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PubMed2004

Restoring hearing with active hearing implants.

Due to shortcomings of conventional hearing aid technology, such as unsatisfactory sound quality due to limited frequency range and undesired distortion, occlusion of the outer ear canal, and acoustic feedback with high amplification, but also psychological aspects of stigmatization, a significant of patients in need of hearing aids are actually not wearing them. Active hearing implants can be distinguished in: (1) impedance transformation implants (ITI), (2) cochlear amplifier implants (CAI), (3) cochlear implants (CI), and (4) brain stem implants (BSI). Whereas ITI are designed for patients with middle ear hearing loss, CAI are intended to restore hearing in patients with inner ear hearing loss. Advantages of CAI may be: (1) improved sound fidelity, (2) no occlusion of the outer ear canal, (3) no feedback, and (4) invisibility. However, not all features are true for every device. CI replace inner ear function in deaf or almost deaf patients. This article gives an overview on the range of active hearing implants to restore hearing and outlines the future use of computer and robot aided surgery.

Amplifiers, Electronic↗
PubMedDate not supplied

Attitudes towards people with mental illness. Effects of a training program for secondary school students.

This article reports a control study on the influence of a training program on attitude change towards people with mental illness. One hundred and seventeen students from 13 schools formed school-based mental health clubs, which composed the treatment group. They were given a mental health training program at different schools. The comparison group consisted of 102 secondary school students who had received no intervention. Students of both groups were assessed before the commencement, at the last session, and seven months after completion of the program with an OMICC (Opinion about Mental Illness in Chinese Community) scale developed by the authors. The study revealed significant positive changes, which could last a longer period of time, in specific attitudes on separatism and stigmatization of people with mental illness among students after the training program.

Adolescent↗
PubMedDate not supplied

Stigma and alcohol misuse during adolescence.

Stigma associated with alcohol misuse can have serious consequences for adolescents, who may be at risk of developing abuse and dependence disorders. Adolescence is a period that involves wide use of psychoactive substances. During this developmental phase, adolescents are strongly influenced by peer group norms, which do not necessarily stigmatize alcohol use. Unintentionally, a significant subgroup of adolescents may develop problems that are a result of alcohol misuse. The stigma about alcohol problems may keep adolescents from admitting that their difficulties are exacerbated by misuse of alcohol. When their behavior crosses the line from norm to inappropriate, the label of alcoholic may be applied and the stigma that is attached to the label will have additional consequences. This includes withdrawal of social supports and even access to treatment. Adolescents with alcohol use problems may be reluctant to identify themselves with these difficulties, because of their concern about being rejected. These adolescents may present with emotional or behavioral problems, rather than alcohol concerns. Clinicians may avoid inquiring about alcohol use, because of their own negative and pessimistic perceptions of this disorder. Clinicians can be important resources for these adolescents, but this requires that clinicians examine their own prejudgments about alcohol abuse and dependence. This can facilitate meaningful inquiry about alcohol use and begin to offset the stigma and negative self-worth of these adolescents.

Adolescent↗
PubMed2004

Anabolic steroid usage in athletics: facts, fiction, and public relations.

Anecdotal evidence suggests the widespread usage of anabolic steroids among athletes (20-90%), particularly at the professional and elite amateur levels. In contrast, scientific studies indicate that usage is rare and no higher than 6%. Conclusions from scientific studies suggest that anabolic steroid usage declines progressively from high school to college and beyond; however, anecdotal evidence claims the opposite trend. In this clash between "hard" scientific data vs. "soft" anecdotal information, it is natural that professionals would gravitate toward scientifically based conclusions. However, in the case of anabolic steroids (a stigmatized and illegal substance), should word-of-mouth testimony from individuals closest to the issues--those who have participated in and coached sports, those who have served as drug-testing overseers, and journalists who relentlessly track leads and verify sources--be set aside as irrelevant? Not if a complete picture is to emerge. In this review, hard scientific evidence is placed on the table side-by-side with soft anecdotal evidence, without weighting or bias. The purpose is to allow the opportunity for each to illuminate the other and, in so doing, potentially bring us a step closer to determining the true extent of anabolic steroid usage in athletics.

Anabolic Agents↗
PubMed2004

Voluntary HIV testing, disclosure, and stigma among injection drug users in Bali, Indonesia.

