The Ripple Effect: Social Network Dynamics, Social Location, and Strategies of Interaction in Mental Illness Careers

Thesis (PhD) - Indiana University, Sociology, 2008Social networks are dynamic in nature, characterized by ebbs and flows in the level and quality of interaction that correspond to important changes in the lives of individuals. Disruptive events and transitions have been theorized to restrict access to existing network ties and provide opportunities for new associations and alter network structure, altering network structure, function, and content in meaningful ways. The main objective of this research is to capture the interplay between the dramatically changing circumstances in individuals' lives, the activation of social resources, and the evolution of networks. Plainly, the central question is 'how and why do social networks evolve in response to disruption and uncertainty?' This research is fundamentally about how crisis requires people to rethink and respond to changes in their social interaction patterns, and reorganize personal social networks challenged by escalating needs, changes in social location, and the stigma attached to mental illness. Using the Indianapolis Network Mental Health Study (INMHS), I follow the social network experiences of 171 "first-timers," that is, individuals making their first major contact with the largest public and private treatment centers in the city. Data reveal that crisis reverberates through the social network, initiating significant changes in network size, functionality, and level of membership turnover. When we experience crisis, support needs increase, in turn shaping interactions in ways that have important implications for the stability of social networks. Moreover, crisis in one life domain tends to lead to disruptive transitions in other domains, as well. Seldom considered, but of great consequence for "first-timers," are changes in social structural location, including residential and relationship instability, jeopardize existing ties and exacerbate the level of disruption in social ties. Network disruption then affects how networks function, as new social ties do not easily replace longstanding friends and family. In short, traumatic events, like illness, in the lives of individuals set into motion a ripple effect that has pervasive consequences for social life. In sum, this research addresses the classic sociological tension between structure and agency. That is, it illustrates that individuals are not unobtrusive observers of social network instability or passive recipients of network resources. Rather, individuals early in their experiences with mental health treatment are often active and occasionally strategic agents who shape and maintain their social networks in ways that help them meet their needs and cope with uncertainty and crisis. However, people's ability to construct their networks and mobilize resources is constrained by structural factors, often out of their control, including disruptive events that force transitions into and out of the different social roles, statuses, and group memberships that accompany mental illness

Therapeutic social control of people with serious mental illness: An empirical verification and extension of theory

Mental health services and psychiatric professional values have shifted in the past several decades toward a model of client autonomy and informed consent, at least in principle. However, it is unclear how much has changed in practice, particularly in cases where client behavior poses ethical challenges for clinicians. Drawing on the case of clients’ sexual behavior and contraception use, we examine whether sociological theories of “soft” coercion remain relevant (e.g., therapeutic social control; Horwitz 1982) in contemporary mental health treatment settings. Using structured interview data from 98 men and women with serious mental illness (SMI), we explore client experiences of choice, coercion, and the spaces that lie in between. Patterns in our data confirm Horwitz’s (1982) theory of therapeutic social control, but also suggest directions for updating and extending it. Specifically, we identify four strategies used to influence client behavior: coercion, enabling, education, and conciliation. We find that most clients’ experiences reflect elements of ambiguous or limited autonomy, wherein compliance is achieved by invoking therapeutic goals. However, women with SMI disproportionately report experiencing intense persuasion and direct use or threat of force. We argue that it is critical to consider how ostensibly non-coercive and value-free interventions nonetheless reflect the goals and norms of dominant groups

Empowering the Next Generation to End Stigma by Starting the Conversation: Bring Change to Mind and the College Toolbox Project

Objective: To examine outcomes in a 4-year college pilot program built on stigma change research. U Bring Change to Mind (UBC2M) was developed and launched at Indiana University (IU) in 2014 as an institutionally supported, student-led organization to make campuses “safe and stigma-free zones.” The accompanying College Toolbox Project (CTP) assessed change in student prejudice and discriminatory predispositions as well as perceptions and behaviors at follow-up. Method: All entering Class of 2019 students were invited to complete a Web-based survey (N = 3,287; response rate = 44.6%). In their third year, students were sent a follow-up survey. Stigma indicators for 1,132 students completing both waves were analyzed using descriptive statistics and multivariate regressions. Models controlled for social desirability, prior contact, socio-demographics, and self-reported mental illness. Participation was examined for potential biases. Results: Statistically significant positive changes in attitudes and behavioral predispositions emerged. Although fewer students with prior contact endorsed stigma items initially, they reported significant reduction at follow-up. UBC2M active engagement was associated with lowering prejudice. Both passive and active engagement predicted change in discriminatory predispositions as well as current inclusive behaviors and positive perceptions of campus mental health culture. Conclusion: A long-term, community-based, student empowerment approach with institutional supports is a promising avenue to reduce stigma on college campuses, to develop the next generation of mental health leaders, and to potentially reduce societal levels of stigma in the long run. CTP provides evidence that both contact and contextual visibility matter, and that UBC2M offers a nationally networked organizational strategy to reduce stigma