From the Couch to the Street: Applications of Psychoanalysis to Work with Individuals Who Are Homeless and Mentally Ill

Current-day psychiatric treatment of severely disturbed populations tends to focus on the biological, behavioral, and social dimensions of rehabilitation. This paper addresses the relative neglect of the complex psychodynamic and interpersonal aspects of treatment of individuals who are homeless and mentally ill by presenting two clinical cases that are discussed from various psychoanalytic frames of reference. Based on their clinical experiences, the authors conclude that psychoanalysis offers valuable frameworks to guide the treatment process and the structure of the treatment setting for individuals who are homeless and suffering from severe psychiatric illness.     

Consumer Preference Programs for Individuals Who Are Homeless and Have Psychiatric Disabilities: A Drop-In Center and a Supported Housing Program

We illustrate Fairweather's approach to Experimental Social Innovation and Dissemination with two experimental studies of programs to reduce homelessness for 168 and 225 people with mental illness and often substance abuse. Literally homeless participants were randomly assigned to programs that emphasized consumer choice or to the usual continuum of care, in which housing and services are contingent on sobriety and progress in treatment. A drop-in center that eliminated barriers to access to services was more successful than control programs in reducing homelessness, but after 24 months only 38% of participants had moved to community housing. A subsequent apartment program, in which individuals in the experimental condition moved to subsidized apartments directly from the street, with services under their control, had 79% in stable housing (compared to 27% in the control group) at the end of 6 months. Groups in this study did not differ on substance abuse or psychosocial outcomes.     

Homelessness in the US and Germany: a cross‐national analysis

A public opinion survey was administered by telephone to nationally representative samples in the US and Germany to assess prevalence of homelessness as well as attitudes, opinions and knowledge regarding homelessness. Lower prevalence rates were found in Germany as compared with the US. German respondents demonstrated higher levels of general compassion, greater support for the public rights of the homeless, a greater tendency to view the homeless as trustworthy, and were more likely to view economic factors and less likely to view personal failings as integral to the problem of homelessness. Respondent age, gender, and political affiliation predicted many public opinion variables. Copyright © 2003 John Wiley & Sons, Ltd.     

The Tao of a peaceful mind: the representation of emotional health and healing in traditional Chinese literature

This paper explores the representation of emotional health and healing in traditional Chinese literature, and the holistic relationship between traditional Chinese mental medicine and literature as well as philosophy. The philosophical, moral and aesthetic significance assigned to emotional health and healing not only inspired but also mandated the representation of these subjects in Chinese literature. For many Chinese readers, emotional health is more than a medical concern but is integral to their moral and spiritual wholesomeness, the attainment of which necessarily involves the edifying role of literature. The literary representation of emotional health and healing gave rise to a subculture of emotional health and a medical dilettantism in Chinese society. The mutual inclusivity of the professional and the amateurish is peculiar to traditional Chinese mental medicine. While facilitating popular appreciation of emotional health and helping to validate the legitimacy and efficacy of emotional healing, such a phenomenon also caused a certain degree of charlatanization that undercut the rationality and validity of mental medicine. An investigation into the relationship between traditional Chinese literature and mental medicine provides an interdisciplinary perspective from which to examine the latter's history, theory, and practice, thus shedding a cross-cultural light on modern psychology and psychiatry.     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.     

Commentary: How Individual and Profession-level Factors Influence Discussion of Disability in Prenatal Genetic Counseling

Hodgson and Weil (Journal of Genetic Counseling, 2011) reports on two interactive workshops in which genetic counselors identified a broad set of counseling issues that may be impediments to promoting an adequate discussion of disability in prenatal genetic counseling. The present commentary discusses two factors that we infer underlie these counseling issues. First, countertransference concerning disability, which is normal and expected, may influence genetic counselors’ decisions about raising and exploring the complex topic of disability in prenatal genetic counseling. Second, the limited involvement of the profession of genetic counseling in the complex social and ethical issues of disability provide little guidance to the individual genetic counselor with respect to discussing disability in prenatal diagnosis counseling. We suggest both factors must be acknowledged and addressed in order to adequately implement the recommendations presented in Hodgson and Weil (Journal of Genetic Counseling, 2011) as well as other efforts to increase discussion of disability in prenatal diagnosis counseling in the service of informed decision making.     

Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.     

Engagement and Interaction: A Comparison Between Supported Employment and ATCs

The interaction and engagement patterns of 13 supported employees and 38 regular Adult Training Centre (ATC) attenders were compared. Data were obtained through direct observation within 13 employment sites and a representative sample of ATC organised activities. Results indicated that individual involvement was significantly higher in employment, compared to ATCs, but that the ATC group experienced significantly more social interaction, mainly due to higher levels of task specific dialogue between individuals and the service staff within ATCs. A breakdown of with whom interactions occurred revealed that individuals in ATCs tended to interact more often with care staff than anyone else. Individuals tended to interact more often during work with their non-disabled co-workers and a substantial proportion of time was spent interacting with the public. These findings suggest that the supported employment option yields advantages for individuals in some key aspects of community integration, compared to ATCs.     

