The American Orthopsychiatric Association (“Ortho”) is an 80-year old membership association of mental health professionals concerned with mental health and social justice. Ortho provides a common ground for collaborative study, research, and knowledge exchange among individuals from a variety of disciplines engaged in preventive, treatment, and advocacy approaches to mental health.
American Journal of Orthopsychiatry:
History and Mission
Since 1930, the American Journal of Orthopsychiatry has been the leading interdisciplinary journal in the mental health field. AJO offers a rich scholarly mix of clinical, research, theoretical, and policy-oriented articles on issues affecting individuals and families across the life span-all serving to inform professional practice and public policy from a multidisciplinary perspective.
Born in the Depression of the 1930s, AJO infused into the usual clinical and intrapsychic fare of the mental health journal aspects of employment and economics, culture and religion, public education, and criminology.
By the 1940s, world events affecting children, highlighted by the war against fascism, augmented clinical insights.
In the 50s, AJO pioneered professional concern about the relation between behavioral disorder and social conditions.
The social activism and the civil rights and anti-war movements of the 60s were reflected in enduringly valuable articles on community mental health, individual resilience, child rearing, education, poverty, and urban issues.
At the start of the 1970s, special sections in the Journal brought the women’s movement and day care to the forefront of professional debate. AJO was the first to pay serious and sustained attention to the emotional sequelae of divorce, especially its effects on the children.
In the 1980s and 1990s, AJO highlighted research, intervention, and social policy aspects of child abuse, family violence, child custody, and a range of issues that are keenly relevant today.
Now, in the new millennium, the American Journal of Orthopsychiatry continues to publish the finest work of its time. Its articles set the directions and delineate the trends in the field. Its breadth of vision, synthesis of viewpoints, and melding of clinical and social issues are unmatched by any other professional journal.
APOLOGIES FROM THE EDITORS
An introduction should have accompanied the article “The Bender-Gestalt II” (Brannigan & Decker, 2006), published in the January 2006 issue of the American Journal of Orthopsychiatry. Richard Ruth, Ph.D., was the “action editor” who oversaw the solicitation and development of this article. Although the previous editor of this journal, Carlos Sluzki, MD, commissioned Dr. Ruth’s prologue to the article, and committed and planned to publish it, due to an editorial oversight his Introduction and proper credit for his work were omitted. This omission was unintentional and due to confusion stemming from a passing of the baton of the editorship from this journal’s past editor to the current one.
We express our regret to Dr. Ruth, to the authors of the article, and to the reader. We encourage you to read this prologue and the Bender II article, further enriched by this Introduction, which appears with the original article.
EDITOR
Nancy Felipe Russo, PhD – Arizona State University
ASSOCIATE EDITORS
Andres Pumariega, MD – The Reading Hospital and Medical Center
Karen Fraser Wyche, MSW Ph.D – University of Oklahoma College of Medicine
Wanda K. Mohr PhD, RN, FAAN – University of Medicine and Dentistry, New Jersey School of Nursing and Robert Wood Johnson Medical School
Kenneth S. Thompson, MD – Associate Professor of Psychiatry and Public Health, University of Pittsburgh
Past Editors: 1930-2004
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When She Was Bad: Borderline Personality Disorder in a Posttraumatic Age
Dana Becker, Ph.D.
The advent of the posttraumatic stress disorder diagnosis has been welcomed by many as a recognition of the circumstances and needs of victimized women. This paper argues that the increasing application of the PTSD label to women formerly diagnosed with borderline personality disorder, rather than resolving the dilemmas inherent in use of the borderline diagnosis, has succeeded instead in further medicalizing women’s problems and reproducing the previously existing caste system of diagnosis and treatment.
Adjustment Problems in Adolescence:
Are Multiracial Children at Risk?
Teresa M. Cooney, Ph.D., and M. Elise Radina, M.S.
Data from a national survey were used to compare adjustment between a group of multiracial adolescents and two groups of single-race adolescents, grades seven to twelve. Significant differences were found on fewer than half of the school, behavioral, and psychological dimensions that were assessed. Implications for research and school interventions are discussed.
