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A Comparative Sociological Investigation of the Conceptions and Perceptions of Mental Health and Illness in Arica, Chile and Rome, Italy

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A Comparative Sociological Investigation of the Conceptions and Perceptions of Mental Health and Illness in Arica, Chile and Rome, Italy A Comparative Sociological Investigation of the Conceptions and Perceptions of Mental Health and Illness in Arica, Chile and Rome, Italy Researcher: Nelly-Ange Kontchou B.A. Candidate in Combined Spanish & Italian Studies, Duke University Advisors: Dr. Luciana Fellin & Professor Richard Rosa Abstract This comparative study aimed to discover the principal factors that influence the perceptions of citizens in Arica, Chile and Rome, Italy toward mental illness. Specifically, the study aimed to investigate how these perceptions affect the societal acceptance of mentally ill individuals and to identify potential sources of stigma. In both cities, mental health services exist for free use by citizens, but stigma makes the use of these services and the acceptance of those who use them somewhat taboo. Past studies on the topic of mental health stigma have investigated the barriers to accessing mental health services (Acuña & Bolis 2005), the inception and effects of Basaglia’s Law (Tarabochia 2011), strategies to combat stigma (López et al. 2008) and images of mental illness in the media (Stout, Villeagas & Jennings 2004). To discover Aricans’ opinions on mental health and illness, personal interviews were administered to five mental health professionals, and a 20-question survey was administered to 131 members of the general population. In Rome, 27 subjects answered an 18-question survey as well as an interview, and 12 professionals participated in narrative interviews. From these interviews and surveys, the lack of economic, structural and human resources to effectively manage mental health programs was gleaned. Moreover, many participants identified how stigma infringed upon the human rights of those with mental illnesses and opined that they were barely accepted in society. Conclusions drawn were that stigma stems from multiple concurrent sources, and strategies to reduce it must align with each society’s unique needs. Stigma prevents people from caring for their mental health and from integrating those with mental illness. Key words: mental health, stigma, mental illness, Basaglia’s Law and human rights 2 Table of Contents Abstract……………………………………………………………………………………2 Acknowledgements…………………………………..……..……………………………..5 List of Figures and Tables…...………………………..…………………………………...8 Introduction……………………………………………………………………………....11 Objectives—Chile ……………………………………………………………………….20 Objectives—Italy………………………………………………………………………...20 Literature Review……….………………………………………………………………..21 Methodology—Chile..…………………………………………………………………...37 Results & Discussion—Chile…….…...……………………...………………………….42 General Population Surveys………………………………..…………………….42 Mental Health Professionals’ Interviews….….…………………….……………60 Methodology—Italy..………………………………………………………………….....69 Results & Discussion—Italy……………...……………………….………………….….78 General Population Surveys & Interviews……………………………………….78 Mental Health Professionals’ Interviews……...……………………………..…135 Comparative Discussion of Both Studies ………………………..………………….....174 3 Conclusion...……………………………………………………………………………183 Recommendations………………………………………………………………………188 Bibliography.…………………………………………………………………………...195 Appendices..…………………………………………………………………………….200 4 Acknowledgements I would like to thank the following people for all of their suggestions, support and encouragement during my research process: Dr. Luciana Fellin, Ph.D: You have been an invaluable source of guidance throughout my entire Duke career. Whether teaching me in your classroom, writing me phenomenal letters of recommendations for my various endeavors, or pushing so hard for me to receive funding to go to Italy, you have always been my main cheerleader! For that, I appreciate you so very much, and I will truly miss you when I graduate. Grazie mille per aiutarmi a crescere come una studiosa e come una appassionata della cultura italiana. Dr. Richard Rosa, Ph.D: Prof. Rosa, le agradezco por su interés genuino en mi proyecto. Estaba muy feliz que Ud. hubiera podido asistir mi presentación el mes pasado. Nuestra discusión sobre Pinochet y la memoria selectiva de Chile añadió el elemento imperativo de la alteración de la conciencia nacional a esta investigación. Dr. Walter Mignolo, Ph.D: Thank you for agreeing to serve on my thesis defense committee and for providing me with an opportunity to conclude what has been a spectacular experience in my academic and personal journey. Dr. Rossana Testa, Academic Director of SIT Chile: Public Health, Traditional Medicnie, and Community Empowerment, Lic., MGP, MBA, Ph.D: Muchísimas gracias por guiarme a través de este proyecto, desde ayudarme a formular