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Continuity and commitment in adolescence : a cognitive-developmental study of suicidal and nonsuicidal… Ball, Lorraine Vivien 1988

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CONTINUITY A OF  AND  COMMITMENT  IN  ADOLESCENCE:  COGNITIVE-DEVELOPMENTAL SUICIDAL AND  STUDY  NONSUICIDAL  YOUTH  by LORRAINE VTVIEN B A L L B.A. (Psychology & E.C.E), University of Waterloo,  1982  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF, T H E REQUIREMENTS FOR T H E DEGREE OF MASTER OF ARTS, DEVELOPMENTAL PSYCHOLOGY. in THE FACULTY OF GRADUATE STUDIES Department of Psychology  We accept this thesis as conforming to the required standard  THE UNIVERSITY  OF BRITISH COLUMBIA  February  1988  © LORRAINE VIVIEN BALL,  1988  In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission.  Psychology The University of British Columbia 2075 Wesbrook Place Vancouver, B.C. Canada February  1988  ABSTRACT  This research was conducted in the hope of making some contribution to the  emerging  examination  field  of  of  the  developmental  relations  social-cognitive maturity  psychopathology  between  progressive  through  movement  an  toward  and socioemotional adjustment in adolescence. The  two developmental matters of particular concern were the contrastive in which suicidal and nonsuicidal adolescents  ways  undertake to secure a sense  of their own personal continuity across time, and a sense of conviction in the  face  of growing  skeptical  doubts.  Alternative  accounts  of suicidal  behaviour generally fail to offer any explanatory framework with which to account for the sudden and dramatic increase in suicidal behaviour during the adolescent years. tendencies  of suicidal youth  manifestations personal  It is argued in this thesis that the self-destructive may be better  understood  as behavioural  of difficulties in dealing with the developmental matters of  continuity  and nascent  skeptical  More  specifically, the  arguments  presented  adolescents  are less able than their nonsuicidal age-mates to 1) adequately  warrant  their  in this thesis  doubt  own and others'  lead to the hypotheses  persistent  identity  that suicidal  across time,  and 2)  make use of more mature strategies for dealing with issues of uncertainty and doubt. To adolescents,  test  these  predictions,  29  psychiatrically  hospitalized suicidal  who were subsequently categorized in to either a high suicide  risk group (n=13) or a low suicide risk group (n_=16), and an age- and sex-matched  group  of  29  high  school  students  were  individually  administered: (1) The Continuity Measure, comprised of 2 stories and a semi-structured  interview  procedure  which  inquires  into  how subjects  warrant their own and others' personal continuity in the face of dramatic personal change; (2) The Nascent Skeptical Doubt Interview, also comprised of 2 stories and an associated  semi-structured  interview procedure aimed  at  determining  uncertainty; permits  subjects'  characteristic  and (3) The  the  Nascent  placement  of  strategies  for  Skeptical Doubt  respondents  along  dealing  with  Questionnaire, which  an  objectivist-relativist  dimension. The  results  of this  study  indicate  that,  in comparison to  their  nonhospitalized age-mates, the psychiatrically hospitalized suicidal adolescents did evidence difficulties both in their abilities to understand how they and others could be said to remain continuous or self-same persons throughout time, and in their ability to cope with questions of uncertainty and doubt. In addition, adolescents other  at  high risk for suicide were distinguished from  psychiatrically hospitalized individuals at  low risk to  suicide, and  from their high school age-mates by: 1) their unique inability to find any workable means of justifying persistent identity across change; and 2) by their  more  uncertainty. theoretical difficulties asynchrony relativized, maturity,  extreme These attempt  endorsement findings of  experienced between  are  this by  of seen  thesis  to to  adolescents  progressive  absolutistic lend  views support  interpret  as  movement  in the  certain  arising from toward  to  task  of securing more mature  general  socioemotional  a developmental  the  and self-reflective modes of thought associated and the  the  face of  more  abstract,  with cognitive  strategies for dealing  with the reconceptualizations of the problems of continuity and doubt which these cognitive advances necessitate.  In addition, a number of theoretical,  diagnostic, and treatment implications which are seen to follow from the results of this study are discussed.  TABLE OF CONTENTS Abstract  ^  Table of Contents  i  List of Tables  .vfe.  Acknowledgement  Chapter 1: Introduction  v  y^K  .  1  Statement of the Problem  1  A Synopsis of Competing Accounts of Suicidal Behaviour  6  Social-Cognitive Developmental Interpretations of Suicidal Behaviour ..13 Identity Diffusion and Adolescent Suicidal Behaviour  14  Skeptical Doubt and Suicidal Behaviour in Adolescence  22  Summary of Hypotheses  28  Chapter 2: Method  31  Measures  31  Procedural Summary  ,  37  Subjects  37  Materials  39  Procedure  41  Scoring  Chapter 3: Results  42  46  The Normative Sample as an Appropriate Comparison Group  46  Continuity and Suicidal Risk  50  Nascent Skeptical Doubt and Suicidal Risk  56  The Nascent Skeptical Doubt Interview  56  The Nascent Skeptical Doubt Questionnaire  61  Summary of Results  Chapter 4: Discussion Details and Implications of the Research Findings Theoretical Implications  64  70 71 71  Diagnostic and Treatment Implications Limitations and Suggestions for Future Research  75 77  References  80  Appendices  88  A. Numerical Identity Interview Procedure  89  B. Nascent Skeptical Doubt Stories and Interview Procedure  92  C. Nascent Skeptical Doubt Questionnaire  96  D. Suicidal Risk Rating Scale  100  vi LIST OF T A B L E S TABLE 1: A Typology of Possible Continuity Warrants  17  TABLE 2: Strategies for Dealing with Nascent Skeptical Doubt  24  TABLE 3: Discharge Diagnosis by Suicidal Risk  45  TABLE 4: Type of Continuity Warrant by Age  47  TABLE 5: Responses to Nascent Skeptical Doubt  49  TABLE 6: Response to Nascent Skeptical Doubt by Age  51  TABLE 7: Type of Continuity Warrant by Suicidal Status  53  TABLE 8: Type of Continuity Warrant by Suicidal Status, Self Only  57  TABLE 9: Responses to Nascent Skeptical Doubt by Suicidal Status  59  TABLE 10: Responses to Nascent Skeptical Doubt, Suicidal vs. Nonsuicidal TABLE 11: Scores on the Doubt  60  Questionnaire  by Doubt Interview Responses  63  TABLE 12: Scores on the Doubt Questionnaire by Suicidal Status  65  TABLE 13: Discriminant Function Analyses, Classifying Suicidal Risk  68  ACKNOWLEDGEMENTS On this page I would like to thank the many people whose help directly contributed to the successful completion of this project, and the many others who, intellectually and emotionally, have guided and supported me throughout this project. To my supervisor, Michael Chandler, I would like to express my deepest gratitude for the ever thoughtful intellectual guidance he has generously and unfailingly provided throughout the hundreds of hours he has dedicated to this project and to my education. I would like to thank Larry Walker and Keith Dobson for serving on my thesis committee and for their helpful comments and unqualified support of this research project. I wish to acknowledge the contributions made by Michael Boyes, Suzanne Hala, and Mita Banerjee as members of our research group out of which emerged the conceptualization and materialization of the central measures employed in this study, and for their efforts in collecting the normative data for this study. I wish also to extend my appreciation to the Department of the Vancouver General Hospital, with special Merv Gilbert and Dan Bilsker, and to the staff, parents, and associated with the Adolescent Psychiatric Unit without whose and participation this project could not have been completed.  Psychology thanks to adolescents co-operation  Finally, for all those less easily definable ways in which I have been helped and influenced throughout the tenure of this project, I wish to thank Anne Fritz, Eric Ball, Jonathan Druhan, Warren Weir, Judith Cutshall, and Joshua Druhan.  1 CHAPTER  It  INTRODUCTION  STATEMENT OF THE PROBLEM This  research  was  conducted  in  the  hope  of  making  some  contribution to the  emerging field of developmental psychopathology, and  with  aim  the  specific  phenomenon  of  of  adolescent  promoting  a  better  suicidal behaviour.  understanding  The  strategy  of  the  adopted  to  accomplish these purposes was to attempt to locate some responsibility for the  self-destructive  acts  of  a  group  of suicidal adolescents  within  the  interpretive context of normative social-cognitive developmental theory. The adolescent  range  of cognitive  development are  accomplishments  typically associated  generally recognized to promote  with  a variety of  positive and prosocial consequences, including a growing awareness of, and sensitivity to, the thoughts and feelings of others (see Chandler & Boyes, 1982;  Shantz, 1983,  for recent reviews). There is, however, a darker and  less well understood side to these otherwise positive achievements and the focus of this study was upon two of these consequences (Chandler & Ball, in press). In the first instance, attention was directed to the manner in which  the  cognitive  disrupt  the  normal  concern  was  on the  achievements process  of  ways  of  the  identity  adolescent  formation.  in which certain  period  Here,  sometimes  the  failures in the  focus of process by  means of which young persons attempt to secure a sense of continuous or numerical identity across time may serve to precipitate crises of identity. Secondly,  attention  was  directed  cognitive changes  sometimes  uncertainty  skeptical  and  to  promote doubt  the a  that  ways  in  which  these  same  potentially destabilizing sense of can  undermine  the  efforts  of  adolescents to act with conviction and commitment. The scope of work outlined above is best viewed as conceptual  piece  with  that  of  other  investigators  being of a  (Achenbach,  1974;  Cicchetti, 1984; attention  Garber, 1984;  upon  Selman, 1976,  the  ways  in  cognitive-developmental  course  may  1980)  which  who also have focused  disruptions  promote  a  in  variety  the  of  usual  maladaptive  behaviours. To date, however, the bulk of this related research has been concerned  with the  middle-childhood relations  emergence of such difficulties in the  years.  between  Consequently,  the  course  of  much  less  is  social-cognitive  socioemotional difficulties experienced  preschool and  known  about  the  and  the  development  by adolescents.  The central  task of  this thesis, then, was to partially redress this short-fall by examining the relation  between  progressive  socioemotional adjustment through  a  adolescents  movement  in the adolescent  comparative  analysis  and  emotionally  other  toward  of the  cognitive  maturity  and  period. This was accomplished manner  troubled  in which  youth  both  warrant  normal  their  own  continuous or numerical identity across time, and respond to their growing sense of uncertainty  and skeptical doubt. The particular patient population  of greatest interest in this study was that of young persons expressed  their  adaptational  failures  who have  by making attempts on their own  lives. The rationale for choosing this particular study population is taken up in the sections that follow. Adolescent Suicide and the Problem of Numerical Identity A  long  history  of  philosophical  and  psychological  thought  has  contributed to the view that an essential component of any mature sense of identity is the identical 1968;  ability to count oneself as  individual despite  Lifton,  1976;  research colleagues  the  inevitability of personal  Maclntyre, (Chandler,  a singular or numerically  1981). In an earlier  Boyes,  document how normal adolescents  Ball,  & Hala,  change effort,  1986)  (Erikson,  I and my undertook  commonly justify or warrant  to  their own  sense of continuous identity. In this earlier study, typical adolescents were found  to  employ  one  or  another  of a  series of increasingly  adequate  strategies  for  identity.  solving the  Based  demonstrated  problem of their  upon evidence  that the  from this  intellectual  own and others'  earlier  achievements  normative  study, which  of adolescents  such young persons confidence in their own earlier practices,  numerical  often cost  continuity warranting  it was hypothesized that such cognitive changes might sometimes  place young persons in the destabilizing position of having outgrown their previous  means  of  understanding  their  having as yet acquired more adequate  own  personal  continuity  before  methods of resolving this problem.  