Relationship Quality Between Multiracial Adolescents and Their Biological Parents
M. Elise Radina, M.S., and Teresa M. Cooney, Ph.D.
National survey data were used to compare single-race white and minority adolescents with multiracial adolescents in terms of relationships with their parents. Three relational dimensions were considered: association/interaction, communication, and emotional closeness. Comparable relationship quality was found between parents and adolescents in all three groups, except that multiracial boys and their fathers were found to be less emotionally close and communicative. Implications for research are discussed.
Racial Differences in Attitudes Toward Professional Mental Health Care and in the Use of Services
Chamberlain Diala, Ph.D., M.P.H., Carles Muntaner, M.D., Ph.D, Christine Walrath, Ph.D.,
Kim J. Nickerson, Ph.D., Thomas A. LaVeist, Ph.D., Philip J. Leaf, Ph.D.
Differences in attitudes toward seeking professional mental health care and in the utilization of mental health services were examined by analyzing the second part of the National Comorbidity Survey. Prior to use of services, African Americans were found to have more positive attitudes than whites toward seeking such services, but less likely to use them. After utilization, their attitudes were found to be less positive than those of whites.
Psychological Aspects of Chronic Tonic and Clonic Stuttering: Suggested Therapeutic Approaches
Alixandra Y. Feinberg, D.Pt., Brian P. Griffin, Ph.D., Mark Levey, M.D.
A comparison of the personality profiles and intellectual functioning of 12 tonic and 18 clonic stutterers indicated that the groups could be discriminated on measures of verbal IQ, object relations, social isolation, somatization, and cognitive processing. Findings are examined in terms of the impact of type of functioning on maintenance of stuttering, and implications for treatment are discussed.
Attachment Theory and Residential Treatment: A Study of Staff-Client Relationships
Tally Moses, M.S.W.
This qualitative study examines residential child care workers styles of engaging adolescent clients. Analysis focuses on staff practices and behavior that facilitate a treatment context conducive to healthier client attachments. Findings demonstrate the complexity inherent in residential treatment and illuminate barriers to optimal staff-client relationships. Suggestions are offered for improvement of agency policies and for future research.
Ecological Outcomes of Adolescents in a Psychoeducational Residential Treatment Facility
Stephen R. Hooper, Ph.D., Joseph Murphy, Ph.D., Asenath Devaney, Ed.S., Todd Hultman, Ph.D.
Cross-sectional follow-up data on 111 adolescents in a re-education residential facility were obtained in three domains school, legal, and level of care at 6, 12, 18, and 24 months post discharge. Reports by community-based professionals on individual functioning were assessed on several criteria, the most stringent of which indicated successful outcomes for nearly 60% of the adolescents. Characteristics of the more successful students are noted, applications of the psycho-educational residential approach for program structure are considered, and implications for positive ecological outcomes are discussed.
Effectiveness of a Social Skills Training Program Using Self/Other Perspective-Taking: A Nine-Month Follow-Up
Natalie Grizenko, M.D., FRCPC, Michael Zappitelli, M.D., Jean-Philippe Langevin, Sophie Hrychko, M.D., FRCPC, Amira El-Messidi, David Kaminester, M.D., Nicole Pawliuk, M.A., Marina Ter Stepanian, B.A.
Using a pre/posttest design, with a nine-month follow-up, a new, “modified” social skills training program, which incorporates the concept of self/other perspective-taking, was evaluated and compared to a traditional social skills program in a sample of 36 children. Students in the modified group showed more short- and long-term improvement in behavior than did those in the traditional social skills training group. Implications for practice and research are discussed.
Social and Environmental Predictors of Maternal Depression in Current and Recent Welfare Recipients
Kristine Siefert, Ph.D., M.P.H., Phillip J. Bowman, M.D., M.P.H., Colleen M. Heflin, M.P.P., Sheldon Danziger, Ph.D., David R. Williams, Ph.D., M.P.H.
