Psychology

Psychological Testing

Psychological Testing from Early Childhood through Adolescence. A Developmental and Psychodynamic Approach

By Miriam G. Siegel

Madison, CT, International Universities Press, Inc., 1987. 529 pp.

Although psychological testing has been around for some time, Miriam Siegel has written a refreshing and insightful guide to the testing of children and adolescents. Most notable is her illumination of the context in which such young subjects present themselves, specifically in terms of its effects on both administration and interpretation. Though the work is evidently written for clinicians, its clear style and case presentations make it a good introduction for interested students and other professionals.

The book is divided into two parts. Part I focuses on the setting in which testing is done and looks at qualitative impressions which the clinician should consider in approaching the child. For instance, the affective and cognitive style of the child, in addition to parental factors (both during and outside the session) form a composite of external effects on the test results. Certain age-specific factors are also relevant, and here Siegel points to developmental milestones (such as Piaget’s stages). Often, the way in which children enter the room, approach the test, and interact with parents, clinicians, and their own bodies will indicate much about their background. Part I advises the clinician to consider the test results with respect to these features, in addition to culture, environmental idiosyncrasies, and past experiences.

A general introduction is then given to several tests: Wechsler intelligence tests, Rorschach Inkblot, Thematic Apperception Test (TAT), Children’s Apperception Test (CAT), human figure drawings, and Bender Gestalt drawing. A brief history and introduction is provided, along with examples. Siegel then spells out age-specific features of administration, along with a guide to integrating the results. It is noteworthy that the author also talks about the clinician as well as the subject, warning, “the clinician’s unconscious attitudes toward mental health and illness may sometimes distort his judgment” (p. 140). Such a careful consideration of all features of testing underlies the entire work. The final chapters in Part I, on integration and presentation of results along with diagnosis, are especially thorough and insightful. Although Siegel writes about age-specific elements, there is a general lack of detail in terms of differentiating children versus adolescents. More information on developmental milestones, especially around the time of puberty, would have been extremely helpful.

Part II consists of eight case studies, and provides all test results (including all responses and relevant human figure drawings) with interpretations. The cases range in age and type of disorder. Siegel draws upon Part I to illustrate her holistic approach, showing how a battery of psychological tests is used to analyze a child. Although the cases are well presented, interesting, and easy to follow, they presume some experience with the tests and with clinical work in general. In addition, several of the analyses seem a bit contrived, especially since the reader knows only a little about the subjects’ backgrounds. It should be noted that the author relies upon a “developmental and psychodynamic approach,” which is appropriate, given the tests’ historical and theoretical basis (especially the projective tests). Again, background knowledge of psychoanalytic and/or developmental theory (Piaget in particular) is useful.

In all, Siegel has written an eloquent, masterful introduction to psychological testing of children and adolescents. The book’s holistic perspective with clear case studies presents a well-substantiated, thorough guide for numerous clinicians and test protocols.

Biological Psychology

Biological Psychology: An Introduction to Behavioral, Cognitive and Clinical Neuroscience (Book and CD-ROM), Third Edition

Mark R. Rosenzweig, S. Marc Breedlove, and Arnold L. Leiman

Sunderland, Massachusetts: Sinauer Associates, 2001. 651 pp.

Biological Psychology by the trio of Rosenzweig, Breedlove, and Leiman explains the biological foundations of evolution, development of the nervous system, regulation of behavior, emotions and mental disorders on a student-oriented textbook. Throughout the entire book lies a strong emphasis in the biological processes that produce and govern behavior and cognition with respect to the environment. The level of the text is geared to the beginning student in the discipline. With a colorful format, icons, key terms, boxes, and a CD-ROM, which contains quizzes and Sylvius, a module to learn neuroanatomy, a new student should consider purchasing or buying Biological Psychology.

The writing is clear and the illustrations that accompany it are not only attractive but illustrative as well. With CD-ROM links to several key illustrations, the book is undoubtedly tightly integrated and cross-referenced among its various modes of presenting information to the student. Because the text is geared for the beginner that would consider specializing in the discipline, it was general, yet technical enough that as a medical student I found it helpful in relearning some neuroanatomy structures such as the circle of Willis. Therefore, certain parts of the text can also be used by students who wish to become clinicians in addition to those who want to become specialized researchers. All chapters contain up-to-date research that would prove useful to both kinds of students. As an aside, the book actually contains photographs of current researchers such as Nancy Wexler, which connects a face with hot-off-the press research.

Usually, I devote the second or third paragraphs in the review to criticisms of the book. The terseness of this paragraph indicates how I feel this textbook is as close to a paragon for excellence for biological psychology textbooks that I have read.

Biological Psychology was clearly designed with the student in mind. I give it the highest recommendation and it should be welcome addition to your library.

