PhD, University of Cincinnati, 2023, Arts and Sciences: Philosophy

It is a normal part of the human experience to feel sad, fearful, and angry. But when should these mental struggles be treated by the mental health community? This project seeks to understand the relationship between difficult emotional, cognitive, and behavioral problems and mental health treatment. The question of the project is: What conditions ought the mental health community treat? Answering this question helps us to determine the purview of mental healthcare. I begin by tracing the history of the debate about the correct definition of “mental disorder,” ultimately concluding that this concept cannot serve as the basis of mental healthcare purview. Alternatively, I argue that the primary aim of the mental health community ought to be treating psychological conditions that consist of or cause suffering—what I call “treatable conditions.” Next, I consider the causal structure of treatable conditions, arguing that these conditions tend to be caused by interactions between biological, psychological, and social processes. I end the project by considering the implications my account has for mental health classification, funding, research, and treatment.

Bachelor of Science in Nursing, Wittenberg University, 2022, Nursing

The novel coronavirus 19 was first recorded in Wuhan China, and spread rapidly through the world. Soon, citizens throughout the United States had to learn how to adapt to a new way of living, and many healthcare workers felt the impact of the pandemic more severely, facing even more extreme stressors than the general public. Because of this, healthcare workers had an increased likelihood to experience greater levels of anxiety, depression, PTSD, suicidal ideation, moral injury, and/or other negative mental health effects. Through various programs that promote healthy coping mechanisms, develop resiliency factors, and improve overall mental and physical health, some hospitals have seen improvement in the impact of COVID-19 on their workers. The hope of this review of literature is to encourage the implementation of these actions at various hospitals to address the invisible pandemic of mental illness that these workers now face.

Master of Science (MS), Ohio University, 2021, Journalism (Communication)

This study examined sourcing and framing in PTSD news coverage published by The New York Times from 1999–2020 using quantitative content analysis. Based on the findings of previous studies, it was hypothesized that the sampled coverage would overrepresent combat trauma relative to other sources of trauma, underrepresent options for treatment and recovery, privilege men and official sources over women and unofficial sources (i.e., men and official sources would speak more often than women and unofficial sources), and favor episodic/individual framing over thematic/social framing. However, these hypotheses were only partially supported. The researcher ultimately found that, while the sampled coverage did overrepresent combat trauma and underrepresent treatment and recovery options, as well as favor men over women in sourcing, it defied expectations in other ways. Namely, it was observed that civilian/unofficial sources predominated over official sources, and that thematic/social framing predominated over episodic/individual framing.

Master of Fine Arts, The Ohio State University, 2021, English

The Kirkbride plan for American mental hospitals first took hold in the late 1840s and remained the most popular floor plan for insane asylums for the next forty years. Kirkbride asylums were considered vital, scientifically advanced centers of mental health treatment throughout the nineteenth century, but quickly became outdated, overcrowded, understaffed, and dilapidated. Today only about one-third of the original Kirkbride buildings constructed from the 1840s to the 1890s remain standing, but their impact on the national imagination is both enormous and permanent. This thesis for the Master of Fine Arts in Creative Writing at The Ohio State University is a combination of memoir and literary journalism documenting the origins, lifespan, decline, and historic preservation of Kirkbride asylums around the continental United States, as well as the author's own experiences with bipolar disorder and psychiatric care.

Doctor of Ministry , Ashland University, 2019, Doctor of Ministry Program

The purpose of this project is to create a resource that will better equip pastoral caregivers to become spiritual companions for people with bipolar disorder. The resource, Spiritual Companionship and Bipolar Disorder, establishes that pastoral caregivers are gateway people for those with bipolar disorder to receive appropriate care and models multi-disciplinary collaboration. The resource is evaluated by twelve experts using a questionnaire that includes both quantitative and qualitative questions. As a result, the resource is found to have a strong foundation and creative spiritual experientials. Insights give direction on how to improve the resource including format and cohesiveness.

