Kim Hopper

Mapping resilience pathways of Indigenous youth in five circumpolar communities.

This introduction to the Special Issue Indigenous Youth Resilience in the Arctic reviews relevant resilience theory and research, with particular attention to Arctic Indigenous youth. Current perspectives on resilience, as well as the role of social determinants, and community resilience processes in understanding resilience in Indigenous circumpolar settings are reviewed. The distinctive role for qualitative inquiry in understanding these frameworks is emphasized, as is the uniquely informative lens youth narratives can offer in understanding Indigenous, cultural, and community resilience processes during times of social transition. We then describe key shared cross-site methodological elements of the Circumpolar Indigenous Pathways to Adulthood study, including sampling, research design, procedures, and analytic strategies. The site-specific papers further elaborate on methods, focusing on those elements unique to each site, and describe in considerable detail locally salient stressors and culturally patterned resilience strategies operating in each community. The concluding paper considers these across sites, exploring continuities and discontinuities, and the influence of cross-national social policies.

The work of recovery on two assertive community treatment teams.

The compatibility of recovery work with the Assertive Community Treatment (ACT) model has been debated; and little is known about how to best measure the work of recovery. Two ACT teams with high and low recovery orientation were identified by expert consensus and compared on a number of dimensions. Using an interpretive, qualitative approach to analyze interview and observation data, teams differed in the extent to which the environment, team structure, staff attitudes, and processes of working with consumers supported principles of recovery orientation. We present a model of recovery work and discuss implications for research and practice.

Central Role of Relatedness in Alaska Native Youth Resilience: Preliminary Themes from One Site of the Circumpolar Indigenous Pathways to Adulthood (CIPA) Study

This qualitative study of youth resilience takes place in an Alaska Native community, which has undergone rapid, imposed social change over the last three generations. Elders, and successive generations have grown up in strikingly different social, economic and political contexts. Youth narratives of relationships in the context of adolescent growth and development offer insights to better understand culturally-patterned experience, continuity and change. Local youth and adults shaped the design, implementation and analysis phases of this participatory study. Multiple interviews, totaling 20 older (ages 15–18) and younger (11–14) boys and girls provide accounts of everyday lives and life histories. Although losing close relationships was the most common stressor, many of the participants’ resilience strategies centered on their connections to others. Participants cultivated ‘relatedness’, nurturing relationships that took on kinship qualities. Within these relationships, youth participants acted more responsibly and/or developed a sense of competency and self-worth because of others’ reliance on them.

The Marmot Review: Social revolution by Stealth

“Rise up with me against the organisation of misery” is the epigraph chosen by Sir Michael Marmot for his deceptively bureaucratic report to Britain’s Secretary of State for Health on the policy challenge of health inequalities. Those words, from the poet and icon of the left, Pablo Neruda, are a reasonably accurate summary of the report’s underlying message: “the fundamental drivers that give rise to [social inequalities in health are] inequities in power, money and resources”(Marmot, 2010, p.16), and serious engagement with those inequities requires that power and resources be redistributed from those at the top to those lower down on the social ladder (Marmot, 2010, p.151). Epigraph not withstanding, this message is otherwisewell disguised in an almost mind-numbing recital of statistics, tables and graphs documenting the social gradient in everything from mortality to use of public parks to children’s bedtime hours, followed by detailed recommendationsdheavily documented and illustrated with case studiesdon what should be done and/or is being done to level the gradient. This is revolution without revolutionaries and politicsdfor many of the report’s recommendations will be politically contentiousdwithout politicians. Readers of Social Science & Medicine (as opposed, perhaps, to readers of the Financial Times) will probably find little to disagree with in recommendations for one year’s paid parental leave following childbirth and a minimum living wage for everyone (among many others). The key question, and the one to which we will devote the bulk of this essay, isdabsent politicians and/or revolutionariesd how are these radical changes to come about?

Rethinking suicide: notes toward a critical epidemiology

Where the genesis of “disease” owes much to causes that are social and economic in nature, epidemiology holds unrealized potential as a tool of social criticism. A particularly interesting example is provided by suicide and suicide research. Methodological difficulties are explored in detail, major findings reviewed, and the dominant interpretations of such findings criticized. Research has consistently pointed to the risks of marginal or minority status, unemployment, weak community supports, situational crises, and the pressures people are subjected to during periods of economic depression. It is argued that the sociostructural implications of such research have been systematically ignored, attention being devoted instead to more efficient management of the suicidal individual—this in spite of the lack of success of suicide prevention centers. Initial steps toward an alternative framework are outlined, with emphasis laid on the need to disaggregate the suicide act. It is further suggested that self-destruction is a far commoner—indeed, integral—part of our social environment than the bare rack of suicide statistics would suggest.