Psychosocial Factors in Pain

Psychosocial Factors in Pain: Critical Perspectives

Gatchel RJ, Turk DC, editors

New York: The Guilford Press; 1999. 510 pp. with index

ISGN 1-57230-285-2

The preface to this book stakes out its claim. We are told that 4 main developments, each involving psychologists, served as the impetus for a revolution in thinking about pain. This revolution consists in the rejection of a “medical model” in favour of a “bio-psychosocial approach.”

The volume comprises 30 chapters. Of these, the first 9 make up Part I, on biopsychosocial context. In Part II 11 chapters deal with special topics and populations, and Part III provides 10 more on issues in prevention and management. The book finishes with an overview on resolution and evolution. Three out of the 43 authors of the 30 chapters are physicians dealing with pain and AIDS (a magnificent review), the epidemiology of low-back pain, and work style and work-related upper extremity disorders. There is an epidemiologist or two, a dentist with qualifications in psychology, and almost all the rest are psychologists dealing with pain. These include 3 Canadians (Gagliese, Katz and Melzack), Flor from Germany, and Main (from Glasgow and now Manchester).

The great bulk of the material reflects the work and views of US psychologists and their special psychosocial context.

This is a long volume, well produced and full of information, often very well worked out. The text itself is easy to read and very solidly written for the most part. Some chapters are excellent in whole or in part, while others seem to exist only to disappoint.

It is an irritating pity that what could have been a superb volume is marred by 2 faults of emphasis. One is needless special pleading and the other is an ill-founded, albeit highly sophisticated, tendency to revise the understanding of what it means to favour a back-pain disability model.

The special pleading begins with the listing of 10 contributors to the psychological approach. Three of these were actually physicians but not identified as such. More important, and tellingly, there is a lack of understanding or recognition that psychosocial factors have always been strong in medicine. Psychologists now dwell in a field long inhabited and not relinquished by internists, family doctors, neurologists, psychiatrists and a host of others.

Psychologists are much more numerous than psychiatrists in the field of pain and have made great contributions, starting with Hebb and Melzack. But some of their contributions (e.g., behavioural therapy of pain) remain controversial, and the field in which they have gained most recognition and added most to the subject appears to be cognitive treatment, which, incidentally, was applied to pain by a psychiatrist, A.T. Beck. Thus, what should have been a friendly and sociable claim to have made a large contribution has been spoiled by exaggeration.

More important, the way in which the biopsychosocial construct is now treated serves to reduce the biological element and to suggest that pain is largely due to psychological causes. I partly made that mistake myself and can sympathize, but the fact is that we have very few genuine indications that pain for which physical explanations are lacking is due to psychological causes except when it occurs with or after the onset of an obvious affective disorder. In other cases, and especially with musculoskeletal pain that arises with questionable indications of psychological difficulty, there is insufficient evidence to support the view that pain is due to vaguely alleged “behavioural factors,” but there is growing evidence from systematic controlled investigations that the determining factor is the state of the facet joints or degeneration (not prolapse) of intervertebral disks.

One of the most insidious practices connected with rejecting the patient’s pain consists in describing correlated information as “predictive.” Every psychologist knows that correlations do not demonstrate a causal link, except when there is a serial position, and should not be thought of as a causal consequence. Yet the insinuating word “prediction” is used repeatedly to corroborate some argument for psychological causation.

I do not want to leave the impression that Gatchel and Turk, as editors, make no attempt to acknowledge evidence that complicates their message. They recognize much of it. However, overall the book states the problems softly when they relate to weaknesses in psychological achievement, and overstates the failures of the organic approach. This is the more distressing because the authors and editors have all made significant contributions in the past, and continue to do so. Unfortunately, as one of my colleagues puts it, those who state their adherence to the biopsychosocial approach most loudly do not appear to be as serious about the “bio-” element.

Neural Networks and Psychopathology

Neural Networks and Psychopathology: Connectionist Models in Practice and Research

Dan J. Stein, Jacques Ludik, editors

Cambridge (UK): Cambridge University Press; 1998. 371 pp. with index

ISBN 0-521-57163-4 (cloth)

Neural networks are mathematical models of how the mind processes information, just as mathematical equations can be seen to describe the universe. Neural networks can provide the theoretical framework that clinical science lacks for integrating psychological and neurobiological data. This theoretical framework is based on the idea that the brain functions by a process of pattern recognition. Each chapter in this collection, edited by Dan Stein and Jacques Ludik, looks at this process from a unique perspective and, taken as a whole, demonstrates the complexity of the mind arising from basic units and their interconnections.

This book is aimed at a very diverse audience including clinicians, researchers in psychopathology and those working in cognitive science and artificial intelligence. Its chapters are organized into 2 broad sections. The first part of the book presents general concepts. Each chapter demonstrates how neural network modelling can be used to understand clinical practice and research in areas such as diagnosis and psychotherapy. The second part of the book constructs neural network models of various clinical disorders and demonstrates their usefulness in helping improve one’s understanding of the pathologic process underlying these clinical disorders.

