Should physicians be Bayesian agents?

Because physicians use scientific inference for the generalizations of individual observations and the application of general knowledge to particular situations, the Bayesian probability solution to the problem of induction has been proposed and frequently utilized. Several problems with the Bayesian approach are introduced and discussed. These include: subjectivity, the favoring of a weak hypothesis, the problem of the false hypothesis, the old evidence/new theory problem and the observation that physicians are not currently Bayesians. To the complaint that the prior probability is subjective, Bayesians reply that there will be ultimate convergence, but the rebuttal to this is that there will not be uniform convergence. Secondly, since the Bayesian scheme favors a weak hypothesis, theories turn out to be a gratuitous risk. The problem with the false hypothesis comes out in the denominator of the theorem, revealing that a factor which is not a theory at all is being considered in the reasoning. On the old evidence/new theory problem old evidence cannot confirm a new theory so that the posterior probability will equal the prior probability. Finally, empiric studies have shown that current physicians are not Bayesians. But on consideration of Bayesian inference as a system of inference, it can be reasoned that physicians should be Bayesians. However, the problem of physicians' and patients' own subjectivity continue to plague this system of medical decision making.     

Carl Rogers and Martin Luther—A “reformation” in the helping professions

The 16th century schism in Christian thought leading to the Reformation has an interesting analogy in Carl Rogers' attempt to reform the helping professions. An exploration of this analogy clarifies much of the theoretical tension in the contemporary arena of pastoral counseling.     

Reliability of job evaluation: Differences across sex-typed jobs

Recent work has questioned whether a single job evaluation instrument can reliably measure jobs from different job families. To test this, a generalizability study was done to determine the reliability of three job evaluation instruments: one for male-dominated jobs, MIMA-Shop, one for female-dominated jobs, MIMA-office and one which evaluated both types, FES. Initial results indicated that the latter instrument suffered no loss in reliability, and that all three instruments were equally highly reliable. A second analysis evaluated the reliability of the FES for male-dominated jobs separately from the reliability of the FES for female-dominated jobs. These results indicated no significant difference in reliability for male-dominated jobs and for female-dominated jobs. Implications of these findings were discussed.A previous version of this paper was presented at the 95th Annual Convention of the American Psychological Association at New York City, August 1987.     

The effects of depression on structural aspects of the recall of prose

Investigated depressed patients' memory for stories. This indicated that although normal Ss showed particularly good recall for units central to the structure of the story, this did not hold for depressed Ss. In contrast, effects of centrality were comparable in high- and low-IQ Ss and effects of imageability of story units were comparable in both depressed and normal Ss. These results are consistent with the hypothesis that depressed patients do not use structure to organize stories when encoding them. A failure to identify central aspects of material and selectively recall them is likely to be a handicap to everyday functioning.     

The development of structural complexity in the child's concept of family: the effect of cognitive stage, sex, and intactness of family

Twenty-eight boys and 28 girls at each of the Piagetian preoperational, concrete operational, and formal operational cognitive stages were given an interview focusing on their concepts of family. Half of each group were from intact families, and half were from divorced families. Interviews were scored for two structural aspects of the concept of family: conceptual level, and use of dimensions that structure the concept. The complexity of children's concepts was strongly related to cognitive stage and, to a lesser degree, to sex. Frequency of use of concept dimensions was strongly affected by general developmental level, though not specifically cognitive stage, and by intactness of family, but to a lesser degree by sex. Specific information is provided on the effect of these factors on perceptions of family composition, parental roles, and breadth of family activities.     

Spatial location judgments as a function of intention to learn, and mood state: an evaluation of an alleged automatic encoding operation

An assessment of the Hasher and Zacks (1979) conceptualization of the automatic nature of the acquisition of spatial location information was made in the context of manipulations of subjects' intention to learn and mood state. The Velten (1968) mood induction procedure was used to establish depressed and nondepressed subjects. Half of each group was then presented with a matrix of geometric forms under instructions to learn the location of the forms (intentional) or to evaluate the pleasantness of the array (incidental). Subsequent tests of spatial location performance found no differences as a function of subjects' mood state, but did find a strong effect for instructional condition. The superior performance of the intentional subjects raises questions about the automatic nature of the encoding of spatial location.     

Conceptual,methodological, and clinical issues in cognitive-behavioral assessment

This article reviews cognitive-behavioral assessment principles and procedures. The functions of such assessments are noted, and issues and advances in cognitive assessment are discussed. The need for integrated cognitive, behavioral, and affective assessments is then explored. Finally, conceptual methodological, and clinical issues in the integration of assessments and study of reciprocal determinants are presented.Preparation of this paper was supported in part by a General Research Board Faculty Research Award from the University of Maryland. The author would like to thank Steve Graham, Donald Meichenbaum, Barbara Keogh, and Bernice Wong for their feedback during the preparation of this paper.     

Clinician attitudes toward stuttering: A decade of change (1973–1983)

The attitudes of 674 speech-language pathologists toward stuttering, stutterers, stuttering therapy, parents of stutterers, and related issues were studied during the years 1973–1983. During that period, clinician attitudes were found to shift away from support of the John-sonian concepts, which suggest parental causality and dangers in early intervention. In addition, clinicians became less likely to perceive stutterers as possessing psychologic disorders and misperceptions of their problem and of their interpersonal relationships. However, a significant number of clinician's were found to continue to hold unsubstantiated beliefs regarding the personality of stutterers, their parents, and the efficacy of early intervention with very young stutterers. The results of the study were interpreted as suggesting the need to educate fluency specialists.     

A preliminary report on defenses and conflicts associated with borderline personality disorder

The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.