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.     

Access to Assistive Technology,Systems Thinking,and Market Shaping: A Response to Durocher et al.

Fairness of access to assistive technology is important for its allocation on an equitable basis and for broader social justice and rights issues. Although the use of Daniels’s notion of “justice as fair opportunity” is helpful to the context of assistive technology, other aspects of Daniels’s broader conceptualisation of “just health” are not appropriate in this context. It is argued that fairness of access to assistive technology is crucial for the equitable attainment of the sustainable development goals; however, such access will be achieved only by the sector developing a much stronger systems thinking and market shaping perspective.     

Mental health counselling in the Black American Church: reflections and recommendations from counsellors serving in a counselling ministry

The goal of this study was to examine the relationship between “The Black Church”, the mental health needs of its members, and addressing those needs from the perspective of counsellors within the church. Four in-depth interviews were conducted with members of the mental health counselling team at one large, African American-serving church in the Midwest to explore their thoughts about their church pastor’s desire to expand their current ministry to a fully operating counselling centre. The findings suggest that “the Black Church” not only has a role and responsibility in addressing the mental health needs of African Americans within and outside of the church but can also use religiosity as a facilitator rather than a barrier to mental health service use among African Americans.     

Lost in the Myst?: Narrative Video Gaming Decreases Self-Reported Propensity for Spiritual/Religious Experience

Based on the proposition that the visual “what you see is what you get” environment of video games may undermine ability/motivation for mental simulation/internal narrative, we hypothesized that exposure to virtual gaming would lead to decreased propensity for spiritual/religious experience. Fifty-six Canadian undergraduates moderately interested in gaming completed measures of propensity for unitive (focus on connectedness) and numinous (focus on presence of Other) experiences online, and again following a randomly assigned virtual or text-based narrative gaming session. Self-reported unitive and numinous propensities both declined significantly following the virtual gaming session as expected. Mystical propensity declined following the text-based session as well, but numinous propensity tended to increase in this condition. Virtual gaming offers an absorbing “escape” narrative with comparatively little “in the head” effort that appears to diminish—at least temporarily—the propensity for spiritual/religious experience, which is predicated upon a sustained internal narrative involving the Unseen.     

“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.     

From Theory to Practice: One Agency’s Experience with Implementing an Evidence-Based Model

As evidence-based practice is becoming integrated into children’s mental health services as a means of improving outcomes for children and youth with severe behavioral and emotional problems, therapeutic foster care (TFC; a specialized treatment approach for such youth) is one of few community-based programs considered to be evidence-based. “Together Facing the Challenge” (TFTC) which was tested in a randomized trial of TFC has been identified as an evidence-based model. We describe the experiences reported by one of the agencies that participated in our study and how they have incorporated TFTC into their on-going practice. We highlight key implementation strategies, challenges faced, and lessons learned as the agency moved forward towards full implementation of TFTC.     

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.     

Internet Addiction in China: The Battle for the Hearts and Minds of Youth

This paper analyzes the lifeworld of those labelled “Internet addicts” in China. Contrary to professional belief, such deviant youth are not simply having trouble controlling their Internet use, but, more seriously, with the normal functioning of society. Underneath this existential, ethical, and social crisis is a social-economic-political phenomenon which pivots around the competition—between China’s education system expressed through the parents (work), and its consumer society expressed through the online gaming industry (leisure)—for the hearts and minds of transforming and individualizing youth. These “Internet addicts” uncover not individual pathology but the following psycho-social-structural dilemma: citizens cannot live on economic reforms alone.     

Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment

Mental health systems need scalable solutions that can reduce the efficacy–effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers’ fidelity to evidence-based treatment models and children’s and caregivers’ engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.     

Expanding the conceptual range of health self-regulation research: A commentary

Abstract

In contrast to models that endeavor to link human motives to important adjustive outcomes in a largely idealized, lock-step fashion, the theory and research presented in this special issue afford the reader an opportunity to consider the advantages of various “deep structural” conceptions of health self-regulation. I discuss how the present elaborated volitional models can help potentially overcome the “problem of psycho-semanticism”, i.e., the faulty doctrine that mental contents or propositional attitudes cause behavior simply be virtue of what they represent. I also suggest several routes by which self-regulated health-promotion efforts can become derailed, including the inherent fuzziness of many health goals, conflict within the individual's system of goals, and conflicts between the goals of the would-be self-regulator and those of significant others.     

