Protectors of Indigenous Adolescents’ Post-disaster Adaptation in Taiwan

The study examined the protectors of post-disaster adaption in indigenous adolescent survivors of a devastating typhoon in Taiwan. In total, 152 adolescent participants were recruited from two mountainous districts that were the most severely destroyed by Typhoon Morakot (August 7, 2009). A self-reported questionnaire with five major sections including: (1) sociodemographic information and previous traumatic experience; (2) the adolescent-family inventory of life events and changes; (3) the Family APGAR Index; (4) the Family Satisfaction Scale; and (5) the WHO Quality of Life Scale was administered to the adolescents. Multiple regression was performed to analyze the collected data. Gender, religion, and perceptions of overall life changes, family functioning, and satisfaction with family were found to significantly affected post-disaster life adaptation in indigenous adolescents. The findings suggest that clinicians should be more sensitive to gender differences, strengthen adolescents’ beliefs and family systems, and minimize transitional post-disaster experience in order to assist indigenous survivors with coping with disasters.     

Using a capabilities approach to understand poverty and social exclusion of psychiatric survivors

The purpose of this project is to better understand poverty and social exclusion of psychiatric survivors using a capabilities approach to social justice as part of a larger mixed-methods longitudinal study (N=380) in Ontario, Canada. Using thematic coding, four themes emerged: poverty, ‘You just try to survive’; stigma, ‘People treat you like trash’; belonging, ‘You feel like you don’t belong’; and shared concern and advocacy, ‘Everyone deserves housing’. This analysis provides a deeper understanding of poverty and other social determinants of experiences of psychiatric survivors, including the synergism of poverty and social exclusion.     

Revitalizing sociology: urban life and mental illness between history and the present

This paper proposes a re‐thinking of the relationship between sociology and the biological sciences. Tracing lines of connection between the history of sociology and the contemporary landscape of biology, the paper argues for a reconfiguration of this relationship beyond popular rhetorics of ‘biologization' or ‘medicalization'. At the heart of the paper is a claim that, today, there are some potent new frames for re‐imagining the traffic between sociological and biological research – even for ‘revitalizing’ the sociological enterprise as such. The paper threads this argument through one empirical case: the relationship between urban life and mental illness. In its first section, it shows how this relationship enlivened both early psychiatric epidemiology, and some forms of the new discipline of sociology; it then traces the historical division of these sciences, as the sociological investment in psychiatric questions waned, and ‘the social' become marginalized within an increasingly ‘biological' psychiatry. In its third section, however, the paper shows how this relationship has lately been revivified, but now by a nuanced epigenetic and neurobiological attention to the links between mental health and urban life. What role can sociology play here? In its final section, the paper shows how this older sociology, with its lively interest in the psychiatric and neurobiological vicissitudes of urban social life, can be our guide in helping to identify intersections between sociological and biological attention. With a new century now underway, the paper concludes by suggesting that the relationship between urban life and mental illness may prove a core testing‐ground for a ‘revitalized' sociology.     

Psychiatry in the age of neuroscience: the impact on clinical practice and lives of patients

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process.     

The Atascadero State Hospital experience. Engaging patients in violence prevention.

When it comes to caring for the forensic psychiatric inpatient, there is no "how to" book. In the forensic hospital environment, the commingling of severe and persistent mental illness with criminality poses vexing clinical challenges and complex moral dilemmas not faced in either general psychiatric or correctional environments. While providing evaluation and treatment in our maximum security forensic environment, we continually strive to create and maintain a therapeutic milieu as we fulfill our social mandate to protect the public from the dangerous "criminally insane." Few studies guide us. We do know that within the forensic population there is a spectrum of psychopathology to manage, some of which responds to traditional psychotherapeutic techniques and some of which does not. For example, patients with psychopathic traits may not respond well to traditional treatment methods (Rice, 1997). As forensic psychiatric staff, we sometimes feel as if we are making it up as we go, adapting and blending psychiatric theory with knowledge from penology and criminal justice science to provide a safe environment conducive to growth for patients, the majority of whom may be considered "violence-prone" persons (Toch, 1969). Change is a characteristic of public-sector settings (Smoyak, 1991). Forensic hospitals must continually strive to monitor, refine, and improve their organizational systems as they respond and adapt to constant change. Despite the inherent challenges posed when collaborating with forensic patients, the VAC has achieved some notable successes. Staff and patients have been encouraged to work together to create and maintain a milieu where violence is neither assumed nor condoned. An active collaboration and partnership with our forensic patients has been one component of the hospital's successful violence reduction program. We trust that ASH's successful effort to collaborate with patients on the issue of violence reduction may be of use to other forensic hospitals faced with similar challenges.     