A number of important ideas are introduced in the first section. For example, neural network or connectionist models “rely on the idea that almost all knowledge is implicit in the structure of the device that carries out the task rather than explicit in the states of the units themselves.” This means that knowledge is stored in the strength of the connections between units or neurons and not in the units’ moment-by-moment activity. Nevertheless, this activity does affect the strength of synaptic connections through the process of learning. This leads to an important dilemma: How can the brain be plastic enough to learn new patterns as well as stable enough to remember old patterns? Knowledge is stored as patterns of activation of neurons, determined by synaptic connections. This leads to another important concept: the function of the brain is to recognize patterns; and the effectiveness of the brain is measured by how accurately it can match patterns and by how well it can generalize (find similar patterns). When the brain becomes faulty in its ability to correctly discriminate patterns, clinical symptoms such as delusions and hallucinations can arise. Delusional individuals interpret all inputs in the light of some false belief. Any bit of information is used to support this false belief no matter how ludicrous the connection. Conceptually, the delusional brain continually matches all inputs to a specific incorrectly matching pattern; or in other cases, one pattern becomes central in interpreting all inputs. With respect to hallucinations, perception involves the superposition of sensory input with higher cognitive expectations, but if the system is strongly focussed on expectations and ignores sensory input then the system will perceive objects that are not there. Again the brain is unable to correctly match incoming patterns (sensory information) with stored patterns (memory or expectations).

In the second half of the book, specific clinical disorders are modelled, based on the basic principles from the first half of the book. The success of this modelling is both thought-provoking, in demonstrating how underlying neuropathology can result in complex symptomatology, and fascinating, by forcing one to reexamine previous views of psychopathology. The models very nicely integrate neurobiology and psychological data, and because the computer models are working models one can see how the brain might process information. Dan Lloyd looks in depth at how a new memory can affect previously learned related memories and vice versa. This process is addressed in the specific context of traumatic memories. He constructs a computer simulation, called Lucynet, that models human learning based on the most basic neural network theoretical principles. The simulation is exposed to the traumas of Sigmund Freud’s patient, Lucy R. The results of this recreation address several aspects of memory. They support the cognitive research showing that recall is the construction of a memory rather than its extraction from a form of storage. The results also show that repression can result from the inherent process of memory formation rather than requiring the hypothesis of a novel mechanism of the ego as proposed by Freud.

In another chapter, Ira Cohen gives an elegant working model of autism. Working from the neurobiological data, which suggests that autistic people have a greater number of synaptic connections, a greater number of neurons or abnormal wiring patterns in various brain regions, combined with the recognition that autistic children are very poor at generalization, the computer model runs several scenarios of either too few, an optimal number or too many neurons faced with a learning task. “With too few neurons, the computer simulation shows that overall learning and generalization are weak and responses are inconsistent. With an optimal number of neurons, both learning and generalization are good and correct responding is consistent and predictable. With too many neurons, learning is good but generalization is poor and shows relatively little variation.” This inflexibility relates to the typically stereotyped and inflexible responses of autistic children. There is more depth and complexity to these models when presented in their respective chapters, but this brief summary may convey the ability of these simulations to recreate psychopathology while functioning with only the basic rules of learning in connectionist theory.

Although the term “neural network” or “neural net” is becoming popularized, at least in science fiction, it is not a well-understood concept. There are few, if any, psychiatry programs or even psychology programs that include it as part of their teaching curriculum. I believe that it will become increasingly advantageous to know something of this area. The scope of this book is wide and it is aimed at a diverse audience. Nevertheless, it is an important attempt to make this area more understandable. Each chapter is written by a different expert, and this format requires a strong introduction to pull the pieces together. The lack of this kind of introduction is the major deficiency of the book. This format also runs the risk of becoming disjointed. Luckily, this does not happen because the structure of the book itself allows for a significant amount of redundancy, and the concepts from the first half of the book are expanded on in the second half. There was only one chapter that I found quite incomprehensible because it was so poorly written. Generally, all authors focus more on concepts than on the details of how to construct and run a neural network model. This approach keeps the book accessible to the diverse audience to which it is aimed.

As a non-expert in the field of neural network modelling, I found the book absolutely fascinating because there are many concepts and reconceptualizations that do not require an intimate working knowledge of neural network theory. Still, some knowledge of neural network modelling is of benefit in appreciating the complexity of the issues. And I must point out that the subject matter is dense.

The editors open the first chapter with the following statement “The recent shift in psychiatry from a predominantly psychodynamic model towards a neurobiological paradigm has led to advances in our understanding and management of many mental disorders. At the same time this shift has been characterized as a move from a brainless psychiatry to a mindless one.” Neural network modelling has the capacity to reintroduce the mind even if not in all its complexity. This makes the final chapter by David Forrest on the challenges facing clinicians and researchers, as well as some of the potential limitations of neurocomputational modelling, an especially appropriate and thought-provoking conclusion to a book that challenges one to think.

