Towards a literary account of mental health from James' Principles of Psychology

The field of mental health tends to treat its literary metaphors as literal realities with the concomitant loss of vague “feelings of tendency” in “unusual experiences”. I develop this argument through the prism of William James’ (1890) “The Principles of Psychology”. In the first part of the paper, I reflect upon the relevance of James' “The Psychologist's Fallacy” to a literary account of mental health. In the second part of the paper, I develop the argument that “connotations” and “feelings of tendency” are central to resolving some of the more difficult challenges of this fallacy. I proceed to do this in James' spirit of generating imaginative metaphors to understand experience. Curiously, however, mental health presents a strange paradox in William James’ (1890) Principles of Psychology. He constructs an elaborate conception of the “empirical self” and “stream of thought” but chooses not to use these to understand unusual experiences – largely relying instead on the concept of a “secondary self.” In this article, I attempt to make more use of James' central division between the “stream of thought” and the “empirical self” to understand unusual experiences. I suggest that they can be usefully understood using the loose metaphor of a “binary star” where the “secondary self” can be seen as an “accretion disk” around one of the stars. Understood as literary rather the literal, this metaphor is quite different to more unitary models of self-breakdown in mental health, particularly in its separation of “self” from “the stream of thought” and I suggest it has the potential to start a re-imagination of the academic discourse around mental health.     

“Heaven and Hell on Earth” A critical discourse analysis of religious terms in Norwegian autobiographies describing personal experience of mental health problems

This article explores the use of religious terms in six Norwegian autobiographies written between 1925 and 2005 by people who themselves have been patients in the mental health services. Through a critical discourse analysis, we discuss the functions of religious discourse in the texts and its position in contrast to the medical discourse predominant in today's mental health services. It was found that religious (predominantly Christian) terms were used to varying degrees in all autobiographies as a means to capture the immensity and inherent ambivalence characteristic of mental health problems. Despite the “medical turn” in professional mental health discourse, there is no clear evidence of a decrease in the use of religious terms from the oldest to the most recent text. We propose that professional mental health workers to a larger extent take into account the religious dimension in therapy, and reflect on its larger historical and sociocultural context.     

Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth

Misdiagnoses of racial/ethnic minority youth’s mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: (1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth’s mental health problems are misdiagnosed? (2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included “race”, “ethnicity”, “minority”, “culture”, “children”, “youth”, “adolescents”, “mental health”, “psychopathology”, “diagnosis”, “misdiagnosis”, “miscategorization”, “underdiagnosis”, and “overdiagnosis”. Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth’s emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.     

Uncivilizing “Mental Illness”: Contextualizing Diverse Mental States and Posthuman Emotional Ecologies within The Icarus Project

This article argues humans should not be defined strictly at their physical boundaries with clear distinctions between anatomical bodies, mental states, and the rest of the world. Rather, diverse mental states, which are often diagnosed as “mental illness,” take shape within greater environmental forces and flows, including those that are constructed online. Drawing from a multi-sited ethnography of The Icarus Project, a radical mental health community, the author situates online narratives written by two of its members within posthuman emotional ecologies in which the exchange of ideas online affects mental states in a profound way. These narratives can be seen as a new type of psychiatric resistance based in new technologies, one that “uncivilizes” mental illness by searching for alternative frameworks and metaphors to understand lived experiences with mental distress. This ethnographic perspective differs significantly from traditional bio-psychiatric models and interventions and can offer both patients and mental healthcare providers with an alternative language to frame mental health.     

Melancholia and the Violent Regulation of Gender Variance: Reply to Commentaries

In this reply to James Herzog and Gayle Salamon, the “in”/“out” boundary of gender and the psychotherapeutic address of gender is considered. Particular emphasis is paid to the ways in which gender is constituted through aggressive and often violent forms of social regulation. Matters of social justice are considered as psychoanalysts and mental health workers take up normative violence in the form of policy speech. Clinical dilemmas with respect to gender melancholia, trauma, and shame are also considered.     

Workplace Violence and Worker Injury in Elderly Care Settings

Abstract

Many incidents of injury, assault, and abuse occur in health care settings. To better examine the situational context of the workplace, this paper examines whether workers providing care to elderly persons experience injuries that are consistent with the “for-profit” and “interpersonal conflict” explanations of elder abuse or neglect. Using data from the Bureau of Labor Statistics, results indicate that nursing home workers and home health care workers have higher rates of workplace injuries resulting from assaults and overexertion than do other workers. The data suggest that there are unique structural and situational factors present in the nursing home, which create a work setting vulnerable to conflict, violence, and elder abuse.     

