The masquerade of mental health reform: Comment on Bagby, Silverman, Ryan, and Dickens (1987).

In a valuable paper, Bagby, Silverman, Ryan, and Dickens (see record 1987-32403-001) analyzed rates of involuntary admissions to Ontario psychiatric facilities for several years before and after Ontario's civil commitment law was changed in November, 1978. Bagby et al.'s paper is timely and important because it is relevant to North America generally, as yet another instance of disparity between change in the semantic formulation of the law and the subsequent behaviour of the psychiatric establishment. It still remains entirely a separate ethical question as to what extent commitment criteria, if the notion is meaningful and enforceable at all, should in fact be as restrictive as Ontario appeared to have intended a decade ago. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of mental illness: A neglected problem in demonstrating the "mental illness culture."

Criticizes I. Silverman and D. Saunders's (1983; see also PA, Vol 67:1855) study of the relationship between physical proximity of psychiatric facilities and patient admission rates. It is suggested that Silverman and Saunders have not used reliably measured and reported behavioral correlates of mental illness; have incorrectly concluded that proximity of the facility creates, in the surrounding area, the perception of undesirable behavior as mental illness; and may simply have demonstrated that admissions tend to reflect logistical convenience of beds, regardless of the type of treatment facility. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The migration hypothesis: A rebuttal to Silverman and Saunders.

Reports the results of a study with 65 psychiatric patients that was conducted in order to investigate the results obtained by I. Silverman and D. Saunders (see record 1982-01855-001), from which they concluded that a mental hospital in or nearby a community seems to create a mental illness culture and that psychiatric facilities foster not the detection, but the perception, of mental illness. The present results render Silverman and Saunders's conclusions unsubstantiated and do not support the supposed simplicity of their concept of mental illness. A reply by Silverman and Saunders is included. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reply to Silverman.

Responds to commentary by I. Silverman (see record 2007-08963-001) entitled "Review of Pure types are rare": Comment on book review. I do not think that either one of us will change his position, and therefore it is up to the interested (yet disinterested) reader to adjudicate our dispute by checking Professor Silverman's book and his references. In the process, the reader will be forced to consider the thought-provoking implications for our mental health system of some of the incidents which the author describes so vividly, and that will not be a bad thing. There is one point, however, which is worth pursuing further here, for Professor Silverman persists in an elementary statistical fallacy. Let us take the situation which he cites, where the base rate for diagnosing schizophrenia is 50%. Suppose with the same base rate the degree of agreement is in fact 53%; this is far above chance level. It must be emphasized, however, that the 53% agreement under discussion came not from a study where the base rate for diagnosing schizophrenia was 50%, but from one where the conditions were far more stringent since the base rate for diagnosing schizophrenia was around 20%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Whither subliminal psychodynamic activation? A reply to Silverman.

The authors reply to comments by L. H. Silverman (see record 1982-21579-001) on their earlier criticisms (see record 1980-26153-001) of subliminal symbiotic stimulation as a clinical adjunct to systematic desensitization. The authors contend that Silverman credits them with an overly nebulous "challenge" that was not made, and cites new data that purportedly contradict this overgeneralized conclusion. None of this "contradictory" evidence deals with desensitization or any other treatment for phobic anxiety. The alternative explanations he derives from these new data are based on an arbitrary and simplistic method of data aggregation that lacks consistency across investigations. The resulting selective bias severely reduces the explanatory power of these alternative possibilities and does not negate the authors' contention that stimulation of unconscious merging fantasies is superfluous in desensitization. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and the health systems agencies.

Criticizes H. Silverman's (see record 1980-30929-001) report on activities as a psychologist involved in health planning because Silverman focuses attention on examples of planning for medical health rather than for mental health. Silverman also does not identify the particular problems, needs, challenges, and opportunities for psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An alternative interpretation of oneness.

Comments on L. H. Silverman and J. Weinberger's (see record 1986-15022-001) interpretation of their data as supporting the concept that subliminally induced gratification of wishes can enhance adaptation in both schizophrenic (SCZ) and non-SCZ individuals. This interpretation was strongly biased by Silverman and Weinberger's original intent. An alternative interpretation of their data is proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reply to Silverman.

Replies to comments by L. H. Silverman (see record 1982-21579-001) on the author's (see record 1980-32531-001) earlier criticism of and failure to replicate Silverman's subliminal symbiotic stimulation as an adjunct to systematic desensitization. The role of individual differences and the implications for a failure to replicate effects of subliminal psychodynamic activation in light of other supportive evidence are discussed. Silverman contends that the results of a particular kind of study using subliminal psychodynamic activation cannot properly be generalized to all studies using this method; the author proposes an alternative view. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental illness culture is alive and well: A reply to Page.

Counters S. Page's (see record 1987-05244-001) criticisms of the 1st and 3rd authors' (1983; see also PA, Vol 67:1855) study of the relationship between physical proximity of psychiatric facilities and patient admission rates, suggesting that statistics showing a steady increase in psychiatric admissions in the US and Canada indicate that a culture that tends to perceive problems as mental illness is real and growing. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problems with linking constructs from different domains: Commentary on Pistole's "adult attachment style and narcissistic vulnerability."

Comments on M. C. Pistole's (see record 1995-33117-001) article on adult attachment (AAT) style. Silverman questions Pistole's linkage of insecure AATs and narcissistic pathology and suggests that the lack of uniformity and consistency across AAT studies limits generalizations. Silverman also argues that Pistole conflates divergent theoretical views, thereby further obscuring the meanings of narcissism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of the voluntarism hypothesis among nonvolunteering opiate addicts who voluntarily return to treatment.

