Concept Of Mental Illness Research Articles

From asylums to deinstitutionalization and after: an analytic review.

After a period of institution-based mental health care, in which the asylum system was the way in which the mental patients were treated, deinstitutionalization brought a set of significant changes and transformations in the conceptualization of mental illness and, by extension, the traditional therapeutic settings in which those in most need were assisted. However, this shift in the psychiatric domain was not only accompanied by valued achievements, but also by difficulties and challenges, as has been evidenced today. The aim of this paper is thus to examine the pros and cons of the closure of asylums, and the subsequent implementation of deinstitutionalization over the 60 years or so of such important transformations in the field of psychiatry. In considering this question, I examine in detail recent works of literature based on scholarly knowledge. In addition, I identify various issues involved, as well as ways of confronting these so as to attempt to overcome the difficulties they present. As I show here, the changes in the treatment and care of the mentally ill after asylum and deinstitutionalization brought a new air of hope to patients and their families, but also had undesirable effects. The paper also considers how mental health professionals today try to solve these effects on behalf of patients and society as a whole.

Cultural Aspects of Mental Health in South Asians

South Asians tend to experience high rates of mental health disorders, which are often unaddressed. Factors including acculturative stress, social determinants, gender predisposition, and cultural beliefs must be considered in diagnostic assessment and determination. Mental health symptoms are generally interpreted as physical illnesses by South Asians, who typically present with somatic symptoms and tend not to seek the required psychological help due to perceived stigma. Treatment models incorporating social and culture-specific interventions (eg, use of native language, involvement of family members, inclusion of traditional and/or religious principles) have been shown to improve mental health outcomes in South Asians. More research focusing on violence, substance abuse, and socioeconomic factors—along with a clearer understanding of the epidemiology and conceptualizations of mental illness—is needed to develop interventions that promote the mental well-being of South Asians in the US. [ Psychiatr Ann . 2023;53(3):117–121.]

“If There’s One Bad Apple, It Affects All of Us”: Filipino-Canadian Men’s Cultural Perspectives on Mental Health, Mental Illness and Stigma

In Canada, there is a dearth of comprehensive literature on the specific needs for the health and well-being of racialized newcomers, especially for mental health in the rapidly growing Filipino-Canadian diaspora. Using two focus groups with 14 participants, this article identified the following themes: Filipino-Canadian men’s conceptualization of mental illness, health, and stigma; gender and intergenerational expectations as a form of mental health stigma; and motivations for joining the Strength In Unity (SIU) project. The insights from these Filipino men should inform approaches to addressing mental health in Filipino communities in Canada.

Perspectives of Black Immigrant Women on Mental Health: The Role of Stigma.

Background:Black immigrants are a major growing segment of the United States population. The intersection of race, gender, and migration places black immigrant women at the confluence of multiple social determinants of health, and thus, black immigrant women experience ongoing mental health disparities. Understanding their perspectives, mental health needs, and associated stigma is critical to promoting positive mental health outcomes.Methods:We conducted five focus groups (N = 22) among women from two black immigrant community organizations from February 2019 to June 2019. We used an inductive driven thematic analysis to identify codes and themes related to mental health and the role of stigma.Results:Overall five core themes associated with mental health and associated stigma concepts were found: The critical role of trusted sources and confidentiality, Conceptualization of mental illness and anticipated discrimination, Acculturative influence and migration as a source of emotional distress, Spirituality as a source of support and source of stigma, and Management of mental illness and addressing stigma.Conclusion:The conceptualization of mental illness and the associated stigma may be rooted in cultural and religious belief systems among black immigrants. Cultural beliefs and biopsychosocial models can coexist positively without interrupting the pathway toward optimized engagement in mental health care. Our mental health systems need to take these factors into consideration to implement programs that effectively serve black immigrant women's mental health needs.

INTERNALIZED STIGMA AND STIGMATIZING CULTURAL BELIEFS ON PARENTING WITH MENTAL ILLNESS AMONG FEMALE PATIENTS WITH SCHIZOPHRENIA: A COMPARISON OF FEMALE PARENT VERSUS NON PARENT