Mental health consultation in infant day care: A new frontier of prevention

This paper deals with the mental health aspects of infant day care emphasizing that mental health input into the design, implementation and ongoing supervision/evaluation of the majority of day care programs is minimal at the present time. The author proposes the following three criteria by which the adequacy of mental health input in a day care program could be judged: 1) ongoing mental health consultation to the caregiver staff on a weekly basis and by the same clinician(s), 2) assignment of primary caregivers to the infants, 3) periodic naturalistic observations of the infants to be recorded and discussed by the caregivers. The author postulates that consultation to the caregiver staff of infant day care programs represents the opportunity to establish a new frontier of prevention. Therefore, the mental health profession should consider it a goal that every infant day care setting would have a mental health clinician as a consultant. The methods, preventive functions and manpower aspects of such consultation work is discussed.     

Wittgenstein on Understanding as a Mental State

In trying to make clear whether understanding is a mental state Wittgenstein asks a series of questions about the timing and duration of understanding. These questions are awkward, and they have posed a great challenge for commentators. In this paper I review the interpretations by Mole and by Baker and Hacker, and point out their problems. I then offer a new interpretation which shows (1) that a “mental state” in this context means a state of consciousness, (2) that Wittgenstein's questions are intended to elicit the grammars of the words “understand” and a “state of consciousness”, (3) that, in this way, he clearly shows that understanding is not a state of consciousness and (4) that he also provides a therapy to dissolve the problem.     

Creativity and mental health in everyday life

Abstract

The connection between mental health and creativity has traditionally been studied in terms of outstanding aesthetic‐professional creativity and mental illness. More interesting however, is the possible connection between “everyday “ creativity and mental health. Everyday creativity involves attacking day to day activities in a divergent way: It derives from a complex of cognitive, affective, personal, motivational, and social factors, and is characterized by openness, flexibility, autonomy, playfulness, humor willingness to take risks, and perseverance. These characteristics are also consistently emphasized in models of “normal”; personality growth, so that the possibility of promoting mental health arises by fostering creativity in day to day life. Several small studies described in this article give examples of how this might be done and the kinds of benefits which can result.     

An Ex-Patient/Practitioner's Comments on Professional- and Consumerisms,with Poetry

SUMMARY

This article, more like a stream of consciousness or conversation, touches on a personal story and leads to a clinical/political stance. It seeks to convey some of the difficulties in the field's quest to practice “consumerism,” the inclusion of mental health service recipients and ex-patients in all aspects of the mental health system. It tells part of the author's story as an ex-patient who has professionalized in the field, and offers readers the chance to ponder their roles relative to the recent phenomenon of asking consumers to participate. It concludes with poetry meant to be read as a letter to mental health workers from a composite client who seeks their support.     

Where the Rainbow Speaks and Catches the Sun

Abstract

Living with a neurobiological brain disorder, commonly known as a mental illness, requires a lifetime of diligent work toward recovery and wellness. This paper outlines the story of one occupational therapist's journey with her own mental illness. She prefers to call her own road of “recovery” one of “discovery,” as it has led her to discover true talents and gifts (strengths) even amongst encounters with old models that emphasize weaknesses and disability over abilities and capabilities. The following journey unfolds as advances in research, changes in services, increased focus on consumer as leader and increased tools and resources available lead the way toward a more positive ability to live a purposeful life, engaging in meaningful activities in spite of an illness. This paper gives a personal account as a tool to be used by other therapists as they travel along their own treatment journeyswhether with, or as consumers, of mental health services.     

A student-operated crisis center

In this article we describe an attempt to meet a university community's needs for emergency mental health services through the establishment of a student-operated telephone emergency service. The service provides an interesting model for use of nonprofessionals in mental health services, in which the professional functions primarily as a trainer and consultant rather than offering direct services. We describe the structure of the center and then discuss further innovations and projects.     

Intensive family intervention in a community consultation framework

This article describes a form of mental health consultation to community workers who have reached a state of crisis in their work with unmotivated, multi-problem families. The central part of the consultation is a therapeutic intervention that draws on principles of time extension and network intervention. The consultant sees the family together with its community workers in a one-time, intensive meeting of up to six hours duration. This meeting is divided into three phases, aimed at achieving respectively (1) structural, (2) emotional, and (3) cognitive imbalancing of the family system. This creates a new situation, which hopefully will enable the community workers and the family to move out of the crisis in which they had become stuck.     

