Geneticization of deviant behavior and consequences for stigma: the case of mental illness

One likely consequence of the genetics revolution is an increased tendency to understand human behavior in genetic terms. How might this "geneticization" affect stigma? Attribution theory predicts a reduction in stigma via reduced blame, anger, and punishment and increased sympathy and help. According to "genetic essentialist" thinking, genes are the basis of human identity and strongly deterministic of behavior. If such ideas are commonly accepted, geneticization should exacerbate stigma by increasing perceptions of differentness, persistence, seriousness, and transmissibility, which in turn should increase social distance and reproductive restrictiveness. I test these predictions using the case of mental illness and a vignette experiment embedded in a nationally representative survey. There was little support for attribution theory predictions. Consistent with genetic essentialism, genetic attributions increased the perceived seriousness and persistence of the mental illness and the belief that siblings and children would develop the same problem. Genetic attribution did not affect reproductive restrictiveness or social distance from the ill person but did increase social distance from the person's sibling, particularly regarding intimate forms of contact involving dating, marriage, and having children.     

Media variants,situation awareness,and protective public-health behaviors

This study investigates the effect of exposure to traditional and social media on protective behaviors during a public health emergency, mediated by situation awareness composed of perceived knowledge and perceived threat. Under the context of the worldwide spread of Ebola in 2014, a survey conducted in Hong Kong showed that, compared to exposure to social media regarding the emergency, exposure to traditional media produced a higher level of situation awareness, which further affected protective behaviors in a public health emergency. In addition, the effect of traditional media exposure on protective behaviors was significantly mediated by both perceived knowledge and perceived threat. However, the effect of social media exposure on protective behavior was only significantly mediated by perceived knowledge, but not by perceived threat.     

Mental Illness and Criminal Behavior

The tragic events in Aurora, CO and Newtown, CT have renewed public perception of mentally persons as ‘dangerous’ and ‘criminal.’ Unfortunately, this perception is based more on conjecture and fear than research. The following essay takes stock of the empirical research on mental illness and criminal behavior. Three noteworthy trends emerge from this literature. First, the prevalence of mental illness is substantially higher among individuals who have come in contact with the criminal justice system relative to the general population. Second, individuals with psychotic and externalizing behavioral disorders, particularly those who also abuse drugs and alcohol, tend to engage in higher levels of violence than individuals with other forms of mental illness. Third, mental illness does not determine whether someone will break the law; rather, it is but one of many criminogenic risk factors that interact in complex ways to influence individual behavior.     

Understanding and influencing the stigma of mental illness

Life goals and the opportunities that define them are impaired by the stigma of mental illness. Three kinds of stigma may act as barriers to personal aspirations: public stigma, self-stigma, and label avoidance. Challenging mental illness stigm is essential in helping individuals accomplish recovery-related goals. Public stigma may be changed through protest, education, and contact. Self-stigma can be addressed by fostering group identity, changing the perceived legitimacy of stigma through cognitive rehabilitation, and making strategic decisions about disclosing one's mental health history. Stigma change for label avoidance is not as well understood but may include the education and contact approaches used for public stigma. Evidence-based approaches to stigma change need to be substantiated by rigorous investigations.     

Terrorism threat in Belgium: The resilience of Belgian citizens and the protection of governmental reputation by means of communication

In November 2015, the terrorism threat in Belgium confronted both citizens and the government with a situation characterized by high uncertainty. In this context, a national survey was conducted among 805 respondents, with three purposes. First, this case study aimed to explore how Belgians deal with the threat by examining if they change their behavior in public places and seek information about the threat. Second, we investigated why people seek and process information about the terrorism threat based on three determinants, namely their level of involvement with the threat, the expert efficacy of the government, and attitudes towards mass media communication. Finally, this study elaborated on perceived governmental efficacy, researching how governmental reputation is affected through institutional trust and governmental responsibility. The results show that the terrorism threat leads citizens to be more alert in public places and participate less in mass events. Moreover, one fifth stopped traveling by public transport. It was found that Belgian citizens also searched for information several times a day, mostly via traditional media such as television and radio. Furthermore, based on structural equation modelling, we found that information seeking and processing behavior is determined by the cognitive assessment of the risk. This cognitive risk assessment is in turn positively influenced by risk involvement and perceived governmental expert efficacy. However, if the mass media are seen to focus too much on drama and sensationalism then the perception of risk decreases, and this in turn reduces information seeking behavior. In addition, results show that a perception of governmental expert efficacy is able to increase trust and decrease the level of governmental responsibility, which is in turn beneficial for governmental reputation. The implications of these findings are discussed.     