Depression is highly prevalent in welfare recipients, and is associated with failure to move from welfare to work. This paper examines the relationship between social and environmental factors in a large, community-based sample of mothers who currently or recently received welfare benefits. Specific and modifiable risk factors related to poverty, gender, and race were found to predict major depression beyond traditional risk factors. Research and practice implications are discussed.
Unintended Pregnancy and Depressive Symptoms
Among First-Time Mothers and Fathers
Sonya J. Leathers, Ph.D., and Michele A. Kelley, Sc.D.
The consequences of unintended first pregnancy on the mental health of cohabitating couples (N=124) were examined in the third trimester of pregnancy and at four months postpartum. Results indicated that the influence of unintended pregnancy on parental depressive symptoms is complex and via different mechanisms for men and women. Pregnancy viewed as unintended by males and intended by their partners appeared to pose the greatest risk for postpartum depressive symptoms, particularly in women.
Family Intervention for Asian Americans With a Schizophrenic Patient in the Family
Sung-Woo Bae, M.S.W., and Winnie Wai-Ming Kung, Ph.D.
A family intervention model designed to meet the unique sociocultural needs of Asian-American schizophrenia patients and their families is proposed. This five-stage model consists of: preparation, engagement, psycho-educational (i.e., survivor skills) workshop, family sessions, and an ending stage. Guidelines and specific suggestions for implementing each of these stages are offered as a means of dealing effectively With Asian Americans differential value orientations and cultural characteristics.
The National Lesbian Family Study 3: Interviews With Mothers of Five-Year-Olds
Nanette Gartrell, M.D., Amy Banks, M.D., Nancy Reed, M.S.W., Jean Hamilton, M.D.,
Carla Rodas, M.P.H., Amalia Deck, B.A.
This third report from a longitudinal study of lesbian families presents data obtained from interviews with mothers of five-year-old children conceived by donor insemination. Results indicated that 87% of the children related well to peers, 18% had experienced homophobia from peers or teachers, and 63% had grandparents who frankly acknowledged their grandchild’s lesbian family. Of the original couples, 31% had divorced. Of the remainder, 68% felt that their child was equally bonded to both mothers. Concerns of lesbian families are discussed.
Parenting Among Mothers With a Serious Mental Illness
Daphna Oyserman, Ph.D., Carol T. Mowbray, Ph.D., Paula Allen Meares, Ph.D., Kirsten B. Firminger, B.A.
In the past few decades, institutionalization and community-based rehabilitation and support programs have increased the likelihood that women with serious mental disorders will be parents and will raise their children. This review describes what is known about the parenting of these women, focusing on diagnosis, child characteristics, and other contextual effects.
Childhood Experiences of Abuse, Later Substance Use, and Parenting Outcomes Among Low-Income Mothers
Maureen O. Marcenko, Ph.D., Susan P. Kemp, Ph.D., Nancy C. Larson, Ph.D.
Relationships among childhood abuse, subsequent adult functioning (with a focus on severity of substance abuse), and child placement were explored in an urban sample of low-income, African-American mothers. Childhood sexual trauma and age were found to be correlated with severity of later drug use; history of physical or sexual abuse was significantly related to psychological distress in adulthood; and addiction was highly correlated with child placement. Implications of the findings are discussed, with particular reference to collaborations between child welfare and substance abuse treatment.
Children’s Emotional and Behavioral Disorders: Attributions of Parental Responsibility by Professionals
Harriette C. Johnson, M.S.W., Ph.D.; David E. Cournoyer, Ph.D., Gene A. Fisher, Ph.D., Brenda E. McQuillan, M.S.W., Sheila Moriarty, M.S.W., Audra L. Richert, M.S.W.,Edward J. Stanek, Ph.D., Cheryl L. Stockford, M.S.W., Beverly R. Yirigian, M.S.W.
In the wake of the neurobiological “revolution,” do mental health professionals still assign etiological responsibility for emotional and behavioral disorders to deficient or harmful parenting? This study investigated differences in attributions of causality by theoretical orientation, professional discipline, areas of practice, familiarity with parent support groups, and demographic characteristics. Implications for policy, research, and practice are discussed.
