Demonizing and mental illness: The problem of identification,Hong Kong

Conclusions Our experience in the seminars and our study of the cases has encouraged us to believe that many Christian pastors, theological students, and lay leaders are open to a multiple causation explanation for demonizing and mental illness.At the same time we recognize that the depth and discernment of cases is very limited in our present experience. Our hope is that more definable criteria for demonizing and mental illness may be developed and that theories for spiritual discernment will be more closely related to clinical practice.Our most satisfying conclusion from the seminars was the willingness of students to think about demonizing and mental illness from a variety of viewpoints, to develop more inductive thinking and to begin the process of dynamic rather than behavioral approaches to these related forms of illness.     

Citizenship and Community Mental Health Care

Citizenship is an approach to supporting the social inclusion and participation in society of people with mental illnesses. It is receiving greater attention in community mental health discourse and literature in parallel with increased awareness of social determinants of health and concern over the continued marginalization of persons with mental illness in the United States. In this article, we review the definition and principles of our citizenship framework with attention to social participation and access to resources as well as rights and responsibilities that society confers on its members. We then discuss our citizenship research at both individual and social‐environmental levels, including previous, current, and planned efforts. We also discuss the role of community psychology and psychologists in advancing citizenship and other themes relevant to a citizenship perspective on mental health care and persons with mental illness.     

Cultural variations in the understanding and treatment of psychiatric disorders: India and England

Although much has been made of the nation of cultural specificity of mental illness, this paper argues that mental illness is a universal human experience. However, the types of disorders, the incidence and the severity of disorders may vary markedly across cultures. To understand mental illness and identify it across cultures, it is necessary to examine the problem against the backdrop of the dominant value systems which prevail in any culture at a given point in time. There are salient value systems to which most cultures subscribe, which in turn influence our understanding, diagnosis and treatment of mental illness and consequently the allocation of resources and the provision of care within the community. The different valueorientations between Western and Eastern cultures have a strong bearing on the problems of diagnosis and on the treatment of mental disorders, which in many instances are the outgrowth of the available resources and the acceptance of traditional arrangements unique to each culture.     

Severe Mental Illness: A Bridge between Neurochemistry and the Collective Unconscious

This article builds a relationship between neurochemistry and Jung's a priori construct of the collective unconscious through an exploration of the psychotic delusions present in severe mental illness and the psychopharmacological drugs used to treat them. Jung's postulations of a collective unconscious were rooted in his clinical work with severely mentally ill patients, and he was aware, early on, that severe mental illness offered an example of the interplay between human biology and our psychological lives. Current post-Jungian discourse has moved away from addressing severe mental illness as a means of understanding the continued relevance of Jungian theory amidst advances in the fields of neuroscience. Narrative analysis of qualitative data on severe mental illness adds psychic dimension to medical research and offers evidence that the rise and fall of delusional content, replete with archetypal patterns of expression, are related to the presence or absence of psychopharmacological drugs used for the treatment of bipolar disorder.     

Mental Illness: Fact or Myth? Revisiting the Debate Between Albert Ellis and Thomas Szasz

Although it is widely accepted that mental illnesses affect millions of people worldwide, there is still disagreement among scholars about the facts of mental illness. The orthodox position is that mental illness is a fact; critics argue that it is a myth. Thomas Szasz was perhaps the most influential critic of mental illness while Albert Ellis was one of the most influential psychotherapists of the twentieth century. Yet, they disagreed about the facts of mental illness. Ellis argued that mental illness is a fact; Szasz argued that mental illness is a metaphor that we have mistaken for a fact. Both men were practicing psychotherapists: Ellis developed Rational Emotive Behavior Therapy and treated mentally ill clients as irrational thinkers; Szasz developed Autonomous Psychotherapy and treated clients as existential game-players who choose, or have been coerced into, the role of sick patient. Szasz vehemently disagreed with Ellis’s view that some people with serious mental illnesses should be institutionalized and treated against their will. While Ellis argued that mental illness is a convenient label for people who are a danger to themselves and others, Szasz argued that mental illness is a metaphor for moral problems in living and involuntary institutionalization and treatment are crimes against humanity. This paper, then, revisits the debate between Ellis and Szasz on the vexed topic of mental illness.     

