Psychiatry - Theses
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ItemMasculinities in local contexts: structural, individual and cultural interdependencies( 2006-06)Knowledge of the terms sex and gender has important political, health and equity considerations. This thesis investigates the macrostructural assertions of Connell’s social theory of gender which is fundamentally concerned with demonstrating the relational and hierarchical nature of gender. A major criticism of the theory has been its lack of account of the individual and the ways in which gender is performed in local settings. Therefore, investigation primarily concerns whether Connell’s macrostructural theory is explicable in local social contexts. A theoretical critique and reframing of the theory lead to articulating the interdependency between structural, cultural and individual factors. By explicitly stating Connell’s implicit assertions, what becomes evident is that people’s gendered relations are interrelated with beliefs which are held personally and shared culturally. Specifically, a major theoretical impasse is overcome when recognising that the “ideology of supremacy” of a dominative masculinity is necessarily interdependent with the structural relations of power. From here I have suggested that there are particular patterns of these structures and beliefs which can be seen in macrostructural terms, but also in local settings. These hypotheses are reframed into social network terms for an empirical investigation of Connell’s theory in local contexts. To determine whether the predicted hypotheses for Connell’s theory occur at greater than chance levels, a particular type of statistical model for social networks, called exponential random graph (p*) models, is employed. Importantly, such models utilize a methodological approach which specifically acknowledges the interdependency of structural, individual and cultural factors, thus aligning Connell’s theory with the method of investigation. Primarily, Connell’s theory is concerned with differing configurations of masculinity, and for this reason my focus is predominantly on males and their relations with one another. To this end, two general local settings were chosen to explore these issues – secondary schools and all-male elite-level (AFL) sporting teams. Social network models were used to examine the relations between masculinities in six schools and four AFL clubs. Importantly, Connell has suggested that local contexts are likely to differ from one another in the degree to which they support gendered relations of power. Results for schools and clubs vary considerably from one another in the ways in which they provide local level support for Connell’s theory. Significantly though, there are some contexts which do show support for Connell’s theory. That such evidence can be found to endorse specifically defined local-level predictions for Connell’s theory, even when controlling for complex micro-level social structures, and also for other individual level effects, and still produce statistically significant effects supporting these predictions suggests that support is not trivial. There is strong evidence that attitudes towards masculinity can be an important organising principle in the emergence of hierarchy, not universally, but in some contexts. It can be concluded that gender relations tend to operate in ways predicted by Connell’s theory, though local context is particularly important. The specific findings from local social contexts do have wider implications for Connell’s theory, including how hierarchy in gender can be tied to other structures of power, where femininities fit into the theory, a more precise account of hegemony and an exploration of the impact culture has in local settings.
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ItemThe effects of immigration and resettlement on the mental health of South-Asian communities in Melbourne( 2006-02)This research explores the relationship between immigration experiences and psychological well-being within the Indian and Bangladeshi communities in metropolitan Melbourne, Australia. The researcher conducted individual in-depth interviews with thirty-eight adult Australian permanent residents/citizens born in India and Bangladesh with the aim of examining personal post-migration accounts of adjustment, acculturation and coping in a foreign society and the effect on their mental health. Through qualitative analysis, the personal experiences and stories of South-Asian migrants and the psychological consequences of resettlement in Australia are explored. The study investigated coping strategies and psychosocial protective mechanisms and explored factors relevant to both successful and unsuccessful resettlement, and their relationship to psychological well-being. The results indicated that social and emotional disconnection, isolation and alienation, lack of recognition of professional skills, experiences of racism and discrimination, cultural incongruity, feelings of cultural uprooting and inadequate English language competency, all may contribute to psychological distress, difficulties in adjustment to life in Australia and in some cases, repatriation to the country of origin.
