Robert J. Kleiner

Migration and mental illness: Some reconsiderations and suggestions for further analysis

Abstract This paper examines the utility of the ‘culture shock’ concept and several alternative social-psychological factors in explaining variations in rates of mental illness among different migratory status groups. The data provide little support for ‘culture shock’ as an explanatory concept. Such variables as goal-striving stress, reference group orientation, and self-esteem are found to be useful, particularly when the presence or absence of certain pathology-linked characteristics in the same individual is considered. The findings suggest the importance of incorporating social-psychological variables into the design of studies of social factors in mental illness. Such global variables as ‘migration’ may be too varied in their situational contexts and effects to order data on mental illness.

Community based treatment of the chronic psychotic.

Community based treatment of the chronic psychotic offers promise as an approach for reducing the high recidivism rate and enhancing the poor community adjustment of this population. The program described is based upon social influence theory and principles of residential social treatment. An essential aspect of the program involves the utilization of indigenous community members who are trained by professional staff to supervise and instruct patients in social and instrumental behavior. A research design is presented to evaluate this program, and preliminary results indicate it is more effective than residential social treatment or traditional hospital programs.

LEVEL OF ASPIRATION AND MENTAL DISORDER: A RESEARCH PROPOSAL*

Although it is generally assumed that the migration experience correlates with high rates of mental illness, this assumption has not been unequivocally established. This point of view maintains that the migrant is either psychologically disturbed prior to migration or that the impact of a new and strange environment precipitates mental breakdown, or both. OdegaardI6 and Malzberg and LeeI3 are most frequently referred to as having supplied empirical confirmations of this position. On the other hand, studies such as those by Clausen and Kohn,8 Hollingshead and Red l i~h ,~ Lapouse et d , I o and Tietze et a1.,18 which do not coniirm it, are less frequently noted. It is also often overlooked that in another study OdegaardI6 found that rates of mental illness were high only for those migrating to Oslo, Norway, from other large cities, whereas migrants from rural areas showed low rates. More recently Kleiner and Parker,6 studying the differential rates of first admissions for mental illness of migrant and nonmigrant Negroes in Pennsylvania, found that, contrary to the more widely held view, the rates of mental illness for southern migrants were lower than the rates for the Pennsylvania native born, particularly for the diagnosis of schizophrenia. At the same time the rates for migrants from other northern states were higher than for the native born. The fact that southern and northern migrants showed different rates of mental illness relative to the native born and to each other would suggest that any generalization about migration and mental disorder is not feasible. The inconsistency in the data of migration and mental disorder is also present in the findings relative to other sociocultural factors. There exists a pressing need to go beyond gross correlations to a finer level of analysis. This can be accomplished by specifying the explanatory variables that intervene between the sociocultural factors and mental disorder. Such variables might explain apparent inconsistencies. Another way of accomplishing the same end would be to specify the sociocultural matrix in which a particular correlation holds. We would then be able to relate mental disorder to a pattern of sociocultural factors rather than to a single variable. In a series of studies by Kleiner et U Z . , ? ~ and Kleiner,6 it was observed that the incidence of schizophrenia was significantly higher for Negroes in contrast to whites, for Catholics in contrast to Protestants, for Baptists and Methodists in contrast to Presbyterians and Episcopalians and, finally, for women in con* The work presented in this paper was supported by Research Grant M-3047 from the National Institutes of Health, Public Health Service, Bethesda, Md.

Social-Psychological Aspects of Migration and Mental Disorder in a Negro Population

The present paper will examine the relationship between migration and mental disorder. It will attempt to explain differences in rates of mental disorder between a population of Negroes who migrated from the South to the North and Negroes native to the North, in terms of such social and psychological factors as social mobility, goal-striving behavior, and ethnic or racial identity. Before dealing directly with these issues, however, we shall outline the research problems and findings that led to the present endeavors. In previous research we attempted to replicate the findings of Malzberg and Lee (1956), who reported that Negroes moving to New York

Characteristics of Negro Mothers in Single-Headed Households

This study contrasts the adjustment and attitudes of mothers in broken and intact families and evaluates the possible effects of these characteristics on their children. Data analyzed in this paper are based on interviews conducted in the Negro community of a large, northern urban center. Mothers in the two types of family situations were compared on educational status, prevalence of psychoneurotic symptoms, scores on a self-esteem index, reference group behavior, and measures of goal-striving stress associated with goals for self and a hypothetical son. In general, these analyses indicated that, compared to mothers in intact families, mothers in the broken family situation had poorer psychological adjustment and less involvement in goals for self and a hypothetical son. These characteristics may have important implications for the achievement-related attitudes of children raised in female-headed households.

