eJournals Arbeiten aus Anglistik und Amerikanistik / Agenda: Advancing Anglophone Studies 48/2

Arbeiten aus Anglistik und Amerikanistik / Agenda: Advancing Anglophone Studies
aaa
0171-5410
2941-0762
Narr Verlag Tübingen
10.24053/AAA-2023-0010
121
2023
482 Kettemann

Mental Health Literacy quest or Three reasons why

121
2023
Sean Holt
This contribution investigates in what way digital narratives, such as hypertext fiction (HTF), could be conceptually integrated in English as a Foreign Language (EFL) classrooms to discuss and promote ‘Mental Health Literacy’ (MHL) among secondary level learners. Through the analysis of the potential offered by HTF, a well-established but often overlooked type of digital literature characterised by decision making through hypertextual links (similar to Choose-Your-Own-Adventure books), the author examines how the distinct affordances of the genre can support the development of MHL in the EFL context. To do so, this contribution first explores the possibilities and limitations offered by the concept of MHL for being embedded into English Language Education (ELE) with a focus on the potential offered by literature education. Based on this approach, it sheds light on the ways digital fiction, but also other forms of literature, can be utilised as authentic language resources to promote positive mental health as well as the concept of MHL. Overall, this article contributes towards the body of literature that offers insights for both researchers and educators working within the ELE context on how to approach and discuss such difficult topics related to mental health in current practices of teaching and learning. It furthermore stresses the potential of HTF for being used to facilitate critical reflective reading as well as expressive writing approaches in which novel multimodal designs can support the engagement with mental health struggles.
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This contribution investigates in what way digital narratives, such as hypertext fiction (HTF), could be conceptually integrated in English as a Foreign Language (EFL) classrooms to discuss and promote ‘Mental Health Literacy’ (MHL) among secondary level learners. Through the analysis of the potential offered by HTF, a well-established but often overlooked type of digital literature characterised by decision making through hypertextual links (similar to Choose-Your-Own- Adventure books), the author examines how the distinct affordances of the genre can support the development of MHL in the EFL context. To do so, this contribution first explores the possibilities and limitations offered by the concept of MHL for being embedded into English Language Education (ELE) with a focus on the potential offered by literature education. Based on this approach, it sheds light on the ways digital fiction, but also other forms of literature, can be utilised as authentic language resources to promote positive mental health as well as the concept of MHL. Overall, this article contributes towards the body of literature that offers insights for both researchers and educators working within the ELE context on how to approach and discuss such difficult topics related to mental health in current practices of teaching and learning. It furthermore stresses the potential of HTF for being used to facilitate critical reflective reading as well as expressive writing approaches in which novel multimodal designs can support the engagement with mental health struggles. 1 The title being a homage to the story Depression Quest (2013) and the novel Thirteen Reasons Why (2017). - With the high prevalence of mental health challenges around the world (WHO 2020), which are likely to rise post COVID-19 (see, e.g., Mayne 2020; Pies 2020), the concept of MHL is growing in importance for schools. However, despite the increasing visibility and awareness of mental disorders 2 , they continue to be heavily stigmatized topics, with stigma here describing negative attitudes directed towards people with mental disorders based on negative social (re)presentation (Neto et al. 2017: 737). To address negative perceptions, decrease discrimination, and foster open discussions while promoting awareness, the integration of MHL into different school subjects seems a valuable endeavour with ELE being an ideal space for authentic language discourses given the discipline’s openness to incorporate diverse issues. This article proposes that one possibility to advance MHL in ELE is through meaningful cognitive and emotional engagement with digital narratives and their (re)presentation of mental disorders. To highlight the potential of digital literature, this article first discusses how literature can support the development of empathy, facilitate critical investigations into the (re)presentation of mental health topics, and enhance students’ understanding of mental disorders as medical conditions. By considering the theoretical framework of MHL and drawing on a broad understanding of texts (KMK 2012a: 20), it investigates the parallels between the concept of MHL and literature teaching in the EFL secondary classroom, offering a rationale for areas of opportunities (term borrowed from Atkins et al. 2010: 47) which allows teachers to address mental health topics. As presenting all relevant aspects in their complexity goes beyond the scope of this article (and the author’s expertise as an ELE researcher), they are intended as starting points for discussing subject-specific opportunities and challenges as to how teachers in ELE can and cannot foster MHL by asking: 1. How can MHL be conceptualised in the context of English language education? 2. How can aspects of MHL be integrated in practices of English language education? The second part of this contribution examines the theoretical intersections and practical implications of employing HTF within ELE. It explores how this digital genre can enable students to actively engage with, and possibly 2 The term mental disorder is used to refer to a person suffering from one or more clinically diagnosable condition that affect their mental health. Other terms like mental illness, psychological issues/ problems, or behavioural disorder may also be used (see, e.g., van Beveren et al. 2020: 1366; Bishop et al. 2021: 18). create, complex digital stories where novel design elements provide opportunities for reading and writing about personal struggles. By considering the more unique affordances of the HTF genre, the article shows its suitability for developing MHL in literature teaching, with the final part exemplifying some of these possibilities with the HTF story Depression Quest (2013). Originally proposed by Jorm et al. (1997), MHL was defined as the set of “knowledge and beliefs which aid in [the] recognition, management and prevention [of mental disorders]” (1997: 182) and has since developed into a key topic for research, policy, and practice (Sweileh 2021: 3-4). One aspect the concept stresses is that in comparison to physical or bodily based ideas of health, the knowledge and attitudes towards the factors that negatively impact mental health are less acknowledged in society (see Jorm, Christensen & Griffiths 2006; also Sweileh 2021: 4). Subsequently, mental disorders are less recognized and treated, leading to a variety of other negative outcomes, such as family/ interpersonal problems, reduced life expectancy, increased health concerns, poorer educational or vocational success, and possibly suicide (see, e.g., Mcluckie et al. 2014: 1; Wei et al. 2014: 1649; Heath, Smith & Young 2017: 543). Although Jorm (2015, 2020) speaks of MHL as being a form of “knowledge”, only occasionally deviating from this denomination, he clarifies that this “knowledge” is not (and