The myth of mental illness.

"My aim in this essay is to raise the question 'Is there such a thing as mental illness?' and to argue that there is not." Major sections are: Mental Illness as a Sign of Brain Disease; Mental Illness as a Name for Problems in Living; The Role of Ethics in Psychiatry; Choice, Responsibility, and Psychiatry; and Conclusions. Mental illness "is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes and feelings of criminal justice personnel toward the mentally ill

The present study compared the attitudes and feelings of law-enforcement, corrections, parole and probation personnel, and college students toward mental illness. Modified versions of the Criminally Insane Scale (Khanna, Pratt, & Gardiner, 1962) and Attitudes Toward Mental Illness Scale (Cohen & Struening, 1962) were used in assessing these attitudes. Law-enforcement and corrections personnel tended to believe many of the stereotypic causes of mental illness, while the college students based their views on more current thinking. In addition, law-enforcement and corrections personnel indicated greater fear of the criminally insane than the other two groups. Possible causes and ramifications of these differences are discussed.     

Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Statement on report of Joint Commission on Mental Illness and Health.

An "endorsement of Action for Mental Health [see 35: 6705], the final report of the Joint Commission on Mental Illness and Health." The report cites the very substantial cost of adequate care for mental patients, hidden costs of mental illness, gross inadequacy of present measures, and presents a pattern of increased federal financial support to deal with the problem. It recommends the demise of the large custodial "mental hospital" and calls for "invention and trial of novel approaches." Reservations about the report are also made explicit: the report emphasized improved treatment of mental illness at the expense of other facets of the problem area; it says little about promoting more effective personal development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health of men with a psychiatric disorder or traumatic brain injury: Wives' labeling and husbands' perceived control.

Objective: To investigate the relations among wives' labeling of their husbands' psychiatric disorder or brain injury as an organic illness, the husbands' perceived control over their disabilities, and the husbands' mental health. Participants: 57 male clients of the Department of Rehabilitation, Israel's Ministry of Defence (26 with a psychiatric disorder and 31 with a traumatic brain injury) and their wives. Measures: Illness Labeling Questionnaire, the Perceived Control Over Illness Questionnaire, and the Mental Health Inventory. Results: Husbands' mental health was low but did not differ according to disability; wives' labeling of husbands' condition was negatively related to the husbands' mental health; husbands' perceived control was positively related to their mental health for both disabilities. Conclusion: Organic illness labels, even when adopted by the wives of the persons with the disability, seem to be negatively related to that person's mental health, whereas perceived control over a mental disorder or a brain injury seems to contribute positively to mental health, independently of how the disorder or injury is labeled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased hyaluronidase levels in breast tumor metastases

We summarize the recommendations for research that emerged from a NIMH-sponsored Conference on HIV, AIDS, and Severe Mental Illness. Recommendations are made in four areas, namely, epidemiology of HIV infection, epidemiology of sexual and drug-use risk behaviors, risk reduction and transmission prevention, and treatment of infected persons. This research is urgently needed to adequately respond to the AIDS epidemic among people with severe mental illness.     

"The myth of mental illness:" continuing controversies and their implications for mental health professionals

Since the publication of "The Myth of Mental Illness" in 1960, there has been an ongoing debate about Thomas Szasz's ideas concerning mental illness. In this paper, Szasz's views are summarized, as are the views of Szasz's critics. Specifically, the following areas are addressed: Szasz's definition of disease, his notions regarding the unconscious and rationality, his beliefs regarding culpability, his proposed differences between psychiatry and other branches of medicine, the uses of the term "mental illness," and the possibility of implicating physical lesions in some mental illnesses. With this discussion as a backdrop, the importance of these issues to mental health practitioners is addressed.     

Cultural mistrust, opinions about mental illness, and Black students' attitudes toward seeking psychological help from White counselors.