Differences in attributions of mental illness and social distance for portrayals of four mental disorders

For individuals with mental illness, others' perceptions of mental illness often limit integration into communities. Perceptions of mental illness manifest as social stigma in the form of social distance and may depend on individuals' attributions of the origins of mental illness. 180 university students completed a survey on attribution of mental illness and social distance across several disorders (psychiatric and physical). Participants indicated greater social distance for severe mental illness (i.e., schizophrenia) than less severe mental illness and physical illness. More desire for social distance may be related to unfamiliarity with severe mental illness rather than less severe mental and physical illnesses. Greater understanding of how individuals perceive mental illness can inform efforts to educate the public.     

Utah youth suicide study: psychological autopsy

We conducted a psychological autopsy study to further understand youth suicide in Utah. While traditional psychological autopsy studies primarily focus on the administration of psychometric measures to identify any underlying diagnosis of mental illness for the suicide decedent, we focused our interviews to identify which contacts in the decedent's life recognized risk factors for suicidal behavior, symptoms of mental illness, as well as barriers to mental health treatment for the decedent. Parents and friends recognized most symptoms universally, although friends better recognized symptoms of substance abuse than any other contact. The study results suggest that parents and friends are the most appropriate individuals for gatekeeper training and, in conjunction with other innovative screening programs, may be an effective strategy in reducing adolescent suicide.     

The Minister and Mental Illness

Focusing on what I present to students on the first day of a seminary class on mental illness, this article cites six reasons why seminary students should learn about mental illness. In addition to noting that they are likely to have many experiences in their ministries of persons who are suffering from a mental illness, I also note the likelihood that some members of the class have experienced mental or emotional illnesses in their lives. These introductory comments emphasize the role that ministers may play in the prevention of mental illness and in supporting persons in the process of rehabilitation. The various roles that pastors may play in relation to mental illness are noted. Finally, I point out that, in the official roster of patron saints, mental illnesses are vastly underrepresented among the illnesses to which human beings are susceptible.     

The Stigma of Mental Illness

Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its impact. Counselor training is a peak time to identify and begin to mitigate stigma related to people with mental illness. Implications for counselor training are addressed.     

心理疾病污名内隐测评的类别标签初探

采用单一类型内隐联想测验,考察以往研究中常用的概括化心理疾病词和具体心理疾病词作为心理疾病内隐污名间接测量概念词或类别标签的有效性。结果发现,相较于与积极词配对的任务,两类概念词与消极词（心理疾病态度词）配对的任务反应时更快,正确率更高。研究表明概括化概念和具体疾病与反映人们对心理疾病患者真实态度的消极词存在更紧密的自动联结,是人们头脑中表征心理疾病的概念词或类别标签,可作为内隐测量中的心理疾病概念词用于污名评估。     

The typology of parricide and the role of mental illness: Data-driven approach

Parricide is a rare type of homicide in which mental illness is often an important factor. The aims of this study were (a) to describe the characteristics of parricide offenders with a focus on mental illness and clinical care and (b) to examine Heide's widely used typology of parricide through a data-driven approach. We analyzed all homicides in England and Wales between 1997 and 2014. Parricide offenders in our sample were most often male, unmarried, and unemployed, with a third of offenders diagnosed with schizophrenia; 28% had been in contact with mental health services before the offense. The latent class analysis resulted in three types of parricide offenders: middle-aged with affective disorder, previously abused, and seriously mentally Ill, which confirmed, to an extent, Heide's typology. Health and social care services should actively engage with carers of people with mental illness and support to those caring for older relatives and victims of abuse.     

