Families, culture, and mental illness: constructing new realities

In Modern Western cultures, conceptual models of mental illness are interwoven with value systems of individualism, agency, internal locus of control, and fear of dependency. These values have translated into psychological theory and practice, affected families' relationships with the professional, legal, and consumer communities and have often exacerbated family burden. Culturally patterned attributions of individual accountability also affect family-patient interactions and may have an effect on relapse and prognosis. The family and consumer movements are discussed in terms of their orientations, services, social impact, and influence on epistemology, particularly with reference to the different effects of protective paternalism and individualistic autonomy. Questions are raised regarding cultural values and differential prognoses in modern and developing countries and whether the process of recovery may be shaped by different cultural introjects. It is suggested that the era of family and consumer empowerment may be heuristic in discovering parameters of mental illness and potential for recovery, and ideas are offered for future cross-cultural research.     

Advocacy, recovery, and the challenges of consumerism for schizophrenia

Advocacy organizations such as the National Alliance for the Mentally Ill (NAMI) and patient consumer groups are playing an ever-increasing role in public health policy and patient care in schizophrenia. The recovery philosophy which recognizes the unique contributions of those who have experienced mental illness is now a part of treatment approaches in many states. Several states have extended these consumer initiatives to incorporate advance directives, an approach that has generated much debate. The NAMI destigmatization campaign, grounded in the neurobiology of major mental illness, is an unprecedented, concerted effort to change public opinion and to achieve parity at all levels for persons with severe and persistent mental illness. This article describes and chronicles these initiatives and explores their implications for the management of schizophrenia into the next millenium.     

Families of psychiatric patients: a critical review and future research directions

It is generally acknowledged that mental illness creates burdens for family caregivers. Since the 1950s, medical literature has identified the type and extent of those burdens, especially for families of patients with schizophrenia. Whereas the imperative to identify interventions for these families is clear, there has been a lack of systematic research of families' responses to and management of mental illness, resulting in significant gaps in knowledge. The rapidly changing health-care environment suggests that our understanding of families' responses to mental illness need to be reexamined for current relevance and new insights. This article critically examines the research to date and identifies gaps in knowledge related to family experience of mental illness. It argues the need to continue studies of caregiver burden and the stress resulting from that burden. Future directions for research are suggested.     

Ethnic differences in family attitudes towards psychotic manifestations, with implications for treatment programmes

The tolerance of Irish-American and Jewish-American families towards psycho-social dysfunction in a psychotic family member was studied. As predicted, significantly more Irish families than Jewish families tolerated deviant thinking in a psychotic relative, while significantly more Jewish families than Irish families tolerated deviant verbal emotionality. These and other findings are discussed in terms of psycho-social and socio-cultural theory and lead to a consideration of the goals of treatment programmes. Differences in family attitudes have been shown to affect the decision to send relatives to a mental hospital, or accept them on discharge. Cultural factors are known to be related to attitudes on a variety of health-related issues, but studies have not focused generally on ethnic contributions to family differences in attitudes towards mentally disturbed family members. One reason for this neglect of cultural factors has been the emphasis on sociological phenomena, stimulated by investigations of social class and mental illness. Yet is has been shown that ethnic factors may be responsible for at least some of the correlations that have been found between community, social class and mental illness. Every social class, furthermore, can muster a variety of patterns for seeking professional assistance for psycho-social dysfunctions, and some of these patterns may be differentiated along cultural lines. The present study attempts such a differentiation. It deals with two ethnic groups and their family attitudes towards disturbing symptoms in relatives.     

Schizophrenia is usually psychogenic.

Comments on D. L. Johnson's (see record 1989-29564-001) view of schizophrenia as a brain disease and on H. P. Lefley's (see record 1989-29581-001) view that families have been stigmatized for their role in major mental illness. Based on clinical experience, it is argued that families can indeed be psychogenic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The consumer–survivor movement, recovery, and consumer professionals.

This article presents a brief history of the consumer-survivor movement in the United States, including the basis for various viewpoints within that movement. The authors also describe the concept of recovery that has arisen primarily from within the consumer movement and how it offers an important perspective for mental health providers. Also described is the impact of stigma and discrimination, which are especially destructive when they come from mental health providers. Finally, the authors explore the importance and utility for consumers to have mental health providers who themselves have experienced a serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Food-contact epoxy resin: co-variation between migration and degree of cross-linking

The last decade has witnessed the increasing importance of consumers as providers of mental health services. Assertive Community Treatment (ACT) teams and ACT variants, with their emphasis on rehabilitation and support in the client's natural environment, have hosted consumer-professional collaborations. The authors discuss one such program in which an ACT program for homeless mentally ill adults employed consumer advocates (CAs). Consumer advocates were found to have a service profile similar to other staff. Further, there is suggestive evidence that the employment of CAs created a more positive attitude toward persons with mental illness. Issues of role definition, boundaries, support with supervision and the importance of CAs' experiences with mental illness are discussed.     

