Occupational alienation and the mental health of university students

Headnote

Abstract

Mental health, especially in the youth, has been a prevailing concern in recent years. University students are a particularly high-risk population for mental health problems. Changing perspectives in the field of mental health present the opportunity to explore this concept through an occupational justice lens - specifically that of occupational alienation. Through a brief review of relevant literature, this critical essay will explore the relationship among the concepts of alienation from both a sociology and occupational science perspective, and consider the insights that may be obtained through application of this concept to understanding the mental health of university students. The use of an occupational justice lens provides an opportunity for an alternative perspective when considering factors potentially contributing to the mental health problems in this population.

Keywords: Mental Health, Social Alienation, Occupational Therapy.

Resumo

A saúde mental, especialmente na j uven tude, tem sido uma preocupaçâo predominante nos últimos anos. Os estudantes universitarios sao uma populaçâo particularmente de alto risco para problemas de saúde mental. A mudança de perspectivas no campo da saúde mental apresenta a oportunidade de explorar esse conceito através de uma lente da justiça ocupacional - específicamente a da alienaçâo ocupacional. Tendo por base uma breve revisao da literatura, este ensaio crítico explora a relaçâo entre os conceitos de alienaçâo tanto na perspectiva da sociologia quanto da ciencia ocupacional, e considera as contribuiçöes que podem ser obtidas por meio da aplicaçâo desse conceito para entender a saúde mental de estudantes universitarios. O uso de uma lente de justiça ocupacional oferece uma oportunidade para uma perspectiva alternativa ao considerar fatores potencialmente contribuintes para os problemas de saúde mental nesta populaçâo.

Palavras-chave: Saúde Mental, Alienaçâo Social, Terapia Ocupacional.

Introduction

Over the last decade, mental health, especially in the youth, has been a prevailing concern (World Health Organization, 2013; Tomacruz, 2018). With suicide being the second leading cause of death among young people globally, closer attention is being paid to the roots of mental health problems and how to address them. University students are a particularly high-risk population, with increasing prevalence of mental health concerns among them (Larcombe et al., 2016). Studies conducted in recent years show at least 25% of university students experience some form of psychological distress (Stallman, 2011; Radeef et al., 2014; Larcombe et al., 2016), and that there is a rising rate of students experiencing depression and suicidal thoughts (Tomacruz, 2018; Caruncho, 2019).

In order to understand the causes of mental health issues, one must look beyond individual, psychological factors and look at other determinants such as social, cultural, economic, political, and environmental factors. These factors play a part in whether certain groups are at higher risk for experiencing mental health problems (World Health Organization, 2013). This shift in perspective is an opportunity to look at how occupations, and the way they are situated and shaped within specific contexts, can also play a role in supporting or not, the mental health of specific populations. Occupational justice and the way occupational injustices may occur offers one such possible perspective.

Occupational alienation, one form of occupational injustice discussed in the literature, is suggested to have a significant impact on a person's well-being (Wilcock & Hocking, 2015). Dissatisfaction with occupational engagement and other consequences of alienation have been linked to illness, health-risk behaviours, and experiences of mental health disorders (Wilcock & Hocking, 2015). However, it is currently underexplored how occupational alienation might be present in everyday contexts (Bailliard & Aldrich, 2017), such as the university, and how it could potentially affect the well-being, including mental health, of university students. The aim of this critical essay will be to explore the relationship between occupational alienation and mental health problems in university students. The first section will discuss the concept of alienation within the social sciences and consider these in relation to the concept of occupational alienation. The second section will examine factors influencing the mental health of university students and how applying the concept of occupational alienation may offer an additional perspective on this important issue.

Alienation

The concept of alienation has roots in the social sciences, particularly sociology. Varying, yet similar, definitions of alienation in literature point to some form of detachment or separation (Mirowsky & Ross, 2003) or discrepancy (Seeman, 1975). This may be from control over the primary work role (Marx, 1964 as cited in Kohn, 1976), from social and cultural structures (Hajda, 1961; Taines, 2012), or an unfulfilled human need (Etzioni, 1968 as cited in Seeman 1968). One important discussion on alienation is the seminal work by Seeman (1959, 1975), who while recognising a diversity historically of theoretical positions, notes 'root ideas concerning personal control and comprehensible social structures" in alienation studies (Seeman, 1975, p. 91). Drawing on previous work, he conceptualizes five basic categories of alienation arising from various forms of loss or limitations: powerlessness, meaninglessness, normlessness, isolation and self-estrangement (Seeman, 1959) with a sixth category, social isolation, added in later work (Seeman, 1975). His work has informed numerous studies involving alienation (Healy, 2020), and this paper will draw particularly on these, while recognising that his is only one of a number of approaches to the concept of alienation in the literature.

