Differential Labeling of Mental Illness Revisited: Patterns Before and After the Rise of Managed Care

With the National Comorbidity Survey of the early 1990s, Thoits (2005) recently showed that lower-status mentally ill individuals were not more often hospitalized or pressured into psychiatric treatment than comparably ill persons of higher status, disconfirming a central hypothesis of labeling theory. However, that finding may have been due to changes in the mental health treatment system introduced by the spread of managed care. The differential labeling hypothesis is reexamined here with data from the Epidemiological Catchment Area Studies (ECA) collected in the early 1980s before managed-care plans began to dominate the insurance marketplace and from the National Comorbidity Survey Replication conducted in the early 2000s when managed care had saturated the market. Little systematic support for the differential labeling hypothesis was found in the three studies, although, over time, the higher rates of mental hospitalization among less educated and low-income individuals found in the ECA survey disappeared. Trends across the studies suggest that educated and affluent persons with psychiatric problems more frequently sought hospital care. These findings further undermine the validity of the differential labeling hypothesis and suggest that service utilization or treatment-seeking factors may help explain mental hospitalization rates.     

Managing the Emotions of Others

Although research has focused on how individuals manage their own emotions, little attention has been paid to how individuals manage the emotions of other people. Here, I describe several techniques of interpersonal emotion-management, drawing from observations of a psychodrama-based encounter group which deliberately manipulated its members' feelings. Analysis reveals a number of strategies (e.g., group enactments, provocations, comforting) which, when used sequentially, produced first emotional loss of control in the individual and then positive emotion. Group solidarity was sometimes affected by these interpersonal emotion-management techniques as well. Some techniques may be similar to those used in military training and cult group recruitment, although further research attention is needed in these arenas. Other settings in which members play upon the emotions of others should be examined to identify other interpersonal techniques and the sequencing of strategies which produce desired individual and group outcomes.     

GENDER DILEMMAS, GENDER QUESTIONS, AND THE GENDER MANTRA

This paper discusses the social constructions of gender and the problematic effects of these constructions-masculine/feminie-on intimate attachments. It summarizes the aspect of feminist scholarship which revised the traditional developmental paradigm to include a psychology of women and cites recent infant research which re-describes development as a process of increasingly complex forms of relatedness rather than as a progression from attachment to separation. The authors are influenced by the school of feminist revisionism which argues on behalf of the integration of male and female attributes in each person. Two clinical techniques are suggested-"gender questions" and the "gender mantra"-which identify the contradictions inherent in the social construction of gender and encourage alternative constructions that more adequately represent men's and women's actual psychological experience.     

Homeless youths' perceptions of services and transitions to stable housing

Use of available services is low among homeless youths, and how youth make decisions to access services or seek housing is unclear. This study explored perspectives of current and former street youth about these processes. Recruited from the streets and a drop-in center, 27 youth ages 16–24, participated in individual qualitative interviews. Findings from consensual qualitative analyses indicated choices to use services were embedded within developing autonomy and identification with street lifestyles. Themes of self-reliance, substance use, and relationships with street and housed persons were expressed as critical for both using services and transitioning to stable housing. Agency-related factors such as caring staff, a nonjudgmental atmosphere, and flexible policies were perceived as important for service use while youth-related factors such as experiencing major events, being internally motivated, and embracing mainstream values were seen as conducive to transitioning off the streets. Implications for service providers and future research are discussed.     

Assessment and management of hospitalized suicidal patients

Suicide in inpatient psychiatric settings is a critical problem. A comprehensive literature review was performed to determine risk factors for inpatient suicide, instruments for assessing suicide, and treatment of hospitalized suicidal patients. Findings suggested that root causes of inpatient suicide were factors related to the treatment environment, failure to assess patient behavioral characteristics, and staff reliance on no-suicide contracts. Recommendations include assessing suicide risk regularly throughout hospitalization, including on admission, during changes in a patient's mental or physical status, after a change in observation level, and before discharge. Orientation and inservice education for all staff and additional research on the psychometric properties of available suicide assessment instruments are also essential.     

The Freshman 15: is it real?

OBJECTIVE: The belief that college students gain 15 lbs during freshman year is widespread, yet the evidence for this is limited. The authors aimed to determine whether college students gain weight during freshman year. PARTICIPANTS: The authors studied unmarried freshmen living on-campus at a private university in the northeastern United States. METHODS: The authors used an online survey to collect information about social behaviors and weight. RESULTS: The authors observed an average weight gain of 2.7 lbs. About half of the students gained weight, and 15% lost weight. Men gained more weight than did women. CONCLUSIONS: Freshman weight gain was 5.5 times greater than that experienced by the general population.     

Anticipating relocation: concerns about moving among NORC residents

Most older adults prefer to live at home as long as possible, requiring supports and services to help them age in place. This study examines the relocation concerns of a group of older adults in a suburban naturally-occurring retirement community (NORC). Twenty-six percent of the 324 residents interviewed expressed concern about having to move in the next few years. Residents who were worried differed from those who did not worry on a number of demographic and biopsychosocial characteristics. Overall, residents present a profile of vulnerability that calls for preemptive action to help them stay in their homes. A NORC is an ideal setting in which to provide supportive services.     

Ethnic and Marital Differences in Family Structure,Risk Behaviors,and Service Requests Among Young Minority Fathers

The purpose of this study was to examine ethnic and marital status differences in family structure, risk behaviors and service requests among African American and Hispanic adolescent fathers participating in a community-based fatherhood program. Demographic factors, risk behaviors, and service requests were gathered at program entry. The results indicated that each group demonstrated distinct patterns associated with family structure, sexual risk behaviors, substance use, and criminal behavior. In comparison to African American fathers, Hispanic fathers were younger and were more likely to be married and present at the delivery of their child. African American fathers reported having more children than Hispanic fathers. Disparities in school-related measures were also found, with African American fathers having higher high school graduation rates than Hispanic fathers. The impact of marriage on risk behaviors had mixed results. Services requests were similar for both groups. The finding that different ethnic groups have specific patterns of risk behaviors highlights the importance of considering the ethnic composition of a population when developing future research and interventions.     

BLOOD MATH

The text takes the form of a dialogue - a series of spoken fragments developed in correspondence by Phelan and Heathfield and written in an interleaved structure. The performance of this dialogue employed slide imagery and a musical score, and the correspondence was pursued through a game of spelling in which the participants gradually chalked out a word on a board. Each letter of the word stands for a thematic concern elaborated in the speaker's writing. Working from various anthropological, psychoanalytic and philosophical discourses on the nature of the gift, the dialogue examines the place of performance within various economies of cultural and personal exchange. Writing letters to one another, the authors move through the intertexts of Beckett, Boltanski, Heidegger, Nabokov and Franko B. The resonance of the act of giving is explored as it is played out in the relations between language and loss, calculation and love, memory and the object, the body and sacrifice, the arts of living and the arts of death. Aside from its conceptual address the presentation explores possibilities within the practice of performative writing and opens the form of the scholarly paper.