Enhancement of host resistance to microbial infections in mice fed a high fat diet by Lactobacillus casei cells

This paper will describe issues arising from a National Mental Health Project funded programme. This programme which is currently operating in Victoria, aims to provide assertive outreach support to the families of clients who have a psychiatric disability with a forensic history, and to the clients themselves. The support offered to families and clients by the Epistle Post Release Service was provided on the basis that patients with a major mental illness are prone to stress-related breakdown. By addressing their needs in a community setting, together with the provision of psychoeducation, emotional support and practical assistance, anxiety levels are diminished in both families and clients with the result that relapse and reoffending rates are reduced.     

The family experience of mental illness: Implications for intervention.

This article discusses the family experience of serious mental illness, including subjective and objective burden, potential for family resilience, family roles, and personal and family variables that can mediate the impact of the illness. Following a specification of essential family needs, a number of effective family interventions are presented, including family support and advocacy groups, family consultation, family education, family psychoeducation, and psychotherapy. Finally, the authors examine ways of resolving potential conflicts related to confidentiality and offer suggestions that can enhance the effectiveness of psychologists who work with these families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staying connected: Young adults’ felt obligation toward parents with and without mental illness.

The present study compares 94 young adults’ self-reported felt obligation toward parents, psychological symptoms, psychological well-being, and interpersonal loneliness in three family types: families where a mother has serious mental illness, families where a father has serious mental illness, and families with nondistressed parents. Results indicated no significant differences in felt obligation toward mothers or fathers as a function of family type. Young adults with a mother with serious mental illness reported significantly more psychological adjustment difficulties than their peers with a father with serious mental illness or nondistressed parents. Young adults’ reports of felt obligation toward both parents were significantly positively correlated with young adults’ psychological adjustment in families with a parent with serious mental illness, but were not significantly correlated in families with nondistressed parents. Study limitations, future directions for research, and implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

I bask in dreams of suicide: Mental illness, poetry, and women.

A consistent research finding in creativity research has been the tendency of poets--especially female poets--to suffer from mental illness. We explore (a) Why poets? and (b) Why female poets? We posit that poetry may attract those with a predisposition toward illness, the domain of poetry may particularly reward those who exhibit illness, and unusual aspects of the domain of poetry writing may increase the likelihood of poets succumbing to illness. These domain-specific aspects of writing poetry affect men and women alike. In addition, the greater difficulty that women tend to experience in ignoring extrinsic motivational constraints may cause successful female poets to have an even higher incidence of psychological stress, and of mental illness, than male poets. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical illness burden, trait neuroticism, and depression in older primary care patients

OBJECTIVE: The authors tested the hypotheses that medical illness burden is independently associated with depression and that this association is moderated by neuroticism. METHOD: Multiple regression techniques were used to determine the independent associations of medical burden and neuroticism with depression in a group of 196 subjects, 60 years of age and older, recruited from primary care settings. RESULTS: Medical burden and neuroticism were independently associated with major depression, depressive symptoms, and psychiatric dysfunction. CONCLUSIONS: These findings support models in which medical disorders may contribute directly to depression. At the same time, the role of neuroticism in later-life depression warrants further study.     

Multicultural experiences of family caregiving: a study of African American, European American, and Hispanic American Families

There is growing attention to the roles of families as caregivers of relatives with serious mental illness. This chapter examines the experiences of family caregivers in diverse cultures and discusses the implications of these experiences for the goal of supporting families in these roles.     

Transgender and gender variant populations with mental illness: Implications for clinical care.

There is a scarcity of literature on clinical care for transgender and gender variant populations with serious mental illness. At times, gender identity issues among individuals with serious mental illness have been labeled as delusions that should not be reinforced by providers. However, there are significant limitations to attributing gender variance among populations with mental illness solely to a psychotic process. The following case study research demonstrates the variation in gender identity issues among individuals with serious mental illness. These individuals may experience gender dysphoria exclusively in the context of acute psychosis or may have gender identity issues that are distinct from the mental illness. Denial of an individual's gender variant presentation by treatment staff may heighten distress, thus interfering with a collaborative treatment alliance while posing additional barriers to recovery from mental illness. Implications and applications for clinical training and further research will be presented in order to promote awareness and competent care of gender issues when co-occurring with mental illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The mental health system: Experiences from both sides of the locked doors.

