Spiritual issues in mental health care

Religious and spiritual issues in mental health are explored in the context of four conceptual models: the medical, the nursing, the humanistic, and the pastoral. This is done by looking at each model in terms of content, diagnostic focus, language and treatment goals, and primary qualities in the health provider.The models are illustrated by case studies gathered from a multidisciplinary setting. The discovery that each model can incorporate the religious and spiritual dimension in mental health care, but that each model does this in distinctive ways, is a key point.     

Physicians and clergy in dialogue

The goals and ends of contemporary medicine are often unclear. An explicit inquiry into the religious dimensions of healing offers an important perspective from which to evaluate the potential capabilities of the medical profession. This paper describes a course in which medical students joined divinity students to explore areas of mutual intellectual, professional, and personal interest. Students and faculty examined in depth three broad areas in which medicine and religion share common ground: concepts of health and illness from the religious perspective, approaches to the understanding of suffering and meaning, and the shared professional stresses of physician and clergy.This paper comes from the Department of Medicine, Beth Israel Hospital, and the Division on Aging and the Program for the Analysis of Clinical Strategies, Harvard Medical School, and the West Roxbury-Brockton Veterans Administration Geriatric Research, Education and Clinical Center, Boston.     

A scale for measuring persistence in children

Persistence and its assessment have been studied since the 1920s. One common approach in measuring persistence has been through testing the subject's ability to solve difficult or monotonous problems. Another approach has been through questionnaires. Although persistence is very important in academic achievement and in the general development of personality, no questionnaires have been developed for measuring persistence in children. The present research concerns the development of such a scale. It includes 40 items and was tested on 322 Israeli children aged 7-13. The internal reliability of the scale (Cronbach alpha) was .66, and the test-retest reliability after 6 months was .77. The scale differentiated active gymnasts from non-gymnasts as well as persistent gymnasts from dropout gymnasts. In addition, significant correlations were found between the scale and the need-persistence measure of the Rosenzweig Picture Frustration Study, Locus of Control, and other measures. We discuss these findings along with the significance of persistence in everyday life.     

Testing the dimensionality of the self-consciousness scales

The self-consciousness scale of Fenigstein, Scheier, and Buss (1975) was subjected to internal and external consistency tests based on the classical test theory model. The scale was found to have five underlying dimensions: two for private self-consciousness (viz., self-reflectiveness and internal state awareness), two for public self-consciousness, and one for social anxiety. The confirmatory factor analysis procedures employed by Burnkrant and Page (1984) are shown to be fallible as indicators of unidimensionality. Theoretical implications of newly identified dimensions in the public self-consciousness subscale are discussed.     

Invariance in the MMPI's component structure

Bernstein and Garbin (1985b) suggested that the Minnesota Multiphasic Personality Inventory's major clinical scales (excluding Scales ? and 5) can be approximated by an oblique three-component structure: (a) Profile Elevation, (b) Test-taking Attitudes, and (c) Optimism-Pessimism, collectively termed the salient weight model. In this study, we found that both this model and the MMPI's principal component structure remain invariant across race, sex, and, as previously noted, context of testing (job applicants vs. inmates in correctional institutions). We further noted that several alternative definitions of Profile Elevation provide equally satisfactory representation of the relations among the scales. This factor invariance is necessary, but not sufficient, for the MMPI to be viewed as unbiased.     

Relative allocation on concurrent schedules can depend on schedule parameters when behavioral parameters are constant

We develop a simple model of switching between the initial links of a concurrent-chain procedure. Behavior is determined by four parameters μ₁, μ₂, q₁, and q₂. The first two are the basic rates of switching from Schedule 1 and Schedule 2, respectively. The second two are the probabilities of leaving Schedule 1 and Schedule 2 after the corresponding terminal link has been completed. We show that for fixed values of these four parameters, the relative allocation on the initial links may change as a result of changes in initial-link schedules. The effect can be quite large if the switching rates are low. An implication is that relative allocation is not necessarily a good measure of behavior.     

Delayed temporal discrimination in pigeons: A comparison of two procedures

A within-subjects comparison was made of pigeons' performance on two temporal discrimination procedures that were signaled by differently colored keylight samples. During stimulus trials, a peck on the key displaying a slanted line was reinforced following short keylight samples, and a peck on the key displaying a horizontal line was reinforced following long keylight samples, regardless of the location of the stimuli on those two choice keys. During position trials, a peck on the left key was reinforced following short keylight samples and a peck on the right key was reinforced following long keylight samples, regardless of which line stimulus appeared on the correct key. Thus, on stimulus trials, the correct choice key could not be discriminated prior to the presentation of the test stimuli, whereas on position trials, the correct choice key could be discriminated during the presentation of the sample stimulus. During Phase 1, with a 0-s delay between sample and choice stimuli, discrimination learning was faster on position trials than on stimulus trials for all 4 birds. During Phase 2, 0-, 0.5-, and 1.0-s delays produced differential loss of stimulus control under the two tasks for 2 birds. Response patterns during the delay intervals provided some evidence for differential mediation of the two delayed discriminations. These between-task differences suggest that the same processes may not mediate performance in each.     

Competitive fixed-interval performance in humans

Two persons responded in the same session in separate cubicles, but under a single schedule of reinforcement. Each time reinforcement was programmed, only the first response to occur, that is, the response of only one of the subjects, was reinforced. “Competitive” behavior that developed under these conditions was examined in three experiments. In Experiment 1 subjects responded under fixed-interval (FI) 30-s, 60-s, and 90-s schedules of reinforcement. Under the competition condition, relative to baseline conditions, the response rates were higher and the pattern was “break-and-run.” In Experiment 2, subjects were exposed first to a conventional FI schedule and then to an FI competition schedule. Next, they were trained to respond under either a differential-reinforcement-of-low-rate (DRL) or fixed-ratio (FR) schedule, and finally, the initial FI competition condition was reinstated. In this second exposure to the FI competition procedure, DRL subjects responded at lower rates than were emitted during the initial exposure to that condition and FR subjects responded at higher rates. For all subjects, however, responding gradually returned to the break-and-run pattern that had occurred during the first FI competition condition. Experiment 3 assessed potential variables contributing to the effects of the competitive FI contingencies during Experiments 1 and 2. Subjects were exposed to FI schedules where (a) probability of reinforcement at completion of each fixed interval was varied, or (b) a limited hold was in effect for reinforcement. Only under the limited hold was responding similar to that observed in previous experiments.     

The psychology of self-esteem: Promise or peril?

The psychology of self-esteem bypasses consequential issues of everyday behavior and moral responsibility in favor of pursuing a global goal of enhanced self-esteem on the assumption that happiness, success, and responsible behavior will automatically follow. The goal is vague and ways of achieving it are confused and conflicting. Greater attention to concrete tasks and challenges and sensitivity to moral issues could help make therapy more clear, effective, and socially useful.     

Male liberation

This article on Liberation approaches the subject from the perspective ofmen. Women have taken the lead in trying to throw off the bondage of patriarchy. Men have, for the most part, been reactors to the evolving changes. The author feels that there is a more creative role for men to play, but first, we must become more conscious of the ways in which our privileged position oppresses us. The author documents this dynamic as well as points to some possible directions for men to move in their personal and professional lives. The priority on developing collegiality and inclusiveness in our professional associations gives this subject an important place in our thinking and decisionmaking.This paper was read at a workshop on male liberation at the National A.A.P.C. Convention in San Antonio, April 30,1982.