Abnormal Psychology

Clinical Diagnosis and Assessment 105

(a question that contemporary science is just beginning to try to answer). They

look to ancestral spirits for an answer to such a question, even when a particular

person is beset with mental rather than physical symptoms. A fi rst experience

of hallucinations and delusions may signal the beginning of a long and chronic

course of schizophrenia, or it may be a one-time occurrence brought on in part

by extreme stress or severe substance intoxication. In the latter case in Zimba-

bwe, the hallucinations and delusions are viewed as signs that the individual is

being called to become a healer, a n’anga, and not as indicators of mental illness.

Thus, knowledge of the patient’s culture infl uences how an outside researcher

such as Linde understands the symptoms. When a patient in Zimbabwe claims to

be hearing voices of dead ancestors, Linde undoubtedly interprets this symptom

somewhat differently than he would if a white, American-born patient made the

same claim. At the same time, knowledge of a patient’s family history of chronic

schizophrenia (which may indicate a neurological factor—genetic, in this case) will

also infl uence the interpretation of the patient’s symptoms. Thus, assessment of each

type of factor can infl uence the assessment of the other types.

However, comprehensive assessment of all three factors in the same pa-

tient is extremely costly and rarely undertaken. Formal testing beyond a brief

questionnaire that the patient completes independently can be relatively ex-

pensive, and often health insurance companies will not pay for routine assess-

ments; they will pay only for specific assessment procedures or tests that they

have authorized in advance, based on indications of clear need (Eisman et al.,

2000). Beyond an interview, other forms of assessment are most likely to occur

as part of a legal proceeding (e.g., custody hearing or sentencing determina-

tion) or as part of a research project related to psychological disorders and

their treatment.

Key Concepts and Facts About Assessing Psychological Disorders

• An assessment may be performed in order to obtain additional
  information for a diagnosis, monitor the course of symptoms,
  determine what type of treatment might be most benefi cial, or
  monitor the progress of treatment.


• Assessment tools and techniques must be reliable and valid,
  and clinicians should take care to compare a patient’s assess-
  ment data to an appropriate norm for the patient’s background.


• Neurological and other biological factors may be assessed with
  various methods. Neuroimaging techniques can assess brain
  structure (X-rays, computerized axial tomography, and mag-
  netic resonance imaging) and brain function (positron emis-
  sion tomography and functional magnetic resonance imaging).
  Neurotransmitter levels can be assessed through magnetic
  resonance spectroscopy, and neurotransmitter and hormone
  by-products can be measured in blood, urine, and cerebrospinal
  fl uid. Neuropsychological testing can assess brain functioning.
  
  
  • Various methods are used to assess psychological factors.
    These include the clinical interview (unstructured, structured,
    or semistructured), observing the patient (e.g., appearance and
    behavior), the patient’s self-report, and the reports of others
    involved in the patient’s life. Each method has advantages and
    limitations. Specific aspects of psychological functioning can
    be assessed through tests of cognitive abilities and personality
    functioning can be assessed with inventories, questionnaires,
    and projective tests.
  
  
  • Some techniques used to assess psychological factors (such
    as interviews and questionnaires) also can be used to assess
    social factors—such as family functioning—as well as to provide
    a more detailed portrait of the patient’s community and culture.
    These social factors affect, and are affected by, neurological and
    psychological factors.
  
  
  
  

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Diagnosing and Assessing Rose Mary

and Rex Walls

Now that you know something about diagnosis and assessment, let’s review what

we know—and what we don’t know—about the Rose Mary and Rex Walls, start-

ing with Rex. We know that he drank alcohol—regularly and to excess. In fact,