In occupational science, the concept of occupational alienation has been developed within broader discussions of occupational justice and injustice. Occupational justice is grounded in the belief that humans are occupational beings, and places emphasis on various occupational needs, strengths, and potentials of individuals and groups (Townsend & Wilcock, 2004). It also focuses on the provision, through structural and contextual conditions, of equity of access to resources and opportunities for engagement and participation in varied and meaningful occupation (Townsend & Wilcock, 2004; Durocher et al., 2014; Stadnyk et al., 2014; Wilcock & Hocking, 2015). This is achieved through upholding occupational rights - the right to engage in meaningful and enriching occupations, the right to develop through participation in occupations, the right to autonomy or choice in occupations, and the right for diverse participation in occupations. Violation of any of these rights results in occupational injustice (Townsend & Wilcock, 2004; Stadnyk et al., 2014).

The concept of occupational alienation has been developed as one of a proposed five forms of occupational injustice. It refers to the imposed engagement in occupation experienced by the person as meaningless or purposeless. This experience of occupation without choice or control, with limited opportunities for decision making and creativity, that does not satisfy inner needs or enrich the self, is suggested to lead to distorted identity formation and a sense of estrangement from society or self (Townsend & Wilcock, 2004; Wilcock, 2006; Stadnyk et al., 2014). However, beyond a broad outline of the concept as presented in the work of Townsend and Wilcock, later supported by Stadnyk, there has been limited further conceptual development (Durocher et al., 2014). Bryant in 2016, building on earlier research work (Bryant et al., 2004) suggested three, interrelated, experiences of alienation: social, existential and occupational. Social alienation is particularly associated with stigma, social exclusion and social isolation. Existential or intrapersonal alienation is linked with hopelessness and feelings of not being oneself. Finally occupational alienation may be identified when a person is not, or is struggling, to engage in occupation, which may be due to a poor 'fit' with the form of the occupation and a limited sense of control over it. Occupational alienation can be viewed as a violation to the right of a person to engage in occupations that they experience as meaningful and enriching. That violation may be due to the nature of the occupations in which they are able to engage, or the conditions surrounding the engagement in occupations, for example "[...] the sociocultural values, laws, and rules; political direction; and economic structure" (Wilcock, 2006, p. 167).

Seeman's Variations of Alienation and Occupational Alienation

In order to extend the conceptual foundations of occupational alienation Seeman's (1959, 1975) and Mirowsky & Ross (2003) discussion of alienation is reviewed in dialogue with discussions of alienation as presented in the occupational therapy and occupational science literature. Although there are some commonalities of terms it is not presumed that these are conceptualised in the same way in these discussions, but that exploring these similarities and differences will contribute to broadening and deepening understanding of occupational alienation (see Figure 1).

Powerlessness and the lack of choice

Both conceptualisations of alienation place importance on the autonomy of an individual. Seeman's (1959) discussion positions this idea of powerlessness as originating in the ideas of Marx and the position of the worker in capitalist society, removed from the possibility for decision making around their work. However, rather than focusing on the conditions (of work for example) Seeman (1959, p. 784) focuses on the "[...] expectancy or probability held by the individual" that their own actions or behaviour cannot influence the outcomes or rewards that they would like. Powerlessness occurs when an individual is unable to achieve desired outcomes. It stems from a lack of control over a situation, leading one to think that outcomes are determined by chance or fate, or someone with more power or authority (Mirowsky & Ross, 2003). From an occupational science standpoint, lack of choice is when an individual or a population have no or very limited autonomy in the occupations available to them (Stadnyk et al., 2014) or the conditions contributing to their ability to engage in occupations (Bryant, 2016). Seeman's (1959) discussion usefully suggests that powerlessness may involve the objective conditions in society, a moral judgement by observers about the conditions, and the importance of a sense of control for the individual. However, he notes that core to the definition is the idea of the person's expectancy towards the conditions (usually socio-political events) they find themselves in. This positions the powerlessness of alienation as neither a general condition of society or a psychological state of the person, but describes the relationship of the person to wider social conditions.

Self-estrangement and disconnectedness

A person who feels no or little intrinsic value or fulfilment in the work done, whether compensated or forced to submit to the work, experiences self-estrangement (Mirowsky & Ross, 2003). It relates to the idea of there being intrinsically meaningful activity and the idea of an ideal self that can be expressed through that (Seeman, 1959). Selfestrangement is experienced in alienated labor - where a worker has no part in the decision or design of the product, no control over the work process, and has no ownership over it. On the other hand, disconnectedness, as discussed in occupation science, occurs when a person is removed from or denied access to culturally relevant occupations due to various external circumstances or policies (Townsend & Wilcock, 2004). Both self-estrangement and disconnectedness deal with the degree of ownership or connectedness to the work or occupation being undertaken, and that the person is unable to engage in occupations that are self-rewarding.

