Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

Covariance structure analysis in several populations

This paper is concerned with the study of covariance structural models in several populations. Estimation theory of the parameters that are subject to general functional restraints is developed based on the generalized least squares approach. Asymptotic properties of the constrained estimator are studied; and asymptotic chi-square tests are presented to evaluate appropriate model comparisons. The method of multipliers and the standard reparametrization technique are discussed in obtaining the estimates. The methodology is demonstrated by a set of real data.Computer facilities were provided by the Computer Services Center, The Chinese University of Hong Kong. The authors are indebted to several anonymous reviewers for suggestions for improvement of this paper.     

The role of familiarity in determining typicality

Ashcraft (1978b) found that people tend to know more properties of instances they rate as typical of a category than of instances they rate as atypical. This suggests that variations in typicality result from variations in familiarity. Three experiments are presented that challenge or qualify this suggestion. Experiment 1 showed that subjects sometimes produce more properties for items they rate as low in typicality. Experiment 2 showed that in a large, random sample of items, there was a tendency to produce fewer properties for atypical items, but Experiment 3 indicated that part of the reason for this result was a response bias to assign low typicality ratings to unfamiliar words, rather than a reflection of low perceived typicality of the referents themselves. These results suggest that variations in typicality can exist independent of variations in familiarity, although familiarity may also play a role.     

Some comments on the role of cotherapists in group psychotherapy with borderline patients

This paper points out examples of patients in a psychotherapy group who meet DSM-III criteria for the diagnosis of borderline personality disorder and who are treated by cotherapists utilizing object relations theory. Interpretations of phenomena shown by borderline patients—splitting, projective identification and denial—are illustrated. How cotherapy lends itself to the recognition and management of the problems these patients bring to group psychotherapy is illustrated.Hope Aspell assisted in the editing of this paper.     

The Headache Symptom Questionnaire: Discriminant classificatory ability and headache syndromes suggested by a factor analysis

A brief Headache Symptom Questionnaire was administered to 129 chronic headache Sufferers. The questionnaire accurately classified 68.42% of headache subjects in their proper diagnostic category, comparable to, but statistically less accurate than, the 86.4% agreement between expert headache diagnosticians using clinical interviews. Results of a factor analysis of the Headache Symptom Questionnaire lend support for their being two commonly accepted global headache categories—vascular/migraine and muscle contraction—and one headache dimension concerned with duration of headache pain. Combined migraine-muscle contraction headache was found to be related more to migraine than to muscle contraction headache, and cluster headaches emerged as a separate clinical entity, not loading positively on any factor and loading negatively on all three.This research was supported in part by Grant NS-15235 from the National Institute of Neurological and Communicative Disorders and Stroke.     

An Evaluation of the Jamaican Anticrime Program

A sweeping anticrime package was implemented in Jamaica in 1974. This program included severe penalties for possession of illegal guns, censorhsip of gun scenes from television and the movies, and greatly broadened police powers. The impact of this anticrime package on crime was assessed using quasiexperimental time-series designs with both months and years as the units of analysis. In a one year period there was a 14% reduction in homicides ( p <.05), a 32% reduction in rapes ( p <.01), a 25% reduction in robberies ( p <.05), and a 37% reduction in nonfatal shootings ( p <.01). Data from the second year following the implementation of the anticrime package were not available. The data from the fist year suggest that strict anticrime measures can reduce crime.     

EVALUATION OF BIOFEEDBACK IN THE TREATMENT OF BORDERLINE ESSENTIAL HYPERTENSION1

Direct biofeedback of blood pressure was compared with frontal EMG biofeedback and with self-instructed relaxation for the treatment of essential hypertension in a controlled group outcome study. Patients were followed up for four months after the end of treatment. Generalization of treatment effects was assessed through pre- and posttreatment measurements of blood pressure under clinical conditions in a physician's office. There were no significant reductions in diastolic blood pressure. The systolic blood pressure (SBP) of the patients receiving blood pressure biofeedback decreased 8.1 mm mercury (p = 0.07) and the SBP of the patients in the relaxation condition decreased 9.5 mm mercury (p = 0.05). In the generalization measures, there were significant reductions in SBP for the relaxation group. The results are discussed in terms of the general lack of replicability within the area of biofeedback treatment of hypertension.     

The effects of conditioning and novelty on the rat's analgesic and pyretic responses to morphine

Six experiments with rat subjects investigated the role of conditioning in morphine tolerance. Concurrent assessments of body temperature and pain sensitivity were conducted. Experience with morphine produced tolerance to its analgesic effects but enhancement of its hyperthermic effects. Environmental novelty enhanced analgesia but not body temperature (Experiments 1 and 4). Under conditions in which a discriminated hyperthermic CR provided clear evidence that morphine-environment learning had developed, discriminated analgesic tolerance was not obtained (Experiments 2 and 3). Similarly, whereas placebo administrations extinguished the hyperthermic CR (Experiments 4 and 6), analgesic tolerance remained unaffected (Experiments 4, 5, and 6). These experiments suggest that the pyretic and analgesic systems are differentially sensitive to conditioning and the effects of novelty.