjects (n = 8) were drawn from a community mental health center in a Midwestern city. Data were collected using an experience sampling method and examined at the experience level of analysis (n = 326). Logistic regression was used to examine if activity characteristics predicted boredom or anxiety. Findings indicated that the majority of subjects' time was spent in activities in which skill exceeded challenge (75.1%). Activity characteristics were found to be significant predictors of the reporting of anxiety, but were not significant predictors of boredom. Findings are discussed in terms of future research and practice.

KEYWORDS: Experience sampling; mental illness; anxiety; boredom; flow.

Introduction

The previous fifty years has seen a marked change in society's approach to care for people with mental illness. This change has seen the evolution of care from total institutional care to the majority of services being provided in communities, with the goal of social integration and improved life quality (Jacobson & Burchard, 1992). At the same time, mental health services, particularly for the most impaired, have been only somewhat successful in achieving such goals (Mueser, Bond, Drake, & Resnick, 1998). Stein and Santos (1998) characterized the lives of people with severe mental illness as marked by isolation with "little to do during the day that they see as useful; they often experience their lives as meaningless and chaotic; and their general health status is often inadequate" (p. 1). At the same time, although leisure activity in the lives of this population appears to be strongly related to life quality (Oliver, Huxley, Bridges, & Mohammad, 1997; Trauer, Duckmanton, & Chiu, 1998), relatively little is known about the day-to-day experience of people with mental illness (Delespaul, & deVries, 1987; deVries & Delespaul, 1989).

Studying the daily experience of individuals with severe mental illness, the researchers examined how characteristics of daily activities were indicative of individuals' negative mood states. Not every individual in the community welcomes and happily embraces free time. For some people, particularly when they have severe mental illness, leisure time may become a heavy burden because of persistent negative mood states such as boredom, anxiety, and depression. Working with psychiatric clients who experienced depression, anxiety, and excessive guilt, Martin (1969) claimed that individuals become emotionally uncomfortable with free time. The present study sought to examine characteristics of daily activity and its relationship to mood, among people with mental illness living in the community.

Review of Literature

Daily Functioning of People with Mental Illness

As noted previously, there has been little research to document and understand the ongoing experiences of people with severe and persistent mental illness (SPMI). The few studies that have been conducted tend to confirm stereotypical views of their lives as being dominated by solitary and passive activities. Much of their time appears to be spent in activities that provide little contribution to personal growth, or opportunities for creativity (Skalko, 1990). Delespaul and deVries (1987) reported the experiences of daily life of "ambulatory chronic mental health patients" finding that subjects spent 71% of their time at home, 37% of their time alone, and 10% of their time "doing nothing." Delespaul and de Vries (1987) also noted that in evenings "when time spent in organized leisure activity almost tripled for normal subjects, it remained unchanged for patients" (p. 540). In addition, the experience of "doing nothing" has also been found to be more common among people diagnosed with depression than among control groups without mental illness (Barge-Schaapveld, Nicolson, Berkhof, & de Vries, 1999). An examination of mood states indicated that depressed levels of mood were most frequently reported when alone, were least prevalent when with one to three individuals, and then increased again with four or more people; indicating that crowded settings were troublesome. Other studies that have attempted to link activity to subjective experience among people with schizophrenia have found that negative mood tended to be greatest during work, yet, at the same time, work occupied a very small portion of their lives (Barge-Schaapveld, Nicolson, Delespaul, & deVries, 1997). Thus, the characterization by Stein and Santos (1998) of the lives of people with SPMI as largely solitary and with little meaningful activity appears to be consistent with the few studies of daily life among this population.

Characteristics of Activity and Mood States

One approach to understanding mood states has been to consider the characteristics of activity. Csikszentmihalyi's (1975; 1990; 1997) theory of flow argues that mood states are affected by the balance of elements of challenge and skill imbedded in activities. When high levels of challenge are met with high levels of skill, a state of flow occurs. In this state of flow, attention is focused on the activity. Although Csikszentmihalyi (1997) noted that flow experience is not directly related to an emotional state, its recollection may be a source of happiness. By contrast, when skills exceed the challenge of an activity, individuals are likely to experience boredom. Conversely, when skills are perceived to be less than the challenge of the activity, tension and anxiety result. Although much of Csikszentmihalyi's work has focused on the flow and optimal experience, others have examined the role of the character of activity on mood state. Voelkl (1990) found in an experience sampling study of nursing home residents, that they spent a large portion of their time in low challenge/low skill activities. This proportion of time was greater than that found among general population studies of adolescents or adults. At the same time, those activities reflecting the highest levels of subjective experiences, measured as positive mood states, matched medium to high challenge with medium to high skill (Voelkl, 1990). Furthermore, most activities characterized by medium to high skill and challenge were "independent activities" and represented elements of leisure/social activities.

The Experience of Boredom and Anxiety

In general, the experience of boredom and anxiety significantly affects individuals with SPMI. Extant literature provides us with an understanding of experiences associated with boredom and anxiety. While some researchers reported that boredom is significantly related to anxiety (Farmer & Sundberg, 1986; Vodanovich, Verner, & Gilbride, 1991), it is necessary to make conceptual explication of these two emotional states.

Boredom. Various perspectives in understanding boredom exist. Psychologists have focused on boredom as both a transitory emotion as well as a psychological trait. Some sociologists have considered boredom a socially constructed emotion, whereas existentialists contend that boredom occurs when individuals fail to create meaningful existence. In order to comprehend boredom in the lives of people with SPMI, a discussion of the full spectrum of perspectives is in order.

Zuckerman (1979) characterized boredom as "an aversion for repetitive experience of any kind, routine work, or dull and boring people and extreme restlessness under conditions when escape from constancy is impossible" (p. 103). Mikulas and Vodanovich (1993) defined it as "a state of relatively low arousal and dissatisfaction, which is attributed to an inadequately stimulating situation" (p. 3). Both definitions suggest boredom as a transitory state resulting from an understimulating environment. Indeed, Weissinger, Caldwell, and Bandalos (1992) noted that boredom is a transitory state of mind in which a person is under a low arousal situation and hence, seeks optimal levels of arousal. According to Csikszentmihalyi's (1975; 1990; 1997) flow model, the experience of boredom occurs as an individual's skill level exceeds the situational demands at hand. In short, a majority of the research on boredom concentrates on its situational determinants.