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A Handbook for the Study of Mental Health
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Book description

The second edition of A Handbook for the Study of Mental Health provides a comprehensive review of the sociology of mental health. Chapters by leading scholars and researchers present an overview of historical, social and institutional frameworks. Part I examines social factors that shape psychiatric diagnosis and the measurement of mental health and illness, theories that explain the definition and treatment of mental disorders and cultural variability. Part II investigates effects of social context, considering class, gender, race and age, and the critical role played by stress, marriage, work and social support. Part III focuses on the organization, delivery and evaluation of mental health services, including the criminalization of mental illness, the challenges posed by HIV, and the importance of stigma. This is a key research reference source that will be useful to both undergraduates and graduate students studying mental health and illness from any number of disciplines.

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Contents


Page 1 of 2


  • 7 - Viewing Mental Health from the Complete State Paradigm
    pp 125-134
  • View abstract

    Summary

    Sociological approaches to psychological well-being are fundamentally different. The distinctive emphasis of sociological approaches is on how processes such as life events, social conditions, social roles, social structures, and cultural systems of meaning affect states of mind. Many sociologists study how social conditions affect levels of mental health. Most research that takes place in clinical settings examines particular types of mental illnesses, such as schizophrenia, bipolar disorder, major depression, and obsessive-compulsive disorder. Emile Durkheim's study, Suicide, is generally regarded as the first explicitly sociological study of mental health. Contemporary studies in the sociology of mental health confirm the importance of social integration as a fundamental cause of well-being. Social inequality relates not only to economic and work conditions but is also an aspect of all social institutions. Birth cohorts are another social influence that shapes mental health. Generational factors also affect general levels of well-being and distress.
  • 8 - Mental Health Systems in a Cross-Cultural Context
    pp 135-162
  • View abstract

    Summary

    This chapter examines the assessment and measurement of mental disorders. It explores the special problems that have arisen in epidemiologists' attempts to transfer diagnostic criteria from the domain of clinical evaluation to the much different epidemiological arena in which disorder is measured in the general population by survey. Some early psychiatric epidemiological studies were based on the assumption that clinical prevalence could be used to validly infer the community population's true prevalence. The most notable attempt in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to make general progress on the false positives problem has been the development of a clinical significance (CS) criterion for use in evaluating mental disorder. The chapter also presents an example of a recent attempt to use DSM derived criteria in an epidemiological study to measure the prevalence of a particular mental disorder, namely, major depressive disorder (MDD).
  • Part II - The Social Context of Mental Health and Illness
    pp 163-406
  • View abstract

    Summary

    An important issue in assessing the societal burden of mental disorders is whether the evidence of increasing prevalence in recent cohorts is real or a methodological artifact. The chapter begins with a broad overview of results concerning the estimated lifetime prevalence, age-of-onset distributions, projected lifetime risk, cohort effects, and sociodemographic correlates of the Diagnostic and Statistical Manual DSM-IV disorders assessed in the National Comorbidity Survey Replication (NCS-R). It then turns to a discussion of the prevalence of these same disorders in the year before the NCS-R interview. This is followed by a brief review of data regarding trends in disorder prevalence and treatment in the NCS-R compared to a decade earlier in the baseline NCS. The chapter closes with a discussion of interpretations and implications of these results along with anticipated future directions in the investigation of the prevalence of mental disorders.
  • 9 - Stressors, Stress, and Distress
    pp 171-199
  • View abstract

    Summary

    This chapter focuses on three areas: brain structure and function (neuroanatomy), brain activity (functional brain imaging), and gene effects (genetics). Information from each area is beginning to be integrated, with the goal of understanding biological disease processes. The chapter focuses on the neurons because it is their functioning that is largely the basis of theories of psychiatric disorders at the level of analysis, with the recognition that the glial cells that support the neurons may also be relevant. Researchers have used several methods to test the hypothesis that psychiatric disorders reflect dysfunctions in neuronal communication systems. Researchers have also examined postmortem brain tissue to see changes in the shapes of neurons and their connections. Sociological analyses of the social construction of psychiatric disorders are also important; particularly at this juncture when the number of disorders officially recognized in psychiatry is growing at an unprecedented rate.
  • 10 - Social Support and Mental Health
    pp 200-212
  • View abstract

