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Chapter 3 explores the contribution of the lifecourse approach and social gerontology to understanding mental health outcomes in later life. It also explores the role played by health and social inequalities. By bringing these perspectives together the Chapter makes visible the ways in which lifecourse inequality and adversity e.g. childhood abuse, create and/or amplify risks to mental health in later life. It also exposes the embedded and structural nature of causative mechanisms. Health inequalities have profound implications for mental health. People from disadvantaged socioeconomic backgrounds suffer disproportionately from common mental disorders, such as depression, across the whole lifecourse. They are also exposed to higher levels of chronic psychosocial stress which, independently and additively, undermines mental wellbeing. These effects are cumulative over the longer term and in more unequal societies; also by exposure to discrimination and oppression. These arguments challenge the dominance of the ‘inevitable decline’ model of ageing exposing a more nuanced complex set of intersecting risks to mental health that are structurally located and socially produced. The role of policy in addressing health inequalities and their social determinants was a key dimension of mental health policy until 2011; since then it has become increasingly uncoupled from the policy agenda.

Persons living with HIV and AIDS face a complex array of stresses and challenges, as discussed throughout this book, which may overwhelm psychological functioning. This leads to considerable distress and suffering (Cohen et al., 2002), manifests in a multitude of psychiatric symptoms, and increases nonadherence to risk reduction and medical care. The aim of psychotherapeutic care for persons with HIV is to mitigate such distress through a combination of psychosocial interventions. Goals of such therapies may include enhancing adaptive coping strategies, facilitating adjustment to living with HIV, increasing social supports, and improving a patient’s sense of purpose, self-esteem, and overall well-being. Goals may also include improving adherence to risk reduction and medical care, as well as preventing HIV transmission. Psychological distress in persons with HIV infection is associated with decreased quality of life, disease progression, and mortality (Leserman, 2008). Considering the biopsychosocial model, emotional distress in HIV can be viewed as resulting from a combination of medical, psychological, and social factors related to the illness (see Table 8.1). In some studies, improved social support and active coping styles in response to illness and stress have correlated with improved immunological parameters. Studies have also linked depressed mood and stressful life events to worsened immunological status, including decreased CD4 cell counts. Nonetheless, randomized controlled data demonstrating the ability of behavioral and social interventions to improve immune status remain conflicted; further evidence-based research is needed. While improving immunological status is a potential benefit of psychosocial treatment for people with HIV infection, it is relieving the suffering inherent to psychiatric illness and improving patients’ quality of life that remain the primary goals. A variety of psychosocial interventions are available to persons with HIV, from individual to group-based formats. Such treatments span a spectrum of psychotherapeutic approaches, including supportive, psychodynamic, interpersonal, and cognitive-behavioral. This chapter will consider the benefits of such psychosocial interventions by summarizing the current state of research and findings for each of these treatment approaches, addressing both individual and group settings.

In 1994, Kenneth Schwartz, a forty-year-old healthcare attorney from Boston, was diagnosed with advanced lung cancer. At different times during his progressive illness, he was deeply moved by aspects of his care that were less strictly medical or technical: a calming visit from a nurse prior to surgery; a personal connection with an anesthesiology resident from his neighborhood; and, toward the end of his life, the kindness and perspective provided by his oncologist. Shortly before his death, Mr. Schwartz founded a non-profit organization to promote the kind of compassionate care that had meant so much to him. Two decades later, the Schwartz Center for Compassionate Healthcare reaches millions of patients and hundreds of thousands of caregivers to realize its founder’s vision of more humane care for the seriously ill. A cornerstone of the Center’s work is the Schwartz Rounds program, which brings healthcare providers from multiple disciplines together for frank discussions about the emotional and psychosocial challenges of caring for patients. More than five hundred healthcare organizations around the world host these ongoing, non-traditional conferences. A few years ago, the organizer of Schwartz Rounds at UNC invited us to lead an upcoming conference. She was aware of our work with the single fathers support group and wanted us to address the challenges that spouses face when caring for a partner with a terminal illness. At the next group meeting, we mentioned this request to the men and asked them for their advice. Each father had been an eyewitness to the end of his wife’s life and knew well how that heartbreaking time had impacted his entire family. Not surprisingly, they had a lot to say about end-of-life care and how it could be improved. Karl was particularly passionate. “I’ve actually thought about this a lot since Susan died. Obviously, the patient is the focus, but I think it’s also important for doctors to appreciate what the family goes through—especially when there are kids at home and the spouse is a co-parent. That dynamic alone influences so many things.”