Attachment to Transitional Objects: Role of Maternal Personality and Mother-Toddler Interaction
Alison J. Steir, Ph.D., and Elyse Brauch Lehman, Ph.D.
The origins of soft-object attachments were explored in terms of maternal personality and child temperament as measured by maternal questionnaires and by laboratory observation of child temperament and mother-toddler interactions. Toddlers’ soft-object attachments were found to be predicted by the maternal variables of constraint and positive affectivity, the latter in combination with low child activity level.
Patterns of Children’s Coping With Life Stress: Implications for Clinicians
Deidre Donaldson, Ph.D., Mitchell J. Prinstein, Ph.D., Michael Danovsky, Ph.D., Anthony Spirito, Ph.D.
In a study of children’s patterns of coping with daily stressors, boys and girls 9-17 years old were asked to complete a coping checklist in response to one of four types of stressors-school, parents/family, siblings, or peer/interpersonal. Patterns of coping-strategy use were found to be similar across the various stressors, with wishful thinking, problem-solving, and emotional regulation being among those most frequently used. Older adolescents, compared to younger children, tended to use a broader range of coping strategies, regardless of stressor. Implications for clinical practice are discussed.
Psychiatric Disorders in Adolescents Exposed to Domestic Violence and Physical Abuse
David Pelcovitz, Ph.D., Sandra J. Kaplan, M.D., Ruth R. DeRosa, Ph.D.,
Frances S. Mandel, Ph.D., Suzanne Salzinger, Ph.D.
The relationship between abuse and psychiatric diagnoses was investigated in two groups of physically abused adolescents, 57 living in homes with interparental violence and 32 in homes without such violence, and in 96 nonabused adolescents living in nonviolent homes. Adolescents in the first group were found to be at greater risk for depression, separation anxiety disorder, post-traumatic stress disorder, and oppositional defiant disorder than were those in the second group. Adolescents in the first group also appeared more vulnerable to anxiety and depression.
Gender Differences in Young Adolescents’ Exposure to Violence and Rates of PTSD Symptomatology
Cheryl Springer, Ph.D., and Deborah K. Padgett, Ph.D.
Gender differences in exposure to violence and levels of PTSD symptomatology were examined in a school-based sample of 621 young adolescents. Also investigated as predictors of PTSD symptoms were cognitive coping strategies, perceived social support, and the affective experience of fear. Results support the importance of evaluating gender differences, differentiating between violence by type and location, and considering both cognitive and affective factors as predictors of PTSD symptomatology.
Assessment of a New Rehabilitative Coping Skills Module for Persons With Schizophrenia
Claude Leclerc, M.S.N., R.N., PhD., Alain D. Lesage, M.D., M.Phil., FRCP(C),
Nicole Ricard, R.N., Ph.D., Tania Lecomte, Ph.D., Mireille Cyr, Ph.D.
A rehabilitative coping skills module employing problem solving and cognitive behavioral therapy and an experimental repeated-measure design was tested on 55 randomly selected persons severely handicapped by schizophrenia, most of whom had lived almost half of their lives in psychiatric wards. Unlike the control group of 44 comparable schizophrenics, the experimental group exhibited a significant decrease in delusions and increase in self-esteem, and maintained hygiene levels.
Effectiveness of Specialized Treatment Programs for Veterans With Serious and Persistent Mental Illness: A Three-Year Follow-Up
Frederic C. Blow, Ph.D., Esther Ullman, M.S.W., Kristen Lawton Barry, Ph.D., C. Raymond Bingham, Ph.D., Laurel A. Copeland, M.P.H., Richard McCormick, Ph.D., William Van Stone, M.D.
This is the first study to test concurrently the effectiveness of four treatment programs for patients with serious mental illness. Three-year outcome data on utilization and functioning demonstrated important positive changes for seriously mentally ill veterans enrolled in specialized, enhanced inpatient and community case management treatment programs, when compared to patients in an enhanced day treatment program or traditional standard care.
The Neighborhood Club: A Supportive Intervention Group for Children Exposed to Urban Violence
Rosario Ceballo, Ph.D.
