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.     

THE EFFECTIVENESS OF REINFORCEMENT,RESPONSE COST,AND MIXED PROGRAMS ON CLASSROOM BEHAVIORS1

Six elementary school children served as subjects in an experiment comparing the relative effectiveness of (1) token reinforcement, in which children received tokens for attending and for correct arithmetic performance; (2) response cost, in which children received “free” tokens at the start of a period but lost them for inattention and for arithmetic performance below a specified level; and (3) a combination of both token reinforcement and response cost. During training, the six subjects received all three procedures in counterbalanced sequence. The effects of the three procedures were assessed by a within-subject comparison divided into three phases: (i) baseline, (ii) training, (iii) withdrawal of tokens. Introduction of the three token procedures markedly increased the two dependent measures. However, there were no differences across the procedures in the amount of change produced in either attending behavior or arithmetic performance. During baseline, the subjects averaged 29% attending behavior and 6.4 correct problems. These levels increased to 85% for attending behavior and 11.4 correct problems for arithmetic performance during training. Removal of all token procedures significantly decreased attending behavior (to an average of 65%), but produced a nonsignificant reduction in arithmetic performance (to an average of 7.6 correct problems). There was evidence that this lack of differential effects of the three token procedures was not due to an inability to discriminate among them. Furthermore, the subjects were evenly divided in their preference for the three procedures.     

TRAINING SUPERVISORS IN A COLLABORATIVE TEAM APPROACH TO PROMOTE PEER INTERACTION OF CHILDREN WITH DISABILITIES IN INTEGRATED PRESCHOOLS

Three supervisors of integrated preschools were trained in a collaborative team approach to encourage resource and classroom teachers to develop strategies that promote peer interaction of all children, including children with disabilities. The focus of classroom teachers' behaviors and the interactive play of children with disabilities were measured daily in both a training (indoor play period) and a generalization (outdoor play period) setting. In a multiple baseline design, supervisors were individually trained in a collaborative team approach using a manual, modeling, and role playing; then they implemented the approach with classroom and resource teachers. We found that after supervisor training, classroom teachers increased their behaviors directed towards children with disabilities and decreased their behaviors directed towards nondisabled children. Moreover, we found a doubling of the interactive play of children with disabilities and, for two of the three classes, an increase in the interactive play of comparison children, randomly selected by the classroom teachers. Changes in both teachers' and children's behaviors were also found in the generalization setting. The implications of the results for interventions in community settings are discussed.     

Bernard Mandeville and the rhetoric of social science

Mandeville's account of the place of rhetoric in the formation of society and of the concepts employed to comprehend it clarifies a number of his arguments and helps to explain their historical significance. Mandeville's theory consolidated a conceptual revolution in the understanding of the relations between motives and acts and resituated the passions as a problem in social analysis. It provides a way of understanding how these arguments played a unique role in the establishment of a rhetorical ideal of social science as they were reluctantly integrated into social theorizing during the two generations after Mandeville's death.     