Isolation

Both sociology and occupational science use the same term, and both have similar definitions. Isolation occurs when a person is detached from social networks or separated from families and friends as a result of required or demanded work or occupations (Mirowsky & Ross, 2003; Townsend & Wilcock, 2004). This separation may be physical, as in the example of Townsend & Wilcock (2004) where people are physically separated from their social circles. It may also be in a more psychological or emotional sense, as when one lacks a sense of fulfilment or support from one's relationships (Mirowsky & Ross, 2003), experiences social exclusion (Bryant, 2016), or when one gives low value to the goals and beliefs of the majority (Seeman, 1959).

Meaninglessness

Like the concept of isolation, both disciplines use the term meaninglessness and have similar definitions. Meaninglessness occurs when a situation or occupation seems to have no sense of purpose (Mirowsky & Ross, 2003; Hasselkus, 2011). However, meaninglessness is not merely a lack or loss of meaning. It can also occur when personal or expected meanings fall apart causing things to become unintelligible, or not understandable (Hasselkus, 2011). Similarly, when there is conflict among beliefs and explanations for phenomena, it can lead to a sense of meaninglessness (Mirowsky & Ross, 2003). Meaninglessness makes it difficult to know how to act as there is a loss of understanding of the meaning of events and their interconnections, making it difficult to predict outcomes (Seeman, 1959). Seeman (1959) suggests the work of Adorno to explain such meaninglessness - that the increasing functional rationality of society, with a focus on efficiency - makes it difficult for the person to act with insight and intelligence.

Role stress and lack of identity

Normality, as stated by Mirowsky & Ross (2003) is when there are a set of reliable expectations for the roles and behaviors of a person. When these expectations are violated or not met, role stress occurs. Seeman (1959, 1975) referred to this as normlessness, describing the situation where there is high expectancy that socially unapproved behaviours are needed for success in achieving goals. In occupational science, identities are formed from experiences gained during engagement in occupations. While Townsend & Wilcock (2004, p. 80) refer to a "lack of a sense of identity" in their definition of occupational alienation, later work presents a more nuanced view of how development of a positive identity may be hindered when the occupations in which a person is able to engage do not fit with the person's aspirations or potential (Stadnyk et al., 2014; Durocher et al., 2016). For both disciplines, alienation plays a part in disruption of roles and identity formation.

This brief overview of the concept of alienation from the sociological and occupational science literature, has highlighted some of the key elements of this concept. In the following section, following a brief discussion of the mental health of university students, the concept of occupational alienation will be utilised to offer an additional perspective to this important issue.

Mental Health of University Students

Transitioning into the role of university student and engagement in related occupations have a strong link to an individual's development and well-being. As a student navigates through new occupations, and the roles, expectations and demands that come with it, it can become a source of stress or pressure on the individual (Chen, 1999; Boyd et al., 2003; Berzonsky & Kuk, 2005; Dzokoto et al., 2007; Ekelman et al., 2013; Ridner et al., 2016; Bhujade, 2017). Changes in environment, academic demands, as well as the social and economic contexts are all factors that are reported to play a role in contributing to the distress experienced by students (Chen, 1999; Boyd et al., 2003; Berzonsky & Kuk, 2005; Yeager, 2006; Dzokoto et al., 2007; Steptoe et al., 2007; Stallman, 2008; Radeef et al., 2014; Bhujade, 2017; Winzer et al., 2018; Hamzah et al., 2019).

Common sources of stress in the literature include too little time for other activities, the amount of academic work, pressure to excel academically, tension in the teacherstudent relationship, lack of social support or sense of community, heavy demands, and pressure from expectations. These have been linked to high levels of stress as well as depression and anxiety (Dahlin et al., 2005; Radeef et al., 2014; Cheung et al., 2016; Bhujade, 2017). Furthermore, taking on multiple roles, i.e., roles in the family, work, and school, also provides an added challenge to balancing academic demands (Ekelman et al., 2013).