Mind and Brain Sciences in the 21st Century

Mind and Brain Sciences in the 21st Century

Robert L. Solso, editor

Cambridge (MA): The MIT Press; 1999. 354 pp. with index

ISBN 0-262-69223-6 (paper)

In this book 18 prominent writers in the field of neuropsychology and neuroscience review recent progress and make prognostications about where the field is going in the 21st century. The topics range from the serious to the whimsical, but all are challenging, yet lucid, and well written. Carl Sagan is a cosmologist and science author of international reputation, and his wife, Ann Druyan, is an author, lecturer and television producer. All the others are leaders in psychological and neurobiological research. The essays are grouped into 4 sections.

The first section deals with consciousness and the 21st century. In cognitive psychology, consciousness has been a central topic, yet until the last decade, the subject was avoided by most researchers, largely because many believed that it was impossible to study one’s own subjective experience in an objective way. Bernard Baars takes a look at this and describes a world of sentient, self-knowing beings; he hopes humans will achieve this in the next century. Carl Sagan and Ann Druyan challenge the traditional notion that humans are the only animals with true consciousness. They suggest that there is no qualitative discontinuity between the cognitive processes of a human and his pet dog. Richard Thompson explores the concept of “mind” as separate from “brain” (”the Ghost in the machine”). As a behaviourist, he feels that in the 21st century we will come to understand “mind” as the behavioural expression of brain function — nothing more. Endel Tulving, with tongue-in-cheek, describes an incident in which a being from 2096 is sent back (time machine?) to help him with his prognostications, and this being tells him about many new terms and concepts of the future. Tulving cleverly lampoons our use of acronyms and our propensity to think we understand something because we have given it a name.

In the second section, “Brain and mind in the 21st century,” 5 essays deal with the separation between cognitive psychology, largely influenced by behaviourism, and cognitive neuroscience, focussing on brain structure and function. Edward Smith postulates that neuroimaging of the normal brain will bring these 2 approaches together. Michael Posner and Daniel Levitin review the impact of neuroimaging on our understanding of how the brain works. Alan Gevins postulates a world in which everyone might be plugged into a brain scanner much as a mechanic plugs your car into a diagnostic computer. Karl Pribram discusses structures of memory and conscious learning, and Michael Gazzaniga asserts that whatever your brain does, its purpose is sex.

In recent years, psychology has moved away from behaviourism and is now trying to pry open Skinner’s Black Box. In the section “Psychology (memory, theory, and cognition) in the 21st century,” 6 well-known writers try their hand at predicting where psychology will go next. Henry Roediger HI, in a thoughtful essay, reviews the accuracy of past predictions (almost zero) and makes 11 “testable predictions” for the next 25 years. Gay Snodgrass looks back from 2050 and suggests a world of “memory trainers.” Jerome Kagan looks at current concepts in psychology and suggests that specific knowledge will change many and render the rest obsolete, with inevitable consequences for the classification systems. George Sperling discusses the role of theories in advancing knowledge. Neil Miller suggests that the future, as the past, is one of totally unexpected opportunities. Hans J. Eysenck writes a masterful historical overview of psychology and sees the future as an extrapolation of the past.

In the final section, “Mind sciences in the 21st century,” Robert Solso reviews the other essays and offers his views on current trends and new directions. He emphasizes the continuing importance of consciousness, the relationships between neuroimaging data and direct observations of behaviour, and the impact of scientific developments in other non-biological areas of science. He states that there has been a paradigm shift in the basic concept of the scientific method in the 20th century and that this will influence the whole direction of science in the next.

I found this book often challenged my conceptualizing powers; however, it was indeed a fascinating read. In fact, upon second reading I discovered many insights that I had missed the first time.

Emergencies in Mental Health Practice: Evaluation and Management

Emergencies in Mental Health Practice: Evaluation and Management

Kleespies PM, editor

New York, The Guilford Press; 1998. 450 pp

ISBN 1-57230-255-0 (cloth)