PUPILS' SELF-SCORED ARITHMETIC PERFORMANCE: A PRACTICAL PROCEDURE FOR MAINTAINING ACCURACY1

Scoring of student performance is often costly in teacher time. Self-rating may be a practical alternative, if ratings are accurate. Some conditions affecting self-rating accuracy were examined in two special-education classes in two experiments. The first assessed the separate effects of submitting self-ratings to the teacher and token reinforcement for those ratings. Actual and self-rated performance during daily 20-minute arithmetic assignments were observed in a class of four boys with an average age of 10 years, four months. Subjects answered assignments in pen for later detection of falsified answers. At the end of the session, correct answers were projected and papers self-scored in pencil. During class dismissal, the experimenter surreptitiously scored actual performance. Three experimental conditions were introduced in an A B C B A design. During A, subjects self-rated but submitted no report, nor received token reinforcement. During B, self-ratings were reported to the teacher on a folded slip of paper, without reinforcement. During C, points were awarded for self-reported scores based on changes in individual performance from the prior condition and later exchanged for prizes. Subjects self-rated accurately during A, with little change during B. However, awarding points for self-reported scores in C, produced highly exaggerated performance. There was little change in correct arithmetic performance throughout the experiment. The second experiment examined a low-cost procedure to produce and maintain a low level of exaggeration in a class of 17 boys with an average age of 15 years, three months. Continuous, then intermittent checks on the accuracy of self-rated arithmetic performance were assessed in a multiple-baseline design across groups of subjects. Following a condition where subjects' self-reported performance was reinforced as in the first experiment, the self-rating accuracy of all subjects was checked publicly and a penalty applied for inaccuracies or bonus points for accuracies (Maximum Checks). During Minimum Checks, the self-rating accuracy of one randomly selected subject was checked. The reduction in checking frequency was gradual for one group and abrupt for the other. When self-reports were reinforced, 13 of the 17 pupils submitted ratings discrepant with actual arithmetic performance by more than two problems per session. Maximum Checks reduced discrepancies below two problems per session for 15 of the 17 pupils. This same low level of exaggeration was maintained during Minimum Checks for 14 of the 17 pupils. Correct arithmetic performance showed no systematic change. Teachers reported that self-rating resulted in time savings over their usual methods of scoring. The results indicated that pupils exaggerate when rewarded for self-ratings. Exaggeration was reduced and maintained at low levels by infrequent accuracy checks.     

Accounting for context: Future directions in bioethics theory and research

Many physicians have found that the traditional approach to bioethics fails to account for important aspects of their moral experience in practice. New approaches to bioethics theory are challenging the traditional application of universal moral principles based in liberal moral theory. At the same time, a shift in both the goals and methods of bioethics education has accompanied its “coming of age” in the medical school curriculum. Taken together, these changes challenge both bioethics educators and theorists to come closer to the details and nuances of real clinical encounters. The emerging trend emphasizes the importance of context in bioethics education and in the moral theory and research under-girding it. This article introduces one research approach examining the practical life contexts of medical students' ethical experiences and learning. It calls for increased attention to research and theory in bioethics that more adequately accounts for the ways different contexts produce significant changes in meaning and understanding in medical encounters.     

The ecobehavioral relationship between teachers' and disabled preschoolers' behaviors before and after supervisor training

A previous study (Hundert & Hopkins, 1992) demonstrated the functional relationship between preschool supervisor training and increased child and teacher behaviors. The present study describes a ecobehavioral analysis to suggest how the intervention worked. Following a baseline phase, three preschool supervisors were trained in a collaborative team approach where classroom and resource teachers jointly developed strategies to promote peer interaction of preschoolers with disabilities in three integrated classes. The results indicated that after the intervention: (a) the frequency of children's interactive play doubled during both training and generalization sessions; (b) covariations of peer interaction and teacher behaviors shifted from being related to the presence of a resource teacher in the class, to classroom teacher focus on groups that included a child with disabilities; and, (c) these shifts in child-teacher relationships were not clearly associated with changes in the frequency of teacher behaviors. The contribution of an ecobehavioral analysis to the understanding of complex environment-behavior relationships before and after an intervention is discussed.     

TRAINING TEACHERS IN GENERALIZED WRITING OF BEHAVIOR MODIFICATION PROGRAMS FOR MULTIHANDICAPPED DEAF CHILDREN

In contrast to previous studies where teachers were instructed how to implement behavior modification programs designed by an experimenter, teachers in the present experiment were taught how to write as well as implement behavior modification programs. The generalized effects of two training conditions on teacher and pupil behaviors were assessed by a multiple baseline design where, following baseline, two teachers of multihandicapped deaf children were taught to set objectives and measure pupil performance (measurement training). Later, through a training manual, they learned a general problem-solving approach to writing behavior modification programs (programming training). After both training conditions, experimenter feedback was given for teachers' application of training to a target behavior for one pupil and generalization was measured across target behaviors for the same pupil and across pupils. It was found that measurement training had little general effect on either teacher behavior or pupil behavior. However, after programming training, teachers increased their program writing and correct use of behavior modification procedures and generalized this training across pupils and target behaviors. Along with these effects, there was improvement in pupil behaviors. Possible explanations for generalized effects of teacher training were considered.