Classification of the behavior disorders

Diagnosis of mental disorders among Turkish and American clinicians

Turkish and American clinicians from two centres in each country were compared in terms of diagnosing mental disorders in standard cases and in terms of stereotypes of symptomatology. Statistical comparisons showed that the American clinicians rated higher symptom severity in the cases and in the stereotypes. In the diagnoses assigned the particular orientations of the centres became evident. Confidence in diagnosis was rather high in spite of inadequate information in the short cases. The shortcoming of psychiatric classification due to differences among clinicians and the need for more studies of their inferential strategies were pointed out.

Dimensions of psychopathology among alcoholic patients, college students, prison inmates and general psychiatric patients

The Differential Personality Inventory was administered to four samples of subjects: 404 alcoholic patients, 292 college students, 720 prison inmates, and 181 general psychiatric patients. Exploratory factor analysis on the self-report data yielded seven factors in each sample. The six factors, interpreted as common across samples, were: hypochondriacal complaining, blunted affect versus emotional reactivity, interpersonal conflict, depressed withdrawal, cognitive disorganization, and dysfunctional coping. Implications for the empirical development of a multiaxial diagnostic system and the construction of a case-identifying instrument in psychiatric epidemiological research were discussed.

Cross-cultural conceptions of mental illness

Previous published papers by the author addressed the issue of the epidemiology of mental illness across different cultures. This paper departs from this basis and stresses the need for examining mental illness within the context of any given culture. Thus, the application of rigorous criteria, such as those specified by DSM III or ICD-9, to all cultures, regardless of how different behaviors are viewed within the culture is deemed to be specious. Moreover, the treatment of mental illness has been shown to be related to the perception of mental illness within any given culture and is clearly affected by social norms. Mental health professionals from over 20 countries were administered a questionnaire querying whether hypothetical cases would be diagnosed as mentally ill and if so what would be their diagnosis. Differences between professionals were discussed in light of cross-cultural variations. Suggestions for future research are offered.

The nature and consequences of forensic psychiatric decision-making

Data collected from the Metropolitan Toronto Forensic Service (METFORS) were examined to determine factors affecting psychiatric assessments completed for the courts. Psychiatric history is found to be a salient factor for fitness to stand trial decisions; prior violence and the type of charge influence dangerousness to others determinations. Variables affecting whether or not a patient is recommended for further assessment include fitness: 78% of those found fit and 100% of those for whom fitness was unclear were recommended for further assessment in 68% of the cases. Patients who were threatening or acting out were not for the most part hospitalized. Relatively high correlations between psychiatric recommendations derived from these assessments and the actual judicial dispositions suggest that knowledge of the extra legal factors and biases which enter into the decisions should be more widely considered in the legal setting.

The Evaluation of Diagnostic Models

There are two kinds of diagnostic models used in psychological research. A categorical model is used most commonly, but dimensional models have also been studied (Skinner, 1979; Strauss, 1973). When developing or using a model, it is important to determine when the model is appropriate for a particular setting. Unfortunately, methods for carrying out this kind of evaluation are only applied infrequently, particularly with categorical models. This paper reviews the importance of evaluating diagnostic models, and empasizes a Bayesian method for evaluating categorical models. An illustration of the method with previously published data is given.

The "urge to classify" the narcotic addict: a review of psychiatric classification. I

Attempts to classify drug addicts are divided into three main groups: (1) psychiatric classifications, (2) psychological classifications, and (3) classifications by pattern of abuse. An extensive literature review of the psychiatric classifications of narcotic addicts suggests that there is no one diagnosis that fits all narcotic addicts and that the importance of psychopathology in drug addiction has been exaggerated. It is concluded that theoretical psychiatric classifications of narcotic addicts have failed to stimulate empirical research and that empirical classifications have not demonstrated their utility for treatment and prognosis.

On being sane in insane places

It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment-the powerlessness, depersonalization, segregation, mortification, and self-labeling-seem undoubtedly countertherapeutic. I do not, even now, understand this problem well enough to perceive solutions. But two matters seem to have some promise. The first concerns the proliferation of community mental health facilities, of crisis intervention centers, of the human potential movement, and of behavior therapies that, for all of their own problems, tend to avoid psychiatric labels, to focus on specific problems and behaviors, and to retain the individual in a relatively non-pejorative environment. Clearly, to the extent that we refrain from sending the distressed to insane places, our impressions of them are less likely to be distorted. (The risk of distorted perceptions, it seems to me, is always present, since we are much more sensitive to an individual's behaviors and verbalizations than we are to the subtle contextual stimuli that often promote them. At issue here is a matter of magnitude. And, as I have shown, the magnitude of distortion is exceedingly high in the extreme context that is a psychiatric hospital.) The second matter that might prove promising speaks to the need to increase the sensitivity of mental health workers and researchers to the Catch 22 position of psychiatric patients. Simply reading materials in this area will be of help to some such workers and researchers. For others, directly experiencing the impact of psychiatric hospitalization will be of enormous use. Clearly, further research into the social psychology of such total institutions will both facilitate treatment and deepen understanding. I and the other pseudopatients in the psychiatric setting had distinctly negative reactions. We do not pretend to describe the subjective experiences of true patients. Theirs may be different from ours, particularly with the passage of time and the necessary process of adaptation to one's environment. But we can and do speak to the relatively more objective indices of treatment within the hospital. It could be a mistake, and a very unfortunate one, to consider that what happened to us derived from malice or stupidity on the part of the staff. Quite the contrary, our overwhelming impression of them was of people who really cared, who were committed and who were uncommonly intelligent. Where they failed, as they sometimes did painfully, it would be more accurate to attribute those failures to the environment in which they, too, found themselves than to personal callousness. Their perceptions and behavior were controlled by the situation, rather than being motivated by a malicious disposition. In a more benign environment, one that was less attached to global diagnosis, their behaviors and judgments might have been more benign and effective.