The new social environment along with the pressures of forming connections and relationships among peers or mentors, and the lack of social support is also found to contribute to mental health issues among university students (Chen, 1999; Dahlin et al., 2005; Dzokoto et al., 2007; Steptoe et al., 2007; Bhujade, 2017). In relation to social contexts, another stressor is separation from home or the transition into university life. For a number of students, going to university will involve moving away from home. Change in routine, lifestyle, and social setting, and the overall transition into a new life stage can be very challenging for students and be a source of distress (Chen, 1999; Steptoe et al., 2007; Bhujade, 2017; Hamzah et al., 2019). Other external factors that are considered stressors to university students are financial constraints or socio-economic background. Coming from a lower socio-economic demographic or difficulties with financial concerns have been linked to high levels of stress and depressive symptoms (Dahlin et al., 2005; Steptoe et al., 2007; Cheung et al., 2016).

Occupational Alienation and the Mental Health of University Students

Given the importance of occupations to a person's well-being, particularly that of mental well-being, there is potential to explore the nature of the structural factors that contribute to the experience of occupational alienation and how it could be related to the mental health of university students. While there are no published studies directly relating the mental health of university students to occupational alienation, we propose some connection among the concepts developed from the discussion in the previous sections (illustrated in Figure 2). While each aspect of alienation will be discussed separately, in practice there is a good deal of overlap between the various aspects which may combine in multiple ways to create the experience of occupational alienation for students.

A sense of powerlessness and lack of choice often stems from external conditions that affect a person's control over and ability to engage in occupations. In relation to stressors experienced by university students, this may be observed in how students often have a sense of obligation to attend and perform well in university or prove their worth (Phinney et al., 2006; Brosnan et al., 2016; Hunt et al., 2018), with little to no control over the quantity and difficulty of class work, and in some university systems little involvement in the processes of the university. Also, students may feel a lack of choice over the conditions surrounding their ability to engage in other activities beyond school work, as a result of the heavy workload. In addition, students may find it difficult to understand their studies, connecting weekly courses into a coherent direction of travel towards the final degree. Aside from powerlessness, a sense of the meaninglessness of the occupation may also emerge.

Moreover, powerlessness and meaninglessness may also be experienced by students who enter an educational program that was not their own choice. As a person develops and new occupations are explored, they are able to envision who they want to become or what potential they want to achieve. While many university students are able to engage fully with their chosen subject, others may enter a course which was not their first choice, some may find that the course does not meet their expectations, while others may have selected programs and entered university through a sense of obligation to family or to wider cultural expectations (Akosah-Twumasi et al., 2020; Hunt et al., 2018; Phinney et al., 2006). These differences in cultural contexts - individualist vs collectivist cultures, views on self and self-worth, culturally-imposed demands and expectations, and attitudes towards mental health (Boyd et al., 2003; Steptoe et al., 2007; Kotera et al., 2020) - can greatly influence a student's university experience. Boyd et al. (2003) have found that for some students, culturally-imposed demands and expectations outweigh that of individual formation and development, further emphasising a sense of meaninglessness and disengagement.

Upon entering university, students engage in a myriad of occupations - ranging from academic to co-curricular and extracurricular occupations - geared towards achieving their potential, developing new identities, and forming new relationships. With forming new relationships comes a sense of belonging, which is often achieved through engaging in shared or social occupations with others (Wilcock, 1999; Hammell, 2004; Ekelman et al., 2013; Hitch et al., 2014) However, the adjustment to a totally new culture - brought about not only by facing new academic demands, but also by changes in routines and lifestyles - may be difficult for many students. This is caused not only by practical stress (e.g., due to limited finances), but also with the world of the university experienced as alien with the students experiencing disconnectedness to it. At the same time many students are separated from family and former school mates, experiencing not only cultural disconnectedness but also social isolation (Chen, 1999; Berzonsky & Kuk, 2005; Dahlin et al., 2005; Steptoe et al., 2007; Bhujade, 2017). Difficulty in establishing relationships with new mentors and peers, as well as a sense of exclusion brought about by differences in socio-economic and cultural backgrounds may also lead to further social isolation (Dahlin et al., 2005; Brosnan et al., 2016). Ekelman et al. (2013) noted that university students with disabilities do not always fit in with other groups, and that the majority experience some level of difficulty with adjusting to the new demands. Research has demonstrated how students from minority backgrounds fare less well at university, with a complex range of factors leading to these outcomes, including that cultural learning styles are not appreciated, and university policies and practices may not be fair and inclusive (Smith, 2017). While this may vary on a case-tocase basis, it is still worth noting that cultural, psychosocial and socioeconomic factors play a role in a student's academic performance and experiences in the university (Dzokoto et al., 2007; Ridner et al., 2016).

