Bottoms up: a whorelistic literature review and commentary on sex workers’ romantic relationships

Abstract

In the field of sex work research, recent decades of scholarship have witnessed an increase in a holistic approach to examining the experiences of this marginalized population. While scholars have examined various aspects of sex workers’ lives, holistic research on their romantic relationships is scarce. However, at the same time, outside the realm of academia, sex workers themselves have been producing their own discourse to approach the various facets they uniquely face in these relationships. Thus, this literature review and commentary analyzes both academic and sex worker published materials.     

Culturally competent health care for sex workers: an examination of myths that stigmatize sex work and hinder access to care

Abstract

Sex workers are individuals who offer sexual services in exchange for compensation (i.e. money, goods, or other services). Within the United States, the full-service sex work (FSSW) industry generates 14 billion dollars annually there are estimated to be 1–2 million FSSWers, though experts believe this number to be an underestimate. Many FSSWers face the possibility of violence, legal involvement, and social stigmatization. As a result, this population experiences increased risk for mental health disorders. Given these risks and vulnerabilities, FSSWers stand to benefit from receiving mental health care however a constellation of individual, organizational, and systemic barriers limit care utilization. Destigmatization of FSSW and offering of culturally competent mental health care can help empower this traditionally marginalized population. The objective of the current review is to (1) educate clinicians on sex work and describe the unique struggles faced by FSSW and vulnerability factors clinicians must consider, (2) address five common myths about FSSW that perpetuate stigma, and (3) advance a research and culturally competent clinical training agenda that can optimize mental health care engagement and utilization within the sex work community.     

Experiences of stigma and discrimination as predictors of mental health help-seeking among sex workers

Abstract

Sex workers face higher levels of stigma and discrimination than those in other service professions, this stigma and discrimination is a potential barrier to seeking mental health support. We surveyed 189 sex workers internationally on their perceived experiences of stigma, discrimination, and mental health help-seeking. It was anticipated that a large portion would report experiences of stigma and discrimination from mental health professionals and in mental health settings. Furthermore, that perceived devaluation and discrimination would predict a lower likelihood of past help-seeking from psychologists and psychiatrists, and perceived experiences of stigma and discrimination would predict a lower likelihood of future mental health help-seeking. We found that perceived devaluation and discrimination predicted lower past help-seeking from psychiatrists, and that past perceived experiences of stigma and discrimination by mental health professionals significantly predicted a lower likelihood of future help-seeking. No other significant effects were found. Results demonstrated a concerning level of stigma and discrimination experienced by sex workers when seeking mental health support, and that such experiences were demonstrated to significantly impact on the intention to seek future mental health support. Implications of these findings, as well as directions for future research in this relatively new field are discussed.     

Guidelines for mental health practice with clients who engage in sex work

Abstract

Many mental health practitioners have had or will have the opportunity to work with clients who engage in sex work (CSW). Sex work stigma is pervasive in the general population, and among mental health professionals, including sex and relationship therapists. Such stigma may lead to differential, unfair, and even unethical treatment of CSW. Although there is a clear need for best practice guidelines for mental health practice with CSW, no guidelines have been developed thus far. Therefore, drawing on feminist, multicultural, and sex-positive philosophies, this paper presents ten guidelines that are designed to: (1) address and increase mental health professionals’ self-awareness of their own bias about sex work; (2) provide useful information about the multifaceted lived experience of CSW; and (3) offer culturally-appropriate counseling skills and intervention strategies in working with CSW. Acknowledging that multicultural competence is a professional process, rather than an outcome or an end, the guidelines included in this paper are developed with the underlying assumption that all mental health professionals are committed to be sex work-affirming and competent in working with CSW, regardless of therapeutic orientation. The guidelines discussed in this paper are informed by current literature about sex work and people who engage in it.     

