Actualizado: 22 de mar de 2020
This innovation facilitates new types of interfaces and interactions between the two groups: the people with mental health disorders and society in general. MEDIATE will use mediated communication for therapeutic purposes, building on the extensive literature on the individual benefits of art therapy to people with mental health diagnoses, to help them see their roles as citizen users of both media and mental health services. MEDIATE use communication technologies to renew access to citizenship, strengthen identity, improve social integration and quality of life, and deconstruct the collective imaginary that discriminates against mental disorders and people diagnosed with them. MEDIATE is at the intersection of critical theoretical research and action research, and is both interdisciplinary and intersectoral.
Prof. Tilli draws from the field of health communication, for the study of alternative care modalities existing in the US and France for people with mental health issues. In MEDIATE, alternative intervention methods are viewed by Prof. Tilli as "dynamic social innovations" and are analyzed as "dispositif" (on the definition developed by Foucault) of "empowerment", denoting an experiential environment used to produce a social event or actiondenoting an experiential environment used to produce a social event or action.
Mental health has traditionally been viewed through a medical or disease model, however, it is important to consider other models that bring the focus not to the disability, but to the individual. Currently, individuals with mental illness suffer from stigma and social isolation. In an effort to avoid further social isolation, individuals avoid disclosing information related to their diagnosis and prolong the onset of treatment.
MEDIATE, proposes the use of mediated communication (such as radio and new communication and information technologies -hereinafter NICTs; i.e., social media-) for therapeutic purposes. Based on the therapeutic principles behind art therapy, this project will examine how communication technologies can increase the participation of people with mental health challenges in their communities, improve social integration and perceived quality of life, and deconstruct the collective imaginary that discriminates against mental disorders and people living with them. MEDIATE is at the intersection of a critical theoretical research and action research. Prof. Nicolas Tilli draws from the field of health communication to examine the mechanisms by which participating in these intervention modalities creates positive change at both the individual and social levels. These interventions that use art and media are viewed by Prof. Tilli as "dynamic social innovations" and are analyzed as "devices of empowerment" or dispositifs, based on the definition developed by Foucault, denoting an experiential environment used to produce a social event or action.
The study will benefit from observation and analysis of various existing workshops for people currently or previously receiving mental health services. Prof. Tilli will compare existing practices, or dispositifs such as the use of art, radio and web production for mental health, with special consideration to cultural factors. Prof. Tilli will conduct extensive field research through ethnographic observation and interviews to understand (a) the therapeutic processes of these non-clinical groups that use art and/or radio and/or NICTs for healing and empowerment, (b) the multiple identities of participants of people with mental health diagnoses and how these interact with their identities as citizen users (hereinafter CU) of both mental health services and media, and (c) how the expectation of having their voice heard impacts the therapeutic mediation process. An important and innovative aspect of this study is the multi-level comparison, which, to the Prof. Tilli’s knowledge, has never been done before.
A main objective of this study is to determine which modality of dispositif is more beneficial to quality of life and stigma reduction, and identify socio-cultural differences in order to enrich these kinds of efforts in both countries. A key construct in this research is the process of therapeutic mediation, which is a means to expose the transitional area of experience between inner experience and external reality. It is important to note that the vision of Prof. Tilli of is in the rebuilding particpants’ own perspective on their quality of life and not in pursuit of a specific clinical outcome. This approach complements medical approaches of treating mental disorders by enabling participants to engage with society and supporting their recovery by strengthening their identity and their image, improving their confidence, reconstructing their past, restoring social ties, and recovering their voice which may be silenced by stigma. This use of mass media allows people’s voices and images to circulate in society, and this exposure slowly changes the societal response to this population.
MEDIATE is a scientifically-based, interdisciplinary, and intersectoral proposal to examine the use of art and communication media for mental health. It will develop process and impact indicators of these practices, and increase the understanding of ethnic and cultural issues including power flow between different dispositifs and socio-cultural factors. The relevance of MEDIATE is reflected by the recognition of mental health a priority by WHO, PAHO, and the Council and the European Parliament. The proposed program is significant in that it is the first to conduct a cross- country analysis of the use of not only art, but also mediated communications, to promote mental health using both qualitative and quantitative research methods. American, European, and international health authorities are seeking alternatives to better integrate people with mental health challenges into society through different types of interventions. The European Parliament has stated that there are still shortcomings in this area and there is a need to encourage and support research on the subject. MEDIATE fits into the objectives set by these institutions, which are interested in improving mental health and require states to implement new measures to achieve this.
2- New concepts and a new approach
Mediated communication for therapeutic purposes (the Prof. Tilli’s own model): Language is the means through which people affirm and transform themselves and their role in the world. The methodology designed by Prof. Tilli is developed within a social dispositif that works through two mediation processes. The internal mediation process is produced as a result of participating in a dispositif. The external process is produced among audience members who listen and read. When the two voices meet in a virtual space, group effects arise between both the participants in the dispositif and society at large. What enriches this dispositif is the feedback from outside through the interactive media. In reality, “the in” does not exist without “the out ” and vice versa. The greater the movement in one field, the greater the possibilities of the other being impacted. The meeting happens in a virtual space thanks to feedback and to the dissemination of the creative work, moving the mediation from the healthcare sector into the social sector.