From Sociocultural Disintegration to Community Connectedness Dimensions of Local Community Concepts and Their Effects on Psychological Health of Its Residents

In a series of community mental health promotion studies in Lofoten, Norway, the concept of sociocultural integration is used to describe properties of a local community that are related to peoples psychological health. Starting with Durkheims description of a cohesive society, we compare different concepts that are related to sociocultural integration, for example, sense of community, social capital, and social cohesion. We then examine the relationship of various individual oriented social psychological concepts to sociocultural integration. These concepts often share theoretical and operational definitions. The concept of sociocultural integration in the Lofoten studies was proved to be very valuable in understanding how the properties of a community can affect peoples mental health and their social psychological properties. It has also shown its value in the planning of mental health services and demonstrating its success in concrete community-based mental health promotion projects. Thus they could make important contributions to further studies and actions in local communities where the intersection between the individual, their social network, and their local community occurs.

Advances in Field Theory New Approaches and Methods in Cross-Cultural Research

A new conceptual and methodological strategy has been proposed for cross-cultural research, based on field theory as formulated by Kurt Lewin. This strategy is applied to several recent research projects and is shown to be capable of explaining seemingly paradoxical findings. The following issues are emphasized: (a) the place of objective, social, and subjective realities in such research; (b) the importance of considering the relationship between these realities; (c) the role of an interdisciplinary perspective; and (d) the appropriateness of traditional research methods. Traditional statistical models and their basic assumptions are examined, and new methods are proposed to fit the requirements of field-theory based research strategy.

Community-Based Treatment of Psychiatric Disorders in U.S.a. and Norway: Insights for New Service Delivery Systems

This article reports on a successful community-based psychiatric treatment program in Philadelphia, Pennsylvania and describes subsequent experiences seeking approval of similar programs in Philadelphia and in Oslo, Norway. Previous studies have shown that the Philadelphia community-based program, which used patient social networks and indigenous community workers assisted by psychologi cal and psychiatric professionals, provided better treatment outcomes than traditional hospital programs and socioenvironmental treatment programs. On the basis of these experiences a new service delivery system was proposed which integrates patient social networks, community workers, and lay community organizations with mental health center professionals. Examination of differences in official responses to the proposal shows the importance of several factors, including the mental health bureaucracys perception of patient potential, their openness to social psychological therapy, and the power struggles within the bureaucracy and the professional community.

Potential Sources of Error in Epidemiological Studies of Mental Illness

ALMOST from the inception of large scale studies of mental illness, A investigators have raised questions about the extent to which variations in illness rates associated with sociological factors (e.g., socioeconomic status, migratory status, etc.) could be a function of &dquo;artifacts&dquo; of the social situation. These situational artifacts include sophistication about psychiatric symptoms and readiness to utilize treatment facilities. The relative contribution of such situational artifacts must be known before concluding that the social structure and culture are linked to the actual genesis of mental disease.

The Social Network as an Etiological Factor in Mental Illness and as a Therapeutic Approach

Although this paper has a number of aims and objectives, perhaps the most important objective is to show how the concept of the “Social Network,” as we have come to use it, evolved. In addition, we will show how the concept influenced the research program, that we have been carrying out, and its development. At the outset, it is necessary to indicate how our use of the concept differs from the prevailing usage in the literature. For our purposes, the “Social Network” is a group of individuals who interact with each other, and maintain an ongoing stable set of relationships. The network, as a consequence of the sustained interaction, takes on some of the qualities of a social system, e.g., class and status characteristics, value consensus, a system of rewards and punishments, cohesion, goals and aspirations, etc. The social network may also be seen as a micro social system. This concept is to be distinguished from the macro social system concept which refers to larger segments of society or even to the total society in which an individual is functioning.