Categories

Table of Contents

Categories
Initial notes from PT
Annotations on common readings
Annotated additions by students
Idea: Collecting and analyzing data requires categories: Have we omitted relevant categories or mixed different phenomena under one label? What basis do we have for subdividing a continuum into categories? How do we ensure correct diagnosis and assignment to categories? What meaning do we intend to give to data collected in our categories?
Guidelines for annotations
Notes and annotations from 2007 course

Initial notes from PT

1. We can identify a chain of steps in scientific inquiry in which each step involves assumptions and is open for negotiation and wider influences (Taylor 2005, chapter 2).

All possible phenomena

Decisions made at early steps influence outcomes at later steps. E.g., if schizophrenia is used as a category as defined by the DSM, it is harder for a clinician to pay attention to the contextual and life history information of patients (Poland 2004). This is not a one-way sequence. There is also the possibility that desired outcomes for the later stages (especially the actions the researcher favors in advance and would like to be supported by the inquiry) influence decisions made at earlier steps.

References: Poland, J. (2004). "Bias and schizophrenia." Pp. 149-161 in P. J. Caplan and L. Cosgrove, eds. Bias in Psychiatric Diagnosis. Lanham, MD: Rowman & Littlefield.
Taylor, P. J. (2005). --Unruly Complexity: Ecology, Interpretation, Engagement--. Chicago, University of Chicago Press.

2. Takes notes on:

3. Comparative methods for studying socioeconomic position and health in different ethnic communities, Davey-Smith et al. 2000 -- Does SES mean the same thing for different communities? If not, what is our proposed remedy?

Poland argues that the category "of schizophrenia and the associated received view [does not] have anything useful to add to clinical practice concerned with severe mental illness."

4. Marriage and divorce by class in the USA, Hymowitz 2007. I heard her on the radio make the case that divorce rates hid that there were different phenomena and trends in different social classes. (I looked for a more scholarly piece by her, but her book did not include any references even though many people were cited.)

George Brown (UK) and Bruce Dohrenwend (USA) have done research for decades on the relationship between mental illness and life events or difficulties. Brown (as described by Birley and Goldberg 2000) developed methods that tried to expose the meaning of an event for the person and was critical of the US emphasis on "objective" surveys (where the same event, e.g, death of a spouse, might have very different meanings and significance for the subject). Dohrenwend describes his group's eventual realization of this issue, but they still wanted to measure events without having the context fused into the rating of the event.

Pickles and Angold examine the use of scales (continuous dimensions) versus categories (e.g., pathological versus not) in mental illness.


Annotations on common readings


Davey-Smith, et al 2000

The article is a review where they describe all the complexities demonstrated when dealing with ethnicity, socioeconomic position and health. When reading articles related to racial, ethnic or minorities, I find some authors use the words interchangeable. These words have very different meaning and I felt it necessary to keep the clear and defined when reading the article. Webster's Dictionary describes them as the following:
Racial :
1 : of, relating to, or based on a race <a racial minority>
2 : existing or occurring between races <racial equality>
Ethnicity:
1 : ethnic quality or affiliation <aspects of ethnicity>
2 : a particular **ethnic** affiliation or group <students of diverse ethnicities>
Minority:
1 a : the period before attainment of majority b : the state of being a legal minor
2 : the smaller in number of two groups constituting a whole; specifically : a group having less than the number of votes necessary for control
3 a : a part of a population differing from others in some characteristics and often subjected to differential treatment b : a member of a minority group <an effort to hire more minorities>

The article overviews how the US traditionally treated group memberships as a socioeconomic measurement. Yet, it does not take into account the socioeconomic position within the group membership. They discuss case studies in United States and Britain. In a report by the Department of Health and Human Services, “Health Status of the Disadvantaged”, the report displayed a table of preventative health indicators. In the table one of the health indicators was race and was not linked to socioeconomic status. They continue to elaborate by saying the report ignores socioeconomic status in health status, and assumes all members of a group are disadvantaged while the sharing common interests. Moreover, the author explains that it is difficult in accounting for cases of minority ethnic groups that are economically disadvantaged compared with populations who have better outcomes.
Davey-Smith, et al further discusses the socioeconomic positions in relation to health status within minority ethnic group. The articles states that there are direct link between socioeconomic status and mortality for minorities. Britain previously defined ethnicity as where an individual was born. The article also stresses the importance of providing a detailed explanation on how classification is designed. This is important due to the changing system in which we define ourselves as groups and individuals. Overall the article provides the reader with detailed explanation on the complexity of defining groups and individuals. Davey-Smith also gives us several potential solutions in making classification system much simpler although not a easy task. They suggest that we bridge the gap between macrosocial and molecular biology, investigate the historical aspect of various demographics. (KP09)