The school psychologist and early education: An ecological view

An ecological view of psychological services to preschool children is described here as a proactive, seeking-out, mental health delivery system that concentrates its effort on prophylactic activities rather than the “diagnosis recommend” or “diagnosis psychotherapy” ritual. Activities for psychological services, training of staff, and competencies for effective delivery are described. Staff competencies to facilitate children's mental health are also described.     

Client Report of Delivery of Common Elements in Usual Care and the Association to Satisfaction

Recently, scholars have advocated for the use of a new flexible approach to evidence-based practice through the use of “common elements”, which are treatment procedures that are utilized in a variety of evidence-based mental health interventions. The objective of this study was to describe the extent to which clinicians are using common elements of evidence-based treatment (EBT) in routine mental health care for children and if they are utilizing more of the elements associated with their client’s diagnosis. A second objective was to determine whether use of these elements was associated with client satisfaction. The Youth Services Survey was administered to a diverse sample of youth and their caregivers (total sample = 1075) to measure satisfaction with services and use of both talk-based and skill-based common elements. More than 74 % of caregivers indicated that their child’s clinician utilized the talk-based common elements frequently or almost always. Additionally, at least 69 % of youth agreed with this finding. Youth and caregivers reported that the common elements related to skill building were utilized less frequently. A Generalized Estimating Equation approach was used to examine the relationship between use of common elements and client diagnosis and satisfaction. The results for diagnosis were mixed and varied by parent and youth report. Finally, the more clinicians discussed and practiced common elements of EBT with their clients, both youth and caregivers were more likely to be satisfied. Due to clients’ reporting that on average clinicians utilized skill building common elements less often, targeted clinician training may be important, since practicing skill-building therapeutic elements is key to adopting new methods of managing behavior and emotions. Further, if families are more satisfied with a common elements approach, then clinicians may be more likely to utilize it.     

“I’m Not Sure I Trust the System Yet”: Lesbian Service Member Experiences With Mental Health Care

The purpose of this research was to understand lesbian service member experiences with mental health care. Individual and organizational factors were explored, including the influence of military policy (e.g., “Don’t Ask, Don’t Tell”) on service member utilization of mental health services. Thirty-seven participants responded to a survey containing 16 open-ended items regarding the impact of “Don’t Ask, Don’t Tell” on one’s professional life, relational life, identity, and willingness to access mental health services. Data were analyzed through an open- and axial-coding and constant comparative method. The findings indicated a lesbian service woman’s likelihood of accessing mental health services was impacted by confidentiality concerns, fear of repercussions, and a sense that military culture lags behind policy changes. Recommendations for therapists included renewed focus on safety through affirmative practices, need for competency in military and lesbian/gay culture, and sensitivity to the effects of systemic oppression on self-esteem. Implications and future research are discussed.     

心理健康素养：概念、评估、干预与作用

心理健康素养是促进心理健康的重要途径。狭义概念指帮助人们认识、处理和预防心理疾病的相关知识和信念; 广义概念指综合运用心理健康知识、技能和态度, 保持和促进心理健康的能力。心理健康素养常采用情景案例问卷、单维或多维评估量表等进行评估, 可以通过社会运动、学校教育、自助式应用程序、心理健康急救培训等方式进行有效干预提高, 其中心理健康知识、心理疾病识别、情绪调节、减少病耻感、积极的求助态度等成分都有促进心理健康的作用。未来研究可以在建构评估指标体系、探索作用机制、扩展涵盖群体与内容、加强实证干预研究等方面深入开展。     

My “Investigation of Things”

“Confucianism” can refer to two topics, namely “Philosophical Confucianism” and “State Confucianism.” Regarding contemporary China and the global world, the one that has a positive content is not the latter but is the former. Philosophical Confucianism takes Mencius’ thesis as its key. It emphasizes knowledge, emotions, and intentions to act as an interrelated mental cluster. It encourages people to focus on family love and its societal expansion. At the same time, through the investigation of such universal topics as humane love, mental tranquility, care, suffering, and empathy, it provides a rich scholarly content and raises positive questions for reflection. Thus, that very old concept of Philosophical Confucianism doubtless has a new destiny, because currently a number of American ethicists and scientists work in closely related topics. Chinese and American scholars not only can develop cooperative work, but also that cooperation will definitely bear abundant fruit.