never has been) theoretical (2020: 146). Instead MHL is a form of knowledge that is proactive and supports either one’s own mental health or that of others (Jorm 2020: 155). Based on a recent definition by Jorm (2020: 146) MHL includes the knowledge of how to prevent (self-help strategies) and identify mental disorders (signs and symptoms), how to seek treatment (being aware of treatment options/ professional help), and how to support others (see Figure 1). MHL can be broadly distinguished into higher or lower levels. A low level of MHL means that mental disorders are not discussed in public discourses and left to mental health professionals. As these cannot help everyone affected they have to focus on chronic or extreme cases (Jorm 2000: 399), making low MHL “a significant barrier [for] receiving treatment” (Bishop et al. 2021: 13) that is associated with higher rates of stigmatisation. A high level of MHL in contrast is assumed to combat the aforementioned negative effects and to support healthier lifestyles (Neto et al. 2021: 66). It furthermore includes non-professionals as active participants in the discourse, i.e., also teachers and students, as discussing topics of MHL is argued to support self-help, early intervention, and community-based care and might severely reduce mental disorders (Sørensen 2020: 40). As MHL can be informed by a variety of sources, ranging from personal experiences and media reports towards scientific evidence and expert knowledge (Jorm 2000: 398), it can consequently also be informed by literature encountered in ELE. By integrating MHL in ELE, educators can thus contribute to an understanding of mental health as being important for an individual’s overall health and take up such topics which are of great relevance to adolescents. A comprehensive conceptualisation of the concept can be viewed in Figure 2. As has been shown, MHL is important for students as it emphasizes the importance of recognizing mental health as a part of everyday live. The review by Sweileh (2021: 4) shows that it is increasingly discussed in relation to adolescents, which is hardly surprising given that this is a vital stage of biological, cognitive, psychological, emotional and social development which influences lifelong self-governance, health-promoting attitudes, and actions (Bröder & Carvalho 2020: 55). These are critical for preventing, identifying, and effectively treating mental disorders (Wei et al. 2014: 1649). However, despite being recognized in their importance, the mental health needs of adolescents are often neglected (Merikangas et al. 2010). Consequently, schools are increasingly discovered as spaces for both the promotion of mental health and the prevention of mental disorders (see, e.g., Kutcher, Wei & Coniglio 2016; Bröder et al. 2019). While originally developed for adults, MHL has thus been extended to include adolescents (see Kutcher et al. 2016; Jorm 2020) as unhealthy opinions, perceptions, and attitudes towards mental health and disorders can be positively changed in this age group (Ball et al. 2019: 4), which provides a compelling argument for integrating positive MHL in schools. Although early definitions of MHL focused on the downsides of mental disorders, newer ones incorporate the long-term gains of ‘positive mental MHL can be broadly distinguished into higher or lower levels. A low level of MHL means that mental disorders are not discussed in public discourses and left to mental health professionals. As these cannot help everyone affected they have to focus on chronic or extreme cases (Jorm 2000: 399), making low MHL “a significant barrier [for] receiving treatment” (Bishop et al. 2021: 13) that is associated with higher rates of stigmatisation. A high level of MHL in contrast is assumed to combat the aforementioned negative effects and to support healthier lifestyles (Neto et al. 2021: 66). It furthermore includes non-professionals as active participants in the discourse, i.e., also teachers and students, as discussing topics of MHL is argued to support self-help, early intervention, and community-based care and might severely reduce mental disorders (Sørensen 2020: 40). As MHL can be informed by a variety of sources, ranging from personal experiences and media reports towards scientific evidence and expert knowledge (Jorm 2000: 398), it can consequently also be informed by literature encountered in ELE. By integrating MHL in ELE, educators can thus contribute to an understanding of mental health as being important for an individual’s overall health and take up such topics which are of great relevance to adolescents. A comprehensive conceptualisation of the concept can be viewed in Figure 2. As has been shown, MHL is important for students as it emphasizes the importance of recognizing mental health as a part of everyday live. The review by Sweileh (2021: 4) shows that it is increasingly discussed in relation to adolescents, which is hardly surprising given that this is a vital stage of biological, cognitive, psychological, emotional and social development which influences lifelong self-governance, health-promoting attitudes, and actions (Bröder & Carvalho 2020: 55). These are critical for preventing, identifying, and effectively treating mental disorders (Wei et al. 2014: 1649). However, despite being recognized in their importance, the mental health needs of adolescents are often neglected (Merikangas et al. 2010). Consequently, schools are increasingly discovered as spaces for both the promotion of mental health and the prevention of mental disorders (see, e.g., Kutcher, Wei & Coniglio 2016; Bröder et al. 2019). While originally developed for adults, MHL has thus been extended to include adolescents (see Kutcher et al. 2016; Jorm 2020) as unhealthy opinions, perceptions, and attitudes towards mental health and disorders can be positively changed in this age group (Ball et al. 2019: 4), which provides a compelling argument for integrating positive MHL in schools. Although early definitions of MHL focused on the downsides of mental disorders, newer ones incorporate the long-term gains of ‘positive mental health’ (Sampaio, Gonçalves & Sequeira 2022: 2), a paradigm shift also recognized by Jorm (2020: 146-147). Bjørnsen et al. (2017), who explicitly refer to their concept as positive MHL, found it to be a “significant explanatory variable of mental well-being” (Bjørnsen et al. 2019: 114). In their systematic review of the concept, Carvalho et al. (2022: 3) identified positive MHL to consist of six constructs: the competence to solve problems and have feelings of self-actualisation, being able to obtain and maintain personal satisfaction, feeling autonomous, being capable of relating to others, self-control, and showing a prosocial attitude (see Figure 3).                         Three of the aspects connect quite directly to ELE. Experiencing school mastery seems like a goal all subjects should support, for example by providing scaffolding. Likewise, pro-social attitudes and the acceptance of others relates to the development of intercultural communicative competence (KMK 2012a: 19; CEFR 2018) whereas the development of empathy is a possible goal/ function of literature in ELE. Other aspects can certainly also be approached, for example to communicate one’s emotions and feelings in English could be seen as a form of self-actualisation, whereas the ability to engage with others aligns with developing communicative competence, highlighting some possibilities how MHL could be taken up in ELE. Following the brief conceptualisation of MHL, this section considers how the concept could be approached in ELE. As MHL describes the complex interplay of skills, knowledge and attitudes, teachers and educational researchers may find it easier to view MHL as a competence (see Sørensen 2020: 44-45 for how the two concepts overlap) consisting of attitudes, behaviours, and skills (which would align with the conceptualisation of the CEFR). The question remains however, how MHL aligns with the conceptual foundation of ELE. While generally making students more knowledgeable and mindful of mental disorders is in itself no small undertaking, it is not reflected in the current syllabus of teaching a foreign language. 