Purpose: Differences in cultural values, norms and conceptualization of mental illness may influence mental illness stigma differently across the globe. Both public and self stigma have widely been researched globally however, little is known about the specific experiences of stigma that females, and in particular mothers, with schizophrenia encounter as parents in Nigeria. The study aims to explore and compare internalized stigma among female parents and female non-parents. The secondary aim is to explore if any association exist between cultural beliefs on parenting with mental illness and internalized stigma among female patients with schizophrenia.
 Methodology: 142 female patients with schizophrenia attending the GOPD clinic at FNPH Maiduguri recruited through convenience sampling completed the study. They completed a socio-demographic questionnaire and a modified version of the Internalized stigma of Mental Illness Scale (ISMI). Analysis was done using Statistical Package for Social Sciences (SPSS). Differences in self stigma were compared using chi-square for categorical variables and student t- test for continuous variables. P-value was set at 0.05. 
 Findings: A total of 65 (75.6%) female parents and 32 (57.1%) of female non parents with schizophrenia had high self stigma. Female parents had a statically significant higher level of self stigma on the alienation subscale as well as the total score. Myths and misconceptions about parenting with mental illness were rampant.
 Conclusion: Self stigma is more prevalent among female parents with schizophrenia, with cultural beliefs and practices playing an important role in influencing stigma of mental illness. Further research of the impact of cultural factors on stigma of mental illness and culture specific interventions should be explored to reduce self stigma among parents with mental illness.

Perspectives of university health care students on mental health stigma in Nigeria: Qualitative analysis.

Mental illness is a significant public health burden in low- and middle-income countries. A wide treatment gap in mental health care exists within the Nigerian health care system and this gap is worsened by the presence of stigma associated with mental illness, which leads to delay in treatment or acts as a barrier to any care. In this study, our aim was to understand the factors that underlie mental illness stigma in order to inform the design of effective stigma-reducing interventions among health care students in Nigeria. We conducted four focus groups among university health care students in March 2019 in Nigeria. The students included nursing, pharmacy, and medical trainees from a university teaching hospital. We used an inductive-driven thematic analysis to identify codes and themes related to mental health stigma and conceptualization of mental health within the study group. Among the 40 participants, we identified how specific interpretations of religious and spiritual beliefs may be associated with stigmatizing behaviors such as social distancing and discrimination. Conceptualization of mental illness as a communicable disease and the attribution of mental illness to a moral failing contributed to stigma mechanisms. Overall, eight themes associated with mental health stigma and mental health-related concepts were found: spirituality, discrimination and devaluation, conceptualization of mental health, attribution theories, methods to reduce stigma, shortage of resources, violence and dangerousness, and maltreatment. We found that the co-existence of spiritual beliefs and biomedical and psychological models of mental health is a key factor to consider in the design of effective stigma-reducing interventions among university health students in Nigeria.

Changing Psychiatry or Changing Society? The Motion for the Rights of the "Mentally Ill" in Greece, 1980-1990.

In 1980, the first formal association of mental patients, their relatives, and mental health professionals was founded in Athens, Greece. The Motion for the Rights of the “Mentally Ill” proposed a total restructuring of mental health care and a novel conceptualization of mental illness. On the one hand, it demanded that the mental health system be based on open services, psychotherapy, and on patients’ active participation in all decisions concerning their treatment and life. On the other hand, it conceptualized mental illness as a political issue that concerned all. Thus, the Motion viewed the promotion of the rights of the mentally ill as part of a broader project of cultivating conscious, active, and collective citizenship. This paper traces the Motion’s history during the 1980s, showing that it was shaped by both the socio-political conditions of Greece in the post-dictatorship period, a time of intense politicization, and by the legacy of mental patient activism in the Western world during the 1970s and 1980s. It argues that, although the Motion had a limited long-term impact, it represented the mental patient movement in Greece as it furthered the latter’s main features, most importantly its twofold endeavor to change not only the mental health system and the attitudes towards mental illness, but also society.

Why Are Psychiatrists Hesitant to Refer Patients For Interventional Treatments?

Why Are Psychiatrists Hesitant to Refer Patients For Interventional Treatments?

Exploring the Representation of Depressive Symptoms and the Influence of Stigma in Arabic-Speaking Refugee Outpatients.