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ItemThe experience of depression: women's perspectives( 2002-12)Reports from epidemiological survey data identify that twice as many women than men suffer with depression over the life cycle. From reviewing the broad research literature, it appears that many studies focus on only one aspect of a bio-psychosocial model and, do not consider how these aspects interact. (For complete abstract open document)
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ItemHuman steady-state visually evoked potential topography and attention( 2004-12)This work began with a review of visual spatial selective attention, from a behavioural perspective with particular emphasis placed upon the spotlight model. To complement the behavioural review, the physiological aspects of the visual system were studied to find possible loci of the spotlight. The literature pointed to the pulvinar nucleus of the thalamus, interacting with the parietal and frontal cortices. Some experimental work examined relationships between visual spatial selective attention and event-related potentials (ERPs) recorded from the scalp. The second section of this thesis reviewed the ERP measures relating specifically to the visual modality for their possible application in a visual attentional task. This yielded two independent findings. First, the Probe-ERP paradigm comprising an attentional task being performed by the subject, with a separate stimulus to probe the unused resources within the system. Second, the steady-state evoked response, with the stimulus presented as a small sinusoidal variation around a mean level of contrast. The combination of the Probe-ERP paradigm and the steady-state visually evoked potential (SSVEP) warranted experimental evaluation.
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ItemThe creative process: A phenomenological and psychometric investigation of artistic creativity( 2005-08)Although a variety of approaches have been adopted to researching creativity, the phenomenology of creativity has not been well-represented in the literature. This constitutes a significant obstacle to achieving a comprehensive, satisfactory model of the creative process. The current thesis aimed to provide a systematic analysis of the phenomenology of artistic creativity. The thesis also attempted to integrate the analysis of phenomenological aspects of artistic creativity with the more established approaches of creativity-personality and creativity-psychopathology research. Specifically, the research investigated whether the phenomenology of artistic creativity varies in relation to features of personality and psychopathology.
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ItemA prospective study of the relationship between stress, coping and the onset of psychosis in a high risk group( 2005-06)The experience of stress and associated coping responses are often described as playing an important role in the onset of schizophrenia and other psychotic disorders. Despite widespread acceptance of this model, there is little empirical evidence to support such a relationship. This is partly due to a lack of well-designed prospective studies of the onset of psychotic disorders that incorporate different aspects of the stress and coping process. The relatively recent development of validated and reliable criteria for identifying young people at high-risk (UHR) of developing psychosis has enabled the process of onset of psychotic illnesses to be studied more closely than was previously possible. It has also opened the way to the development and evaluation of preventive interventions. This longitudinal study aimed to compare the experiences of stress and coping between a UHR cohort (N = 143) and a group of young people without mental health concerns (HC group, N = 32). In addition, the contribution of stress and coping in the development of acute psychosis in a subgroup of the UHR cohort (UHR-P, n = 18) was also investigated.
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ItemSelf-ambivalence in obsessive-compulsive disorder( 2005-01)According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, perfectionism and an overestimation about the importance of thoughts. Despite much support for this hypothesis, there is a lack of understanding about the role of self-concept in the maintenance or treatment of OCD. Guidano and Liotti (1983) suggest that individuals who are ambivalent about their self-worth, personal morality and lovability use perfectionistic and obsessive compulsive behaviours to continuously restore self-esteem. This thesis develops a model of OCD that integrates self-ambivalence in the cognitive model of OCD. (For complete abstract open document)
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ItemEvaluation of the Bilingual Case Management Program in community mental health services in Melbourne( 2001-06)This thesis describes the evaluation of a program to employ bilingual staff in case management positions in community mental health services in Melbourne, Australia. A literature review showed that no previous research in Australia had investigated the impact of bilingual staff on clients of mental health services. While research conducted in the USA shows that ethnic matching (matching clients and clinicians on the basis of language or ethnic background) increases service use, its impact on outcome domains such as social functioning remains uncertain. (For complete abstract open document)