Examined the relationship among mistrust of Whites, opinions about mental illness, and help-seeking attitudes among 105 Black college students. Participants completed the Cultural Mistrust Inventory (F. Terrell and S. L. Terrell; see record 1982-29464-001), the Opinions About Mental Illness Scale, the Help-Seeking Attitude Scale (R. Plotkin, unpublished), and the Reid-Gundlach Social Service Satisfaction Scale (P. N. Reid and J. H. Gundlach, 1983). The hypothesis that higher levels of cultural mistrust would predict negative help-seeking attitudes was generally supported through regression analyses. Greater mistrust of Whites was associated with more negative general attitudes about seeking help from clinics staffed primarily by Whites and with an expectation that the services rendered by White counselors would be less satisfactory. Limitations of this study, as well as implications and recommendations for future research and practice, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Locus of control and attitudes toward mental illness among mental health volunteers.

Administered Rotter's Internal-External Control (I-E) Scale and Opinions about Mental Illness (OMI) Scale to 30 volunteers at a state mental hospital and 34 undergraduate controls. It was found that the volunteer group was more internal on the I-E Scale and less likely to feel that patients should be restricted in their social functioning. Retest OMI Scale scores of 16 volunteers after 6 mo. indicated that Ss' attitudes toward patients became more benevolent over time, and they may have begun to adopt the ideology of the mental health professional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Basal expression, subcellular distribution, and up-regulation of the proto-oncogene c-JUN in the rat dentate gyrus after unilateral entorhinal cortex lesion

OBJECTIVE: To compare perceived current mental health and disablement between primary care and end-stage renal disease (ESRD) patients, and to study social support and stress and severity of illness as possible determinants of mental health and disablement. METHOD: Observational cross-sectional analysis of 414 primary care patients in a rural community health center and 125 ESRD patients requiring hemodialysis in two community dialysis units. The Duke Health Profile (DUKE) anxiety-depression scale was used to assess mental health; the DUKE disability scale, to indicate disablement; the Duke Social Support and Stress Scale, to measure support and stress; and the Duke Severity of Illness Scale, to rate severity of illness. RESULTS: Perceived current mental health in terms of anxiety and depression symptoms was worse for primary care than for ESRD patients, and perceived current disablement was no different for the two groups. Patients' perception of their health status and of stress from family members were more closely associated with their level of anxiety and depression symptoms than were their diagnostic profiles or overall severity of illness. In turn, their level of anxiety and depression symptoms was the principal correlate of their disablement. CONCLUSIONS: The demonstration of strong relationships among anxiety and depression symptoms, disablement, and family stress in these two very different patient populations should stimulate further research and motivate clinicians to evaluate all three parameters as part of routine patient care.     

The differential effect of child age on the illness intrusiveness–parent distress relationship in juvenile rheumatic disease.

Objective: Examine age-related patterns of association between parent-reported illness intrusiveness and parent distress in parents of youth with juvenile rheumatic diseases (JRDs). Study Design: Cross-sectional multiple regression analysis tested child age as a moderator in the illness intrusiveness–distress relationship. Participants: Fifty-two parents of children ages 9–17 diagnosed with JRD. Main Outcome Measures: The Illness Intrusiveness Scale—Parent Version and the Brief Symptom Inventory. Results: Parent-reported illness intrusiveness demonstrated a significant main effect on distress for all parents in the sample. This was qualified by an Illness Intrusiveness × Child Age interaction. Illness intrusiveness was found to be significantly related to distress among parents of older youth, but was only marginally related to distress for parents of younger children. Conclusions: Results are consistent with family life cycle development models of adjustment to childhood chronic illness. The clinical implications of the findings are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cross-national study of attitudes toward mental illness.

Administered Cohen and Struening's Opinions About Mental Illness scale to a total of 1,212 college students, physicians, nurses and police in Great Britain, Czechoslovakia, and West Germany. Although there were differences among occupational groups, the differences among countries were much more substantial. Results suggest that (a) attitudes toward mental illness are part of a person's general orientation to social issues, rather than a narrow function of his concept of mental illness; and (b) in a community climate characterized by an authoritarian social-political structure, authoritarian and socially restrictive attitudes toward the mentally ill can be expected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of change and physical activity among individuals with severe mental illness.