Poland 2004
Prior to reading this article I researched Jeffrey Poland, PhD and the Rhode Island School of Design. The article seemed to be a reaction piece about the perception of schizophrenia in society. This is seen when the author uses bold font and the overall tone of the article. Yet, I thought why is an individual at the Rhode Island School of Design writing an article about Schizophrenia. The author begins the piece by over viewing Schizophrenia and the how the disease is presented and treated. It seems as if the author was defending the creditability of Schizophrenia as a “Real” disease to society. He identifies the multiple assumptions that clinicians and lay people have about people who have schizophrenia. In addition, author displays the process involved in diagnosing an individual with Schizophrenia. How individuals are classified when schizophrenia is very difficult. The author explains that if there is no proper database for clinicians to reference when diagnosis, then people will be misdiagnosed or not diagnosed at all. The article discusses the complexities in diagnosing schizophrenia because although there are ideal clinical features. The author concludes the article by saying if clinicians are to make the appropriate diagnosis on a individual they must all agree on multiple levels of decision making and classification. (KP09)



Annotated additions by students

Birley & Goldberg
As this article is so amply titled, Jim Birley and David Goldberg have presented a reading that discusses the contributions that George W. Brown has made to the field of psychiatry; specifically schizophrenia and depression.

Over the years, Brown has conducted many research studies. Of note was his research that examined the visitor’s books of two different hospitals. He used these books as tools to determine length of patient stay. He was able to determine that there were patterns (in patient length of stay) that developed based on visitor frequency and discharge policy. Due in part to this study, George and others were able to reasonably conclude that one’s social environment can contribute to the symptoms of schizophrenia, and to recovery.

Brown’s endeavors have led to further research in this area. He hypothesized that “severe loss” and a “predisposition of vulnerability” (p. 56) contributes to depression. He was able to confirm through his research that the onset of depression often occurred after severe loss was experienced. Interestingly, George and his colleagues were able to determine that both childhood and adult adversity led to depression, but that only childhood adversity led to anxiety in adulthood. Also, he alluded to the fact that “humiliation and entrapment” also led to depression in women (p. 57).

Although Brown’s work has been seen as incapable of accurate prediction, I think that he has successfully concluded that this course has some value, especially in the mental health arena. It is true that people interpret events differently, but it can be a beneficial course of action when handled properly – through interviews, data collection, and analysis.

Essentially, Brown has found new and innovative ways to improve evaluative procedures. He has taken others’ ideas and refined them in a way that is more efficient. For example, he has found that patients need not simply rate certain events that have occurred, but that the events should be explored by gathering as much information about the person’s history (past and present).

George Brown has contributed much to the field of psychiatry, and along the way, he has been criticized for his forward thinking ideas. However, he has been able to successfully generate new interest in the field of psychiatry through his determination and innovation. His commitment should be commended. (CH 09)
Birley on George Brown’s contribution to psychiatry

Brown brought to light the importance of social factors in mental health disorders. Brought into psychiatric research the important element of looking at social variables to predict outcomes—not just the commonly researched psychiatric variables.

Brown also introduced time sensitive note taking on patient’s life events. This allowed for researchers to observe possible social variables which may contribute to disease progression.

The authors claim (sidenote: there aren’t citations. also, they call him by his first name.) that Brown discounts the influence of genetics in psychiatry, which the authors see as a fault.

