John H. Coverdale

Depictions of mental illness in print media: a prospective national sample.

Objective: Because there are no published reports of depictions of mental illness in print media based on national samples, we set out to prospectively collect and analyse a near complete New Zealand sample of print media. Methods: A commercial clipping bureau was contracted to provide cuttings of all items with any mental health or illness aspect over a four week period. These items were analysed for potentially positive and negative depictions and how mental illness was represented within each item. An independent search for additional newspaper items concerning one prominently featured topic indicated that the rate of identification of relevant stories was at least 91%. Result: The collection consisted of six hundred print items which were most commonly news or editorial pieces (n = 562, 93.7%). Negative depictions predominated, with dangerousness to others (n = 368, 61.3%) and criminality (n = 284, 47.3%) being the most common. Positive depictions, including human rights themes, leadership and educational accomplishments occurred in 27% (n = 164) of all items. Generic mental illness terminology without reference to specific diagnostic categories was present in 47% of all items (n = 284). Conclusions: Negative depictions that predominate confirm the stereotypic understanding of mental illness that is stigmatizing. These findings underscore the challenge facing us as mental health professionals attempting to change attitudes towards mental disorders when the stereotypes are so regularly reinforced.

Mental illness depictions in prime‐time drama: identifying the discursive resources

Objective: The aim of this study was to determine how the mentally ill are depicted in prime-time television dramas. Method: Fourteen television dramas that included at least one character with a mental illness, shown in prime-time during a 1-year period, were systematically viewed and analysed. Results: Fifteen of the 20 mentally ill characters were depicted as physically violent toward self or others. Characters were also depicted negatively as simple or lacking in comprehension and appearing lost, unpredictable, unproductive, asocial, vulnerable, dangerous to self or others because of incompetent behaviours, untrustworthy, and social outcasts, and positively as caring or empathic. Conclusions: These data are consistent with an overwhelming negativity of depictions of the mentally ill found in other forms of media and settings, and contribute to the stigmatisation of this population.

A Systematic Review of Stress-Management Programs for Medical Students.

ObjectiveBecause medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.MethodsThe authors searched the published English-language articles on PsycINFO and Pub Med, using a combination of the following search terms: stress-management, distress, burnout, coping, medical student, wellness. Both randomized, controlled trials and controlled, non-randomized trials of stress-management programs were selected and critically appraised.ResultsA total of 13 randomized, controlled trials or controlled, non-randomized trials were identified. Interventions included self-hypnosis, meditation, mindfulness-based stress-reduction, feedback on various health habits, educational discussion, changes in the length and type of curriculum, and changes in the grading system. Only one study was identified to be of very high quality, although several had described group differences at baseline, used blinding, had good follow-up, and used validated assessment tools. There was a wide heterogeneity of outcome measures used. Interventions that were supported by a reduction in stress and anxiety in medical students included mindfulness-based stress-reduction or meditation techniques, self-hypnosis, and pass/fail grading.ConclusionsSignificant opportunities to advance educational research in this field exist by developing more high-quality studies with particular attention to randomization techniques and standardizing outcome measures.

Delirium: current trends in prevention and treatment

Abstract

Optimal Treatment Strategies to Enhance Recovery from Schizophrenia

Objective: The aim of this paper is to examine the base for integrating biomedical, psychological and social strategies in the management of schizophrenia. Method: A review of the literature on schizophrenia with particular emphasis in management considerations. Results: Effective treatment components include psychoeducation, medication strategies, carer-based stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioural strategies for residual symptoms. Conclusions: Treatment for schizophrenia is best provided by integrating the various and specific psychosocial intervention strategies in addition to the optimal use of medication. Methods for implementing these strategies in outpatient settings include the use of a comprehensive assessment and treatment plan, the training of mental health professionals, and periodic review with assessment packages.

A survey of threats and violent acts by patients against training physicians.

The primary purpose was to determine the prevalence of various types of threats or assaults by patients against training physicians and to determine the psychological impact of the most distressing incidents. Differences between specialty of training and gender were examined.