3 What is proposed in the following is not envisioned as a stand-alone program but a thought experiment on how MHL could be incorporated in subject-specific teaching and learning. This approach might be characterised as “school friendly […] [having been] designed to be delivered by existing school resources (primarily teachers) within existing school activities” (Kutcher, Wei & Hashish 2016: 164). Studies by Perry et al. (2014) or Mcluckie et al. (2014) highlight the merits of such approaches. Consequently the idea outlined asks how MHL could be embedded into everyday teaching and learning (see Wei et al. 2014: 1654) while being:  Age, development, and language appropriate.  Teachable by teachers in their usual teaching practices.  Designed with familiar pedagogical and subject-specific approaches. These considerations build upon Becker (2021: 141), who discussed the conditions of the German curricula and the grounds on which topics of mental health could be approached in ELE. While references to mental health are absent in the curricula, he did identify a tendency to exclude such aspects in favour of a “rationale of market competitiveness”, where the “not mentioned” becomes the “not wanted” (Becker 2021: 154; 150- 154). However, he also showed that such topics can be taken up in ELE and although he addresses depression specifically, his reasoning appears valid for MHL as he points out that:  Schools are expected to take an active role in addressing mental health (KMK 2012b: 2).  The German ELE curricula has “free spaces” (among them ICC, expressing feelings or beliefs in English, discussing cultural practices and identities, 3 As mandated by the German Kultusminsterkonferenz: „in die eigenen curricularen Rahmenvorgaben zu integrieren, um so einen fachspezifischen Beitrag zur Förderung gesundheitlicher ‚Alltagskompetenzen‘ […] zu leisten“ (KMK 2012b: 2). Following the brief conceptualisation of MHL, this section considers how the concept could be approached in ELE. As MHL describes the complex interplay of skills, knowledge and attitudes, teachers and educational researchers may find it easier to view MHL as a competence (see Sørensen 2020: 44-45 for how the two concepts overlap) consisting of attitudes, behaviours, and skills (which would align with the conceptualisation of the CEFR). The question remains however, how MHL aligns with the conceptual foundation of ELE. While generally making students more knowledgeable and mindful of mental disorders is in itself no small undertaking, it is not reflected in the current syllabus of teaching a foreign language. 3 What is proposed in the following is not envisioned as a stand-alone program but a thought experiment on how MHL could be incorporated in subject-specific teaching and learning. This approach might be characterised as “school friendly […] [having been] designed to be delivered by existing school resources (primarily teachers) within existing school activities” (Kutcher, Wei & Hashish 2016: 164). Studies by Perry et al. (2014) or Mcluckie et al. (2014) highlight the merits of such approaches. Consequently the idea outlined asks how MHL could be embedded into everyday teaching and learning (see Wei et al. 2014: 1654) while being:  Age, development, and language appropriate.  Teachable by teachers in their usual teaching practices.  Designed with familiar pedagogical and subject-specific approaches. These considerations build upon Becker (2021: 141), who discussed the conditions of the German curricula and the grounds on which topics of mental health could be approached in ELE. While references to mental health are absent in the curricula, he did identify a tendency to exclude such aspects in favour of a “rationale of market competitiveness”, where the “not mentioned” becomes the “not wanted” (Becker 2021: 154; 150- 154). However, he also showed that such topics can be taken up in ELE and although he addresses depression specifically, his reasoning appears valid for MHL as he points out that:  Schools are expected to take an active role in addressing mental health (KMK 2012b: 2).  The German ELE curricula has “free spaces” (among them ICC, expressing feelings or beliefs in English, discussing cultural practices and identities, 3 As mandated by the German Kultusminsterkonferenz: „in die eigenen curricularen Rahmenvorgaben zu integrieren, um so einen fachspezifischen Beitrag zur Förderung gesundheitlicher ‚Alltagskompetenzen‘ […] zu leisten“ (KMK 2012b: 2). literature teaching, see Becker 2021: 148; 144-150) that allow teachers to take up such topics.  Research supports that EFL learners, being non-native speakers, may engage with difficult topics like mental illnesses on a more cognitive-intercultural level, with a lighter emotional response, more reflectiveness, and emotional distance providing a safer space than their L1 (see Keysar, Hayakawa & An 2012; Becker 2021: 147). A starting point for the promotion of MHL in ELE could thus be to take up prominent mental disorders, such as depression, eating disorders or alcohol abuse (Jorm 2020: 147-148) as well as aspects of positive MHL and integrate them into tasks and discussions which are already taking place in the EFL classroom. As adolescents prefer to seek mental health support and information from people they know (see, e.g., Slone, Meir & Tarrasch 2013; Tuijnman et al. 2019), students are likely to want to talk about mental health as this is a significant topic in their daily lives. They may however hesitate to get involved in such topics if they fear being misunderstood or stigmatized (see, e.g., Tariku Seboka et al. 2022: 8160-8161), making stigma reduction a valuable endeavour in ELE. Otherwise, students might refrain from meaningfully engaging with mental health issues or may not take suffering individuals (real or fictional) seriously. Such an unserious treatment of mental disorders is often grounded in a lack of understanding that mental disorders are medical conditions (see van Beveren et al. 2020: 1368). As studies have shown that mental disorders which are frequently depicted in the media are generally better understood (Furnham & Sjokvist 2017: 32), it seems likely that this would also apply to literature. Teachers could thus incorporate how mental disorders are portrayed in the literature used in ELE and analyse these indirect (re)presentations, for example if and how they differ within different literary periods or texts (see Heath, Smith & Young 2017). Taking up such topics in literature education allows teachers to support learning about signs, symptoms, and treatment options as well as aspects of positive MHL (see Figure 1 and Figure 3). Literature in ELE is an important provider of authentic language usage and allows learners to explore (non-)fictional human experiences, worlds, and topics. Despite the trend towards communicative competences having marginalized literature in the CEFR or KMK (see, e.g., Volkmann 2019: 19-20; Weskamp 2019: 118), it remains a central part of language education literature teaching, see Becker 2021: 148; 144-150) that allow teachers to take up such topics.  