Search

This article reports the case of a patient suffering from psychosis. B is a 34-year-old woman, born and raised in Africa, who immigrated to the U.S. as a young adult. Her biological mother died when she was very young. At some time prior to leaving Africa, she was diagnosed as being HIV-positive. She did not know how she became infected. Once in the U.S., she sought treatment from a local hospital but made no appointments for follow-up treatment. B became pregnant and had a child. B first came to psychiatric attention when the police brought her to a local hospital emergency room for evaluation. On mental status examination she was described as fully oriented but had extreme difficulty focusing on what was happening.

Introduces a series of articles on the state of knowledge about anxiety and panic disorders including its diagnostic formulation.

Discusses issues concerning the report "Mental Health: Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General," which examined mental health services administration in the U.S.

Abstract: Definitions and theoretical models of the stigma construct have gradually progressed from an individualistic focus towards an emphasis on stigma''s social aspects. Building on other theorists’ notions of stigma as a social, interpretive, or cultural process, this paper introduces the notion of stigma as an essentially moral issue in which stigmatized conditions threaten what is at stake for sufferers. The concept of moral experience, or what is most at stake for actors in a local social world, provides a new interpretive lens by which to understand the behaviors of both the stigmatized and stigmatizers, for it allows an examination of both as living with regard to what really matters and what is threatened. We hypothesize that stigma exerts its core effects by threatening the loss or diminution of what is most at stake, or by actually diminishing or destroying that lived value. We utilize two case examples of stigma—mental illness in China and first-onset schizophrenia patients in the United States—to illustrate this concept. We further utilize the Chinese example of ‘face’ to illustrate stigma as having dimensions that are moral-somatic (where values are linked to physical experiences) and moral-emotional (values are linked to emotional states). After reviewing literature on how existing stigma theory has led to a predominance of research assessing the individual, we conclude by outlining how the concept of moral experience may inform future stigma measurement. We propose that by identifying how stigma is a moral experience, new targets can be created for anti-stigma intervention programs and their evaluation. Further, we recommend the use of transactional methodologies and multiple perspectives and methods to more fully capture the interpersonal core of stigma as framed by theories of moral experience. [Copyright &y& Elsevier]

To understand Chinese immigrants' experiences with mental illness stigma and mental health disparities, we integrate frameworks of 'structural vulnerability' and 'moral experience' to identify how interaction between structural discrimination and cultural engagements might shape stigma. Fifty Chinese immigrants, including 64% Fuzhounese immigrants who experienced particularly harsh socio-economical deprivation, from two Chinese bilingual psychiatric inpatient units in New York City were interviewed from 2006 to 2010 about their experiences of mental illness stigma. Interview questions were derived from 4 stigma measures, covering various life domains. Participants were asked to elaborate their rating of measure items, and thus provided open-ended, narrative data. Analysis of the narrative data followed a deductive approach, guided by frameworks of structural discrimination and "what matters most" - a cultural mechanism signifying meaningful participation in the community. After identifying initial coding classifications, analysis focused on the interface between the two main concepts. Results indicated that experiences with mental illness stigma were contingent on the degree to which immigrants were able to participate in work to achieve "what mattered most" in their cultural context, i.e., accumulation of financial resources. Structural vulnerability - being situated in an inferior position when facing structural discrimination - made access to affordable mental health services challenging. As such, structural discrimination increased healthcare spending and interfered with financial accumulation, often resulting in future treatment nonadherence and enforcing mental health disparities. Study participants' internalizing their structurally-vulnerable position further led to a depreciated sense of self, resulting in a reduced capacity to advocate for healthcare system changes. Paradoxically, the multi-layered structural marginalization experienced by Chinese immigrants with mental illness allowed those who maintained capacity to work to retain social status even while holding a mental illness status. Mental health providers may prioritize work participation to shift service users' positions within the hierarchy of structural vulnerability., (Copyright © 2013 Elsevier Ltd. All rights reserved.)