“MY RESISTING GETTING WELL”: NEURASTHENIA AND SUBCONSCIOUS CONFLICT IN PATIENT‐PSYCHIATRIST INTERACTIONS IN PREWAR AMERICA

This study examines experiences of individual patients and psychiatrists in the Henry Phipps Psychiatric Clinic at Johns Hopkins between 1913 and 1917. The dynamics of these patient‐psychiatrist interactions elucidate the well‐known conceptual shift in explanations of mental illness during the twentieth century, from somatic models rooted in the logic of “neurasthenia” and damaged nerves to psychodynamic models based on the notion of “subconscious conflict.” A qualitative analysis of 336 cases categorized as functional disorders (a catchall term in this period for illnesses that could not be confirmed as organic diseases), shows that patients explained their symptoms and suffering in terms of bodily malfunctions, and, particularly, as a “breakdown” of their nervous apparatus. Psychiatrists at the Phipps Clinic, on the other hand, working under the direction of its prominent director, Adolf Meyer, did not focus their examinations and therapies on the body's nervous system, as patients expected. They theorized that the characteristic symptoms of functional disorders—chronic exhaustion, indigestion, headaches and pain, as well as strange obsessive and compulsive behaviors—resulted from a distinct pathological mechanism: a subconscious conflict between powerful primal and social impulses. Phipps patients were often perplexed when told their physical symptoms were byproducts of an inner psychological struggle; some rejected the notion, while others integrated it with older explanations to reconceptualize their experiences of illness. The new concept also had the potential to alter psychiatrists' perceptions of disorders commonly diagnosed as hysteria, neurasthenia, or psychoneuroses. The Phipps records contain examples of Meyer and his staff transcending the frustration experienced by many doctors who had observed troubling but common behaviors in such cases: morbid introspection, hypochondria, emotionalism, pity‐seeking, or malingering. Subconscious conflict recast these behaviors as products of “self‐deception,” which both absolved the sufferer and established an objective clinical marker by which a trained specialist could recognize functional disorder. Using individual case studies to elucidate the disjunction between patients' and psychiatrists' perspectives on what all agreed were debilitating illnesses, this analysis helps to illuminate the origins of a radical transformation in psychiatric knowledge and popular culture in the twentieth century—from somatic to psychodynamic explanations of mental illness.     

Correlates of malingering

The author presented anonymous questionnaires to 172 patients and 160 medical students to assess the frequency and correlates of malingering in various groups in a medical center on a V.A. campus. The results indicate that sociopaths, drug abusers, and alcoholics are more prone to malinger than other individuals, supporting previous assertions that mental health professionals should have a higher index of suspicion for malingering in these diagnostic groups. Race and age were found to have small but significant correlations with malingering, but at present, this finding must be viewed cautiously. No association was found between somatization disorder and malingering.     

Effect of symptom information and validity scale information on the malingering of depression on the MMPI-2

MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) data from college students who were attempting to malinger depression (199 women and 171 men) were compared to MMPI-2 data from students who responded honestly (50 women and 45 men). Mean MMPI-2 scores were compared with analyses of variance, and students' success in malingering depression was evaluated with criteria based on cutting scores for validity indexes and on the clinical scales commonly associated with depression. Students who were given information about the validity scales or about the symptoms of depression were more successful at malingering than students who received no information, indicating that malingerers of depression may be able to elude detection by the MMPI-2 if they are informed about the validity scales or the symptoms of depression.     

Cross-validation of the MMPI-2 in detecting malingered posttraumatic stress disorder

We attempted to cross-validate findings from a previous study (Elhai, Gold, Sellers, & Dorfman, in press) using a clinical sample of combat-related war veterans to distinguish genuine from malingered posttraumatic stress disorder (PTSD) on the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MMPI-2 scores of 124 male combat war veterans at the PTSD outpatient treatment program of a Veterans Affairs Medical Center were compared with those of 84 adult college students instructed and trained to malinger PTSD. MMPI-2 overreporting variables examined were F, F-Fb, F-K, F(p), Ds2, O-S, OT, and FBS. A stepwise discriminant analysis identified F. F-Fb, F-K, Ds2, O-S, and OT as the best malingering predictors. A predictive discriminant analysis yielded good hit rates for the model with impressive cross-validation results. We assessed cutting scores for the predictors of the model. We discuss clinical implications for using the MMPI-2 to distinguish malingered PTSD from combat-related PTSD.     