Doctor of Philosophy, The Ohio State University, 2019, Philosophy

In this dissertation, I examine our mental health concepts to see what work they are currently doing as well as what work they could be doing. In 1976, Christopher Boorse stated that the mental health literature is a “web of obscurities” (p. 51). To resolve some of this confusion, I argue that we need to consider the goals we should have for our mental health concepts and then give accounts of those concepts that meet our stated goals. I argue that our goals for our mental health concepts should be twofold: first, we need concepts that will work to alleviate the stigmatization of mental disorder as this stigmatization gets in the way of providing and receiving medical help, and second, we need concepts that will be useful tools for medical practitioners to use in their diagnosis and treatment practices. I begin by arguing that our mental disorder concept is not currently a useful tool for medical practitioners. Moreover, I argue that our mental disorder concept is confused in such a way that it is unlikely that it could ever be a useful tool for medical practitioners. If we cannot give an account of the mental disorder concept that is a useful tool for medical practitioners, then perhaps we can give an account of the mental disorder concept that can be used toward our goal of alleviating the stigmatization of mental disorder. Before we can do that, however, we need an account of the stigmatization concept so that we can understand what our mental disorder concept needs to be alleviating. I argue that stigmatization is a process whereby some entity becomes marked as disgraceful or shameful. This stigmatization process includes (1) an attitude against the entity for reasons found in the social ideology, and (2) acts against the entity. I then argue that acts of stigmatization take two forms: direct stigmatization (where stigmatizors take acts against the stigmatized entity) and indirect stigmatization (where potential victims of stigmatization take acts to (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2005, Physical Activity and Educational Services

Much has been written about the characteristics of success for persons with a primary diagnosis of a mental health disorder. However, few studies have examined the characteristics of success for persons with a primary mental health disorder that reside in rural areas. This study explored differences in characteristics of success in service delivery and outcome for individuals residing in urban and rural areas that received services through the state-federal vocational rehabilitation system (VR) in a Midwestern state during the year 2002. The demographic data describing urban and rural individuals highlight some disparities that exist prior to service delivery. This study examined the differences in total case expenditure, hourly wages, weekly hours worked, and level of education at the end of case closure for those successfully employed (status 26) to determine if the VR system works to improve some of the demographic disparities between the two groups. Logistic regression analysis was conducted to determine any differences in working at time of referral, educational level at time of referral, and services received between those residing in an urban or rural county. The logistic regression model demonstrated that working at time of referral and having a bachelor's degree were more probable for those consumers residing in an urban county. A t-test indicated that there was not a difference in mean number of services for those in urban and rural counties; however, the logistic regression model indicated that Business or Vocational training and Maintenance services has a higher probability of occurring for those consumers in an urban county. MANOVA results of outcome variables indicated that hourly wage was statistically significant between consumers residing in urban and rural counties. The mean hourly wage for the urban population was $9.28 and the mean hourly wage for the rural population was $4.82. The results of the study demonstrate some differences in the VR expe (open full item for complete abstract)

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2012, Philosophy, Applied

This dissertation is about ‘mental disorder.' More specifically, the focus of this work will be a particular approach to understanding ‘mental disorder' which I label “biological functionalism.” What the defenders of biological functionalism claim is that any successful account of disorder must take seriously the idea of natural dysfunction. Because ‘natural dysfunction' is thought to be drawn directly from the facts of natural function, the biological functionalist goes on to assert that ‘natural dysfunction' is free of evaluative content. The relevance of this approach to ‘mental disorder' lies in its implications for the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM offers a definition of mental disorder which is intended to address certain concerns over the legitimacy of psychiatry. In particular, it is meant to answer anti-psychiatry critics who question the way the psychiatric establishment distinguishes between disorder and psychiatric normality. I argue that the DSM's efforts are not successful because a key component of its definition — ‘dysfunction' — is left ambiguous. To address this weakness, biological functionalism offers a naturalistic understanding of ‘dysfunction' which supposedly honors the DSM's scientific focus. My main contention is that the biological functionalist project fails on two counts. The first flaw is in its execution. I argue that leading biological functionalist accounts do not pay proper respect to the practical commitments of psychiatry. But a second, more critical flaw occurs at the conceptual level. Biological functionalism fails to recognize that ‘dysfunction' is an inherently evaluative concept. Consequently, the biological functionalist paradigm is left in a dilemma. It either commits the naturalistic fallacy; that is, it attempts to derive an evaluative sense of ‘dysfunction' from a strictly explanatory sense of ‘natural function.' Or it cannot account for the eval (open full item for complete abstract)

