Leighton C. Whitaker

Treatment and Prevention

This chapter first addresses general considerations that are basic to any successful treatment approach and then discusses three major modes of treatment: psychotherapy; psychosocial approaches; and drug treatment. This ordering of the modes of treatment emphasizes the psychological and social approaches because they are the most currently underemphasized forms of treatment and are the most important to a favorable long-term outcome. This chapter concludes with a discussion of prevention.

Exploring schizophrenic thinking in older adolescents with the WAIS, Rorschach and WIST†

Literature that addresses the diagnosis of mental disorder in adolescents strongly suggests that it may not be possible to do so. Schizophrenic thinking, in particular, has been seen as generally characteristic of adolescents. Making judgments of specific responses from the Rorschach, the WAIS, and the WIST, 10 expert clinicians were able to make judgments with regard to 12 adolescents in the 16-19 age range that were surprisingly accurate in discriminating among schizophrenics, nonschizophrenic hospitalized adolescents, and a normal control group. Results indicate that schizophrenic thinking is not necessarily characteristic of adolescents and that information from the WIST may be helpful in identifying schizophrenic adolescents.

HMOs and the Future of Student Mental Health Services

Abstract The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nations health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.

The Empathic Ward: Reality and Resistance in Mental Health Reform

This article provides perspective on our experiment to change a psychiatric hospital ward from reliance on drug therapy to psychological treatment. Resistances to the change took many forms, including delaying publication of the results for nearly a decade. Although successful, the treatment program itself was never adopted. The work did have a major impact on the “right to refuse treatment” case originally titled Rogers v. Okin (1979), which barred forced medication and involuntary seclusion except in certain emergencies if an outside consultant agreed. Two publications (Deikman & Whitaker, 1979; Whitaker & Deikman, 1980) described much of the program and its vicissitudes but did not include some of the more resisted features reported in this article.

Forces Pushing Prescription Psychotropic Drugs in College Mental Health.

Abstract A complex of forceful influences is greatly accelerating the use of what are usually referred to as “psychiatric drugs,” although most prescribing is not done by psychiatrists. Many other clinicians, including other kinds of physicians, and recently psychologists, prescribe these medications. The influences contributing to this dramatic surge include the pharmaceutical and managed care industries, the more exclusively biologically-oriented “new psychiatry,” lack of governmental supervision and safeguards, and the gullibility of consumers, Americans especially, in accepting misleading and unproven claims. The nations future college and university students are increasingly medicated instead of nurtured and disciplined in more traditional ways. Yet, a strong counterbalancing force can be effective; institutions of higher education represent the kinds of critical thinking that could improve a rapidly deteriorating picture of medication misuse.

The measurement of schizophrenic conceptualization using a spanish translation of the whitaker index of Schizophrenic Thinking

The Spanish translation of Form A of the Whitaker Index of Schizophrenic Thinking (WIST) was administered to 50 schizophrenic (25 acute; 25 chronic) and 50 (25 = depressives; 25 = normals) nonschizophrenic residents of the Commonwealth of Puerto Rico. Results suggest that this translation effectively discriminated between schizophrenics and non-schizophrenics on the WIST total score, time, and index. A cut-off of 25 on the WIST index correctly classified 98% of the schizophrenic volunteers.

The Whitaker Index of Schizophrenic Thinking (WIST) and thirteen systems for diagnosis schizophrenia

Developed the present study in conjunction with a project that evaluated the psychiatric diagnosis of schizophrenia (Landmark, 1982; Landmark & Leslie, 1982). This design, which included 13 different interview systems for diagnosing schizophrenic disorders, allowed for an in-depth analysis of the Whitaker Index of Schizophrenic Thinking (WIST). Eighty-five outpatients who were receiving long-term chemotherapy for schizophrenia at the Moditen Clinic of London Psychiatric Hospital were reassessed individually using each of the 13 systems, following a clinical interview format, and the WIST. Major statistical analysis evaluated the concurrent validity and discriminatory efficiency of the WIST in comparison to the 13 systems. The WIST was found to show a consistently high agreement with each of the 13 systems for an average WIST discriminatory efficiency of 70%. The WIST is suggested as a practical, easily administered, diagnostic tool that performs well in comparison to the interview systems.

Interdisciplinary Considerations in the Psychotherapy of Psychosomatic Patients

Abstract Patients with psychosomatic conditions, who comprise a significant proportion of students seeking health care, demonstrate clearly the need for effective functioning of the health care team. These patients usually present themselves with problems of physical illness for practical, social, and psychodynamic reasons. Socially they seek to avoid the stigma attached to acknowledging psychological problems. Psychodynamically, such patients have transformed psychological problems into physical illness and need help in reversing this transformation. Attending only the physical illness or dismissing the patient because “its all in your head” are inappropriate responses deeply embedded in popular culture. Case illustrations are used to show the need for careful diagnosis from physical and psychological standpoints, for skillful referral and interdisciplinary collaboration, and to show how psychotherapy can reverse the psychosomatic process and the underlying psychological determinants. The illustrations ...

The Persistence of Shrinking: Remembrance of Things Not So Past

Abstract This article explicates the importance of becoming aware of the social and personal past for the sake of effective psychotherapy. The image of the mental health practitioner as “shrink” is discussed in terms of stigma, both historically and currently, which tends to reduce instead of to help develop the faculties of those treated. Historical recounting includes witch-hunting in the Middle Ages and its analogous phenomena in this century, and the use of isolation, lobotomy and neuroleptics. Current pressures to reduce rather than to help troubled people develop are related to under par mental health coverage, breaching of psychotherapy confidentiality, a narrow version of the medical model limited to symptom targeting, promiscuous prescribing, and stringent limiting of psychotherapy length. The importance of tolerating remembering the personal past in psychotherapy is emphasized. Remembrance of both our societal and personal pasts is vital to our not automatically repeating in the present our prob...

Structured Interviews and Diagnostic Systems

During the late 1970s, while the third edition of the Diagnostic and Statistical Manual (DSM-III; American Psychiatric Association, 1980) was being developed, the definition of schizophrenia in the United States narrowed, and the concept of schizophrenia as a unitary disease diminished (Haier, 1980). Two considerations contributed greatly to these changes.