The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues 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 - 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 will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. 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.     

Contextualizing experience

This paper extends the discussion of Luke and Banerjee published in an earlier issue of this Journal by suggesting that psychologists studying the effects of stressful experiences on a later outcome do not always acknowledge the possibility that the experience might be correlated with conditions that are necessary for the outcome. This essay argues that the victims of a stressful event are not a random sample of the population and often belong to gender, class, or ethnic groups during particular historical eras that contribute to the outcome. The properties of these groups represent causal patterns that should replace the usual practice of examining the relation between a single independent and dependent variable.     

Foreword--As Per Verse: The Queer in the Clinic in the Poem

This essay introduces a series of poems by six authors: Rafael Campo, Susan Holbrook, Katie Price, Trish Salah, Qwo-Li Driskill, and Brian Teare. I argue that the poems demonstrate that a queer bioethics, whether literary or medical, must dispense with commonplace assumptions about the ways in which selves, especially queer selves, are represented in language. Instead, poetry’s sound-sense and avoidance of language-as-usual can serve as an analogy for modes of approach, analysis, and even recognition that do not receive official sanction; the non-linear modes of reading required by contemporary poetry can serve as methodological models for a queer bioethics.     

Team Coordination in Basketball: Description of the Cognitive Connections Among Teammates

This study investigated team coordination in basketball using the course-of-action theoretical framework. The focus was on how the players were connected with their teammates' activities. The activity of five French basketball players (17.60 ± .89 years) was studied during an official match. The data were collected and processed according to a procedure defined for course-of-action analysis. The results were used to characterize the coordination modes among players and the team coordination network that was built. The processes that underlie team coordination are discussed (i.e., mutuality and awareness), and some directions for practical applications are addressed.     

Physical activity does not provoke panic attacks in patients with panic disorder: A review of the evidence

Abstract

This paper summarizes the results of published studies in which physical activity has been performed by patients with panic disorder. Several case studies of apparent exercise-induced panic attacks were found. However, in field studies that involved ambulatory monitoring of panic disorder patients only 1 of 91 panic attacks that were monitored actually occurred while the test subject was engaged in moderately intense physical activity. Moreover, only five panic attacks occurred in association with 444 exercise bouts performed by 420 panic disorder patients in laboratory settings despite the fact that exercise induces somatic signs and symptoms of anxiety. Thus, the weight of the published evidence shows that acute physical activity does not provoke panic attacks in panic disorder patients.     

What is wrong with incest?

Incest taboos should be seen as involving non‐sexual objections to sexual relations, that is, objections based on who people are in relation to each other, rather than their activities. What is at stake is brought out by considering certain objections to father‐daughter incest and certain features of taboos. The objections that matter do not depend on social ties and distinctions having a biological basis, but there is nonetheless a biological element in incest taboos. To see it, one must look to the nature of the Oedipus complex, and to the conditions for the development of the individual and of society. There may be prohibitions which are necessary (to morality, to society, to humanity) even though they may not be justifiable within a narrower conception (e.g. utilitarian) of morality and justification. And so taboos which are universal (occur, in one form or another, in every society), and absolute (allow no questioning), and impose strict liability (allow no excuse), may not be irrational: they may mark the boundaries that shape a way of life.     

A Comparison between Certain Properties of the Level of Aspiration and Random Guessing

Differential predictions have been made concerning the effect of external beliefs on the skilled performance of Negroes. In the present study i was found that among black college athletes, externality covaried with elevated attainment on unobtrusive tasks.     

Uncovering beliefs embedded in the culture and its implications for practice: the case of Maltese married couples

Given the low incidence of marriage breakdown in Malta, this study investigates the level of marital satisfaction among Maltese couples and how they manage conflict between them. One particular interest in conducting this study has been that of exploring how cultural beliefs shape marital relationships and to what extent Maltese clinicians can rely on the Anglo-American literature in their clinical work with married couples. Three hundred and fifty-four randomly selected couples answered a self-administered questionnaire simultaneously and separately. A number of findings, namely the influence of a child-oriented family in the level of marital satisfaction and the predominance of a constructive style of conflict resolution, differed from those we normally find in the Anglo-American literature. The study addresses the importance of taking into account the cultural context when working with couples. The implications for practice of the various beliefs embedded in the culture are highlighted.     

Making Sense of Suffering: A Preliminary Study of Changes in Religious Women Adjusting to Severe Adversity

This qualitative study examined interviews from 25 women who held theistic beliefs from Christian, Islamic, or Jewish traditions. All had recently experienced severe adversity but reported they were coping well. Analysis illustrated changes in religious beliefs and attitudes they made as a result of learning to cope. Differences were found among the 3 religious groups. Findings of this preliminary study suggest that religious meaning and experience may change because of the process of learning to cope with severe adversity. Recommendations are made for counseling theistically oriented women.