Interpersonal Dependency Among Adult Survivors of Childhood Sexual Abuse in Therapy

ABSTRACT

This study investigated dependency in survivors of childhood sexual abuse (CSA). The Interpersonal Dependency Inventory (IDI) was administered at intake to 24 men and 85 women seen in therapy at a university-based community mental health clinic. In contrast to findings from earlier studies, no significant gender differences were obtained for IDI whole-scale or subscale scores. Analyses comparing CSA IDI scores with the IDI scores of previously studied groups indicated that among women, CSA survivors obtained higher dependency scores than non-CSA psychiatric patients, community adults, and college students. Findings for men were less consistent. Follow-up analyses revealed that commonly investigated CSA characteristics were unrelated to survivors' dependency scores. Implications of these findings for future research and clinical practice are explored.     

Becoming Dialogical: Psychotherapy or a Way of Life?

After birth the first thing we learn is becoming a participant in dialogue. We are born in relations and those relations become our structure. Intersubjectivity is the basis of human experience and dialogue the way we live it. In this paper the dilemma of looking at dialogue as either a way of life or a therapeutic method is described. The background is the open dialogue psychiatric system that was initiated in Finnish Western Lapland. The author was part of the team re‐organizing psychiatry and afterwards became involved in many different types of projects in dialogical practices. Lately the focus has shifted from looking at speech to seeing the entire embodied human being in the present moment, especially in multifarious settings. Referring to studies on good outcomes in acute psychosis, the contribution of dialogical practice as a psychological resource will be clarified.     

“Learning to live with it”: Coping with the transition to cancer survivorship in older adults

This article explores the coping experiences of elderly cancer survivors in the Intermountain West. Semi-structured telephone interviews were conducted with 55 older adult cancer survivors at 1 and 3 months following the last radiation or chemotherapy treatment. All interviews were fully transcribed and topic-coded for emergent themes. The coping process was characterized by the core theme of “Learning to Live WITH it (cancer).” The process begins when the survivor enters the cancer experience with prior life experiences and ends with a state where cancer survivors potentially achieve new balance or growth. The coping process is dynamic and is affected by the survivor's previous life experience, attitudes and sense of self, positive or negative intervening factors, and coping strategies. The ‘Learning to live with it' model shows how survivors draw upon various strategies, attitudes and prior life experiences to integrate the cancer diagnosis into their lives.     

Interdependence of theoretical concepts and neuroimaging data

Traditionally, discussion about neuroimaging focuses on methodological improvement and neurobiological findings. In current psychiatric neuroimaging, the research focus broadens and includes concepts such as the self, personality, well-being, and psychiatric disease. This calls for the inclusion of disciplines like psychology and philosophy in a dialogue with neuroscience. Furthermore, it raises the question of how theories from these areas relate to neuroimaging findings: are results generated by objective data independent of theories? Is there an epistemological priority for the theories used for generating hypotheses and for interpreting the results? Or do theoretical concepts and neuroimaging data influence each other? In this paper, we will discuss these positions concerning the priority of concepts and data in neuroimaging and provide arguments for an interdependence of concepts and data. An awareness of these considerations may help professionals from the life sciences and humanities as well as laypersons to avoid misunderstandings and oversimplifications.     

Understanding Very Old Age: Looking Back and Thinking Forward

ABSTRACT

Understanding human development among the oldest old is a sequential building process taking into account building-block data, theories, and models from childhood, adulthood, and old age toward a new territory of oldest-old survivors who have lived way beyond the average life-span. A central question is whether the oldest-old survivors have developed specific survival techniques and/or protective environments that nurture survival. Or are the oldest old statistical outliers who by happenstance continue to survive further into old age? This commentary provides a historical framework on the papers in this series that describe challenges confronted by the oldest-old survivors in order to advance our understanding of survival of the oldest old. A clear understanding of the contributors to longevity could guide public policies toward well-being and life satisfaction among our oldest-old citizens.     