In the introduction to this book, the editor points out that most training sites for psychology interns provide limited or no training at all in emergency psychological services, reflecting a general inattention to such services in the field of professional psychology. However, the editor suggests, if clinicians are to regard themselves as independent practitioners, they must be prepared to assist patients in the event of a life-threatening behaviour or a psychological emergency, whether in the office, the emergency department or elsewhere. Referring to psychiatry as a paradigm, he recommends that mental health disciplines incorporate training in the management of emergencies as a professional requirement. For the purpose of such training, the editor offers the structure of this book as “a proposed curriculum for a knowledge base in emergency psychological services/’ The book is structured into 6 parts consisting of 19 chapters. Most of the chapters have been written from the perspective of the mental health professional who must evaluate and manage a behavioural emergency in the emergency department or, occasionally, in another setting. Some of these chapters are excellent, offering useful and practical advice. This is especially true of the chapters on emergency interviews, evaluation and management of suicidal patients and potentially violent patients, and emergency telephone calls. The 2 chapters on risk management offer helpful reminders of the importance of consultation and proper documentation in dealing with suicidal or violent patients. A laudable feature, not found in other comparable books, is the devotion of 3 chapters to the stressful impact on the clinician of patient suicidal behaviour, violent behaviour and disaster. The weaknesses of the book are likely the result of the large number of contributors — 33 in all — with 2 to 5 authors in 15 of the 19 chapters. There is duplication between chapters, the writing style is variable, and even the perspective from which the chapters are written differs. For instance, the last chapter is written from the point of view of the psychologist. The entire Part 5, consisting of nearly 100 pages, is not about emergencies but about syndrome psychiatry and pharmacotherapy, which are best covered in a traditional text-book. Inconsistencies also occur. A notable example is that considerable effort is expended in the first 2 chapters to distinguish “crisis” and “crisis intervention” from “psychological emergency” and “emergency intervention,” and to dissuade the reader from using these terms interchangeably. However, in chapters 3, 4 and 6, either these terms are used interchangeably or new definitions are given. Some chapters would benefit from increased succinctness and decreased preoccupation with referencing every statement.

The inspiration for this book came from the editor’s considerable clinical and supervisory work with psychology interns in emergencies at the Boston Veteran Affairs Medical Center. The editor and the chapters’ authors, most of whom are psychologists, have created a book that will serve well psychology interns, their supervisors, and students and staff of other mental health professions in the evaluation and management of emergencies in mental health practice. I hope that this book will be a catalyst for increased training in this important but rather neglected field of mental health practice.

Schizotypy: Implications for Illness and Health

Schizotypy: Implications for Illness and Health

Claridge G, editor

New York: Oxford University Press; 1997. 340 pp with index

ISBN 0-19-852353-X (cloth)

Psychiatrists and psychologists start from a different place. Given their medical background, psychiatrists tend to emphasize the dichotomy between health and illness. Moreover, classifications of mental disorders, such as the various editions of the Diagnostic and Statistical Manual of Mental Disorders, are taken to imply that psychiatric illnesses, like medical conditions, are distinct entities with unique etiologies.

Yet a great deal of evidence indicates that psychiatric diagnoses are very fuzzy indeed. In fact, the phenomenon of “comorbidity,” which is the focus of many research studies, may be nothing but a reflection of the failure of the categorical system to describe psychopathology adequately.

Psychologists, who study normality and variation from it, are much more inclined to see health and illness as continuous. Since the editor (a professor at Oxford University) and most of the contributing authors of this book are psychologists, it is not surprising that this volume takes a strongly dimensional view of psychopathology. “Schizotypy” — the focus of this book — can be conceptualized as a set of traits that form the basis of a variety of illnesses, ranging from schizophrenia to personality disorders, as well as of normal variations in personality that can produce eccentricity or creativity.

Two issues arising from this theory are of particular interest to psychiatrists. First, some evidence suggests that both forms of psychosis originally described by Kraepelin (i.e., schizophrenia and bipolar disorder) could lie on a single dimension, and may not be as separate as we often assume. Second, disorders not usually considered to reflect schizotypal traits, such as obsessive-compulsive disorder and dyslexia, may reflect the same psychopathologic dimension — at least in part.

Several chapters in the book raise questions of broader theoretical significance. There are excellent reviews of research on cognitive processes and cerebral lateralization in schizotypy. Other chapters concern the measurement of schizotypal traits. Finally, there is a whole section entitled “schizotypy in health subjects.”

This book has strengths and weaknesses. Since all chapters are written by Claridge and his collaborating colleagues, the text is much more coherent than many multi-author books. On the other hand, research conducted outside of Great Britain is not given enough weight. Although Claridge suggests that readers also consult a recent companion volume based on a conference on schizotypal personality, the contributions of investigators such as Holzman and Siever and Davis could have been given much more space.

Claridge’s strong editing leads to a relatively high standard of scientific writing throughout. Inevitably, however, some of the chapters are hard-going, while those written by the editor himself are the best. Claridge is a natural writer and communicates in an incisive and witty way that quickly engages the reader.

I was particularly stimulated by Claridge’s ideas about how to conceptualize psychopathology in a dimensional system. The point of view is refreshingly different from the perceived wisdom in North America. These principles are also developed in several of the chapters written by neuropsychologists.

Although I agree strongly with the general approach of this book, it lacks breadth. It fails to address some of the most crucial areas for theory, most particularly genetics and neurobiology. I also found myself less than sympathetic toward the chapters on normal schizotypy, some of which come dangerously close to reviving the Laingian romanticism of the 1960s.