Recently, large increases have been noted in injection drug use and HIV prevalence in Indonesia. Because voluntary HIV counseling and testing can play an important role in HIV prevention, it is important to understand factors related to its use. The objective of this study was to identify factors related to the use of voluntary HIV testing among drug users. In-depth interviews were conducted with a sample of 40 drug users in the Denpasar area of Bali, Indonesia. Drug users may be interested in testing if they have enough information about AIDS to know that they are at risk and that they need this information to protect themselves and others from infection. Barriers toward testing included the fear of a positive result, fear of reactions from family and community members and stigmatization. Other obstacles include a feeling of hopelessness, problems with testing, unavailability and side effects of AIDS drugs and other factors. Many persons would not disclose their status to community members and sexual partners. There were serious concerns about others being ashamed of them and the impact of HIV on relationships with spouses and sexual partners and on employment.

Adult↗
PubMed2005

Community environment and HIV/AIDS-related stigma in China.

This article examines the contextual effects of community environment on individual stigmatizing attitudes toward people with HIV/AIDS in China. Multilevel logistic regression models are used to analyze data on 5,658 respondents aged 15-49 from 66 communities in the Baseline Information, Education, and Communication Survey for HIV/AIDS Prevention in China, conducted by the State Family Planning Commission in 2000. The results show that a high level of HIV/AIDS-related risk behavior in the community and a low level of community development are associated with increased HIV/AIDS-related stigma, after controlling for respondents' sociodemographic characteristics, including extent of knowledge about HIV/AIDS. The findings suggest that interventions for reducing HIV/AIDS-related stigma in China should take into account community characteristics, such as level of HIV/AIDS-related risk behavior and level of development in the community.

Adolescent↗
PubMed2005

Acceptability of HIV/AIDS counseling and testing among premarital couples in China.

Premarital counseling is required for couples wishing to be married in China. The counseling primarily provides information about contraception. We evaluated adding premarital HIV/AIDS counseling and voluntary HIV testing to the standard counseling. The test was offered free to one group and at the standard cost to the other. The proportion of those accepting HIV testing among all participants receiving premarital counseling was used as a measure of acceptability. Sixteen percent of participants not charged chose to accept testing versus 1.4% of those charged ( p < .001). Lack of HIV/AIDS knowledge and charging for the test were correlated with refusal. Over 5% of participants admitted to premarital sex, most with their fianceé, and a significantly higher portion was female. Only 22% used condoms. Study participants were randomized for 1-year follow-up. Only four participants reported extramarital sexual activity during that year. Acceptance of HIV testing was disappointingly low. Implementing strategies to reduce stigmatization and increase knowledge of HIV/AIDS, in addition to not charging for testing, may increase the acceptance of HIV testing.

AIDS Serodiagnosis↗
PubMed2005

Through their own eyes: a media-based group approach to adolescent trauma.

This paper describes the process of two groups of students from high schools located in the immediate vicinity of the World Trade Center grappling to make sense of the events of September 11 through the creation of a documentary chronicling their experiences. The process of creating these videos mirrored the process and curative factors of a psychotherapy group in a non-stigmatizing, innovative, and accessible format, one generated by the students themselves with the assistance of professionals in the visual and performing arts. After reviewing the literature on the potential impact of violence on adolescents and the use of group treatment, especially in school settings, as an optimal choice for this population, we describe the distinctive process of the two separate groups of students, each culminating in different expressions of their very personal experience of September 11. We understand and contextualize their process through the lens of the therapeutic dynamics and elements of group work.

Adolescent↗
PubMed2006

No place to hide: the group leader's moments of shame.

Shame is a powerful, universal experience; yet because of its painful, secretive nature, it often remains an underground affect for many therapists. On behalf of our patients and ourselves, we must de-stigmatize it. My aim is to further a dialogue among group therapists about processing our own shame, by openly discussing the phenomenology and dynamics of shame. Such discussion is not easy, as shame by its nature seems almost unspeakable; yet leaders, due to the group setting, are especially at risk of having shame activated. Using a self-psychological/intersubjective approach, this paper suggests how we as therapists can become cognizant of and work with our own shame. Given the dearth of experience-near accounts of the group therapist's own shame, the author provides detailed vignettes of her own experiences with shame in the clinical setting.

Humans↗
PubMed1985

Creative productivity in women analysts.

