Papers by Neely Laurenzo Myers
SMU Undergraduate Research Journal , 2024
This is an undergraduate student paper based on research from my lab.
Community Mental Health Journal, 2019
While there are high rates of food insecurity among individuals with serious mental illnesses, an... more While there are high rates of food insecurity among individuals with serious mental illnesses, and among African Americans, there is very little research on the ways African Americans in public-sector mental health services cope with food insecurity. This research paper presents qualitative data from a mixed methods study on the prevalence and management of food insecurity among African Americans using public sector mental health services. We interviewed 21 people about their everyday experiences of food insecurity and strategies they used to cope. While participants reported experiencing high levels of food insecurity, they also described the use of communal strategies to help them cope, including sharing food and cooking meals jointly, which seemed to reduce the negative effects of living with high levels of food insecurity as well as a serious mental illness. Policy innovations like communal gardens and kitchens provided through public mental health services may be particularly helpful.
Objective: This study elicited factors that shaped treatment decision making for young adults and... more Objective: This study elicited factors that shaped treatment decision making for young adults and their key supporters after an initial hospitalization for psychosis to generate hypotheses about how to improve service engagement.
Community Mental Health Journal, 2019
While there are high rates of food
A potential new form of jail diversion and reconnection to mental health services: I. Stakeholders' views on acceptability
The most effective point of intervention to prevent unnecessary arrest/incarceration of persons w... more The most effective point of intervention to prevent unnecessary arrest/incarceration of persons with serious mental illnesses is the initial encounter with police. We piloted a new police–mental health linkage system. When officers run an enrolled participant's name/identifiers, they receive an electronic message that the person has mental health considerations and that they should call for information. The linkage specialist receives the call and assists telephonically. In this qualitative study to examine acceptability of the linkage system, we conducted nine focus groups with diverse stakeholders (e.g., enrolled patients, officers). Focus groups revealed that patients enrolled with the hope that the linkage system would prevent negative interactions with police and minimize risk of arrest. Officers reported preferring not to arrest mental health patients and were genuinely invested in helping them, and felt that the linkage system might be an additional tool during encounters. Findings revealed acceptability of the intervention, and further research is warranted.
Objective: Opening Doors to Recovery (ODR) in southeast Georgia included a family community navig... more Objective: Opening Doors to Recovery (ODR) in southeast Georgia included a family community navigation specialist (F-CNS) in addition to a peer specialist and a mental health professional. This qualitative study assessed the usefulness of the F-CNS role. Methods: Semistructured interviews were conducted with 30 respondents (ten ODR participants with serious mental illnesses; ten family members; and ten ODR leaders and team members, including two F-CNSs). Interviews were recorded and transcribed for qualitative analysis. Results: Many respondents found the F-CNS to be helpful , providing psychosocial support, serving as a communication liaison, and being a team member dedicated to the family. Aspects that might require improvement include insufficient description of the F-CNS role to participants and the limited experience and training of the F-CNSs. Conclusions: The F-CNS represents an unexplored role for family members of persons with serious mental illnesses that may complement the roles of other service providers and strengthen recovery-oriented teams.
The recovery concept encompasses overcoming or managing one's illness, being physically and emoti... more The recovery concept encompasses overcoming or managing one's illness, being physically and emotionally healthy, and finding meaningful purpose through work, school, or volunteering, which connects one to others in mutually fulfilling ways. Using a mixed-methods approach, we studied the emphasis on ''a meaningful day'' in the new Opening Doors to Recovery (ODR) program in southeast Georgia. Among 100 participants, we measured the meaningful day construct using three quantitative items at baseline (hospital discharge) and at 4-, 8-, and 12-month follow-up, finding statistically significant linear trends over time for all three measures. Complementary qualitative interviews with 30 individuals (ODR participants, family members, and ODR's Community Navigation Specialists and program leaders) revealed themes pertaining to companionship , productivity, achieving stability, and autonomy , as well as the concern about insufficient resources. The concept of ''a meaningful day'' can be a focus of clinical attention and measured as a person-centered outcome for clients served by recovery-oriented community mental health services.
