Wisdom in clinical reasoning and medical practice

Exploring informal components of clinical reasoning, we argue that they need to be understood via the analysis of professional wisdom. Wise decisions are needed where action or insight is vital, but neither everyday nor expert knowledge provides solutions. Wisdom combines experiential, intellectual, ethical, emotional and practical capacities; we contend that it is also more strongly social than is usually appreciated. But many accounts of reasoning specifically rule out such features as irrational. Seeking to illuminate how wisdom operates, we therefore build on Aristotle’s work on informal reasoning. His account of rhetorical communication shows how non-formal components can play active parts in reasoning, retaining, or even enhancing its reasonableness. We extend this account, applying it to forms of healthcare-related reasoning which are characterised by the need for wise decision-making. We then go on to explore some of what clinical wise reasoning may mean, concluding with a case taken from psychotherapeutic practice.

Publication trends in individual DSM personality disorders: 1971–2015

Growth in personality disorder research has been documented by previous authors up to 1995. The aim of the present study was to extend this by examining publications rates for individual DSM personality disorders over the period 1971–2005, and making projections to 2015 based on these data. It was found that personality disorder research has grown in absolute terms, and as a proportion of overall psychopathology research. Research output is dominated by borderline personality disorder, with strong publication rates in other conditions such as antisocial and schizotypal personality disorders. In contrast, several personality disorders such as schizoid and paranoid personality disorder have failed to attract research interest. Based on current projections, there is expected to be no research output in 2015 for schizoid personality disorder. It was found that the rate of publications for personality disorders was not influenced by the publication of the last three revisions of the DSM diagnostic criteria. Several potential explanations such as the difficulty in conducting certain types of personality disorder research, and the validity of the current DSM diagnostic taxonomy are discussed.     

When vaccinating against information reduction works and when it does not work

Practice not only affects how information is processed, but also which information is processed. The Information-Reduction Hypothesis (i.e. Haider & Frensch, 1996) holds that — with practice — irrelevant task information (i.e. information that is not logically needed to correctly perform the task) is discarded from processing. Recently, Gaschler and Frensch (2007) have demonstrated that Information Reduction is not affected by the frequency with which individual task configurations are presented: well-practiced and little-practiced irrelevant task configurations are discarded at the same point in time during practice; Information Reduction is thus an item-general phenomenon. These findings suggest that Information Reduction is at least in part a consequence of top-down, voluntary control. In the present research, we ask how tasks can be constructed such that Information Reduction is avoided. Our results show that item-general Information Reduction is observed even when it leads to severe processing costs (i.e. errors). On the whole, the present results are in line with models of skill acquisition incorporating top-down modulation (e.g. Haider & Frensch, 2002) and are incompatible with purely data-driven accounts of skill acquisition (e.g. Logan, 1988; Nosofski & Palmeri, 1997; Palmeri, 1997; Rickard, 2004).     

走向实践的共同体——论现代性的反思性重建

现代性的基本矛盾是由其运作机制反思性唯我主义所导致的人类生存的具体性与抽象的客观体系的矛盾。重建现代性就需要克服反思性唯我主义。黑格尔的承认的辩证法、哈贝马斯的交往行动理论和马克思的实践的共同体,是现代性重建的三种不同路径。实践共同体就是马克思为之奋斗终生的人类理想社会自由人联合体的哲学表达。     

Making psychology incorruptible

This paper is a response to criticisms, by Peterson (1995) and others, of positions I took in an earlier article, “Manifesto for a science of clinical psychology” (McFall, 1991). I had argued that professional practice and training in clinical psychology must be governed by a scientific epistemology, and had outlined some of the specific reasons and implications. In this article, I attempt to correct misinterpretations of my previous arguments, to clarify ambiguities, and to fill any serious omissions. The fundamental points of the original Manifesto are defended, buttressed, and extended. In response to issues highlighted by the criticisms, two new corollaries are added to those offered in the original article. These summarize the arguments presented in this paper, with special emphasis on the essential role of skepticism as the best protection against the corruption of knowledge and practice in psychology.     

Correlation between EEG and auditory perceptual measures in auditory agnosia

We describe a child who acquired a gradual sustained speech deficit for which no specific etiology was found, and who had an associated epileptogenic abnormality on EEG. Assessment of auditory perceptual skills and receptive language confirmed that gradual parallel improvement occurred with the EEG after therapeutic anticonvulsant blood levels were obtained. Prospective trials of anticonvulsant drugs in conjunction with serial measures of central auditory abilities are necessary to establish their value in the management of the linguistic deficit in children with auditory agnosia.     

Dimensional structure and psychopathology correlates of the fear survey schedule (FSS-III) in a phobic population: A factorial definition of agoraphobia

The responses of 703 non-institutionalized phobics to the Fear Survey Schedule (FSS-III) were factor-analyzed utilizing a principal components procedure. Factors previously identified in student, adolescent and ‘non-phobic patient’ populations—(I) Social Anxiety, (III) Fears related to Bodily Injury, Death and Illness. (IV) Fear of Display to Sexual and Aggressive Scenes, (V) Small Animal Fears—were replicated. Additionally, an Agoraphobia (II) factor, corroborating recent findings by Hallam and Hafner (1978), and pointing to the specificity of this fear, emerged. Due to substantially high intercorrelations found, the Social Inadequacy dimension of the Symptom Checklist (SCL-90) and the Social Anxiety scale (I), on the one hand, and the Agoraphobic dimension of the SCL-90 and the Agoraphobia scale (II), on the other, could be used interchangeably with phobic populations. A higher-order factor analysis run on psychopathology scales employed, including factored FSS scales, yielded three components, (1) Neuroticism, (2) Phobia and (3) Agoraphobia. Opportunity was taken to define the Agoraphobic Syndrome empirically. A specific Somatization dimension was as highly related to Neuroticism, as to the higher-order Agoraphobic cluster, clearly supporting clinical observations with regard to the Agoraphobic syndrome. Some interesting findings are focused upon and discussed.