Within child and adolescent psychiatry, there are a number of potential dilemmas pertaining to diagnosis, treatment, the protection of the child, as well as the child's own developing intelligence and moral judgement. Diagnostic Dilemmas in Child and Adolescent Psychiatry is the first in the IPPP series to explore this highly complex topic.

Several clinical cases are presented to illustrate the phenomenon of discontinuity of personal narrative. These discontinuities are markedly and overtly present in the cases described, which include cases of bipolar disorder, incipient schizophrenia, dissociative disorder, and others. One of the patients suggests that they are also ubiquitous in people without psychiatric diagnoses.

In lieu of an abstract, here is a brief excerpt of the content:Ontological and Other AssumptionsLloyd A. Wells (bio) and Sandra J. Rackley (bio)Fahrenberg and Cheetham have conducted an immensely thought-provoking study of the assumptions about human nature made by 800 students and pose a question about the future impact of these assumptions on individuals’ practice in professions including medicine and psychotherapy.This work represents a branch of “philosophical anthropology,” which considers assumptions people make about human nature. The authors used a (...) questionnaire, much of which was newly designed, to assess the assumptions made by university students studying psychology, philosophy, sciences, and other disciplines. Most of the respondents were studying at Freiburg, but some were sampled at several other universities in both the former East and West Germanies. Questions involved consciousness and the brain, evolution, free will, belief in God, the meaning of life, and theodicy.Given the importance of these beliefs and assumptions in so many peoples’ lives, it is quite surprising that there are so few modern data available, and this study ventures an important first step in assessing these assumptions. However, there are many problems inherent in this study (and any like it).The first, for us, is the validity of the questionnaire itself, an issue that was not specifically addressed in the paper. Face validity is a problem even in the few questions quoted directly in the paper. For example, some statements contain two clauses, and one could well agree with one without agreeing with another: “I do not know whether a God exists and I do not believe it is possible to know.” This is the most relevant answer for a true agnostic, but the assumption that “I do not know whether a God exists” does not necessarily link at all with “I do not believe it is possible to know.” Similarly, a theist might have trouble with the two clauses, “I know God really exists” and “I do not doubt this.” (Technically, knowledge does imply a lack of doubt, but belief certainly does not.) Particularly in the trilemmas, where various patterns of response were analyzed, these multiple-clause statements may have led students to respond in a manner inconsistent with their true beliefs and assumptions. Furthermore, many of the questions contain terms that may have been unfamiliar to first-year university students. The authors explain their rationale in not defining terms, but the lack of clarity about definitions may have led some of the students to not fully understand the questions asked and to perhaps influence the answers they chose.Misunderstanding of the questions may account for some of the disparities reported in the results. Other apparent inconsistencies, however, do not seem to be a result of unclear questions. For example, sixty percent of the students agreed with the statement that “I believe in … existence after death,” whereas forty-seven percent agreed with the statement that “when my brain is dead my consciousness and my person cease to be.” These [End Page 203] findings do not add up, and this study has several similar sets of data. People contradict themselves in long and complex questionnaires, and this may be a simple explanation for these findings, but is this the only explanation? How seriously did the students take the questionnaire, often given as part of their class? How honest were their responses?How generalizable are the findings of this study? It is very difficult even to speculate about this. The statistics are incomprehensible in light of the data given, and one must essentially take them on faith, wherever one falls on the God/theodicy questions. The design has many flaws, but we do learn how a subsample of German university students rate important factors about the meaning of life. Statements are made in the paper that the students’ results correlate with similar results for the general population, but this assertion seems to be based on a very few questions. One would like much more delineation of this apparent correlation, because we wonder about the juxtaposition of developmental factors with the answers the students gave to this questionnaire. First-year university students are at a critical developmental point, and it would be fascinating to follow this large cohort of students over time to see whether... (shrink)