Stigma Resistance in Patients With Schizophrenia

Background: An individual''s capacity to counteract the stigma of mental illness, stigma resistance (SR), is considered as playing a crucial role in fighting stigma. However, little is known about SR and its correlates in patients with schizophrenia or schizoaffective disorder. Aim: Exploring SR in patients with schizophrenia or schizoaffective disorder. Method: One hundred fifty-seven participants completed the “Internalized Stigma of Mental Illness” (ISMI) Scale including its subscale on SR. Measures of perceived devaluation and discrimination, depression, self-esteem, empowerment, quality of life, and demographic and clinical variables were obtained. Results: Two-thirds of all patients showed high SR. SR correlated positively with self-esteem, empowerment, and quality of life and negatively with stigma measures and depression. A social network with a sufficient number of friends, being single or married, in contrast to being separated, as well as receiving outpatient treatment, was associated with higher SR. Conclusions: SR is a new and promising concept. The development of stigma-resisting beliefs might help individuals in their hope of finding a fulfilling life and in their recovery from mental illness.     

Stigma in psychiatric nursing

TOPIC: Stigmatizing attitudes in psychiatric nursing. PURPOSE: To develop a greater awareness of the existence of stigma associated with psychiatric nursing. SOURCES: Published literature. CONCLUSIONS: Professional self-understanding and knowledge are methods by which psychiatric nursing can elevate its professional image and value.     

Stigma and Suicide Warning Signs

The current study explored the relationship between stigma and suicide warning signs using a case vignette methodology. Three comparable vignettes were used varying only the essential warning signs, including heart attack, suicidality without specific mention of suicidal thinking, and suicidality with specific mention of suicidal thoughts and associated intent to die. After reading the vignette, participants responded to questions gauging urgency of response, along with their appraisal of the situation across six domains including: seriousness, time (how quickly should they respond), comfort 1 (how comfortable they were with the situation in general), sureness (how sure they were in their response), comfort 2 (how comfortable they were in implementing their response), and hopefulness (how hopeful they were that their response would be helpful). Consistent with study hypotheses, results indicated that participants were significantly less comfortable, less sure, and less hopeful when responding to a suicidal crisis when compared to a heart attack. In addition, participants were significantly less likely to access emergency services for a seriously suicidal individual in comparison to someone suffering a heart attack, instead choosing to talk with family and friends first. The potential moderating effects of family and individual history of psychiatric illness and treatment, along with current individual psychological symptoms, were also explored and discussed, with no significant impact uncovered. The importance of more targeted efforts to train individuals to not just recognize suicide warning signs, but on how to specifically respond, is emphasized.     

Exploring Mechanisms of Mental Illness Stigma Reduction in Asian Canadian Men

Objective:Although there is evidence of effective stigma reduction by various psychological and educational interventions, the mechanisms of change remain unclear. In this article, we examine hypothesized processes that might have mediated reductions in stigma observed among Asian men who had received in mental health promotion interventions in Greater Toronto Area, Canada.Method:Our sample consisted of 495 Asian men, who received either acceptance and commitment therapy (ACT; n = 133), contact-based empowerment education (CEE; n = 149), combination of ACT and CEE (n = 152), or psychoeducation (n = 61). Group differences on intervention outcomes, including stigmatizing attitudes (Community Attitudes toward the Mentally Ill), internalized stigma (Internalized Stigma of Mental Illness), valued living (Valued Living Questionnaire), and attitudes to engage in social change (Social Justice Scale) were hypothesized to be due to the impact of the different interventions and mediated by changes in specific underlying psychological processes. These process-related changes were modelled using measures of mindfulness (Freiburg Mindfulness Inventory), psychological flexibility (Acceptance and Action Questionnaire version II), and empowerment (Empowerment Scale [ES]). Their pre- and post changes were analyzed with repeated measures analysis of variance, and mediational analyses were performed.Results:Findings from mediational analyses suggest that empowerment (ES) mediated a significant portion of the effects observed in reduction in stigmatizing attitudes and internalized stigma across intervention groups (t = 3.67 to 3.78 for CEE groups, and t = 4.32 to 4.56 for ACT groups). For the ACT groups, reduction in internalized stigma might also have been partly mediated by psychological flexibility, an intervention-specific psychological process.Conclusions:Results from the current study suggest that different stigma reduction interventions may be mediated by increased empowerment as a common mechanism of change, while intervention-specific mechanism of change, improved psychological flexibility through ACT, may also contribute to improvement in internalized stigma.     