The number of distressed refugees from the Arab world is relatively high in Germany and other host countries worldwide. For this specific population, substantial challenges and barriers have already been identified that hamper access to Germany's health care system. This study aims to contribute to this line of research by exploring the representation of depressive symptoms, both somatic and psychological, in order to inform clinicians about the most prevalent symptoms reported by Arabic-speaking refugee outpatients. Furthermore, this paper investigates the longstanding claim that mental health stigma fosters the expression of bodily distress. For these purposes, a total of 100 Arabic-speaking refugee outpatients, mostly Syrians, were recruited in Berlin, Germany. Somatic and psychological symptoms were assessed with the Patient Health Questionnaire (PHQ) 15 and 9, while stigma was assessed with the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10). Study results show that both somatic and psychological symptom severity was moderate while sleeping problems and energy loss were the most reported symptoms across both scales. Stigma was low and showed no association with somatic complaints in a multiple regression analysis, but was associated with more psychological symptoms. A principal factor extraction on the PHQ-15 items revealed five independent, somatic symptom clusters that were interpreted considering the rich poetic resources of the Arabic language. In conclusion, both somatic and psychological symptoms were commonly reported by Arabic-speaking refugees with symptoms of depression. Whereas, stigma does not seem to influence the expression of somatic symptoms, the present results provide first empirical indications for the relationship of symptom expression with the use of explanatory models and conceptualizations of mental illness within the Arabic culture and language. Future research efforts should be dedicated to enhancing our understanding of mental health care needs in this population as well as to exploring other mediators that might help explain the varying degree of somatic symptoms in depression across cultures.

Strengthening mental health services in Sierra Leone: perspectives from within the health system.

Though mental and substance use disorders are a leading cause of disability worldwide, mental health systems are vastly under-resourced in most low- and middle-income countries and the majority of people with serious mental health needs receives no formal treatment. Despite international calls for the integration of mental health into routine care, availability of outpatient mental health services and integration of mental health into the broader healthcare system remain weak in many countries. Efforts to strengthen mental healthcare systems must be informed by the local context, with attention to key health system components. The current study is a qualitative analysis of stakeholder perspectives on mental health system strengthening in one low-income country, Sierra Leone. It utilizes locally grounded knowledge from frontline healthcare providers to identify constraints and opportunities for strengthening mental health care within each component of the health system. In-depth semi-structured interviews were conducted with 43 participants including doctors, nurses, community health workers, mental health advocates, mental health specialists, and traditional healers recruited from the Bo, Moyamba and Western Area Urban Districts. Interview transcripts were content-coded in NVivo using both a priori and emergent codes and aggregated into broader themes, utilizing the World Health Organization Health Systems Framework. Participants described an extremely limited system of mental health care, with constraints and obstacles within each health system component. Participants identified potential strategies to help overcome these constraints. Findings reinforce the importance of factors outside of the healthcare system that shape the implementation of mental health initiatives, including pervasive stigma towards mental illness, local conceptualizations of mental illness and an emphasis on traditional treatment approaches. Implications for mental health initiatives in Sierra Leone and other low-income countries include a need for investment in primary care clinics to support integrated mental health services and the importance of engaging communities to promote the utilization of mental health services.

Social Constructions of Mental Illness: A Review

Social representations of certain identifiable images of mental illness that are adopted in examining the sanity of individuals are critical to understanding madness or mental illness as a concept. Identifiable images of the insane (Gilman 1988) that describe them as violent, dangerous, vagrant, unkempt, bizarre, childlike and blameworthy (Wahl 1992; Philo et al. 1996; Aina 2004; Knifton and Quinn 2008) characters have influenced standards adopted in the evaluation of individuals as sufferers of madness, an extension of which permits laymen and specialists to see the signs of danger and illness everywhere (Foucault 1965), particularly in ways that are influenced by socio-cultural practices. These socio-cultural practices, as it pertains to mental illness, vary in perception and practice across various cultures in different parts of the continent. In some cultural context, Africa specifically, mental illness is explained from views that are predominantly magical or supernatural, but in the western culture, violence and aggression are themes that are constantly evoked in mediated representations of mental illness. The media is also an important social structure that has been reported to reinforce existing social-cultural beliefs about mental illness. The differences and diversity in the way mental illness is understood across cultures are crucial to understanding the relativity and realism in social constructions of mental illness. This is so because social constructionism is concerned with putting in proper context which agency- human or social- is responsible for formulating and sustaining popularly held views about mental illness. Thus, this review analysed ways the media as an important social structure formulate or reinforce socially held views on manifestations of stigma and explanations of causes and treatments of mental illness. Also, this review made an attempt to fuel on-going debate about social constructionism, by explaining ways the individual creates or recreates personal views about mental illness while using social structures like the media and religion for these purposes. This review adopted social constructionism as explained by Burr (1998) and Berger and Luckmann (1966) to further explain the importance of magic and supernaturalism in the conceptualisation of mental illness in African and Asian societies, and the implication of these beliefs in the sustenance of psychiatry.

Overcoming mental disorder stigma: A short analysis of patient memoirs.

