Diane T. Marsh

Psychopathology of Opiate Addiction: Comparative Data from the MMPI and MCMI

The MMPI and MCMI were administered to 163 former opiate addicts who were being maintained in a methadone program affiliated with an urban hospital. Highest group mean MMPI scores were found for Psychopathic Deviate, Depression, Hypomania, and Hysteria. For the MCMI, highest group mean clinical syndrome scores were found for Drug Abuse, Alcohol Abuse, Anxiety, and Dysthymia; highest personality disorder scores were found for Antisocial, Narcissistic, Histrionic, and Paranoid. The MCMI Drug Abuse Scale identified only 49% of subjects as having a recurrent or recent history of drug abuse. Frequency and factor analyses documented the heterogeneity of the population with respect to clinical syndromes, as well as the prevalence of personality disorders (86% had elevations on MCMI Personality Scales). Factor and correlational analyses did not provide strong evidence of similar factor structure or convergent validity of the MMPI and MCMI with this population.

Approaches to serious emotional disturbance: Involving multiple systems

Practice with children who have serious emotional disturbance (SED) increasingly requires multiple-systems intervention. Through a sample case, this article explores these interventions within the context of current national policy. Mental health collaboration with the systems of juvenile justice, education, child welfare, primary health care, and drug and alcohol services is summarized. The specific programs of multisystemic therapy, Pennsylvanias family-based mental health services, and Wraparound Milwaukee are presented as multiple-systems approaches that are successful with this population. The authors offer suggestions for emerging roles for psychologists within this context.

Serious Emotional Disturbance in Children and Adolescents: Opportunities and Challenges for Psychologists

Approximately 4.5 to 6.3 million children and adolescents in the United States have a serious emotional disturbance that undermines their present functioning and imperils their future. However, at least two thirds of young people with a diagnosable mental disorder receive no services at all. Responding to this unmet need, psychologists are assuming new roles in a changing mental health marketplace and are adopting new intervention strategies to work with these children, adolescents, and their families. This article addresses the scope of the problem, opportunities and challenges for practitioners, the larger context of professional practice, future directions, and suggestions for psychologists. Over a decade ago, I received a call from a single mother in my community. In a voice trembling with emotion, she told me that her 14-year-old daughter (I will call her Ellen) was hiding in the woods behind their home—terrified, confused, and very delusional. Refusing to come inside, Ellen would dart periodically into the busy highway adjacent to the property, clearly placing herself at risk. What should she do, this frantic mother beseeched me? What had happened to her daughter? In fact, her daughter was experiencing the first episode of a severe and persistent mental disorder. Admitted to the inpatient unit of a local mental health center, Ellen received a diagnosis of schizophrenia. For the next decade, she and her mother became travelers in a tangled mental health system that left them with a paralyzing sense of hopelessness and helplessness. Over these years, Ellen experienced multiple brief hospitalizations (the “inpatient revolving door”), received several diagnoses, and was given a plethora of medications. Much of her adolescence was spent in a fog of disabling symptoms and inappropriate treatments, profoundly disrupting all aspects of her life. For example, her high school years were marked by irregular attendance and a chaotic pattern of educational placements and plans that deflected Ellen far from her expected educational course. These years were also traumatic for her younger sister, Joyce, who felt her own needs were largely ignored in the midst of repeated family crises. Eventually, Ellen received an accurate diagnosis of bipolar disorder and began a multimodal treatment plan that included individual psychotherapy, family psychoeducation, and a moodstabilizing medication. Collaborating with Ellen’s psychiatrist, her psychologist offered psychosocial services for Ellen and her family and monitored the psychological effects and side effects of her medication. With appropriate treatment, Ellen began to come to terms with her disorder and to reconstruct her life. Although gratified by this positive outcome, Ellen and her family paid an enormous price for the shortcomings of the mental health system. In the current era, there is much reason to hope that, with an earlier diagnosis and more effective treatment, adolescents like Ellen will lose fewer irreplaceable years of their lives and that their families will receive the support and education they so urgently need under these circumstances.

Personal accounts of consumer/survivors: Insights and implications

The personal accounts of people diagnosed with mental illness have much to teach practitioners. Based on the four articles in this issue, the expanding literature of personal accounts, and the relevant professional literature, some of the salient themes are discussed. Initially, the human context of mental illness is explored, including the diversity among those diagnosed with mental illness and the cataclysmic impact of such a diagnosis on individuals. The recovery process also is examined, including the role of hope, locus of control, coping skills and strategies, and social support and self-help. Finally, the mental health system is considered, including the limitations of the system, patienthood, professional roles and relationships, and psychotherapy. Implications for practitioners are noted.

Effects of Role, Gender, Age, and Parental Status on Perception of Childhood Problems

Effects of rater characteristics (role, gender, age, and parental status) on ratings of childhood problems were investigated. Four groups of raters were included: clinical psychologists, school psychologists, teachers, and parents. Ail raters evaluated the psychological importance of the 118 items comprising the Child Behavior Checklist developed by Achenbach and Edelbrock. A discriminant function analysis provided strong evidence that role groups could be differentiated on the basis of ratings. One-way analyses of variance, Scheffe post hoc comparisons, and Spearman rank-order correlations also yielded many significant results. These included role group differences for 78 items, gender differences for 12 items, age differences for 59 items, and parental status differences for 15 items.