A pilot study of female analyst creative productivity finds that women authors are well represented in numbers in two leading analytic journals, The Journal of The American Academy of Psychoanalysis and Journal of the American Psychoanalytic Association, for 1980-81. However, women analyst members of the journals' parent organizations are very poorly represented compared with male analyst members. This has led to an exploration of factors affecting female analyst productivity, encompassing a broad sweep from the sociological to the personal, dynamic level. Differential opportunities for women analysts may be inherent in the educational processes. There is evidence for an "accumulation of disadvantage" for women in the field of psychiatry, as well as the impression of gender bias and feelings of stigmatization in psychoanalysis. The question of whether academic research career paths for women are adequately encouraged is raised. Mentorship patterns are also discussed. Whether gender bias affects journal publications and the nature of psychoanalytic thinking is questioned. Women's lessened productivity is sometimes ascribed to practical aspects of feminine role. This myth is debunked for women in science, where married women with children are equally productive. The author suggests that women analysts, however, may be a select group and may be more subject to role conformity pressures. Feminine role conflicts and their effects are discussed. Dynamic issues related to creative productivity are explored in two major areas. The author suggests that female preoedipal object relations may play a part in females devaluing of their own creative efforts in a competitive arena. The oedipal situation is also discussed, especially with regard to very high-achieving women. It is suggested that though competition with the maternal-nurturant rival may be worked through, often there is incomplete resolution of the surpassing and separation from the protective, loving, but dominant oedipal father, thus limiting true professional autonomy.

Clinical Competence↗
PubMed1995

Comparing child victims and adult survivors: clues to the pathogenesis of child sexual abuse.

Sexual abuse consists of two discrete traumatic elements; the repeated infliction of sexual assault that is superimposed on a chronic background of pathological family interaction, including betrayal, stigmatization, role reversal, and violation of personal boundaries. The acute episodes of sexual assault may be overwhelming to the child and result in anxiety-related symptoms, including PTSD. The long-standing family dysfunction leads to a pathological defensive organization that becomes woven into the victim's personality structure, resulting in long-term characterological changes. As the sexually abused child progresses through adolescence into adulthood, and the immediacy of his or her victimization recedes to the background, the acute posttraumatic anxiety symptoms are gradually replaced by more enduring symptoms and characterological defenses. Traumatic memories of the abuse become repressed or dissociated from consciousness. Identifications, attitudes, and affects derived from the abusive environment are usually organized around victimization experiences, leading to identifications with the aggressor or victim, which contribute to sadomasochistic object relationships and problems with the regulation of sexual behavior. The repressed or dissociated traumatic memories of sexual abuse carry the potential for producing future psychopathology through displacement in the form of conversion symptoms or somatization, and by generating delayed PTSD when these memories are elicited by current experiences. Anxiety and depression triggered by the emergence of these traumatic memories often lead to alcohol and drug abuse. These substances may be used for their anxiolytic and antidepressant effects.

Adaptation, Psychological↗
PubMed2005

Personal narratives of illness in schizophrenia: associations with neurocognition and symptoms.

Controversy exists regarding whether unawareness/denial of illness in schizophrenia results from neurocognitive deficits or a rejection of stigmatized social roles. One possibility is that some elements of a narrative of mental illness are primarily a matter of personal/social construction while others may be uniquely curtailed by neurocognitive deficits. Accordingly, we gathered narratives of illness among 52 persons with schizophrenia spectrum disorders using a semi-structured interview. Ratings of the plausibility, adequacy of detail, and temporal conceptual organization of each narrative were correlated with assessments of neurocognition, symptoms, and traditional insight measures. Degree of plausibility was significantly related to performance on the Wisconsin Card Sorting Test (WCST), a measure of executive function and levels of Positive symptoms on the Positive and Negative Syndrome Scale (PANSS). When entered into a regression to predict plausibility, positive symptoms and WCST performance made unique contributions (R2 = .51, p < .0001). Higher levels of Positive symptoms were associated with poorer temporal conceptual organization within narratives. Adequacy of detail within narratives of illness was related to traditional insight measures but not neurocognition or symptoms.

Attitude to Health↗
PubMed2003

Minor physical anomalies in schizophrenic patients and normal controls.