Without some effective means of welding links between their own past and likely future, such adolescents,  it was argued, might temporarily lose their  sense  and  of  personal  selfhood.  Such  vulnerable  to  continuity  young various  persons, crises  it  consequently was  of identity  commitment to and connectedness  any  reasoned, and,  coherent would  because  sense  be  of  especially  of their  lack  of  with- their own futures, would be at risk  to suicide. Adoleserit Suicide and the Emergence of Skeptical Doubt Over and above the risks to suicide precipitated by the continuity problems  outlined  sometimes  above,  it  was  also  assumed  that  adolescents  the victims of a second developmental asynchrony  their inability to accomodate the doubts and uncertainties accompany  their  increasingly  previous research (Boyes, of  the  subjective  adolescents,  1987)  character  sometimes  relativized  of  makes  conception  are  created by  that naturally  of knowledge.  Again,  has indicated that the growing recognition the  knowing process,  untenable  their  own  common previous  to  most  means  of  securing a sense of absolute certainty without simultaneously providing for some better means for proceeding in the face of such ambiguities. Lacking any  workable strategy for achieving personal conviction in an  world, such adolescents  may find themselves  uncertain  unable to ground their own  beliefs or to justify the making of personal commitments.  Such crises of  confidence,  it  was  hypothesized,  might  also  promote  a  variety  of  extravagent and even self-destructive behaviours. The Target Population: Why Study Suicidal Youth? The preceding arguments that  the  routine  cognitive  are  intended to introduce the possibility  accomplishments  of  the  adolescent  period  naturally carry in their wake certain adaptational problems. In particular, it has been suggested with  a  new  sense  confronted  with  continuity  or  that adolescents  of  the  uncertainty  difficult  numerical  task  identity.  or  are  commonly forced to contend  skeptical  doubt,  and  are  newly  of  warranting  their  own  personal  While  limited  evidence  is  currently  available to suggest that these adaptational problems account for some of the difficulties experienced by normal adolescents Boyes, Ball,  & Hala,  1986), a deeper  (Boyes,  1987;  Chandler,  understanding of this relationship  was seen to require the study of young persons who occupy a broader range  of adolescent  adjustment  problems.  Consequently, the  comparative  study of extreme groups of young persons who differ dramatically in the success  with  which they  have  come  to  terms  with the  demands  of  adolescent development constituted a natural extension of this earlier work. While any one of a variety  of contrast groups might have been chosen  for this purpose, the present  study undertook to explore the differences  which divide "normal" adolescents from those who have attempted to end their own lives through various suicidal actions. Justification for this choice lies in the fact that, in contrast to adolescents youth appear  to constitute  more generally, suicidal  a kind of end-state group of young persons  who, through their own self-destructive  acts, have defined themselves  as  being in an all but terminal state of developmental crisis. Consequently, for the purpose of this study, the making of serious suicide threats and attempts was taken as an operational definition of dramatic failure,  and  adolescents  who qualified  for  this  adaptational  dubious distinction were  contrasted with adolescents more generally. The  present  adolescents  attempt  to  as extreme reactions  interpret  the  suicidal  to social-cognitive  acts  of  certain  problems common to  young persons more generally is sufficiently novel as to require elaborate justification. Consequently, in what follows, three tasks will be taken up in turn. First, the scope of the problem of adolescent suicidal behaviour will be  outlined.  Second,  a  summary  of  competing  accounts  of suicidal  behaviour will be offered as a preamble to a more elaborated discussion of the alternative explanation of this phenomena to be attempted context of this research.  Finally, a summary  within the  and particularization of the  hypotheses of this study will be detailed.  Suicidal Behaviour in Adolescence: How Serious a Problem? It  is a well documented  but poorly  understood  fact  that  actual  suicides and suicide attempts, both of which are extremely rare in youngerchildren,  suddenly  and dramatically  increase  in frequency  during the  adolescent years (Carlson, 1983; Diekstra & Moritz, 1987; Hawton, 1986; Shneidman, 1985). Reported suicides in Canada for the 15- to 19-year-old age  group jump from previous rates of less  younger  children to approximately  12.1  teenage  years  1981).  (Statistics  Canada,  than  .5 per 100,000 for  per 100,000 for those in their Even  more  dramatic  are the  estimated rates of adolescent suicide attempts, of which there are from 50 to  150 for every completed suicide (McKenry & Kelly,  of  attempted  counterpart Carlson  to  completed  suicides  is dramatically  ratio of 10:1 for adults estimated  (1983). 1  Related  findings  (Ross,  1983). This ratio  different  by Jacobziner  1985),  based  on  from the (1965) and self-report  1 Although reported sex ratios differ by age group, location, and year, the recent trend, both within Canada and internationlly, has been for males to outnumber females by approximately 1.7:1 to 2.7:1 in actual suicides (Madison, 1978; Shneidman, 1985; Syer, 1981), while females tend to outnumber males in number of suicide attempts, at least in the under  measures,  indicate that 10% - 13% of high school students and 15% of  college students  reported having made one or more suicide attempt. The  seriousness of such figures is underscored by the fact that, across all age groups, between 20% - 65% of actual suicides are completed by persons who have  made previous attempts,  and that  10% - 15% of attempters  eventually kill themselves (Carlson, 1983; Hendin, 1982; Kreitman, 1981), often  within  2 years  of their  first  attempt  (Dalgren,  1977).  Incidence  figures of this sort need to be viewed with caution. Self-report measures may spuriously inflate the number of estimated suicide attempts and more "objective"  measures  almost  certainly  under-report  (Nelson, Farberow, &  MacKinnon,  1978; Taylor, 1982). On the assumption that the "truth" falls  somewhere  between these extremes, however, available evidence makes it  clear that suicidal behaviour, which is almost nonexistant in the childhood years, becomes a serious problem in adolescence. Why this should be so why the sudden increase in suicidal behaviour in the adolescent years - is among the questions that prompted the present study.  A SYNOPSIS OF COMPETING ACCOUNTS OF SUICIDAL BEHAVIOUR Despite extensive documentation of the problem of adolescent suicidal behaviour, studies  there has been  on this  topic.  In  a serious their  shortage of methodologically sound  review  of the  appearing in the English language literature between  40  empirical  reports  1960 and 1979, for  example, Berman and Cohen-Sandier (1982) found that only 10 of these had employed any control or comparison group whatsoever,  just  4 had  operationally defined the suicidal sample, and only 9 had subjected their results  to  statistical  analyses.  Methodological problems  aside,  the great  1 (cont'd) 30 age group. Across sixteen studies in which such comparative data are available, the number of female to male attempts ranged from equal numbers of both sexes to four female for every one male who attempted suicide with a mean ratio of approximately two (1.8) to one (Termansen, 1972; Wexler, Weissman & Kasl, 1978).  majority issues  of empirical studies of  demography,  to date have  precipitating  events,  focused on age independent family  characteristics and  behavioural correlates, none of which have much to contribute toward an understanding of the apparent association between becoming adolescent and increased vulnerability to suicidal behaviour. Not only is it the case that the body of recent empirical research on adolescent  suicidal behaviour is extremely  sparse,  but similarly, most  existing theoretical  accounts fail to offer any explanatory  which to account  for the dramatic  increase  framework with  in suicidal behaviour during  the adolescent years. In fact, most explanations of suicidal behaviour make few, those  if any, distinctions regarding who make  omission main  is made  thrust  attempts clear  upon  the age or developmental their  own lives.  by the following review  of sociological,  psychodynamic,  station of  The extent  of this  which summarizes the  and cognitive  accounts of  suicidal behaviour. Sociological Accounts of Suicidal Behaviour As is widely known, Durkheim (1897/1966) is credited with having done early ground-breaking work on suicide within the field of sociology. From  Durkheim's perspective  the frequency  of suicide within any given  social group is understood to be the consequence of the degree to which that society has failed to meet certain basic human needs. Individual well being, according to Durkheim, requires a certain optimal balance between social and personal identity on the one hand, and social constraint and individual independence on the other. The direction in which this balance of needs and presses is tipped within any given society  was understood  by him to determine which of four types of suicide individuals are likely to commit. These four types of suicide are referred to as 1) egoistic, 2) altruistic, 3) anomic, and 4) fatalistic. In terms of the social structure of society, two dimensions are identified: a social integration dimension and a  vulnerability  to  deregulation  dimension  (Krauss,  1976).  What  Durkheim  called "egoistic suicide" is associated with a lack of social integration, most typical in societies  with low social cohesion. This lack of integration of  religious, domestic, or political society is said to weaken the collective force of  social  bonds  directing  them  which away  serve from  to  restrain  self-oriented  individuals from  reflection  feelings of isolation and meaninglessness.  and  suicide  the  by  subsequent  By contrast, Durkheim's second  or "altruistic" type of suicide is said to occur in overly integrated  societies  where personal identity is highly subordinated to social identity. In such a setting, the life of a specific individual is accorded little meaning or value beyond its social contribution. Suicide within this type of social structure is said  to  stem  either  from  a  failure  to  live  up  to  the  expectations  associated with one's social role, or from so complete an identification with some extra-personal  goal that one's life may be sacrificed in its pursuit.  What Durkheim described as "anomic suicides" find their explanation along his  second  associated  dimension  of  deregulation.  Such  self  destructive  acts  are  with conditions in which normally functioning social controls are  loosened. This loss of social restraint and control, according to Durkheim, leaves individuals without the kind of guidance necessary to identify and pursue goals, and thus without "resistance" to suicide. The other end of this dimension defines the social conditions under which "fatalistic suicide" is said to most likely occur  in response  to excessively  oppressive social  regulation. Durkheim's explanatory model, like that of other more contemporary investigators  working  within  this  sociological  tradition,  was  primarily  intended as a means of accounting for differential suicide rates in different cultures individual  and,  as  such,  difference.  is  While  only his  indirectly theory  concerned does  with  assume  matters certain  of core  psychological dynamics (i.e., both a tendency toward self-reflection, which is associated  in the extreme with skeptical uncertainty,  and a need to seek  out some extra-personal faith), these factors  imperative associated  with systems  of organized  are subordinated in his view to what are for him  more compelling matters having to do with different social structures. In support of Durkheim's theory, suicide and attempted suicide rates do seem to fluctuate over time Boss,  1976;  Carlson,  and differ by country 1983;  adequate  psychological  however,  attempt  Hendin,  understanding  1982;  and culture  Madison,  of such  (Biller, 1977;  1978).  