There is controversy concerning the relationship between stigma and the conceptualization of mental illness as a biomedical disease. Proponents of the biomedical model argue that conceptualizing mental illness as a biochemical disease benefits patients, because it not only enables them to receive medical treatments but also helps them avoid the stigmas associated with mental illness. Opposing this position, others suggest that biomedical causal trajectory further contributes to stigma. When considering individuals' sense of well-being while living with a mental illness, we believe that this debate detracts us from the most important aspects of removing stigma and enabling patients to develop fulfilling lives. Thus, using patient memoirs, we refocus attention on the patient experience itself, searching for how patients' memoirs can illustrate roads to recovery, resilience, and coping. We examine first what facilitates patients to live a fulfilling life and next, what obstacles they identify to a fulfilling life in the face of their encounter with mental illness.

\u2018The threads in his mind have torn\u2019: conceptualization and treatment of mental disorders by neo-prophetic Christian healers in Accra, Ghana

BackgroundIn many low- and middle-income countries, faith healing is used alongside biomedical treatment for many health problems including mental disorders. Further, Christianity in Africa has seen much transformation in recent decades with the growth of charismatic or neo-prophetic churches whose doctrines include healing, miracles and prophecies. As such, many charismatic pastors have been engaged in faith healing for many years. Such faith healers form a significant portion of the mental health workforce in these countries, partly due to the limited number of biomedically trained professionals. In this study, we sought to examine the beliefs of charismatic/neo-Pentecostal faith healers about mental disorders, as well as to examine the treatments that they employed to treat such disorders.MethodsWe interviewed neo-prophetic pastors who undertook faith healing, and examined their work relating to mental disorders. Ten pastors from eight churches in the Greater Accra Region of Ghana were interviewed using semi-structured interviews.ResultsThe data suggest that the pastors’ conceptualization of mental illness was generally limited to psychotic disorders. Their beliefs about causation were predominantly supernatural in nature although they acknowledged that drug misuse and road traffic accidents were also potential causes. The pastors’ expectations of healing also showed different perceptions of illness chronicity. Their diagnostic and treatment methods revolved around using prayer, prayer aids such as oils and holy water, as well as spiritual counselling for patients and their caregivers. However, they were not opposed to referring patients to hospitals when deemed necessary.ConclusionWe discuss the above results with emphasis on their implications for collaboration between biomedical and alternative healing systems in Ghana. In particular, we advocate a mutual understanding of illness perspectives between biomedical practitioners and faith healers as an important component for integrating different health systems in Ghana.

'A more perfect arrangement of plants': the botanical model in psychiatric nosology, 1676 to the present day.

Psychiatric classification remains a complex endeavour; since the Enlightenment, nosologists have made use of various models and metaphors to describe their systems. Here we present the most common model, botanical taxonomy, and trace its history from the nosologies of Sydenham, Sauvages and Linnaeus; to evolutionary models; to the later contributions of Hughlings-Jackson, Kraepelin and Jaspers. Over time, there has been a shift from explicit attempts to pattern disease classification on botanical systems, to a more metaphorical use. We find that changes in the understanding of plants and plant relationships parallel changes in the conceptualization of mental illness. Not only have scientific discoveries influenced the use of metaphor, but the language of metaphor has also both illuminated and constrained psychiatric nosology.

Mental illness and mental health care as experienced by persons who die by suicide; a qualitative analysis of suicide notes

While mental illness is a risk factor for suicidal behaviour and many suicide victims receive mental health care prior to death, there is a comparative lack of research that explores their narratives of care. Suicide notes offer unique insight into these subjective experiences. Our study explores the following questions: “How is mental health care experienced by those who die by suicide?” and “What role does this experience play in an individual's journey to suicide?” Our sample is a set of 21 purposefully selected notes that explicitly make mention of mental illness and/or mental health care, from a larger sample of 255 notes obtained through the Toronto Coroner's Office. We utilized a constructivist grounded theory framework to engage in line-by-line open coding, axial coding, memo-ing and theorizing of the data. Preliminary themes include (1) perception of recurrent utilization of mental health care as personal failure, (2) recurrent utilization of mental health care as a manifestation of accumulating hopelessness, (3) the construction of suicide as being beyond the scope of mental health care, (4) tensions between the conceptualization of mental illness as an inherent part of the self and mental illness as a disease to be fought or overcome, and (5) suicide as an exertion of self-autonomy, distinct from the influence of mental illness. An exploration of the complexity of an individual's relationship with mental illness and mental health care can foster better identification, understanding and support for those at risk for suicide.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Indigenous Medical Knowledge Systems, Perceptions and Treatment of Mental Illness Among the Yoruba of Nigeria