Master of Science, The Ohio State University, 2024, Genetic Counseling

Background: Vascular Ehlers-Danlos syndrome (vEDS) is a life-threatening connective tissue disorder caused by pathogenic variants in the COL3A1 gene. Patients can experience aortic or arterial dissections and hollow organ rupture. While it is rare, affecting between 1/50,000 and 1/200,000 people, support organizations exist. The goal of this study is to determine what information would be helpful for support organizations of the vEDS community to prioritize programming regarding mental health support and how the social aspect of support organizations impacts mental health. Methods: People with vEDS and their first-degree family members, including spouses/partners, were surveyed about their mental health, traumatic experiences -including vicarious trauma -, and support organization participation. An electronic survey was administered, which included the STOP-D, OSSS-3, demographic questions, and questions regarding support organization participation, priorities, exposure to trauma, what materials they would like a support organization to provide regarding grief/trauma, and preferred ways of receiving information. Results: One hundred forty-three people participated. Statistically significant relationships were found between experiencing trauma and vicarious trauma (p=0.002) and having access to a provider who listens and confidence in a provider's knowledge of vEDS (p=0.001). Ninety five percent of those who reported vicarious trauma also reported experiencing at least one traumatic event. There was no association found between vicarious trauma and subtype of experienced trauma, or between vicarious trauma and support group participation. Although not statistically significant, high stress was reported for both people with vEDS (65%) and their unaffected family members (60%). Participants also wanted a variety of materials or programs from a support organization, including peer support, individual and group therapy, information on advanced directives, and 24/ (open full item for complete abstract)

Doctor of Philosophy (PhD), Ohio University, 2024, Counselor Education (Education)

Eating disorder mental health literacy (ED-MHL) refers to one's knowledge and beliefs about eating disorders which aid their recognition, management, and prevention. While programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) are recognized for the content and quality of their programs, they do not currently require specific training in eating disorders counseling despite increasing prevalence and the highest mortality rates of any psychiatric disorder. The primary purpose of the current study with 239 participants was to examine mental health literacy among counselor trainees in identifying and treating eating disorders. Additional aims of this study included determining whether gender and racial identity combinations of fictional clients impacted counselor trainee ability to correctly diagnose an eating disorder; exploring the relationship between orthorexia and ED-MHL using the ORTO-R scale; and analyzing whether these variables (ability to correctly diagnose an atypical eating disorder based on a vignette, ORTO-R score, and select sociodemographic items) could be used to predict ED-MHL. Findings indicated that counselor trainees possessed overall low levels of ED-MHL, and there were no factors predictive of the ability to correctly diagnose an atypical eating disorder. The results of this study have several implications for various stakeholders, including counselor trainees, counselor supervisors, counselor educators, healthcare providers, and those directly impacted by eating disorders and negative body image. These implications, as well as limitations to the study and suggestions for future research, are presented.

Psy. D., Antioch University, 2024, Antioch Seattle: Clinical Psychology

This mixed-methods study explored the quality of life and lived experiences of adult individuals with diagnoses of schizophrenia spectrum disorders residing and receiving treatment on the Social Learning Program (SLP) at Fulton State Hospital, a high-security state forensic facility. Eleven participants completed the WHOQOL-BREF quantitative quality-of-life measure. Ten participants completed in-depth, semi-structured, qualitative interviews. Interviews were transcribed then analysed using Interpretive Phenomenological Analysis. The major themes that emerged included “Working the Program,” “Relationship Dynamics with Self and Others,” “Meaning,” “I've Been Having Breakthroughs,” and “Areas for Improvement in the Program.” Combined, the findings of the present investigation demonstrate the utility of the SLP and highlight the importance of studying the lived experience and quality of life of individuals with diagnoses of schizophrenia spectrum disorders residing in forensic facilities.

