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.     

Meaning making in mothers' and children's narratives of emotional events

Narrative coherence and the inclusion of mental state language are critical aspects of meaning making, especially about stressful events. Mothers and their 8- to 12-year-old children with asthma independently narrated a time they were scared, frustrated, and happy. Although mothers' narratives were generally more coherent and more saturated with mental state language than children's narratives, for both mothers and children narratives of negative events were more coherent and contained more mental state language than narratives of positive events overall, and narratives of scary events contained more mental state language than narratives of frustrating events. Coherence appears to be multifaceted, in that the three dimensions of coherence coded, context, chronology, and theme were not strongly interrelated within narratives of the same event, but use of mental state language, including cognitive-processing and emotion words, appears to be more integrated. Moreover, while thematic coherence seems to be a consistent individual narrative style across valence of event being narrated, mental state language appears to be a consistent style only across the two stressful event narratives. Finally, and quite surprisingly, there were virtually no relations between mothers' and children's narrative meaning making.     

Meaning making in mothers’ and children's narratives of emotional events

Narrative coherence and the inclusion of mental state language are critical aspects of meaning making, especially about stressful events. Mothers and their 8- to 12-year-old children with asthma independently narrated a time they were scared, frustrated, and happy. Although mothers’ narratives were generally more coherent and more saturated with mental state language than children's narratives, for both mothers and children narratives of negative events were more coherent and contained more mental state language than narratives of positive events overall, and narratives of scary events contained more mental state language than narratives of frustrating events. Coherence appears to be multifaceted, in that the three dimensions of coherence coded, context, chronology, and theme were not strongly interrelated within narratives of the same event, but use of mental state language, including cognitive-processing and emotion words, appears to be more integrated. Moreover, while thematic coherence seems to be a consistent individual narrative style across valence of event being narrated, mental state language appears to be a consistent style only across the two stressful event narratives. Finally, and quite surprisingly, there were virtually no relations between mothers’ and children's narrative meaning making.     

基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用——基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用

在积极心理学的影响下,心理健康双因素模型包含主观幸福感和精神病理学指标。研究旨在验证心理健康双因素模型在老年人中的适用性,考察老化态度在生命意义感和心理健康间的多重中介作用。采用爱丁堡幸福量表、一般健康问卷、老化态度问卷和人生意义问卷调查了283名广州市社区老年人。结果发现：（1）心理健康双因素模型较单因素模型的拟合度更优。（2）生命意义感通过老化态度的三条路径（对身体变化、心理获得和心理社会丧失的积极态度）促进心理健康,但具体机制不同。增强意义体验、意义追寻通过老化态度的完全中介作用,提高主观幸福感。增强意义体验通过老化态度的完全中介作用,减弱意义追寻通过老化态度的部分中介作用,减少精神病理学症状。研究结果扩大了心理健康双因素模型的适用年龄范围,为提升老年人的心理健康提供实证依据。     

Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States. The 6-month multilevel, strengths-based Refugee Well-being Project (RWP) intervention brought together university students enrolled in a 2-semester course and recently resettled refugees to engage in mutual learning and collaborative efforts to mobilize community resources and improve community and systems responsiveness to refugees. Data collected from 290 Afghan, Great Lakes African, Iraqi, and Syrian refugees at four time points over 12 months were used to test the effectiveness of RWP to reduce distress (depression and anxiety symptoms) and increase protective factors (English proficiency, social support, connection to home and American cultures). Intention-to-treat analyses using multilevel modeling revealed significant intervention effects for all hypothesized outcomes. Results provide evidence to support social justice approaches to improving refugee mental health. Findings have implications for refugees worldwide, and for other immigrant and marginalized populations who experience inequities in resources and disproportionate exposure to trauma/stress.     

Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem

This paper examines the issue of poverty among people with serious mental illness (SMI), positioning it as a key issue to be confronted by community mental health systems and practitioners. The paper reviews three perspectives on poverty, considering how each sheds light on poverty among people with SMI, and their implications for action: (a) monetary resources, (b) basic needs, and (c) capabilities. The paper argues that community mental health programs and systems are currently unable to address poverty as they are overly focused on individual‐level interventions that, on their own, cannot raise people out of poverty. The paper calls for a social justice value, informed by the concept of citizenship, as a necessary complement to the recovery concept that has informed community mental health practice for almost 25 years. Finally, the paper argues that community psychologists, with their concepts, methods, and values, are well positioned to contribute to this important issue. However, it also contends that addressing poverty requires collaboration from community psychologists with researchers and practitioners from other fields and domains of expertise to begin to make progress.     

Return of the mental image: are there really pictures in the brain?

