Denial and Confirmatory Search: Paradoxical Consequences of Medical Diagnosis1

An experiment was conducted to examine the effects of medical diagnostic-test results on illness appraisal and the recall of symptoms and behavior. Subjects were tested for a fictitious enzyme deficiency and were told either that the test result was positive (deficiency present) or that it was negative (deficiency absent). In addition, some of the subjects were told the test was accurate 95% of the time and others were told it was accurate 75% of the time. As predicted, subjects judged the enzyme deficiency as less serious and more prevalent when presented with positive test results. Subjects with positive test results also recalled more behaviors that had been labeled as risk factors. Although positive test subjects tended to report more deficiency-related symptoms, diagnosis did not affect the free recall of general symptoms. In addition, information concerning the reliability of the diagnostic test had no effect on judgments or recall but did affect information seeking. Subjects with positive test results were less likely to request a definitive follow-up test when their results were unreliable. The results are interpreted as evidence for independent confirmatory search and denial processes following medical diagnosis.     

Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior

In the context of a school-based prevention of conduct disorder program, 7,231 first- through fourth-grade children were screened for cross-setting disruptive behavior. Frequencies of DSM-III-R psychiatric disorders and patterns of comorbidity were assessed. We also examined the association of psychiatric diagnosis with child and parent characteristics to determine differential risk based on diagnostic subgroups. Attention deficit hyperactivity disorder (ADHD) and oppositional-defiant disorder (ODD) were the most frequent diagnoses. Mood and anxiety disorders were infrequent as single diagnoses. Patterns of comorbidity demonstrated that both externalizing and internalizing disorders commonly cooccurred with ADHD. More severe degrees of psychopathology and psychosocial risk accrued to the subgroup of youths with ADHD plus a comorbid externalizing disorder.This study was supported by grant MN-46584 from the National Institute of Mental Health.     

Values interpretation: A new model for hospital ministry

The importance of values in clinical settings is a topic of increasing discussion in the medical literature, but the nature of values and the process of interpreting them have received little attention. The hospital chaplain or religious professional is an underused resource in addressing values issues. This paper summarizes the current models of the hospital chaplaincy in historical context, and then develops a new model drawn from the disciplines of pastoral care and clinical medical ethics in order to address problems involving values in clinical settings. The model construes the chaplain as values interpreter who provides both consultation and liaison functions in clinical situations. We present a clinical case to illustrate the role of the values interpreter. We conclude that the religious professional can make an important contribution to both clinical decision making and medical education through such a model.The authors thank Don S. Browning, Ph.D., and Thomas H. Jobe, M.D., for their critical readings of earlier versions of this paper.     

The influence of unionization on job satisfaction and work perceptions

Unionized and nonunionized processing employees were compared on their perceptions of job characteristics and different facets of satisfaction. In addition, the relationship between job characteristics and job satisfaction were compared for unionized and nonunionized samples. Jobs generally were not significantly different in relation to job challenge for the two groups, but nonunionized employees reported higher levels of some satisfaction measures. The correlations between job characteristics and job satisfaction were stronger in the unionized sample. Implications of the present results and suggestions for further research are discussed.This article is based on research presented at the meeting of the Industrial Relations Research Association at Chicago, December, 1987.The author would like to thank James Martin for his help on this project.     

Prime time: Fatigue and set effects in the perception of reversible figures

Subjects viewed unambiguous versions of both stationary and rotating Necker cube illusions for varying durations prior to the presentation of the standard ambiguous figure. In each case, the subjects were more likely to report the ambiguous figure to be (1) in the same configuration as that of the preceding prime following brief preexposure periods and (2) in the opposite configuration from that of the preceding prime following long preexposure-periods. In addition, the number of reversals of the figure during the test period was also strongly related to the duration of the preexposure period, with progressively fewer reversals reported following longer preexposure periods. The results are interpreted as revealing the concurrent roles of “set” effects in the brief preexposure conditions and neural fatigue effects in the long preexposure conditions. Furthermore, the ability of the proposed two-process model to integrate the myriad of empirical effects in the reversible-figure literature is emphasized..