Doctor of Nursing Practice, Mount St. Joseph University , 2023, Department of Nursing

Historically, a visit to the medical director was not consistently provided to each new patient at the TriHealth Outpatient Alcohol Drug Treatment Program (TOADTP). This resulted in patients being dispossessed of access to care such as evaluation and comprehensive treatment of co-occurring mental health diagnoses, the initiation of pharmacotherapy, and initiation of medication-assisted treatment for persons living with substance use disorders. This project centered on development and implementation of a standardized intake process for TOADTP patients with the goal of increasing referrals to the medical director to expand access to these lifesaving interventions. Over an eight-week period, pre-intervention data were collected. During this pre-intervention period, only one of the 12 new patients was referred to the medical director. Development, education, and mobilization of the new standardized intake process included: analyzing the old intake process for variances, educating the direct care team about the benefits of practicing from an evidence-based platform, developing a new intake process that included a hard stop in the electronic health record, and educating the TOADTP team about it. The process then was mobilized. Post-intervention outcome measures were collected over an 8-week period. These measures revealed that 17 out the 24 new patients were referred to the medical director. In sum, the implementation of a standardized referral process to the medical director increased referrals from 8.4% to 70.8%, thus expanding access to life-saving evidence-based care for people living with substance use disorders.

Doctor of Philosophy, Case Western Reserve University, 2022, Sociology

The growing prevalence and severity of both clinical and subclinical eating disorders resulted in the inclusion of a Healthy People 2020 objective aimed at reducing the proportion of individuals who engage in disordered eating behaviors. At the same time, survivors of intimate body trauma (childhood abuse, sexual assault, dating violence, etc.) are coming forward with their own violence narratives at unprecedented rates thanks to global support movements such as #MeToo. Research on the development of disordered eating behaviors after the experience of recurrent intimate body trauma (IBT) over the life course is limited but has been linked in compensatory &/or coping mechanistic ways. This dissertation explored the relationships that may exist between poor body image, a range of maladaptive eating behaviors, comorbid mental health issues, and experiences of IBT over the early life course. This research specifically utilized secondary data analysis from a large, nationally representative sample of U.S. men and womxn followed over 24 years (1994-2018) to expand on the methodology and findings from previous clinical, small-scale studies. Drawing on sociological theories related to cumulative disadvantage, stress proliferation, and toxic socialization this dissertation systematically explored the impact(s) of IBT over the early life course. A sociological understanding of the cumulative impact trauma has on the body is necessary to evaluate who may be at most risk for future revictimization and their associated mental health outcomes. Findings from this dissertation revealed that survivors of recurrent IBT experiences are roughly 2 to 4 times more likely to suffer from a range of mental health issues as compared to those who have not experienced sexual violence. Additionally, according to analysis results, queer IBT survivors are at risk of developing maladaptive mental health outcomes at a rate of 2 to 3 times that of heterosexual survivors. Analysis results al (open full item for complete abstract)

Psy. D., Antioch University, 2022, Antioch Santa Barbara: Clinical Psychology

This systematic literature review explores the relationship between mental disorders and nutrition through a review 547 available articles. Of these, 74 were selected for inclusion in this review. The research question guiding this inquiry was: What is the effect of nutrition on the mental health of individuals in the United States? A PRISMA flow diagram was used to develop systematic assessments of the existing research to produce a dataset of literature to answer the research question. It was found that nutrition and health are critically linked, with supplements being associated with positive health outcomes. It was also found that research is shifting to focus on the connection between the gut and the brain. The culmination of this review is that nutritional changes and support can positively impact anxiety and depression, and probiotic treatments have been linked to better dopamine regulation. Each disease is reviewed in relation to existing evidence on nutritional supplements that impact health symptoms. The findings of this review indicated that nutrition could have a notable impact on managing health conditions. It is recommended that models for health and nutrition be updated to encompass nutritional issues in the treatment of mental health disorders with a critical focus on patients' nutritional intake. This dissertation is available in open access at AURA, https://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu.