A related objection concerns the emphasis in many chapters on the role of psychosocial factors in the etiology of schizophrenia and related disorders. I agree with Claridge that psychiatrists are often too busy prescribing medication to consider individual differences in the psychology of their patients, and that cognitive therapy may well have a role in the treatment of psychosis. However, his views on the role of the environment can be somewhat quirky, most particularly his somewhat dogmatic idea that trauma and bad parenting are the major factors that determine whether traits develop into disorders.

With these caveats, I found this book highly original and extremely thought-provoking. Researchers studying disorders related to schizotypy will find it a useful reference, and clinicians and clinician-teachers will benefit from reading the theoretical chapters. The main impediment to the wide use of this volume is the price, which, whatever the state of the Canadian dollar, is much higher than for books imported from our southern neighbour.

The Millon Inventories: Clinical and Personality Assessment

The Millon Inventories: Clinical and Personality Assessment

Millon T, editor

New York: The Guilford Press; 1997. 552 pp

ISBN 1572301848 (hard cover)

This book provides an overview of the growing family of personality inventories developed by Theodore Millon and members of the Institute for Advanced Studies in Personology and Psychopathology. Chief among these instruments is the Millon Clinical Multiaxial Inventory (MCMI), which is one of the 2 or 3 of the most widely used personality assessment methods in the world; 16 chapters of the book are devoted to it. While there are 6 books describing the inventory, this is the only one edited by Millon himself. The introductory chapter reviews Millon’s theoretical approach to personality assessment, which balances the nomothetic and idiographic traditions; the chapter illustrates how this theory guided the design of the assessment inventories.

A distinguishing feature of the MCMI and the more recent Index of Personality Styles is that they are systematically linked to a comprehensive theory of personality. This has an evolutionary base that draws parallels between the phylogenetic evolution of a species and the development of adaptive strategies for a person or a group, including personality style. The evolution of personality style is honed by a formative process involving biological endowment, social experience and interaction with the environment, both at the personal level and as a facet of culture. Millon identified 3 “motivating aims” that prompt and direct human behaviour: preservation of life, adaptation to change, and reproduction or replication. In this model, personality is dynamic; it includes behavioural elements (expressive behaviour and interpersonal conduct), phenomenological aspects (cognitive style, self-image and object representations), intrapsychic elements (covering the person’s regulatory mechanisms such as projection, exaggeration or acting out) and, at a biophysical level, mood and temperament.

The MCMI translates these theoretical insights into a diagnostic instrument suited for clinical populations; it is not intended for use as a general personality assessment. Rather than classify people into set personality types, the MCMI follows a prototypal approach that scores them along 11 personality dimensions, such as schizoid, avoidant, depressive, dependent or narcissistic. The emphasis is on identifying elements of multiple patterns that may co-exist in the person; the goal is to emphasize quantitative gradations rather than qualitative, all-or-none distinctions. Of the many theoretically possible permutations of personality types, about 20 cover over 80% of cases. Assessments can be linked to the DSM taxonomy of personality disorders. The MCMI is heuristic and seeks to provide clinicians with a “means for understanding the principles that underlie their patients’ functional and dysfunctional behaviors, thoughts and feelings.” The dynamic formulation of personality addresses the question “what functional processes and structural attributes are necessary for the client’s personality pattern to exist as an organic whole?” The process of interpreting the MCMI is complex (and is illustrated rather than explained in full in this book); it also takes account of scores indicating severe personality pathology and clinical syndromes. As well, the MCMI includes items designed to identify various response biases.

In addition to covering the MCMI, the book devotes 6 chapters to reviewing other scales developed by Millon’s group. These include the Millon Adolescent Clinical Inventory, intended for measuring adolescent personality and adjustment, and the Behavioral Health Inventory, which covers styles of coping with physical illness. The book also briefly describes 3 other personality scales: the Millon Personality Diagnostic Checklist, the Personality Adjective Check List and the Index of Personality Styles. Each assessment inventory is described only in general terms and the scales themselves are not shown. For this the reader would have to turn to the existing manuals for each instrument; this book does not address any of the practical details of how to obtain copies of the instruments. Somewhat more attention is paid to the clinical interpretation of scores, which is illustrated by case reports. Summary information on reliability and validity is provided and fairly extensively referenced.

The book is written for people who are already familiar with the Millon Inventories. Indeed, one weakness of the book may be that it assumes undue familiarity with the scales: the chapter headings refer to abbreviated titles of the scales, which are, in some instances, not spelled out in the chapter. The reader is assumed to understand chapter titles such as “The Role of Psychological Assessment in Health Care: the MBHI, MBMC, and Beyond.” Furthermore, descriptions of the purpose of each instrument are often sketchy. The chapter on the Millon Behavioral Health Inventory, for example, describes it as “a standardized, objective psychological assessment tool that offers significant utility in the assessment of medical patients and as such may be a significant addition to the assessment technologies of the primary care physician” (page 389). Later clarification doesn’t help very much: the MBHI is “designed to assess the personologic and psychological coping factors related to the physical health of adult medical patients” (page 391). One has the impression that the authors were perhaps too close to their subject, and there seems a risk that this book may fall between the cracks: it does not provide sufficient information for the neophyte to decide whether a scale will suit a particular purpose, nor does it offer a full review of the latest information on each scale for the experienced user seeking an update.

