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 UNC 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.
Diversity, Equity, and Inclusion Statement
The principles and practices subsumed under DEI are at the core or my teaching, research, and service on and off campus. I completed the 2-day REI training virtually in 2020.
All the courses I teach in the School of Medicine have a focus on health disparities, social justice, structural vulnerabilities and violence, health disparities, racism, ableism, and other social factors such as implicit bias that influence health care and health outcomes. The SHS 1-2 curriculum covers all of these topics repeatedly, including sexualities and genders, race and ethnicity, disability, social class and health disparities to name only the most obvious. This includes the summer reading program sessions for incoming students, for the last years devoted to discussion of the book Medical Apartheid, which I teach regularly in class. This year I lead a seminar discussion of the film, Gen Silent, about elder LGBTQ individuals for the returning Foundation students.
My SHS 3 seminar is devoted entirely to stigmatized and otherwise ‘different’ people with disabilities and other conditions that limit their opportunities and well-being. DEI issues are consistently discussed in my SHS 4 seminar as part of the RICE curriculum. The students are assigned to write about race, sexualities, genders, and culture as they play out in clinical settings.
I am an elected member of the Faculty Executive Committee. As such, I participate in discussion, advocacy, and policy making for issues related to race and racism, ableism, gender identity and sexuality, and other issues that affect members of the University community. We interact regularly with University level administrators responsible for DEI across campus, and advise and are advised about challenges and progress.
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 regularly take my SHS 3 class to Club Nova for an immersive experience with the members and staff. This is a transformative experience for the students as the members give them a tour of the clubhouse and then we have a roundtable where the members tell the students what makes a good doctor.
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, (Volume I, Ethics and Cultures of Biomedicine and Volume II, Differences and Inequalities, 2019, Duke University Press).