In the past decade there has been renewed interest in the study of mental imagery. Emboldened by new findings from neuroscience, many people have revived the idea that mental imagery involves a special format of thought, one that is pictorial in nature. But the evidence and the arguments that exposed deep conceptual and empirical problems in the picture theory over the past 300 years have not gone away. I argue that the new evidence from neural imaging and clinical neuropsychology does little to justify this recidivism because it does not address the format of mental images. I also discuss some reasons why the picture theory is so resistant to counterarguments and suggest ways in which non-pictorial theories might account for the apparent spatial nature of images.     

社区服刑人员心理健康状况调查

以探讨社区服刑人员的心理特点为目的,以康健街道社区服刑人员为范围,采用艾森克人格问卷(EPQ)及SCL-90症状自评量表对社区服刑人员的人格、心理健康方面进行调查。结果发现社区服刑人员在总体上虽基本属于正常人群在其人格特征仍与罪犯人群所特有的特点具有少量共性;其心理健康也普遍存在一定问题;同时,证明了社区服刑人员的人格与心理健康有一定的联系,其结果可以在今后的社区心理矫正工作中加以关注和应用。     

Teenage Childbearing,Reproductive Justice,and Infant Mental Health

Reproductive justice advocates emphasize the rights of women to choose to have children, to decide the conditions under which they give birth, and to parent their children with support, safety, and dignity. This article examines what a reproductive justice perspective contributes to infant mental health work with teenage mothers and their families. It explores the historical framing of teenage pregnancy in which young mothers are the cause of a variety of social problems and in which the primary policy and practice approach is pregnancy prevention. The article offers alternative framings of teenage childbearing, based on reproductive justice principles, which focus on social conditions surrounding teenage parenthood and the meaning of motherhood in the lives of young women. These alternative frames shift the practice agenda to eradicating unjust social conditions and providing supports for young women in their roles as parents. The article then describes ways in which two infant mental health programs have incorporated reproductive justice principles into their work with young families: Chicago's community doula model and Florida's Young Parents Project for court-involved teenage parents. Finally, the article extracts a set of principles deriving from a reproductive justice perspective that are relevant to infant mental health work with young families.     

Interpreting our emotions

This essay looks at the important, but often neglected, contribution that self-interpretation makes to emotional self-knowledge. We engage in acts of self-interpretation when (A) we try to understand what it is that we are feeling, or, relatedly, what it is that we ought to be feeling. On such occasions, we draw upon social and personal narratives as well as on the emotional conceptual repertoires at our disposal. We also engage in acts of self-interpretation when (B) we try to ascertain the meaning or significance of an emotion, treating it as a datum, or piece of evidence, upon which to make inferences or further Interpretations. Although we often seem to have first-person privileged access to our mental states, the third-person strategy of self-interpretation can be a valuable source of self-knowledge. I focus here upon the role that self-interpretation plays in providing us with knowledge about our emotional experiences.     

WONDER SUSTAINED: A REPLY TO CRITICS

A set of science‐inspired cosmic narratives referred to as the Epic of Evolution and the Universe Story or, collectively, the new cosmology, proposes to bring humans closer to nature by placing us into the broader narrative of the cosmos. This article responds to commentary and critique on my book Consecrating Science: Wonder, Knowledge, and the Natural World, which critically examines these science‐based cosmic narratives and their particular and problematic modes and objects of wonder. Themes include the relationship of wonder to science and ethical engagement; the question of whether wonder, grounded in everyday sensory experience, can scale up to the level of global environmental problems; the relevance of wonder to nonideal environments and negative affects like fear or grief; and the importance of humanistic and religious studies scholarship for critiquing grand narratives of science, among other themes. I also respond to claims that my book misdiagnoses and distorts the work of the new cosmology and its claims to wonder.     

Some psychoanalytic and philosophical reflections on the signification of residence in the therapeutic care of people with schizophrenia

Last year saw the 20th anniversary of the Wagner report Residential care: A positive choice. The report tried to shift the emphasis away from the view that residential care is the last resort and to value its role as a vital part of community care. However, over the last few years there has been a move away from residential care for people suffering from mental ill-health. The rationale for this shift has been the prevailing idea that it is better to treat people in their own homes. Although this is to a large extent driven by financial constraints on the part of health and social service commissioners, running parallel is the development of policy informed by ideas of normalization, anti-stigma and the increasing drive to empower service users, and diminish the authoritarian relationship that professionals have with them. While much of this is commendable, there has been very little serious thinking about the meaning of residence or dwelling in relation to care and treatment. This has resulted in the ensuing ideological shift often amounting to little more than a fashionable mantra. In this paper the author discusses the meaning of residence and its relation to care, with reference to the work of Lacan and Heidegger, in an attempt to re-situate the debate about the therapeutic potential of residential care at a more fundamental level.     

