Sarah Rosenfield

Labeling Mental Illness: The Effects of Received Services and Perceived Stigma on Life Satisfaction

Labeling theory proponents and the theorys critics have different views of stigma and thus differ on the consequences of labeling for people with mental illness. The labeling perspective posits that because of stigma, official labeling through treatment contact has negative consequences for mental patients. In contrast, critics of labeling theory claim that stigma is relatively inconsequential. Instead, they argue that because labeling results in receiving needed services, it provides significant benefits for mental patients. Thus far, no study has tested the relative positive and negative effects of labeling. The author examines these views by comparing the importance of perceived stigma versus the receipt of services for the quality of life of persons with chronic mental illness. Results show that both stigma and services received are significantly associated with quality of life but in opposite ways. These findings have important implications for interventions for mental illness

Gender and Mental Health

Men and women experience different kinds of mental health problems. While women exceed men in internalizing disorders such as depression and anxiety, men exhibit more externalizing disorders such as substance abuse and antisocial behavior, which are problematic for others. These differences also vary by race and social class: for example, African Americans possess better mental health and, thus, a smaller gender gap in psychiatric problems. What explains these differences? We concentrate on conceptions of gender and gender practices. Research on gender and mental health suggests that conceptions of masculinity and femininity affect major risk factors for internalizing and externalizing problems, including the stressors men and women are exposed to, the coping strategies they use, the social relationships they engage in, and the personal resources and vulnerabilities they develop. This chapter investigates explanations in these areas for gender differences both in general and by race and class.

Negative and Supportive Social Interactions and Quality of Life Among Persons Diagnosed with Severe Mental Illness

This study examined the relative importance of negative and supportive social interactions in predicting different aspects of quality of life (QOL) in a sample of persons diagnosed with severe mental illness (n = 104). Controlling for other variables that might explain such a relationship, we found that negative social interactions were significantly related to lower QOL in three subjective domains, while supportive social interactions were related to higher QOL in four objective domains and one subjective domain. We found negative social interactions that are stigmatizing to be particularly important in predicting QOL; additional analyses suggested that perceived stigma partially mediated the relationship between negative social interactions and QOL. We discuss the implications of the present findings for the study of the link between social relationships and QOL among persons with mental illness.

The Self and Mental Health: Self-Salience and the Emergence of Internalizing and Externalizing Problems*

How do schemas about self-salience—the importance of the self versus the collective in social relations—affect mental health? We propose that self-salience shapes the likelihood of experiencing internalizing or externalizing problems. Schemas that privilege others over the self increase the risk of internalizing symptoms, including depressive symptoms and anxiety, whereas those that privilege the self over others predispose individuals to externalizing behaviors of antisocial behavior and substance abuse. Furthermore, we propose that these schemas contribute to the gender differences that exist in these problems. We test these predictions with data from adolescents, the stage at which these problems and the gender differences in them arise. Results show that self-salience underlies both internalizing and externalizing problems. In addition, schemas about self-salience help explain the gender differences found in mental health problems.

Gender stratification and mental health : An exploration of dimensions of the self

Recent evidence, showing that gender differences in depression and antisocial behavior originate in early adolescence, points to the importance of socialization and dimensions of the self in understanding the higher rates of internalizing disorders among females and higher rates of externalizing disorders among males. We review theories and research that link gender stratification to dimensions of the self and, through this, to gender differences in disorders. These theories and evidence further suggest that girls and boys differ in the boundaries drawn between the self and others. Ranging from high degrees of connectedness to high degrees of separation, such boundaries are conceptualized as peoples basic operating assumptions about social relationships. An analysis of empathy provides a preliminary test of the contribution of boundary assumptions to explaining gender differences in internalizing and externalizing disorders.

Triple jeopardy? Mental health at the intersection of gender, race, and class

Structural theories of stratification predict that groups with low positions in social hierarchies experience high rates of mental health problems. Extensions of this approach such as a triple jeopardy hypotheses claim that groups that are subordinate in multiple stratification systems such as gender, race and class are at especially high risk. Multiple minority statuses affect mental health in paradoxical ways, however, that refute triple jeopardy approaches. This paper presents a theoretical perspective based in cultural as well as structural theories that offers an alternative to triple jeopardy. I predict that certain relational schemas are jointly shaped by gender, race, and class and help explain their anomalous effects on mental health. These schemas of self-salience refer to beliefs about the relative importance of the self and others in social relations; they affect mental health by forming subjective alternative hierarchies to larger societal stratification systems. I use secondary analyses of two U.S. data sets to investigate this perspective. Results of regression analysis show that self-salience helps explain the paradoxical patterns of mental health by gender, race, and social class. The findings underscore the importance of using an intersectional approach and integrating cultural and structural factors to understand how stratification shapes mental health.

Homelessness and rehospitalization: The importance of housing for the chronic mentally ill

Many have argued that problems with housing contribute to the high relapse rate among chronic mentally ill patients. Evidence that homelessness is associated with rehospitalization suggests that interventions for housing can reduce relapse rates. In this study, the relative importance of housing services versus psychiatric factors as determinants of rehospitalization, emergency room use, and aftercare compliance is examined. The analysis investigates the relative importance of housing within a community that has high rates of homelessness versus a comparison community with low homelessness rates. Results indicate that when patients need both housing and psychiatric care, services for housing make the critical difference for community tenure.

Studying inpatient treatment practices in schizophrenia: An integrated methodology

A multi-phase research project examining current impatient psychiatric practices and the relationships between different treatments and patient outcomes is described. The study sample includes Medicaid patients with a diagnosis of schizophrenia who have been treated in inpatient units of general hospitals in New York State. The research is focused at the heart of the debate concerning the appropriate role of inpatient psychiatric care within a balanced system of mental health services. Addressed are the conceptual issues that guided the project, research strategies, instrument development, measures used and the preliminary findings that informed successive phases. Design issues are reviewed in light of the conceptual and pragmatic decisions made with a multiple site design. A compelling argument is made about the need for a long-term treatment orientation that prepares patients for what lies ahead and that assures communication and continuity between inpatient and outpatient care.

Splitting the Difference

In her book, The Mismeasure of Woman, Carol Tavris tells a story about how men and women express love: A friend of mine, who I will call Roberta, has been mildly unhappy for years about one flaw in her otherwise excellent husband, Henry. The flaw rises and falls in importance to her, depending on Roberta’s state of mind and general stresses, but it has long been a chronic irritant. Henry’s problem is that he doesn’t like to “chitchat,” as he puts it. This means, Roberta explains, that he doesn’t like to gossip about friends and family, he doesn’t like to analyze his marriage on a weekly or even a yearly basis, he doesn’t like to analyze his feelings.... Once, pressed to reveal his passion, Henry said, “I vote with my feet. If I didn’t love you, I wouldn’t be here.” Instead of killing Henry at that moment, which was her inclination, Roberta did what she usually does: She called a woman friend, and they met for lunch to discuss Henry. Several hours later, Roberta emerged refreshed, invigorated, and prepared to cope with Henry for another few months (Tavris, 1994, p. 246).