If every public health researcher had a calling card indicator, Dr. Larry Yang's would be stigma.
What began as a curiosity to think, study and write about his own culture -- Chinese culture and its influences on the manifestation of stigma -- drove the CGPH Associate Professor to develop a framework for how stigma acts to impede social recovery cross-culturally to improve the lives of countless people with mental illness and their families around the world.
"I was drawn by the global and applied perspective of CGPH. I saw working at CGPH as an incredible research opportunity to build mental health programs and the college's ties to NYU Shanghai as a unique opportunity to further establish research studies throughout China," said Larry regarding his new position on the CGPH Social and Behavioral Sciences team. As part of the faculty, Larry will teach Psychometric Measurement and Analysis in the fall as well as a Social Behavioral Sciences course in the spring. In addition to teaching, Larry will continue several ongoing research studies on the forefront of public health and psychiatric epidemiology.
As PI of a five year study, R01-Stigma of Clinical High-Risk Psychosis (CHR) funded by the NIMH, Larry is examining the impact of stigma on identity among youth diagnosed with a Clinical High-Risk State for Psychosis (CHR). The research is being conducted in partnership with the medical schools of Harvard, Columbia and Maine. "People used to think that intervening with psychosis when a person first has a psychotic break was early intervention," said Larry. "Now, we understand that the first psychotic break is actually well into the development of the disorder." Using a diagnostic interview that identifies a Clinical High-Risk Psychosis state to look for clinical features and symptoms of psychosis, a mental health professional can detect the signs of psychosis and begin treatment. Early treatment can help delay onset of psychosis and possibly improve the course of the illness. Yet, only 30 percent of those with the earliest signs of psychosis will develop a full-psychotic disorder. "Early detection comes with a potential cost," said Larry. "There are all sorts of implications regarding how early diagnosis could negatively affect a young person's identity and the way the rest of the world views them." For the past four years, Larry has been examining the impact of psychological, social, and developmental outcomes among participants identified as CHR. The study is now in its 5th year and nearing completion. Additionally, Larry is conducting a supplemental study to examine the manifestation of stigma using neuroimaging and to determine whether and how stigma is expressed in the brain.
Larry's fascination with stigma was first sparked during his dissertation research in Shanghai with a leader in global mental health research, Michael Phillips. "I saw stigma in its most terrifying and ferocious form," said Larry describing his first experiences working with people with severe mental health in Shanghai. "For the family members and those with mental illness themselves, it's crippling and debilitating. What 'face' (a crucial Chinese concept) allows you to do is to plug into social networks and enables you to access social resources. Just imagine if you are cut off from any social resource? You have no power. You have no way to access the common things that most people do in their everyday lives. People call this being 'faceless' or 'social death'." From this experience, Larry became motivated to do something to empower people with mental illness and their families within their communities.
After receiving an NIMH K-award, Larry conducted a study in New York City of the psychological factors, including stigma, that shape the course of mental illness among Chinese immigrants. As a result of this study, Larry formulated theoretical work on how culture relates to stigma and implementing interventions to improve recovery for different stigmatizing conditions on which his future research is based. He learned that upholding face (or preserving honor and the community's respect) is important among Chinese immigrants, as it is for Asians in many countries. When someone develops signs of mental illness, that person loses face in many circumstances. Resulting from his K-Award, Larry used the study to formulate an anti-stigma intervention to help people with mental illness take a powerful step towards regaining face. "Arthur Kleinman and I call it "remobilization", Larry said. "We helped Chinese immigrants with psychosis move from a position where they were completely disempowered in society to a place where they could reengage with society. To work if they wish, to volunteer if they wish. We were able to help them re-engage in social interaction and reduce internalized stigma." Although his anti-stigma intervention has been based in the US, they have now conducted similar research in China and in other international settings such as Chile, Argentina, India and Botswana.
Larry returned to China as PI of an R01 study with co-PI's, Michael Phillips and Larry Seidman, Characterizing Cognition of Untreated Psychosis in China. Recently, China has been rolling out programs in detection of untreated psychosis around the country. As the program had not yet reached the poorest provinces in China, including Ningxia, Larry chose to propose a study there which has since become supported by the Ningxia Ministry of Health. The study includes 400 untreated psychosis participants, who are then matched with 400 treated psychosis participants and an additional 400 healthy control participants in Ningxia Province.
"If you've ever seen "A Beautiful Mind", you may have noted that there were points where the main character John Nash, Jr. maintained his brilliance and others where he was more dull and slowed down. Unfortunately, this slowing of cognition happens to a lot of people with psychosis. But we've never been able to disentangle how much of this is connected to the illness and how much is due to the medication. This study is a historic scientific opportunity to examine what cognition looks like in people who are completely untreated for psychosis."
Additionally, Larry's team will work with Michael Phillips and local psychiatrists in the province to scale up their capacity to treat first episode psychosis by providing more advanced clinical training.
While Larry has conducted several studies in China, his latest research has also taken him to South America (Argentina, Chile and Brazil). Currently, he is part of a study, the Collaborative Hub for International Research in Mental Health, an NIMH U-19, establishing a network of research hubs: two in South America (including his team's study in Chile, Argentina and Brazil), one in Asia and one in Africa. Following a scale up intervention conducted by his research partners, Larry co-leads a qualitative evaluation to measure the barriers and facilitators to scale-up social interventions for psychosis in Latin America and across all hub sites. His collaborating research partners on this study include the University of Chile (Santiago) and the University of Frederico (Rio). Larry's role is to harmonize interviews and the collection of data across all five global hub sites so that the research teams can collect uniform data to facilitate the scale up of interventions worldwide.
Larry holds a doctoral degree from Boston University in Clinical Psychology. He was awarded a clinical fellowship at Harvard Medical School to work at the Massachusetts Mental Health Center and has received 8 early career awards for his work on stigma, 6 of which are national. Larry is a member of two prestigious editorial boards: the Cultural Diversity and Ethnic Minority Psychology Board of the Journal of the American Psychological Association, and the Stigma and Health Board of the Journal of the American Psychological Association. He has also authored publications in The Lancet, British Journal of Psychiatry, and the Journal of Abnormal Psychology.