Any more  suicidal behaviour  must,  to shed some light upon what it is about particular  individuals within a given social structure that leads some, but not others, to undertake to end their own lives. Psychodynamic Accounts of Suicide Psychodynamic theories  represent  a second major  tradition in the  study of suicidal behaviour, and one that does emphasize  the affective  roots and individual pathological nature of such acts. Freud, for example, offered  two such  theory  and (2)  interpretations the death  of suicide:  (1)  the narcissism-frustrated  instinct hypothesis. The latter  interpretation,  which has garnered little support, basically proposes that suicide represents the precocious victory of the inner drive toward death (Krauss, 1976). As Hendin  (1982)  explanatory way  of  points  out, however,  such  an interpretation  has little  power in that it amounts to little more than a roundabout saying  that  narcissism-frustrated  people  theory  kill  suggests  themselves. that  The  narcissistic  more  popular  attachments  to  libidinal objects result in highly unstable object relations because of their excessive demands for gratification. Given the narcissistic identification with such objects, the frustration and anger created by their eventual loss may, according to Freud, become  directed at the self. In the extreme,  self-directed  to suicide  rage  may lead  (Krauss,  1976).  This  such  theoretical  interpretation, while difficult to test directly (Bennum, 1984), underlies a number of psychodynamically inspired accounts that focus on early family  dynamics  (Brown,  precipitating  1985; Madison,  factors  in suicide  1978)  or various emotional losses as  (Farberow,  1985;  Peck,  1985).  As with  psychodynamic interpretations more generally, however, such accounts often amount to case specific explanations that narratively incorporate individual personality and situational variables but lack generalizability. Attempts to remedy the idiosyncratic nature of such interpretations of suicidal behaviour have tended to take one of two forms. On the one hand, there are a number of investigators who, while still theory driven, have adopted an eclectic psychodynamic 1976; almost  approach often involving some mixture of both  and sociological theories  Madison,  1978).  certainly  On  see Hendin,  While any behavioural act,  multi-determined,  toward conceptual incoherance destructive  (i.e.,  such  eclectic  1982; Krauss,  including  approaches  suicide, is often  tend  as the locus of responsibility for the self  act shifts more or less haphazardly with the individual case.  the other  hand there  are those  researchers  who appear  to have  abandoned all theories and have opted for more data driven approaches to the  problem of suicide  (Arffa,  1983).  Representatives  of this unguided  empirical orientation tend to lean upon other theoretically and empirically driven  studies  and have  typically proceeded  opportunistically to identify  interrelations between a mosaic of borrowed variables (e.g., see McKenry & Kelly,  1983; Siegel & Griffin,  1983). Research  of this sort gains a  certain amount of generalizability but ultimately suffers from the lack of a conceptual framework within which to place these results or make them comprehensible.  Common to all of these,  as well as to the previously  mentioned approaches, is that little distinction is made between the suicidal behaviours of various age groups. The sudden increase in such behaviour in adolescence,  when it is noted at all, is generally attributed in some  post-hoc fashion to the biological and social changes which are assumed to characterize  this period.  Cognitive Accounts of Suicidal Behaviour Finally, relation  between  exceptions, kind  a number of researchers have focused attention cognition  and suicidal  these cognitively  of "narrow  theoretical  oriented  empiricism"  1982)  However,  have  with few  also  favoured a  which largely  avoids any  untouched the particular  the suicidal acts of adolescents. the  investigators  (Taylor,  analysis and leaves  behaviour.  upon the  issues  unique to  One major emphasis within this cognitive  approach  has been  characterization  of aspects  associated  with suicidal behaviour. The most consistent  of cognitive  style  findings here are  that suicidal individuals tend to display rigid, dichotomous thinking (Arffa, 1983;  Beck,  1961,  1964,  Luscomb,  Shaw,  1967;  Neuringer  1984;  Faberow,  & Lettieri,  1982;  1984), low tolerance for uncertainty 1982), restricted  time  perspective  1978),  and fear  Carroll,  1984; Taylor,  Hendin,  1982; Shneidman,  the  & Emery,  contributions  undertaken (1985),  by suicidologists  and by researchers  style  (Beck  such  as  et al., 1984; Berman &  suicidal  Shneidman  in the newly  &  1983; Berman &  of loss of control  to  Clum,  (Beck et al., 1984; Taylor,  1985). More comprehensive  of cognitive  1985; Neuringer,  Patsiokas,  1979), poor problem solving abilities (Arffa,  Carroll, 1978,  Rush,  (Arffa, 1983;  investigations  behaviour (1985)  have  into been  and Faberow  emerging cognitive-behavioural  orientation. Shneidman associated  (1985)  with suicide  argues  are most  that  the  "accurately  psychological seen  circumstances  as a more  or less  transient psychological constriction of affect and intellect" (p. 138) which is manifested in a reliance upon dichotomous thinking such that the problem solving alternatives magical)  reduce to either the finding of "some specific (almost  solution or cessation".  Associated  with this constricted  cognitive  state are those idiosyncratic and destructive styles of reasoning Shneidman refers to as "catalogical  reasoning".  In an attempt to elucidate  specific  aspects of this suicidal mode of thought, Shneidman developed a system of logical  content  applied  analysis  based  to suicide notes.  on principles of formal  The types  of logical fallacies  logic  which he  most commonly  identified in such notes were: 1) semantic fallacies which are dependent on the ambiguous meaning of terms; involve  fallacious  identification  spectator-survivor Shneidman, generally  to  1985).  one's  and 2) psychosemantic  in which  own death  According to this  one  imagines  (Shneidman view,  assumed to be a multi-faceted  fallacies which oneself  as  & Faberow,  a  1957;  while suicidal behaviour is  phenomenon, it is the suicidal  logic which ultimately leads to the lethal decision to take one's own life. Parallels between Shneidman's views and the conclusions of this thesis will be drawn out later,  with specific emphasis upon how the developmental  approach adopted here explicates why such "cognitive" difficulties are likely to put in their first appearance in adolescence. Other cognitive-behaviouralists have adopted positions similar to the one just located  outlined in that primary responsibility for the suicidal act is at  the  juncture thought  of  maladaptive  which  severely  idiosyncratic  constriction  of  limits  alternatives.  However, underlying these more  the  general  beliefs  and  consideration  characteristics,  a of  and  what is understood to be the central psychological core common to suicidal individuals is a overwhelming sense of hopelessness  (Beck  et al., 1984;  Minkoff, Bergman, Beck & Beck, 1973). This sense of hopelessness is said to be manifested in suicidal persons by an attitude of general pessimism or negative  expectancy  in regard  to their own personal future and has  been found to be more predictive of suicidal intent than is depression, with which it is often correlated. measure study.  of "hopelessness"  On the strength  of these findings, a  was incorporated into the methodology of this  SOCIAL-COGNITIVE DEVELOPMENTAL INTERPRETATIONS OF SUICIDAL BEHAVIOUR In contrast to the sociological, psychodynamic, and earlier cognitive accounts outlined above, the central hypothesis to be tested in this study was that suicidal adolescents would differ from their "normal" age mates in  terms  of  continuity rooted  their  and  in  a  conceptual  epistemic series  management  doubt.  of  The  papers  of  rationale  outlining  problems  for  the  this  of  personal  hypothesis  potentially  negative  was or  maladaptive consequences of cognitive difficulties associated with failures to successfully negotiate period.  According  certain of the developmental tasks of the to  these  Chandler, Boyes, & Moran,  earlier 1984;  1987),  the  cognitive  advances  them,  not  only  range  a  but also a series  such  persons  young  Central  among  an  these  (Chandler,  1975,  1987;  Chandler, Boyes, Ball, & Hala,  common to  of  consequences,  accounts  adolescent  obvious  early  and  adolescence  well  1986,  carry  documented  with  positive  of disquieting realizations which can cost  earlier  equanimity  important  but  born  disarming  of  simple  discoveries  ignorance. are  the  realizations: 1) that the grounds for assuming the persistence of one's own identity  in  the  face  of  change  are  not  self-evident  or  automatically  guaranteed; and 2) that old confidences in presumptively shared certainties are  unfounded. Earlier research  efforts have demonstrated that these two  issues become matters of focal concern  in the lives of most  adolescent  youth, and that wide developmental and individual differences exist in the degree  of success  these  problems.  with which particular While  both  of  these  distinguish younger and older adolescents adaptational difficulties characterize  range, in  there are  resolving  these  adolescents  manage  dimensions  of  to  resolve  difference  also  who function within the normal  also good reasons developmental  to assume dilemmas  that special  will  especially  young persons who make serious attempts to take their own  lives. Why this should be so is detailed in the sections which follow.  Identity Diffusion and Adolescent Suicidal Behaviour One of the organizing assumptions of this study is that, relative to their non-suicidal peers, young persons who have made serious attempts against  their  questions  own lives  will  of numerical identity  prove  less  able  in the face  to  successfully  of change.  resolve  The conceptual  grounds for this hypothesis are located in a series of papers (Chandler et al., 1984; Chandler et al., 1986, 1987) which have had as their purpose the task which  of developing a descriptive account  young persons  of the alternative  of varying ages undertake  to warrant  ways in their own  continuity across time. A  number of philosophers (Maclntyre,  1976) and social scientists argued coherent  1975; Rorty,  (Gergen & Gergen, 1983; Harre,  persuasively  that  meaning,  it must  if the concept refer  to a  somehow persisting through time. these authors  1981; Perry,  of selfhood self  that  Such an account  1984) have  is to  survives  have any changes by  of personal identity,  claim, is fundamental to our everyday notions of personal  reidentification, responsibility for our past actions, and concern for our own future  well  being  (James,  1910).  Erikson  (1968),  among  Dobert, Habermas, & Nunner-Winkler, 1987; Rosenberg,  others  (e.g.,  1984), has made  such an achievement of personal continuity a prerequisite for a coherent sense of identity, and the formation of such a stable identity the central psychosocial  task  of adolescence.  By these  accounts,  failure to maintain  some diachronic connection or sense of continuity between one's own past, present, and potential future selves would leave no reason for one to act with any special care or concern for what would otherwise be understood as in one's own future interests. On the preceding logic, adolescents  who have seriously entertained  and acted upon the intention to end their own lives represent a group of individuals who, by their own actions, have demonstrated an extreme lack  of  commitment  self-destructive  to  their  tendencies,  own  it  future  is argued  selves.  here,  Consequently,  may  be  such  understood  as  a  partial consequence of these young persons having suffered extreme failures in  their  efforts  to  achieve  an appropriate  sense of personal continuity.  Testing this theoretical possibility is a central task of the research to be reported here.  How is Personal Continuity Warranted in the Usual Developmental Course? While  the  simple assertion  that  one  persists  in a  self-same  or  numerically identical way through time is rarely called into open question, the private achievement of some conception of selfhood that actually allows for  such  a  sense  of  connectedness  across  the  physical,  social  and  psychological changes to which we are all subject is often hard won, and in  no  sense  is  automatically  guaranteed.  What  is  required  is  some  conceptual means of counting one's self as continuous despite and across such changes. Phrased somewhat differently, the task of achieving a sense of continuous criteria  by  personal  which one  identity can  amounts  count  the  to  the  problem of identifying  conclusion  of  persistent  identity  justified. In principle, a number of different classes of justificatory criteria are  potentially  certain  available which, if applicable, can  personal connectedness  serve  to guarantee a  across time. How adequate  each of these  different types of warranting strategies actually is depends, in some large measure,  on  the  consequently, are adolescence,  sorts  of  reflect  required to take into personal account.  