Children and Young People Living Through a Serious Family Illness: Structural,Interpersonal and Personal Perspectives

This study explores the experiences of children and young people in Britain living through a serious family illness. The study considers the interplay between social structures, social relationships and individual agency. We draw on data from the Millennium Cohort Study to estimate the number of children and young people affected nationally and on seven in‐depth interviews to understand young people’s experiences and the effects on their daily lives. Living through a serious family illness impacts on young people’s educational achievements, mental health and social relationships over long periods. Policy and service responses are suggested.     

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.     

Mental illness, supported education, employment and recovery: Ben's story

Supported education programs aim to facilitate the successful return to higher education for people living with mental illness who may have experienced educational interruptions due to their illness. This article shares the story of Ben who lives with mental illness and his experience of participating in an Australian supported education course. The two authors draw on a qualitative life history approach as they reflected on Ben's experiences of mental illness, educational disruption and returning to education and employment. The losses associated with educational disruption and the positive and empowering experience of becoming a student again are described as positively impacting recovery. Ben's story is shared in anticipation that other people living with mental illness, their family and carers, or workers supporting those people, may draw from his determination and success, in their own journeys of recovery.     

Measurement for a human science

This paper argues a number of points about measurement in the sociology of mental health: (1) measurement is critical, (2) measures should represent and assess elements of human experience, taking measure of life as people feel it, sense it, and understand it, and (3) social scientists should create a human science, producing information for the people it studies so that they can better understand and control their own lives. We argue that a human science is best achieved with the use of indexes, not diagnoses, to measure mental health. We present a brief history of diagnostic instruments and detail how a diagnosis is made. We show how use of diagnoses to measure mental health discounts much human suffering. They dichotomize the true range of feelings and emotions into crude either/or distinctions that do not reflect the reality of people's lives, and they often exclude suffering such as that due to loss or illness that does not meet medical model preconceptions about mental disorder. Using diagnoses to measure mental health presents a reified image of hidden disease knowable and manageable only by trained professionals--beyond the capacity of the suffering individuals to understand and control.     

Work, employment, and mental illness: expanding the domain of Canadian social work

Despite established evidence that work and employment are an important component of recovery for people who experience mental illness, social work education in Canada seldom offers graduate training or courses on the significance of work in peoples' lives or on the practices involved in helping to gain and retain employment for these individuals. In this article the authors argue that the high levels of unemployment among people who experience mental illness, and the rising incidence of mental health and addictions issues in workplaces, offer the opportunity, as well as the mandate, for social work educators to provide professional education in the area of employment support and assistance.     

Memories, vision and hope: themes in an historical sociology of Britain since the Second World War

Abstract This paper suggests in an exploratory way that an historical sociology of post-war British society should include a concern with changes in sentiment and emotion or in what following Raymond Williams is termed 'structures of feeling'. The main theme discussed is what people from different social backgrounds feel about the changes which have taken place in their lives and in the society around them and in how the future is conceived. Three issues focus this - change in aspects of national identity, in prevailing conceptions of citizenship and belonging, and in feelings towards the welfare state.     

Homelessness and mental illness: who resorts to state hospitals?

Mental illness among the homeless is a topic which has received much attention in the last few years. Most studies in this field have examined the incidence and prevalence of mental illness among the residents of temporary shelters, missions and SRO hotels. Using data from a broader policy study of community mental health, this study addresses the issue of mental illness and homelessness from a different direction. By examining the incidence and subjective meaning of homelessness among patients in state hospitals, this study attempts to understand the relationship between homelessness, illness and the admission process. It was found that a significant portion (18 percent) of hospitalized mental patients attributed their admission to problems in housing. This group uses the hospital as a resource in their lives, admitting themselves to the hospital to replace inadequate social networks. For such patients, a mental hospital admission reflects a rational decision, based on his/her understanding of the limited options for care in an age of deinstitutionalization.     

The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer

Does the impact of stigma on the self differ by illness type? This study focuses on a comparison of the effects of the stigma associated with HIV/AIDS and cancer on self-esteem, body image, and personal control. We test the hypothesis that individuals' perceptions of stigma account for significant differences in the impact of an illness on the self. We examine four dimensions of perceived stigma: social rejection, internalized shame, social isolation, and financial insecurity. In turn, we consider how these dimensions medicate the effects of HIV/AIDS and cancer. Our sample includes 130 persons with HIV/AIDS and 76 persons with cancer. We control for illness severity by including a measure of functional health status that is based on participants' subjective perspectives of the severity of their symptomatology. Our findings provide additional support for modified labeling theory; however, our findings also point to the dimensionality of stigma and its differential negative impact on particular elements of the self, regardless of illness type.     