Bachelor of Social Work Students and Mental Health Stigma: Understanding Student Attitudes

Bachelor-level social work students (n = 198) at a midsized Midwestern public university were surveyed to evaluate their attitudes toward those with mental health concerns. Additionally, students were surveyed regarding their willingness to seek treatment for their own mental health needs. Results of the analyses suggest that the majority of students do not hold stigmatizing attitudes toward mental illness. Students who believed mental health work is rewarding were less likely to be afraid or uncomfortable around people with mental illness. In addition, these students were more likely to report attitudes that acknowledge the capabilities of people with mental illness and were less concerned with others knowing their own mental health status. Implications for social work education and directions for future research are discussed.     

Risk and selection processes between the general and the specialty mental health sectors

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.     

Rejection of the Mentally Ill: an Experiment in Labeling

Several studies of public rejection of the mentally ill using written vignettes have demonstrated limited support for the societal reaction perspective. Since written vignettes may be inadequate, this investigation used video-taped sequences of individual behavior during a counseling session. The study was a 2 × 2 × 3 factorial experiment with behavior, label, and actor's account as the independent variables. College students served as subjects. Both behavior and label (paranoid, normal) had significant main effects on the social rejection variable, whereas only label had a significant effect on the second dependent variable–perceived social competence. These findings are in contrast to the earlier studies and indicate that labels are likely to more powerfully affect public reaction to mental illness when behavior is directly perceived in a situational context.     

Genes Spell Danger: mental health service users/survivors, bioethics and control

The focus of this discussion is disability, culture and identities in relation to bioethics and mental health service users/survivors. Taking account of the inclusion of mental health service users/survivors within the administrative categories of disability, this article argues for debates about bioethics and disabled people to address and include the perspectives of psychiatric system survivors, and their concerns about psychiatry and bioethics. There is currently an increasing emphasis in both the media and government policy on the danger, threat and 'otherness' of mental health service users, and increasing provisions to restrict their civil and human rights. This development is international and has also tended to be racialised in its public presentation. While genetic approaches to physical and sensory impairment can be seen to be concerned with physical and bodily conformity, genetic approaches to madness and mental distress that are gaining increasing power and official legitimacy, are also closely associated with regulating diversity, divergence and dissent in thinking and perceptions. The aim of this article is raise and explore these issues, and highlight the common and different concerns for us as survivors and disabled people as a basis for encouraging alliances, shared understanding and common resistance.     

Heterosexism,racism, and mental illness discrimination: Experiences of people with mental health conditions and their families

Experiencing discrimination related to race/ethnicity, sexual orientation, or having a mental health condition is associated with negative outcomes. Research comparing types of discrimination or considering intersectionalities is lacking. This study reports findings from interviews with people with mental illnesses (PWMI) or family members of PWMI; all study participants also are of color and/or lesbian, gay, or bisexual. Findings include the following: participants experienced multiple forms of discrimination, mental illness discrimination shares characteristics with racism and heterosexism, and heterosexuals and people of color reported more mental illness discrimination than their counterparts. Implications for change advocates, mental health providers, and researchers are offered.     

The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.

The survey data presented here are on the national prevalences of major life-time perceived discrimination and day-to-day perceived discrimination; the associations between perceived discrimination and mental health; and the extent to which differential exposure and differential emotional reactivity to perceived discrimination account for the well-known associations between disadvantaged social status and mental health. Although more prevalent among people with disadvantaged social status, results show that perceived discrimination is common in the total population, with 33.5 percent of respondents in the total sample reporting exposure to major lifetime discrimination and 60.9 percent reporting exposure to day-to-day discrimination. The associations of perceived discrimination with mental health are comparable in magnitude to those of other more commonly studied stressors, and these associations do not vary consistently across subsamples defined on the basis of social status. Even though perceived discrimination explains only a small part of the observed associations between disadvantaged social status and mental health, given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.     