Studies in African indigenous medical knowledge and the perception and treatment of illnesses require a significant intellectual concern given the interface of indigenous knowledge and health. This paper seeks to argue that there exist an indigenous peoples’ medical knowledge systems and these influence their perceptions and treatment methods of mental illness. The research was conducted by using ethnography to elicit data on how indigenous knowledge is connected with the conceptualisation of mental illness, how this constructs the treatment strategy and then enhances the effectiveness of their practice. The Yoruba people of Southwest of Nigeria have an indigenous knowledge system that is technical. The paper concludes that indigenous medical knowledge system in the treatment of mental illness is efficacious in the treatment of different kinds of mental illnesses. It will be foolhardy to underrate and cast aspersion on this kind of practice especially among indigenous practitioners.

Children and young people's conceptualizations of depression: a systematic review and narrative meta-synthesis.

There is an increasing research interest in conceptualizations of mental illness, examined in association with help-seeking, stigma and treatment preferences. A recent focus on young people's concepts has been identified, with depression being one of the most examined conditions. The purpose of this systematic review is to synthesize evidence on children and adolescents' conceptualizations of depression, adopting the model of illness representations. The review further aims to examine developmental trends, gender differences and the role of experience. A systematic review and narrative meta-synthesis were conducted, reviewing 36 studies identified through a systematic search of six databases in March 2016. Thirty-six quantitative and qualitative studies were included. Half of the young people are able to recognize depression, and recognition increases when symptoms are more severe (e.g. suicidality). Young people are able to name a variety of causes for depression. Mental health professionals are considered the appropriate source of help by half of the young people, followed by family and peers. However, stigma constitutes a major barrier to help-seeking. There are developmental trends and gender differences in young people's conceptualization of depression, while experience with depression is associated with a broader conceptualization. Young people's concepts of depression resemble aspects of adult conceptualizations, however are sometimes incomplete. Further research on younger children and clinical populations is needed. Research on young people's conceptualizations informs both clinical practice and mental health literacy interventions.

Knowledge and conceptualisation of mental illness among the Muslim population in Harare, Zimbabwe

ABSTRACTReligion is a powerful force in people’s conception of mental illness. The extent to which Muslim populations in Zimbabwe understand and conceptualise mental illness is largely unknown. Thus, a descriptive cross-sectional study aimed at determining knowledge and conceptualisations of mental illness among Muslims was conducted in Harare. Seventy-one participants drawn from three mosques in Harare responded to self-administered questionnaires, which assessed their knowledge on causes, signs and symptoms as well as the treatment of mental illness. Descriptive statistics were used for data analysis. Respondents defined mental illness within the social, spiritual and medical realms. The main perceived causes of mental illness were evil spirits (66%) and stress (62%). Treatment methods included medication (68%), prayer (66%) and Quranic verse recitations (64%). Both modern medicine and religious methods emerged as important in managing mental illness which suggests the need for a multi-sectoral approach.

Ideological vs. Instrumental Barriers to Accessing Formal Mental Health care in the Developing World: Focus on South-eastern Nigeria.

The striking gaps in formal mental health care in the developing world are largely traceable to Instrumental and Ideological Barriers. Focusing on south-eastern Nigeria, the study aimed to establish the relative weight, significance and determinants of these barriers for prioritised policy interventions. Multistage sampling method was used to select participants (n = 706) to whom questionnaires were administered. Ideological Barriers (cultural and mental health literacy constraints) were more significantly perceived (84.8%) than Instrumental Barriers (systemic and financial impediments) (56.6%). The study demonstrated the primacy of improved knowledge in plugging the gap in conventional mental health care in a region ironically defined more by systemic and material poverty. This is instructive for prioritised policy interventions with an indication that even if facilities and socio-economic status improve, services will likely be underused without greater improvement in people's conceptualisation of mental illness. It equally underscored the need for cultural competence in mental health service provision.

The psychiatry of children aged 0–4: advances in assessment, diagnosis and treatment

SummaryMental illness in very young children is relatively rare and the number of 0- to 4-year-olds seen in secondary care psychiatric services has recently declined. Conceptualisation of mental illness in this age group is shifting towards a model that views disorders as part of the wider spectrum of diagnoses, rather than distinct, developmentally specific conditions. This article discusses the epidemiology of psychiatric illness in preschool children, evaluates assessment tools that have only recently been validated for use in secondary care and considers evidence of the efficacy and cost-effectiveness of early intervention using treatments encompassing pharmacological, psychological and social approaches.