upon  and,  The move into  1987), marks the beginning of a period of development  during which young persons' of dramatic  undermine  individuals  it is argued here and elsewhere (Chandler & Ball, in press;  Chandler et al.,  sorts  changes  simpler  self-reflective  physical, social, physicalistic  and  strategies  abilities are psychological by  means  focused upon the changes  likely  to  of which personal  continuity  was  themselves  confronted with an expanding horizon of personal change  routinely  once  called  easily  upon to  justified.  As  such,  mount increasingly  adolescents  more  who  adequate  find are  warrants of  personal sameness. A typology of alternative continuity warrants Previous research (Chandler et al., 1987)  has documented that the  manner in which young persons undertake to warrant personal continuity progresses  through  increasingly continuity  a  adequate warranting  predictable  and  warranting  strategies.  strategies  can  orderly  be  age-graded These  sequence  various  schematized  types  according  to  of of the  five-part typology summarized in Table 1. In brief, the first three types of continuity warranting  strategies outlined here are  common assumption that persistent  predicated upon the  identity rests upon, and is vouchsafed  by the presence of, some structural similaritj' between one's roster of past and  present  attributes.  The  differences  which  divide  these  contrasting  claims of identity through structural similarity hinge upon the conceptions each  of self upon which they are  incorporates  or  resolves  issues  alternative  based, and the ways in which  of manifest  personal  change.  The  simplest of these alternatives rests upon the assumption that one or more of one's defining attributes persist wholly unchanged despite other obvious transformations. relevance  Such  simple inclusion arguments  of such manifest change  and solve  identity by pointing to counter-examples  the  (level  1)  discount  the  question of numerical  which appear  to have  somehow  remained impervious to the workings of time. The obvious problem with claims of this sort is that as more and more of one's attributes undergo undeniable change the potential grounds upon which one's identity can be warranted are systematically eroded. Level by  2 typological warranting  discounting all personal  change  strategies argue for self continuity as  only  apparent  rather  than  real.  Table 1 A Typology of Possible Continuity Warrants Structural Warrants Level 1: Simple Inclusion Arguments Conception of Self  Grounds of Continuity Claims  The self is seen as a static, composite collection or mosaic of juxtaposed attributes. Change amounts to the simple addition or deletion of parts.  A "sufficient" number of attributes characteristic of one's former self are assumed to co-occur in one's self of the moment.  Level 2: Typological Arguments Conception of Self  Grounds of Continuity Claims  The self is conceived of as a typologic space, each facet of which represents another side of one's fixed character. Change is considered merely presentational and should be discounted as only apparent.  Facets of one's character are sometimes eclipsed from view but, although hidden, remain as fixed features of the architecture of the self.  Level 3: Essentialist Arguments Conception of Self  Grounds of Continuity Claims  The self is conceived of as a hierarchicalized system governed by deep lying essential attributes. Change is considered phenotypic, only occuring in surface attributes, but not in the essential core of self.  Phenotypic changes are rationalized as alternative manifestations or paraphrases of a common, unchanging essential core of one's identity.  Functional Warrants Level 4: Foundational Arguments Conception of Self  Grounds of Continuity Claims  The self is understood as a network of relations of implicative mediation tying the present to its ancestoral past. Changes may be structural but are seen to constitute the conditions of satisfaction of a determining past.  The novel aspects of the person one has become are seen to be coherently connected to the person one once was because it would be logically impossible to become the latter without previously having been the former.  Level 5: Narrative Arguments Conception of Self  Grounds of Continuity Claims  The self is conceived of as an autobiographical or narrative centre of gravity. Changes may be structural and these structural changes are matched by changing constructions of the narrative meaning of the self.  The narrative that constitutes one's autobiographical self is counted as continuous so long as it makes possible a coherent and followable network of interpretable connections.  Such level 2 strategies are based upon the more complex typologic vision of selfhood as a sort of solid, polyhedronic space formed by many planar surfaces,  each  one of which is imagined to  one's fixed identity. Authentic change, apparent  change  manifested certain  is  explained  aspect of the  particular  away  self is  personal  another  by these accounts, on  a  reference  the  grounds  consequence  attributes  which  is denied and  that  of the  were  facet of  any newly  illumination  always  present  of but  previously eclipsed from view. Such typologic claims are both fatalistic and incapable  of  facilitating  the  creation  of  a  coherent  or  integrative  biographical account which incorporates manifest qualitative change. Level 2 warrants,  then, are perfectly capable of preserving sameness  but only at  the cost of flatly denying the possibility of real change. Essentialist  warrants  (level  3)  represent  the  first  of  these  alternative strategies which is capable of simultaneously acknowledging real change and preserving personal sameness through time. Exponents of such essentialistic organized  views  conceive  self-system,  occupy more  than  a  the  of  identity  component  as  parts  rooted  in  a  hierarchically  of which are  single level of abstraction  or  understood to  internality. By this  accounting strategy the more central and defining of one's attributes  are  thought to underlie and inform their various surface manifestations which, for their own part, are taken to be mere phenotypic appearances.  So long  as one is able to rationalize the conclusion that there is at work beneath one's surface productively  attributes  some inner core of essential sameness  paraphrasing  itself  in  variously  phenotypically  capable of diverse  but  genotypically equivalent forms, real differences can be acknowledged while continuous identity is still preserved. Such strategies are relatively robust in that the changing features of oneself can, in principle, be continuously reinterpreted abstract core. relying  on  as  different  expressions  of  an  ever  deeper  lying  inner  The sorts of problems that eventually arise for individuals such  essentialist  claims  to  continuity  are  that  as  new  differences capable  arise  on  the  scene,  the  search  for  of subsuming such phenotypic changes  some  interior  esssence  is moved to increasingly  remote levels of abstraction  until all that is left is a nameless pointing  operation long on generality  but short on interpersonal currency - some  secular equivalent of a featureless but immutable soul. In practices  contrast outlined  to  the  three  above,  the  types  last  two  depicted in this typology abandon as the persistence  of structurally continuity  unnecessary  of shared parts and substitute  based  warranting  conferring  strategies  all assumptions about  in their place a  thematic  conception of persistence identity that is rooted in various relations thought to obtain between  the  foundational arguments  diverse  episodes  of one's  own life course.  Both  (level 4) and narrative continuity arguments (level  5) rest all claims for the persistence of selfhood on the assumption that the person one once was functionally  rather  and the person one has  than  structurally  related.  The  or will become main  are  dimension  of  difference which divides these two functionally based types of warrants is the degree  of constraint  each  imposes on one's  oneself. Level 4 foundational arguments  changing conceptions of  claim continuity on the grounds  that one's present self is the logical outcome of one's own ancestoral past. In this manner, the individual is seen as a coherently connected product of a determining past whose potential future  selves  become increasingly  constrained by the canalization of time. Narrative arguments (level 5), on the  other  hand,  free  individuals  of  the  constraining  aspects  of  a  determining past by resting claims of continuity entirely on the basis of a self-recognized interpretive process for which the criteria for continuity is the  successful  interpretive  construction  connections  diachronic self.  of  between  a  coherent the  and  various  followable  network  manifestations  of  of  one's  Continuity and Suicidal Behaviour Earlier critical  points  continuity  based  of a  sameness,  (Chandler  relative  warrants  structurally creation  research  to  in  the  et  al.,  development  adolescence.  level  3  First,  essentialist  not  processes  has  and it  surface  demonstrated  application  has  arguments,  levels distinction separating  been which  change  two  of  such  shown  that  rely  on  the  from essential  and levels 4 and 5 functional arguments, capable of justifying  relational connections between earlier are  1987)  available  to  young  of thought associated  and later  persons  who  ways of being, typically  lack  the  kinds  of  with formal operational reasoning  abstract (Piaget,  1970). Second, it has been demonstrated that what adolescents commonly count as defining features of their own identity are precisely those level 1 and 2 surface attributes which are most in transition during their teenage years. The warranting  confluence of these two restrictions personal  continuity  all  but  upon earlier  guarantee  the  methods of  prospect  of  an  important crisis of identity for all those young persons who continue to stake their claims to identity upon inherently transient features  of their  own personality make-up. It also follows that adolescents will be able to justify their own temporal coherence only to the extent that they abandon such simple inclusion and typologic arguments  for personal continuity in  favour of more essentialistic and functional styles of justificatory reasoning. Such prospects  open up the possibility that for certain youth that have  failed to acquire these more mature modes of warranting continuity, the usual changes associated with adolescence are likely to disrupt their sense of connectedness across time. In the extreme, the lack of adequate means to understand their own numerical identity may cost such young persons interest in their own continuing personal history.  If, as Erikson (1968) and others 1984)  (Dobert et al., 1987;  Rosenberg,  argue, a sense of selfhood and a stake in our own past and future  require  a  capacity  sense  to  of personal  successfully  continuity,  and  if certain  youth  mount such continuity warrants,  then  lack  the  for such  individuals identity crises are inevitable. In particular, such individuals are likely to lack a sense of commitment to their own past and future selves and to act in ways that do not show proper concern for their own future well being. On these grounds it was hypothesized that adolescents without an effective means of warranting their own personal continuity would be at  risk to various self-destructive  group,  suicidal  youth  successfully warrant  would  behaviours, and conversely, that as a demonstrate  themselves  less  able  to  personal continuity than would their nonsuicidal age  mates. Skeptical Doubt and Suicidal Behaviour in Adolescence Previous work (Boyes, 1987; has documented  that the  achievement  common to the early adolescent costing  young  persons  Chandler, 1975;  their  of certain  period has  earlier  Chandler et al., role-taking  1986)  competencies  the  negative  consequence  of  of  absolute  conviction  by  sense  confronting them with the apparent person-relative character of knowledge. According to this  account,  younger children are  egocentricity from any clear awareness  insulated by their own  that different people find different  meanings in what are for them common experiences. With the advent of mature role-taking competencies,  however, such naively realistic views are  naturally sacrificed to the better relativized appreciation that all persons are  in some  Consequently, promotes which  a  earlier  sense trapped behind the it  has  kind case  been  argued,  of "Cartesian  this  anxiety"  specific doubts  walls of their  about  growing  sense  (Chandler, this  or  own subjectivity.  