This work is born out of previous research, conducted by this researcher, into the effects of psychiatric labelling on individuals thus differentiated. Informed by the investigative thrust of phenomenological inquiry, it is the aim herein to provide an illumination of the dramatic confrontation of the labelled individual with the classificatory branding that is his or her label. The question asked is: What is the experience of the labelled individual, and how does the label function as a ‘scientific fact’ (Kiesler, 2000) suffused within his being? In answering these questions, the researcher aims to abandon his own expectations, as is fitting with the phenomenological method, and to devote his sympathies entirely to the subjective disclosures which, it is hoped, the participants will offer. On this point, an obvious tension exists insofar as expectation and hypothesis necessarily constitute the inception of any research endeavour; and so, the notion of a complete bracketing of assumption and anticipation seems methodologically vague. The explorative impetus within this dissertation aims towards an elucidation of the effect of psychiatric diagnosis on the labelled individual, in terms of the individual’s experience of being-with-others. The impact of the offering of the label upon the individual’s interpersonal and intersubjective presence will be explored so as to establish whether psychiatric labelling unfolds as a disconnection of the individual from his co-existence with others.

Background: Psychotropic medicines are widely used to treat mental illness in the community. In prisons, however, the continuity and appropriateness of prescribing for mentally ill prisoners have been questioned. There has been little research on the use of psychotropic medicines in prisons in England and Wales; yet this information is essential for determining the extent to which there is equivalence of care between prisons and the community and for effective medicines management. Aims and objectives: This study aimed to determine patterns of psychotropic prescribing in prisons and consider the extent to which people with mental illness have 'equivalent' access to psychotropic medicines in prison. Methods: A mixed methods design was used, incorporating three interrelated studies: a retrospective case note review to estimate the proportion of prescriptions for psychotropic medicines which were discontinued on entry to prison; a cross-sectional survey to estimate point-prevalence psychotropic prescribing rates in prisons, as compared with the community; and a qualitative interview study with members of prison healthcare staff and patients with mental illness to a) explore the perceived purpose of psychotropic prescribing and b) to deconstruct patient and doctor accounts of medication changes on entry to prison. Findings: Half (47%) of all psychotropic medicines reported on entry into prison were not prescribed within seven days of arrival. The cross-sectional study found that psychotropic medications were prescribed to 20% of men and 44% of women in prison; age-adjusted prescribing rates were at least five times higher in prison than in the general population. However, no valid clinical indication was recorded for half (47%) of prescriptions for psychotropic medication in prison. Qualitative analysis showed that patients interpreted the principle of equivalence differently to doctors and attributed negative outcomes to changes to medication regimes in prison. Patients reported using psychotropic medicines to reduce symptoms of mental illness, but also as a coping strategy and to reduce insomnia. Whilst staff voiced concerns regarding possible overreliance on psychotropic drugs, patients perceived insufficient access to alternative forms of treatment and support in prison. Discussion: These findings confirm high use of psychotropic medicines in prison and caution prison prescribers against abrupt withdrawal of psychotropic medicines on entry to prison, overreliance on psychotropic medicines, potentially inappropriate prescribing and poor record keeping. Strengths and limitations, implications for practice and recommendations for future work are also discussed.

Drop-in centers for individuals with serious and persistent mental illness offer a unique and perhaps under-recognized environment option for adjunct treatment. The current study examines and evaluates components thought to be a part of an enriched drop-in center experience that contribute to positive member outcomes through the effects of empowerment. These components include self-help, peer support, and creative expression. Outcomes were evaluated based on quality of life, self-worth, and symptom reduction. Such data are necessary in promoting the growth and development of drop-in centers and identification of components that contribute to positive member outcomes. Participants (n=101) were administered a series of measures including The Multidimensional Scale of Perceived Social Support, The Empowerment Scale, The Rosenberg Self-Esteem Scale, The World Health Organization Quality of Life-BREF, The BASIS-32™, and a series of questions created for the purposes of the current study regarding creative expression and self-help. The psychometric properties of each measure were evaluated and reviewed. Additionally, mean differences between normative data and participant means were examined and demographic data were analyzed. It was hypothesized from the literature that self-help, peer support, and creative expression would have significant indirect effects on all of the proposed outcome variables through the effects of empowerment. Results revealed significant indirect relationships between peer support and all of the outcome variables through the effects of empowerment and between self-help and all of the outcome variables through the effects of empowerment. No significant relationships were found between creative expression and any of the outcome variables through the effects of empowerment. These findings suggest that peer support and self-help may be instrumental in achieving positive outcomes through the effects of empowerment. Centers that offer experiences to enhance self-help and peer support will subsequently enhance feelings of empowerment in members, which relates to higher levels of self-worth, higher levels of quality of life, and lower levels of psychiatric symptomatology. Further implications of such findings and suggestions for continuation of this research are discussed in detail.

