Medicalizing Mental Health: A Phenomenological Alternative

With the increasingly close relationship between the pharmaceutical industry and the American Psychiatric Association (APA) there has been a growing tendency in the mental health professions to interpret everyday emotional suffering and behavior as a medical condition that can be treated with a particular drug. In this paper, I suggest that hermeneutic phenomenology is uniquely suited to challenge the core assumptions of medicalization by expanding psychiatry's narrow conception of the self as an enclosed, biological individual and recognizing the ways in which our experience of things--including mental illness--is shaped by the socio-historical situation in which we grow. Informed by hermeneutic phenomenology, psychiatry's first priority is to suspend the prejudices that come with being a medical doctor in order to hear what the patient is saying. To this end, psychiatry can begin to understand the patient not as a static, material body with a clearly defined brain dysfunction but as an unfolding, situated existence already involved in an irreducibly complex social world, an involvement that allows the patient to experience, feel, and make sense of their emotional suffering.     

CD4 Count and Physical Symptoms Among Urban African American Mothers with HIV: An Examination of the Role of Optimism and Depressive Symptoms

The current study examined the link between immune functioning (CD4 count) and physical symptoms, as well as the moderating role of optimism and depressive symptoms, in a sample of 99 low income, inner city African American women with HIV. Although there was no main effect of CD4 count on physical symptoms, depressive symptoms moderated the association between CD4 count and physical symptoms. More compromised immune functioning (lower CD4 count) was associated with more physical symptoms under conditions of higher levels of depressive symptoms, but not lower levels of depressive symptoms. This finding was observed using both a self-report measure and a clinician-rating of women’s depressive symptoms. There were no main or interactive effects for optimism. Clinical implications and future research directions are presented.     

Factor structure and correlates of the dissociative experiences scale in a large offender sample

The authors examined the psychometric properties, factor structure, and construct validity of the Dissociative Experiences Scale (DES) in a large offender sample (N = 1,515). Although the DES is widely used with community and clinical samples, minimal work has examined offender samples. Participants were administered self-report and interview measures, and a subsample was followed longitudinally to determine criminal and violent recidivism. The DES exhibited good psychometric properties, but an identified three-factor structure was of questionable replicability. Moreover, the DES factors displayed no evidence of differential correlates. DES total scores were correlated with trauma-related variables even after controlling for negative affectivity. Total scores were related to measures of antisocial behavior and aggression but did not predict recidivism. These findings support the reliability and construct validity of the DES in offenders but raise questions regarding the clinical utility of the DES factor scores above and beyond that of the total score.     

Classification accuracy of MMPI-2 validity scales in the detection of pain-related malingering: a known-groups study

The purpose of this study was to determine the accuracy of Minnesota Multiphasic Personality Inventory 2nd edition (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity indicators in the detection of malingering in clinical patients with chronic pain using a hybrid clinical-known groups/simulator design. The sample consisted of patients without financial incentive (n = 23), nonmalingering patients with financial incentive (n = 34), patients definitively determined to be malingering based on published criteria ( n = 32), and college students asked to simulate pain-related disability (n = 26). The MMPI-2 validity scales differentiated malingerers from nonmalingerers with a high degree of accuracy. Hypochondriasis and Hysteria were also effective. For all variables except Scale L, more extreme scores were associated with higher specificity. This study demonstrates that the MMPI-2 is capable of differentiating intentional exaggeration from the effects on symptom report of chronic pain, genuine psychological disturbance, and concurrent stress associated with pursuing a claim in a medico-legal context.     

I still think it was a banana: memorable 'lies' and forgettable 'truths'

Interpersonal influences on cognition can distort memory judgements. Two experiments examined the nature of these 'social' influences, and whether their persistence is independent of their accuracy. Experiment 1 found that a confederate's social proximity, as well as the content and the confidence of their utterances, interactively modulates participants' immediate conformity. Notably, errant confederate statements that 'lied' about encoded material had a particularly strong immediate distorting influence on memory judgements. Experiment 2 revealed that these 'lies' were also memorable, continuing a day later to impair memory accuracy, while accurate confederate statements failed to produce a corresponding and lasting beneficial effect on memory. These findings suggest that an individual's 'informational' social influence can be selectively heightened when they express misinformation to someone who suspects no deceptive intent. The methods newly introduced here thus allow multiple social and cognitive factors impinging on memory accuracy to be manipulated and examined during realistic, precisely controlled dyadic social interactions.     

