Bernice A. Pescosolido

“A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence

OBJECTIVE Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact of this approach with a 10-year comparison of public endorsement of treatment and prejudice. METHOD The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma. RESULTS In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection. CONCLUSIONS More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.

Durkheim, suicide, and religion: toward a network theory of suicide

This paper redirects debates over the religion-suicide link away from specific empirical quarrels to a consideration of Durkheims general proposition regarding religions protective power. We argue that his proposition must be tailored to social and historical contexts and that research must specify the underlying social mechanism at work. A consideration of historical trends leads to a more detailed specification of religions in analyses of contemporary cases, and more importantly, to an inductive elaboration of Durkheims theoretical underpinnings. Analysis of religions effects on United States county group suicide rates in 1970 reveals that religion continues to affect suicide rates, with Catholicism and Evangelical Protestantism tending to lower rates, and Institutional Protestantism tending to increase them. The presence of Jewish adherents produces a small but inconsistent protective effect. We attempt to account for these results first by examining a variety of standard religious typologies and second by examining evidence on whether religious affiliation reflects the operation of network ties. Finding this evidence suggestive, we move toward a network reinterpretation to clarify and elaborate Durkheims theory.

The Construction of Fear: Americans' Preferences for Social Distance from Children and Adolescents with Mental Health Problems.

Debates about childrens mental health problems have raised questions about the reliability and validity of diagnosis and treatment. However, little research has focused on social reactions to children with mental health problems. This gap in research raises questions about competing theories of stigma, as well as specific factors shaping prejudice and discrimination toward those children. Here, we organize a general model of stigma that synthesizes previous research. We apply a reduced version of this model to data from a nationally representative sample responding to vignettes depicting several stigmatizing scenarios, including attention-deficit/hyperactivity disorder (ADHD), depression, asthma, or “normal troubles.” Results from the National Stigma Study—Children suggest a gradient of rejection from highest to lowest, as follows: ADHD, depression, “normal troubles,” and physical illness. Stigmatizing reactions are highest toward adolescents. Importantly, respondents who label the vignette childs situation as a mental illness compared to those who label the problem as a physical illness or a “normal” situation report greater preferences for social distance, a pattern that appears to result from perceptions that the child is dangerous.

Social Networks and Patterns of Use Among the Poor with Mental Health Problems in Puerto Rico

OBJECTIVES This study uses the recently developed Network-Episode Model (NEM) to examine the nature and correlates of utilization among Puerto Ricans reporting mental health problems. The NEM highlights two issues: (1) examining the patterns or combinations of lay and formal use that individuals employ and (2) reformulating how the availability and content of social networks influences patterns of care. METHODS Using data from the 1989 Mental Health Care Utilization Among Puerto Ricans Study (probability sample of 1,777 individuals living in low-income areas of the island), the authors focus on the patterns and correlates of use for 365 Puerto Ricans reporting service use for mental health problems in the previous year. RESULTS A combination of clustering and multinomial logit techniques indicates that there are six unique care patterns. Two patterns include the use of mental health providers and are associated with different contingencies. CONCLUSIONS In general, patterns of use are shaped by age, education, gender, and illness severity. Larger, more supportive networks decrease the use of patterns of care that include formal health care providers, and decrease direct entry into the mental health sector. These results are in line with NEMs predictions for lower class populations and help clarify inconsistencies in previous research on social networks. The implications of this perspective for health services research and treatment are discussed.

The Web of Group Affiliations Revisited: Social Life, Postmodernism, and Sociology

We address current debates about the future of society and the future of sociology. From Simmels distinction between social forms in premodern and modern society, we resurrect his original geometric analogy and recast it in current network terms. In this light, we consider various substantive and methodological claims of postmodernists and suggest that their contribution lies in capturing the spirit of rapid social change and the ambiguity that characterizes the present era. The basic problem with the postmodern critique, we argue, lies in its embrace of these characteristics as the new social form - mistaking transition for type. In response, we sketch out a third social form, a spoke structure, with accompanying tensions and freedoms that Simmel recognized as inevitable. Finally, we examine how approaches to two social problems - serious mental illnesses and homelessness-reflect and shape the contours of an era s network formation. In particular, we discuss how the emergent spoke structure presents challenges to current methodological approaches

The Public Stigma of Mental Illness: What Do We Think; What Do We Know; What Can We Prove?

