An uncertain revolution: why the rise of a genetic model of mental illness has not increased tolerance

This study uses the 2006 replication of the 1996 General Social Survey Mental Health Module to explore trends in public beliefs about mental illness in the USA. Drawing on three models related to the framing of genetic arguments in popular media, the study attempts to address why tolerance of the mentally ill has not increased, despite the growing popularity of a biomedical view. The key to resolving this paradox lies in understanding how genetic arguments interact with other beliefs about mental illness, as well as the complex ideational implications of genetic frameworks. Genetic arguments have contingent relationships with tolerance. When applied to schizophrenia, genetic arguments are positively associated with fears regarding violence. Indeed, in this regard, attributing schizophrenia to genes is no different from attributing schizophrenia to bad character. However, when applied to depression, genetic arguments are positively associated with social acceptance. In addition to these contingencies, genetic explanations have discontinuous relationships with beliefs regarding treatment. Although genetic arguments are positively associated with recommending medical treatment, they are not associated with the perceived likelihood of improvement. The net result of these assorted relationships is little change in overall levels of tolerance over time. Because of the blunt nature of the forces propelling a biomedical view-including the growing popularity of psychiatric medications-altering beliefs about the etiology of mental illness is unlikely, on its own, to increase tolerance.     

Health work, female sex workers and HIV/AIDS: global and local dimensions of stigma and deviance as barriers to effective interventions

This paper addresses the near global attribution of stigma and deviance to female sex workers, and the salience of this attribution for health interventions in HIV/AIDS. A conceptual frame is developed as a guide to comparative sociological study in this area, and the importance of explanation at the level of social structure emphasized. After a general review of the empirical literature, more sustained attention is paid to specific aspects of female sex work in three contexts or figurations, the cities of London, Bangkok and Kolkarta. It is argued that norms of shame and blame and the labelling process with which they are bound up always arise within a structure nexus. We emphasis, in particular, the figuration-specific tensions between the global and the local, system and lifeworld and, the relationship between structure, agency and culture. The article concludes with a discussion of attempts to empower female sex workers and with a series of five orienting themes comprising a research programme for the future.     

Church ladies, good girls, and locas: stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk

Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of "loca" (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of "good girls" and "church ladies". Therefore, in spite of their association with the "loca", the women also identify with faith and religion ("church ladies") and uphold more traditional gender norms ("good girls") that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.     

Rethinking theoretical approaches to stigma: a Framework Integrating Normative Influences on Stigma (FINIS)

A resurgence of research and policy efforts on stigma both facilitates and forces a reconsideration of the levels and types of factors that shape reactions to persons with conditions that engender prejudice and discrimination. Focusing on the case of mental illness but drawing from theories and studies of stigma across the social sciences, we propose a framework that brings together theoretical insights from micro, meso and macro level research: Framework Integrating Normative Influences on Stigma (FINIS) starts with Goffman's notion that understanding stigma requires a language of social relationships, but acknowledges that individuals do not come to social interaction devoid of affect and motivation. Further, all social interactions take place in a context in which organizations, media and larger cultures structure normative expectations which create the possibility of marking "difference". Labelling theory, social network theory, the limited capacity model of media influence, the social psychology of prejudice and discrimination, and theories of the welfare state all contribute to an understanding of the complex web of expectations shaping stigma. FINIS offers the potential to build a broad-based scientific foundation based on understanding the effects of stigma on the lives of persons with mental illness, the resources devoted to the organizations and families who care for them, and policies and programs designed to combat stigma. We end by discussing the clear implications this framework holds for stigma reduction, even in the face of conflicting results.     

Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia

BackgroundKrokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region's recent social history.MethodsWe searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives.FindingsKrokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but – given the rudimentary ‘laboratory’ conditions – the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help.ConclusionA comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments – that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point in case.     