Labeling theory and community care of the mentally ill in California: the relationship of social theory and ideology to public policy

The practical merit of a labeling theory approach to mental illness is examined and assessed through an exploration of its application in terms of public policy, i.e., community mental health policy in the state of California since 1968. Primary focus is placed on the impact of the deinstitutionalization of mental health services in that state, and the release of former mental patients into the community. Similarities in the fundamental ideological underpinnings of labeling theory, an associated conspiratorial model of mental illness, and contemporary California mental health policy, are presented and examples of policy input by labeling theorists and researchers are detailed. The impact of the California policy on the mentally ill is generally negatively assessed in terms of three major criteria: (1) rehabilitation; (2) reintegration; and (3) quality and continuity of care. The "translation" of several theoretical misconceptions regarding mental illness, caused by putting labeling theory into official policy, is suggested to lie at the root of many of the policy's implementation problems. The uses of social science theory and research are discussed, and caution is advised in the translation and application of social scientific theory and research to public policy proposals and programs.     

Out of the Darkness: Three Waves of Family Research and the Emergence of Family Therapy for Lesbian and Gay People

Like family relationships themselves, the history and treatment of lesbian and gay people and their families is complicated. For this paper, three waves of research on the families of gay and lesbian individuals are described. During the first wave, gay and lesbian sexual orientation was seen as a disease and family dynamics were blamed for its genesis. Subsequently in the second wave it was believed that, fearing rejection many gay and lesbian people either distanced or were rejected from their own families and established friendship networks that have been described as families of choice. More recently, in the third wave, the family has been identified as a resource for lesbian and gay youth whereby open relationships with parents can help protect them from mental illness, substance abuse, and HIV risk. Furthermore, an increasing number of same-sex couples are choosing to become parents, overcoming biological and social obstacles. In this article these shifting views of the role of family in the lives of lesbian and gay people will be described along with case material that illustrates the historic influences, current developments and future directions of family treatment for this population. To be maximally effective with gay and lesbian people and their families, clinical social workers and other mental health professionals must understand how family therapy has been influenced by a progression of ideas that continue to evolve. In this paper, research examining the role of the family in the lives of lesbian and gay people will be described in three waves; as a source of blame, to an impediment to gay and lesbian happiness and ultimately a resource that can enhance lesbian and gay well-being. The influences of research on family therapy with this population will be described and case examples will demonstrate how to harness the strengths of family relationships identified in the most recent wave.     

Making connections: Severe mental illness and closeness with other people

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate co-workers. It could push them away. In mental health programs, we found that closeness has more of a chance to develop (1) during evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.     

Disablism in the lives of people living with a chronic illness in England and Portugal

This article is based on research about the daily lives of people living with chronic illnesses in England and Portugal. Through the first-person narratives of participants, I argue that the lives of people living with debilitating chronic illnesses are affected by disablism, discrimination and exclusion. These aspects affect them in several important realms of life such as lack of or poor social support, difficulties in obtaining reasonable adjustments or the inability to obtain any kind of state support at all. These aspects are also widespread and compound and greatly influence their lives, beyond or in addition to the physical experience of the illness itself. I conclude that it is fundamental to change these structural and policy aspects and that people should have access to what I have termed a paradigm of sustained well-being, despite the illness.     

‘Someone of Your Own to Love’: Experiences of Being Looked After as Influences on Teenage Pregnancy

Previous research has shown that children and young people who are looked after are vulnerable to poor life outcomes, including early pregnancy. This paper examines how experiences of being looked after may contribute to teenage pregnancy. Using in‐depth interviews, data were collected from 63 young people recently looked after who are aged 15–24 and 78 professionals, across four research sites. The young people reported feelings of loneliness, rejection, stigma and not being able to trust others, emotions which seriously influenced their decisions about becoming parents. The findings suggest that such young people may benefit from a greater degree of emotional and practical support throughout their lives in care. Copyright © 2006 Institute of Education, University of London.     

