Evaluating Attributions for an Illness Based Upon the Name: Chronic Fatigue Syndrome, Myalgic Encephalopathy and Florence Nightingale Disease

In recent years, considerable discussion has occurred about stigma surrounding the name given to an illness currently known as chronic fatigue syndrome (CFS). Although patients and medical personnel have expressed varying opinions on this issue, no studies have evaluated how beliefs about the illness change based upon the type of name used for diagnostic purposes. Proposals have been put forth to rename the illness with an eponym (a famous patient's or researcher's name) or with a less trivial sounding, more medically based type of name. In this study, attributions about CFS were measured in three groups of medical trainees. All groups read the same case study of a person with classic symptoms of chronic fatigue syndrome, with the only difference being in the type of name given. Trainees then were asked to provide attributions about certain aspects of the illness, including its cause, severity, and prognosis. Results suggested that, across name conditions, most trainees appeared to consider the symptom complex of CFS a serious illness resulting in poor quality of life. In addition, findings indicated that the name, chronic fatigue syndrome, may be regarded less seriously than the Myalgic Encephalopathy name with respect to some important aspects of the illness. In this study, specialty of medical trainee also played a role in how the illness was perceived.     

Understanding the Relationships Among HIV/AIDS-Related Stigma,Health Service Utilization,and HIV Prevalence and Incidence in Sub-Saharan Africa: A Multi-level Theoretical Perspective

HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.     

Influence of character strengths on mental health stigma

We examined traits of open-mindedness, kindness, hope, and social intelligence in the context of mental health stigma. Stigma – a process that objectifies and dehumanizes a person who has mental illness – diminishes people’s ability to control their behavior as coping with stigma requires self-regulation. Exploring mental health stigma through the lens of character strengths allows for understanding individual differences and kinds of characteristics that help decrease the ramifications associated with stigma of mental health. Several tasks explored the effects of character strengths on implicit and explicit mental health stigma: implicit association task, measures of willingness to interact with those with a mental health disorder, and a social distance task of self, friend, and person with a disorder. Character strengths of social intelligence and kindness were indicative of less stigma of mental health. More open-minded individuals tended to not hold individuals diagnosed with a mental health disorder personally responsible for acquiring that disorder.     

BDSM: A Subcultural Analysis of Sacrifices and Delights

This is a qualitative investigation of 73 individuals in the Bondage and Discipline, Dominance and Submission, and Sado-Masochism subculture. There is tremendous stigma attached to this subculture, and while the academic community may be increasingly accepting, the general public is not as accepting or knowledgeable. Fear of negative consequences means that many engage in secrecy and concealment strategies as protective measures. Although there is much literature on the possible consequences and the reasons for concealment, there remain gaps. Our findings reveal how many conceal to cover up or to hide what outsiders may consider immoral or otherwise unacceptable behavior. Others conceal as a means to create a distinction for themselves as part of a secret subculture. Whatever their reasons, those in this subculture engage in a variety of strategies to manage their identity and to minimize their vulnerability.     

The stigmatized perceiver: Exploring the implications of social stigma for cross-race face processing and memory

The human face is an important source of information, such as race or ethnicity, which can guide social interaction and outcomes. Research suggests that compared to majority and dominant group members, minority and subordinate group members tend to experience chronic stigma, resulting in more negative life outcomes (e.g., educational and occupational attainment). We argue that theory and research exploring face perception has not led to models that incorporate how the chronic experience of stigma may impact judgments, reflecting a gap with potential consequences for the validity and generalizability of the theories developed. We propose a framework for understanding how experiencing a socially stigmatized racial identity may lead perceivers to engage in face processing differently from their non-stigmatized counterparts. With a focus on the literature examining the cross-race effect, we explore the potential impact of chronic social stigma on three theorized moderators guiding processing and memory for same-versus cross-race faces. Our analysis suggests that future research focusing on stigmatized perceivers could help to explain some variation in findings, lead to novel theoretical development, and ultimately produce more generalizable research across several domains of inquiry.     

Self‐Stigma,Mental Health Literacy,and Health Outcomes in Integrated Care

The authors describe research on the self‐stigma of mental illness and help seeking, mental health literacy, and health outcomes in an integrated care medical center. Results revealed that self‐stigma of mental illness and self‐stigma of seeking help had an inverse relationship with mental health literacy. No statistically significant relationships were found between health outcomes, either type of self‐stigma, and mental health literacy. The authors discuss these and other findings and offer research and counseling implications.     

Stigma towards Mental Health Problems during Childhood and Adolescence: Theory,Research and Intervention Approaches

Many children and teenagers living with mental health problems experience stigma from within their peer group, yet this remains an under-researched topic in developmental science and the broader mental health literature. This paper highlights the limitations of adopting measures, concepts and theories that have exclusively emanated from the adult mental health literature. We argue that the social context of children and adolescents is critical in understanding the development and maintenance of stigma towards those with mental health problems, alongside the changing developmental needs and abilities of children and adolescents. In this article we argue that a theory proposed to explain the development of stereotypes and prejudice in childhood has potential as a framework for integrating existing research findings on mental health stigma in childhood and adolescence and providing direction for further research. The need for interventions that are grounded within the developmental science literature and that explicitly state their theory of change are identified as key research priorities for reducing stigma during childhood and adolescence.     

