“Yet there’s method in his madness …”: Dimensions of deception and dangerousness

Undiagnosed malingering (symptom overreporting or fabrication) can endanger mental health staff. This review paper presents a systematic and empirically based framework to assess symptom overreporting and violence potential. The first half reviews three models of malingering and their implications for violence potential. The first model proposes that people who malinger are attempting to cope with major mental disorders or organic deficits. The violence potential of these often overlooked disorders is explained. The second model describes how some people with character disorders overreport psychological symptoms and use violence to manage interpersonal relationships. The third model proposes that people who malinger are attempting to get their needs met in complex situations. Mishandling these often desperate people can result in a dangerous situation. The second half of this article focuses on conducting evaluations with potential malingerers, including ethical issues, assessment techniques, and treatment recommendations. Public policy implications are also addressed.     

Vulnerable Populations in Research: The Case of the Seriously Ill

This paper advances a new criterion of a vulnerable population in research. According to this criterion, there are consent-based and fairness-based reasons for calling a group vulnerable. The criterion is then applied to the case of people with serious illnesses. It is argued that people with serious illnesses meet this criterion for reasons related to consent. Seriously ill people have a susceptibility to “enticing offers” that hold out the prospect of removing or alleviating illness, and this susceptibility reduces their ability to safeguard their own interests. This explains the inclusion of people with serious illnesses in the Belmont Report’s list of populations needing special protections, and supports the claim that vulnerability is the rule, rather than the exception, in biomedical research.     

Sustaining our Spirits: Spiritual Study/Discussion Groups For Coping with Medical Illness

Illness is a universal experience that evokes a range of difficult emotions and tough spiritual questions, often without satisfying answers. Illness can be alienating and isolating. Sustaining ones spirits and preserving identity in the face of illness is a challenge for patients, family members, and caregivers. This paper introduces Spiritual study/discussion groups to strengthen patients perceived coping with illness. The groups introduce a spiritual perspective, provide emotional support, and offer a variety of spiritual coping tools, utilizing traditional and contemporary resources. Preliminary evaluations suggest that a healing time and space is created through the provision of comfort, connection, support, and inspiration.     

Spiritual Disposition and Understanding Illness

Although Dull and Skokan (1995) proposed a cognitive model of the effect of religion on health, they neglected to clearly identify the multi-dimensional nature of religion as a cognitive schema. The present paper identifies various aspects of spiritual disposition (defined as personality and beliefs) that can play a role in an individual’s adaptation to illness. Specifically, this paper reviews the factors of religious doctrine and affiliation, spiritual beliefs, religious orientation, God locus of control, faith and hope as aspects of a spiritual disposition and explores how they can function as resources and/or negative factors in the process of adjustment to illness. Implications for clinical health care (e.g., pastoral counsellors) are drawn from this review.     

The Context of Caretaking in Rural Areas: Family Factors Influencing the Level of Functioning of Seriously Mentally Ill Patients Living at Home

After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers’ social support were tested in a model of caretaking that examines the relationship between these factors and patients’ symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.     

Defining Location in the Mental Health System: A Case Study of a Consumer-Run Agency

In this ethnographic study of a mental health service agency staffed by “consumers,” or fellow “recipients” of services for serious mental illness, the concept of community narrative provides the framework for examining how such an agency preserves its consumer identity while providing services dictated by the established service system. Locating the agency's narrative in its “origins tale,” analysis revealed five principles comprising the agency's identity: a normalizing view of mental illness, a commitment to helping, a dual-valued understanding of the mental health system, and beliefs in recovery and in the significance of employment as a criterion for recovery. Predicted consequences of narrative functioning emerged in social climate and staff expressions of cohesion and commitment. The local meaning of these narrative themes reveals the agency's view of the consumer element in its work and its solution to the dilemma of being both inside and outside of the mental health system.     

Fear of Physical Harm: Factor Structure and Psychometric Properties of the Injury/Illness Sensitivity Index

Three fundamental fears—anxiety sensitivity, fear of negative evaluation, and injury/illness sensitivity—are believed integral components of anxiety-related psychopathologies. S. Taylor (1993) performed a cumulative factor analysis on measures of these and found them factorially distinct. Subsequently, separate factor analyses have been performed on measures of anxiety sensitivity and fear of negative evaluation. No such analysis exists for the Injury/Illness Sensitivity Index (ISI; S. Taylor, 1993). The ISI, an 11-item self-report questionnaire intended to measure fear of illness and injury, has the potential to inform the understanding of mechanisms underlying anxiety-associated chronic health conditions. The primary purpose of this study was to assess the factor structure and psychometric properties of the ISI. A principal components analysis with oblique rotation, conducted on data from 122 participants, suggests the ISI comprises two distinct lower order factors—Fear of Illness and Fear of Injury—that load onto a higher order factor of Fear of Physical Harm.     

The belief in a just world and distress at school

This article investigates the relationship between the belief in a just world (BJW) and distress at school. On the basis of just world theory, the authors argue that strong student BJW should be associated with low school distress. Two questionnaire studies with German secondary school students attending grades 7–13 are reported. Both studies found strong BJW to be associated with less distress at school, better grades, and the evaluation of grades and teachers as more just. Moreover, the relationship between strong BJW and low school distress persisted when controlled for grades, justice of grades, and teacher justice. This relationship held for all students, independently of their school track, grade level, or gender. Overall, the pattern of results reveals school distress to have a unique association with BJW and school-specific justice cognitions.     

Patient Responsiveness to a Sleep and Circadian Intervention in a Sample of Adults With Serious Mental Illness

Understanding patient responsiveness, a component of fidelity, is essential as it impacts treatment outcome and ongoing use of treatment elements. This study evaluated patient responsiveness—operationalized as receptivity to treatment modules and ratings of the usefulness and the utilization of treatment elements—to the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in a sample of adults with serious mental illness (SMI) and sleep/circadian dysfunction. Adults with SMI and sleep/circadian dysfunction (N = 104) received TranS-C in a community mental health setting. Independent raters rated TranS-C sessions to assess receptivity. At posttreatment and 6-month follow-up, participants completed a usefulness scale, utilization scale, the PROMIS Sleep Disturbance (PROMIS-SD) and Sleep-Related Impairment (PROMIS-SRI) scales, DSM-5 Cross-Cutting Measure (DSM-5-CC), and Sheehan Disability Scale (SDS). Receptivity was rated as somewhat to fully understood, and predicted a reduction on the DSM-5-CC. On average, participants rated TranS-C as moderately useful and utilized treatment elements occasionally. Ratings of usefulness were associated with the PROMIS-SD, PROMIS-SRI, and DSM-5-CC at posttreatment, but not with the SDS. Ratings of utilization were not associated with outcome. The findings add to the literature on patient responsiveness, an implementation outcome, and provide data on the utility of TranS-C within a community mental health setting.     

Chronic illness and COVID-19-related risk and protective behaviors

People with chronic illnesses are at increased risk of contracting COVID-19. Still, little is known about whether such an increased risk relates to COVID-19-related protective behaviors among those with chronic illness. This study compares the self-reported COVID-19 risky and protective behaviors—specifically physically distancing, handwashing, and having houseguests—of people (N = 936) (1) living with chronic illnesses or (2) cohabiting with someone with chronic illness to those who fall in neither category at the beginning of the COVID-19 pandemic (April 2020). Study results were mixed: people with a chronic illness were more likely to have had houseguests in the past 5 days and less likely to have increased their handwashing in response to the pandemic, but were also more likely to physical distance when outside the home. Those cohabiting with someone with a chronic illness were more likely to have had houseguests, but did not differ in other outcomes.