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al., 1994) and the Indiana Mental Health Services and HIV Risk Study (Wright, 2003). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HIV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.     

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al, 1994) and the Indiana Mental Health Services and HTV Risk Study (Wright, 1999). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations’ and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HFV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.     

ATTITUDES TOWARD THE MENTALLY ILL:

Labeling theory posits that people labeled mentally ill experience negative societal reactions. Past research on this question is contradictory, due primarily to methodological problems. This study overcomes some of these problems by having respondents indicate their willingness to interact with a person with a specific mental disorder, or with an identically behaving person with a specific physical disorder. As expected, respondents reject the mentally ill significantly more than identically behaving physically ill persons, as supports labeling theory. Respondents also consider the mentally ill less predictable and to have less positive outcomes than those with physical illness. These beliefs highly correlate with rejection and account for some, but not all, of the effects of label on rejection.     

'Because they have all the power and I have none': state restructuring of income and employment supports and disabled women's lives in Ontario, Canada

We examine the connections between neo-liberal forms of state restructuring and intervention in disabled people's lives, looking in particular at how these have affected disabled women's experiences of an income support program, the Ontario Disability Support Program (ODSP), in Ontario, Canada. We first outline why and how state programs have been re-designed and implemented in increasingly harsh ways as a result of such neo-liberal forms of state restructuring. Even groups formerly considered among the 'deserving poor' have found their access to social assistance diminished. We then argue that this is an outcome of state programs, policies and practices which are re-asserting and more deeply entrenching 'ableness' as a necessary condition of citizenship, inclusion and access to justice. Finally, we illustrate how disabled women's lives and well-being have been altered as a result of changes in the provision of these forms of state assistance using in-depth semi-structured interviews conducted with 10 women in Ontario.     

Trust and recognition: a comparative study of client attitudes and workers' experiences in the welfare services

Since professional conduct is important in the lives of many people, trust and recognition between professionals and their clients are critical. Social professionals administer public resources on behalf of the welfare state, and their approaches and methods of intervention are mostly founded in current welfare policy. Despite this mandate, social professionals receive little acknowledgement and recognition. This article investigates the level of public trust in the Norwegian social services compared to the national insurance agencies, and to what extent the providers of these welfare services experience recognition and public approval. A central question is whether these aspects of external appreciation influence the professionals' motivation and feelings of accomplishment. Findings indicate that the social services receive less public support than the social insurance agencies, owing to the discretionary services provided and the stigma related to social assistance. The variation in institutional trust is reflected by the differences in workers' subjective experiences. That result notwithstanding, the service providers reveal a split view of themselves: while they experience themselves positively with respect to involvement and pride in their work, they also see themselves through the deprecating eyes of the public.     

Older people’s perspectives on dignity: the benefits and challenges of a qualitative longitudinal approach to researching experiences of later life

Abstract

This article discusses findings from a qualitative longitudinal study of dignity in later life, which focused on the perspectives of older people at a time when their need for help and support was increasing as a result of long-term illness. It reflects critically on the methodology for its ability to generate knowledge about this eventful and unstable period of the life-course. It is argued that a longitudinal qualitative approach provides the optimum conditions for researching older people’s perspectives on their health and illness as well as on their experiences of being helped and supported. It sheds light on the changes they faced in their relationships, their home environments and their daily lives as well as how they dealt with these changes while maintaining their dignity.     

Physical activity in the life of a woman with cerebral palsy: physiotherapy,social exclusion,competence, and intimacy

Although physical activity can have substantial mental and physical health benefits, people with cerebral palsy usually lead sedentary lives. To understand, at an individual level, this inactivity, we interviewed a 29-year-old minimally active woman with cerebral palsy (Alana) about the meanings and experiences of physical activity throughout her life. Using a case-study approach, we found that Alana had adverse childhood experiences with physical activity, including: having to perform difficult, and sometimes painful, physiotherapy; wearing callipers to assist her walking; demonstrating limited competence at physical activity; being excluded from physical education and other organised physical activity at school; and feeling socially isolated from her classmates. These experiences seemed to contribute to feelings of difference/inferiority and the subsequent avoidance of physical activity, which, in turn, might have contributed to premature functional decline. Physical activity levels in people with cerebral palsy might be increased through focusing on enhancing childhood experiences.