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Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness, thereby creating the appearance of an emerging epidemic with increasing prevalence.

Method – I review the recent psychiatric and epidemiological research to reveal that the intellectual and scientific debates that occur in the psychological laboratory and in survey research are in fact falsely increasing the figures that show that an epidemic of bipolar is emerging.

Findings – For centuries, bipolar disorder was equated with severe psychosis and had a prevalence rate between 0.4% and 1.6%. As spectrum and subthreshold conceptions of bipolar disorder become established in official psychiatric diagnostic manuals, however, estimates of the prevalence of bipolar spectrum disorders have risen to almost 25%. I demonstrate that nearly all of this increase is a result of changes in the scientific and intellectual definition of bipolar disorders among psychiatric professionals, and that rates of symptoms are not in fact increasing.

Contribution to field – The arbitrariness of diagnostic thresholds naturally leads researchers to argue for lower thresholds. This allows more individuals who were previously considered psychiatrically normal to be reclassified as psychiatrically disordered. Lowering diagnostic thresholds increases the risk of confusing normal elation or sadness with disordered states, increasing the potential of false-positive diagnoses and the false impression of rising rates of disorder.

To examine the exercise experiences of women with obsessive-compulsive disorder (OCD) in order to highlight the complex relationship between mental illness and physical activity, as it intersects with other identities and social locations (e.g., gender and sexuality) as well as other mental health conditions (e.g., eating disorders and exercise addiction).

Semi-structured interviews were conducted with 14 women who self-identify as having OCD. A thematic analysis was conducted to understand the role of physical activity in the participants’ lives.

The participants experience holistic benefits from being physically active. At the same time, however, their symptoms of OCD and related disorders (e.g., eating disorders) make it challenging to be physically active in meaningful and healthy ways.

Public health messages promoting exercise as a form of therapy must take into account the complex relationship between physical activity and mental illness. Additional research and programing is also needed in order to help women with mental health issues be physically active in safe and enjoyable ways.

It is well known that mental health disorders cause substantial functional limitations and disability (Surgeon General, 1999). Less well known is the central role that mental health plays in economic disparities. The prevalence of depressive disorders is almost 3 times as high among individuals in the bottom 20% than among individuals in the top 20% of the income distribution, a much steeper gradient than for hypertension, heart disease, arthritis, chronic pain, or the number of medical problems (Sturm & Gresenz, 2002). In addition, individuals with mental disorders are less likely to have savings than individuals with physical health problems and the disparity widens with advancing age (Gresenz & Sturm, 2000).

While much research examines the consequences of deinstitutionalization for caregivers, few studies address support mobilization strategies used by patients themselves. We examine the relationship between mental health patients’ needs, their activation of network ties for health discussion, and network dynamics during the course of treatment. We hypothesize that patients strategically activate their network ties for support that matches their needs. Linking activation to network dynamics, we also propose that patients with greater needs exhaust their supportive relationships and experience more network turnover.

We draw on a dataset of new mental health patients (N=173) and their associated network members (N=4,144) observed over three years. Random-intercept regression models test the relationship between patients’ needs and (1) network tie activation for health discussion and (2) network turnover.

Although the overall level of need does not predict network tie activation, mental health patients are more likely to activate network ties who provide support that matches their expressed needs for discussion, emotional, and financial support (although not instrumental or informational support). In addition, patients with elevated needs experience increased network turnover. Strategic activation and its unintended consequence together suggest a revolving door of support for patients in crisis.

In the post-deinstitutionalization era, patients’ informal social safety nets must compensate for needs that are left unmet by deficits in the formal treatment system. We find that patients seek out network members who are well-equipped to help them cope with the onset of illness. At the same time, network activation may lead to instability as high-need patients churn through supportive relationships. Future research should examine the consequences of tie activation and support needs for network dynamics in different treatment contexts.

We argue that self-stigma places patients on a path of marginalization throughout their life course leading to a negative cycle of opportunity and advancement. Mental health patients with higher levels of self-stigma tend to have much lower self-esteem, efficacy, and personal agency; therefore, they will be more inclined to adopt role-identities at the periphery of major social institutions, like those of work, family, and academia. Similarly, the emotions felt when enacting such roles may be similarly dampened.

Utilizing principles from affect control theory (ACT) and the affect control theory of selves (ACTS), we generate predictions related to self-stigmatized patients’ role-identity adoption and emotions. We use the Indianapolis Mental Health Study and Interact, a computerized version of ACT and ACTS, to generate empirically based simulation results for patients with an affective disorder (e.g., major depression and bipolar disorder) with comparably high or low levels of self-stigmatization.

Self-stigma among affective patients reduces the tendency to adopt major life course identities. Self-stigma also affects patients’ emotional expression by compelling patients to seek out interactions that make them feel anxious or affectively neutral.

This piece has implications for the self-stigma and stigma literatures. It is also one of the first pieces to utilize ACTS, thereby offering a new framework for understanding the self-stigma process. We offer new hypotheses for future research to test with non-simulation-based data and suggest some policy implications.

Purpose – The purposes of this chapter are to describe both the within-group and between-group variance in Black Americans’ (Blacks’) prevalence of mental illness. This chapter also comments on the impact that poorer mental health has on this group's subsequent social mobility and explores recommendations for the reduction of these inequities.

Methodology/approach – This chapter reviews Black's history in America. It also outlines the influence of this history and related factors on Black Americans' current rates of illness and subsequently vulnerable upward mobility.

Research implications – The history of Blacks in America is tumultuous and has contributed to their vulnerable state. Blacks, on average, are poorer and sicker than Whites, and Blacks’ higher rates of illness are due to a number of factors. As a result, Blacks’ social mobility is precarious. Future research should continue to explore mental health care programs that are specifically designed to address Blacks’ unique culture and worldview.

Social implications – In addition to culturally competent and culturally responsive health care, future initiatives should focus on improving the accessibility and quality of health care, and alleviating socioeconomic disparities, racism, and racism-related stress. These initiatives, in conjunction, are the best approach to improving Blacks’ rates of mental illness.