Religious delusions and filicide: a psychodynamic model

In this article, we present a psychodynamic explanation for the complex crime of filicide motivated by religious delusions. To begin, we provide an overview of filicide, including its typology and epidemiology. Second, we examine the psychoanalytic theories of Heinz Kohut and Otto Kernberg so as to better understand how family-of-origin experiences add to the ways in which psychotic disorders later take shape in filicide cases. Third, we offer an explication of the psychology of religion, including the role that religious defences and religious delusions play in cases involving filicide. Ultimately, we hypothesise that mothers with religious delusions commit acts of filicide due to the dynamic and reciprocal interaction between mental illness, psychological functioning, and the psychological role played by religion. We conclude our article with a case illustration to demonstrate our theoretical model.     

刺激强度与个体差异对心理生理测谎的影响

探讨不同说谎经验的被试在完成不同刺激强度的任务时,其生理反应和说谎分数的变化。结果表明,在测谎过程中,任务刺激强度不仅影响测试结果的有效性,而且与被试的生理反应和说谎分数成正相关;不同类型被试的说谎分数没有显著差异,测谎应对任何人群都普遍有效。     

The Context of Caretaking in Rural Areas: Family Factors Influencing the Level of Functioning of Seriously Mentally Ill Patients Living at Home

After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers’ social support were tested in a model of caretaking that examines the relationship between these factors and patients’ symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.     

Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm

In this article, I argue that (1) transgender adolescents should have the legal right to access puberty-blocking treatment (PBT) without parental approval, and (2) the state has a role to play in publicizing information about gender dysphoria. Not only are transgender children harmed psychologically and physically via lack of access to PBT, but PBT is the established standard of care. Given that we generally think that parental authority should not go so far as to (1) severally and permanently harm a child and (2) prevent a child from access to standard physical care, then it follows that parental authority should not encompass denying gender-dysphoric children access to PBT. Moreover, transgender children without supportive parents cannot be helped without access to health care clinics and counseling to facilitate the transition. Hence there is an additional duty of the state to help facilitate sharing this information with vulnerable teens.     

Public, Social, and Individual Perspectives on Religious Education. Voices from the Past and the Present

Inspired by Charles Taylor’s recent quest for the meaning of religion today, this article concentrates on the question of the meaning of religious education (RE) today. The focus is not so much on the ‘what’ but instead more on the ‘where’ (the locus) and the ‘how’ (the function) of RE. The view on what is held to be a pedagogically tenable position regarding RE is build up by methodologically using a differentiated practical–theological three-course model that distinguishes between the public, the social and the private domain. Developments and tendencies within the three domains are shown in respect with religion as such and RE in particular. It is made clear what this may mean for religious educators and philosophers of religious education today, who conceptualize religious education as an impossible possibility. Miedema is full professor of Educational Foundations, Endowed professor of Christian Education in and Dean of the Faculty of Psychology and Education, and full professor of Religious Education in the Faculty of Theology, Vrije Universiteit Amsterdam, The Netherlands. His research is focusing now on pragmatism, history of education, the philosophy of religious education, and early childhood education.     

The typology of parricide and the role of mental illness: Data-driven approach

Parricide is a rare type of homicide in which mental illness is often an important factor. The aims of this study were (a) to describe the characteristics of parricide offenders with a focus on mental illness and clinical care and (b) to examine Heide's widely used typology of parricide through a data-driven approach. We analyzed all homicides in England and Wales between 1997 and 2014. Parricide offenders in our sample were most often male, unmarried, and unemployed, with a third of offenders diagnosed with schizophrenia; 28% had been in contact with mental health services before the offense. The latent class analysis resulted in three types of parricide offenders: middle-aged with affective disorder, previously abused, and seriously mentally Ill, which confirmed, to an extent, Heide's typology. Health and social care services should actively engage with carers of people with mental illness and support to those caring for older relatives and victims of abuse.     

The massacre mentality and school rampage shootings in the United States: Separating culture from psychopathology

School rampage shootings in the United States are becoming a common occurrence. The purpose of this article is place school rampage shooting in a broader cultural context. Specifically, in this article, I introduce the concept of the “massacre mentality” as a cultural manifestation of western and southern U.S. values. The massacre mentality is a state of mind in which the individual feels justified in committing indiscriminate killings in defence of honour, protection of property, assurance of absolute personal safety, or the elimination of challenges to the “natural order” from the perspective of the offender. A review of the social psychological literature will contrast the massacre mentality with related concepts of “culture of honour” and “sanctioned massacre.” The relationship between street violence, another major form of violence, and the massacre mentality is also addressed. A cultural analysis suggests that interactions between individual psychology in the form of U.S. regional values and sociocultural context of schools contribute to school rampage shootings more often than mental illness. The prevention of school rampage shootings will require the identification of students predisposed to adopt the values contributing to the massacre mentality and challenging social hierarchies by restructuring the context of schools, as well as changing cultural norms in the broader society. The ultimate goal is to create a U.S. culture where the massacre mentality is obsolete.     