People never see us living well: an appraisal of the personal stories about mental illness in a prospective print media sample

OBJECTIVE Having found no discussions of self-depictions offered by psychiatric patients in the mass media we sought such items in a prospective national sample of print media and analysed how those speakers portrayed themselves. METHOD As part of a larger study of media depictions of mental illnesses in print media all items with any mental health or illness aspect that appeared in a New Zealand publication over a four-week period were collected. The resulting collection of 600 items ranged from news briefs to full-page newspaper articles. From that set we selected and analysed items in which a person identified as having been a psychiatric patient or as having a mental disorder was either quoted by the reporter who had interviewed them, or personally described their experiences. Employing both propositional analyses and discourse analysis we explored how the speakers were positioned and identified patterns or themes in their construction of living with a mental illness. RESULTS Only five articles (0.8%) met our criteria for a person with a mental disorder being reported directly. In those items the journalists had positioned the speakers as credible, expert sources who, in representing their lives and experiences, drew on five clusters of resources, that we titled: Ordinariness/Living Well; Vulnerability; Stigma; Crisis; and Disorder/Treatment. Ordinariness/Living Well foregrounded the role of personal strengths in living well and in overcoming adversity, particularly that associated with being stigmatized. We identified that theme as central to the ways in which these speakers depicted themselves as recognizably human and understandable. CONCLUSION The findings are preliminary but these depictions are different from those reported by most researchers. Unlike those depictions, these speakers provided accessible and recognizably human self-portrayals. That finding intensifies our concern that most researchers appear to be unaware that these consumer voices are largely absent from mass media depictions of mental illnesses.

From Source Material to News Story in New Zealand Print Media: A Prospective Study of the Stigmatizing Processes in Depicting Mental Illness

Objective: The aim of this study was to analyse how newspaper articles that depict mental illnesses are generated from source materials. Method: From a prospectively collected national sample of print materials involving mental illness, 50 published items that related to the Privacy Commissioners opinion about disclosure of a psychiatric patients health information were identified. A copy of the Privacy Commissioners original Case Note and three news stories about the Case Note distributed by the New Zealand Press Association constituted the database. These materials were subjected to discourse analysis. We identified themes and their transformation from the Case Note through the news stories and examined the impact of these transformations on the stigmatization of mental illness. Results: Four themes were identified: human rights, vulnerability, risk of dangerousness and threat, and mental illness/psychiatric patient. The only potentially positive theme, human rights, was limited both by being fragmented in the source material, and by being utilized, in the published news stories to undermine the legitimacy of the patients right to privacy. Use of the other themes was consistent with stereotypes about mental illness. Conclusions: Although there were no inaccuracies in the content of the news stories they were substantially more negative than the source material in their depiction of the identified patient. A potentially positive discourse (human rights) was not by itself sufficient to ensure a positive portrayal of mental illness. An understanding of the transformations is important for efforts to effectively combat the stigmatization of those with mental illness.

Constructing mental illness as dangerous: A pilot study

Objective: There is a dearth of studies examining how dangerousness is constructed in media depictions of mentally ill individuals who are frequently portrayed as acting violently. The aim of the present study was to identify the contribution of diverse technical, semiotic and discursive resources utilised in portraying a character with a mental illness in a prime-time drama as dangerous. Method: Discourse analytic techniques, involving systematic, repeated, critical viewings, were applied to a single program drawn from a sample of prime-time television drama episodes touching on mental illness. Results: Nine devices (appearance, music and sound effects, lighting, language, intercutting, jump-cutting, point of view shots, horror conventions and intertextuality) were identified as contributing to the signified dangerousness of person receiving care in the community for a mental illness. Conclusions: These techniques combine in signifying mental illness and a person suffering from it as dangerous. The findings suggest that mental health professionals working to reduce the stigma of mental illness need to have a reasonably sophisticated understanding of the practices and priorities of television production if they are to collaborate effectively with producers to create dramas that convey more human and sympathetic understandings of mental illness or to combat the negative effects of such portrayals.

Ethically justified clinically comprehensive guidelines for the management of the depressed pregnant patient

OBJECTIVE This article proposes ethically justified clinical guidelines for managing depressed patients during pregnancy. STUDY DESIGN We reviewed literature on depression and its consequences for pregnancy and related that literature to ethical principles. RESULTS The health effects of depression on the pregnant woman and her fetus cannot be managed without consideration of the chronic and variable impairment of autonomy that may result from the effects of depression on the pregnant womans decision-making capacity. CONCLUSION When the fetus is previable, recommendations concerning the disposition and prenatal diagnosis of the pregnancy should be nondirective, whereas strong treatment recommendations are justifiable if the pregnant woman has decided to continue her pregnancy and is severely depressed. After viability, directive counseling for fetal benefit is ethically justified. The guidelines focus on preventive ethics strategies to enhance the decision-making capacity of the depressed pregnant patient.