exactamente lo que quería investigar hasta tus múltiples redacciones de mi encuesta y mi informe. No puedo expresar cuánto aprecio tu paciencia y aliento inagotable durante cada paso del periodo 5 de ISP y del otoño 2011, en general. Sin tí, no habría podido embarcar en este viaje academico fenomenal. Ester López, Ps., Director of Public Mental Health Services in Arica: Es obvio que te agradezco por tu cariño y jubilo constante. Me ayudaste muchísimo durante el proceso del ISP, desde la planificación de cómo y dónde iba a administrar las encuestas hasta su revisión de mi presentación oral final. Gracias por hacer todo muy divertido, aún las horas de transcribir las entrevistas cuando luchabas por respirar entre tus risas incontrolables por mis frases sin sentido. Dr. Concetta Pastorelli, Italian In-Country Advisor, Ps., Ph.D: To you, I owe my ability to come to Italy in the first place. You took a chance on me when you were extremely busy with multiple projects during the summer of 2012, so know that I am grateful for your sacrifice. You welcomed me into the Sapienza community and guided me especially in the initial phases of this challenging project. La ringrazio profondamente per la sua guida e per i suoi sforzi per assicurare il mio succcesso accademico. Dr. Grazia Serantoni, Ps., Psychotherapist, Ph.D: Grazia, spero che Lei sappia quanto apprezzo la sua dedicazione impressionante ad aiutarmi quando stavo in Italia. Lei ha pianificato il corso d’azione con me per iniziare lo studio, ha contattato quasi tutti i professionsti che dovevo intervistare, mi ha guidato a quasi tutti i posti di salute mentale e ha aspettato con me durante le interviste, mi ha spiegata le cose che non avevo capito, mi ha aiutato con le trascrizioni delle interviste con il pubblico generale, e della stessa importanza mi ha incoraggiata con una faccia sorridente o con delle parole gentilissime ogni volta che ci siamo viste. La sua energia positiva ha reso questa esperienza anche più piacevole. 6 Francesca: Eri realmente la mano destra di Concetta, e mi hai guidata nel mio soggiorno nell’Italia. Grazie per il tuo aiuto, la tua amicizia e le rise costanti! The Godoy Aguilera, my home stay family without whom there is no way I would have had such an incomparable semester studying in Chile: Uds. locos siempre me mostraron nada más que cariño y me acogieron en su familia con mucho amor. Quiero agradecer especialmente a Pamela Godoy por ayudarme a transcribir una entrevista para mi informe y por siempre corregir mi español raro de “formigas” y “zapallos”. Natalia Pérez, Antonia Varas, Dr. Cristian Osorio, Carla Quiroz y Maritza Acosta: Les agradezco infinitamente por aceptar ser entrevistados para mi investigación. Gracias por sus conocimientos y sus opiniones honestas sobre la salud mental en Arica y Chile. To the twelve Italian mental health professionals who let me into their offices, minds and hearts: Grazie per il loro tempo, la loro confidenza e la loro disponibilità non solo a partecipare nel mio studio ma anche a migliorarlo significatamente con i loro pensieri valiosi. I would like to thank all of the members of the general public in Arica and Rome, who agreed to complete the surveys and interviews that provided me with invaluable data for this investigation. Finally, I would like to thank the Reginaldo Howard Memorial Scholarship, Trinity Deans’ Summer Research Fellowship and DCCE Civic Engagement Summer Fellowship for the funding that allowed me to study and conduct research abroad. 7 List of Figures and Tables Figure 1. Sex…….………………………………………………………………………42 Figure 2. Age..………………………………………………………………………...…43 Figure 3. Education Level……………………..…………………………………………43 Figure 4. Health Insurance Provider……………...……………………………….……..44 Figure 5. More Important Type of Health……………………….…………….……...…44 Table 1. Ways to Take Care of One’s Mental Health….…...………..…….……...……..45 Table 2. Participants Who Do Not Take Care of Their Mental Health………….............46 Figure 6. The Percentage of Subjects Who Have Accessed a Mental Health Center in their Lives …………...………………..……………….………………………………...46 Figure 7. Most Frequently Stated Mental Illnesses……………………………………...47 Figure 8. The Number Subjects Who Know a Certain Number of Mental Illnesses….....48 Table 3. Education Level of Those Who Could Not Name Any Mental Illness...............49 Table 4. Most Frequently Named Mental Health Centers………………………….........50 Figure 9. Principal Sources of Information About Mental Illness……………………….52 8 Figure 10. Major Barriers to Seeking Mental Health Care……………………................53 Figure 11. The Gender Most Affected by Mental Illness………………………..………54 Table 5. Segments of the Population Most Likely To Have a Mental Illness…………...56 Figure 12. Ease in Identifying People with Mental Illness……...……………………….57 Figure 13. Potential of People with Mental Illness to Complete Tasks in Workforce…..58 Figure 14. Perceived Acceptance of People with Mental
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