The corrective effects of warning on false memories in the DRM paradigm are limited to full attention conditions

Effects of attention control and forewarning on the activation and monitoring of experimentally induced false memories in the Deese/Roediger-McDermott paradigm were investigated in a young adult sample (N=77). We found that reducing the degree of attention during encoding led to a decrease in veridical recall and an increase in non-presented critical lure intrusions. This effect could not be counteracted by a forewarning instruction. However, these findings did not emerge in a (retrieval supportive) recognition task. It seems that divided attention increases false recall when attention control and forewarning have to compete for limited cognitive resources in a generative free recall as opposed to a retrieval supportive recognition task. Forewarning instructions do not always protect young adults against experimentally induced false memories.     

Effortful control, explicit processing, and the regulation of human evolved predispositions

This article analyzes the effortful control of automatic processing related to social and emotional behavior, including control over evolved modules designed to solve problems of survival and reproduction that were recurrent over evolutionary time. The inputs to effortful control mechanisms include a wide range of nonrecurrent information--information resulting not from evolutionary regularities but from explicit appraisals of costs and benefits. Effortful control mechanisms are associated with the ventromedial prefrontal cortex and the ventral anterior cingulated cortex. These mechanisms are largely separate from mechanisms of cognitive control (termed executive function) and working memory, and they enable effortful control of behavior in the service of long range goals. Individual differences in effortful control are associated with measures of conscientiousness in the Five Factor Model of personality. Research in the areas of aggression, ethnocentrism, sexuality, reward seeking, and emotion regulation is reviewed indicating effortful control of automatic, implicit processing based on explicit appraisals of the context. Evidence is reviewed indicating that evolutionary pressure for cooperation may be a critical adaptive function accounting for the evolution of explicit processing.     

Elaboration and consequences of anchored estimates: An attitudinal perspective on numerical anchoring

In the standard numerical anchoring paradigm, the influence of externally provided anchors on judgment is typically explained as a result of elaborate thinking (i.e., confirmatory hypothesis testing that selectively activates anchor-consistent information in memory). In contrast, theories of attitude change suggest that the same judgments can result from relatively thoughtful or non-thoughtful processes, with more thoughtful processes resulting in judgments that last longer over time and better resist future attempts at change. Guided by an attitudinal approach to anchoring, four studies manipulated participants’ level of cognitive load to produce relatively high versus low levels of thinking. These studies show that, although anchoring can occur under both high and low thought conditions, anchoring based on a higher level of thinking involves greater use of judgment-relevant background knowledge, persists longer over time, is more resistant to subsequent attempts at social influence, and is less likely to result from direct numeric priming.     

Distinctive shapes benefit short-term memory for color associations, but not for color

In four experiments, we examined the effect of pairing colors with either homogeneous or heterogeneous shapes on a short-term memory task. In Experiment 1, we found no differences in color memory for displays in which colors were each associated with different shapes, paired with individual homogeneous shapes, or paired with heterogeneous shapes. In contrast, in Experiment 2, we found that when participants were asked to remember the specific pairings of colors, memory was improved for heterogeneous-shape displays. The benefit for heterogeneous shapes appears to be memorial, rather than one that occurs at the time of encoding (Experiment 3) or retrieval (Experiment 4). The present study suggests that distinctive shapes can be used to help bind color associations in visual short-term memory.     

Tuning in to another person's action capabilities: perceiving maximal jumping-reach height from walking kinematics

Three experiments investigated the ability to perceive the maximum height to which another actor could jump to reach an object. Experiment 1 determined the accuracy of estimates for another actor's maximal reach-with-jump height and compared these estimates to estimates of the actor's standing maximal reaching height and to estimates of the perceiver's own maximal reaching and reach-with-jump height. Perception of another actor's maximum reach-with-jump height was less accurate than the other estimates, but still accurate to within 8% error. The actor's reach-with-jump height was modified in Experiment 2 by attaching weights around the actor's ankles. Perceivers, who were explicitly aware of the manipulation, adjusted their maximum reach-with-jump estimates for the actor accordingly. In Experiment 3, perceivers were not explicitly aware of the weight manipulation, but provided significantly lower maximum reach-with-jump estimates after watching the actor walk while wearing the weights compared to estimates obtained after watching the actor walk while not wearing the weights. The results suggest that the actor's walking pattern was informative about the actor's capacity to produce a different action, jumping to reach an object.