“I'm a police officer not a social worker or mental health nurse”: Online discourses of exclusion and resistance regarding mental health‐related police work

Despite estimates suggesting that around 15% of UK police incidents involve people with a mental health concern, officers receive very little mental health training. The police have faced high‐profile criticisms over their handling of mental health‐related incidents, whereas the underfunding and fragmentation of UK mental health services has led to concerns that police officers are being forced to undertake a primary role in mental health care. At a time of austerity and widespread cuts to public services, it is important to explore how particular groups work to justify the parameters of their professional duties. This article therefore explores the discourses surrounding mental health problems on an online police discussion forum, highlighting two distinct ways in which mental health‐related work is represented as being incompatible with policing. First, mental health problems are delegitimised and conflated with “scrounging,” positioning individuals as undeserving of police time; second, mental health problems are reified and associated with violence and extreme behaviour, justifying the use of force by police officers and deflecting responsibility onto mental health services. Findings are consistent with previous research suggesting that mental health work is not perceived to be a valid part of the police role.     

Gender Differences in the Effects of Community Violence on Mental Health Outcomes in a Sample of Low-Income Youth Receiving Psychiatric Care

Previous research suggests that community violence impacts mental health outcomes, but much of this research has not (a) distinguished between different types of community violence, (b) examined gender differences, and (c) focused on youth living in urban poverty. The current study addresses these questions. Participants were 306 youth (23 % girls) and one parent/guardian receiving outpatient psychiatric services for disruptive behavior disorders in a large urban city. Youth and parents reported on youth’s experience of different types of community violence (being a direct victim, hearing reports, and witnessing violence), and whether violence was directed toward a stranger or familiar. Outcomes included youth externalizing, internalizing, and posttraumatic stress symptoms assessed via parent and youth reports. Being a direct victim of violence accords risk for all mental health outcomes similarly for both boys and girls. However, gender differences emerged with respect to indirect violence, such that girls who hear reports of violence against people they know are at increased risk for all assessed mental health outcomes, and girls who witness violence against familiars are at increased risk for externalizing mental health symptoms in particular. There are gender differences in violence-related mental health etiology, with implications for intervention assessment and design.     

The “Clean for Gene” Phenomenon: The Effect of Students' Appearance on Political Campaigning1

Field experiments investigated the relationship between a political campaigner's dress and appearance and his campaign effectiveness. In one study deviant, “freaky” appearing campaigners attempting to hand out innocuous leaflets in a shopping center had a lower acceptance rate than did more conventionally dressed campaigners. Those shoppers who did accept leaflets from “freaks” were more likely to throw them away unread. The first experiment suggested that deviant-appearing campaigners have difficulty communicating information to potential voters, but it was argued that, in another sense, they convey all too much information. Knowing only that the campaigners for one candidate were deviant and “hippy” in appearance as compared to the conventionally dressed campaigners supporting a second candidate, voters in a second experiment were willing to ascribe more radical opinions to the deviants' candidate. Voters then used their inferences as the basis on which to select a candidate. The rationality of inferring beliefs from appearances is discussed in terms of correspondent inference theory.     

The link between mental health,crime and violence

Research investigating the link between mental health, crime and violence often rely on populations that are at a high-risk of violent and criminal behaviour, such as prison inmates and psychiatric patients. As a result of this selection bias, the relationship between mental health, criminal and violent behaviour is significantly over-estimated, with mental health being incorrectly linked with violent and criminal behaviours. This study examines the relationship between mental health, violence and crime in a more representative community-based sample. One hundred and twenty-one individuals with and without a mental health disorder reported their involvement in crime and completed an aggression questionnaire. The results revealed that there is no statistically significant difference in terms of violence and crime involvement between individuals with a mental health diagnosis and those without. Moreover, the study did not find any statistically significant associations between specific mental health disorders and specific crime offences. The findings suggest that certain mental health disorders do not strongly contribute to crime violence and involvement. Limitations and implications are discussed in detail.     

“The Thing Happened as He Wished”: Recovering an American Indian Cultural Psychology

One of the chief questions confronting mental health professionals who serve American Indian communities is how best to offer genuinely helpful services that do not simultaneously and surreptitiously reproduce colonial power relations. To ensure that counselors and therapists do not engage in psy‐colonization, it is crucial to recognize the sometimes divergent cultural foundations of mental distress, disorder, and well‐being in “Indian Country.” In this article, I will consider four excerpts from a research interview undertaken among my own people, the Aaniiih Gros Ventres of north‐central Montana. At a superficial level, these excerpts seem to reinforce reigning sensibilities that are readily familiar within the mental health professions. And yet, closer analysis of these interview excerpts reveals several tantalizing facets of an indigenous cultural psychology that may well continue to shape life and experience among tribal members in this setting. I recover this distinctive cultural psychology through archival representations of cultural and community life, including analysis of an important tribal myth. This analysis makes possible an alterNative interpretation of these interview excerpts, grounded in an aboriginal cosmology, that yields important implications for conceiving a more inclusive knowledge base for psychology that only robust community engagement can reveal.     

