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Witchcraft in Honduras is an unprotected marginalized woman’s efforts to gain social, economic, and political power through an informal economy by utilizing the cultural belief in the witches’ supernatural power. The Honduran post-colonial Latin American culture allows for a persistent informal economy, in part, based on the commoditization of witchcraft and exorcism. The case study provides a specific example through ethnographic interviews of this under-researched informal economy driven by fear and economic desperation. Further research and analysis of these poorly understood and rarely recorded modern phenomena and the associated informal economy is needed.

Trauma has become a buzz term, and the responses to trauma are slick and swift. Teams of mental health professionals can now be dispatched within hours of a catastrophe, and psychological intervention is fast becoming an industry. A more penetrating look at the state of trauma intervention reveals a less impressive picture. In spite of the heightened interest in the effects of trauma, mental health professionals are in fact a long way from fully understanding the impact of such trauma, and from providing responses to victims that are effective. Not only do we lack a psychotherapeutic antidote that can be distributed to the hundreds of thousands of victims of conflict across the globe, but to date we have failed to provide scientifically evaluated, evidence-based treatment guidelines for the psychological rehabilitation of victims.

This article presents a typology of the medicated self, as developed through in-depth interviews with twenty-two social work students and practitioners. Utilizing an interactionist perspective, the experience of taking psychiatric medication is examined in both samples, using a comparative analysis. Emphasis is placed on the impact of taking psychiatric medication on the sense of self. The data suggest that the development of a medicated self is complex and varied, and includes a small number of those who feel that medication led to an improved self, and the majority who felt damaged by their experience with medication, and expressed varying degrees of ambivalence about its use. Despite this ambivalence, most of our respondents seemed to develop an altruistic, empathetic self geared toward helping others. This self emerged in spite of respondents saying that their self was damaged. Implications are presented, and conclusions and suggestions for further work on the impact of psychiatric medication use on the self are presented.

Mental illness, in its various forms, is common in the United States. Tens of millions of Americans are afflicted by an episode of mental illness every year. Estimates of the 12-month prevalence of mental disorders in the U.S. (including alcohol and substance abuse or dependence) indicate that 22–30 persons per 100 in the adult population are afflicted each year.¹ An episode of a psychiatric disorder, like a physical disorder, is debilitating – often disrupting the ability of the afflicted to carry on normal personal, social, and work activities. Mental illness also commonly results in large medical expenses. In addition, a number of recent papers have found that mental illness imposes large labor market losses on the ill, decreasing the likelihood of employment and limiting earnings for the employed.² In particular, research by two of the authors indicates that depressive disorders cause significant reductions in the labor force participation of women and the earnings of both men and women.³

The objectives of the current interim report are to measure the extent of the access to care problem, identify and compare the types of patient- and system-based barriers experienced by Vietnam veterans at risk for suicide when seeking care for physical, psychiatric, and substance abuse conditions, analyze patient-perceived quality of care for individuals who obtained access to care, and identify how the care-seeking experience effected future care seeking. This study is based on a longitudinal sample of 494 Vietnam veterans discharged from military service in September 1971 and subsequently identified as at risk for suicide (306 low risk; 188 high risk). Seventy-one percent (350) of 494 participants completed an extensive qualitative and quantitative interview covering, among other topics, physical conditions, psychiatric conditions, substance use, barriers to care, facilitators of care, and quality of care. Barriers, satisfaction, and effect of the experience were compared by type of condition and suicidal risk category using χ2 analysis and Fisher's as appropriate. The analysis is based on 257 interviews (73 percent) with qualitative data transcribed thus far. Results: Of the 195 patients with self-reported health conditions, 76 (39.0 percent) and 45 (23.1 percent) expressed system-based barriers to care, respectively. The group at higher risk of suicide was significantly more likely (p<0.01) to report patient-based barriers to care and system-based barriers to care (p<0.05), and more likely (p<0.05) to experience negative effects of the care-seeking experience. Both self-perceived and system-based barriers to care pose obstacles for patients at high risk of suicide. Targeted interventions are required to reach out to these patients to address needs for care currently unmet by the health care system and to reduce negative effects of the health care experience.

The purpose of this chapter is to apply structural functional theory and the concept of “unbundling” to an analysis of the deinstitutionalization and community mental health efforts that have shaped the current mental health services environment.

We examine the original goals of the institutional movement, the arguments supporting it, and the functions of the institutions that were created. We then examine the criticisms of that approach and the success of the subsequent deinstitutionalization process, which attempted to undo this process by recreating the hospitals’ functions in community settings. Finally, we address the question of whether the critical functions of psychiatric institutions have indeed been adequately recreated.

Our overview of outcomes from this process suggests that the unbundling of state hospital functions did not yield an adequate system of care and support, and that the functions of state hospitals, including social control and incapacitation with respect to public displays of deviance were not sufficiently recreated in the community-based settings.

The arguments for the construction of state hospitals, the critiques of those settings, and the current criticism of efforts to replace their functions are eerily similar. Actors involved in the design of mental health services should take into account the functions of existing services and the gaps between them. Consideration of the history of efforts at functional change might also serve this process well.

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.