Research supports that EFL learners, being non-native speakers, may engage with difficult topics like mental illnesses on a more cognitive-intercultural level, with a lighter emotional response, more reflectiveness, and emotional distance providing a safer space than their L1 (see Keysar, Hayakawa & An 2012; Becker 2021: 147). A starting point for the promotion of MHL in ELE could thus be to take up prominent mental disorders, such as depression, eating disorders or alcohol abuse (Jorm 2020: 147-148) as well as aspects of positive MHL and integrate them into tasks and discussions which are already taking place in the EFL classroom. As adolescents prefer to seek mental health support and information from people they know (see, e.g., Slone, Meir & Tarrasch 2013; Tuijnman et al. 2019), students are likely to want to talk about mental health as this is a significant topic in their daily lives. They may however hesitate to get involved in such topics if they fear being misunderstood or stigmatized (see, e.g., Tariku Seboka et al. 2022: 8160-8161), making stigma reduction a valuable endeavour in ELE. Otherwise, students might refrain from meaningfully engaging with mental health issues or may not take suffering individuals (real or fictional) seriously. Such an unserious treatment of mental disorders is often grounded in a lack of understanding that mental disorders are medical conditions (see van Beveren et al. 2020: 1368). As studies have shown that mental disorders which are frequently depicted in the media are generally better understood (Furnham & Sjokvist 2017: 32), it seems likely that this would also apply to literature. Teachers could thus incorporate how mental disorders are portrayed in the literature used in ELE and analyse these indirect (re)presentations, for example if and how they differ within different literary periods or texts (see Heath, Smith & Young 2017). Taking up such topics in literature education allows teachers to support learning about signs, symptoms, and treatment options as well as aspects of positive MHL (see Figure 1 and Figure 3). Literature in ELE is an important provider of authentic language usage and allows learners to explore (non-)fictional human experiences, worlds, and topics. Despite the trend towards communicative competences having marginalized literature in the CEFR or KMK (see, e.g., Volkmann 2019: 19-20; Weskamp 2019: 118), it remains a central part of language education across Europe (Gabrielsen, Blikstad-Balas & Tengberg 2019: 2). While the variety of functions and goals of using literature in ELE are well established (see, e.g., Heinz & Hesse 2014; Delanoy, Eisenmann & Matz 2015; Hallet, Surkamp & Krämer 2015; Lütge 2018; Surkamp & Viebrock 2018), the beliefs and perspectives that inform them have at times ”little in common [...] [and may] even be contradictory or mutually exclusive” (Volkmann 2019: 26). Considering the impact of educational, sociocultural, and literary-theoretical concepts (Weskamp 2019: 110), literature is argued to support Bildung as well as the development of multiliteracies, functional communicative, cognitive aesthetic and intercultural competences (Figure 4). Elaborating on all these aspects would go beyond this article, but three prominent ones are discussed in the following and related to MHL. These are the development of empathy and reflection capabilities, the opening of the literary canon (topicand multimodality-wise) and the critical analysis of (re)presentation (for topics of mental disorder and health) in literature (which could be extended to media in general). These developments have become possible, as conceptions of what constitutes literature have changed significantly with a growing awareness of the importance of multimodal literary forms (see Heinz 2020) and the ongoing incorporation of literature with a non-capital ‘l’ from non-core English-speaking countries, 4 (see McRae 1991) opening up new topics; including taboo issues (see Becker, Summer & Ludwig 2022). Literature education in ELE has a long tradition of being linked to the development of empathy as it is well-established that fictional texts evoke emotional responses (see, e.g., Delanoy 2005; Bredella 2012). Bearing in 4 Referring to the wide variety of literary texts and not only those that are considered as part of the canon of high Literature and to be of intellectual, aesthetic or cultural value (such as poems or plays by Shakespeare). mind that students often treat fictional characters like actual beings (Volkmann 2019: 24), engagement with literature can enable a variety of activities, for example acts of identification, the negotiation of different perspectives, critical considerations of moral questions or analytical procedures investigating the narrative design (Volkmann 2019: 24). Koopman and Hakemulder propose such literary-born “insight[s] into human nature” to be distinguishable as either offering insights into the nature of others (what they refer to as empathy) or into one’s own nature (what they refer to as reflection; 2015: 82). A comparable distinction between the affective and cognitive is echoed in the field of psychology, with empathy describing different ways of understanding (see, e.g., Shamay- Tsoory, Aharon-Peretz & Perry 2009). Emotional empathy is the process of affectively relating to the experiences of others (feeling them yourself), whereas cognitive empathy underscores the mental process of imagining the situation of another (their feelings, views, etc.) with an objective perspective/ emotional distance (Furnham & Sjokvist 2017: 32). While both analytical and emotional reading approaches are valuable (see Alsup 2015), the sensitive nature of mental disorders might itself provide an argument that the focus in ELE be best placed on the cognitive side of empathy development. It connects well with the goal of providing opportunities for reflection (see Figure 5) and does not facilitate feelings of powerlessness amongst students. 5 Although both processes take place and cannot be omitted in reading, their development does not happen on its own as they need to be facilitated (Gabrielsen, Blikstad-Balas & Tengberg 2019: 2; see also Volkmann 2019: 31) through careful task-design(s), mindful text and topic selection(s), and by considering the individual learners. In conclusion, in its subject-specific function literature provides students with aesthetic second-hand experiences of fictional (potentially extreme) situations. These can be taken up to promote active reading experiences that encourage engagement with mental health from the “relatively secure position” of the text (Delanoy 2005: 57) and align with the function of empathy development (an important predictor of MHL, Furnham & Sjokvist 2017: 38). Here the wider understanding of literature furthermore allows for new topics and multimodal forms. In addition to fostering empathy, the incorporation of diverse topics and formats appears beneficial for promoting MHL within ELE. As pointed out by Becker (2021: 146-147), the genre of young adult literature (YAL) has 5 In this regard, empathy in literature can be a double-sided sword, disregarding the fictional and how authors guide ideas and reactions with literary devices or the portrayal of stereotypes. Volkmann (2019: 30) notes that empathy can be used to evoke negative effects and feelings in the reader. taken up mental disorder/ health topics with novels like Thirteen Reasons Why (2017) or Looking for Alaska (2006). Both novels present teachers with possibilities and challenges on how to discuss issues like suicide or depression, where difficult teaching situations might occur with students identifying with characters suffering from depression or when discussing negative coping strategies presented in the text. Regarding their discourse competence, students might also need guidance on, for example, how to write a characterisation for a depressed character without engaging in