Although people who have been diagnosed and treated for serious mental illness are visible as advocates and for some new paying jobs within public mental health systems, there are few psychologists actively engaged in the emerging models of consumer-provider collaboration. The key values and concepts of the consumer, and even more so the psychiatric survivor, have received too little attention. The lack of information, dialogue, and trust sustains an adversarial relationship that prevents the respectful sharing of expertise attained from different learning experiences. The knowledge gleaned from consumer/survivors' personal experiences can provide a rich resource for everyone who attempts to aid individuals engaged in the struggle to deal with these painful life circumstances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family burden and family stigma in major mental illness.

Discusses the stresses and burdens on families of mentally ill (MI) individuals, including stigmatization, and problems in dealing with mental health (MH) professionals. Converging historical events, new biogenetic research findings; widening recognition of the dimensions of family burden; deinstitutionalization, have led to a reconceptualization of the family role. The growth and influence of the National Alliance for the Mentally Ill have also been part of the historical process and have contributed to the new respect for families of MI individuals. The new and collaborative model of clinician–family relationships has done much to destigmatize families, to reorient the thinking of many MH professionals, and to alleviate the burden of families of MI individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A dialogue among patients, families, and professionals. Overview and reflections

What seems to be a general dissatisfaction with the mental health system is discussed in the context of the inevitable problems created by chronic mental illness. Patients, families, and professionals can, instead of blaming each other for such problems, acknowledge the common difficulties and begin to seek new strategies. Each of us has unique strengths to share, but to do so requires moving beyond traditional roles.     

Acculturative family distancing: Theory, research, and clinical practice.

Despite the rapidly growing immigrant population settling in the United States, our knowledge of acculturative processes and their impact on immigrant families remains quite limited. This article describes a theoretical construct called Acculturative Family Distancing (AFD), the distancing that occurs between immigrant parents and children that is a result of immigration, cultural differences, and differing rates of acculturation. AFD occurs along two dimensions: communication and cultural values. Breakdowns in communication and incongruent cultural values between immigrant parents and children are hypothesized to increase over time and place families at risk for mental illness and family dysfunction. Clinical illustrations of AFD's impact on immigrant Asian families are provided and recommendations for dealing with AFD are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The economic burden of depression in 1990

BACKGROUND: We estimate in dollar terms the economic burden of depression in the United States on an annual basis. METHOD: Using a human capital approach, we develop prevalence-based estimates of three major cost-of-illness categories: (1) direct costs of medical, psychiatric, and pharmacologic care; (2) mortality costs arising from depression-related suicides; and (3) morbidity costs associated with depression in the workplace. With respect to the latter category, we extend traditional cost-of-illness research to include not only the costs arising from excess absenteeism of depressed workers, but also the reductions in their productive capacity while at work during episodes of the illness. RESULTS: We estimate that the annual costs of depression in the United States total approximately $43.7 billion. Of this total, $12.4 billion-28%-is attributable to direct costs, $7.5 billion-17%-comprises mortality costs, and $23.8 billion-55%-is derived from the two morbidity cost categories. CONCLUSION: Depression imposes significant annual costs on society. Because there are many important categories of cost that have yet to be estimated, the true burden of this illness may be even greater than is implied by our estimate. Future research on the total costs of depression may include attention to the comorbidity costs of this illness with a variety of other diseases, reductions in the quality of life experienced by sufferers, and added out-of-pocket costs resulting from the effects of this illness, including those related to household services. Finally, it may be useful to estimate the additional costs associated with expanding the definition of depression to include individuals who suffer from only some of the symptoms of this illness.     

Training mental health practitioners to assist families of persons who have a psychiatric disability.

Reports on the development, implementation, and evaluation of an 18-hr in-service training program designed to improve the knowledge and change the attitudes practitioners have about families in which there is a member with mental illness. 47 practitioners (aged 26+ yrs) from a community mental health center served as Ss. Comparisons between practitioners who received training (n?=?29) and those who did not suggest that this model is an effective method of training practitioners. Trained practitioners reported more positive attitudes about providing services and information to families and more contact concerning educational and supportive topics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)