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BA 1972, Duke University
MA 1975, and PhD 1978, Anthropology, University of Wisconsin – Madison

Graduate training in Anthropology and Psychiatry has informed both the research topics and methods I have pursued. Collaborations with clinician researchers and other social scientists have contributed to my use of mixed methods, both qualitative and quantitative, in various projects to date. My research has been primarily with clinician and social science colleagues working on exploring individuals diagnosed with severe, persistent psychiatric disorders and the service systems, treatment, life experiences, and public policies that impact their recoveries, or lack thereof. This was the focus of a multi-year grant from NIMH, that examined how people with severe, persistent psychiatric disorders became considered to be ‘disabled’ by becoming recipients of Social Security Disability Income. A similar analysis was included in the recent RAISE study of early intervention in schizophrenia. That project produced multiple publications, both conceptual and empirical, and created a data set that was subsequently used to examine violence in the lives of the study participants. A competitive continuation award extended the data collection for 3 years so that we could examine the impact of disability income receipt on the recipients and compare these with the experiences of those who did not receive disability income.

At issue is accounting for the social and structural factors that figure in the personal, clinical, and social outcomes for people with severe, persistent psychiatric disorders. These studies revealed that ‘becoming disabled’ was as much a social process as a clinical trajectory. Transformations of social and personal identity were central to the disabling process as study subjects’ social networks and forms of subsistence were all tied to being mentally ill. A fusion of identity and illness was an unintended consequence of long- term hospitalization, of not having a job and ‘getting on disability’ and having social networks comprised primarily of treatment staff and other people with similar diagnoses and lives. In collaboration with psychiatrist John Strauss, we published these views in a special section in Schizophrenia Bulletin.

The closure of a large state psychiatric hospital in Pittsburgh presented another opportunity to examine the issues outlined above, this time in collaboration with colleagues in Social Work and the county mental health authority. We followed the people who were discharged for 18 months, collecting data on a wide range of topics—clinical, experiential, and social. I have continued to examine these factors as a member of the RAISE early intervention in schizophrenia research team funded by NIMH. Analysis and Publication of these results continues to the present.

Another research project arose when a ºÚÁÏÍø colleague participated in a feasibility trial for in-utero closure of neural tube defect. The concern here was that a therapeutic misconception might lead expecting parents who had just found out that the fetus had a neural tube defect to consent to be in the study.  Our team consisted of a bioethicist, an internal medicine fellow, myself, and the ob-gyn surgeon. We recorded all of the consent discussions between the surgeon and the parents and coded these for content. We found that the potential subjects already considered themselves to be ‘parents’ and used the term ‘baby’ rather than fetus in discussion with the research team. Their decisions in the consent process centered around this view of the moral responsibilities of parents to their children.

Teaching

In the School of Medicine I teach in the required Social and Health Systems curriculum courses, mentor individual student elective projects, and contribute to the Social Medicine scholarly concentration. These courses introduce students to social, cultural, economic, and historical factors that influence health and illness as well as the practice of medicine.  Bioethics, population health, health policy and finance, and medical humanities and social science topics and scholarship are central to the curriculum.  I also teach in a seminar during clinical training in SHS 4 where students reflect on and apply these foundations to actual practice with critical incident reports and analysis.  On request I give grand rounds and conduct clinical training seminars on disability, health humanities, and various topics in our curriculum depending on the specialty of the group.

I advise graduate students in Anthropology in the College of Arts and Sciences whose research is relevant to medical anthropology and serve on doctoral committees.  I have taught a seminar on disability and difference for undergraduate first year students as part of the ºÚÁÏÍø First Year Seminar requirement.

Service and Community

All my research has been focused on people with enduring, disabling psychiatric conditions and the social and clinical challenges they experience. I have been and continue to be an advocate for their rights and dignity at the local, state, and national level.  I have worked with Disability Rights North Carolina on matters of involuntary psychiatric treatment and consumer participation in the mental health policy making process.

For over a decade I served as a board member and then president for Threshold Psychosocial Clubhouse in Durham, NC. For the past 5 years I have served as a board member for Club Nova, a similar program in Carrboro. Club Nova provides a supportive network of belonging, work skills, opportunities for housing, recreation, and activities of daily living, as well as promoting mental and physical health.

I hold appointments in the departments of Anthropology and Psychiatry, in addition to Social Medicine.

Dr. Estroff is the co-editor of the 2-volume series The Social Medicine Reader, 3rd edition, (Ìý²¹²Ô»åÌý2019, Duke University Press).