This paper describes a short-term, supportive intervention group, the “Neighborhood Club,” designed to assist children with the psychological impact of exposure to urban violence. It addresses the void of therapeutic work attending to poor children’s chronic exposure to community violence. Theoretical and clinical rationales for this intervention are discussed, and illustrations from ten school-based groups are offered.
Psychological Adjustment in Adult Adoptees: Assessment of Distress, Depression, and Anger
David S. Cubito, Psy.D., and Karen Obremski Brandon, Ph.D.
Psychological adjustment was assessed in a sample of 525 female and 191 male adoptees. Analyses were conducted by gender; by search status, i.e., those who had never searched, those who were searching, and those who had made contact with their biological parents; and by history of mental health service utilization. Compared to normative data, the sample reported significantly higher levels of psychological maladjustment; only women adoptees scored higher on a scale measuring anger. Overall, adoptees’ scores were elevated but did not approach levels typical of outpatient populations.
The Professional Is Political: An Interpretation of the Problem of the Past in Solution-Focused Therapy
Amy Rossiter, M.S.W., Ed.D.
This paper proposes that therapists subject their work to radical doubt designed to uncover and interpret the micropolitics that inhere in professional knowledge and practice. Using Orlie’s notion of trespass, the approach to the past employed by solution-focused therapies is examined. These trespasses involve the therapy’s silence about the meaning of injustice; its role in relation to social movements; and its potential to reproduce relations of domination. A new conception of ethics is proposed that takes into account the inevitable presence of the political as it fashions the history that conditions us as human beings.
Computer Addiction: A Critical Consideration
Howard J. Shaffer, Ph.D., Matthew N. Hall, Joni Vander Bilt
This article examines problems related to intemperate Internet use within the conceptual framework of addiction. After reviewing the concept of addiction and the recent media and professional attention given to “Internet addiction”, this article discusses some of the conceptual flaws inherent in this concept. Specifically, this article argues that the Internet itself cannot be considered an object of addiction. This article also suggests that empirical support for the construct validity of Internet addiction has yet to emerge, and thus it is premature to define “Internet addiction” as a unique psychiatric disorder; in the majority of cases, other more primary disorders my provide better explanations of excessive computer use. Thus, this article urges more caution and rigor among the researchers and clinicians who study and treat problems related to intemperate computer use.
Psychosocial Intervention in Stroke:
Families in Recovery From Stroke Trial (FIRST)
Thomas A. Glass, Ph.D., Barry Dym, Ph.D., Sarah Greenberg, Ed.D., David Rintell, Ed.D., Carol Roesch, M.S.W., Lisa F. Berkman, Ph.D.,
A family-focused psychosocial intervention for stroke survivors is described and illustrated with case studies. It is designed to improve functional recovery through four specific pathways: increased knowledge, efficacy, and control through stroke education; optimized social support; increased network cohesion; and improved problem-solving abilities. Rationales for these pathways are presented and methods of implementing them discussed.
Cultural Determinants in the Treatment of Arab Americans: A Primer for Mainstream Therapists
Anna Y. Nobles, M.Ed., and Daniel T. Sciarra, Ph.D.
As the population of Arab Americans grows, so does their presence among mental health clientele, creating a need among clinicians for information about these clients. The broad lines of Arab culture are delineated: its roots, language, religion, and political history; patterns of immigration to the United States; and the salient differences between Arab culture and the dominant U.S. culture. The effects of negative stereotyping and discrimination against Arab Americans are examined, as are specific clinical issues in treating them. Recommendations for more culturally sensitive treatment are enumerated.
Attachment Experiences Transformed Into Language
Eva Appelman, Ph.D.
This exploratory study examined the linguistic components of adults’ narratives on their attachment experiences, focusing on the process of transformation of the nonverbal experience into language. Securely attached mothers were found to differ significantly from insecurely attached mothers on cognitive ability to connect between experience and language. Results support the notion that language becomes the dynamic tool through which the individual negotiates meaning and transforms the nonverbal organized pattern of relatedness. Applications for therapy and directions for further research are discussed.