Seeking authenticity in diverse contexts: How identities and environments constrain “free” choice

Diversity and inclusion are a key goal in 21st century society, but people continue to self‐segregate in occupations, communities, and everyday interactions. Are people's choices to separate by groups into these different spaces truly “free?” In this paper, we review and extend a new framework for understanding how social identities contextually and automatically constrain the choices people make. We consider how situations subtly cue a sense of fit to one's identity, automatically eliciting state authenticity and a desire to return to those settings that afford authenticity and avoid those that do not. Actors and observers alike often explain these behaviors after the fact as freely chosen. We discuss how the SAFE model can clarify and expand what it means to feel a sense of belonging and explain why those who are advantaged in a setting are often less aware of the way in which their identity advantages them. We end by highlighting how environments can be shaped to foster fit and authenticity among members of underrepresented groups as a means to facilitate diversity.     

An Evidence‐Based Model for Understanding the Mental Health Experiences of Transgender Australians

A growing body of empirical research has documented the mental health experiences of Australian transgender people. This research indicates three key factors that appear to play a role in determining outcomes for adult transgender Australians: (a) discrimination, (b) access to hormones and/or surgery, (c) community connectedness. Two theoretical frameworks clarify why these factors exist and how they can lead to either negative or positive mental health outcomes. The first is cisgenderism, which describes the ideology that delegitimises people's own understanding of their genders and bodies. Although anyone can experience cisgenderism, it is a particularly common experience for transgender people. The second is decompensation, which describes the processes through which the cumulative effects of stressors may lead to poor mental health. Drawing on both previous empirical findings and these two theoretical frameworks, this article proposes, and provides initial testing of, a model for understanding the mental health of transgender adults in Australia. The article concludes by suggesting the need for changes regarding how decisions are made about mental health service provision for transgender people, how mental health professionals understand the lives of transgender people, and how legislation can better ensure the full inclusion of transgender people in Australia.     

基于连续体信念的精神障碍污名化干预探索

以往研究尝试阐明精神障碍患者污名化的产生机制,并提出相应的干预方案。然而,不同方案的干预效果却不尽如人意,并导致了众多理论纷争。解决上述争论的关键在于揭示污名化产生的核心认知机制,即精神障碍的污名化源于人类自发性的社会分类加工。上述核心认知机制的提出将引领以连续体信念为切入点的全新污名化干预路径。该干预路径能够整合精神障碍污名化消除的理论之争,进而衍生出完整的连续体信念干预理论模型和实践模式。     

Mental Health and Spirituality in Later Life: Pastoral Approaches

SUMMARY

This chapter proposes a perspective on providing pastoral care for people at risk of, or who have mental health problems in later life. Two major areas of mental health, depression and dementia are explored, examining their impact on older people and strategies to identify risk in depression, and signs indicating need for pastoral intervention in depression and/or dementia. The work from two studies that examine issues for meaning of people, the first for older people living independently and the second in residential care, form the basis of the material presented in this chapter. It is maintained that pastoral interventions may greatly improve quality of life for these people, their families and carers.¹     

The Power of Language and Labels: “The Mentally Ill” Versus “People With Mental Illnesses”

Undergraduate students (N = 221), adults in a community sample (N = 211), and professional counselors and counselors‐in‐training (N = 269) were given a measure of tolerance. Within each sample, half of the participants were given a version that used the term “the mentally ill” and half were given a version that used the term “people with mental illnesses.” Individuals receiving the version with the term “the mentally ill” had lower levels of tolerance. Professional counselors had the largest differences in tolerance on the basis of language.     

Effects of Viewing “Holocaust” on Germans and Americans: A Just-World Analysis1

This study examines attributions of blame to the Nazis and the Jews for the events of the holocaust. The sample consisted of Germans and Americans who had viewed the television series “Holocaust” and comparison groups who had not seen the program. It was found that among viewers who identified with the Nazis, attributions of blame to the Jews were higher than among nonviewers or viewers who identified with the Jews. Attributions of blame to the Nazis did not vary as a function of viewing the television series. However, people who identified with the Nazis blamed the Nazis less for the holocaust than people who identified with the Jews. These results are discussed in terms of the justworld hypothesis (Lerner & Miller, 1978) and their implications for media presentations on the victims of oppression.     

Studies on antiviolent and “normal” communities

Limited preliminary studies have provided identification of several communities in the Valley of Oaxaca, Mexico, that successfully control major interpersonal violence without formal police and judicial apparatus of the sort customary in industrial societies, even though these antiviolent towns are surrounded by others showing a “normal” level of violence. Because the antiviolent places share biological inheritance, culture, language (Zapotec and Spanish), climate, ecology, poverty, boundary disputes, and abundant use of alcohol with their neighbors, such factors may be discarded as determining either violence or antiviolence. The antiviolent communities do differ from their neighbors, however, in showing a near absence of “machismo,” contrasting practices in child rearing, very few close friendships linking adults of the same sex, and a much stronger social role for women. First results from trials of psychological tests are highly congruent with ethnographic observations.     