心理疾病内隐污名：来自单类内隐联想测验的证据

以61名大学生为被试,采用三个独立的单类内隐联想测验（SC-IAT）考察心理疾病内隐污名的构成及其内隐效应。结果发现：（1）在认知评价、情感反应、行为倾向及其三者合并的4个SC-IATs中,被试在相容任务上的反应时均显著快于不相容任务;（2）总的SC-IAT和三个独立SC-IAT的内隐效应显著;（3）65.27%的被试的内隐效应值大于0,表现出对心理疾病患者负面的内隐态度;（4）研究采用的心理疾病内隐污名SC-IAT具有较好的信、效度指标。研究表明,被试倾向于将心理疾病与消极词联结在一起,心理疾病污名的内隐效应显著;心理疾病内隐污名包括自动化的负面认知、消极情感反应和歧视倾向。     

Mental illness disclosure in organizations: defining and predicting (un)supportive responses

Employees with a mental illness regularly encounter situations where they must make decisions regarding the extent to which they discuss their stigma. Past research has found links between positive disclosure experiences and positive well-being and job-related outcomes for the individual disclosing. However, research on stigma disclosure has not yet defined what differentiates a supportive response from an unsupportive one, and there is evidence to suggest that people are unsure of how to best respond to a disclosure. In a series of three studies, we sought to develop a better understanding of mental illness disclosure at work. First, we created a typology of supportive and unsupportive responses to disclosure via critical incidents gathered from working adults with a mental illness. Second, we surveyed working adults with and without a mental illness to examine if they perceive the supportiveness of responses differently. Third, in an experimental study, we examined which methods of disclosure are most effective in eliciting a supportive response. This work identifies several types of supportive (e.g., providing emotional support) and unsupportive (e.g., denial of symptoms) responses to mental illness disclosure and finds that individuals without a mental illness have a reasonable understanding of what an individual with a mental illness would also identify as supportive/unsupportive responses. We also find that downplaying one’s mental illness will likely lead to a less supportive response.

     

Crying wolf? Australian adolescents’ perceptions of the ambiguity of visible indicators of mental health and authenticity of mental illness

Young people’s perspectives about mental health concepts shape both their interactions with sufferers of mental illness and their actions related to their own mental health. The current study employed a cross-sectional qualitative design to explore how adolescents (aged 12–18 years) speak about mental health and illness in order to gain insight into young people’s perceptions and experiences and contribute to shaping approaches to policy and practice. When discussing mental health concepts and appropriate behaviours toward sufferers of mental illness, adolescents conveyed a sense of acceptance and understanding of the potential complexity and severity of mental health problems. In contrast, when discussing mental health in the context of their own lives, a stronger sense of scepticism was conveyed, with students expressing difficulty with the lack of visible markers of mental health and confusion determining authenticity in the mental health states conveyed by their peers. Interestingly, adolescents interviewed commonly conveyed the notion that young people may exaggerate or “fake” a mental illness for personal gain. Adolescent perceptions of mental health and illness hold practical implications for policy and school-based programs aimed at improving mental health knowledge, attitudes and behaviours among youth.     

Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness

Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed "narrative enhancement and cognitive therapy (NECT)". We describe the treatment approach and offer an illustration of it by way of a case vignette.     

Mothers’ Perspectives on Their Child’s Mental Illness as Compared to Other Complex Disorders in Their Family: Insights to Inform Genetic Counseling Practice

To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.     

What If? The Farther Shores of Neuroethics

Neuroscience is clearly making enormous progress toward understanding how human brains work. The implications of this progress for ethics, law, society, and culture are much less clear. Some have argued that neuroscience will lead to vast changes, superseding much of law and ethics. The likely limits to the explanatory power of neuroscience argue against that position, as do the limits to the social relevance of what neuroscience will be able to explain. At the same time neuroscience is likely to change societies through increasing their abilities to predict future behavior, to infer subjective mental states by observing physical brain states (??read minds??), to provide evidence in some cases relevant to criminal responsibility, to provide new ways to intervene to ??treat antisocial brains,?? and to enhance healthy brains. Neuroscience should make important cultural changes in our special, and specially negative, views of ??mental?? versus ??physical?? illness by showing that mental illness is a dysfunction of a physical organ. It will not likely change our beliefs, implicit or explicit, in free will, or spark a new conflict between science and religion akin to the creationism controversy.     

Mental Illness and the Ministry of the Local Church

Due to the stigma associated with mental illness in America, religious leaders and their congregations might be fearful of caring for and worshipping alongside a person with mental illness. This article recounts some of the challenges encountered by the pastor of a small congregation in attempting to provide care for a church member suffering with schizophrenia. It is proposed here that congregations need to grow in courage as they attempt to serve people who struggle with mental illness, just as people with mental illness exhibit courage in venturing out to participate in church life.