In this way, participants get feedback from society about their achievements: they listen to each other and hear outside perceptions – by web, the social networks, blogs, etc.). This is one of pillars of this model: co-construction, where each person plays an active part in constructing more democratic health care spaces).
A practical difference between using NICTs as opposed to only art, or only classical radio is that it allows reching a larger audience, providing a louder voice and facilitating the social integration of the participant by (a) breaking physical and symbolic isolation imposed by society, and (b) allowing participants to recognize themselves as “discourse makers.” The key is providing the “transactional object,” which is the regulating entity of the therapeutic mediation process, so that the person starts to build a bridge between symbolic and the physical spaces. With this approach, Prof. Tilli wants to encourage the emergence of new contexts through the use of NICTs for mental health through a process where the planned communication event, the unexpected reaction, the audience’s participation, and the encounter between the symbolic and the concrete, occur at three levels (1) Intra-community: among participants in a dispositif, (2) Inter-community: between participants in one dispositif and others working in different dispositifs, and (3) Extra-community: between dispositif participants and society at large.
The purpose is not to deny what society thinks of mental disorders and people living with them, but rather to deconstruct the imaginary about mental illness and mental helath, from the perspective of the undetermined other who will begin to question his own perceptions from his social position and think differently about mental helath issues. The dynamics of the co-construction of mental disorders demystifies the problem without denying it, acknowledging a different point of contact from which social empathy may emerge.
The work proposed is structured within a dispositif of empowerment characterised by a set of interactions facilitated by NICTs, between actors and discourse, thus creating a greater social ties. The impact of this approach occurs at both the personal and social level. At the personal level, the process of mediation that takes place in the creation of content that represents their lived experience, serves a therapeutic function the leads to empowerment, self-efficacy, and improved perceived quality of life. At the social level, the dissemination of media content serves to change social norms and perceptions about people living with mental disorders and also leads to increased empowerment, decreased feelings of isolation and great social integrations. At the personal and social level, the approach creates a tiers symbolisant (symbolizing third party) as defined by Louis Quéré, which encompasses a set of composite elements representing the symbols that social subjects can use to “gain access to reality, shape their identity and community, acquire the ability to think and act, and thus play an active part in writing their own history.” The use of interactive media amplifies the role of the tiers symbolisant, when the worlds of production and reception interact.  This is the basis for the expansion of the principles of mediation through art therapy to a mass audience. In the case of radio, the audience is limited to those with access to the signal. In the case of web-based media, the audience is unlimited among Internet users.
 WHOQOL Group, “Development of the WHOQOL: Rationale and current status”, International Journal of Mental Health, no 23, 1994, p. 24-56.
 Michel Callon, “L’innovation sociale. Quand l’économie devient politique” in L’innovation sociale. Emergence et effets sur la transformation des sociétés, Québec, 2007, Presses universitaires du Quebec.
 Michel Foucault, Saber y verdad, Madrid, La piqueta, Coll. Genealogia del poder, 1991, n°10, p. 218.
 Michel Foucault, Dits et écrits, Paris, Gallimard, Tome II, 1994, p. 299. “Dispositif” is a term used by Foucault to denote a very specific concept that is key to this project, for which reason we will use the original French term. Its literal translation — “device,” “procedure,” “mechanism,” — does not encompass the full meaning we wish to express. For our purposes, a dispositif can be an environment or material and conceptual framework used to produce an event or action. In this case, media - such as a radio show - can be a dispositif, although it is the radio show as a set of relations in a wider social context that is underlined. "What I try to pick out with this term is, firstly, a thoroughly heterogeneous ensemble consisting of discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral and philanthropic propositions – in short, the said as much as the unsaid. Such are the elements of the dispositif. The dispositif itself is the system of relations that can be established between these elements. Secondly, what I am trying to identify in this dispositif is precisely the nature of the connection that can exist between these heterogeneous elements." (FOUCAULT's interview 1977).
 Philippe Corcuff, “De la thématique du lien social à l'expérience de la compassion”, Pensée plurielle, 1/ 2005, no 9, p. 119-129.
 European Parliament resolution of 19 February 2009 on Mental Health (2008/2209(INI)).
 Donald Woods Winnicott, “Jeu et Réalité”, Paris, Gallimard, 1975.
 Margaret Barry, Rachel Jenkins, Implementing mental health promotion, Oxford, Elsevier, 2007.
 David L. Penn, Til Wykes, “Stigma, Discrimination and Mental illness”, London, Journal of Mental Health, 2003, n°3, vol.12, pp. 203-208.
 Philippe Corcuff, “De la thématique du lien social à l'expérience de la compassion”, Pensée plurielle, 1/ 2005, no 9, p. 119-129.
 Louis Quéré, “Des Miroirs équivoques, Aux origines de la Communication Moderne”, Paris, Aubier Montaigne, 1982, p. 84.
 Mark Salter, Peter Byrne, “The stigma of mental illness: how you can use the media to reduce it”, London, Psychiatric Bulletin, 2000, n°24.