1987)  that  of  according  truth  replaced by a more wholesale brand of generic uncertainty  relativism  claim  to are  that renders  essentially everything subject to doubt. The dilemma which this poses is that  of  finding  some  conceptual  means  of  acting  with  conviction or  commitment. In studies of normal adolescents, three alternative responses to the emergence of such skeptical doubts have been identified, each one of which differs in terms of how the problem of uncertainty is construed, what constitute the necessary criteria for acting with conviction, and how available these  criteria are  understood to be. Each of these  alternative  responses which have been more fully elaborated elsewhere (e.g., Chandler, 1987;  Chandler et al., 1986)  are detailed in brief in the paragraghs which  follow and summarized in Table 2. Level one - defended realism. The first, and most early arriving, response to nascent skeptical doubt is referred to here as defended realism (level 1). By this account, alternative interpretations of reality are held to be  the  product  of  vested  interests  and  private  agendas  which  are  understood to interfere with objective efforts to arrive at a shared truth. That is, the common search overrun by veiled interests  for certain knowledge is understood to be or biases  which operate  on cultural, social,  generational, and individual levels. The same prospect of bad faith is even extended to the self by persons at  this first level, who recognize that  they too are potentially guilty of distorting the truth in the service of their own situated interests. Interpretation of any kind, by this account, is a  kind of social disease  the only cure for which lies in finding some  completely disinterested third party who, because he or she has no stake in the matter,  is capable of viewing the situation objectively and thereby  veridically. Because accomplishing this task is no easy matter  and often  ends up with experts that also disagree among themselves, such defended realists are commonly forced to abandon their efforts to run undisputed facts to earth.  Table 2 Strategies  for Dealing  Nascent S k e p t i c a l  Level  with  Doubt  C r i t e r i o n for Knowledge Claim  E x p l a n a t i o n of Divergent Views  Response to Diversity  Defended Rea1i sm  Absolute Certainty  Personal b i a s e s and vested I n t e r e s t s block the s o r t of o b j e c t i v i t y that would lead to a consensus of t r u t h .  Search f o r d i s i n t e r e s t e d t h i r d p a r t y who can objectively arbitrate truth claims.  Dogmatism/ Skepticism  Absolute Certainty  Knowledge claims are inherently subjective and amount to no more than p e r s o n a l o p i n i o n s which can not be evaluated r a t i o n a l l y .  (D) Search out some e x t r a - p e r s o n a l source of o b j e c t i v e t r u t h or (S) r e j e c t a l l r a t i o n a l c r i t e r i a and r e l y , i n s t e a d , upon n o n c o g n l t i v e d e c i s i o n making s t r a t e g i e s .  Relative Certainty  Knowledge claims are inherently subjective but standards of judgement can be found by which to e v a l u a t e such r a t i o n a l l y based truth claims.  Search f o r r a t i o n a l c r i t e r i a by which to choose between one t r u t h c l a i m and another.  Post-Skept ica1 Rat iona1i sm  Level  two  -  the  dogmatic/skeptical  abandoned hope of divesting themselves  axis.  Individuals  who  have  or remedying others of personal  bias are typically prompted to move in one or the other of two opposing but related directions, both of which fall along what is described here as the dogmatic-skeptical axis. Those who favour skeptical solutions reject as unrealistic  all  prospects  choosing between anything  as  of  important  true,  finding  any  alternatives.  such skeptics  acceptable  cognitive  Unprepared to  struggle  Examples  of  impulsivism  mechanisms such  (acting  whenever  to suspend all judgment  noncognitive without  decisions  are  decision-making  thought),  intuitionism  of  assert or accept  what it is that should be done and instead rely on various decision-making  means  forced  extra-cognitive upon  strategies (doing  about  them. include  what  affect  demands), conformism (doing the done thing), and indifferentism (tossing a coin). Dogmatists, who occupy the opposite end of this dogmatic-skeptical axis,  share the skeptic's poor opinion about the prospects  generated  knowledge, but resolve  some extra-personal  for personally  this dilemma by placing their faith in  source of objective truth. Blind allegiance to religious  dogma, or conversion to "scientism" and the canons of methodologic rigor are examples of such dogmatic solutions which are meant to provide some absolute  corrective  to  the  inherently  subjective  character  of  personally  generated knowledge. The down side of these truth preserving commitments is that they tend, as do all dogmatic views, to have an all or nothing quality. Consequently, when any crack appears in such seamless pillars of faith their entire structure tends to come crashing down. The alternatives along this axis again reduce to another  round of skepticism or a search  for some new dogmatic faith. Level three - post-skeptical rationalism. A third alternative  response  to such persistent doubts is to abandon the search for absolute knowledge  in favour of what amounts to a search  for arguably good reasons  choosing one belief or course of action over another. views  amount  making  to  rational  an  endorsement  commitments  of the  in the  for  Such post-skeptical  possibility and practicality  face of the  clear  of  knowledge that  other defensible alternatives continue to exist (Chandler, 1987). By such an account,  the  lack  of  absolute  certainty  is  not  understood  as  an  unsurmountable obstacle to making rationally based truth claims. Instead, individuals who hold to such post-skeptical views accept the reasonableness of identifying provisional standards without  recourse  to  the  of judgment  that  unmitigated  truth.  absolute  can  be  The  evaluated advantages  afforded by such a post-skeptical solution include the freedom to envision a variety of defensible alternative life courses none of which need to be held out as being ultimately correct. Doubt and Suicidal Behaviour  It 1986)  has  that  been  argued  individuals  elsewhere  whose  (Chandler,  development  is  1987;  Chandler et al.,  foreshortened  and  whose  response to uncertainty remains at level 1 (defended realism) or level 2 (the dogmatism-skepticism axis) are in highly vulnerable positions. Defended realists are forced to see everyone, themselves included, as the victims of their  own petty  biases.  Dogmatists,  by contrast, are  vulnerable to  the  likely prospect that their authorities will fail them and skeptics are forced to leave little  things to whim,  reason  to  invest  Fortunately,  for  alternatives.  Instead,  to  realize  many  impulse, or convention, and consequently have themselves  adolescents,  in  their  these  are  with increasing maturity,  that it is not necessary  to  own not  capricious the  only  future.  or  usual  most young persons come  be more certain  than  certainty  permits, and that it is possible to find good, if not ironclad, reasons for preferring realistic,  one  alternative  dogmatic,  or  over  skeptical  another, views  leading in  them  favour  of  to  reject  some  such  form  of  post-skeptical rationalism. While positions  the  of  ;  foregoing  defended  account  realism,  is  meant  skepticism  to  and  order  the  dogmatism,  epistemic  and  finally,  post-skeptical rationalism along a common dimension of increasing formal adequacy, it does not follow as a consequence that only those adolescents who achieve the third or highest of these levels are insulated against the adaptational  difficulties common  to  this  developmental  conclusion might be successfully argued with reference least in Western cultures, adolescence  there is a long precedent  period.  Such  a  to adults but,  at  for assuming that  is a staging ground on which young persons are  alternatively  try  out  commitments  (Marcia,  and  reject  1983).  various  On these  identities  grounds  it  and  can  meant  to  provisional  and  has  been  argued that an epistemic posture of dogmatism or skepticism is entirely age appropriate for persons in this age group. The realism,  same  thing may  however.  adolescence opinions  On  not  the  likely  without being made  that  are  held  be  said  of the  prospect  that  aware of the  regarding  almost  position of defended few  persons  great range  every  matter  reach  of divergent of  moment,  skepticism, and the dogmatic views that it sometimes fuels, while offering no  rational  solution  to  this  conundrum,  at  least  creates  a  certain  sympathy for it. Those that deeply doubt the prospect of finding human ways  of  empathetic  making  resonance  same boat. who persists every  personal  commitments  can  scarcely  avoid  a  certain  with others who they perceive to be adrift in the  Quite the opposite is true, however, for the defended realist in the view that there is a single and correct answer  to  problem. For such individuals, two equally unattractive possibilities  exist. Either no one as  yet knows the  real truth of some matter, in  which case those that presume to tell one what to believe or how to behave  are  simply exercising  their  arbitrary  authority,  or the  one and  only correct belief has been identified but others perversity  or  mean-spiritedness,  to  press  their  persist,  out of simple  biased and wrong-headed  case. In either instance the likely response is anger and frustration. For the two sets of reasons outlined above, two general hypotheses regarding  the  likely  relation between  epistemic  development  are  possible.  personal First,  adjustment  and  most  and level of  generally,  it  is  hypothesized that arriving at a mature position of post-skeptical rationalism will be more likely to occur among the normal adolescents  of this study  than among those who have been hospitalized as a result of psychiatric difficulties.  Second,  and  more  specifically,  it  is  hypothesized  that  the  hospitalized sample in general and the suicidal subjects in particular will be more likely to persist at the level of defended realism than will their better adjusted high school peers.  SUMMARY OF HYPOTHESES The  normative  demonstrated  that  research  in the  course  upon  which  of adolescent  this  study  rests  has  development most young  persons are forced, as a consequence of their increasing cognitive maturity, to come to terms with the issues of their own continuity in the face of personal change and the need to formulate commitments in an increasingly uncertain world. The hypotheses that have guided the present study centre on the general expectation that the inability to make adequate progress on these two  central  developmental tasks predispose  a certain  subgroup of  adolescents to lose faith in their own future prospects and costs them all serious  commitments  to  themselves  and  their  own future  welfare. The  group of young persons who, through their own actions, appear to most clearly qualify for such dubious distinctions are those who have undertaken to end their own lives. On the strength  of this argument  a plan was  undertaken to identify such a group of suicidal adolescents  and to test  them with the  expectation  that they  would distinguish themselves  from  their nonsuicidal age mates by being less able to deal with matters of uncertainty and doubt, and their own continuous identity through time. Two realities of the present undertaking served to complicate this otherwise straight-forward prediction. The first concerns the fact that the developmental route along which young persons typically move in coming to a mature sense of continuity and commitment is marked by a sequence of intermediate levels or stages the achievement of which are  correlated  with but not specified by increasing chronological age. This fact, combined with the reality that the ages of the suicidal subjects to be studied could not be specified in advance,  necessitated • that the hypotheses to be held  up for specific test could not be stated in any simple either/or fashion, but needed to be formulated instead in a rather suggesting  that  suicidal  subjects  would  show  less precise  developmental  language delays  in  moving through these progressions relative to their nonsuicidal age-mates. The hypotheses  second  difficulty  that intruded into  to be tested in this study arose as  the  crisp  formulation of  a function of the fact  that, for reasons that were neither anticipated nor are fully understood, it proved  to  be  impossible to  hospitalized adolescents  clearly  identify a  group  of psychiatrically  that were entirely free of evident risk to suicide.  