stereotyping practices. Additionally, the multimodal opening of the literary canon might support MHL. A study by Tse et al. (2015) suggests that developing multimodal literacies assists students in critically reflecting upon (mental) health information in digital formats. Graphic novels or interactive narratives might similarly support this development. Overall, less restrictive ideas of what literature can be allows not only for topics like mental health to be embedded into ELE but also for new (digital) forms of linguistic and multimodal (re)presentations to be considered. Social representations of mental health represent a discourse of collective power which shapes how such topics are conveyed and talked about (Neto et al. 2017: 736). Studies on mental health reporting in newspapers revealed, for example, that negative depictions account for 39% of reporting in the US (Corrigan et al. 2005), with Thornicroft et al. (2013) identifying a similar level in England. Literature is here argued to equally shape (and having been shaped) by discourses of what constitutes good and bad mental health but is less direct in its portrayal (see Mar & Oatley 2008; Richmond 2014). While the idea of literature as a mirror is well-established, literature is not an objective (re)presentation (see Volkmann 2019: 31). Consider for example, the portrayals of illness in classical novels like One Flew Over the Cuckoo’s Nest (1962) or Mrs. Dalloway (1925) in contrast to The Perks of Being a Wallflower (1999) or Thirteen Reasons Why (2017). By selecting appropriate texts that allow students to engage with topics of mental healthm, MHL can be taken up in ELE. Here literature can then be a valuable instrument for promoting MHL where the depiction of characters with mental disorders can lead to learning about symptoms. Teachers could also reflect on the (re)presentations of mental disorders in literary texts and how it supports or breaks down misconceptions. Building upon the three aspects, how this can be done is explored in the following section with the digital genre of HTF. Similar to how the invention of the printing press made the reproducible written word the medium of choice for knowledge distribution and literary experiences, advancements in technology have made multimodal forms like digital storytelling 6 (e.g., television, movies, interactive stories, computer games, etc.) commonplace in the 21 st century (Smed et al. 2021: 10). Digital literature broadly refers to a category of storytelling that is intentionally produced with technology and meant to be consumed on digital devices (e.g., computer screens, smartphones, etc.). Unlike e-books which are electronic copies that mirror their paper origin (Heinz & Hesse 2014: 89), digital-born forms utilize their technological possibilities for new forms of storytelling. This allows for crafting and presenting narratives that would have been “unthinkable with the materiality of print and pagebound books” (Lütge et al. 2019: 521). A digital-born text consequently “would lose something of its aesthetic and semiotic function if it were removed from that [digital] medium” (Bell & Ensslin 2011: 311). The development of MHL for adolescents has recently seen a focus on utilizing such digital formats, for example so-called ‘serious games’ (see Michael 2006). Broadly defined as games where the goal goes beyond simple enjoyment, these are close to Aarseth’s notion of ‘ergodic literature’ as requiring non-trivial effort to take part in reading (1997: 1). According to Jorm (2020: 154), ‘serious games’ 7 can increase adolescents participation in mental health topics and might better reach younger males, who are less drawn to traditional offers. HTF seems to be able to fulfil a similar function and its inclusion in ELE might open new ways to approach difficult issues such as MHL. 6 I speak generally of storytelling, because it describes the most fundamental form of narrative experience; the telling of (non)fictional experiences for a variety of purposes such as explanation, escapism, entertainment, etc. 7 An example might be SPARX, see https: / / landing.sparx.org.nz/ . Furthermore, keeping in mind the expansive view of literature and the significance of multimodal practices in ELE, incorporating new storytelling formats such as HTF can allow educators to promote a more nuanced understanding of how the written word (which after all remains central in society) can be linked with other modes of meaning-making (see, e.g., Kress & van Leeuwen 2010; Bezemer & Kress 2016; Bateman, Wildfeuer & Hiippala 2017; Cope et al. 2017). In this regard, HTF is a distinctive textbased genre of digital fiction, which can easily be multimodally supported. This makes it an ideal ‘stepping stone’ genre for ELE which can be used for the development of digital literacy and other multiliteracies. Figure 6 outlines how students might move from traditional written print-based forms of communication to other forms of multimodal meaning-making, where teachers would support the development through meaningful engagement with different text types, such as HTF, that rely strongly on the written word but include other modes to support their writing (e.g., visual ones). The question remains, however, why educators should consider using HTF to foster MHL, especially as it is a genre most people have either not heard of or know only as the digital counterpart of the once popular Choose-Your-Own-Adventure (CYOA) books. Following a brief overview of the genre, the next section outlines its suitability for contributing to MHL. Hypertext, coined by Theodor Nelson, describes the linking of digital texts (so-called nodes) into an interwoven environment, where hyperlinks establish purposeful connections between digital files with the most well-known example being the internet (Ensslin & Skains 2017: 2). Building upon this textual linking capability, HTF is the use of links for storytelling purposes which allow the reader to influence the story (see Holt 2022: 47; see Screenshot 1). The HTF authoring platform Twine and its associated community has been repeatedly identified in the research literature as being noteworthy in its dealing with sensitive and difficult issues (see, e.g., Friedhoff 2013: 1-2; Harvey 2014: 97; Braganca et al. 2016: 944; Ensslin et al. 2016: 181; Thevenin 2017: 2; Skains 2019: 6; Salter & Moulthrop 2021: 8). Nonetheless, apart from one study (Ensslin et al. 2016), the author has not encountered any investigations that specifically address how HTF created in Twine could be used to support mental health. Considering both HTF and the Twine community through an affordanceoriented perspective, three reasons are presented why such stories are valuable to consider for the development of MHL in ELE. These will be explored in the next sections but are briefly summarised as: 1. The ‘immersion-breaking’ nature of HTF hinders students from becoming too absorbed in the story and provides an extra layer of safe narrative space. 