The Clinical Effects of Massive Psychic Trauma in Families of Holocaust Survivors*

For years we have been treating numerous concentration camp survivors in the psychiatric clinics and hospitals of Israel. In recent years we have been seeing increasing numbers of the second generation suffering from a wide spectrum of emotional disorders, personality disturbances, borderline and psychotic states which are clearly related to the long-term effects of massive traumatization in the survivor parents. These effects are manifest in four inter-related areas of disturbance within the family—the parents' mental state, the family atmosphere, inter-personal functioning in the family and specific distortions in the parent-child interaction. Excessive talking about holocaust experiences to children, or the opposite —lack of communication, avoidance and denial of these experiences—are patterns frequently found in the children of survivors who seem to be most affected by the massive traumatization of the parents. It is postulated that therapy of the survivor parents can modify the transmissions of affects to the children. Family therapy is indicated whenever possible.     

Voices in discourses: Dialogism, Critical Discourse Analysis and ethnic identity

In this article we attempt to combine the Bakhtinian, dialogical philosophy of language and critical discourse analysis (CDA) with our analysis of ethnic identity. The data we discuss are an interview with a Sami journalist who works in the Sami media. We analyse the interview from the points of view of dialogism and CDA to illustrate how identity must be understood as something which is both individual and social in nature. We reject the earlier essentialist interpretations of identity which see it as purely individual and psychological in nature. At the same time, we argue that those views of identity that see it as exclusively socially constructed can be misleading as well. We aim to illustrate our individual‐cum‐social viewpoint by discussing how identity is represented through a variety of voices and a variety of discourses. We discuss ethnic identity as related both to social level discourses that our subject drew on – such as the discourses of the journalistic profession or ethnicity and to 'voices' that bear witness to his experiences as an individual and his individual life course.     

More responsibility, less control: psychiatric survivors and Welfare State restructuring

This paper is concerned with the implications of recent Welfare State restructuring for psychiatric survivors' citizenship status. Using the Province of Ontario as a case study, the paper examines the extent to which recent change in mental health care and social assistance programs has worked to facilitate or constrain survivors' ability to exercise control over their lives. Despite recognition of the importance of survivors' participation in the mental health care system in the late 1980s, recent years have seen a return to a more traditional treatment paradigm characterized by professional control. Concurrently, restructuring of social assistance programs has led to a decline in the real value of income supports and growing pressure on informal support networks. As a result, psychiatric survivors are increasingly held responsible for their own material well-being and public conduct, but are less able to exercise control within everyday life.     

Social Constructions of Masculinity and Male Survivors of Wartime Sexual Violence: an Analytical Review

ABSTRACT

Male sexual violence has been reported in 25 armed conflicts in recent years. However, communities and organizations are not equipped to deal with male survivors of sexual violence because it undermines the ideals of social constructions of masculinity. Compared with females, male survivors lack access to reproductive health programs and are generally ignored in gender-based violence discourse. Yet, male survivors are known to suffer from numerous physical injuries and psychosocial disorders. In this review, we call for a move beyond the paradigm of female-only sexual violence victims and for programs that address both male and female survivors.     

Quality of life in the evaluation of community support systems

As a result of the authors' experience in conducting an evaluation of the community support system (CSS) program in New York State, they have identified five reasons for focusing on quality of life (QOL) as a desired outcome for programs for the chronically ill. These reasons are presented and problems in QOL evaluative research are discussed. Psychological indicators are distinguished from social indicators of QOL, and two methods of operationalizing perceived QOL, the psychological well-being and life domains methods, are examined. A conceptual model is presented and the results of an exploratory study of the QOL of 118 chronic psychiatric patients receiving CSS services are presented.     

What is this moment we are caught in?