Using Force: Australian Newspaper Depictions of Contacts Between the Police and Persons Experiencing Mental Illness

The media creates and sustains knowledge about socially relevant issues such as crime, mental illness, and policing. Past research suggests that while the media portrayal of the police is undoubtedly complex, their portrayal of people experiencing mental illness remains mainly negative. The depiction of their encounters in the mass media is of considerable interest because of the influential role the media has on public opinion and debate; however, there is a lack of current research in this area. This study aimed to examine media items in the major newspapers across Australia between January 2006 and December 2007 (n = 77) to investigate their portrayal of this interface. The dominant themes encountered in the initial analysis depicted people experiencing mental illness as dangerous and a threat to the public, where the mental health system has failed to manage them adequately. Further analyses found that people experiencing mental illness were stigmatised in a third of the media items reviewed and were represented significantly more negatively in these encounters than the police. Implications of these findings and some suggestions regarding possible strategies that could improve socially responsible media reporting and public discourse on mental illness are proposed.     

Imagined contact and mental illness stigma in an Asian context: Bolstering the effect and examining the impact of factual information

Imagined contact can be effective at reducing social stigma. However, the effect may depend on the strength of the stigma held. We tested the robustness of imagined contact in an Asian setting where stigmatization of mental illness is stronger than in Western countries. In Experiment 1 (n = 167) with five conditions, only an enhanced version of positive imagined contact was able to decrease stigma towards people with schizophrenia through decreasing intergroup anxiety. Given the potential discrepancy between imaginations and reality about experiences with stigmatized groups, in Experiment 2 (n = 121), we tested the hypothesis that after presenting participants with factual information about a mental illness group, imagined contact might backfire, resulting in more negative perceptions. However, enhanced imagined contact alongside factual message about schizophrenia did not increase stigma. The backfiring hypothesis was therefore not supported. Nevertheless, providing realistic information did negate the positive effects of enhanced imagined contact on stigma reduction. In both experiments, we also showed that intergroup anxiety mediated the effect of enhanced imagined contact on various measures of stigma.     

Highlighting the Way Forward: A Review of Community Mental Health Research and Practice Published in AJCP and JCP

Articles published in the two most prominent journals of community psychology in North America, the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP), provide a clear indicator of trends in community research and practice. An examination of community psychology's history and scholarship suggests that the field has reduced its emphasis on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses over the past several decades. To further investigate this claim, the current review presents an analysis of articles relevant to community mental health (N = 307) published in the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP) from 1973 to 2015. The review focuses on article characteristics (e.g., type of article and methods employed), author characteristics, topic areas, and theoretical frameworks. Results document a downward trend in published articles from the mid‐1980s to mid‐2000s, with a substantial increase in published work between 2006 and 2015. A majority of articles were empirical and employed quantitative methods. The most frequent topic area was community mental health centers and services (n = 49), but the past three decades demonstrate a clear shift away from mental health service provision to address pressing social issues that impact community mental health, particularly homelessness (n = 42) and community integration of adults with serious mental illnesses (n = 40). Findings reflect both the past and present state of community psychology and suggest promising directions for re‐engaging with community mental health and fostering well‐being, inclusion, and liberation of adults experiencing serious mental health challenges.     

Mechanical Chair Massage and Stress Reduction in the Seriously Mentally Ill Consumer: A Preliminary Investigation

In the present study, the authors evaluate the effectiveness of a mechanical massage chair in reducing stress for people with serious and persistent mental illness. This preliminary investigation involves the use of massage therapy for 19 people with serious mental illness, using a standardized massage protocol. Stress levels were assessed using a 7-point Likert scale, administered before and after each treatment session. Self-reported stress was found to be significantly reduced, with participants reporting an average stress reduction of 1.48. This preliminary investigation demonstrates that use of a mechanical massage chair can significantly reduce self-identified stress levels in persons with serious mental illness.     

On the Relation Between Job Characteristics and Depression: A Longitudinal Study

The current study assumes that workers actively influence the characteristics of their work environment. Not only will one's work environment (job characteristics) affect personal characteristics, such as feelings of depression; depression in turn is expected to affect the characteristics of one's work environment as well. Using a sample of 593 young Dutch workers, a longitudinal model relating feelings of depression and job characteristics to each other was tested using structural equation modeling. The results largely supported our expectations. Depressive workers were less likely to experience a job transition than non-depressive workers. If depressive workers did experience a job transition, work outcomes were less positive than for nondepressive workers. Thus, it appears that the relation between job characteristics and depression can be construed as a reciprocal relation. Implications and limitations of the study are discussed.