Nonetheless, the book is useful in drawing together in one source a wide range of general information on these scales. The book is technical and scholarly but still very readable. Although it is an edited volume, the style and content are successfully integrated, and one can sense Millon’s guiding hand in each of the chapters. The book offers useful background reading for practising psychometricians; it will provide a good introduction to Millon’s approach for students taking courses on psychological assessment. The book might also benefit the reader with a general interest in psychological and health measurement: many insights lie in these pages. The introductory discussion on the role of theory in developing personality assessments, for example, is excellent, and so is the discussion in chapter 14 on issues in assessment in different cultural settings. This is a book to encourage your library to buy as a general reference rather than a “must have” for your own bookshelf.

General Psychopathology [Allgemeine Psychopathologie]

General Psychopathology [Allgemeine Psychopathologie], Volume 1, 7th edition

Karl Jaspers. Translated by John Hoenig and Marian W. Hamilton

Baltimore (MD): Johns Hopkins University Press; 1997. 448 pp

ISBN 0-8018-5775-9

We take issue … with every treatment of psychology that is based on simple self-observation or on philosophical presuppositions.

Wilhelm Max Wundt (1832-1920)

Over the years I have had several German-speaking psychiatrists say to me, in so many words, “How can you possibly practise psychiatry without having studied philosophy?” This is a very European attitude and one not well understood in English-speaking psychiatry. We believe that we study psychiatry from an empirical or common sense viewpoint, and we see it as a virtue that we are not programmed by a particular set of organized beliefs. Of course, we are not free of prejudice, and our own idiosyncrasies may profoundly influence our understanding of what we read, and what we observe in our patients.

The philosophically minded psychiatrist sees him- or herself as provided with an arsenal of techniques, a system of logic and a methodology by means of which he or she can organize observations and communicate them meaningfully to others. The pragmatist will say that this is more likely to be a distorting mirror and that it provides the ever-present temptation to “explain” in terms of one’s philosophical beliefs when, in fact, no explanation is possible with the flimsy data we possess.

Throughout the years, I have maintained a simple-minded belief that the scientific medical model is in fact a reasonable basic belief system for someone practising psychiatry. For a long time that was an unpopular viewpoint: How on earth could the medical plodder ever understand the metaphysical world of the mind? Well, surprise! It turns out that the mind is indeed a product of the brain and that brain, although incredibly complex, can be studied like other organs with techniques that have served the rest of medicine well.

However, it will be a long time before clinical psychiatry can benefit from these techniques as radically as other aspects of medicine have. One very good reason for this is that we are terrible diagnosticians. As a former colleague of mine used to say, “You can’t get a touch of pregnancy but you can certainly still get a touch of schizophrenia.”

We are only beginning to establish a widely accepted lexicon of technical terms in psychiatry. We have spurious diagnostic systems, currently crystallized in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, whose criteria for diagnosis are so crude that, if we were automobile engineers, we would still be having difficulty distinguishing a Chevy truck from a breadmaker.

Our method of diagnosis is to form a vague gestalt of a disorder, then try to figure out if the phenomena we think we observe fit with the description in the textbook. Then, before we can confirm that these phenomena are actually present, we modify them out of recognition with powerful drugs. And, in any case, many psychiatrists nowadays cannot recognize, or even name, the phenomena that presumably do make up illness patterns.

For half a century we have failed to observe systematically and we have failed to derive numbers from the observations we have made. So here we are, at the end of the 20th century, feeding junk into our evermore sophisticated computers and expecting them to tell us what schizophrenia is, how common it

may be and how it responds to treatment. And hoping that delusions, thought disorder, abnormal affect an’ stuff like that will somehow be explained by abnormal neurotransmitter function in areas of the brain that we are hurriedly having to mug up on.

Such iconoclastic thoughts have been running through my head while I have been re-reading volume 1 of Karl Jaspers’ General Psychopathology, the monumental work first written in 1913 and gradually (although not fundamentally) revised in subsequent editions until 1959. The original German version, Allgemeine Psychopathologie, is one of the most influential but misquoted works on psychopathology, and English-language psychiatry owes a great debt to Professor John Hoenig and Ms. Marian Hamilton for their scholarly translation of the seventh edition from the German. The translation first appeared in 1963. This book is a reissue of the English translation, with an amiable and balanced foreword by Dr. Paul R. McHugh.

When I first read General Psychopathology in the mid-1960s, I found the task laborious, and it hasnit got much easier with time. However, it was a rewarding read because I discovered that much of what I was reading agreed with what I had been taught as a resident in Scotland. So, somehow, my teachers had been able to delve into Jaspers’ writings before they had been adequately translated into what passes for English in Scotland.