Objective: To apply the constructs of the transtheoretical model (TTM) of change to understand physical activity among individuals with severe mental illness. Method: Predictions of stages of change of physical activity and self-reported physical activity were investigated among 92 adults with severe mental illness, using cognitive and behavioral processes of change, self-efficacy, and perceived pros and cons of exercise as predictors. Results: Separate logistic regression analyses for adjacent pairs of stages indicated that 33% of the variance was accounted for when predicting preparation versus action/maintenance stages, with behavioral processes making a significant unique contribution to prediction. A multiple-regression analysis was conducted to examine prediction of self-reported physical activity on the basis of all of the TTM measures, and the full model accounted for nearly 27% of the variance. Conclusion: Results suggest that TTM constructs hold promise in understanding physical activity of people with severe mental illness with significant implications for clinical practice and future research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mechanisms of health behavior change in persons with chronic illness or disability: The Health Action Process Approach (HAPA).

Objective: The present article presents an overview of theoretical constructs and mechanisms of health behavior change that have been found useful in research on people with chronic illness and disability. A self-regulation framework (Health Action Process Approach) serves as a backdrop, making a distinction between goal setting and goal pursuit. Risk perception, outcome expectancies, and task self-efficacy are seen as predisposing factors in the goal-setting (motivational) phase, whereas planning, action control, and maintenance/recovery self-efficacy are regarded as being influential in the subsequent goal-pursuit (volitional) phase. The first phase leads to forming an intention, and the second to actual behavior change. Such a mediator model serves to explain social–cognitive processes in health behavior change. By adding a second layer, a moderator model is provided in which three stages are distinguished to segment the audience for tailored interventions. Identifying persons as preintenders, intenders, or actors offers an opportunity to match theory-based treatments to specific target groups. Numerous research and assessment examples, especially within the physical activity domain, serve to illustrate the application of the model to rehabilitation settings and health promotion for people with chronic illness or disability. Conclusions/Implications: The theoretical developments and research evidence for the self-regulation framework explain the cognitive mechanisms of behavior change and adherence to treatment in the rehabilitation setting. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychosocial rehabilitation of deaf persons with severe mental illness: A multivariate model of residential outcomes.

[Correction Notice: An erratum for this article was reported in Vol 39(3) of Rehabilitation Psychology (see record 2007-10691-001). The article "Psychosocial Rehabilitation of Deaf Persons with Severe Mental Illness: A Multivariate Model of Residential Outcomes" by Judith A. Cook, Karen Kozlowski Graham, and Lisa Razzano was published with an excessive number of typographical errors. The publisher apologizes to the Journal's readers, the article authors, and the Guest Editor of the Special Issue on Deafness, for the confusion these misprints caused. Revised reprints of both articles may be obtained from the Publisher at the following address: Springer Publishing Co., Journals Department, 536 Broadway, New York, NY 10012.] Focuses on an innovative model of community treatment that integrates the fields of psychosocial rehabilitation (PSR) and deaf culture. A longitudinal research design was used to evaluate the progress of 60 Ss with mental illness and deafness toward living in the community due to a PSR program. Results suggest that deaf, mentally ill clients can increase their residential independence through PSR program participation. The number of Ss living in normal, commercial housing rose 25% after program participation. Multivariate regression analysis revealed that 5 factors account for 47% of the variance in the residential outcomes of the Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural syndromes and age moderate the emotional impact of illness intrusiveness in rheumatoid arthritis.

Objective: The authors investigated cultural syndromes (multidimensional vectors comprising culturally based attitudes, values, and beliefs) and age as moderators of the emotional impact of illness intrusiveness—illness-induced lifestyle disruptions—in rheumatoid arthritis (RA) and examined illness intrusiveness effects in total and separately for three life domains (relationships and personal development, intimacy, and instrumental). Research Method/Design: People with RA (n = 105) completed the Illness Intrusiveness Ratings, Individualism–Collectivism, and Center for Epidemiologic Studies—Depression scales in a one-on-one interview. Results: Controlling for disease and background characteristics, the association between illness intrusiveness (total score and the Relationships and Personal Development subscale) and distress was inverse when young adults with RA endorsed high horizontal individualism. Illness intrusiveness into intimacy was associated with increased distress, and this intensified when respondents endorsed high vertical individualism, horizontal collectivism, vertical collectivism, or low horizontal individualism. The negative emotional impact of illness intrusiveness into intimacy diminished with increasing age. Conclusion: Given an aging and increasingly pluralistic society, diversity can no longer be ignored in addressing the psychosocial impact of chronic, disabling disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating Outcomes of Rehabilitation for Severe Mental Illness.