Individual and environmental factors related to job satisfaction in people with severe mental illness employed in social enterprises

Objective: The purpose of this study was to enhance understanding of the impact of individual and environmental variables on job satisfaction among people with severe mental illness employed in social enterprises.Participants: A total of 248 individuals with severe mental illness employed by social enterprises agreed to take part in the study. Methods: We used logistic regression to analyse job satisfaction. A model with job satisfaction as the dependent variable, and both individual (occupational self-efficacy and severity of symptoms perceived) and environmental (workplace) factors (provision of workplace accommodations, social support from co-workers, organizational constraints) as well as external factors (family support) as predictors, was tested on the entire sample. Results: All findings across the study suggest a significant positive impact of both individual and environmental factors on job satisfaction. People with higher occupational self-efficacy who were provided with workplace accommodations and received greater social support were more likely to experience greater job satisfaction.Conclusions: These results suggest that certain features of social enterprises, such as workplace accommodations, are important in promoting job satisfaction in people with severe mental illness. Further studies are warranted to expand knowledge of the workplace features that support employees with severe mental illness in their work integration process.     

Changing Perceptions through Contact

Contact has long been the major vehicle for changing beliefs and perceptions of minority groups. However, few studies in the area of integration of people with mental retardation have examined underlying assumptions of contact situations. Contact between volunteers and people with mental retardation at a Special Olympics' state games was examined within a theoretical framework wherein mental retardation was viewed as social construct and contact conceptualized within five components of contact theory. Theoretical and empirical study indicated that instances of negative effect limit the extent of change in perceptions the general public hold of people with mental retardation. However, contact, as compared to no contact, does contribute to positive changes in perceptions.     

The labeling paradox: stigma, the sick role, and social networks in mental illness

Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic "sick role" concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.     

Wearing two hats. Consumer & provider.

To change public attitudes toward people with mental illness, consumers need positive visibility and a strong community voice. We are making progress, although slowly, to eliminate the stigma surrounding mental illness. Progress can be attributed to the fact that the mentally ill are now living in our communities among us, and people are beginning to understand them more.     

From past trauma to post-traumatic growth: The role of self in participants with serious mental illnesses

Studies have shown that people with serious mental illness are more likely to have experienced trauma compared to the general population. This qualitative study employed a grounded theory approach to explore how trauma histories influenced the process of triggering, developing, and recovering from serious mental illness. Findings based on in-depth interviews with 15 participants illustrated the intersection of trauma, serious mental illness, and post-traumatic growth. Experiencing trauma compromised participants’ self-functioning, causing issues such as affect dysregulation, distorted self- and other- concepts and relationship difficulties, meaninglessness, and existential fears, all of which negatively impacted participants’ mental health and behavior. At the same time, participants with serious mental illness were able to achieve post-traumatic growth with the “transformed-self” via self-acceptance, self-exploration, self-worth, and self-fulfillment. Findings of this study have useful implications for trauma-informed care in mental health treatment. Mental health professionals should address clients’ trauma histories to prevent re-traumatization and design trauma-informed programs that use and build clients’ inner resources and strengths to promote post-traumatic growth.     

Normal life crises and insanity—mental illness contextualised

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city's population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one's disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client's socio-economic and psychosocial needs, rather than solely follow a medical model.     

Using the Americans with Disabilities Act to the advantage of persons with severe and persistent mental illness: what rehabilitation counselors need to know

This article explains central constructs and definitions underlying the Americans with Disabilities Act (ADA) and discusses their implications for persons with severe and persistent mental illness, as well as for rehabilitation counselors working with this population. Focus is placed upon Title I of the ADA, which prohibits discrimination in employment. The article provides a brief review of legislative history relevant to the integration of people with mental illness into public life. It proceeds with a discussion of definitions under Title I of the ADA. Considerations in applying the ADA to assist persons with severe and persistent mental illness in employment are addressed throughout and are discussed in detail in the final section of the article.     

Psychiatrist–consumer relationships in US public mental health care: consumers’ views of a disability system

The US public mental health system is a disability system. By this is meant that public programs for people with mental illness serve consumers who are seriously and chronically ill, functionally disabled and eligible for benefits by virtue of their disability. This study explores, through focus groups and qualitative data analysis, the perceptions of these consumers of their relationships with public sector psychiatrists. Thematic analysis finds relationships of three types – compliance, collaboration and contention – and constituent sub‐themes that specify these further. Issues of poverty and powerlessness arise in every category, but especially in contentious relationships. Although the converse is widely believed to be true, this paper argues that the economic and political empowerment of people with psychiatric disabilities is vital to the success of their clinical care