By the 1990s, sociology faced a frustrating paradox. Classic work on mental illness stigma and labeling theory reinforced that the “mark” of mental illness created prejudice and discrimination for individuals and family members. Yet that foundation, coupled with deinstitutionalization of mental health care, produced contradictory responses. Claims that stigma was dissipating were made, while others argued that intervention efforts were needed to reduce stigma. While signaling the critical role of theory-based research in establishing the pervasive effects of stigma, both claims directed resources away from social science research. Yet the contemporary scientific foundation underlying both claims was weak. A reply came in a resurgence of research directed toward mental illness stigma nationally and internationally, bringing together researchers from different disciplines for the first time. I report on the general population’s attitudes, beliefs, and behavioral dispositions that targeted public stigma and implications for the next decade of research and intervention efforts.

Complementary and Alternative Medicine : Challenge and Change

Preface: The Challenge of CAM Introduction 1. Conceptions of the Body and CAM 2. The Fitness Movement and the Use of CAM 3. The Psychology of the Use of CAM 4. The Therapeutic Relationship and the Use of CAM 5. Psychosocial Determinants of CAM Utilisation 6. Changes in Characteristics of CAM Users Over Time 7. The Diffusion of CAM 8. Partners in Illness: Who helps You When You are Sick? 9. Investigating Symbolic, Experimental and Social Realities 10. Assessing the Evidence Base for CAM 11. Rethinking Models of Illness Behaviour 12. Medical Pluralism and the Re-emergence of CAM 13. Professionalisation, Politics and CAM 14. Strategies for Future Research

Of Pride and Prejudice: The Role of Sociology and Social Networks in Integrating the Health Sciences

Calls have been issued for understanding the “contexts” or “environment” shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociologys view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social networks have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociologys rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within “big science” to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point.

The “Backbone” of Stigma: Identifying the Global Core of Public Prejudice Associated With Mental Illness

OBJECTIVES We used the Stigma in Global Context-Mental Health Study to assess the core sentiments that represent consistent, salient public health intervention targets. METHODS Data from 16 countries employed a nationally representative sampling strategy, international collaboration for instrument development, and case vignettes with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition depression and schizophrenia criteria. We measured knowledge and prejudice with existing questions and scales, and employed exploratory data analysis to examine the public response to 43 items. RESULTS Across countries, levels of recognition, acceptance of neurobiological attributions, and treatment endorsement were high. However, a core of 5 prejudice items was consistently high, even in countries with low overall stigma levels. The levels were generally lower for depression than schizophrenia, and exclusionary sentiments for more intimate venues and in authority-based roles showed the greatest stigma. Negative responses to schizophrenia and depression were highly correlated across countries. CONCLUSIONS These results challenge researchers to reconfigure measurement strategies and policymakers to reconsider efforts to improve population mental health. Efforts should prioritize inclusion, integration, and competences for the reduction of cultural barriers to recognition, response, and recovery.

Responses to nervous breakdowns in America over a 40-year period. Mental health policy implications.

The 1957 and 1976 Americans View Their Mental Health surveys from the Institute of Social Research were partially replicated in the 1996 General Social Survey (GSS) to examine the policy implications of peoples responses to feeling an impending nervous breakdown. Questions about problems in modern living were added to the GSS to provide a profile of the publics view of mental health problems. Results were compared for 1957, 1976, and 1996. In 1957, 19% of respondents had experienced an impending nervous breakdown; in 1996, 26% had had this experience. Between 1957 and 1996, participants increased their use of informal social supports, decreased their use of physicians, and increased their use of nonmedical mental health professionals. These findings support policies that strengthen informal support seeking and access to effective psychosocial treatments rather than current mental health reimbursement practices, which emphasize the role of primary care physicians.