The effect of personal and group discrimination on the subjective well-being of people with mental illness: the role of internalized stigma and collective action intention

The goal of this study is to test a model in which personal discrimination predicts internalized stigma, while group discrimination predicts a greater willingness to engage in collective action. Internalized stigma and collective action, in turn, are associated to positive and negative affect. A cross-sectional study with 213 people with mental illness was conducted. The model was tested using path analysis. Although the data supported the model, its fit was not sufficiently good. A respecified model, in which a direct path from collective action to internalized stigma was added, showed a good fit. Personal and group discrimination appear to impact subjective well-being through two different paths: the internalization of stigma and collective action intentions, respectively. These two paths, however, are not completely independent, as collective action predicts a lower internalization of stigma. Thus, collective action appears as an important tool to reduce internalized stigma and improve subjective well-being. Future interventions to reduce the impact of stigma should fight the internalization of stigma and promote collective action are suggested.     

Stigma, obesity, and the health of the nation's children

Preventing childhood obesity has become a top priority in efforts to improve our nation's public health. Although much research is needed to address this health crisis, it is important to approach childhood obesity with an understanding of the social stigma that obese youths face, which is pervasive and can have serious consequences for emotional and physical health. This report reviews existing research on weight stigma in children and adolescents, with attention to the nature and extent of weight bias toward obese youths and to the primary sources of stigma in their lives, including peers, educators, and parents. The authors also examine the literature on psychosocial and physical health consequences of childhood obesity to illustrate the role that weight stigma may play in mediating negative health outcomes. The authors then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and they highlight complex questions about the role of weight bias in childhood obesity prevention. With these literatures assembled, areas of research are outlined to guide efforts on weight stigma in youths, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes and identifying effective interventions to improve attitudes.     

More Than a Sex Machine: Accomplishing Masculinity Among Chinese Male Sex Workers in the Hong Kong Sex Industry

Situated in the masculinity and deviance literature, this article examines a “deviant” masculinity, that of the male sex worker, and presents the ways men who engage in sex work cope with the job. Based on in-depth interviews of Chinese male sex workers (n = 18) in the Hong Kong sex industry, I argue that the stigma management techniques these men employ are simultaneously gender strategies they use to accomplish masculinity. It is through this process that they negotiate a masculine identity within the hierarchy of masculinities in order to become “respectable” and “responsible” Chinese men.     

职业污名与离职倾向：牵连家人污名与家庭卷入的作用

职业污名对从业者的工作态度和工作行为有着重要影响。以往研究从个体职业身份的视角解释职业污名的作用, 忽略了从业者个体身份认同的多重属性。本研究基于身份边界理论, 提出职业污名会通过牵连家人污名这一机制影响从业者的离职倾向。另外, 这一机制的强弱取决于个体的家庭卷入程度。本研究通过对分属不同职业的384名从业者的3轮问卷调研发现, 家庭卷入调节了牵连家人污名在职业污名与离职倾向之间的中介作用。当个体的家庭卷入水平高时, 这一中介作用更强; 家庭卷入水平低时, 该中介作用更弱。本研究在理论上提出并检验了职业污名影响的新机制, 同时对实际管理工作提出了建议。     

Strategies used by transmasculine and non-binary adults assigned female at birth to resist transgender stigma in healthcare

Abstract

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33?years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.     

Disruption,dialogue, and swerve: Reflective structured dialogue in religious studies classrooms

This article focuses on Reflective Structured Dialogue as a set of practices developed in the context of conflict resolution that are well suited to handling quotidian uneasiness and extraordinary moments of disruption in religious studies classrooms. After introducing Reflective Structured Dialogue's history, goals, and general practices, the authors consider its uses in classroom settings. They argue that a classroom in which teachers understand themselves as facilitators, and in which students are experienced in structured dialogue practices – including being comfortable in a state of intellectual “wobble” – is one more apt to be able to engage with, and more likely to benefit from, disruptive events.     

Developing spirituality through the use of literature in history education

This paper demonstrates the significant potential for history teachers to contribute to the development of children’s spirituality through the use of literature within the history curriculum. Using four case studies of history teaching in English comprehensive schools, the paper outlines a holistic approach to the subject – drawing upon art and music as well as literature – to foster children’s capacity for meaning‐making from historical interpretations. The paper argues that history education prepares children for the spiritual by virtue of three elements unique to the subject: First, the subject matter and conceptual content of history provide the context for students to engage with the complexity of questions at the essence of the human condition, establishing a cognitive conflict through which spiritual development is fostered. Second, the subjectivity of historical knowledge allows for the development of a community of ethical enquiry within the classroom through which individuals can explore their own ideas and beliefs as well as those of others. Such enquiry fosters the development of reflexive empathy – the capacity to reflect on one’s own life in the light of understanding the lives of others. Third, the subject provides children with a language through which they can articulate their thoughts, beliefs and feelings. The paper argues that these unique elements are significantly strengthened through the complementary use of literature within history lessons, providing a powerful methodology which fosters children’s spirituality.     