As will be described more fully in the methods section that follows, all but one of a series of 35 consecutive admissions to the psychiatric facility from which the adolescent subjects of this study were drawn carried with them psychiatric histories that included some reference to the possibility of suicidal risk. As a consequence proved  available  did not  of this fact, the comparison groups that  include,  as  originally planned,  a nonsuicidal,  though psychiatrically hospitalized control, but are made up instead of a high suicide risk group, a low suicide risk group, and a set of matched normal control subjects.  Given  these  various considerations, the  specific hypotheses to be  tested were as follows: 1) With respect to the measure of personal continuity a) nonhospitalized subjects were expected to show more mature continuity warrants than all hospitalized subjects taken as a group; b) high risk subjects were expected to show less adequate strategies  for warranting personal sameness than  other psychiatrically hospitalized subjects at low risk to suicide; and c) the normal  control, low risk,  distinct from  and high  one another  risk  subjects  and ordered with  were  respect  expected  to be  to their ability to  justify their own numerical identity. 2) With respect to nascent skeptical doubt a) nonhospitalized subjects were expected to evidence more mature skeptical  doubt  than  were  the  strategies  hospitalized  for dealing with emergent subjects;  b)  none  of the  hospitalized subjects were expected to make use of post-skeptical solutions to the  problem  of doubt; and c)  high  risk  persist with level 1 defended realist strategies.  subjects  were expected to  31  CHAPTER 2: METHOD  MEASURES While not unique to this project, several of the measures employed in this study are  not widely known and, consequently, will need to be  described in some detail. Following this presentation, conventional summary of the particular tasks,  a briefer and more  subjects,  and procedures is  offered. The first part of this method section, then, describes the measures employed  in  skeptical  operationalizing  doubt.  In  addition,  the  constructs  of  numerical  a  description  of  the  psychiatrically hospitalized youth were  identity  means  by  and  which  subdivided into high and low risk  suicidal groups is detailed. Measuring Numerical Identity The  numerical  identity  measure  employed  in  this  study  was  developed by Chandler and his colleagues (Chandler, Boyes, Ball, & Hala, 1985)  and  involves a  set  of procedures  for  systematically  interviewing  subjects about how they understand the radical changes that take place in their own lives and in the lives of third party story characters. Simplified versions of Charles Dicken's "A Christmas Carol" and Victor Hugo's "Les Miserables"  are  presented  in  colour-illustrated  booklets  followed  by  a  standard interview. Subjects are asked to first describe the ways in which these story characters are different at the beginning and the end of the story  and  identical  then  with  to  warrant  themselves  Following this inquiry characters,  a  series  the  conclusion  throughout  the  that  stories  they despite  are  numerically  these  changes.  into the continuity of the lives of these fictional of  questions  understanding of their own persistent  are  posed  regarding  subjects'  identity. For this purpose, subjects  are asked to describe themselves as they presently are and as they recall themselves  to  have  been  5  years  ago.  Having  offered these two self  portraits, subjects are asked to justify their assumption that they continue to be one and the same person despite all the changes they have chosen to highlight. An outline of the standard interview procedure is presented in Appendix A. Responses  to each  scored with reference  of these  three  continuity  to the five possible classes  problems are then  of continuity warrants  outlined in Table 1 according to criteria set out in Chandler and Ball (in press).  This scoring system  allows for the assignment of one of fifteen  possible scores to each of the continuity warranting opportunities. Five of these scores correspond to modal instances of the five, classes of continuity claims already described. The remainder correspond to transitional versions of these  warrants,  including  two which represent  complete  failures to  justify persistent identity, either by offering no warrant whatsoever or by immediately  discounting all such  warrants  score assigned to each subject represents  already  presented.  The total  their averaged score across the  three continuity problems. Measuring Skeptical Doubt The work of researchers such as Perry (1970) and Kitchener and King (1981) have shown that college students commonly come to entertain serious doubts about even the most means  of  documenting  this  fact,  expert of knowledge claims. As a these  authors  have  undertaken  to  demonstrate, that many well educated young adults appreciate that experts often attach irreconcilably different meanings to the "same" event. These earlier measurement efforts have employed open ended interview procedures and  have  tended  to focus  attention  upon  issues  of a rather  abstract,  technical or academic nature which are remote from the everyday lives of most adolescents.  As such, the procedures utilized in these earlier studies  hold out little hope of illuminating the nature of issues of uncertainty as they may unfold over the course of the adolescent years and may have  seriously underestimated the age at which such concerns first emerge. In support of this possibility, the work of Broughton (1978) and Mansfield and Clinchy (1985), and, less directly, that of Turiel (1983) and Smetana (1983, 1985) have indicated that when asked about more familiar matters, adolescents are often quick to characterize debatable  matters  of taste,  opinion,  competing knowledge claims as  or simple social  convention. While  pointing to the likelihood of early emerging doubts, these efforts do not directly address the question of when young persons first become capable of entertaining the serious skeptical doubts which are of interest in this study. For these reasons, and in light of the previously outlined conceptual analysis, which strongly suggests  that such skeptical doubts first put in  their appearance in the early adolescent years, measures were devised for the  purpose  of  documenting  emergent  skeptical  doubt  in  adolescence  (Chandler et al., 1986). These measures have subsequently been validated on a normative  sample of elementary  and high school children (Boyes,  1987). Nascent Skeptical Doubt Interview Procedure. The form which these measures  have  taken  is a set of two story  dilemmas which pit the  knowledge claims of one group against those of another. The two stories vary in terms of the status of each of the groups. Thus the stories are comprised points  of: 1) reports  of view  by two groups of experts expressing different  regarding  the  same  social  issue;  and 2)  an  article  generated by a group of parents contrasted with a student authored article regarding the same designed  school policy issue. The content  to be of interest  or relevance  of each  story was  to young adolescents,  and to  concretize these "disagreements" as much as possible. Accompanying each story  is  a  series  of questions  or probes  designed  to  elicit  subjects'  thoughts about the nature of, the reasons for, and the possible ways to resolve such disagreements (see Appendix B). Using the Nascent Skeptical Doubt Scoring Manual  (Boyes,  1987),  responses  are then  scored  as to  whether they illustrate an awareness of the relativistic nature of thought (story construction)  and, if so, which of the three possible strategies for  dealing with this awareness two subscores,  is being used (story resolution). From these  a single score is derived for each story. Finally, subjects  whose scores are not identical across the two dilemmas are assigned the average of the two global story scores. In this manner it is possible, in principle, for individuals to be categorized either into one of four "pure" levels: level 0 - naive realist position; level 1 - defended realist position; level 2 - dogmatism-skepticism position; level 3 - post-skeptical rationalist position,  or  derivations have  one  three  transitional  of these levels as  documented  (Boyes,  of  1987;  the  well as  age-graded  Chandler,  levels.  1987;  Based  on  the  conceptual  previous empirical results which  sequencing of the Chandler et  al.,  responses  1986),  the  to doubt adolescent  participants in the present study were expected to display responses that varied between levels 1 and 3 in this typology. Nascent  Skeptical  Doubt  Questionnaire.  In  addition  to  the  semi-structured interview procedure outlined above, a second and converging paper and pencil measure was developed by Chandler, Banerjee and Ball (Banerjee,  1986)  which utilized a graded agreement response format. This  more objective measure designed  to  express  consists of a series of 20  either  extremely  relativized  attitudinal statements or  extremely  realistic  positions regarding the possibility of absolute knowledge or certainty with reference to a number of common topics (see Appendix C). For each item, respondents are  asked to indicate, on a scale of 0-3,  how dissimilar or  similar a particular statement is to their own personal view. Half of the items are phrased as realistic attitudes and half are relativistically phrased views.  Questionnaire responses  are  then  matched  to  an  all skeptically  phrased item key and individuals are assigned a number between 0 and 3 corresponding to their averaged response across all items.  Previous versions of this objective measure were piloted on samples of both university and high school students. The results of these efforts lead to the 20-item test used in the present study. The inclusion of this questionnaire as  part of the testing procedure was meant to serve two  purposes. The first and most immediate purpose was to investigate  the  usefulness of such an objective measure by administering it to individuals who  were  also  being  assessed  via  the  more  time  interpretive interview method. By doing so, it was how  well  the  categorized  questionnaire  by the  possible to  discriminated between  interview procedure. With  consuming  and  evaluate  persons differentially  this purpose in mind, the  present study offered the opportunity not only to make this comparison across a varied age hypothesized adolescents  range but, in addition, to make it in light of the  differences  between  being studied. The  the  clinical  and  limitation here,  nonclinical groups  of course,  is  that  of the  present study does not provide for the large scale samples that would be required  for  a  full  assessment  of  the  properties  of  the  instrument.  Consequently, the use of the questionnaire in the present context may be seen as a specialized piloting project. Measuring Degree of Suicidal Risk The admission and discharge summaries of each of the hospitalized subjects was reviewed in detail. It became apparent, under close inspection of  these  records,  that  what  counted  toward  particular  patients  being  labelled as suicidal varied considerably from one case to the next. It also appeared that there was pressure in favour of over-inclusion with regard to suicidal risk. This was likely due to the fact that the consequences of any  suicidal gesture  most reasonable  are  course  so potentially tragic  is to label as  and irreversible that the  suicidal all individuals for whom  there was even a remote possibility of their seriously considering suicide. While probably generally true, it was particularly likely that something of  this sort was operating in the context of the Adolescent Unit where individuals  in  professionals  question feel  an  were  young  especially  persons  heavy  practices, while clinically sound, are  for  weight  of  whom  the  parents  responsibility.  