2. The ‘non-mainstream’ community surrounding Twine offers a rich and accessible source of HTF stories that allow educators to bring unusual narratives into the classroom, especially stories that engage in the (re)presentations of mental disorders. This can potentially provide mental health information and function in anti-stigmatising ways. Twine itself might also support expressive/ personal writing in productive approaches in which students create their own stories with the added multimodal possibilities, focusing on personal topics or struggles in their everyday life. 3. Some of the medium-specific affordances of HTF allow the topic of MHL to be experienced within ‘novel narrative designs’ which cannot be encountered in traditional literature. These can offer insights into the multicausal nature of mental disorders. First generation HTF writers, such as Joyce (1990), Jackson (1995) or Moulthrop (1991), used the program Storyspace 8 to create hyperlinked literary texts characterised by non-/ multilinear narrative structures. In these, the reader clicks on a link to interact with the story (or indeed stories) and is thus able to shape the branching narrative, while continuously being “reminded of […] paths not taken, voices not heard.” (Aarseth 1997: 3). The concept of interactive storytelling is intriguing as it allows readers to actively guide the unfolding of narrative events instead of being passive observers (Smed et al. 2021: 3). However, the interactive aspect of HTF simulates autonomy rather than granting it. While the reader is free to choose between links on the surface, the underlying structure between the nodes is still deliberately designed by the author. The reader can thus only navigate the branching story by using the paths provided but is unable to take any actions outside of them (e.g., in Screenshot 1 it would not be possible to take the bottle and throw it). Thanks to this trait, HTF can deliberately heighten and diminish the reader’s awareness of authorial control through the ‘illusion of choice making’. 9 Additionally, with there often 8 As Storyspace predates the internet these stories were sold on disks and referred to as electronic literature. 9 A fitting term one of my students used in her hypertext fiction story. being no traditional ending or final page to reach, it is up to the reader to reach their own conclusion. This search for closure invites the reader to reread the story with different possible purposes, for example, finding the best or most interesting ending or to “understand the story” (Mitchell & McGee 2012: 104). However, as Mangen & van der Weel (2017: 167) note, while scholars interested in HTF (and postmodern literary theories especially, see Ensslin & Skains 2017: 5) suggested several reasons why it should have appealed to readers, it failed to attract public interest. One reason for this marginal status might be that the disruptive tendency of non-linear reading in HTF stands fundamentally at odds with the passive following of a story one associates with literary fiction. Readers favour an immersive reading experience, in which they (often emotionally) engage with characters, plot, and the fictional world while passively following the events drawn up by the author and where the pleasure of reading fundamentally stems from becoming “lost in the book” (Mangen & van der Weel 2017: 171; 168-171). This seems to not occur in HTF, as empirical studies found its active choicemaking component to disrupt the reader’s passive reading; leaving them “frustrated, disoriented, [and] confused” (Mangen & van der Weel 2017: 170). As such, the immersion-breaking characteristic seems to be one reason why the HTF genre was quickly replaced by other digital forms (Smed et al. 2021: 14). Given its non-closure format and immersion-breaking quality, a current trend in HTF leans towards less open-ended narrative designs and the integration of game-like multimodal features (Ensslin et al. 2016: 179), with superior ways of encoding complex data (e.g. music, pictures, etc.) allowing for the easy integration of multimedia elements (Ryan 2006: 148). While decision-making through links remains at the heart of the genre, these technical features support the writing. HTF authoring systems like Twine or Inform7 can thus enable a variety of designs, be they game-imitating (e.g., inventories or status bars), multimodally supported (e.g., visual and audio) or experimental. The Twine community especially has received scholarly and media attention for its use of HTF storytelling in nonmainstream ways to address difficult topics. - Twine is a cost-free, user-friendly, open-source tool developed by Klimas in 2009. It is an HTF authoring program that allows a single person to create interactive choice-based stories by linking text passages within an easy-touse graphical interface. 10 Twine stories are viewed and shared as HTML 10 It is available for Windows, Mac and Linux but can also be used online. Twine and its online resources are primarily written in English but community translations (including German) can be selected. files, a nearly ubiquitous data format readable by any web browser. The platform is built around the idea of removing hardware and knowledge barriers with neither a high-end computer nor experience in coding or programming being required to use Twine (Salter & Moulthrop 2021: 11). The affordances of Twine, its easy creation and HTML sharing possibilities, result in an unrestrictive publication process without any quality control by a publishing authority (unlike the early Storyspace system, see O’Sullivan 2021: 256). 11 Similar to some Fanfiction genres, this allows Twine to take up “taboo content” (Friedhoff 2013: 8) such as MHL. Twine rose to prominence with the so-called Twine revolution, which originated with indie game developer Anthropy (2012) promoting Twine as a tool for the creation and telling of stories that the male-dominated gaming industry would not consider. As a result, Twine has been argued to challenge the “Hegemony of Play” (see Fron et al. 2007: 309; also Harvey 2014: 96) going against the assumptions of themes, design elements, and topics that appeal to the target demographic of digital games, predominantly white heterosexual men (Braganca et al. 2016: 937). Analogous to (re)presentations in literature, games also reflect “normative discourses […] [that] teach […] and reinforce the division between the acceptable and unacceptable” (Peele 2007: 2). Twine’s prominence for engaging in non-mainstream topics is arguably fuelled by its non-commercial and accessible nature (Ryan 2006: 152). Facilitated by the absence of a publishing authority, it is the community that promotes stories. Digital fiction communities reflect in their stories a set of aesthetic, social, and cultural values and practices (Eskelinen, Koskimaa & Di Rosario: 235-236). Twine might consequently be called a tool for resistance (see Braganca et al. 2016, 938), as the community places emphasis on storytelling and not on game-design (with Twine itself referring to any product created within it as a story) and reflects such assumptions in the paratexts and stories that it endorses (Harvey 2014: 97). To summarize, because of its affordances, the characterisation it has received and the authors it has attracted and still attracts, Twine is a prominent storytelling space for difficult topics and non-mainstream (re)presentations, including LGBTQ+ experiences, discrimination, and mental disorders. One prominent example is the Twine story Intake by Maddox Pratt (2012), a brief but fast-paced CYOA-style narrative in which the reader partakes in a conversation with a mental health provider. In the story, the healthcare worker asks the protagonist several questions and the reader selects the answers, simulating a diagnostic conversation. However, only by selecting the correct answers can the reader advance the story. With this mechanism, the story critically explores disempowerment in the mental 11 Which might be why Storyspace authors continue to be referred to as they indicate some sort of sociocultural value, as “we assume, rightly or wrongly, something about self-published literature” (O’Sullivan 2021: 256). health context. Another example is the (semi-)fictional piece Conversations With My Mother (2013) by merritt kopas who identifies as a trans woman. Here, the reader selects the answers of the author’s mother during a conversation with her daughter while discussing the gender transition, having to choose language