Psychoanalytic developmental psychology and the supervision of psychotherapy supervisor trainees

While literature on psychotherapy supervision abounds, literature on supervisor supervision (i.e., the actual supervision of a supervisor trainee who is in the process of learning to supervise) is far more scarce. How might the supervision of supervision process be best understood? What is the developmental experience of supervisor trainees? How can supervisors effectively intervene when working with supervisor trainees? Those questions have been addressed in only the most meagre fashion, and guidance on how to engage in the supervision of supervision is sorely lacking. In this paper, a psychoanalytic developmental framework is used to provide a means of conceptualising the supervisor trainee experience and to suggest a programme by which supervisors can best respond to their supervisor trainees' needs. Supervisor trainee ‘unfolding’ and ‘becoming’ are captured within a developmental progression that punctuates separation and individuation processes. The place of the supervisor – in holding and containing, loosening and liberating, buffering and bolstering, and refuelling and reloading – is considered in the facilitation of supervisor trainee development.     

Stigma of mental illness,religious change,and explanatory models of mental illness among Jewish patients at a mental-health clinic in North Jerusalem

During 3 months in 2004, 38 recent referrals to a Community Mental Health Clinic in North Jerusalem, a substantially Ultra-Orthodox Jewish neighborhood, were evaluated by the Explanatory Model Interview Catalogue. This questionnaire, which includes a 13-item scale measuring stigma towards mental illness, was adapted and translated into Hebrew. Patients with a more religious upbringing expressed a greater sense of stigma towards mental illness; however, patients who now had a more religious affiliation did not. The 14 patients who had experienced a religious change toward a more religious affiliation reported a lower level of stigma than the 24 non-returnees. Even when controlling for religious upbringing, the partial correlation between stigma score and religious change was significant. Stigma was lower among younger but not older returnees. Findings from this study support the hypothesis that a stigma of mental illness may be a deterrent to the use of a public mental-health clinic for religious Jews in Israel. Ultra-Orthodox Jewish patients (especially non-Hasidic) used a nonreligious explanatory model (perception and understanding) of mental illness more often than a religious explanatory model. This last finding could reflect a shift in the Ultra-Orthodox Jewish communities from a religious to a more medical and psychological explanatory model.     

Thoughts on how to regulate behaviours: an overview of the current debate

ABSTRACT

The article intends to present the debate on behaviour modification in the regulation studies literature, at a time of renewed interest among regulators for new ideas and strategies. As the financial crisis has led to the most public critique yet of the rational choice view of individuals that has informed regulation in the last few decades, other ideas that value realism more than simplicity and parsimony deserve some attention. Some of these – proposed by behavioural economics – have already raised considerable interest from regulators, especially in the UK and the USA, and have begun to impact various types of regulation. This article puts these various elements in perspective and as such provides tools to appraise and engage with past and future attempts to regulate social groups in health care and elsewhere.     

AIDS-related stigma,personal risks and career objectives among makerere medical students

The aims of this study were to investigate variables that influence AIDS-related stigma and to assess occupational risks, behavioural change, and career objectives of students in face of the AIDS epidemic. Data available on 150 randomly selected medical students were analysed statistically. Results indicated that sex and year of study significantly influenced AIDS-related stigma while age, religion and tribe did not. The majority of students recommended screening and health education for high-risk people and reported high levels of perceived risk. Various occupational hazards and behavioural changes were reported, but students still wanted to remain in the medical profession. Implications of these findings are discussed.     

Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking Among African American Boys

African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined with the frequent distrust of professionals and peer networks, would indicate that working with families may improve initial identification of depression among African American adolescent boys and decrease their barriers to care.     

Stigma and hostility towards pregnant smokers: Does individuating information reduce the effect?

Australia is at the forefront of tobacco control, yet 17% of Australian women smoke during pregnancy. Negative attitudes to smoking are intensified when the smoker is pregnant, consistent with a discourse that encourages surveillance of pregnant women. Such overt anti-smoking attitudes create a context which may make it difficult for pregnant smokers to seek assistance to stop. However, there is little evidence on the extent to which pregnant smokers are stigmatised by community members. We used vignettes to examine the degree of smoking-related stigma expressed by 595 Australian university students who rated a woman, described as a mother who was smoking or not, and pregnant or not. Further, we examined whether provision of individuating information reduced the degree of stigma. Mothers described as smokers were rated more negatively than those not, particularly if they were pregnant: smokers were perceived as unhealthy, and also as bad mothers. Provision of individuating information slightly reduced these effects. These findings support the view that smokers – particularly if pregnant – are subject to negative moral judgement. Our findings contribute to the ethical debate about stigma-inducing tobacco control efforts, and suggest that anti-smoking campaigns that contextualise smoking in pregnancy might reduce stigma and assist cessation.