Transcultural psychiatry and anthropology have long championed the comparative study of emotional... more Transcultural psychiatry and anthropology have long championed the comparative study of emotional distress to better understand how people experience, interpret, and manage extraordinary mental events and emotional quandaries around the globe. This special issue brings together practitioners, scholars, and experts from both disciplines working at the intersections of the community and the clinic, the personal and the social, the local and the global, to ask: where does this effort currently stand? We hope this collection of articles will serve as a bellwether selection of provocations and future directions for transdisciplinary research in psychiatric anthropology.
Ministries of churches, temples, mosques, and synagogues are a potential resource for individuals... more Ministries of churches, temples, mosques, and synagogues are a potential resource for individuals with chronic psychoses. Church attendance is highest in states with the least mental health funding, suggesting a role for community religious groups to aid over-extended mental health systems. The American Psychiatric Association has initiated new efforts to foster partnerships between psychiatrists and religious groups. Such partnerships should be informed by research evidence: (1) religious coping can have both beneficial and adverse effects upon psychosis illness severity; (2) psychosocial programs for persons with psychotic disorders should target specific psychobiological vulnerabilities, in addition to providing compassionate emotional support; (3) family psychoeducation is a well-validated model for reducing schizophrenia illness severity that could inform how religious groups provide activities, social gatherings, and social networks for persons with psychotic disorders. Positive impacts from such collaborations may be greatest in low-and middle-income countries where mental health services are largely absent.
Our article draws on ethnographic research with African American males diagnosed with a psychotic... more Our article draws on ethnographic research with African American males diagnosed with a psychotic disorder in a high-poverty urban area of the northeastern United States. Our participants frequently described the ways public mental health services led them to experience a paralyzing erosion of autobiographical power, which we define as the ability to tell one's own story and be the editor of one's own life. We identified three important points when the loss of autobiographical power seemed to perpetuate social defeat or a sense of social powerlessness (Luhrmann 2007) for our participants during their interactions with public mental health care. We invite further inquiry into the loss of autobiographical power in settings of public mental health care, the sense of social defeat it seems to perpetuate, and the impact of these on mental health recovery, especially for people living in contexts of persistent social adversity. [African American, psychosis, public mental health, recovery, social defeat] Anthropologists have made significant contributions to understanding the complex relationships between inequality, culture, care, and illness for African Amer
Clinical Correlates of Initial Treatment Disengagement in First-Episode Psychosis
Clinical Schizophrenia & Related Psychoses, 2014
Aim: Early engagement in care is thought to reduce disabling social losses related to the duratio... more Aim: Early engagement in care is thought to reduce disabling social losses related to the duration of untreated psychosis (DUP), such as school dropout, homelessness, and incarceration, which contribute to chronic disability. Early intervention services that promote recovery will not be effective if eligible persons drop out of treatment after an initial hospitalization for a psychotic disorder. We had the unique opportunity to examine the treatment disengagement rate of patients with early psychosis after an initial hospitalization.Methods: In a predominantly male, African American, and socioeconomically disadvantaged group of 33 participants with first-episode psychosis assessed at initial hospitalization and six months after discharge, we compared clinical characteristics (medication adherence attitudes and behaviors, knowledge about schizophrenia, insight, symptom severity, and persistence ofalcohol and drug use) among those who disengaged and people who engaged in care.Results: More than half (18, 54.5%) attended <3 outpatient appointments in the six months after hospital discharge, and of those, nearly all (15, 83.3%) attended no outpatient appointments. Disengaged people were much less adherent to medications in the past month and six months, and scored lower on medication adherence attitudes, knowledge about psychosis, and insight. They had greater positive symptom severity and a higher likelihood of continuing drug use.Clinical Relevancy: Initial treatment disengagement is very common among young people with first-episode psychosis and associated with poorer clinical status. More research is needed onthe causes of disengagement during this critical period, and ways to improve initial treatment engagement among people with first-episode psychosis.