Improving the quality of life of individuals with severe mental illness has been the focus of considerable research. With advances in treatments for severe mental illness, particularly in psychiatric rehabilitation, evaluating outcomes has become increasingly important. Given the complex and multidimensional nature of severe mental illness, outcome evaluation of psychiatric rehabilitation is particularly difficult. This article addresses issues in evaluating psychiatric rehabilitation outcomes, including key outcome domains, selection of methods and measures, and meaningful use of results. Continuing conceptual and methodological issues are discussed. Also, future directions are explored, including evaluating multidimensional treatment effects and interactions and building an integrated understanding of all of the outcomes involved in psychiatric rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development and psychometric validation of the Disability Attitude Implicit Association Test.

Objectives: Develop and validate the Disability Attitude Implicit Association Test (DA-IAT). Participants: Two hundred twenty-three rehabilitation counseling students. Outcome Measures: DA-IAT, Attitude Toward Disabled Persons Scale, Marlowe-Crowne Social Desirability Scale, Collett-Lester Fear of Death Scale, Internal and External Motivation to Respond Without Prejudice Toward People With Disabilities Scales, Contact With Disabled Persons Scale, and demographics. Results: DA-IAT congruent associations (disability plus negative-nondisabled plus positive) occurred more frequently than incongruent associations (disability plus positive-nondisabled plus negative). DA-IAT had no relationship with the Attitude Toward Disabled Persons Scale, an explicit attitude measure. Demographics did not predict DA-IAT scores. Contact with Disabled Persons Scale was the dominant predictor for the DA-IAT. Conclusions: The DA-IAT has the potential to become a useful measure of implicit group disability attitudes on the basis of experience versus belief. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping skills training: Attitude toward mental illness, depression, and quality of life 1 year later.

Presents a follow-up assessment of 18 outpatient clients who had participated in the author's (see record 1980-26239-001) coping skills curriculum of progressive relaxation, anxiety management, assertiveness, and self-reinforcement. Focusing on 3 outcomes that were not targets of training but were hypothesized as potential generalized effects of the intervention, the study revealed that coping-skills Ss held attitudes about the etiology of psychological problems (Opinions about Mental Illness Scale) consistent with those modeled during the program and reported less depression (Beck Depression Inventory) than 17 Ss in a supportive group counseling program. No differences in quality of life emerged between the 2 groups. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection of serum transforming growth factor-alpha in patients of primary epithelial ovarian cancers by enzyme immunoassay

OBJECTIVE: To survey the social outcome of patients with schizophrenia attending State mental health facilities in southern Tasmania. METHOD: Using the Statewide Mental Health Register, patients using inpatient and outpatient facilities who received a diagnosis of schizophrenia between 1981 and 1988 were identified (n = 771), and demographic and illness measures, and admissions and length of inpatient stay were compiled. The Life Skills Profile (LSP) was completed by mental health personnel for the 247 who were regular attenders or inpatients in 1991. RESULTS: Social morbidity as indexed by the LSP was highest in psychiatric hospital inpatients and patients in long-term rehabilitation programs, and lower in patients attending community centres. The majority of patients in suburban settings and attending community centres lived with their families, whereas patients in the inner city or in the rehabilitation service were mainly in hostel accommodation or living alone. Patients with schizophrenia attending State services were of a similar age range but had a longer duration of illness and more admissions, and had spent more days in hospital than patients who were not in regular contact with the service. CONCLUSIONS: The distribution of social morbidity in schizophrenia confirms that the public health system is supporting a group with high social morbidity. Patients with the highest morbidity are receiving the highest levels of care and intervention.