Research on the voluntarism hypothesis, which holds that self-reported psychopathology is greater on MMPI clinical scales among addicts who enter treatment on their own volition than among those who do not, has been plagued by differences in treatment settings, types of voluntarism, and lack of experimental designs. Experimental design deficiencies were corrected in the present study, where MMPI scores of 20 former nonvolunteering addicts who voluntarily returned for treatment were compared with 20 matched addicts who had volunteered on both 1st and 2nd admissions. The voluntarism hypothesis was supported. Former nonvolunteers evidenced significantly higher MMPI scores on 2nd admission for scales F, Mf, Pt, Sc, and Si. Volunteers did not significantly differ between 1st and 2nd admissions. Findings underscore the necessity for continuing to improve methods in addiction research. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Length of hospitalization and rate of readmission of paranoid and nonparanoid schizophrenics.

The underrepresentation of paranoids-a group that manifests less psychological deficit-in hospitalized chronic schizophrenic cohorts has been cited as a source of sampling bias in behavioral studies comparing acute and chronic schizophrenics. The sampling bias hypothesis assumes this underrepresentation to be due to the better social prognosis of paranoid patients. The present study examined hospitalization and follow-up records for 1,249 consecutive inpatient admissions. Consistent with the sampling bias assumption, paranoids were found to be hospitalized more briefly than nonparanoids and to experience fewer rehospitalizations 1, 3, and 5 yrs after discharge. As expected, the social prognosis of 1st admissions was found to be more favorable than that of readmissions, independently of paranoid symptomatology. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

SPA is subliminal, but is it psychodynamically activating?

Responds to comments by J. Weinberger (see record 1990-04808-001) on Balay and Shevrin's (B&S; see record 1988-20203-001) work on the subliminal psychodynamic activation (SPA) method, which, contrary to Weinberger's assertion, was not an attempt to destroy the work of L. H. Silverman (published 1974–1985) and others who have used the SPA method. Rather, B&S hoped to encourage investigators using this method to take a closer look at the theoretical assumptions underlying SPA (i.e., the generic vs specific nature of subliminal stimuli that might activate conflict-related, unconscious fantasies). Analyses are also offered of comments made by T. E. Moore (see record 1990-04745-001), M. D. Figueroa (see record 1990-04666-001), and D. K. Silverman (see record 1990-04785-001). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Silverman replies to Lasser.

Lasser's (see record 1990-58318-001) concern about the ethics of conducting research in which psychopathology is intensified is fully justified and one that I have spent considerable time reflecting on. There were two relevant references (Footnotes 9 and 14) in the Silverman (1976) article, but to do justice to the ethical issues would have required a lengthy discussion that was not in place in that article. The explicit purpose of the Rubin and Mitchell (1976) article, to which Lasser alludes, was the unintended effects of research procedures on human subjects, while the purpose of the Silverman (1976) article was very different. To set the record straight, as far as our own research is concerned, the following points can be made, each of which has been elaborated on in the past and are now discussed collectively in a single document (Silverman, Note 1): (a) Informed consent is regularly obtained, (b) Pathology intensification brought about by subliminal psychodynamic activation is slight and, with but rare exceptions, very fleeting. Note that pathology-intensifying stimuli are presented only in a single session. It is only pathology-reducing stimuli, which are given for therapeutic purposes, that are presented over a period of time, (c) Extensive debriefings are regularly carried out at the end of each experiment, one part of which involves revealing the content of stimuli to the subjects. This, we have found, further lessens the possibility of any lingering negative effects, (d) In the rare instances where there are indications that there may be such effects, clinical interviews are conducted and further appropriate action taken, if necessary. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reply to Cyr and Haley.

Responds to comments by Cyr and Haley, on the authors' original record entitled, "Extraneous factors in institutionalization for mental retardation: Demographic analyses for Ontario" (Canadian Journal of Community Mental Health, 1982, 1, 107-113). Silverman and Saunders discuss the effects of residence changes on readmissions to mental retardation institutions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internet use and ties that bind.

Replies to comments by T. Silverman (see record 1999-11125-007), J. Rierdan (see record 1999-11125-008), and J. S. Shapiro (see record 1999-11125-009) regarding the original article by Kraut et al (see record 1998-10886-001) on the impact of Internet usage on social relations and depression. The authors respond to the concerns of the previous authors. In response to Silverman, they note that most online relationships formed by participants in their study resulted primarily in informational rather than emotional support, unlike the participants in Silverman's group. In response to Rierdan, the authors argue that the importance of results was not in the size of the effects, but in their direction; even small negative changes experienced by many people using the Internet can be significant. The authors also respond to Shapiro's methodological concerns and her alternative explanation of results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI evaluation of 5-year methadone treatment status.

Evaluated treatment outcome over a 5-yr period for 148 1st admissions (mean age, 27.14 yrs) to a methadone treatment program. Eleven Ss (7%) were successful treatment completions, 16 Ss (11%) transferred to other methadone programs, 38 Ss (26%) remained in continuous treatment, and 83 Ss (56%) were unsuccessful treatment terminations. Discriminant analysis using the MMPI suggested that the more stable Ss at admission had the best treatment outcome. For the patients in continuous treatment, MMPIs administered at 6-wk, 6-mo, and 5-yr intervals indicated that this group of Ss did not change on the personality dimension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical considerations in pathology-intensifying research.

Suggests that L. H. Silverman's (see record 1977-05955-001) article on psychoanalytic theory fails to confront an important ethical issue raised by the research it reviews. It does not appear that the Ss' informed consent was acquired before participation in the research. A response from Silverman is also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relevance of irrelevant relevance.

Comments on I. Silverman (see record 1972-02778-001) and encourages him to devote his methodological efforts to areas in which realistic contributions can be made to the improvement of society and of social psychology (in that order). (PsycINFO Database Record (c) 2010 APA, all rights reserved)