VIDEO: Becoming Recovered and Moral Agency: Local and Global
ABSTRACT: Moral agency, or the ability to act in a way that makes possible intimate connections t... more ABSTRACT: Moral agency, or the ability to act in a way that makes possible intimate connections to others, is a critical ingredient of mental health recovery. Based on my own fieldwork, I argue that this is also the very kind of opportunity that is eroded and then ignored in current western mental health care, even well-intentioned care that claims to be recovery-oriented. Persons in recovery, such as Pat Deegan, explain recovery as a process of transformation from a disabled to an able sense of self. My work attends to the importance of intimate connections in this process. Cultural expectations that mental health services users become “recovered” by demonstrating that the can be rational, autonomous, and hard-working overlook the incredibly stressful conditions of users’ everyday lives and their culturally constrained access to moral agency. Moreover, the cultural expectation that users’ should do prove they could go through this process alone in order to earn access to lost moral regard was impairing. In addition, my ethnographic work with peer service providers, self-proclaimed “experts by experience,” suggested that peers may have a better sense of how to account for and replenish moral agency. Going forward, in terms of mental health recovery both locally and globally, peers (or equivalent nonspecialists considered to be local experts by experience) may be important in developing plans for care that mobilize and protect local resources for moral agency and so promote recovery.
Transcultural Psychiatry
Moral agency has been loosely defined as the freedom to aspire to a “good life” that makes possib... more Moral agency has been loosely defined as the freedom to aspire to a “good life” that makes possible intimate relationships with others. This article uses ethnographic research to further the discussion of the role of moral agency in mental health recovery. This article attends to the ebb and flow of moral agency in the life stories of three people diagnosed with a psychotic disorder at different stages in their individual recoveries to illustrate particular aspects of moral agency that may be most relevant for recovery. It suggests a more complex notion of moral agency as not only the freedom to aspire to a “good life,” but to also achieve a “good” life through having both the intention to aspire and access to resources that help bring one’s life plans to fruition. Each storyteller describes an initial Aristotelian peripeteia, or “breach” of life plan, followed by a subsequent erosion of moral agency and sense of connection to others. The stories then diverge: some have the resources needed to preserve moral agency, and others attempt to replenish moral agency that has been eroded. In these stories, the resources for preserving and nourishing moral agency include: the ability to cultivate the social bases of self-respect, autobiographical power and peopled opportunities. These stories cumulatively suggest that without such resources one’s attempts to develop the moral agency needed for recovery after the peripeteia of a serious psychiatric disability may fall short.
This course provides undergraduates with an overview of methods and topics in medical anthropolog... more This course provides undergraduates with an overview of methods and topics in medical anthropology: an interdisciplinary field that explores health, illness, and systems of healing through holistic and crosscultural study. Students will be introduced to the major theoretical paradigms and perspectives of this field, to its methods of research, and to a variety of cases that illustrate how health, illness, and healing are culturally patterned across diverse human societies. Case studies will be taken from several locations around the globe. We will challenge the assumptions of our own ways of understanding, particularly the Western assumptions inherent to biomedical practice, and broaden our knowledge of non-Western healing systems and multi-culturalism in Western contexts. Students will be asked for regular, well-informed debate within class meetings, and to prepare written argumentation on several topics.
Based on ethnographic fieldwork and interviews collected with meditation teachers and students in... more Based on ethnographic fieldwork and interviews collected with meditation teachers and students in the United States, this article will argue that active training in meditation-based practices occasions the opportunity for people with traumatic stress to develop a stronger mind–body connection through heightened somatic awareness and a focus on the present moment that they find to be therapeutic. Three important themes related to healing through meditation for trauma
emerged from the data and centered around the ways our interlocutors attempted to
realign their sense of self, mind and body, after a traumatic experience. The themes helped explain why US women perceive meditation as therapeutic for trauma, namely that the practice of meditation enables one to focus on the lived present
rather than traumatic memories, to accept pain and ‘‘open’’ one’s heart, and to make use of silence instead of speech as a healing modality. As meditation practices increasingly enter global popular culture, promoted for postulated health benefits, the driving question of this research—how meditation may perpetuate human resilience for women who have experienced trauma based on their own perspectives of meditation practices—is a critical addition to the literature.