Finally, it is possible to see how the need to take on the role of student and shape it successfully within the ongoing construction of one's identity, may be challenged in this new and potentially 'alien' context of the university. This period of transition for university students is critical in identity formation and development (Boyd et al., 2003; Berzonsky & Kuk, 2005; Dzokoto et al., 2007). Additionally, engagement in occupations contribute greatly to a person's sense of identity (Laliberte-Rudman, 2002). Through actively doing and participating in meaningful occupations, a person is able to develop a deeper understanding of who they are - their roles and identities - as occupational beings. Disruptions in this identity formation may be linked to the academic challenges experienced (perhaps unexpectedly), difficulties in making new friends or in the relationship with lecturers, conflict between personal and academic expectations, tensions between previously held notions of oneself and their new identity as students, or in the sense of connection or not to the subject being studied (Brosnan et al., 2016; Dahlin et al., 2005; Hamzah et al., 2019; Kotera et al., 2020).

This brief analysis has drawn on the concept of alienation to explore the situation of university students and particularly those factors that seem to be linked to their mental health. A limitation of this paper is that the discussion focused primarily on the work of one author. While this was a rich resource, it is proposed that a systematic review of the concept of alienation would be valuable. Another limitation of this paper is that the relationship between alienation and the mental health of students has been postulated from the literature without empirical support. More generally there are very few studies that have applied the concept of occupational alienation, with only two studies taking an occupational alienation lens to analyse work situations (Durocher et al., 2016) and mental health day services (Bryant et al., 2004). The first study explored the experience of occupational alienation in relation to work participation, focusing primarily on systemic factors rather than highlighting personal factors and individual experiences (Durocher et al., 2016). In the latter study, Bryant et al. (2004) found that clients had experienced occupational alienation as both a result of their mental illness and from their experiences with mental health day services. However, there is no mention of the impact of occupational alienation itself on the mental health conditions of the participants.

The occupations related to being a university student are multiple and inter-related. The lens of alienation enables an exploration of the nature of the social structures together with the personal response to those that may result in the particular experiences of these occupations affecting mental health. It is seen that alienation may be experienced in various forms, including the social isolation of moving physically into a new environment where socio-economic and cultural differences may be experienced, but also through a disconnection with the processes of the educational system itself, making it difficult to regularly engage successfully with the occupations expected. The analysis suggests that when working to support the mental health of students, it will be important to consider the nature of the occupations of the university world, the autonomy that the student may experience in relation to these, and their sense of connection to them, including in relation to their developing identity as a student. It may be important to consider ways that occupations can connect to who the student experiences themselves to be, as well as to engage the students actively in the organisation and processes of the occupations of the university.

Conclusion

Mental health has been an increasing public health concern in recent years, with university students at greater risk for experiencing distress and mental health issues. A shift in the public health perspective of health and well-being has led to the possibility of using the lens of occupational alienation to understand mental health among university students. This paper engaged in a preliminary exploration of the social sciences literature, and particularly that of Seeman, to support and extend the discussions of occupational alienation. It is suggested through this analysis that the mental health of university students may be affected by both internal, personal and occupational experiences, as well as broader, external structural conditions surrounding university studies. These conditions may support the development of the experience of alienation from their occupations as students.

Recently, Bryant (2016) stated that there is still some difficulty in recognizing and identifying occupational alienation in our lived experiences, and this may also include that of university students. It is therefore important that further research in this area be conducted to add valuable insights into understanding the links between occupational alienation and the mental health of university students. For example, one might explore how occupational alienation is experienced by university students and its impact on their mental health. Further research is also needed to determine the correlation between occupational alienation and mental health. This could potentially contribute to the discussions on how to better support mental health needs, and how to build 'healthy universities' (Newton et al., 2016) for all students.

Using an occupational justice lens and specifically the concept of occupational alienation, allows an exploration of the intricate interrelationship between the person and the nature of the social structures with which they engage on a daily basis, potentially providing a different perspective on mental health.

Sidebar

How to cite: Nañagas, M. L., & Kantartzis, S. (2022). Occupational alienation and the mental health of university students. Cadernos Brasileiros de Terapia Ocupacional, 30(spe), e3097. https://doi.org/10.1590/2526-8910.ctoRE23433097

Received on July 20, 2021; Accepted on Jan. 28, 2022.

Author's Contributions

This essay is based on original work conceptualized and written by the lead author as a partial requirement for the MSc in Occupational Therapy (post registration) of Queen Margaret University, Edinburgh. Maria Lucia Nañagas and Sarah Kantartzis are responsible for review, revision, further analysis, and writing of the finished manuscript. All authors approved the final version of the text.

Corresponding author

Maria Lucia Nañagas

e-mail: [email protected]

Guest editor

Dr. Rebecca Twinley

References

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