Employment Outcomes in Family-Aided Assertive Community Treatment
William R. McFarlane, M.D., Robert A. Dushay, Ph.D., Susan M. Deakins, M.D.,
Peter Stastny, M.D., Ellen P. Lukens, Ph.D., M.S.W., Joanne Toran, M.P.A., Bruce Link, Ph.D.
Family-aided assertive community treatment (FACT) was enhanced by adding vocational specialists to help persons with severe mental illness obtain competitive employment. Results were then tested against those of conventional vocational rehabilitation (CVR). The FACT cohort demonstrated significantly better employment rates than did the CVR, while negative symptoms declined in the former and increased in the latter. No evidence was found that competitive work presented a significant risk for relapse.
Social/Emotional Intelligence and Midlife Resilience in Schoolboys With Low Tested Intelligence
George E. Vaillant, M.D., and J. Timothy Davis, Ph.D.
Seventy-three inner-city boys with a mean IQ of 80 were followed prospectively from age 14 until age 65. Their adult adjustment was compared to a socioeconomically matched sample of 38 boys with a mean IQ of 115. Although childhood social disadvantage did not distinguish the groups with low and high IQs, half of the low-IQ men enjoyed incomes as high and had children as well-educated as did the high IQ men. These resilient low-IQ men were more likely to be generative, to use mature defenses, and to enjoy warm object relations than the high IQ group as a whole.
Effects of Early Intervention on Psychiatric Symptoms of Young Adults in Low-Risk and High-Risk Families
Eeva T. Aronen, M.D., Ph.D., and Terttu Arajärvi, M.D., Ph.D.
Effects of early risk and intervention on the psychiatric symptoms of young adults were studied. By means of a weighted risk index, 160 families with a baby born in 1975-1976 were classified as being at low or high risk. Half of the families attended a five-year family counseling program, the other half served as a control group. At age 20-21 years, the young adults from the counseled families had significantly fewer psychiatric symptoms than did those from the control families. A significant interaction between family risk and counseling was found. Implications for preventive intervention efforts are discussed.
Preference for Violent Electronic Games, Self-Concept, and Gender Differences in Young Children
Jeanne B. Funk, Ph.D., Debra D. Buchman, M.S., R.N., Julie N. Germann
Electronic game-playing has been linked to adjustment problems in player subgroups. This study examined relationships among time commitment, gender, preference for violent games, and self-concept in 364 fourth and fifth graders. Main effects were identified for game preference and gender, with stronger preference for violent games being associated with lower self-perceived behavioral conduct. Implications for future research are discussed.
Coping with Psychotic Symptoms in the Early Phases of Schizophrenia
Steve Boschi, M.S.W., Richard E. Adams, Ph.D., Evelyn J. Bromet, Ph.D., Janet E. Lavelle, M.S., Elyse Everett, M.S.W., Nora Galambos, Ph.D.
How people diagnosed with schizophrenia cope with positive symptoms after their first hospitalization is explored, along with the relationship of their coping strategies to their psychosocial functioning. The strategies most frequently endorsed were cognitive in type, while those considered most helpful were behavioral. Respondents identifying an active strategy as most helpful displayed better psychosocial functioning at 24-month follow-up.
Comorbidity of Substance Use and Post-Traumatic Stress Disorders in a Community Sample of Adolescents
Rose M. Giaconia, Ph.D., Helen Z. Reinherz, Sc.D., Amy Carmola Hauf, B.A.,
Angela D. Paradis, B.A., Michelle S. Wasserman, B.S., Denise M. Langhammer, B.A.
A study of 384 18-year-old adolescents living in the community demonstrated a frequent co-occurrence of substance use disorders and post-traumatic stress disorder. Multiple pathways appeared to lead to this comorbidity, which was associated with widespread psychological impairment that might have serious developmental consequences. Implications for research and practice are discussed.
Exposure to Community Violence and Post-Traumatic Stress Symptoms: Mediating Factors
Stacy Overstreet, Ph.D., and Shawnee Braun, B.S.