Understanding and measuring AIDS-related stigma in health care settings: A developing country perspective

AIDS-related stigma and discrimination remain pervasive problems in health care institutions worldwide. This paper reports on stigma-related baseline findings from a study in New Delhi, India to evaluate the impact of a stigma-reduction intervention in three large hospitals. Data were collected via in-depth interviews with hospital staff and HIV-infected patients, surveys with hospital workers (884 doctors, nurses and ward staff) and observations of hospital practices. Interview findings highlighted drivers and manifestations of stigma that are important to address, and that are likely to have wider relevance for other developing country health care settings. These clustered around attitudes towards hospital practices, such as informing family members of a patient's HIV status without his/her consent, burning the linen of HIV-infected patients, charging HIV-infected patients for the cost of infection control supplies, and the use of gloves only with HIV-infected patients. These findings informed the development and evaluation of a culturally appropriate index to measure stigma in this setting. Baseline findings indicate that the stigma index is sufficiently reliable (alpha = 0.74). Higher scores on the stigma index – which focuses on attitudes towards HIV-infected persons – were associated with incorrect knowledge about HIV transmission and discriminatory practices. Stigma scores also varied by type of health care providers – physicians reported the least stigmatising attitudes as compared to nursing and ward staff in the hospitals. The study findings highlight issues particular to the health care sector in limited-resource settings.To be successful, stigma-reduction interventions, and the measures used to assess changes, need to take into account the sociocultural and economic context within which stigma occurs.     

精神疾病公众污名的研究进展

公众污名是一种多层次、复杂的现象,是指人们对待被污名化群体的态度及行为,这些被污名化的群体均具有社会不期望或不名誉的特征,如同性恋、艾滋病、性病及精神疾病患者等。精神疾病公众污名则指人们对待精神疾病患者消极的态度及行为,它已经成为精神疾病患者治疗和康复的一大障碍,对患者回归社会造成了直接的影响。为了降低人们对精神疾病的污名,澳大利亚、加拿大及英国等率先发起和实施了反对污名的项目,比如英国在2009年开展的＂Time to Change＂运动等,国内关于此方面的活动或研究少见报道。而我国在集体主义文化的影响下,精神疾病公众污名比西方国家更为严重。     

Stress, appraisal, and coping: a comparison of HIV-infected women in the pre-HAART and HAART eras

BACKGROUND: It has been widely suggested that highly active antiretroviral therapy (HAART) has improved the psychosocial aspects of living with HIV/AIDS. METHOD: A sample of 79 women living with HIV/AIDS in the pre-HAART era (1994-1996) were compared with a matched sample of 79 women with HIV/AIDS from the HAART era (2000-2003) on measures of stress, illness appraisals, and coping strategies. RESULTS: Contrary to expectations, HIV-infected women in the HAART era were significantly more likely than women in the pre-HAART era to report health-related stress, to report stress from stigma and disclosure, to view HIV as having caused them harm, to report that their health is due to chance, and to report more use of maladaptive forms of coping (e.g., escape-avoidant coping). CONCLUSION: Although HAART may have extended survival for many HIV-infected individuals, they have not resulted in equivalent psychosocial improvements. Thus, efforts are needed to address the psychosocial difficulties that HIV-infected women in the HAART era continue to experience.     

Stigma starts early: Gender differences in teen willingness to use mental health services

PurposeTo explore gender differences and the role of stigma in teen willingness to use mental health services.MethodsSelf-administered, written questionnaires were conducted with 274 eighth graders in a suburban community in a mid-Atlantic state. Teens reported on social support for emotional concerns, mental health experience and knowledge, and stigma and barriers associated with mental health service use. Data analysis included chi-square statistics and analysis of variance (ANOVA) to examine associations between gender and independent variables of interest. Logistic regression analyses assessed the relationship of gender, stigma, and willingness to use mental health services, adjusting for race and receipt of mental health services.ResultsMore girls than boys turned to a friend for help for an emotional concern, whereas more boys turned to a family member first. Boys had less mental health knowledge and experience and higher mental health stigma than girls. In adjusted analyses, girls were twice as likely as boys to report willingness to use mental health services (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.20–4.99). Parental disapproval and perceived stigma helped to explain the relationship between gender and willingness to use mental health services (OR 1.65, 95% CI .72–3.77).ConclusionsGender differences in negative mental health attitudes and willingness to use mental health services are present early in adolescence. Enhanced mental health education and services in middle school may reduce gender disparities by incorporating stigma reduction efforts that actively involve parents and address differences in knowledge and exposure to mental health issues.