    Summary

    This chapter discusses the major psychological perspectives on mental illness. In terms of the biopsychosocial model, the unique contribution of psychology lies in its attention to the intra individual mechanisms that produce abnormal thoughts, feelings, and behaviors. Although there are a number of popular psychological models of abnormality, the chapter focuses on four: the psychoanalytic, cognitive behavioral, humanistic-existential-phenomenological, and the family systems approaches. Many psychodynamic theorists today are particularly interested in the mental representations that people have of themselves and others. Several theories of schizophrenia, propose that the disorder is most likely to occur in families in which messages are consistently disguised, contradictory, or accompanied by strong criticism. In family therapy, the therapist attempts to establish a healthy equilibrium within the family. Studies show that this kind of therapy is often effective for reducing conflicts and resolving specific problems such as bulimia.
  • 11 - Work and Unemployment as Stressors
    pp 213-225
  • View abstract

    Summary

    The biological or medical approach views mental illness as if it were a disease or physical defect in the brain or body. Within the social approach, there are three dominant theories of mental illness etiology: stress theory, structural strain theory and labeling theory. This chapter describes each theory's basic concepts and assumptions, theoretical limitations and advantages, and implications for treating or preventing mental illness. According to stress theory, when events and strains accumulate in people's lives, they can overwhelm people's psychosocial resources and abilities to cope and then generate symptoms of psychological disorder. Labeling theory picks up at this point and suggests that frequent, severe, or highly visible symptoms or symptoms exhibited by those with little social prestige or power, can launch a victimizing process. Societal reactions to symptoms may result in the person's receiving a formal psychiatric diagnosis, becoming hospitalized, and, ultimately, accepting a mental patient identity.
  • 12 - Socioeconomic Stratification and Mental Disorder
    pp 226-255
  • View abstract

    Summary

    By combining the pathogenic and salutogenic paradigms, the complete state approach is the only paradigm that can achieve true population mental health. This chapter illustrates the model of health as a complete state through a review of research on mental health as a complete state. Borrowing from the World Health Organization's definition of health, here we define mental health as not merely the absence of psychopathology but also the presence of sufficient levels of emotional, psychological, and social well-being. The chapter consists of reviews of several published papers using data from the MacArthur Foundation's 1995 Midlife in the United States survey (MIDUS). The complete mental health diagnostic states have been shown to be independent risk factors for cardiovascular disease. Evidence to date suggests that flourishing, a central component of complete mental health is a desirable condition that any community, corporation would want to protect or promote in its citizens.
  • 13 - Gender and Mental Health: Do Men and Women Have Different Amounts or Types of Problems?
    pp 256-267
  • View abstract

    Summary

    This chapter explores the relationship between culture and the experience of stress and describes a variety of culture-bound syndromes. Concepts of mental health, distinctions between mental health and mental illness, and distinctions between mental and physical illness are highly variable across cultures. Individual characteristics also interact with social roles in specific cultural contexts. Culture-bound syndromes may either form a distinctive class of disordered behaviors or ultimately turn out to be local variants of known psychiatric diagnoses. Reports on psychoeducational interventions for ethnically diverse families in the United States suggest possible adaptations. These might include involving extended family networks or community support persons, reducing the length of sessions, focusing on economic survival issues, eschewing egalitarian approaches and confirming the authority of group leaders, and other special cultural considerations. Cultural constructivists and symbolic interactionists remind us that all human behavior must be viewed in fluid interaction with ever moving cultural currents.
  • 15 - African American Women and Mental Well-Being: The Triangulation of Race, Gender, and Socioeconomic Status
    pp 291-305
  • View abstract

    Summary

    This chapter distinguishes stressors, stress, and distress in the interest of bringing the use of these terms more into line with the way they are used in the stress literature and to reduce the problems of inconsistent usage prevalent in the discussion of stress in everyday life. It discusses two original stress models- biological and engineering. The chapter distinguishes varieties of stress, from life events to chronic to traumas to nonevents to daily hassles, at the individual level. It demonstrates that these distinctions are empirically supported by findings that different sources of stress have distinct impacts on mental health outcomes. The chapter discusses the issue of misconceptions about stress to argue that stress, although a general concept is a concept with theoretical and operational borders. It reviews trends in stress research, which reveal an upward trajectory in the study of all of the kinds of stress.
  • 16 - Marital Status and Mental Health
    pp 306-320
  • View abstract