Written in first person, NOTHING NORMAL HAPPENS TO ME is a memoir in essays that traces the narrator’s journey from self-destruction to creation. Part one encompasses the narrator’s lost years, after she breaks free from the tyranny of her mentally ill mother and goes to live on her own at 17. Part two provides context for those bad girl years, exploring her childhood when she identified with her histrionic mother. Part three comprises stories about the narrator’s years of awakening when she seeks out transcendence, faith, and a family of her own. The pieces vary tonally and stylistically as they attempt to trace the maturing voice of the narrator. Like SEEKING RAPTURE: SCENES FROM A WOMAN’S LIFE by Kathryn Harrison, this collection centers on a young girl, who without her mother’s love, struggles to love herself. It is both a cautionary tale and a story of redemption.

Thus study seeks a contribution to the understanding of the problems of immigrant Chinese by comparing them with Canadian-born Chinese. It is almost impossible to understand the ways and customs of the Chinese without some insight into their culture. But to understand the adjustment problems of this minority group, their cultural background must be discussed in comparison with the North American culture. The study is focussed upon a small group, both immigrant and Canadian-born, whose failure to "make good" in Canada is signalized by their admission to a mental hospital. For case-study, eighteen immigrant Chinese patients and a comparative group of nine Canadian-born Chinese patients were selected. Data was obtained from clinical files recorded by doctors, psychiatrists, nurses, social workers and other members of the treatment team. A rating scale was devised to help assess the major factors in adjustment to life, subdivided into (a) personality constituents, (b) social factors, and (c) economic factors; this is then used to examine and compare the social functioning of each group. To substantiate the findings and to present a clearer picture of the causal factors, three illustrative cases are presented in detail - one Canadian-born Chinese, and two immigrant Chinese patients, in the ratio of the number studied. Each case is appraised in the same three areas: personality constituents, social factors, economic factors. Continually unsatisfactory employment and the barriers to communication created by cultural confusion show up among the factors at work. Problems of communication, social integration and cultural conflict are brought into clearer light as correlatives of mental illness, and the significance of these findings is appraised. / Arts, Faculty of / Social Work, School of / Graduate

There has been a growing conviction on the part of medical and nursing staff in the Homes for the Aged in British Columbia, which provide psychiatric care for the aged, that some of the residents have sufficient physical and mental health to be discharged. This study makes an analytical survey of some of the needs and resources of a group of patients considered to be ready to leave one of these institutions (the Port Coquitlam Unit). The purpose of the survey was to determine what kinds of resources these people would require to maintain an optimal level of adjustment in the community, as well as to describe the possible contribution social services could make in facilitating their discharge. The areas selected for assessment were grouped into two broad categories, (1) the patient's needs which resulted directly from his hospitalization and (2) the personal and social resources which he could employ upon discharge. There are two steps involved in selecting the group for study. First, through the use of a questionnaire submitted to the medical and nursing staff in order to determine which patients were judged to be mentally and physically ready for discharge, and second, from this larger number of patients, through the use of routine sampling procedure, a smaller group was selected for study. This final group was assessed by the clinical team in the institution primarily through the use of rating scales. An examination of the needs and resources of these patients revealed that all of these patients could benefit from the assistance of social work in one or more of the areas evaluated. Although the needs and resources of the group varied considerably, there were some indications that the patient's length of stay had a marked effect upon the type of social work service they could use. Those remaining in hospital for a period of less than two years had usually retained some resources in their former community which could be mobilized to assist them in discharge. On the other hand, the indications for these patients is that they would need an extension of hospital services after they were discharged. The patients who had remained in hospital for a longer period of time, had less need for out-patient hospital services, yet had little in the way of social resources or contacts in their former community to assist them once they had left the hospital. This group also evidenced less motivation for discharge and seemed to regard their hospitalization as a permanent living arrangement. In conclusion, the study points out the need for further definitive assessments of the areas of function of a social worker in an institution where the aged, psychiatrically ill are treated. Also pointed out is the need for social work programme planning in the light of these assessments, as well as the insurance of adequate provisions for further research to help develope it. Treatment programmes in other psychiatric institutions are mentioned, indicating that with the use of more advanced therapies, an increasing number of geriatric patients with mental illnesses are responding to treatment and are, therefore, eligible for discharge. Thus, there is a growing need for social work contributions in planning with the older person who is leaving hospital. Some indications of community concern in planning for these people are cited as evidence of awareness on the part of both the institutions for the geriatric patient and the community that the change from hospital life to community life must be an uninterrupted process. / Arts, Faculty of / Social Work, School of / Graduate