Detection of malingering of psychiatric disorder with the personality assessment inventory: an investigation of criminal defendants

To assess the diagnostic accuracy of the Personality Assessment Inventory (PAI; Morey, 1991) Validity scales for the detection of malingered psychiatric disorders, we divided a sample of criminal defendants referred for forensic evaluation by the federal courts into malingering and not malingering groups based on their performance on the Structured Interview of Reported Symptoms (Rogers, Gillis, & Bagby, 1990). Logistic regression analyses (LGAs) revealed that there were no differences between the malingering and not malingering groups with respect to age, race, years of education, history of drug abuse, or number of previous felony convictions. LGA with malingering versus not malingering as the criterion revealed that the PAI Negative Impression Management (NIM) scale but not the Rogers Discriminant Function (RDF; Rogers, Sewell, Morey & Ustad, 1996) nor the Malingering index (MAL; Morey, 1996) significantly differentiated the malingering from the not malingering group. Receiver operating characteristics analyses demonstrated acceptable sensitivity and specificity for the NIM scale but not the RDF scale or the MAL index. We discuss the results in terms of the suggested cutoff scores for the PAI Validity scales in detecting criminal defendants who are attempting to feign psychiatric disorder.     

California Firearms Law and Mental Illness

California provides numerous pathways by which people with mental illness can qualify for a state-level firearm prohibition. The state's involuntary detention for psychiatric treatment, or “5150” (CA W&I Code 5150) process, is often cited as one potential mechanism for reducing violence by dangerous people, though its use is limited to people whose dangerousness is due to a mental illness. Additionally, California has taken legislative steps to prohibit firearm ownership among other people who have an increased risk of violence, regardless of whether or not mental illness is a factor. This article compares the California firearm ownership disqualification system for mental illness with the federal system and those of other states, examines the strengths and weaknesses of this system, and reviews alternatives. Copyright © 2015 John Wiley & Sons, Ltd.     

Children lose confidence in their potential to “be scientists,” but not in their capacity to “do science”

Over the course of middle childhood, children's interest and beliefs about their own capacities for success in science often decline. This pernicious decline is especially evident among underrepresented groups, including girls, members of some racial and ethnic minorities, and children from lower socioeconomic backgrounds. The present research (N = 306, ages 6–11) found that while children lose interest and feelings of efficacy about their potential to “be scientists” across middle childhood, they maintain more robust interest and efficacy about “doing science.” These patterns were confirmed in both longitudinal and cross‐sectional analyses; effects were stable or increased across time and age. Mediation analyses revealed that the positive effect of action framing is partially accounted for by children's views that the group of people who do science is more inclusive than the category of scientists. These findings suggest that using action‐focused language to encourage children in science is more inclusive and may lead to more science engagement across middle childhood than language that emphasizes scientists as an identity category. Implications for educational practices will be discussed.     

Delusional disorder and delusions: is there a risk of violence in social interactions about the core symptom?

Delusional disorders are rare, but psychoses with prominent and persistent delusions are less so. A small but significant association between psychosis and violence is often mediated by delusions in such illnesses. Traditionally, delusions have been viewed as “incorrigible”, but there is evidence that they change over time. During development of a scale for measuring delusions, it was found that people who acted violently on their “most important” delusion were more likely to have modified that belief after a mild form of challenge to it. When cognitive–behaviour therapy (CBT) is used for schizophrenia, attempts to modify psychotic symptoms are generally included. Could studies of CBT provide further information about possible risks of social interactions about delusions? In the UK, 2000 people with schizophrenia have been in randomized controlled trials of CBT with a goal of symptom modification. These studies were examined for evidence of violence during the treatment. There was none. Given the period prevalence of violence among people with psychosis, this is surprising. In these studies, however, both challenge to delusions and change in them was minimal and in the context of a safe clinical relationship. Challenge to delusions may, however, occur in a variety of social situations. There are no systematic data on lay challenge to them, but it seems likely that some in the sufferer's social circle will do so vigorously. Relatives, friends, and acquaintances are the people most vulnerable to the most serious violence by someone with psychosis. Study of how people interact in these circumstances and whether their interactions are relevant to modification of delusions would be worthwhile. Could those close to a sufferer learn skills for responding to such pathological beliefs that could be protective against violence, perhaps derived from the principles of CBT?. Copyright © 2006 John Wiley & Sons, Ltd.