But — and this is a very big but — I realized that what I had been taught was largely the phenomenological material, and that much of the psychopathology had been selectively culled. This book is a treasure-trove of psychiatric phenomena, described in the days when phenomena were phenomena and could be observed over years without interference by effective treatments. It can only do the present-day psychiatrist good to read about them as they are described here.

On the other hand, the psychopathology is speculative, based on traditional belief and strongly influenced by 19th-century German philosophy. This is not surprising, since Jaspers was a philosopher of his time. Like many philosophers then, he believed his methods of psychological dissection to be highly scientific. He was very critical of the spurious explanations produced by the psychoanalytic school, but unfortunately he was also prone to explaining, although his explanations often end with the “black box” approach — “This cannot be explained.” Not surprisingly, this somewhat nihilistic attitude, natural enough in a time of therapeutic nihilism, really leads us nowhere. Despite its influence, Jaspers’ approach has led to little continuing experimentation or observation.

Pity! If you simply took the phenomena he describes and started counting their occurrence in your everyday patients, you would have the beginnings of a basic science. But that would be laborious, unglamorous and unlikely to be supported by today’s big-money sources.

If we think we are good at observing psychiatric phenomena we should go back to this book and be humbled. We should go back to this book anyway and, using our critical faculties, try to sort out the lasting wheat from the ephemeral chaff. It will take a long time, but it will be good for the soul. At the end of the day, perhaps we might be a little better at distinguishing between schizophrenia and a hole in the ground.

Unfortunately, few people will take the time and, if they are interested, may want to rely on the commentaries on Jaspers’ contributions contained in the few modern works on descriptive psycho-pathology, such as Andrew Sim’s Symptoms in the Mind. That’s a start, but not enough to experience the richness and depth of Jaspers’ phenomenological descriptions.

Nowadays, there are umpteen CDs of “The Best of . . .” various composers. I am grateful to Johns Hopkins Press for reissuing this work, and I look forward to seeing volume 2 appear before long. But I would look forward even more to “The Best of Karl Jaspers” if someone could spend the time to review this masterpiece objectively and sift the relevant from the redundant and the passe, with unbiased and atheoretic commentary.

Come on! Surely one of you reading this is just gasping to undertake such a task.

The Insider’s Guide to Mental Health Resources Online

The Insider’s Guide to Mental Health Resources Online

Grohol JM

New York: The Guilford Press; 1997. 326 pp with index

ISBN 1-57230-262-3 (cloth)

ISBN 1-57230-229-1 (paper)

This book is the sixth in the “Clinician’s Toolbox” series. The author, John M. Grohol, is a psychologist whose credentials and training are not specified but who has developed a reputation as an expert in psychological informatics. At his Web site (grohol.com), he informs consumers and answers simple questions about mental disorders and treatment. He apparently has a broad, in-depth knowledge of mental health resources on the Internet.

The author’s objective is to initiate the busy clinician to the World Wide Web; he guides the reader to what’s available and where to find it online so as to avoid surfing aimlessly. He critically evaluates numerous Web sites, making our journey into cyberspace easier.

The book is well organized and is divided into 4 parts: the first contains basic maps and tools for finding mental health information online; the second involves getting answers to your professional questions; the third is on patient education resources; and the fourth contains appendices and a useful glossary. For the novice Web-surfer, the first part is a very helpful introduction to the major resources online and the way search engines work. (Formulating a search question properly is essential to obtaining relevant information, whether it is a MEDLINE literature search or a search for a specific self-help group.) The second and main part of the book has specific chapters on finding information about disorders, treatments, employment opportunities and continuing education as well as on researching, networking and finding useful books, journals and software online. In one chapter, the author discusses psychotherapy and counselling online, and he clearly states the ethical issues involved. The third part contains 3 chapters listing patient-education resources and includes consumer mailing lists and news-group discussion and support groups. The fourth part has 4 appendices, one of which is a brief introduction to creating your own Web site.

I found the book to be free of errors (except for 2 minor ones) and easy to read. As a psychiatrist, though, I take exception with the author’s bias against electroconvulsive therapy. On page 195 he writes, “radical treatments such as electroconvulsive therapy (ECT)” and, on the next page, “About the only useful thing this site does offer is information on the pitfalls of ECT.” Elsewhere, he states his own biases clearly and reasonably.

One of the redeeming qualities of the book is the frequent reference to the “Insider’s Guide” online update page, which at the time of writing contained 3 pages of updates — mainly changes to uniform resource locators (URLs) and notices of “bad” links. Without such an update, this book would become outdated very quickly.

In conclusion, this book can help allay a middle-aged novice’s fears of the Internet and add another dimension to the communication of information, both among doctors and between doctors and patients. Although the book is targeted to a larger readership than the subscribers of this journal, it contains enough relevant material for me to recommend it to psychiatrists as well as allied health professionals interested in “psych” online.