not helpful to a research  and Such  enterprise  that requires some means of discriminating between persons who pose only a minimal threat to themselves, and those individuals for whom the taking of their own life seems a real and imminent possibility. In light of the hypotheses  which have  guided the  present  research  project,  some such  discrimination was considered essential. To  this  end,  a  number  of  steps  were  taken  in  an  effort  to  discriminate subjects who were at high and low risk to suicide. First, four point categorization  scheme was laid out which operationalized  a  what  was meant by various degrees of suicidal risk (see Appendix D). Each of these four levels was meant to be a concluding statement of risk based upon the combination of three main factors: 1) details of suicide attempt(s) (i.e., whether there was an explicit attempt, how many, when, surrounding circumstances, whether  lethality,  currently  intent,  threatening  reports of suicidal ideation,  etc.); 2)  current expression  of state (i.e.,  suicide, specificity of threats, self or other etc.);  and  3)  degree of professional  (i.e., highlighting of suicide risk, special suicide precautions  concern  taken, suicidal  behaviour considered in light of histrionic style, etc.). This scale served as a means of categorically  assigning all of the hospitalized subjects to one of  four risk levels ranging from those considered at suicide (level  extremely low risk for  1) to those considered to be in great danger of commiting  suicide (level 4). Secondly, procedures  were set up in co-operation  with the hospital  staff to access the sorts of information required to categorize individuals according  to  the  scheme outlined  above.  For  this  purpose,  access  was  granted to the complete, ongoing hospital charts, which included summaries  of  personal  nursing  history,  records,  initial  as  well  interviews, as  to  the  details  of  discharge  admission,  summary  and daily  charts which  included the final psychological and psychiatric reports for each subject. All of  this  information  was  painstakingly  reviewed  in each  case,  and all  relevant information transcribed on to summary record sheets. The  final step in this procedure was to assess whether individuals  could be reliably scored  according  to this  scheme  on the  basis  of the  available information. To test this, two independent judges familiar to the categorization of risk scheme, read the summary record sheets for each of these young patients  and, on the  basis  of that information, -categorized  them into one of the four levels of risk. There was complete agreement on  26  of the  categorized  by  29  cases (89.7%). Each of the three disagreements  the  two  raters  into  adjacent  levels.  The  final  were  category  assigned in these three cases was decided through discussion.  PROCEDURAL SUMMARY  Subjects Thirty-five adolescent  inpatients of the  Adolescent Psychiatric  Unit  of the Vancouver General Hospital were nominated, over a period of 11 months, as potential participants in this study by professional members of the  hospital's Psychological Services  for nomination were: young  person  to  Department.  The inclusionary criteria  1) written, informed parent/guardian  participate  (written,  informed  consent for the  personal  consent  was  subsequently required of each participant); 2) the professional judgment by their  attending  psychologist,  in  the  form  of  written  consent,  that  participation would not be contrary to the best therapeutic interests of the individual; and 3) that the young person was professionally assessed to be of  at  least  normal  intelligence.  Of  the  35  consecutively  admitted  adolescents of  the  who met these criteria and who were then informed in detail nature  disassociation  of  from  this  study,  hospital  with  emphasis  assessment  laid  and treatment,  upon  both  its  and upon the  voluntary nature of their own involvement, 30 agreed to participate. Upon review of hospital discharge summaries, it was learned that for one of the adolescents  tested there was some concern regarding possible brain damage  despite an assessment of within-normal-range intellectual functioning. This youth  was  dropped  from  the  study  leaving  a  total  sample  of 29  hospitalized adolescents between the ages of 13 and 18 years. Twenty-nine Vancouver personal  student  area,  consent  volunteers  and for whom were obtained,  drawn from public schools  written, also  informed  participated  in the  parent/guardian and  in the study.  Student  volunteers were selected to match as closely as possible their hospitalized peers  in terms  of age,  sex,  family  intelligence.  Since no formal intellectual  adolescents  were  variable,  available  individuals  to serve  who were  in  occupational  status,  and general  assessments of the high school  as a check grade  on this  levels  lower  last that  selection normally  appropriate for their age were excluded. The average age of the hospitalized group was 15.33 years (183.96 months,  SD= 14.71)  which  was  almost  identical  to  that  of  the  nonhospitalized group whose mean age was 15.30 years (183.62 months, SD= 15.57). There were 10 boys and 19 girls in each of the two groups. For both the hospitalized and the high school samples, the boys tended to be slightly older on average  (X= 188.0 months, SD=12.4 and X = 188.4  months, SD=13.7 respectively)  than the girls (X= 181.8 months, SD=15.7  and X = 181.1 months, SD=16.2 respectively). Information young  psychiatric  on parental patients  occupation and  International Occupational Prestige  coded  was gathered according  to  on each the  of the Standard  Scale (Treiman, 1977). The scale has a  range of 92 points, from -2 (gatherer) to 90 (chief of state) with a mean scale score of 43.3 (SD=16.9). The mean of the occupational scores for the hospitalized group was 41.62 (SD= 11.79). When information on both parents' occupations was available, the average of these scores was used in calculating the overall mean. Mothers' (n_=21) occupation scores ranged from  16  with  a  (living on public assistance) to 57 mean  score  of 39.81  (SD= 10.93).  (elementary Fathers'  school teacher)  (n = 22)  occupation  scores ranged from 26 (farm labourer) to 71 (lawyer in private practice) with a mean score of 44.4 (SD= 13.08). In general, a diverse range of occupations  were held by the parents of the hospitalized adolescents with  professionals,  self-employed business  people,  and skilled,  semi-skilled, and  unskilled labourers all represented. Equivalent information was not available for  the  high  approximate students high  a  school broad  sample. range  However,  of parental  an  attempt  backgrounds  was  made  to  by selecting the  from two different high schools. Approximately two thirds of the  school  lower-middle  sample  were  drawn  to middle class  area  from  a  school  in a  high  rental,  while the remaining one third were  drawn from the school in a predominantly middle to upper-middle class section of the city. Materials The measure of numerical identity used was the Continuity Measure as revised by Chandler and Ball (in press). This revised version developed out of refinements of earlier work by Chandler, Boyes, and Moran (1984) and Chandler, Boyes, Ball,  and Hala (1985). The story presentation and  associated  interview  semi-structured  procedure,  aimed  at  determining  subjects' characteristic manner of accounting for personal continuity in the face of change, have been detailed in the previous section. The two measures designed to assess subjects'  awareness of, and  characteristic responses to, conditions of uncertainty and doubt employed in  this study were the Nascent Skeptical Doubt Interview procedure originally developed by Chandler, Boyes, Ball, and Hala (see Boyes, 1987; Chandler et  al.,  1986),  and the  Skeptical  Doubt  Chandler, Banerjee, and Ball (Banerjee, measures  and the rationale  Questionnaire  developed by  1986). A description of these two  for their  use have  been  outlined in the  preceding methods section. In addition to the measures outlined above, the standardized 20-item paper-and-pencil  Hopelessness Scale  (Beck,  Weissman, Lester,  & Trexler,  1974) was administered to the psychiatrically hospitalized adolescents. This procedure was not given to the high school students on the grounds that there  is  evidence  to  suggest  that  social  desirability  response  biases  contaminate the scale results when used with nonclinical samples (Linehan &  Nielsen,  1981) but do not seem to present this problem when used  with clinical samples (Petrie & Chamberlain, 1983). The Hopelessness Scale was  designed  expectancies  to  be  meant  an  to  easily  administered  correlate  with  clinical  measure ratings  of of  negative depth  of  hopelessness which, in turn, are meant to correlate with degree of suicidal risk.  Since  this  scale  has been  used  most  often  with adults  it was  included in the present study not as the primary measure of suicidal risk, but rather correlate  a convergent  assessment  highly with other indices of risk, would be informative both of  the usefulness of the scale characteristics statements whether  strategy which, if it was found to  of these young hospitalized patients. For each of the twenty  which comprise  that  with suicidal youth, and perhaps of certain  statement  this  does  scale,  (true)  subjects  or does  were  asked  not (false)  to indicate  describe  their  attitude over the preceding week. A score of one was assigned to each response that matched the key (pessimistic responses) and a score of zero was  assigned otherwise. Following Beck et al. (1974), each subject was  then assigned their total summed score which was meant to measure their sense  of hopelessness  according to the following guidelines: 0-3 none or  minimal; 4-8 mild; 9-14  moderate; and 15-20  severe.  Procedure Each  of  the  psychiatrically  hospitalized  adolescents  was  seen  individually in a room provided by hospital personnel on the premises of the Adolescent Unit. Due to the special circumstances  which defined this  subject population, great care was taken to describe the purpose and limits of this project and to emphasize the voluntary nature of both their initial consented participation and their continued co-operation. Each young person was  seen  for approximately  skeptical doubt measures,  one and one half hours during  the continuity measures,  and the  which the hopelessness  scale were administered in randomized order. All but one subject chose to remain  throughout  the  entire  testing  procedure.  While  it  was originally  planned that the hospitalized subjects would be seen within two weeks of their admission to the Unit, hospital procedures and professional judgments of subjects' readiness made it impossible to adher strictly to this criterion. Instead, after  these young persons were  admission (X= 15.24  seen  anywhere  from 5 to  28  days  days, SD = 5.55). All testing done on the Unit  was carried out by either Dr. Chandler or myself. Adolescent  volunteers  selected  from  the  Vancouver  public  school  system were likewise seen individually in a room provided by their school. The format of these interview sessions were identical to those with the special  population  Hopelessness Scale already  as was  described  above  with  the  exception  that  not administered to this group for the  outlined. Interviews  were  scheduled  at  the  convenience  the  reasons of  the  school personnel and the individual student. All testing sessions were audio tape-recorded and later transcribed. All scoring was done from these. written transcripts which were identified by code only. Strict confidentiality with respect to all aspects and in all  phases of this project was maintained throughout.  SCORING Due to the interpretive nature of the scoring procedures involved in the two primary measures  employed in this study, it was necessary  to  establish again that such scoring could be done in a consistent manner by independent judges. To this end, two raters, trained in the scoring of the Nascent  Skeptical  Doubt  Interview,  independently  coded  15  randomly  selected protocols of the doubt section of the procedure. Thus, each rater coded a total of 30 resolutions  of  the  story  presented  dilemmas on both subjects' problems.  Both  raters  constructions and  were  blind  to  the  relevant statuses of the adolescents whose protocols they scored. Interrater reliability between the two judges was considered adequate (total absolute agreement  =  85.71%) and disagreements were resolved through discussion.  The remainder of the transcripts were coded by the author of this thesis, still blind to the ages and suicidal statuses of the subjects. A total of 57 transcripts  were available for coding as one subject requested withdrawal  from the procedure prior to completing the doubt interview. The majority (72%)  of subjects were found to score at the same level on both of the  story dilemmas, and no subject obtained scores that were more than one level apart. Interrater Continuity  reliability was  assessed  Measure. Half of the total  in  a  similar manner  for  the  number of protocols were scored  independently by two trained raters blind to the relevant statuses of the subjects.  