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Winter 2009/10 | Vol 13 No 2

Focus

One entry at a time

Bloggers create communities of support – but with some risks

By Anne Ptasznik

Cristina, 34, began blogging in 2006, just weeks after being diagnosed with bipolar disorder. When she went online looking for people who shared her experience, most of them were bloggers. She decided to try it herself. “I used to journal when I was younger, and I missed it,” she says in a phone interview. “I thought it would be a good way to cope and get my feelings out.”

Journaling and writing have long been used in psychotherapy, based on the principle that emotions and experiences can be better “understood, mastered and assimilated when explored through language,” says Dr. John Suler, a psychology professor at Rider University in Lawrenceville, New Jersey, and author of the online book The Psychology of Cyberspace. But while many psychotherapies encourage people to talk about their issues, Suler says that for some people, putting words to their experience is easier in writing.

But there’s a fundamental difference. Journal writing can be kept private, whereas blogging is public, not only inviting information exchange and support for people who write about their mental health issues, but also exposing them to potential discrimination and abuse. Yet, according to a 2005 America Online survey, almost 50 per cent of people used blogs as a form of self-therapy. Suler says there is no empirical evidence that mental health bloggers are particularly exhibitionistic or narcissistic; so what motivates them to expose their struggles publicly? Some say it is the public nature of blogging that provides benefits beyond the therapeutic value of writing – obtaining and giving support, becoming part of a community, educating the public and fighting stigma.

Cristina says that the potential shame and stigma from being identified as someone with a mental illness is a small price to pay for the “peace, understanding and acceptance” she has gained from Raw Writing for the Real World of Bipolar. Her blog was recognized as one of the top 10 bipolar blogs for 2009 by Psychcentral.com, a popular online mental health network. “You find out who you are when you blog,” says Cristina. “All of you is laid out for the world to see. It’s a good way to see your reflection and to find out if you love yourself enough to continue in this life.” Suler says that anticipating and writing for an audience “stimulates a valuable process of trying to see oneself through the eyes of others – trying to see oneself more objectively.”

James, 34, from Colorado, who has been blogging as Handsome B. Wonderful since 2005, refers to his Letters from the Sanitarium blog as a sort of online group therapy. “If I didn’t have the Internet to interact with others like me, I’d feel so alone, isolated and trapped,” he tells me in an e-mail. James, diagnosed with schizoaffective disorder, explains: “We really are there for each other and look after one another. If a mental health blogger hasn’t posted in a while, we check in on them.” Blogging also provides an outlet for people who might be afraid of traditional group therapy or for those with disorders like his for which there are few support groups. “If you come from a country that isn’t very advanced in psychiatry, blogging is a life-line that many isolated patients desperately need,” James explains.

Madalyn Marcus, a doctoral candidate in clinical psychology at York University in Toronto, and one of the authors of a study that analyzed the blogs of young people with mental health problems (see sidebar), was struck by the sense of connection these isolated young people felt online that they weren’t necessarily experiencing in the “real physical world.” The blogs provided a space for support, even allowing readers to check on one another, for example, when one of them had talked about suicide the previous day.

But Suler warns that not everyone online is supportive or benign. “People do all sorts of acting out in cyberspace, and they are looking for targets,” he says. Transference reactions, where people misperceive others based on their own needs and fears, are common, and he says bloggers can easily become the target of these hostilities.

James admits that he was initially worried about receiving negative comments. He has had the occasional “outright mean” person visit his site and tell him that he is “lazy, irresponsible and a whiner.” He either deletes these or responds just as strongly. He says it can be depressing when he has expressed strong emotions and no one has commented, but he mostly blogs to express himself without filtering his thoughts from “other people’s fears of strong emotions.” Besides, he knows that many people read his blog and support him, whether or not they comment. “I am always amazed at the compassion, empathy and intimacy shown by complete strangers,” he says.

Ashley’s blog, Overcoming Schizophrenia, has helped her to “come out” as having a mental illness, not just online, but offline as well. Prior to starting the blog, Ashley, 24, from Atlanta, Georgia, was private about her diagnosis. She began blogging a year after being diagnosed with paranoid schizophrenia in 2007, when she landed in jail and then a state psychiatric hospital. Ashley originally intended to use the blog to track her moods and feelings, but she quickly shifted its focus to educating others and sharing her experiences with treatment so others would know that “recovery and healing are possible.” Blogging even motivated Ashley to start Embracing My Mind, Inc., through which she runs offline support groups.

But the supportive role of blogs has stirred controversy, notably around pro-ana (anorexia) and pro-suicide blogs. Yum originally started her pro-ana blog (yummy-secrets.blogspot.com) because she was “looking for others who would not judge me for my actions, because they were going through similar experiences.” Concerned about the misinformation that abounds on other pro-ana and weight loss sites, Yum also wanted to share her knowledge of mental and physical health as she learned more about her eating disorder. She admits that people who are pro-ana use these blogs to “trigger” or motivate themselves to maintain their habits, but she doesn’t consider herself responsible for triggering someone, because, as she explains, people with eating disorders who want to be triggered can – and will – use anything as “thinspiration.” People read a warning before entering Yum’s site, but according to the National Eating Disorder Information Centre (NEDIC), these warnings merely feed people’s curiosity to visit pro-ana sites.

NEDIC also warns that pro-ana blogs may encourage harmful behaviours and normalize, even glamourize, eating disorders. But Kat, 18, who has a popular pro-ana blog, Quest for Perfection, disagrees: “I never made it seem glamorous, unless people think that passing out on the side of the road is glamorous.” Kat started blogging to express her thoughts and feelings, not thinking she would have any readers. She says she does not want people who don’t have an eating disorder to develop one because they are reading her blog, but if people have made that decision, even knowing it could be dangerous, she wants to support them. She wants to dispel the belief that pro-ana bloggers are evil people trying to ruin girls’ minds. “America has all kinds of really messed up views on dieting,” she says. “If girls are searching pro-ana blogs, it means something else has triggered it.” But at the same time, Kat admits that her blog keeps her tied to her eating disorder.

While Kat says that finances prevent her from seeing a therapist, some bloggers share their blogs with their therapists. James, however, says that blogs are a “no-go area” for therapists, and that people in treatment should be able to choose whether or not their therapist reads their blog. “Blogs are often places where clients can freely write about therapy sessions without fearing to threaten the relationship,” he says. Some bloggers might censor their writing, knowing their therapist is reading it, and for people with paranoia, James says that lurking can reinforce that fear of being watched.

But Marcus at York University says that blogs can help therapists gain insight into the experiences of their clients, including how isolating and all-consuming mental illness can be, and how to best offer support. However, she agrees that although blogs are public, reading a client’s blog could breach confidentiality. If the client is open to this, it can be worked out together, along with discussing the pros and cons of blogging. Ultimately, Marcus says blogging is a decision clients need to make for themselves: “They may look back and be concerned at the level of detail they disclosed,” she says. “Or they may look back and feel proud that they were able to share their story, support people and get support.”