Toward a Developmentally Informed Narrative Therapy

Narrative approaches to psychotherapy emphasize the impact of the stories or narratives we construct on our reality and behavior. However, little effort has been made to elucidate how individuals' differential capacities for meaning-making influence the process of re-storying lives. The present article introduces to family therapy a model of the changing nature of individuals' ability to create meaning. The model, referred to as developmental-constructivism ( 10 ), suggests that, in addition to contextual factors, individual differences in the capacity for organizing experience will influence therapeutic efforts to generate new and more adaptive narratives. The model is also presented as a heuristic for comparing and integrating two influential approaches to narrative therapy: the externalizing approach of Michael White and the solution-focused approach of Steve de Shazer.     

NEUROMYTHOLOGY: BRAINS AND STORIES

Abstract. I sketch a synthetic integration of several levels of explanation in addressing how myths, narratives, and stories engage human beings, produce their sense of identity and self‐understanding, and shape their intellectual, emotional, and embodied lives. Ultimately it is our engagement with the metanarratives of religious imagination by which we address a set of existentially necessary but ontologically unanswerable metaphysical questions that form the basis of religious belief. I show how a multileveled understanding of evolutionary biology, history, neuroscience, psychology, narrative, and mythology may form a coherent picture of the human spirit. Neuropsychological functions involved in constructing and responding to the narratives by which we form our identities and build meaningful lives include memory, attention, emotional marking, and temporal sequencing. It is the neural substrate, the emotional shaping, and the narrative structuring of higher cognitive function that provide the sine qua non for the construction of meaning, relationship, morality, and purpose that extend beyond our personal boundaries, both spatial and temporal. This includes a neural affect system shaped by our developmental dependency, the dynamic narratives of self formed in the development of identity and reconstructed over the life span, drawing on culturally available mythic and storied forms. Narrative constitutes our movement in moral space and may have the potential both for healing and for disruption for us as individuals and as a species, providing a contingent solution to the alienation and fragmentation of personhood, relationship, and community.     

Indigenous Psychotherapies and Religion: Moral Vision and Embodied Communities

Over the past century, the dominant model for addressing mental illness has been the treatment of individuals, largely by individual therapists who assume the availability of individual psychological resources. That form of therapy is a scarce commodity in capitalist societies, and social models of healing have been largely marginalized and forgotten. From the point of view of an indigenous psychology of religion, this essay (1) reports on local cultural and community models of healing that honor the common good, draw on local, communal narratives, and involve a given community in the process of healing. However, because it is not simply community in itself that is therapeutic, the authors argue (2) that healing cultures have communities that are guided by their moral vision and are committed to justice, moral integrity, and the sharing of resources. They draw on intergenerational studies that detail the effects in Inuit communities where a moral vision and a sense of community was present but then was eroded. Therapists whose interventions draw on the moral resources of the community may facilitate healing, as demonstrated by the use of allocentric imaging in more communal traditions. Finally, it is not simply communities with moral ideals that are therapeutic but (3) indigenous communities whose structures and whose role models embody their ethic that is critical for healing. The authors examine ecological communities in China committed to Confucian values and protection of the earth. The L’Arche communities begun in France by Jean Vanier and Alcoholics Anonymous groups around the world serve as examples of embodied moral communities.     

Selling Sanity Through Gender: The Psychodynamics of Psychotropic Advertising

This paper provides a brief visual history of the ways women patients, and specifically women patients whose marital status is identified in conjunction with their “illness,” have been constructed as abnormal in the images of advertisements designed to promote psychotropic medications to an audience of psychiatrists. The advertisements I discuss come from the two largest circulation American psychiatric journals, The American Journal of Psychiatry and Archives of General Psychiatry, between the years 1964 and 2001. I use the ads to focus on two concomitant narratives. On one hand, I show how the advertisements situate the rise of “wonder drugs” in the context of an era described as the “golden age of psychopharmacology,” during which time drug treatments helped revolutionize the diagnosis and treatment of anxiety, depression, and other outpatient mental illnesses in the United States. On the other hand, the advertisements also illustrate the ways in which these new scientific treatments could not function free of the culture in which they were given meaning. In the space between drug and wonder drug, or between medication and metaphor, the images thus hint at the ways psychotropic treatments became imbricated with the same gendered assumptions at play in an American popular culture intimately concerned with connecting “normal” and “heteronormal” when it came to defining the role of women in “civilization.”