Doctor of Philosophy, The Ohio State University, 2021, Nursing

Background: Caregivers of children with Autism Spectrum Disorder (ASD) have been found to have poor mental health outcomes and higher stress compared to the general population, parents of typically developing children, and parents of children with other chronic health care conditions. Emotional support for caregivers has been shown to buffer the stress and negative effects that some caregivers experience. Caregivers living in rural areas may face additional barriers to obtaining support for themselves due to the lack of local support resources. Purpose: The purpose of this dissertation study is to examine geographic (urban, suburban, and rural setting) disparities in overall mental health and stress for caregivers and the amount of emotional support sources received by caregivers of children with ASD. In addition, the impact emotional support has on caregiver overall mental health and stress for caregivers of children with ASD is explored. Method: A cross-sectional secondary analysis of the 2016-2019 National Survey of Children's Health (NSCH) data was used to conduct this dissertation study. Complex survey data analyses techniques with bivariable and multivariable linear regression models were employed for the statistical analyses. Results: No geographic disparities were found in caregiver overall mental health, caregiver stress, or emotional support received when controlling for possible confounding variables. Informal emotional support was found to significantly decrease caregiver stress for caregivers of children with ASD when controlling for covariates. In addition, formal emotional support was found to increase stress for caregivers, but this relationship was no longer significant when controlling for covariates. Overall, near or over a quarter of the subpopulation sample in each geographic area reported having no informal support sources and over half reported having no formal support sources. Conclusion: Despite hypotheses based on previous research, (open full item for complete abstract)

Master of Arts (MA), Wright State University, 2020, Applied Behavioral Science: Criminal Justice and Social Problems

The study examines adverse childhood experiences among individual who use illicit opioids, focusing on emotional, physical, and sexual abuse. The study uses data collected from a sample of 357 individuals with opioid use disorder who were recruited in the Dayton area between May 2017 and October 2018. The study builds on the life course and social learning theories to examine the association between childhood experiences and drug use behaviors in later life. The key aims of the study are to: 1) assess the prevalence of adverse childhood experiences in the community-recruited sample of individuals with opioid use disorder; 2) analyze the relationship between adverse childhood experiences and family history when growing up, including economic hardship and parental history of mental and substance use problems, and 3) analyze the associations between adverse childhood experiences and selected drug use characteristics, such as age of first use, frequency of use, and whether or not they inject. Participants were recruited used targeted and respondent-driven sampling. Structured interviews were conducted by trained interviewers and covered history and patterns of drug use, sociodemographic characteristics, and adverse childhood experiences (ACE). Descriptive statistics and univariate analyses were used to characterize the sample. Chi-square test was used for categorical variables. One-way ANOVA was used to assess differences in drug use characteristics (continuous variables) between those who experienced childhood abuse and those who did not. Multiple linear regression analysis was used to assess the relationships between age heroin initiation (dependent variable) and childhood abuse experiences (independent variable), controlling for socio-demographics and family history when growing up. Multivariate Logistic Regression analyses were used to assess the association between a) early initiation of alcohol use (dependent variable) and childhood abuse experiences (independent) (open full item for complete abstract)

Psy. D., Antioch University, 2020, Antioch Seattle: Clinical Psychology

Stigma toward individuals with eating disorders is common and well-documented. Individuals with eating disorders regularly report experiencing stigma associated with perceptions that they are to blame for their illness, that their illness is trivial compared to other conditions, or that they are engaging in disordered behavior to gain attention. These stigmatizing attitudes toward eating disorders are also reported by the general public and healthcare professionals, including those who treat eating disorders. Treatment of these illnesses at all levels of care often include paternalistic approaches such as coercion and compulsion that can have both adverse and advantageous consequences. While there are ethical, clinical, and legal justifications for these treatment approaches, this study provides a novel exploration of the relationships between stigma toward individuals with eating disorders and coercive and compulsive treatment. This was accomplished using a survey methodology to assess the attitudes and treatment practices of treatment providers across the United States. The results of this study suggest that there is no significant relationship between treatment providers' attitudes toward individuals with eating disorders and coercive or compulsive treatment methods. Implications for clinical practice and future research are discussed and center on the need for additional inquiry to better understand the complexities of these two variables in light of the ongoing debate concerning the risks and v benefits of coercive and compulsive treatment. This dissertation is available open access at AURA, http://aura.antioch.edu and Ohio Link ETD Center, https://etd.ohiolink.edu

