"It's often liberating": consumers discuss causal beliefs in the treatment process

Self-stigma and bipolar disorder: A systematic review and best-evidence synthesis

BACKGROUND

Bipolar disorder is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania or hypomania. In addition to the burden of the disease and its consequences, self-stigma can impact people with bipolar disorder. This review investigates the current state of research in self-stigma in bipolar disorder.

METHODS

An electronic search was carried out until February 2022. Three academic databases were systematically searched, and best-evidence synthesis was made.

RESULTS

Sixty-six articles were related to self-stigma in bipolar disorder. Seven key themes were extracted from these studies: 1/ Comparison of self-stigma in bipolar disorder and other mental illnesses, 2/ Sociocultural context and self-stigma, 3/ Correlates and predictors of self-stigma, 4/ Consequences of self-stigma, 5/ Treatments and self-stigma, 6/ Management of self-stigma, and 7/ Self-stigma and recovery in bipolar disorder.

LIMITATIONS

Firstly, a meta-analysis could not be performed due to the heterogeneity of the studies. Secondly, limiting the search to self-stigma has excluded other forms of stigma that also have an impact. Thirdly, the under-reporting of negative or nonsignificant results due to publication bias and unpublished studies might have limited the accuracy of this reviews' synthesis.

CONCLUSION

Research on self-stigma in persons with bipolar disorder has been the focused on different aspects, and interventions to reduce self-stigmatization have been developed, but evidence of their effectiveness is still sparse. Clinicians need to be attentive to self-stigma, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight self-stigma.

Explanatory models of mental illness among working professionals diagnosed with bipolar or depression in the United States

BACKGROUND

People diagnosed with mental illness develop a variety of explanatory models of their conditions in the face of uncertainty. Explanatory models matter because they are associated with internalized stigma and illness behaviors such as treatment preferences.

AIMS

This paper explores how working professionals in the United States draw on biological and/or environmental factors to explain the cause(s) of their diagnoses of bipolar or depression.

METHOD

Findings are derived from an analysis of transcripts of in-depth interviews with 52 individuals from across the United States who were invited to participate in a study of working professionals diagnosed with mental illness. About 25 self-identified as having bipolar disorder and 27 as having major depression. Transcript data were analyzed following the principles of flexible coding with the goal of establishing a typology of explanatory models of self-identified bipolar versus depression.

RESULTS

Six types of explanatory models emerged from the analysis. One was exclusively biological, a second was exclusively environmental, and the remaining four combined biological and environmental factors in different ways. Quotations from the interviews are provided to illustrate each type, and comparisons between types are made based on primary diagnosis (bipolar vs. depression), and self-reports of trauma and stressful experiences.

CONCLUSION

Implications for the future research on explanatory models and how they may impact people who are diagnosed with a mental illness across multiple dimensions of their lives are presented.

Psychotherapy as making

Historically, research and practice of psychotherapy have been conducted within conceptual frameworks defined in terms of theoretical models. These models are in turn guided by meta-theories about the purpose of psychotherapy and its place in society. An image of psychotherapy that underpins much contemporary practice is the idea that therapy operates as an intervention that involves the implementation and application of a pre-existing theoretical model or set of empirically validated procedures. The present paper introduces the idea that it may be valuable to regard psychotherapy not as an intervention but instead as a process of making, in the sense of offering a cultural space for the co-construction of meaningful and satisfying ways of living that draw on shared cultural resources. We offer an overview of what a therapy of making might look like, followed by an account of theoretical perspectives, both within the psychotherapy literature and derived from wider philosophical and social science sources, that we have found valuable in terms of making sense of this way of thinking about practice. Our conclusion is that we need something in addition to theory-specific and protocol-driven therapies, in order to be able to incorporate the unexpected, the not-before-met perspective, event or practice of living, and to be open towards the radically new, the given, and the unknown.

A Call to Action. A Critical Review of Mental Health Related Anti-stigma Campaigns

Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between "us" and "them." In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.

Subjective experience of the origin and development of avoidant personality disorder

OBJECTIVE

To better understand how persons diagnosed with avoidant personality disorder (AVPD) make sense of the origin and development of their current everyday struggles.

METHODS

Persons with AVPD (N = 15) were interviewed twice using semi-structured qualitative interviews, which were analyzed through interpretative-phenomenological analysis. Persons with the first-hand experience of AVPD were included in the research.

RESULTS

The superordinate theme, "a story of becoming forlorn," encompassed three main themes: "it goes all the way back to when I was little," "there was a distance between others and me," and "transitions made it worse."

CONCLUSIONS

Though the results are not necessarily specific to AVPD, the findings clarify how people with AVPD can make sense of their current struggles by constructing developmental life stories in the interplay between themselves as persons and the growing demands of their social world. Furthermore, childhood relational vulnerabilities may challenge the ongoing development of social cognition and skills.