精神发育迟滞的性犯罪和性受害分析

作者分析了精神发育迟滞（ＭＲ）中５８例性犯罪和７９例性受害的特征：年龄多数处于青春期，农民占５０％以上，单独犯罪、累犯和以熟人为作案对象者较多。ＭＲ性犯罪者以男性，兴奋型为主，强奸案居多。性受害者年龄偏幼，除１例外全为女性，安定型占优势。     

Engaging adolescent girls in transactional sex through compensated dating

Transactional sex through so-called compensated dating in adolescent girls is a problem in need of public concern. Compensated dating typically involves the use of information communication technology to advertise, search, bargain, and eventually arrange for transactional sex. The technology enables the sexual partners to maintain privacy and secrecy in transactional sex. Such secrecy necessitates the girls' disclosure about their life experiences in order to address the concern. The disclosure is the focus of the present qualitative study of 27 girls practicing the dating in Hong Kong, China. Based on the disclosure, the study presents a grounded theory that epitomizes engagement in compensated dating by referential choice. Such a referential choice theory unravels that choice with reference to the family push and social norms sustains the engagement. Meanwhile, the choice rests on expectancy and reinforcement from experiential learning about compensated dating. The theory thus implies ways to undercut the engagement through diverting the referential choice of the dating.     

Stigma and discrimination against older people with mental disorders in Europe

BACKGROUND AND OBJECTIVES: The European Office of the World Health Organization (WHO/EURO) has established a Task Force On Destigmatization. Upon the release of the Technical Statement on Old Age Psychiatry 'Reducing stigma and discrimination against older people with mental disorders', the Task Force run a small survey in two European subregions to investigate the extent of stigma and discrimination with reference to the elderly person affected from a psychiatric disorder in the countries of those subregions. METHODS: WHO/EURO mental health counterparts completed a short questionnaire inquiring on the inclusion of epidemiological studies on the elderly in their country's research program; the time devoted to the teaching to old age psychiatry during psychiatric residence; the degree of coverage of services for the elderly person and their caregivers; and the extent of stigma present in society with regard to three psychiatric disorders. RESULTS: Stigma and discrimination seem to be present both in the health sector and among the public at large. CONCLUSION: The development of effective health and social facilities to support older persons with mental disorders should be a high priority of any strategy to reduce stigma and discrimination. These facilities should coordinate their efforts with those of other sectors of society to reach the highest possible impact.     

Metaphorical Stories for Education About Mental Health Challenges and Stigma

In 1989, my psychiatrist convinced me to present to a small group of parents of people with mental health challenges. I had terrible stage fright, but I coped well. It was such a success that I was invited to present to other groups. Thus, I started presenting to groups and other audiences. In this article, I want to share my experience using metaphorical stories when presenting. The more I presented to different audiences, the more I found I was trying to explain complicated matters. It is not enough to want to communicate with someone, and it is not enough that he or she wants to communicate with oneself. Suitable conditions are required for communication. Because I was captivated in my childhood by the fables of Aesop, La-Fontaine, and Krilov, I used in my presentations various fables and other types of metaphorical stories to bridge the gap of knowledge and to enable communication. When I could not find metaphorical stories to suit my presentations, I made them up.     

Stigma and treatment delay in first-episode psychosis: a grounded theory study

Aim: A longer duration of untreated psychosis (DUP) is associated with greater morbidity in the early course of schizophrenia. This formative, hypothesis-generating study explored the effects of stigma, as perceived by family members, on DUP. Methods: Qualitative interviews were conducted with 12 African American family members directly involved in treatment initiation for a relative with first-episode psychosis. Data analysis relied on a grounded theory approach. A testable model informed by constructs of Link's modified labelling theory was developed. Results: Four main themes were identified, including: (i) society's beliefs about mental illnesses; (ii) families' beliefs about mental illnesses; (iii) fear of the label of a mental illness; and (iv) a raised threshold for the initiation of treatment. A grounded theory model was developed as a schematic representation of the themes and subthemes uncovered in the family members' narratives. Conclusions: The findings suggest that due to fear of the official label of a mental illness, certain coping mechanisms may be adopted by families, which may result in a raised threshold for treatment initiation, and ultimately treatment delay. If the relationships within the grounded theory model are confirmed by further qualitative and quantitative research, public educational programs could be developed with the aim of reducing this threshold, ultimately decreasing DUP.     