Our response to the question ‘What is this moment we are caught in?' is articulated through our collaborative reading of Berlant's (2011) Cruel Optimism (Durham, NC: Duke University Press). Cruel optimism, Berlant suggests, is a desire for something that undermines its own potentiality. As queer academics we expose the cruelty of our desires to live a good academic life, and we do so from our different positions as postdoctoral fellow, tenured academic and PhD candidate. In labouring to consolidate relationships and practices that hold the promise of our own sustainability, we give accounts of the material and affective work we perform to constitute what Berlant calls an intimate public, a collective space of mediation that functions as a key tactic to manage our academic life. These accounts take the form of three vignettes, each inflected by the specificities of our different positions and histories of becoming academics. We use Berlant as a point of departure to both interrogate practices of self‐management and find possibilities for a collective response to the moments in which we find ourselves caught.     

Domestic violence counselors and secondary traumatic stress (STS): A brief qualitative report and strategies for support

ABSTRACT

Mental health counselors who provide trauma counseling to domestic violence survivors are exposed to catastrophic stories of danger, physical and emotional vulnerability. As counselors try to assess and treatment plan for and with survivors, they are often deeply affected. For some practitioners, bearing witness to these frightening narratives results in a sympathetic form of trauma known as secondary traumatic stress. This article reports on the findings from a convenience sampling of domestic violence shelter counselors (N = 11). Patterns of emotional reactions emerge as a result of two focus groups. Four themes emerged: 1) hypervigilance, 2) impact on personal life, 3) a shift in worldview and 4) methods of coping.     

The team as a secure base: Promoting resilience and competence in child and family social work

This paper outlines research findings on the relevance of the Secure Base model (Schofield & Beek, 2014) for developing supportive teams in child and family social work. When the social work team functions as a secure base, this can help workers cope with the emotional demands of the role. The concept of the secure base comes from attachment theory (Bowlby, 1969) in which our relationships with significant others, who are available, sensitive to our needs and reliable, provide us with a secure base to return to when life is stressful and provide us with comforting internal mental models when we are physically away from them. This ‘secure base for exploration’ reduces anxiety and enables us to engage with the world, consider the internal world of others (empathy) and remain resilient when life is stressful. Using data from 52 phone interviews with child and family social workers across eight local authorities in the UK, we show how the Secure Base model has relevance for emotion regulation and resilience for child and family social workers. Data were analysed using Theoretical Thematic Analysis (Braun & Clarke, 2006). In the context of the emotional demands of social work, our data indicate that the supervisors and teams provide a work related secure base across five dimensions by behaving in ways which instil these beliefs: Availability -‘People are there for me’; Sensitivity - ‘My feelings are manageable’; Acceptance - I don't always have to be strong’; Cooperation - ‘I can work with others to find a solution’; Team belonging - ‘I am valued and I belong’. Implications for practice are proposed to help supervisors and team members reflect on beliefs and behaviours which can help provide a secure base for their teams.     

Narrative Psychiatry and Family Therapy: Promoting Resilience and Collaboration with Persons with Intense Mental and Emotional Experiences at Risk of Causing Violence

Narrative psychiatry identifies meaning‐making as a primal force in our lives and guides family therapists and psychiatrists in cultivating narratives of resilience that support safety and wellbeing when working with families in which a member is dealing with intense mental and emotional experiences and may be at risk of causing violence. These contexts are fraught with implications about power, control, identity, and ethical responsibilities of care for those consulting with us and for the wider community. Offering benefits distinct from pathology‐focused psychiatric practice, narrative psychiatry applies the practices of narrative therapy in psychiatric contexts, focusing on strengths and meaning and honouring how values, intentions, and commitments compel and constrain our actions. Illustrated by case conversations, this paper describes five key practices of narrative psychiatry, including emotional attunement, understanding the person without the problem, externalising problems, creating narratives of resilience, and collaborative treatment planning. It shows how narrative psychiatry facilitates risk reduction through helping a person identify values and narratives that support non‐violence and strengthening abilities, relationships and resources that help them stay true to this commitment. Practical ways that family therapists and psychiatrists can use conversations about resources, including medicines, to deconstruct damaging discourses and generate narratives of resilience are described. Discussion is offered about how narrative psychiatry can support clinicians in ethically negotiating clinical dilemmas in which the preferences of the person or family are in conflict with the clinician's ethical and legal duty to protect life.