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.     

Following Foucault: Tall stories of mapping and inhabiting Pierre Rivière's landscapes as a 21st century inquiry

This paper documents the research methods adopted in a series of workshops on Pierre Rivière that took place at the University of Bristol. A group of scholars from Europe and Australia used philosophical, narrative, performative and artful approaches to re-examine the life of Pierre Rivière and family as documented by Michel Foucault (1975) and his team. They watched the film of the book (Allio, 1976) listened to emerging papers and wrote themselves into pivotal moments within the narratives they heard. They conducted narrative family therapy sessions with the ‘Rivière family’ and wrote themselves into the ensuing moments of evocation and connection. They made dolls, and wrote themselves into the voices of those dolls, and they gave presentations about how Pierre Rivière might be positioned within contemporary therapeutic, educational and media discourses. They wanted to find out if different kinds of knowledge might emerge from these ways of doing research differently. And yet it seemed that whatever form of inquiry they undertook, other subliminal, imaginary, fantasy and folk and fairy tale narratives seeped under efforts to produce rational, coherent academic texts. This paper explores this dual process of investigation in real time accompanied by eruptions into imaginary folklore and fairy story times, with segues into contemporary, fantastical stories of horror and murder. Each step the research team took became a doubled step, involving doubled listening and doubled knowing. To this end they have represented their research process (after Lather, 2007) as a doubled text and yet they have still not fully captured the emotional space of the workshops they inhabited. It was as if they were, for the short, intense period of time they were working together, collectively emotionally disassociated.     

The Practice of a Wellness Lifestyle in a Selling Environment: A Conceptual Exploration

The present study introduces the concept of a wellness lifestyle into the sales literature. In performing the role of an organizational boundary spanner, a salesperson may encounter an environment that generates a great deal of job stress. The stress-inducing situations are often broad in scope and influenced by multiple sources. Clarifying and expanding the knowledge of factors that influence salespersons’ abilities to cope with their stressful environments is important to sales organizations. We explore the notion of a salesperson practicing a wellness lifestyle and its potential to positively influence the development of coping strategies and organizational outcomes. Research propositions are presented.     

The Impact of Periventricular Brain Injury on Reading and Spelling Abilities in the Late Elementary and Adolescent Years

The present study was designed: (1) to investigate the long-term consequences of both the presence and the severity of periventricular brain injury (PVBI) on intellectual, academic, and cognitive outcome in extremely-low-birthweight (ELBW: < 1,000 grams) children at a mean age of 11 years; and (2) to determine the nature of the underlying difficulties associated with academic problems in these children. The results indicated that ELBW children without PVBI performed as well as full-term children on intelligence, academic, and cognitive ability tests. In contrast, ELBW children with mild and severe PVBI achieved significantly lower scores than either ELBW children without PVBI or children who were born at term. A second analysis indicated that, after accounting for Full Scale IQ, working memory and phonological processing were significant predictors of reading and spelling performance in ELBW children. These findings suggest that the presence and severity of PVBI, and not ELBW status alone, is associated with performance on tests of intelligence, and academic and cognitive functioning, and that some of the same factors known to be associated with learning disabilities in full-term children contribute to learning disabilities in ELBW children.     

Religion,Spirituality, and Marriage and Family Therapy: A Study of Family Therapists' Beliefs about the Appropriateness of Addressing Religious and Spiritual Issues in Therapy

For many years the literature in the field of family therapy was silent as to the religious and spiritual aspects of clients' lives. During the past five years, however, many voices have come forth calling attention to the importance of bringing spirituality and religion into our conversations with clients. The result of these new voices has been a significant increase in attention to spirituality in journal articles, books, and presentations at national conferences. While there appears to be a strong movement in favor of bringing spirituality and religion into the therapy room, there have been no published studies in marriage and family therapy journals that explore marriage and family therapists' beliefs about the appropriateness of addressing spiritual issues in therapy. The purpose of this study was to fill this gap in the literature by examining the beliefs of a random sample of clinical members of AAMFT in respect to this issue.     

Reduced specificity of autobiographical memory as a moderator of the relationship between daily hassles and depression

Autobiographical memory biases are potential cognitive vulnerability factors for depression, with recent research highlighting the potential importance of accompanying high levels of life stress. Using a prospective design, the current study examined the role of autobiographical memory performance, both reduced specificity and propensity towards categoric memories, as moderators of the relationship between life stress and depression in a non-clinical college sample. Findings suggest that an increased propensity towards categoric recall emerged as a vulnerability factor for future depressive symptoms, with this vulnerability not being dependent upon the presence of high levels of life stress. In contrast, while reduced autobiographical memory specificity did not emerge as a vulnerability factor alone, it did emerge as a moderator of the relationship between chronic daily hassles and depression. These findings highlight the potential importance of both propensity towards categoric recall and reduced specificity of autobiographical memory as vulnerability factors for the experience of future depressive symptoms.     

The effects of cue modality on the quality of personal memories retrieved

We investigated the effect of cue modality on the specificity, speed, vividness, and age of autobiographical memory retrieval. Cues were presented as either an odour, a visual image, or a word label. Odour-cued memories were older, more likely to be categoric, and were slower to be retrieved. Few gender differences were found although females reported more vivid memories than males. We suggest that cue modality directly affects retrieval processes; odour cues are more likely to initiate a perceptual search strategy, in contrast to memories cued by visual images and words, which are usually conceptually/verbally mediated.     

Assessment of Repeated Relational Patterns for Individual Cases Using the SASB-Based Intrex Questionnaire

Repeated interpersonal patterns are central to case conceptualization and treatment planning in interpersonal and attachment-based approaches to therapy. In this study, raters (133 college students, 165 inpatients) provided data on the Intrex questionnaire (Benjamin, 2000 Benjamin, L. S. 2000. Intrex user's manual, Salt Lake City: University of Utah.  [Google Scholar]) about self-treatment, relationship with a significant other, and remembered interactions with parents in childhood. Within-subject profiles were inspected for precise behavioral matches conforming to 3 “copy process” (CP) patterns: identification (behaving like an important other), recapitulation (behaving as if the other person is still present and in charge), and introjection (treating the self the way another did). We observed CP evidence in most individual ratings. Consistent with expectation, nonclinical raters tended to copy a securely attached pattern of affiliation, low hostility, and moderate degrees of enmeshment and differentiation. Only patients copied maladaptive behavior at greater than base rate expectation. We discuss implications and provide recommendations for use of Intrex in individual assessment of CP.     

Paranoia and Power Anxiety

Several previous studies of paranoid schizophrenia have provided only scattered support for Freud's notion that homosexual wishes and fears are the root of the difficulty. The present study was designed as a partial test of the broader theory that paranoid schizophrenia in men involves severe anxiety over aggression or assertion. The subjects were men and women in three categories: paranoid schizophrenic, nonparanoid schizophrenic, and people without any history of psychiatric trouble. Using a set of TAT cards portraying various situations of anger and aggression, it was found, as predicted, that paranoid schizophrenic men, and only paranoid schizophrenic men, show a defensive response. These findings are discussed in the context of traditional gender roles and other evidence about the paranoid style.     

The Barbour – Smith – Gilkey Paradox: Historical Relativity in Natural Science and Historical Religion

This paper is about the relation of historical relativity and religious certainty. To live in history and to live with historical relativity is to admit that we are subject to the limitations of creaturehood: we know right and wrong, truth and falsity, relative to our own time and place, history and culture, but we do not know any truth or right that is non-relative to time and place. The differences between historical and naturalistic discourses of explanation are radical, and usually overlooked by scientists.