Le modèle écoculturel: un cadre pour la psychologie culturelle comparative

The main goal of this article is to examine the epistemological foundations of the contemporary cross‐cultural psychology from a constructivist point of view. We argue for the necessity of heuristic paradigms like the eco‐cultural framework of John Berry. Such an approach can be considered as a systemic modelling of complex phenomena by a psychologist (e.g., the relations of “mind‐brain‐culture” as well as their development). At the individual level, we argue the necessity to surpass the classic distinction between competence and performance. Competences are differentiated here as “intuitive representations” (or elementary mental functions) and “reflective representations” (or superior mental functions). Intuitive and reflective representations remain at the origin of both behaviour and performance. Such systemic conception allows the theoretical possibility of a “relativist constructivism” that could be more suitable than the “absolutist constructivism” proposed by Jean Piaget.     

Burnout and psychiatric “cases”: Early evidences of an association

This exploratory study extends the phase model of burnout in a critical direction by assessing whether individuals assigned to eight progressive phases will present escalating mental health symptoms. Despite the small convenience population (N = 161), the present affirmative results encourage early replications for three basic reasons. Thus the associations with mental health reported here are consistent with numerous other tests of the concurrent validity of the phase model. Moreover, substantial proportions of the variance are explained here by data supporting the view that the progressive phases are associated with accelerating proportions of “cases,” here defined as respondents to the General Health Questionnaire (GHQ) who report four or more non-psychotic psychiatric symptoms. The GHQ form used here is modified for U.S. contexts. In addition, this basic conclusion is reinforced in three ways: by factor analysis of GHQ items; by rejecting several variables alternative to the phases as GHQ variants; and by using canonical discriminant functions to compare phase assignments with the actual group memberships of “normals” and “cases” assigned by the GHQ.     

The clinical psychologist as program consultant: When is enough enough?

One of the most influential roles clinical psychologists play in health care settings is as consultant to medical colleagues. The psychologist consultant typically approaches either clinical or programmatic questions intending to tap both empirical research and clinical judgment perspectives in trying to answer them. This paper describes a specific “program consultation case,” a not atypical consultation situation in which graduate medical education directors asked for advice about their residency training program. The purpose is to use this example to generate ideas and provoke discussion about such consultation processes and their usefulness in the health care training and service delivery world. The psychologist may be faced with questions that have meaningful implications beyond the specific consultation. What if the concerns being posed by this particular program are concerns which have been raised before, have been researched before, and have generated reasonable suggestions, conclusions, and strategies for improvement? And what if no one has paid attention, so that the questions are being raised again? When empirical and clinical data consistently combine to identify problems within health-related training or service delivery systems, and when suggestions or alternatives for their solutions have been presented and, also presumably, ignored, what does the clinical psychologist consultant do next?     

Divorce,conflict, and mental health: how the quality of intimate relationships is linked to post‐divorce well‐being

Partner relationships, including new relationships after divorce, are found to be beneficial for mental health. However, the impact of their quality remains unclear; this uncertainty applies to past and ongoing relationships between ex‐spouses as well. We study the relationship between conflict—in the prior marriage, with the ex‐partner, with a new partner—and both positive and negative mental health. Multilevel linear models are carried out on a subsample of 892 divorcees from the dataset “Divorce in Flanders.” Living together with a new partner, either in marriage or cohabitation, seems beneficial for mental health, even in cases of (high) conflict. Nevertheless, conflict places a burden on well‐being, especially for women in nonmarital relationships. Ongoing conflict with the ex‐spouse is also damaging for mental health. In contrast, prior marital conflict does not relate to lower, but to slightly higher, levels of life satisfaction after divorce.     

A Personal Note by the Guest Editor

SUMMARY

“Theological Perspectives on Ageing and Mental Health” begins by setting the scene for discussion of the topic. An exploration of the variety of meanings attributed to mental health, ageing, spirituality and religion provide a framework for what follows. The paper argues that a richly textured understanding of human personhood is a prerequisite for any analysis of ageing and mental health. A brief historical and theological sketch is provided in support of this contention. From the foundation of the human person four characteristics of mental health or well-being, especially among the aged, are developed.