The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches 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 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 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.     

The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined.     

Content and temporal structure of autobiographical knowledge: Remembering twenty-five seasons at the Metropolitan Opera

Three experiments were designed to explore the structure and content of a well-defined subset of very long-term autobiographical memory. In Experiment 1, the author free-recalled in a single session details about the dates and casting of 284 opera performances seen at the Metropolitan Opera over a period of 25 seasons. Recall accuracy was measured by comparing the recall with the programs for each performance. Primacy and recency effects were prominent in recall of both temporal and casting details. Also, recall of performances was superior if the performances were included in the sequential structures of seasons in memory. Experiments 2 and 3 were designed to examine the effect of an opera performance's relative importance (or intensity) and opportunities for rehearsal of an opera performance on the author's free recall of the performance. In Experiment 2, importance/rehearsal opportunity was estimated from nine sources, including recordings, telecasts, tapes, and photograph books. In Experiment 3, the set of opera performances was rated and ranked by four opera experts on the dimension of intensity or importance of each performance. In both experiments, importance/rehearsal opportunity was related to superior recall of casting but not to recall of temporal details. Results suggest that detailed temporal structure in autobiographical memory is lost over time, whereas contents may be updated through various forms of rehearsal.     

Dominance: Another Facet of Type A1

Aggression, but not dominance, is typically used as a criterion for the assessment of Type A behavior. This study proposed and demonstrated that nonaggressive dominance, defined as interpersonal resistance or persistence in efforts to control a competitive situation, is associated with Type A behavior for both males and females. Forty males and 35 females typed with the Jenkins Activity Survey participated in a revised version of the classic Deutsch and Krauss (1960) competition paradigm. Both A males and females were more dominant than their respective Type B counterparts. Type A males were not different from Type A females in persistence, nor were Type B males different from Type B females. Female Type A's were more resistant to their competitor's efforts at controlling the situation than were their Type B counterparts. Male Type A's did not differ from their Type B counterparts in resistance. The implications of these results in further elucidating the mechanisms underlying the relationship between Type A and pathophysiologic health hazards are discussed.     

Adolescent Adjustment and Coping Strategies

This study examines the relation between psychosocial adjustment and coping strategies among college freshmen. Three hundred thirty-one college students completed the Inventory of Psychosocial Development (IPD; Constantinople, 1969) and the Adolescent Coping Orientation for Problem Experiences (ACOPE; Patterson & McCubbin, 1987) inventory. Factor analysis of the ACOPE scales revealed two factors interpreted to represent the coping strategies of "salutary effort" and "stress palliation." For each subject a relative salutary effort score was calculated to reflect the proportion of coping efforts ascribable to mature, salutary coping efforts. Optimal adjustment was associated with adolescents whose reported means of dealing with tension reflected a high proportion of salutary effort. These findings, which support the notion of a covariation between styles of coping and psychological adjustment among adolescents, are discussed in light of psychosocial development, coping, and methodological issues related to research on coping and adjustment.     

Gender differences,mediation, and disciplinary styles in children's responses to television

A sample of kindergarten and first-grade children was studied in a research center and at school to determine the extent to which family communication mediated their comprehension of television, as well as a series of cognitive skills necessary for such comprehension. Separate analyses were conducted for boys and girls, and results indicated that certain styles of family mediation facilitated comprehension more effectively for boys than for girls. Additionally, differential effects of two styles of discipline were found for each sex.This research was funded by a grant to Jerome and Dorothy Singer from the John D. and Catherine T. MacArthur Foundation entitled Television and Family Living Patterns.     

A group approach to guilt in depressive and suicidal patients

Summary A psychiatrist and a pastoral psychologist considered the problem of guilt as a source of alienation in depressed and suicidal patients by using a four-dimensional approach in a group psychotherapy setting. This involved functioning as cotherapists representing theological and psychiatric orientations and utilizing both didactic and insight-oriented approaches to elicit and explore meaningful material related to guilt feelings. With a number of exceptions, the patients did not appear to make a sharp distinction between the cotherapists' roles. The didactic openings on guilt served to provoke ready discussion of personal conflicts involving guilt feelings, especially in the silent patients who were not easily drawn into spontaneous discussion.     

Absolute motion parallax and the specific distance tendency

In the absence of definitive cues’to distance, the perceived distance of an object will be in error in the direction of the object appearing at a distance of about 2 m from O. This tendency to perceive an object at a relatively near distance is termed the specific distance tendency (Gogel. 1969). Also, it has been found that an error in perceiving the distance of an object will result in an apparent movement of the object when the head is moved (Hay & Sawyer. 1969; Wallach, Yablick. & Smith. 1972). From these two results, it was expected that the direction of trie apparent movement of a stationary point of light resulting from head movement would vary predictably as a function of the physical distance of the point of light from O. This expectation was confirmed in an experiment in which both the perceived motion and perceived distance of the point of light were measured. The consequences of the study for the role of motion parallax in the perception of distance and for the reafference principle in the perception of object motion with head motion are discussed     

Reciprocation of generosity and knowledge of game termination in the decomposed Prisoner's Dilemma Game

Sahlins proposed a model of reciprocity for social interaction citing three forms drawn from observations of kinship systems. The model describes an altruistic form of reciprocity, a balanced or economic form and a negative form in which individuals try to outdo each other. This model was applied to a two-person variation of the Prisoner's Dilemma Game where Ss were presented with a confederate who responded over trials entirely generously, contingently generously or non-generously. Half of the Ss were informed that there would be ten trials while the other half were uninformed. Basically, Ss tended to match the generosity level of the confederate and were less generous when trial number was known. Evidence for Sahlins' model is provided by Ss reports of reasons for their choices in the game. Those in the generous condition gave reasons for reciprocating based on a general feeling of obligation, trust and desire to cooperate. Those in the contingently generous condition gave reasons for reciprocating based on economic exchange and a desire to maintain a balance of resources. Ss in the non-generous condition gave reasons based on a desire to take what profits one could before the other got them. In addition, Ss indicated a significant tendency to exploit the other on the final trial under the informed condition for the contingently generous but not for the generous condition.