男性癫痫病人血清性激素水平的初步观察

用放射免疫法测定５０例成年男性癫痫患者的血清总睾丸酮（ＴＴ）、黄体生成素（ＬＨ）和促卵泡素（ＦＳＨ），并以５０名健康人作对照。结果发现，癫痫组ＴＴ、ＬＨ均较对照组明显升高，频繁癫痫发作、服用苯妥因钠和卡马西平等抗痫药与性激素改变有关。同时对性激素改变的可能机理进行了讨论。对已婚男性癫痫病人有可能或已经发生性功能障碍者，建议选用丙戊酸钠治疗。     

Stigma associated with schizophrenia: Cultural comparison of social distance in Japan and China

Aims:  The aim of the present study was to investigate social attitudes toward schizophrenia in Japan and China in view of social distance and knowledge of psychiatry, as well as sociocultural aspects.
Methods:  Two self-rating scales were used to compare social distance and knowledge regarding schizophrenia in 352 Japanese subjects and 347 Chinese subjects. The Social Distance Scale–Japanese version was used to measure social distance from schizophrenia subjects in Japan. This scale consists of eight questions graded using a 4-point Likert scale (0–3 points), with higher scores representing increased social distance. A translation of the SDSJ into Chinese was used to assess social distance in China. The Knowledge of Illness and Drugs Inventory was used to determine participant knowledge of mental illness and its treatment (medication) through 20 questions (responses are graded as correct or incorrect, with higher scores indicating greater knowledge). A Chinese version of this questionnaire was also created.
Results:  Total scores of both scales were significantly higher in Japanese subjects than in Chinese subjects.
Conclusions:  Social distance associated with schizophrenia is large in both Beijing and Fukuoka, but the features of social distance differ between countries. It is important to determine the features of stigma associated with schizophrenia and develop anti-stigma programs based on trans-cultural considerations.     

The Stigma of Psychiatric Disorders and the Gender,Ethnicity, and Education of the Perceiver

The purpose of this study is to determine how the demographics of perceivers influence their stigma of people with mental illness or with substance abuse. A nationally representative sample (N = 968) was asked to respond to a vignette describing a person with a health condition (schizophrenia, drug dependence, or emphysema) and his/her family member. Consistent with our hypotheses, women were less likely to endorse stigma than men. Participants with higher education were also less likely to stigmatize than less educated participants. Contrary to our expectations, nonwhite research participants were more likely to endorse stigma than whites. Implications of these findings for better understanding the stigma of mental illness, and the development of anti-stigma programs, are reviewed.     

Stigma in families of individuals in early stages of psychotic illness: family stigma and early psychosis

Aim: Stigma is pervasive among families of individuals with psychotic disorders and includes both general and ‘associative’ stigma – that is, the process by which a person is stigmatized by virtue of association with another stigmatized individual. These forms of stigma may present a barrier to help seeking. However, little is known about stigma in the early stages of evolving psychotic disorder. Methods: Family members of 11 individuals at clinical high risk and of nine patients with recent‐onset psychosis were evaluated for generalized and associative stigma using the Opinions about Mental Illness (modified) and the Family Experiences Interview Schedule. Results: In this small study, the level of stigma was low, as families endorsed many supportive statements, forexample, patients should be encouraged to vote, patients want to work, mental illness should be protected legally as a disability and parity should exist in insurance coverage. Families also endorsed that both talking and a belief in God and prayer can help someone get better. Only ethnic minority families of individuals with recent‐onset psychosis endorsed a sense of shame and need to conceal the patient's illness. Conclusions: This preliminary study suggests that family stigma is low in the early stages of psychotic disorder, a finding that requires further investigation in a larger and more representative sample. This may be an opportune time to engage young people and families, so as to reduce duration of untreated illness. Ethnic differences in stigma, if replicated, highlight the need for cultural sensitivity in engaging individuals and their families in treatment.