Psychopathology reconsidered: Depressions interpreted as psychosocial transactions

A Comment on “The Comprehensive System for the Rorschach: A Critical Examination”

Wood, Nczworski, and Stejskal are correct in noting that the Comprehensive System has been scrutinized less carefully than might have been expected or desired A few critiques have addressed isolated variables in the system, and some comments that have been published suggest that attempts at detailed scoring-coding of the Rorschach tend to neglect the idiographic features of the subject and that the system itself has limited use because it is not aligned with any particular theory of personality This article by Wood et al evolves from a different perspective in which the authors attempt to evaluate the system from an empirical basis Unfortunately, I am not sure that they have achieved their objective, mainly because the manner in which they have addressed each of the issues selected for discussion presents a rather misleading picture Let me attempt to address each in this comment

Attributions of responsibility for addiction: the effects of gender and type of substance

In 1997, 248 urban university students in central Massachusetts rated responsibility for addiction using the Attributions of Responsibility for Addiction Scale (ARAS), developed for this study with university-based financial support. The vignette-based factorial design varied sex of drug user and type of addictive substance. Factor analysis yielded two subscales: internal and external responsibility attributions; the dependent variable was the internal-to-external attribution ratio. Analysis of variance indicated main effects for substance type and drug abuse experience and showed interaction effects for participant's sex by user's sex and user's sex by substance type. Authors discuss implications, study limitations, and future research.

The diagnostic efficiency of the Rorschach Depression Index and the Schizophrenia Index: a review

This review focuses on the diagnostic efficiency of the new versions of the Rorschach Comprehensive System Depression Index (DEPI) and the Schizophrenia Index (SCZI). Clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders was chosen as the external validation criteria. The sensitivity, specificity, and overall classification rates for the indices were presented from the studies or computed from the data when possible. The positive and negative predictive validity was estimated at three different base rates. As regards the DEPI the results showed a large variation in diagnostic performance as the index seemed to have relatively more success in identifying nonpsychotic and unipolar depression than psychotic and bipolar depression. The DEPI did not successfully identify depression among adolescent patients. As regards the SCZI the results more consistently indicated that the index effectively discriminates between psychotic and nonpsychotic patients and the predictive validity of both a positive and negative SCZI was found to be high.

Drug advertisements and the medicalization of unipolar depression in women

Unipolar depression occurs twice as frequently among women as among men, and the pharmacological industry maintains a massive advertising campaign that encourages psychiatric professionals to rely on antidepressant medication as the solution to this problem. The pictorial content of drug advertisements shows women as victims of depression. The social problems and situational stresses associated with unipolar depression are never shown, and depression is assumed to be a personal and biological illness, its etiology decontextualized. In these advertisements, women are not offered a choice between medical and nonmedical treatment and are not empowered to become more active participants in their health decisions. Therapists are urged to become alert to this oversimplification.

Dysphoria: a major symptom factor in persons with disability or chronic illness

Depression frequently is diagnosed in persons with chronic illness or following the onset of disability. The overlap of symptoms of many chronic illnesses and disabling conditions with depression may lead to an overestimation of depression in such populations. Some investigators have proposed revised criteria for diagnosing depression in these conditions without an understanding of the contribution of diagnostic criteria in disabling conditions. This study investigated the nature of depressive symptom criteria constellations by individually factor analyzing the Inventory to Diagnose Depression (based on DSM-III diagnostic criteria) in spinal cord injury (n = 134), rheumatoid arthritis (n = 78), student (n = 140), and community (n = 150) groups. A four-factor solution emerged, with the first factor labeled "dysphoria" being represented by symptoms of negative self-evaluations, depressed affect, and suicidal ideation. The results indicate that a core element of the syndrome of depression is dysphoria, which suggests that the contribution of somatic items may be less important to the identification of the depressive syndrome in chronic illness.