Independent review of social and population variation in mental health could improve diagnosis in DSM revisions.

At stake in the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are billions of dollars in insurance payments and government resources, as well as the diagnoses and treatment of millions of patients. We argue that the most recent revision process has missed social determinants of mental health disorders and their diagnosis: environmental factors triggering biological responses that manifest themselves in behavior; differing cultural perceptions about what is normal and what is abnormal behavior; and institutional pressures related to such matters as insurance reimbursements, disability benefits, and pharmaceutical marketing. In addition, the experts charged with revising the DSM lack a systematic way to take population-level variations in diagnoses into account. To address these problems, we propose the creation of an independent research review body that would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice, and recommend new avenues of research. Drawing on the best available knowledge, the review body would make possible more precise and equitable psychiatric diagnoses and interventions.

Confronting the Sorry State of U.S. Health

President Obama should convene a National Commission on the Health of Americans to address the social causes that have put the U.S.A. last among comparable nations. In January 2013, the U.S. National Research Council (NRC) and Institute of Medicine (IOM) issued U.S. Health in International Perspective: Shorter Lives, Poorer Health, a stunning depiction of how, over the past four decades, the comparative health status of Americans has declined (1). The report applied a term, commonly used to describe the relative deprivation of social groups, to the nation as a whole: the “U.S. health disadvantage.” How can this be explained and what is to be done?

Found in translation: Decoding local understandings of genetics and heredity in a Yup'ik Eskimo community.

The Center for Alaska Native Health Research is a community-based participatory research center that conducts studies involving genetic research with Yup’ik Eskimo community members in Southwest Alaska, where Yup’ik remains the first language for most residents. Cultural equivalents are needed to communicate results of these studies among all partners and members of the participating communities, since many scientific terms have no direct translation in Yup’ik. To inform that effort, we examined local understandings of genetics and heredity in one community. Here, we report results from back-translated Yup’ik interviews, and identify working genetic concepts shared by participants from interviews and focus groups. We suggest issues involved in, and some potential steps toward, developing a concise, scientifically accurate and culturally relevant term for “genetics” and other health concepts.

Signing on for dirty work: Taking stock of a public psychiatry project from the inside.

As applied anthropologists used to working at arms length from public psychiatry, we step out of the daily grind to take stock of the challenges of taking on ethnography entrained–harnessed to the implementation of a new program. These include the loss of critical distance, the struggles to negotiate locally viable forms of authority and relevance, the necessity of sustaining a Janus-faced relation with principal players, the urgency of seeing time-sensitive information converted into corrective feedback, and the undeniable attraction of being part of “committed work” with game-changing potential. In so doing, we rework the terms of witnessing and revive an old alternative: that documentary dirty work be reclaimed as a variant of public anthropology, one that transforms the work of application from mere afterthought to integral part of the original inquiry.

The Double Stigma of Limited Literacy and Mental Illness: Examining Barriers to Recovery and Participation among Public Mental Health Service Users

The disadvantaged social position of public mental health service users reflects synergistic relationships among tangible disadvantage and stigma and its consequences. Limited literacy, an important factor in social disadvantage and an additional source of stigma, is virtually absent from the discussion. Employing a mixed-methods, service user–informed design, we explore the meaning and impact of limited literacy in the lives of public mental health service users in the United States. Of 267 participants, 184 (69 percent) read at or below an eighth-grade level. Next, we demonstrate levels of and explore relationships among both literacy and mental illness concealment stigma and stigma consciousness (for mental illness). Finally, informed by our qualitative data, we describe how people encounter and manage this double burden of stigma with respect to: contexts of concealment, dilemmas of disclosure, and reduction and exclusion. Limited literacy and its associated stigma are important and underexamined barriers to mental health, well-being, recovery, and social inclusion for public mental health service users. Future work should include further examination of the multiple and layered stigmas in the lives of people with serious mental illness.