Children’s perceptions of safety and family conflict were examined as mediators of the relation between exposure to community violence and post-traumatic stress symptoms. Results indicated that exposure to community violence was related to perceptions of decreased neighborhood safety and increased family conflict, and that this, in turn, mediated the impact of violence exposure on children’s post-traumatic stress symptoms. Implications for research are discussed.
Trauma-Related Symptomatology Among Children of Parents Victimized by Urban Community Violence
Catherine N. Dulmus, Ph.D., and John S. Wodarski, Ph.D.
The effects of parents’ victimization by community violence on children’s psychological functioning was examined in a group of 30 6-12-year-old African-American children. In comparison with 30 demographically similar children in the same urban community whose parents had never been victimized, the victims’ children exhibited higher levels of distress symptoms. Implications for research and practice are discussed.
Prenatally Drug-Exposed Toddlers: Cognitive and Social Development
Delmont C. Morrison, Ph.D., Lin Cerles, Ph.D., Luisa Montaini-Klovdahl, Ph.D.,
Elizabeth Skowron, Ph.D.
In a replication of an earlier study, 122 prenatally drug-exposed toddlers were assessed on four cognitive scales and rated by their caregivers on socialization, communication, and daily living skills. A significant number of the sample performed below age expectancy on the cognitive scales and on at least two of the three domains rated by caregivers.
Special Section
Racism and Mental Health Into the 21st Century: Perspectives and Parameter
David Rollock, Ph.D., and Edmund W. Gordon, Ed.D.
Definitions and theories of racism are reviewed, and the influence of racism on the American mental health system is examined, with special attention to the effects on racial and ethnic minorities of the sociopolitical climate of the 1990s. The aims of this special section are outlined and an overview is presented of the articles, which define some of the key problems of racism and mental health, describe their scope and effects, and propose approaches to remediation as we move into the 21st century.
Racism as a Clinical Syndrome
James E. Dobbins, Ph.D., and Judith H. Skillings, Psy.D.
This paper examines the clinical effects of racism on its targets and, in particular, on its agents, the individuals who, wittingly or not, partake of the culture of racial privilege. It proposes a paradigm shift in regard to the clinical study of racism, and presents a structural model of racism, analogous to addiction as a disease, which holds that racism has an etiology and a clinical taxonomy that lends itself to differential diagnosis and treatment of those who manifest symptoms.
From Evil to Illness: Medicalizing Racism
David Wellman, Ph.D.
Arguments for treating racism as an illness or an addiction are critiqued, and it is suggested that such efforts constitute a step backward in the battle against racism and discrimination. Medicalization, rather than being a catalyst for social change, is a mode of social control. The assumptions underlying the disease model are examined, and a strategy is outlined for dealing with racism as a structural phenomenon broader and more complex than personal prejudice and individual pathology.
Invisibility Syndrome: A Clinical Model of the Effects of Racism on African-American Males
Anderson J. Franklin, Ph.D., and Nancy Boyd-Franklin, Ph.D.
Adaptive behavior and psychological well-being of African Americans can be affected by prejudice and discrimination. Encountering repeated racial slights can create “psychological invisibility.” The invisibility syndrome is presented as a conceptual model for understanding the inner evaluative processes and adaptive behavior of African Americans in managing experiences of racism.
A Multidimensional Conceptualization of Racism-Related Stress: Implications for the Well-Being of People of Color
Shelly P. Harrell, Ph.D.
A conceptualization of racism-related stress and its impact on well-being is offered that integrates existing theory and research on racism, multicultural mental health, and the stress process. The conceptualization is relevant to diverse racial/ethnic groups, considers the larger social and historical context, and incorporates attention to culture-based variables that may mediate the relationship between racism and well-being. Implications for intervention are discussed.
Treatment Delay Among Asian-American Patients with Severe Mental Illness
Sumie Okazaki, Ph.D.
Length of treatment delay and cultural-familial correlates were studied in a group of 62 Asian-American patients with severe mental illness, and 40 of their relatives. Contrary to prior findings of long treatment delay among Asian Americans, this cohort reported relatively low levels of stigma and shame and relatively short delay between onset of psychiatric symptoms and inception of treatment. Higher levels of shame and stigma felt by the relatives were associated with patients longer treatment delay.