elements (such as pronouns or name), as well as conversation topics to engage in or to omit, making it a story about discovering someone’s queerness. Additionally, HTF writing favours small-scale explorative choice-making, which Salter (2016: 1) notes make it suitable for portraying emotional discourses, especially with the accessible affordances of Twine. As a result, HTF lends itself quite naturally to writing about personal topics (Hudson 2014). This particular characteristic of Twine stories has led some to refer to them as “personal games” (Harvey 2014: 98-99) or to view them as forms of “expressive writing” (Ensslin et al. 2016: 195). Such a writing format might be interesting to consider for creative writing in ELE. In such a productive approach, students could be encouraged to first produce a suitable situation for a decision-based story. They would then need to imagine possible (realistic) choices and their outcomes while reflecting on their effects and interplay within a branching narrative. Additionally, learners would need to carefully plan and connect these choices and consider if and how to portray or enhance them multimodally before creating the final product. In structural terms, this would be a complex creative writing undertaking that also allows students to integrate and bring important personal topics into the classroom in a novel narrative format. Moreover, the community aspect of digital literature writing might be important to consider (Peterson et al. 2022: 1950). Like adolescents who engage in fanfiction writing find digital affinity groups (Jacobs 2013: 3), digital fiction spaces like Twine are also “community centred” (Eskelinen, Koskimaa & Di Rosario: 235). Students who created HTF in school may decide afterwards to engage with the community, for example by publishing stories. As the Twine community is considered supportive of newcomers and open to discussing challenging subjects, this might lead to other forms of contact with MHL-related topics. - Finally, HTF conventions can display narratives with novel ways of (re)presenting mental health. In her study on how Twine stories encourage empathy interaction, Salter (2016) identified several Twine/ HTF characteristics which resonate with mental health topics. As these features are difficult to portray in a vacuum, they will be outlined in connection to the HTF story Depression Quest (2013) as to how they could be discussed with learners of English. The prominent (and contextually complex 12 ) HTF Depression Quest (2013) created by Quinn, Lindsey, and Schankler narratively simulates the experience of suffering from depression. The story is text-based and only lightly multimodally supported with music and a selection of images (photographs at the top of the page) reinforcing a gloomy atmosphere. The first page of the story is notably situated on a metatextual level and gives contextual information where the authors outline the intention of the story, provide a trigger warning, and supply links to real-life mental health providers and an emergency contact number. The story begins on the second textual node, with the reader being introduced to the character’s situation and background information being available through a number of links. In the typical form of HTF, the reader follows the protagonist (who suffers from undiagnosed depression) and at pre-defined points selects choices for them to advance the story. Right from the start, one choice, notably the seemingly healthiest one given the situation, is crossed out and unavailable), forcing the reader to select what they believe to be the next best option: 1. Order some food, grab a drink, and hunker down for a night of work. 2. Reluctantly sit down at your desk and try and make yourself do something 3: Turn on the TV, telling yourself you just need a quick half hour to unwind from work 4: Crawl into bed. You're so stressed and overwhelmed you couldn't possibly accomplish anything anyways. This limitation continues throughout the story and as some outcomes are difficult to anticipate, the reader might (often unintentionally) pick options that worsen the depression. This in turn restricts more options and allows the mechanical layer of the story to rapidly (and forcefully) display a depressive downward spiral that cannot be undone and requires a restart if one wants to arrive at a more positive ending. Furthermore, the narration style in Depression Quest is a 2 nd person narrator, which in the literary context is often associated with reader personification and the portrayal of internal discourses. Here, Depression Quest reflects the broader conventions of HTF, where choice-based narratives invite the use of present tense, the progressive and imperatives (commonly below the descriptive text) to show the reader’s shaping of the story. While such a storytelling style supports the illusion of choice, it also contributes to the immersion breaking aspect as reflecting on the story choices and their possible outcomes is required. Consequently, the reader is prevented from 12 DQ (sadly) is strongly connected to the online harassment campaign ‘Gamer Gate’, where Zoë Quinn was a main target of a misogynistic, anti-feminism and antidiversity online gaming movement. identifying with the protagonist completely (Bell & Ensslin 2011: 313) and this type of reading might be better characterised as “forced participation” (Walker 2001: 19). However, the narration style also allows for different roles to be taken up by the reader, for example they might select choices that seem most realistic given the protagonist (affective empathy focused), the choices might reflect what they themselves would do (personificationand reflection focused), or they might assume responsibility for the protagonist and strive to make good choices for them (cognitive empathy focused). The last role is arguably implied as the objective in Depression Quest as the story displays a (game-like) status bar below the hyperlink area which signals the character’s mental state and changes depending on the options selected (see Screenshot 3). It depicts three pieces of information: if the character is seeing a therapist, if the character is taking medication as well as outlining the general energy level of the character. The goal (or quest) of the story seems to be to change these three situations for the betterment of the protagonist. Overall, the limited range of choices and the 2 nd person narration in Depression Quest ask the reader to reflect on positive and negative forms of mental health action while stressing that the best-seeming choice may be impossible for someone suffering from depression. This restriction placed on the mechanical layer encourages a reflected understanding of how depression might 13 feel, while the constant questioning and reflection on mundane as well as meaningful choice-making situations supports antistigmatisation as it draws attention to flaws in the reader’s perception as what they regard as an easy or obvious choice might be perceived differently by someone with a mental illness. Overall, this supports de-stigmatisation and can aid the development of affective and cognitive empathy towards people suffering from this mental disorder, especially if actively discussed and analysed with students in ELE. Furthermore, the ambiguity of the 2 nd person narration allows for different reading roles to be assumed by the reader, potentially adding emotional distance. Experiencing and reflecting on these different reading roles and their textual implications can enhance students’ language learning and MHL as they actively analyse situations within the narrative. This fosters critical thinking and encourages learners to think about their own perspective and choice