In this chapter, pediatric diseases are defined as “illnesses that affect a person for an extended period of time, often for life, and that require medical care attention above and beyond the normal requirements for a child or adolescent” (American Academy of Pediatrics 1993). The prevalence of such chronic illnesses has steadily increased over the past 20–30 years (Downs et al. 2001; Vincer et al. 2006; Marelli et al. 2007), with estimated rates ranging from below 1% to 44% depending on the definition, method, and sample included in the different studies (van der Lee et al. 2007). Several theoretical frameworks and models have been presented to explain how diagnosis-specific effects and generic factors across disorders affect cognition and behavior. The transactional stress and coping model (TSC) is one of the most cited theories on psychological adaption in children with a chronic illness, encompassing both specific and generic effects (Thompson and Gustafson 1996). Dennis (2000) has presented a similar model of factors affecting cognitive outcome in chronically ill children. The models describe how disease-related variables interact with child characteristics, developmental level, family resources, and peer relationships, and provide a useful framework to the present chapter. Several epidemiological and clinical studies have documented that children with pediatric diseases have an increased risk of emotional and behavioral problems (Lavigne and Faier-Routman 1992; Glazebrook et al. 2003; Hysing et al. 2007). Symptoms of internalizing and externalizing disorders are frequently found across the diseases but illness-specific manifestations also exist. Externalizing symptoms of hyperactivity and social problems are most often shown by children with neurological disorders (Rodenburg et al. 2005), while the rate of emotional problems has been reported to be especially high in children with asthma (Vila et al. 2003). Peer interaction and social functions are often affected in children with pediatric disorders. Investigations of the impact of social functioning is a growing research field in pediatric psychology, as part of a general trend in developmental psychology that focuses on close peer relationship as a moderator of nonoptimal functioning (Bukowski and Adams 2005; Burt et al. 2008).

This chapter defines psychosocial treatments for schizophrenia and discusses how conceptualizations of recovery, which emphasize meaning and purpose in life, have shaped the nature and delivery of services. Substantial progress in psychosocial treatment has been made; rigorous controlled and replicated research has demonstrated the effectiveness of a variety of interventions, including contingent reinforcement, family intervention, supported employment, cognitive behavioral therapy, cognitive remediation, illness self-management training, and social skills training. Despite progress these services are not available in routine care. Obstacles to disseminating psychosocial treatments are considered, including insufficient professional training and the need for more research on the science of implementation. Recommendations for improving psychosocial intervention quality include targeting predictors of treatment response, evaluating critical components or mechanisms underlying effective programs, improved goal setting and monitoring outcomes to facilitate individual tailoring, and training of clinicians across the range of effective treatments to maximize the creative use of clinical expertise. Published in the Strungmann Forum Reports Series.

This chapter offers a psychoanalytically-informed psychosocial perspective on aggression between sisters, illustrated by case studies from a qualitative study of children and young people’s sibling relationships. While aggression is commonly associated with harm (and indeed, often defined as involving the intent to harm) and also with masculinity, the chapter highlights the centrality of ordinary aggression to relationships with self and others, as much for girls as for boys, and its creative uses in family relationships for the development of identity and individuality.

The conversation opens with reflections on the process of thinking with others, including the place of ‘ancestral voices’. It considers the delicate balance between certainty and uncertainty in critical thinking before turning to thinking with and through ‘race’. From there, the conversation explores some of the dimensions and dyna mics of crisis.

This chapter discusses the themes that emerged from the research, particularly those that relate to boxing’s enduring appeal, and those that demonstrate how the sport can be a fundamental source of masculine accomplishment and status. This chapter discusses how boxing is a response to personal and structural vulnerability and illustrates how the appeal of boxing has changed over men’s amateur and professional careers. It further explores the tension between the straightforward ‘surface’ reward-statements of men (money, status, fame, health, discipline, etc.) and what are interpreted as ‘deeper’ motivations that suggest the gym is a physical, social, but also a psychological space for accomplishing masculinity, and for creating and sustaining self-worth in the face of chronic autobiographical and structural limitations