Remission from Depression in the DSM: Moving from Rhetoric to Restoration

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, uses the term “remission” to describe the reduction of depressive symptoms. This paper argues that by categorizing someone who no longer has depressive symptoms as “in remission,” that person may feel indefinitely tied to his or her diagnosis. Considering the unfortunate stigma associated with mental illness, permanent linkage to diagnosis through records and professional memory may cause individuals to internalize pathology. In fact, the language of the diagnosis can affect self-perception in sensitive souls for a lifetime. As an implication for practice, we propose that cognitive and narrative therapy approaches, mood-memoirs, and use of metaphor present alternative uses of language that can reduce power imbalances between clinicians and clients, providing a bridge to healing.     

Preferences and Expectations for Delivering Bad News Among Korean Older Adults

ABSTRACT

 The purpose of this study was to explore Korean older adults’ perspectives toward physicians’ disclosure of serious illness to patients. Seventy Korean older adults residing in the community were interviewed in person using a semistructured interview guide. Major themes included conflicting desires among participants to: 1) inform the patient directly, 2) inform the patient indirectly, and 3) inform only the family. Subthemes under the first theme included: a) decision making about treatment, b) planning and preparation for the future, c) need for use of an ethical standard, d) consideration of patient coping responses, and e) disclosure of serious illness as a relational process. Disclosure of bad news is more than revealing or concealing information. Needs and preferences regarding to what extent and how information is delivered differ by culture. Thus, understanding preferred communication pathways for advanced care planning in specific cultural frameworks is important. Future studies using clear concepts and measures about serious illness disclosure can better prepare health care professionals in interacting with those from minority cultures. In addition, studies of those with poor health status from diverse cultural groups may further assist social workers to tailor interventions to accommodate cultural needs and expectations in end-of-life settings.     

Voices of resilience: older adults in hospice care

Terminally ill older adults have the capacity to live well in the context of dying. Having negotiated a lifetime of challenges, they have resources to demonstrate resilience and achieve wholeness in life's final phase, but research has not adequately investigated this process. This qualitative research study considered the paths to resilience used by 30 older adult hospice clients in Kansas and Illinois. Responses were coded using the grounded theory method of Strauss and Corbin (1990) where data drives interpretation and text is coded into categories. Results centered on four themes that included: (1) a redefinition of self; (2) use of religion/spirituality or openness to uncertainty; (3) maintenance of social investments; and (4) guarding independence even as the scope of life contracted. Results imply that attention should be paid to building environments of wellness. This may be accomplished paradoxically through facilitating continuity of client interests and yet opportunities for creativity and growth as well. Listening with a healing stance and cultivating a habit of being fully present in interactions with clients assist in this process.     

Religion and coping in older adults: a social work perspective

Religion is an important coping resource for many older adults. This paper briefly describes social work's religious roots, makes a distinction between religion and spirituality for older adults, and presents empirical data showing how older adults employ religious strategies to cope with life challenge. The study reports on religious coping in an available sample of 79 European American and African American older adults residing in urban community dwellings. Implications suggest how social workers and others may support religious coping.     

Responding to the Hartford Geriatric Social Work Initiative: a multilevel community approach to building aging competency

Infusing age-specific, multigenerational content into social work curricula at both the MSW and BSW levels are key goals in preparing age-competent social workers to meet the needs of our current and future aging populations. The social work profession has a holistic approach and crucial skills that can promote aging well. This article will discuss an innovative, multilevel intervention strategy supported by the Hartford Geriatric Social Work Initiative that formulates, implements, and sustains age-infused curricula and assures the education of age-competent social workers by capitalizing on a "community-focus" strategy.     

Spiritual assessment in aging: a framework for clinicians

Older adults may benefit from clinical conversations about the role of spirituality in their lives, but social workers and other helping professionals often do not have an understanding of where to proceed beyond initial questions of whether spirituality and/or religion are important and if so, what religious preference is held. Much has been written about definitions of spirituality and religion, but the literature has not yet provided a clear focus on ways to assess whether these are integrated positively or negatively in the lives of older adults. This article identifies eleven domains in spirituality that might be assessed. Within each domain an explanation is provided as well as a brief discussion of the rationale for including it in the classification. Sample interview questions and an illustrative vignette are included. Together these eleven domains build an important framework and resource for spiritual assessment with older adults.     

Spiritual distress to spiritual transformation: Stroke survivor narratives from Hong Kong

Cardiovascular accident (stroke) is a leading cause of long-term disability for older adults worldwide, including Hong Kong. The stroke event leaves stroke survivors experiencing great distress as they struggle to regain physical ability and develop a frame of meaning. In a Chinese context, several religious traditions and secular philosophies including Buddhism, Daoism, Christianity, and Confucianism contribute to reconstruction of a meaningful post-stroke self. Symbolic interactionism interpreted by Charmaz (1987) and social constructionism offer perspectives for this work. This paper reports on a qualitative study about the spiritual transformation of 11 female stroke survivors in Hong Kong using a naturalistic inquiry approach. Data was analyzed using NVivo to create common categories and profiles. After an initial period of despair and disequilibrium, participants drew on social/environmental resources and personal spiritual resources to reconnect to spiritually-rich beliefs and practices. The stroke ultimately resulted in transformation of the loss and creation of a resilient post-stroke self. Implications suggest that the spiritual transformation process is complex in a diverse society and social care professionals do well to recognize and support culturally relevant spiritual expressions.     

Korean Older Intimate Partner Violence Survivors in North America: Cultural Considerations and Practice Recommendations

While literature on elder abuse has expanded, elder abuse by intimate partners has been less investigated. Even less is known about intimate partner violence among older Koreans living in North America. This article identifies important cultural considerations for individuals helping the Korean older adult community, beginning with the definition of intimate partner violence in this community and barriers to leaving that include traditional views of the East Asian self. Current practice interventions are discussed and recommendations for future practice such as healing han, the accumulated suffering from years of abuse, are suggested. The ultimate goal of this paper is to expand awareness in order to develop the best culturally competent prevention and intervention practice for Korean older intimate partner violence survivors in North America.