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.     

Encoding context and false recognition memories

False recognition of an extralist word that is thematically related to all words of a study list may reflect internal activation of the theme word during encoding followed by impaired source monitoring at retrieval, that is, difficulty in determining whether the word had actually been experienced or merely thought of. To assist source monitoring, distinctive visual or verbal contexts were added to study words at input. Both types of context produced similar effects: False alarms to theme‐word (critical) lures were reduced; remember judgements of critical lures called old were lower; and if contextual information had been added to lists, subjects indicated as much for list items and associated critical foils identified as old. The visual and verbal contexts used in the present studies were held to disrupt semantic categorisation of list words at input and to facilitate source monitoring at output.     

Covariates of Production and Perseveration on Tests of Phonemic,Semantic and Alternating Fluency in Normal Aging

ABSTRACT

Standard measures of phonemic and semantic fluency, as well as fluency measures that impose additional demands upon set-switching were administered to younger and older adults. No age effect was found for total output on semantic fluency, while older participants generated significantly more responses relative to their younger counterparts on the phonemic measure. However, older adults made significantly more perseverative errors on both these measures. For tests of alternating fluency, only where participants were required to switch between two semantic dimensions, was an age deficit observed. Although the correlation between phonemic repetitions and age remained significant when performance on the Digit Symbol Test or a measure of fluid intelligence was partialled out, age effects for semantic repetitions and semantic alternating fluency were substantially reduced. The age benefit for number of correct responses upon phonemic fluency was significantly attenuated when a measure of crystallized intelligence was entered as a control variable. The theoretical and practical implications of these results are discussed.     

Spiritual Coping in American Buddhists: An Exploratory Study

Researchers in the United States have examined spiritual coping in Christians, Jews, Hindus, and Muslims, but rarely Buddhists. Using qualitative methodology, the present study represents an initial investigation into Buddhist forms of coping. Twenty-four Buddhists from across the United States were interviewed by phone, examining how their spirituality is used to cope with stress. Thematic analyses revealed six forms of Buddhist coping—right understanding, meditation, mindfulness, spiritual struggles, morality, and finding support in one's sangha. Implications of the study are discussed, including possibilities for future research on Buddhist coping.     

Global Self-Esteem as a Correlate of Work-Related Attitudes: A Question of Dimensionality

We examined the dimensionality of one of the most frequently used measures of global self-esteem, the Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965). Although the RSE is assumed to be unidimensional, Kaplan and Pokorny (1969) provided evidence that the scale taps two independent constructs: self-derogation versus defensive assertion of self-worth, in our study a confirmatory factor analysis was conducted which supported the superiority of the Kaplan and Pokorny two-factor model over a one-factor model but indicated that their model provided a poor fit to the data. Consequently, an exploratory factor analysis was conducted which revealed two dimensions, one mostly defined by negatively worded items (self-derogation) and the second by positively worded items (self-enhancement). Although the correlations obtained were generally quite small, relations with work-related attitudes shown for the negative factor were in the opposite direction and somewhat larger than those shown for the positive factor. Thus, additional support was provided for a two-dimensional conceptualization of the scales.     

Bearing Witness Through Medicine: An Exploratory Study of Attitudes to Service Among Australian Evangelical Christian Doctors

This study explores the attitudes of Australian evangelical Christian doctors to healing, suffering and good practice, using in-depth interviews. Doctors described an intellectualised faith, in which medical care was conceived in itself as a way of bearing witness. The alleviation of suffering, for these doctors, included supporting patients to rediscover purpose and meaning in their lives. There was diversity of opinion about evangelising, with many feeling that this was a contingent activity best conducted outside the consultation. This cohort of doctors, mostly non-denominational, had consciously engaged in work with the poor and marginalised as an expression of their faith.     

The Elective System in American Education

Abstract

The Distribution and Relation of Educational Abilities. By Cyril Burt. London, Darling, 1917. 93 p.

The Child's Unconscious Mind. By Wilfrid Lay. N. Y., Dodd, Mead and Co., 1919. 329 p.

Education For Character. By Frank C. Sharp. Indianapolis, Bobbs-Merrill Co., 1917. 453 p.

Mental Hygiene of Childhood. By William A. White. (With an introduction by H. Addington Bruce.) Boston, Little, Brown and Co., 1919. 193 p.

Experimental Education. By Robert R. Rusk. N. Y., Longmans, Green and Co., 1919. 346 p.

The American Language. By H. L. Mencken. N. Y., Knopf, 1919. 374 p.

The Winston Simplified Dictionary. Edited by William D. Lewis and Edgar A. Singer. Phil., Winston Co., 1919. 820 p.

First Lessons in Business. By J. A. Bexell. Philadelphia, Lippincott, 1919. 174 p. (Thrift Text Series).     

Dimensions of temperament and depressive symptoms: Replicating a three-way interaction

High negative emotionality (NE), low positive emotionality (PE), and low self-regulatory capacity (i.e., effortful control or EC) are related to depressive symptoms and furthermore, may moderate one another’s relations to such symptoms. Indeed, preliminary evidence suggests they may operate in a three-way interaction (Dinovo & Vasey, 2011), but the replicability of that finding remains unknown. Therefore, we tested this NE × PE × EC interaction in association with depressive symptoms in 5 independent samples. This interaction was significant in 4 of the 5 samples and a combined sample and approached significance in the fifth sample. In contrast, the NE × PE × EC interaction was unrelated to general anxious symptoms and thus may be specific to symptoms of depression. Implications, directions for future research, and limitations are discussed.