This reading was particularly relevant to my research interests, though perhaps not the research interests that I’ve already shared with the class. I’m interested in how a history of sexual assault, particularly in childhood, effects the mental and physical health of an individual. Brown’s work seems to be integral in this sort of research. There are many physical manifestations of disease and disorders, most notably pain-related disorders, that appear to be linked to a history of sexual trauma. It is an emerging field. I’m currently interested in exploring the incidence rates of sexual assault in America, particularly among children, because I think it might be occurring in epidemic proportions which then effects everything from the rising rates of obesity to newer, so-called “medically unexplained illnesses” like fibromyalgia. (MC '09)
Hymowitz article
The author cites the high level of divorce and number of children born out of wedlock in the U.S., both higher than one-third but less than one-half, as evidence that a critical societal infrastructure has been crumbling. She uses some data, within categories that support her ideological argument. Since women with higher levels of education are more likely to have children within marriage, and less likely to be divorced, she attempts to establish causality between education attained and these negatively characterized outcomes, rather than looking at what education may be a proxy for.. It’s as if she is saying, those women ‘smart enough’ to wait to be financially stable, and to stay in a marriage….do so and reap the benefits.
It’s interesting that she notes associated net worth and net wealth of a certain socio-economic group and attributes it to marriage – rather than considering the possibility that some get married and stay married because they have something to lose, as compared to those who have nothing to lose, and perhaps nothing to gain by marriage or divorce. Marriage may not serve as a way out or a step up for individuals in deep poverty. Perhaps it’s more important for children to be raised in homes with sufficient financial resources, as compared to being raised within a married family setting.
She overlooks her own argument re: marriage and private property to conclude that marriages fail due to desire for adult happiness, i.e. selfishness. Moreover, her views on marriage are heterosexist and culturally narrow – in that she defines it as monogamy between a man and a woman, with no consideration of polygamy, polyandry, and so on. This is altogether not surprising given the conservative agenda of The Heritage Foundation. (AH, '09)
There is no doubt that divorce has serious emotional, psychological, and financial consequences for adults and for their children. However, in her article, Hymowitz uses arguments that resonate more like an official policy in favor of traditional marriage than a scientific article. This is partly due to the fact that it was a speech given at Heritage Foundation. Nonetheless, her arguments are not fully convincing and there are some limitations to the findings she is referencing in her speech. Hymowitz does not reference who conducted the research, when the research was done, or what methods were used to collect and analyze any of the the data. Secondly, as noted in another annotation by AH, Hymowitz only discusses heterosexual marriage. Therefore, she leaves out other types of partnerships, like civil unions, etc. As Davey-Smith pointed out that racial and ethnic categories were inadequate substitutes for socio-economic status (Davey Smith, 2000), because the lists were not exhaustive so some categories were omitted or "lumped" with other categories, or because those classified within a certain category sometimes differ more due to another factor that was not taken into account. The way Hymowitz uses marriage as socio-economic determinant results in a similar mistake.
Hymowitz also does not really discuss socio-economic success (or failure) of the children whose parents who divorced were highly educated (or financially strong) in comparison to children of the parent who were lower educated (or in worse financial position). Do those children do the same, better, or worse than the children of the parents who were lower educated or poor? Do educated adults, on an average, manage better to help their children overcome the stress caused by divorce and ensure that their children obtain higher education (as they did), or is there no difference and divorce is a single factor for future outcomes? She also does not discuss socio-economic outcomes of the children whose parents stayed in marriages that had serious problems, frequent arguments, or even problems with drugs or abuse. Do some of the children in those situations do better after the divorce than the children who remained in that kind of family environment through adulthood? These are only some of the questions that were left unanswered. (DBJ, 09)


Pickles and Angold
This article explores the issue of employing a categorical and/or scalar approach to diagnosing mental illness. Really cannot have one without the other, as categories of symptoms provide the context for the degree, or scale, of severity of symptoms. One cannot evaluate the severity of auditory hallucinations, and their indication of schizophrenia, without first characterizing what the symptom is, and it’s co-occurrence with other symptoms. Yet, severity and manifestation are no less important. If an individual has an auditory hallucination that she is supposed to harm herself or others, which is certainly more significant than one that involves no threat of harm.
These are important aspects to consider with respect to mental illness treatment and epidemiology. The authors also explore whether one approach is more empirically sound, or ‘scientific’ than the other, but conclude that both categorical and scalar approaches are well grounded in research and practice. It’s interesting to note the subjective nature of both approaches dependent as they are on practitioners’ and parents’ observations and judgments. Both approaches have limitations, and thus are best employed in concert with one another, as is the case in the mental health field. (AH, '09)