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.     

A prototype approach to understanding sexual intimacy through its relationship to intimacy

The nature of sexual intimacy using lay conceptions (i.e., prototypes) of intimacy and sexual intimacy has been explored. In Study 1, participants listed the features of sexual intimacy and intimacy. In Study 2, centrality ratings of these features were obtained. Although the 2 prototypes were very similar, they each had unique central attributes. In Study 3, central features of both concepts were found to be more salient in memory than peripheral features. Finally, in Study 4, the endorsement of central intimacy and sexual intimacy attributes in real romantic relationships were associated with relationship quality and sexual well‐being, respectively. The nature and function of sexual intimacy is discussed, and it has been concluded that sexual intimacy is best conceptualized as a subtype of intimacy.     

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.     

Remembrance of lies past: A comparison of the features and consistency of truthful and fabricated trauma narratives

The credibility of reports of victimization must be evaluated by police and adjudicators. The present prospective study investigated the features of truthful and fabricated narratives of trauma and their relative consistency over a 6‐month period. Participants described both a genuine and fabricated traumatic experience on three occasions over the 6 months. The narrative features were coded at each phase and the stories' consistency was examined at Times 2 and 3. We found that truthful trauma narratives contained more: details, contextual information, and emotional details, and were rated as more ‘plausible’, relative to fabricated traumas. The details of truthful narratives also were more factually consistent than fabricated narratives over the 6 month interval. This research offers basic information on the nature and consistency of traumatic memories, and potentially applicable information for discriminating true and false allegations. Copyright © 2010 John Wiley & Sons, Ltd.     

Neurobehavioral sequelae of child sexual abuse.

This study examined intellectual and memory functioning in a sample of sexually abused children compared to demographically and age-matched controls. The severity of abuse and other pertinent factors were also examined in relation to cognitive performance. Elevated levels of psychopathology were present in the abused children, as well as diminished performance on tasks influenced by attention/concentration. However, after controlling for differences in IQ and socioeconomic status (SES), significant differences in memory function were not found. Results are discussed in the context of stress effects on cognition and the potential resiliency of cognitive function in children undergoing treatment for sexual abuse.     

Relationship context and personality shape people's preferences for network relationship partners

This study investigates how people weight potential relationship partners' personal characteristics (i.e., warmth and competence) when deciding to initiate professional versus personal network relationships, and it also examines how certain personality traits (extraversion and conscientiousness) shape this process. Results from two samples indicate that people tend to value competence more highly when initiating professional relationships, whereas they tend to value warmth more highly when initiating personal relationships. Furthermore, neither extraversion nor conscientiousness was related to how people weighted competence when initiating professional relationships. However, supplementary analyses demonstrated that people high in conscientiousness tend to value competence and people high in agreeableness tend to value warmth in their network relationship partners, regardless of whether they are initiating a professional or personal relationship.     

Reading between the lies: identifying concealed and falsified emotions in universal facial expressions

The widespread supposition that aspects of facial communication are uncontrollable and can betray a deceiver's true emotion has received little empirical attention. We examined the presence of inconsistent emotional expressions and "microexpressions" (1/25-1/5 of a second) in genuine and deceptive facial expressions. Participants viewed disgusting, sad, frightening, happy, and neutral images, responding to each with a genuine or deceptive (simulated, neutralized, or masked) expression. Each 1/30-s frame (104,550 frames in 697 expressions) was analyzed for the presence and duration of universal expressions, microexpressions, and blink rate. Relative to genuine emotions, masked emotions were associated with more inconsistent expressions and an elevated blink rate; neutralized emotions showed a decreased blink rate. Negative emotions were more difficult to falsify than happiness. Although untrained observers performed only slightly above chance at detecting deception, inconsistent emotional leakage occurred in 100% of participants at least once and lasted longer than the current definition of a microexpression suggests. Microexpressions were exhibited by 21.95% of participants in 2% of all expressions, and in the upper or lower face only.     

Behavioural coherence in violent group activity: An interpersonal model of sexually violent gang behaviour

This study provides an analysis of offender‐victim interactions in 223 cases of sexual violence committed in gangs. Cases were derived from archival sources such as law reports. A multivariate analysis revealed four interpersonal themes (dominance, submission, co‐operation, and hostility) previously identified in studies of lone sexual assault [Alison and Stein, Vicious Circles: Accounts of stranger sexual assault reflect abusive variants of conventional interactions. J Forensic Psychiatry 12:515–538, 2001]. These themes have also been identified in many other forms of human relating [Wiggins, An informal history of the interpersonal circumplex tradition. J Pers Assess 66:217–233, 1996] and conform to a structure known as the interpersonal circumplex. The circumplex has previously been used to conceptualise the relationships between individuals in terms of dynamic interactions that are mutually influencing. Thus, dominance elicits submission and submission elicits dominance. Each interpersonal style could be further subdivided according to the use of either verbally or physically abusive strategies. Point‐Biserial correlations with other aspects of the offence (e.g., mobility of the group, post‐offence treatment of the victim) provided additional support for these conceptually different themes and demonstrated that gang rape represents a distorted and violent form of interpersonal relating. Further, this dynamic interaction emerges not just at an individual level, but at a group level, suggesting that the thematic concepts underpinning the interpersonal circumplex can be extended to group activity and sexually aggressive behaviour. Aggr. Behav. 30:449–468, 2004. © 2004 Wiley‐Liss, Inc.