Honors Theses, Ohio Dominican University, 2020, Honors Theses

Eating disorders are serious mental illnesses with high levels of stigma and a heightened awareness of the judgements of an individual based on the health and portions of food on their plate. The purpose of this study was to investigate the influence of public eating and stigma awareness in the development of eating disorders in high risk college aged individuals. Participants were randomized and placed into observed and unobserved eating groups, offered a buffet of healthy and unhealthy foods, and after a timed eating period filled out a series of questionnaires. Results indicated that there was no significant difference in caloric intake or health intake between the observed and unobserved groups. Furthermore, the knowledge of mental illness stigmas in society had no impact on risk, the health of the selected foods, or caloric intake. Analysis did show that a BMI classified as obese or overweight was significantly correlated with a higher risk for eating disorder development. This indicates that stigma awareness and awareness of public perceptions of food may not contribute to eating disorder development, however, a higher BMI may be a risk factor for eating disorder development.

Bachelor of Science of Communication Studies (BSC), Ohio University, 2020, Communication Studies

The majority of individuals who engage with the criminal justice system go through a quick, standardized, impersonal process of adjudication (Feeley, 1979; McCoy, 2003; Odegaard 2007; Sherwin, 2009). In select courts, however, alternative programs called specialized dockets exist to better serve the needs of convicted individuals who may be particularly susceptible to prison or jail re-entry (Castellano, 2017; Fisler, 2005; Moore & Hiday, 2006). The present study explores a case study of two specialized docket programs in Appalachian United States with analysis guided by communicative theories of performance, narrative, and stigma. The findings demonstrate that program participants navigate stigma and enact parts of their identities in the program through performing different “selves” for the courtroom staff and peer participants. The findings also suggest that informal peer interactions and performances—which primarily took the form of sharing—had the most significant impact on a participant's identity work in the program.

Psy. D., Antioch University, 2019, Antioch Santa Barbara: Clinical Psychology

While psychiatric medications have been categorized as the same as substances of abuse in Alcoholics Anonymous (AA), medications for common medical disorders were not affected by this disapproval of medication. It may be time for a new dialogue (Woody, 2015). According to Gjersing and Bretteville (2018), there has been a concerning increase in overdose deaths in the last decade. This includes a threefold increase in overdose deaths from prescription narcotics and six-fold increase in overdose deaths from heroin in the United States. When prescription opioid users find difficulty in obtaining pills, they may move on to heroin, which is much more readily available on the streets, in an effort to avoid painful opioid withdrawal. For this study, individuals who had previously achieved long-term abstinence from alcohol or substance use but relapsed after a significant amount of time sober were interviewed in order to better understand their experience with relapse as well as their experience returning to at least partial remission. Thematic analysis was conducted on interview data. The results from this phenomenological analysis of interviews with eight participants identified several themes regarding the experience of being a long-timer, relapsing after a substantial amount of time abstinent, and challenges to as well as factors in returning to AA. These themes are organized as long-term recovery, relapse, and a new beginning. Long-term recovery is further explored as acute treatment only, treatment did not utilize evidence-based interventions, treatment did not address emotional issues, contact with mental health, long-timer, and complacency and drifting. Relapse is further explored as medical issues, new trauma, and justification of the use of medication or marijuana. A new beginning is further explored as recovery challenges such as feelings of ostracism, age-related issues, and shame as well as recovery factors such as finding acceptance and love within the fellowsh (open full item for complete abstract)