Psychological prognosis of outcome in the mental disorders.

Abstract

HEN mental disorders are regarded as continuing processes running a regular course with definite characteristics and not as haphazard vicissitudes of life, it becomes possible to study the initial, middle, and ultimate stages of these processes and hopefully to obtain indicators in each stage of the probable subsequent course of the disorder. This is the essence of the prognostic problem. The personality of the patient, his genetic and environmental background, his family relationships, vocational and social adjustment, in fact all his assets and liabilities at any given period, may become important indicators of the probable course of his illness from then on.The wise clinician has always been aware that the characteristics of the patient at the time he comes for treatment have an important relationship to his chances for eventual improvement, provided the stage of the illness can be determined. One able diagnostician, Kraepelin, has even proposed for one illness, dementia praecox, that diagnosis be based on the probable outcome of the disease. Presentday clinicians still follow this pattern to some extent; they examine disease processes with an eye to their eventual outcome and diagnose accordingly. But the observations on which these prognoses are made are usually impressionistic. Whether the psychologist can do any better with tests than the clinician with his intuition is perhaps debatable, but there is such a definite demand for improving prognostic criteria that tests are well worth trying. The demand for improvement arises hi the wake of the general rinding that modern specific therapies of both the psychotherapeutic and somatotherapeutic variety seem to have an advantage over nonspecific therapies, such as "total

Prognosis in schizophrenia: The role of premorbid, social class, and demographic factors

“…Several investigators have reviewed the empirical literature dealing with prognosis in schizophrenia (Houston and Pepernick, 1958;Pascal, et al;Schoefield, Hathaway, Hastings, and Bell, 1954;and Zubin and Windle, 1954). These investigators agree on (I) the need for greater methodological sophistication in prognostic research in terms of operational definitions of predictor and criterion variables; (2) the utilization of appropriate time intervals and criteria for assessing outcome; and (3) clearly delineating the characteristics of the sample under study.…”

Experimental psychology and the problem of behaviour disorders.

“…Consider, for example, the mass of research with the Rorschach and other similar personality tests designed to yield meaningful predictive statements about a person on the basis of an assessment of "his psychodynamics." The negative verdict on the claims of psychodynamically oriented tests arrived at in the reviews of Windle (33), and Zubin and Windle (36), and in reviews of the literature on personality assessment techniques published in the recent volumes of the Annual Review of Psychology, is well known by now. There are also a number of negative findings obtained in carefully controlled recent studies of investigators such as Holtzman and Sells (12), Kelly and Fiske (15), Kostlan (16), and Sines (29).…”

The measurement of personality.

“…These measures will have to be related to more behavioral systems of personality evaluation or to the results of scientific content analyses of systematic interviews. Some success has already been achieved with such methods in studying the personality of chronic schizophrenics (15). It seems probable on the basis of preliminary investigation that chronic schizophrenics whose perceptual functioning is not as disorganized as their conceptual usually fail to recover.…”