The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM ?C whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.     

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self‐Help Program for Mexican American Women With Binge Eating Disorders

Data on the compatibility of evidence‐based treatment in ethnic minority groups are limited. This study utilized focus group interviews to elicit Mexican American women's (N= 12) feedback on a cognitive behavior therapy guided self‐help program for binge eating disorders. Findings revealed 6 themes to be considered during the cultural adaptation process and highlighted the importance of balancing the fidelity and cultural relevance of evidence‐based treatment when disseminating it across diverse racial/ethnic groups.     

Differential Effect of Inter-Role Conflict on Proactive Individual’s Experience of Burnout

Purpose

This study examined how proactive personality interacts with inter-role conflict, measured as work?Cfamily conflict and family?Cwork conflict, to predict burnout, measured as emotional exhaustion, depersonalization, and reduced personal accomplishment.

Design/Methodology/Approach

Participants were 171 clerical employees. Hierarchical multiple regression was used to test whether proactive personality moderated the relationship between inter-role conflict and forms of burnout.

Findings

Family?Cwork conflict was not associated with burnout, but work?Cfamily conflict explained 30% of unique variance in emotional exhaustion and 9% in depersonalization. Proactive personality explained 12% of variance in personal accomplishment. Three-way interactions indicated that at high levels of work??family conflict and family??work conflict, proactive individuals reported lower levels of emotional exhaustion and personal accomplishment and higher levels of depersonalization than less proactive individuals.

Implications

While previous research has generally documented the virtues of proactive personality, our research indicates that when simultaneously faced with work?Cfamily and family?Cwork conflict, individuals with proactive personality experience more depersonalization and less personal accomplishment relative to less proactive individuals. Overall, results of three-way interactions imply that while a certain level of proactive personality may be necessary to buffer feelings of emotional exhaustion, beyond a certain level, proactive personality may lead one to experience higher levels of depersonalization and reduced personal accomplishment.

Originality/Value

This study extends previous research by examining the influence of two types of inter-role conflict on all three dimensions of burnout. It also responds to calls for additional research on potential moderators, buffers, or even antidotes to stress by examining how proactive personality interacts with stressors.     

The Relationship Between Dysfunctional Interpersonal Tendencies, Derailment Potential Behavior, and Turnover

Managerial derailment, which includes failure in the form organizational exit, poses costly consequences for organizations. We investigated the relationship between dysfunctional interpersonal tendencies, derailment potential behaviors, and actual managerial derailment in the form of voluntary and involuntary turnover. Data were from an archival database of high-level managers working for a global retail organization, including self-report interpersonal tendencies, 360-degree feedback data, and personnel history (N?=?1,796). Managers who exhibit the dysfunctional interpersonal tendencies associated with ??moving against people?? were more likely to enact derailment potential behaviors. As a result, these managers were more likely to be fired or quit. This study advances our understanding of the managerial derailment process by providing evidence of the positive relationship between derailment potential behaviors and both voluntary and involuntary turnover as well as the potential for ??moving against?? people to result in derailment. Our results may help to inform the selection, promotion, and training strategies employed by practitioners and potentially reduce the costs associated with losing high-potential executives. This is one of the first studies to provide evidence of the relationship between derailment potential behaviors and turnover, and in a rarely obtained sample of high-level managers. Additionally, derailment potential ratings were collected before managers?? exit from the organization, thus helping to overcome retrospective bias evident in prior studies; managers who ultimately derail were perceived as having exhibited behaviors consistent with the potential to derail before organizational exit.     

Meta‐analysis methods for risk differences

The difference between two proportions, referred to as a risk difference, is a useful measure of effect size in studies where the response variable is dichotomous. Confidence interval methods based on a varying coefficient model are proposed for combining and comparing risk differences from multi‐study between‐subjects or within‐subjects designs. The proposed methods are new alternatives to the popular constant coefficient and random coefficient methods. The proposed varying coefficient methods do not require the constant coefficient assumption of effect size homogeneity, nor do they require the random coefficient assumption that the risk differences from the selected studies represent a random sample from a normally distributed superpopulation of risk differences. The proposed varying coefficient methods are shown to have excellent finite‐sample performance characteristics under realistic conditions.     

Collins’ core fine-tuning argument

Collins (The Blackwell companion to natural theology, 2009) presents an argument he calls the ‘core fine-tuning argument’. In this paper, I show that Collins’ argument is flawed in at least two ways. First, the structure, depending on likelihoods, fails to establish anything about the posterior probability of God’s existence given fine-tuning. As an argument for God’s existence, this is a serious failing. Second, his analysis of what is appropriately restricted background knowledge, combined with the credences of a specially chosen ‘alien’, do not allow him to establish the premise \( \Pr (LPU \mid NSU~ \& ~k') \ll 1\) .     

Going to School with Friedrich Nietzsche: The Self in Service of Noble Culture

To understand Nietzsche’s pedagogy of self-overcoming and to determine its true import for contemporary education, it is necessary to understand Nietzsche’s view of the self that is to be overcome. Nevertheless, previous interpretations of self-overcoming in the journals of the philosophy of education have lacked serious engagement with the Nietzschean self. I devote the first part of this paper to redressing this neglect and arguing for a view of the Nietzschean self as an assemblage of ontologically basic affects which have been guided and modulated by the incorporation of perspectives. This interpretation has important consequences for self-overcoming, for it constrains the individual’s conscious agency to operations on perspectives. In light of this view I then advance a competing conception of self-overcoming and discuss some of the shortcomings of antecedent interpretations. Although previous interpreters have done their part to exhaust the characteristic actions of self-overcoming, I argue that they have either exaggerated the deleteriousness of social influence in the formation of the authentic individual, or else ignore it altogether. In the final part I reconsider the debate over the democratic or aristocratic nature of Nietzsche’s pedagogy of self-overcoming. Interestingly, self-overcoming cannot be labeled strictly as either, and out of this ambiguity grows the role of the school as an agent of cultural transformation.     

Reply to Kenneth Thomas's “Wild Analysis in Politics”

We try to clarify Kenneth Thomas's (“Wild Analysis in Politics”) mistakes about our analysis of the question: Do right‐wing authoritarian (RWA) beliefs originate from psychological conflict? We suggest, contrary to Thomas's analysis, an approach that builds on the kinds of psychodynamic causes we use to explain RWA and the importance of confirming them empirically.