making. Overall, incorporating interactive narratives in ELE engages students with language in new and meaningful ways. Overall, HTF allows for new possibilities to explore mental health topics in ELE that are different, and arguably novel, in comparison to other literary forms. Stories like the one mentioned above, while still fictional, may help in better grasping the challenges faced by people suffering from mental disorders, resulting in more nuanced (re)presentation(s). Novel design 13 As this is still a narrative and deliberate (re)presentation that is not reflective of reality or individual experiences. identifying with the protagonist completely (Bell & Ensslin 2011: 313) and this type of reading might be better characterised as “forced participation” (Walker 2001: 19). However, the narration style also allows for different roles to be taken up by the reader, for example they might select choices that seem most realistic given the protagonist (affective empathy focused), the choices might reflect what they themselves would do (personificationand reflection focused), or they might assume responsibility for the protagonist and strive to make good choices for them (cognitive empathy focused). The last role is arguably implied as the objective in Depression Quest as the story displays a (game-like) status bar below the hyperlink area which signals the character’s mental state and changes depending on the options selected (see Screenshot 3). It depicts three pieces of information: if the character is seeing a therapist, if the character is taking medication as well as outlining the general energy level of the character. The goal (or quest) of the story seems to be to change these three situations for the betterment of the protagonist. Overall, the limited range of choices and the 2 nd person narration in Depression Quest ask the reader to reflect on positive and negative forms of mental health action while stressing that the best-seeming choice may be impossible for someone suffering from depression. This restriction placed on the mechanical layer encourages a reflected understanding of how depression might 13 feel, while the constant questioning and reflection on mundane as well as meaningful choice-making situations supports antistigmatisation as it draws attention to flaws in the reader’s perception as what they regard as an easy or obvious choice might be perceived differently by someone with a mental illness. Overall, this supports de-stigmatisation and can aid the development of affective and cognitive empathy towards people suffering from this mental disorder, especially if actively discussed and analysed with students in ELE. Furthermore, the ambiguity of the 2 nd person narration allows for different reading roles to be assumed by the reader, potentially adding emotional distance. Experiencing and reflecting on these different reading roles and their textual implications can enhance students’ language learning and MHL as they actively analyse situations within the narrative. This fosters critical thinking and encourages learners to think about their own perspective and choice making. Overall, incorporating interactive narratives in ELE engages students with language in new and meaningful ways. Overall, HTF allows for new possibilities to explore mental health topics in ELE that are different, and arguably novel, in comparison to other literary forms. Stories like the one mentioned above, while still fictional, may help in better grasping the challenges faced by people suffering from mental disorders, resulting in more nuanced (re)presentation(s). Novel design 13 As this is still a narrative and deliberate (re)presentation that is not reflective of reality or individual experiences. elements, such as restrictive choice making, can invite personal reflection and encourage cognitive empathy development. Furthermore, especially Twine stories show an unusual openness for including characters with mental disorders within their community of practice. This may make it a valuable space to consider given its acclaimed uptake of taboo topic, where the representation in stories can empower individuals who feel marginalized due to their mental health issues. Taking up HTF in expressive writing formats in ELE would allow students to craft stories highlighting personal struggles. Through this, they may take ownership of their experiences and feelings which can lead to a sense of empowerment crucial for mental well-being. However, further research investigating such productive approaches would be needed. MHL is entering the school context but integration efforts are still “patchwork” (Weist et al. 2017: 345). As an integrated educational approach currently seems distant, language teachers and researchers might want to consider how MHL could be addressed in subjects such as ELE. In this article I have shown that the rather unusual genre of HTF has potential for fostering interaction with mental health topics in ELE. Similar to other literary texts, HTF can be used to promote empathy or reflect on the (re)presentation of mental disorders in narrative formats. However, communities like Twine, the immersion-breaking nature of HTF and the novel narrative design possibilities make HTF stand out. Additionally, a cognitive empathy focused reading seems to align with the branching explorative nature of the genre. While such possibilities would need to be carefully facilitated by teachers, especially given the difficult nature of the subject, they highlight some possibilities how HTF could be an interesting genre for the integration of MHL in ELE. Especially its unusual (or novel) storytelling format and the taboo-embracing Twine community present teachers with entry points to facilitate meaningful interaction with mental disorders and their (re)presentation. Furthermore, the decision-making style of HTF as a form of personal story co-creation may support a safe(r), immersion-breaking reading that seems valuable for reflective and cognitive empathy development, with the non- / multilinearity of HTF perhaps better reflecting the multifaceted nature of mental disorders. HTF thus seems well suited as one genre among many to engage learners in MHL related topics, by fostering critical thinking, reflection, and a broader understanding of mental disorders. Although the features and dimensions discussed seem promising, further research is clearly needed. Among other aspects, it should focus on evaluating and identifying possible texts in terms of topic portrayal, as well as age and language appropriateness. Although Twine seems like a rich narrative space, the language levels and aesthetic complexity displayed in many HTF stories seem generally too advanced for younger learners. Furthermore, the same (small) canon of HTF tends to be referred to in the literature, potentially indicating the discussed lack of quality control as a challenge in terms of identifying suitable stories. However, such an assessment could align with research questioning how HTF might support the development of language competences in ELE, going beyond the literary dimension discussed in this article. In this regard, language education researchers might also want to think about how the language in HTF affects our perception of mental disorders in contrast to print literature with both forms ideally being combined. Finally, it would be important to empirically identify and evaluate design features that appeal to or hinder the reading of readers (see Ensslin et al. 2016: 189). In summary, this article has found HTF, despite its relative niche status, to offer several innovative opportunities for integrating MHL into ELE within a subject-specific framework. 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