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4 results

  • 15 - Changing Caregiver Needs with Increasing Age of People with Schizophrenia

  • from Section 5 - Treatment and Services
  • Edited by Carl I. Cohen, Paul D. Meesters
  • Book:
    Schizophrenia and Psychoses in Later Life
    Published online:
    15 March 2019
    Print publication:
    28 March 2019, pp 190-199

  • Summary

    With deinstitutionalization, family members, typically parents, have become providers of long-term home care for many patients with schizophrenia. However, caregivers age along with patients and are largely impotent in finding replacements. This chapter combines research findings and clinical reports from families describing home conditions and patient progress. Agreeable patients may be boons to aging parents. More typical are difficult patients who sometimes become angry and threatening , reject medication, and may require police interventions that usually lead to cursory crisis interventions that are countertherapeutic. In the U.S., familial replacement caregivers may be scarce. Research on elderly caregivers indicates little future planning and ignorance of resources. Many fear that patients will fight displacement from the family home and decompensate further. Research on siblings indicates willingness to supply social support, but many report hostility from patients. Research examples of cultural differences in caregiving, largely relate to family structure and available resources. Worldwide solutions and some national attempts to address aging caregiver loss among persons with disabilities are presented. Some helpful planning resources for U.S. caregivers are provided.

  • 8 - Mental Health in Cross-Cultural Context

  • from Part I - Theoretical Perspectives on Mental Health and Illness: Introduction to Part I
    • By Harriet P. Lefley, Professor, Department of Psychiatry & Behavioral Sciences D-29, University of Miami Miller School of Medicine
  • Edited by Teresa L. Scheid, University of North Carolina, Charlotte, Eric R. Wright, Georgia State University
  • Book:
    A Handbook for the Study of Mental Health
    Published online:
    28 May 2018
    Print publication:
    08 June 2017, pp 145-172

  • Summary

    Concepts of mental health, distinctions between mental health and mental illness, and distinctions between mental and physical illness are highly variable across cultures. Lefley examines the cultural context of defining mental health and mental illness. The first part of the chapter explores the relationship between culture and the experience of stress. The second part of the chapter turns to international research and provides an integration of its empirical findings. The third part focuses on cultural diversity in mental health service systems and describes the important role played by social stressors, ethnicity, and minority and refugee status. It contrasts the traditional and biomedical healing systems and describes the Italian experiment to improve the quality of life of persons with mental illness. Self-help groups and the consumer movement have also emerged internationally, and the chapter examines some of these movements. The chapter concludes by considering the future of mental health services and the merging of Western concepts with those of the developing world. Is there a universal or optimal way to describe mental health and illness? Students should consider variability among meanings attached to mental health and illness.

    Introduction

    In this chapter, we deal with culture as a major variable in the conceptualization, development, and administration of mental health systems. The study of culture has typically referred to the beliefs, values, symbolic meanings, and normative behavioral practices of a specific human group. But in social science research today, cultural groups are usually categorized and compared along axes such as Western versus non-Western or modern versus traditional. In recent years, there has been increasing attention to differentiating individualistic cultures, which give primacy to individual rights, from collectivist or sociocentric cultures which focus on group loyalties and social role obligations (Triandis, 1995). These respective modes of categorization in many ways tend to distinguish the wealthier, industrialized nations from the developing world. Thus, they represent differences not only in worldview and norms, but in resources available for the provision and structure of health care. Within nation states, modal cultural attitudes as well as intergroup differences may shape the accessibility, appropriateness, and effectiveness of services for population subgroups such as racial or ethnic minorities (Substance Abuse and Mental Health Services Administration, 2015b; Takeuchi, Uehara, & Maramba, 1999).

  • 8 - Mental Health Systems in a Cross-Cultural Context

  • from Part I - Approaches to Mental Health and Illness: Conflicting Definitions and Emphases
  • Edited by Teresa L. Scheid, University of North Carolina, Charlotte, Tony N. Brown, Vanderbilt University, Tennessee
  • Book:
    A Handbook for the Study of Mental Health
    Published online:
    05 June 2012
    Print publication:
    16 November 2009, pp 135-162

  • Summary

    This chapter examines the assessment and measurement of mental disorders. It explores the special problems that have arisen in epidemiologists' attempts to transfer diagnostic criteria from the domain of clinical evaluation to the much different epidemiological arena in which disorder is measured in the general population by survey. Some early psychiatric epidemiological studies were based on the assumption that clinical prevalence could be used to validly infer the community population's true prevalence. The most notable attempt in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to make general progress on the false positives problem has been the development of a clinical significance (CS) criterion for use in evaluating mental disorder. The chapter also presents an example of a recent attempt to use DSM derived criteria in an epidemiological study to measure the prevalence of a particular mental disorder, namely, major depressive disorder (MDD).