    Summary

    Social bonds, social integration, and primary group relations are central constructs in sociological theory and have been prime considerations within sociological analyses. This chapter begins with a description of prominent conceptualizations of social support. It discusses current knowledge of this topic, paying particular attention to the challenges of assessing both the mechanisms underlying the association between social support and mental health and the causal direction of this association. The chapter considers how the relationship between social support and well-being is importantly influenced by one's social location. The perception of being loved and wanted, valued and esteemed, and able to count on others must be a function of one's history of supportive and unsupportive experiences, with both early life and recent experiences representing major influences. Social support tends to matter for psychological distress and depression independent of stress level. However, it tends to matter more where stress exposure is relatively high.
  • 17 - Stress and Distress in Childhood and Adolescence
    pp 321-333
  • View abstract

    Summary

    This chapter considers some of the mental health consequences of work and unemployment. Two major changes involved the nature of work and participation of women in the labor force. This chapter describes each of these changes, providing a context for the consideration of the relation of work and unemployment to mental health. First, there have been a number of changes in the types of work available in the United States. Second, women have entered the labor force in increasing numbers, partly in response to changes in the occupational structure. The chapter focuses on the stressful aspects of work; the benefits of work are examined indirectly when the authors consider the effects of unemployment. Many studies have found that the effect of unemployment is more negative among persons of low socioeconomic status. Several investigators have shown the importance of examining the economic context in which individuals experience unemployment.
  • 18 - Psychopathology and Risky Sexual Behaviors among Black Adolescents
    pp 334-360
  • View abstract

    Summary

    This chapter reviews sociological theories and measurements of stratification and social class in the process of relating inequality to mental disorder. It reviews the major research studies, noting differences in indicators of social class and methodological variations. Mental disorders can have infectious, toxicologic, genetic, neurodevelopmental, psychological, and social causes. Adolescence and young adulthood appear to be important developmental periods, both for the process of socioeconomic stratification and for the onset of mental disorders. A classic early study of social class and mental disorder concluded that selection and drift, rather than social causation, were the dominant explanation for the relationship between socioeconomic status and mental disorder. In analyzing data on social class, ethnic group, and mental disorder, it is important to compare rates in ethnic groups at the same level of social class. Research on the mediating variables may eventually prove more helpful in improving the lives of individual human beings.
  • 19 - Well-Being across the Life Course
    pp 361-383
  • View abstract

    Summary

    Among the most profound social divisions in our culture is the one we make by gender. Because our social practices are fundamentally gendered, mental health and emotional troubles should also differ for men and women. For some time, however, there have been heated debates over the differences between the mental health of men and women. Some argue that women have more psychopathology than men, and some claim men have more. Others think that both genders suffer equally, but from different maladies. This chapter presents examples of these conflicting positions, examines the evidence for them, and discusses social explanations for disparities by gender. Looking at numerous levels, from macro-level broad sociohistorical forces to micro-level aspects of the self, the chapter explains how social differentiation by gender shapes the psychological problems of men and women.
  • 20 - Mental Health and Terrorism
    pp 384-406
  • View abstract

    Summary

    The current racial categories reflect the convergence of geographic origins, exposure to prejudice and discrimination, and socioeconomic disadvantage. This chapter provides an overview of the mental health status for each minority population and evaluates the available scientific evidence of racial variations in mental health. In considering directions for future research, the chapter emphasizes the need to identify the ways in which the mental health problems of each group emerge from the larger social context in which the group is embedded. Race is strongly associated with socioeconomic status (SES), with American Indians, Hispanics, Blacks, and certain subgroups of the Asian and Pacific Islander population having lower levels of multiple indicators of SES than the White population. Challenges deriving from the adaptation to mainstream American culture and socioeconomic disadvantage can lead minority group members to experience high levels of stressful experiences that could adversely affect health.

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