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ItemWilliams Syndrome: links between brain, cognition, and behaviour( 2005-10)The interrelationships between brain, cognition, and behaviour are complex but can be more clearly characterised by studying disorders with an underlying genetic basis. This thesis examined these interrelationships in the context of Williams syndrome (WS), a neurodevelopmental genetic disorder that affects aspects of cognition, behaviour, and brain structure. The principal aims of this thesis were to evaluate the cognitive, behavioural, and neuroanatomical profile of WS individuals and to explore the relationships between aspects of the cognitive and behavioural profile and the neuroanatomical changes that are evident in WS. Three general hypotheses, and 10 specific hypotheses, were postulated as a means of exploring these aims. The first general hypothesis predicted that WS individuals would demonstrate distinct features within their cognitive and behavioural profile. Specifically, it was predicted that WS individuals would show relative strengths on verbal tasks and significant deficits on visuospatial and mathematical tasks, in contrast to control participants who were predicted to show a more even profile. It was also predicted that WS individuals would show evidence of heightened affect in response to music and demonstrate hypersociability as compared to control participants
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ItemDepot medications and the treatment of schizophrenia in community psychiatry( 2005)Since their introduction in the 1960s, depot antipsychotics have played a substantive role in the pharmacological management of patients with schizophrenia in Australia. During the 1990s, among radical changes to the structure and function of community services in the State of Victoria, a new generation of improved oral antipsychotics was introduced. The latter were anticipated to replace older antipsychotic medications. This thesis examines the impact these changes have had on depot prescribing in community psychiatric settings. It tests the hypothesis that due to widespread concerns over the consequences of non-adherence that frequently accompany the use of all oral antipsychotics, depot agents will maintain a key place in pharmacotherapy. The research is based on Australian data taken from community care teams in Victoria, complemented in one study with data from Western Australia. The prescribing patterns data indicate that between 1998 and 2003 substantial changes in the use of antipsychotics have occurred. The results show a rapid increase in second generation antipsychotics from 38 percent to 78 percent over the five year period of the study. Over the same time, first generation antipsychotics fell from 27 percent to 3 percent of prescriptions. Prescriptions of depot agents also fell, but by a much lesser amount, from 46 percent to 29 percent of prescriptions, a level close to the absolute level of non-adherence proposed in the literature. This supports a further hypothesis that depot antipsychotics use will stabilise at a level close to the absolute level of non-adherence. The findings also indicate that from the perspective of initially distinct prescribing practices in different services, there has been a convergence of prescribing trends towards a common level of use for each group of antipsychotic medications studied. Both depot and newer oral antipsychotics demonstrate a high degree of prescribing stability over time, which is found to be inversely related to the risk of admission for population of patients considered. The clinical application of depots is effected by factors relating to the Service, the range of medications available and, characteristics of the Patient. Four studies were undertaken to explore the likely impact of these influences on community prescribing. The first shows that community treatment orders are used with depot agents more than with other antipsychotics. This supports the hypothesis that involuntary treatment orders facilitate the instigation of depot antipsychotics in reluctant community-treated patients. The second study shows that fewer than 10 percent of patients meet non-adherence criteria of less than 75 percent adherence, that an inverse relationship exists between depot adherence and hospital admission and, a critical level of depot adherence of less than 85 percent is predictive of admission with respect to this population. These findings support the decision of clinicians who prescribe depots with the expectation they will lead to better adherence. The third and fourth studies examine the attitudes of mental health professionals and depot treated patients, respectively. Differences in critical attitudes towards depot antipsychotics between professionals and between services are described. Additionally, patient attitudes to depots, assessed through a pilot satisfaction survey, indicate that only a minority of patients (46 percent) are clearly dissatisfied with their depot medications. This is at odds with the negative attitudes towards depots found among many of the clinical staff. In conclusion, the thesis demonstrates that depot antipsychotics remain an important component of the pharmacotherapy of people with schizophrenia in community psychiatric settings in Victoria. For multi-disciplinary clinical care teams their utility lies in addressing non-adherence, and so preventing relapse and rehospitalisation, and the subsequent, often widespread, costs that ensue.