MENTALLY ILL CAREGIVERS AND DIFFERENTIAL PATTERNS OF SUBSTANCE ABUSE IN A SAMPLE OF UNIVERSITY STUDENTS Teliyah A. Cobb1, Alyssa P. Gretak1, MA, Kelcey L. Puszkiewicz1, MA, Jill D. Stinson1, PhD, and Megan Quinn2, DrPH, MSc, East Tennessee State University, Johnson City, TN 1Dept. of Psychology, College of Arts and Sciences 2Dept. of Biostatistics and Epidemiology, College of Public Health Existing literature demonstrates a dose-responsive relationship between adverse childhood experiences (i.e., abuse, neglect, and household dysfunction) and the risk of problematic substance use later in life. While controlling for the effects of early adversity, a recent study found that childhood household dysfunction independently increased the risk of excessive alcohol use in adulthood. However, there are few studies focusing specifically on differences in substance use behaviors in individuals who had a caregiver with a mental health diagnosis. This study aims to fill this gap by examining whether having a caregiver with mental illness during one’s childhood increases the risk of abusing alcohol and illegal or prescription drugs in adulthood in a college sample. Our sample includes University students in the Southeastern U.S. (N = 995) who are mostly Caucasian (84%) and female (63%). Participants completed an online, anonymous survey for course credit. Approximately 23% (n = 227) reported having a caregiver with mental illness or who attempted or died by suicide. Regarding substance abuse, nearly 11% of the sample (n = 106) reported abuse of alcohol, 13% (n = 126) indicated abuse of illegal drugs, and almost 5% (n = 47) reported abuse of prescription medication. Pearson Chi-square tests were conducted to analyze the relationship between caregiver mental illness, including a caregiver who attempted or died by suicide, and abuse of alcohol, illegal, and prescription drugs in adulthood. Interestingly, individuals with a mentally ill caregiver were less likely to abuse alcohol, c2 (1, N = 983) = 12.56, p = .000, and illegal drugs, c2 (1, N = 984) = 22.68, p = .000, as an adult, compared to those without a mentally ill caregiver. In contrast, students with a mentally ill caregiver were more likely to abuse prescription drugs as adults, c2 (1, N = 979) = 32.54, p = .000, compared to those without a caregiver suffering from a mental illness. Thus, findings suggest that having a mentally ill caregiver differentially impacted the risk of abusing varying types of substances. Additional analyses examining the influence of mental illness in biological versus non-biological caregivers (e.g., stepparent, foster parent) and further discussion of implications will be included.

The purpose of this thesis is to provide a descriptive study of psychiatric and social variables related to aged first admissions to a private psychiatric hospital in the calendar years 1959 through 1963. The study also seeks to determine what, if any, relationship exists between background characteristics of the patients and their diagnoses. Finally, the diagnosis of the patient is compared with a series of patient outcome variables to determine the relationship, if any, between diagnosis and selected recovery variables. Due to the nature of the data used, the emphasis of the thesis is upon describing relationships rather than testing hypotheses.

Although criminality among mentally ill individuals is a well-documented phenomenon, limited research has focused on specific factors that need to be addressed to combat this issue. Utilizing the theoretical framework of Shaw and McKay’s (1942) Social Disorganization Theory, in conjunction with collective efficacy (Sampson et al., 1997) and social capital (Coleman, 1988), different factors were explored in an attempt to discover their relationship with recidivism. Using secondary data from Criminal Justice Drug Abuse Treatment Studies, variables such as homelessness, unemployment, and religious importance were analyzed in relation to rearrest rates from 889 parolees nine months post-release. Marriage, sex, and age were controlled for. A relationship was found between unemployment and rearrest; however, no relationship was found between rearrest and homelessness or religious importance among this sample. Results from this study could contribute to the future implementation of programs aimed at assisting mentally ill offenders who are being released from confinement.

Magister Artium - MA / My MA mini-thesis in Creative Writing is a collection of 33 poems titled Learning to Exhale. The poems are centred around a character – a black African woman who is sharing her experiences of mental illness. The poems revolve around memory, forgetting and remembering; going back to the moment when the woman realises that she is ill, understanding it from the present while working to find ways to express what bipolar disorder is and how she experiences it. The collection also highlights her search for words and meaning to describe these experiences that are highly traumatic. This is to create a language of expressing the indescribable. This means that the form and structure is experimental, combining differing styles and form to show different voices, different states of mind that swing from depression, mania to suicidal thoughts.