The aim of the study is to investigate the rate and topographical pattern of minor physical anomalies in schizophrenic patients and normal subjects and determine their value in predicting the patient-control status. Seventy-six schizophrenic inpatients (43 men, 33 women) and 82 normal control subjects (42 men, 40 women) were examined for minor physical anomalies on the Waldrop scale. Schizophrenics showed a higher rate for almost all examined anomalies, the differences reaching statistical significance for six of them: fine electric hair, epicanthus, high/steepled palate, tongue with smooth/rough spots, third toe the second, and big gap between I and II toes. They have significantly higher values for 5 out of 6 body regions and for the total anomalies score. Anomalies in schizophrenics show higher prevalence in the craniofacial complex than the periphery, but the periphery is also considerably stigmatized. Seven anomalies distinguish patients from controls, classifying correctly 81.6% of the patients and 82.9% of the controls. Some anomalies show an almost equal rate in the schizophrenics and the controls, while the rate of others is more than 10 times greater in the patients (odds ratios range: 1.0 to 10.9). Viewed within the multifactorial-polygenic threshold model of liability to a disease, minor physical anomalies might reflect a type of neurodevelopmental risk factor, which by interaction with other genetic or environmental factors could result in passing a threshold and producing symptoms of the disorder, at least in one subpopulation of schizophrenics.

Adolescent↗
PubMed2006

A test of the effectiveness of a list of suicide warning signs for the public.

In this study we examined the effect that reading a list of warning signs for suicide has on beliefs about suicide, including the belief that one can recognize a suicidal crisis. All participants read two sets of warning signs (with only the experimental group reading the suicide warning signs) and then answered questions concerning beliefs related to three health problems. Results indicate that participants who read the suicide warning signs reported greater abilities to recognize if someone is suicidal but did not report stronger beliefs that suicidal individuals are partly to blame, nor did they report lower likelihoods of befriending suicidal individuals. Results suggest that reading the list of warning signs may be effective in increasing the public's ability to recognize suicidal crises without creating or magnifying stigmatizing beliefs about suicidal individuals.

Culture↗
PubMed2001

Does suicidal history enhance acceptance of other suicidal individuals?

Suicide is stigmatized, so suicidal people may be especially hard to accept. To see if moderately suicidal outpatients were more accepting of a suicidal person than never-suicidal or severely suicide outpatients, 105 respondents completed measures of suicidality, depression, acceptance, and empathy. A curvilinear ANCOVA was nonsignificant, but a linear ANCOVA significantly adjusted for depression, and indicated, unexpectedly, that net of depression, never-suicidal people were more accepting of a suicidal person than moderately or severely suicidal people. Empathy and acceptance were moderately related. An implication is that social support for suicidal individuals might best be obtained from those who were never suicidal themselves.

Adult↗
PubMed2000

W.H.R. Rivers Graduate Prize Essay (1996). "Imperfect angels" : narrative "emplotment" in the medical management of children with craniofacial anomalies.

This article uses the paradigm of "therapeutic emplotment" to investigate the medical management of children with facial disfigurements at a craniofacial anomalies center in Northern California. Data are observations of, and semistructured interviews with, plastic surgeons, nurses, geneticists, orthodontists, and other medical professionals who composed the craniofacial anomalies team. Team members perceived that children feel socially stigmatized by their disfigurements. These medical professionals adjusted their own behavior according to these perceptions. They "emplotted" their actions, using the theme that disfigured children are attractive and worthy of attention and affection. Medical professionals attempted to depersonalize and neutralize the symbolically loaded disfigurements through the use of clinical language in an attempt to "separate" the child from his or her facial anomaly. The range of styles and approaches to interaction was diverse and varied in effectiveness, suggesting that some medical professionals were more skilled at emplotment than others.

Anthropology↗
PubMed2001

The pollution of incontinence and the dirty work of caregiving in a U.S. nursing home.

In U.S. nursing homes, it is the job of nursing assistants to tend to residents' basic bodily needs, including elimination and incontinence care. Given their frequent contact with pollutants, aides are very much at risk of becoming "polluted people." In this article, I investigate how nursing assistants' continual contact with contaminating substances impacts their status within the workplace, their relationships with others, and their attitudes toward their work and themselves as workers. I also explore how aides manage their encounters with pollutants and their stigmatized role as "dirty workers." In doing so, I hope to explicate the meaning of elimination and of incontinence caregiving in the United States.

Adult↗
PubMed2001

Gender, body, biomedicine: how some feminist concerns dragged reproduction to the center of social theory.

This article tracks the growth of medical anthropology in the United States in the decades since the 1970s, as it has intersected the expansion of feminist activism and scholarship. I argue that feminist attention to embodied inequalities quickly focused on reproduction as a site of investigation and intervention. Medical anthropology has benefited from feminist concern with stratified reproduction, especially its interrogation of nonnormative and stigmatized fertility and childbearing. When reproduction becomes problematic, it provides a lens through which cultural norms, struggles, and transformations can be viewed. Examples drawn from prenatal diagnosis are particularly revelatory of the diverse interests and stakes we all hold in reproduction.

Achondroplasia↗