Training in Cultural Schemas: An Antidote to Unintentional Racism in Clinical Practice
Charles R. Ridley, Ph.D., David W. Chih, M.S., Ronald J. Olivera, M.S.
Although recent attempts have been made to bolster multicultural training, problems remain in defining effective training and providing equitable service delivery to minority consumers. This article argues that cultural schema is a useful construct for helping clinicians identify, organize, interpret, and integrate cultural data into clinical practice. Further, it is proposed that training in the use of cultural schemas will serve to also reduce the prevalence of unintentional racism in the mental health field.
The Long and Winding Road: Personal Reflections of an Anti-Racism Trainer
Jeffrey M. Ring, Ph.D.
This paper addresses the intense personal and professional preparation necessary for becoming an effective anti-racism trainer. The author draws upon diversity training models and theory, as well as personal experiences and reflections charted as a white man actively involved in this field over the past ten years.
Articles
Early Intervention Programs for Children With Autism : Conceptual Frameworks for Implementation
Heather Whiteford Erba, M.Ed.
Four diverse early intervention programs for children with autism discrete trial training, LEAP, floor time, and TEACCH are described. For each program, the concepts of learning, development, and autism are summarized, intervention procedures are outlined, and connections between theory and practice are illustrated. Research outcomes for each of the four programs are discussed.
Relation of Mothers Affective Developmental History and Parenting Behavior : Effects on Infant Medical
Maria V. Hammond, Ph.D., Susan H. Landry, Ph.D., Paul R. Swank, Ph.D., Karen E. Smith
Mothers of infants with varying degrees of medical risk were grouped according to their perception of acceptance or rejection in childhood. Those who recalled the highest degree of acceptance showed greater warmth and flexibility as parents, regardless of their infants degree of medical risk. However, infant medical risk was an important moderator in relations between maternal perceptions of childhood rejection and parental behavior.
Emotional Availability : Conceptualization and Research Findings
Zeynep Biringen, Ph.D
The emotional availability construct (based on observations of parent-child interactions) was first reconceptualized for research in 1991 as a way to describe the quality of parent-child interactions. Since then, there has been considerable refinement of the construct. EA refers to several parental dimensions (sensitivity, structuring, non-intrusiveness, non-hostility) and two child dimensions (responsiveness to parent and involvement of parent). The EA empirical link with attachment and parent-child relationship is reviewed and avenues for future research are suggested.
Preschool Children’s Exposure to Violence: Relation of Behavior Problems to Parent and Child Report
Ariana Shahinfar, Ph.D., Nathan A. Fox, Ph.D., Lewis A. Leavitt, M.D.
A group of 155 parents and their preschool children attending Head Start reported on the children’s exposure to community violence, level of distress symptoms, and behavioral problems. The behavioral correlates of exposure were found to differ according to exposure modality: internalizing problems were more likely in children who witnessed violence, and externalizing problems in those victimized by violence. Issues regarding self-reports by preschool children are highlighted, and clinical and research implications discussed.
Differences Among Families Coping With Serious Mental Illness: A Qualitative Analysis
Eric D. Johnson, Ph.D.
Families of 180 people with serious mental illness, representing various socioeconomic and ethnic groups, were interviewed about their understanding of their family member’s illness, coping with problems caused by the illness, sources of support, effects of medication and substance abuse, and dealing with mental health professionals. Several significant areas of concern emerged, and are explored with attention to differences based on gender, ethnic group, socioeconomic status, and role of the family member.
Impact of Welfare Reform on Teenage Parent Recipients: An Analysis of Two Cohorts
Mary Elizabeth Collins, Ph.D.
To assess early effects of welfare reform, administrative data was used to compare pre-reform and post-reform cohorts of teenage parents regarding the impact of reform on welfare enrollments, case closures, child maltreatment, and subsequent births. The relation of mandated living arrangements to outcomes was also examined. Cohort differences were observed in enrollments and reasons for closure, but not in maltreatment or birth rates. Living arrangements were found to be associated with case closure.