The incidence of schizophrenia, as well as the
symptoms, course, and outcomes for people so diagn... more The incidence of schizophrenia, as well as the
symptoms, course, and outcomes for people so diagnosed
seem to vary across some cultural contexts. The mechanisms
by which cultural variations may protect one from or
increase one’s risk of developing schizophrenia remain
unclear. Recent findings from transdisciplinary crosscultural
research, indicate ways that we may better understand how socioenvironmental and cultural variables interact with physiologic pathways relating psychosocial stress and psychotic symptoms, epigenetic changes, and people’s use of culturally available tools to mitigate stress, in ways that may inform relevant, effective interventions for people diagnosed with psychotic disorders worldwide.
This cultural case study investigates one U.S. psychosocial rehabilitation organization’s (Horizo... more This cultural case study investigates one U.S. psychosocial rehabilitation organization’s (Horizons) attempt to implement the recovery philosophy of the U.S. Recovery Movement and offers lessons from this local attempt that may inform global mental health care reform. Horizons’ ‘‘recovery-oriented’’ initiatives unwit-
tingly mobilized stressful North American discourses of valued citizenship. At times, efforts to ‘‘empower’’ people diagnosed with schizophrenia to become esteemed self- made citizens generated more stressful sociocultural conditions for people whose daily lives were typically remarkably stressful. A recovery-oriented mental health system must account for people diagnosed with schizophrenia’s sensitivity to stress
and offer consumers contextually relevant coping mechanisms. Any attempt to export U.S. mental health care practices to the rest of the world must acknowledge that (1) sociocultural conditions affect schizophrenia outcomes; (2) schizophrenia outcomes are already better in the developing world than in the United States; and (3) much of what leads to ‘‘better’’ outcomes in the developing world may rely on the availability
of locally relevant techniques to address stress.
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Papers by Neely Laurenzo Myers
emerged from the data and centered around the ways our interlocutors attempted to
realign their sense of self, mind and body, after a traumatic experience. The themes helped explain why US women perceive meditation as therapeutic for trauma, namely that the practice of meditation enables one to focus on the lived present
rather than traumatic memories, to accept pain and ‘‘open’’ one’s heart, and to make use of silence instead of speech as a healing modality. As meditation practices increasingly enter global popular culture, promoted for postulated health benefits, the driving question of this research—how meditation may perpetuate human resilience for women who have experienced trauma based on their own perspectives of meditation practices—is a critical addition to the literature.
symptoms, course, and outcomes for people so diagnosed
seem to vary across some cultural contexts. The mechanisms
by which cultural variations may protect one from or
increase one’s risk of developing schizophrenia remain
unclear. Recent findings from transdisciplinary crosscultural
research, indicate ways that we may better understand how socioenvironmental and cultural variables interact with physiologic pathways relating psychosocial stress and psychotic symptoms, epigenetic changes, and people’s use of culturally available tools to mitigate stress, in ways that may inform relevant, effective interventions for people diagnosed with psychotic disorders worldwide.
tingly mobilized stressful North American discourses of valued citizenship. At times, efforts to ‘‘empower’’ people diagnosed with schizophrenia to become esteemed self- made citizens generated more stressful sociocultural conditions for people whose daily lives were typically remarkably stressful. A recovery-oriented mental health system must account for people diagnosed with schizophrenia’s sensitivity to stress
and offer consumers contextually relevant coping mechanisms. Any attempt to export U.S. mental health care practices to the rest of the world must acknowledge that (1) sociocultural conditions affect schizophrenia outcomes; (2) schizophrenia outcomes are already better in the developing world than in the United States; and (3) much of what leads to ‘‘better’’ outcomes in the developing world may rely on the availability
of locally relevant techniques to address stress.