A high level of agreement  was obtained across the two judges  (94% agreement) and again disagreements were resolved through discussion. As with the doubt interview, the remainder were scored by the author, still blind to the ages and suicidal status of the subjects. Nine subjects (8 control  and  1 hospitalized) did not  complete  all three  sections  of the  interview. However, based on the remaining 49 interviews, an assessment of response consistency  across the three warranting opportunities indicated  that  and  the  measures  interpretation Concordance, variation  of  subjects'  W = .93,  coding  procedures  continuity  claims  captured  a  (Kendall's  %* (48) = 134.31, JD<.0001).  in individuals' scores across the three  consistent  Coefficient  While there measures,  of  was some  none  of the  The last measure to be coded which required interpretive  scoring  subjects' scores varied by more than one adjacent level.  was the assessment of suicidal risk. The specifics of that procedure have already been described in some detail and all that will be added here is a brief summary by way of reminder. Two independent raters each coded all of the 29 hospitalized adolescents into one of four categories of risk on the  basis  of information recorded  sheet. No information regarding  on each  subjects'  continuity measures was contained was  individual's summary  scores on either  in these records.  record  the doubt or  Complete agreement  obtained in 89.7% of the cases. Each of the three subjects about  whom scoring  there  was disagreement  levels.  Final  was coded  categorization  by the raters  was determined,  once  into adjacent again,  through  discussion. Of the 29 hospitalized subjects, 9 were coded at the lowest level of risk (level 2),  1), 7 were placed into the second lowest risk category (level  8 were scored as belonging to the second highest category (level 3),  and 5 were coded at the highest level of risk (level 4). Levels 1 and 2 were then collapsed to form the low risk group (n=16) and levels 3 and 4  combined  to form  the high  risk  group  (n= 13).  There  were equal  numbers of males in each of the two final risk categories, but there were slightly  more  female  adolescents  in the low (n = 11)  (n_=8) risk groups. Overall, the distribution of males  than  in the high  and females closely  conformed to the 1.9:1 female-to-male ratio selected for in the high school  sample on the basis of the overall sex ratio  in the hospitalized group  (Mann-Whitney U-test, j_=-.13, JD>.89 across all three groups). In addition, one-way the  analyses  high  and  of variance low  risk  indicated no significant differences between groups  in  parental  occupational  prestige  (F(l,27) = .0773, _p_>.78) or subject age (F(l,27) = .6748, _p_>.41). The mean ages of the high and low risk groups were 181.5 months (SD = 14.02) and 186.0 months (SD = 15.39) respectively. An inspection of the distribution of diagnoses across the four risk categories indicated that increased level of suicide  risk  was  not  directly  associated  with  severity  of emotional  disturbance or any one particular diagnostic label, although depression was featured  more often among the higher versus  lower levels of risk (see  Table 3). The Hopelessness Scale scores were not used in the assessment of suicidal risk. It was originally anticipated that these scores might provide a convergent measure be the negative,  of degree of risk. However, given what proved to  but statistically  non-significant, correlation  between the  four clinically based levels of increasing risk and increasingly higher (more pessimistic) scores on the Hopelessness Scale, subjects' scores on this scale were not taken into account in the judgment of suicidal risk. The obtained correlation between individuals' actual total score on the Hopelessness Scale and assessed  level of risk was -.31 (Spearman-rank, jo>.06). Using the  published cut off scores provided with the scale to categorize subjects into one of four levels of hopelessness (none; mild; moderate; severe) the same non-significant relation to suicidal risk category obtained (rho = -.29, jo>.06).  45  Table 3 Discharge Diagnosis by S u i c i d a l Risk  Discharge Diagnosis (DSM I I I : Axis 1)  Rating of S u i c i d a l Risk l(low)  conduct disorder attentional disorder school r e f u s a l  2  adjustment disorder post-traumatic stress  1  obsessive  0  compulsive  2  3  dysthymic  0  1  major depression/ depression bipolar depression  1  5  schizophreniform a - t y p i c a l psychosis  3  0  schizophrenia psychotic  2  0  4(high)  CHAPTER 3: RESULTS Prior  to  assessing,  differences between was necessary  the  through  comparative  variously suicidal and the  to determine  the  degree  conformed to the theoretic expectations and  analyses,  the  anticipated  nonsuicidal groups, it  to which the  normative sample  outlined earlier in the introduction,  to previous empirical results obtained with other high school samples  (Boyes,  1987;  Chandler et al., 1987). Consequently, this section begins by  first detailing the results present  normative  expectations. series  of an assessment  sample  Following  a  of comparative  conforms  to  of the extent to which the more  general  description of these results,  analyses  aimed at  developmental  the  describing the  outcome ways  of a  in which  suicidal and nonsuicidal youth deal with the issues of personal continuity and nascent skeptical doubt is detailed.  The Normative Sample as an Appropriate Comparison Group  Warrants of Personal Continuity The  routine expectation  of any developmental sequence relevant to  the range of ages under study is that increasingly higher levels ought to be  generally  associated  with  a  corresponding increase  in  age.  In  the  present sample a moderate but significant correlation was obtained between the high school students' averaged continuity scores and their chronological ages measured in months indicates that the years  old,  large  SD = .63)  (r = .45, JD<.008).  majority  made  use  An examination of Table 4  (87%)  of the  of the  more  older subjects mature  (X= 16.34  essentialistic  and  functional warranting strategies, whereas only slightly more than a third (36%)  of  the  younger  members  of  this  sample  (X= 14.18  years  old,  SD = .77) employed these higher level arguments. In addition, although 4 of the youngest of these subjects  still relied on the most primitive of the  Table 4 Type of Continuity Warrant by Age (non-hospitali2ed  sample)  Type of Warrant Subjects Dichotomized by Age  1. Simple Inclusion 2. Typological  3. E s s e n t i a l i s t 4. Functional  Younger (n=14)  9 (64%)  5 (36%)  Older (n=15)  2 (13%)  13 (87%)  E=.O06 (Fisher's Exact)  H=29  continuity warrants  (level  group  to  were  continuity  found  scores  1 simple inclusion claims),  do so. While  the mean  employed by the somewhat  none of the older  rank  older  of the average  male  subjects was  slightly higher than that of the females, both sexes were generally evenly distributed  across  the range  of obtained  scores  (Mann-Whitney U-test,  _z_=-.48, jp_>.62). The continuity data generated by the present normative sample were found generally to conform then to that produced by other comparable samples (e.g., Chandler et al., 1987). Strategies for Dealing with Nascent Skeptical Doubt As expected, none of the 29 high school students responded to the Nascent Skeptical Doubt interview procedure with reasoning scored  at a  pure level 0 (i.e., naive realist positions). In fact, only one young subject evidenced any level 0 reasoning at all. This finding was consistent with the expectation that within a sample for which at least transitional formal operational competencies might be anticipated, subjects ought to express, at minimum, a beginning awareness of the subjective character of knowledge. Table 5 arrays  the percentage  of high school adolescents  highest of each  of the three alternative  found to make  use. As can be seen  by the  strategies of which they  were  from an inspection of Table 5,  almost half (48%) of these students interpreted the situations in skeptical and dogmatic terms (i.e., employed level 2 strategies). The remaining half were  almost  evenly split between  defensive level  1 strategies (defended  realist positions) concerned with justifying the possibility of absolute truth, and  level  3  (post-skeptical  rationalist)  solutions  which  embrace  the  possibility of finding rational criteria for resolving matters of uncertainty. Again, these results are consistent with theoretical expectations  and with  previous related findings in that all three strategies were in evidence in this 13- to 17-year-old high school sample, with the most typical responses falling into scoring category two (see Boyes, 1987).  49  Table 5 Responses to Nascent Skeptical Doubt (non-hospitalized sample)  Type of Strategy  Level 0  Level 1  Naive Realism  Defended Realism  0 (0%)  N=29  7 (24%)  Level 2 DogmatismSkepticism  14 (48%)  Level 3 Post-Skeptical Rationalism  8 (28%)  Finally, the use of increasingly mature responses to uncertainty was associated  with increasing age  was  selected  not  to  bring  (r = .35, JD<.04). out  such  While the present sample  developmental  trends,  the  data  generated does conform to the generally anticipated age relation, with the older of these subjects (60%)  more frequently making use of dogmatic/skeptical  and rational (33%)  strategies. In contrast, almost half (43%)  of the  younger group still relied upon defensive level 1 solutions, and only one fifth (21%)  evidenced level 3 rational solutions. Table 6 summarizes these  general age associations by contrasting those subjects who showed evidence of appreciating the relativized nature of the problem (levels 2 & 3) with those individuals who held to a simpler defended realist position (level 1). As illustrated in Table 6, all but one of the older subjects made use of at least a level 2 strategy (93%) younger subjects (57%) score  at  whereas only approximately half of the  did so. Males, who were somewhat older, tended to  somewhat  higher  levels  than  did  female  adolescents  (Mann-Whitney U-test, _z=-2.12, j><.04). Based on the above analyses, the high school students selected for participation in this study were considered to conform to theoretically and empirically derived expectations on both of the measures of central interest to this thesis. On these grounds the high school sample was judged to be an appropriate normative group for subsequent comparisons involving the hospitalized subjects.  In light of the experimental nature  of the  Nascent  Skeptical Doubt Questionnaire no such comparative analysis was possible.  Continuity and Suicidal Risk A Kruskal-Wallis one-way analysis of variance by ranks carried out with the averaged continuity scores of the 58 subjects grouped by level of suicidal risk (high school controls, low risk, high risk) indicated significant differences  between  groups  in  the  types  of  warrants  employed  51  Table 6 Response to Nascent Skeptical Doubt by Age (non-hospitalized sample)  Type of Strategy Subjects Dichotomized by Age  Younger (n=14)  Older (n=15)  1. Defended Realism  6 (43%)  1 (7%)  2. Dogmatic/Skeptical 3. Rational  8 (57%)  14 (93%)  B=.03 (Fisher's Exact) N=29  (X (2)= 18.88, jp_<.0002), with the high school sample obtaining the highest l  mean rank (38.48) and the high risk subjects obtaining the lowest mean rank  (15.12).  differences  Mann-Whitney  both between  J25--001),  and between  U-tests  further  demonstrated  significant  the high school and low risk groups the low risk  and high  risk  (z = -3.10,  groups  (z = -2.50,  _p_<.02). In short, membership in graded levels of increasing suicidal risk was found to be associated  strongly with corresponding immaturity in the  types of continuity warranting practices employed. As  was discussed  earlier,  it was also  anticipated  that:  1) the  nonhospitalized subjects would rely primarily upon essentialist (level 3) and functional (levels 4 or 5) continuity warrants; score  primarily  at  levels  1  and 2  2) the low risk group would  (simple  inclusion  and typological  continuity warrants); and 3) that the high risk group would show little or no ability to count themselves these  three  risk  groups  continuous  against  through time. Table 7 arrays  their  proposed  levels  of  continuity  warrants. Several important results  can be observed in Table -7. First, and-  most striking, was the finding that almost 80% (10 of 13) of the high risk suicidal subjects were wholly at a loss to understand how they or others  could  change  in important  ways  and  still  persist  at  being  themselves  (i.e., level 0). By contrast, only one of the low risk suicidal  adolescents  (6%) and none of the high school subjects found  without  any such  through  time.  adolescents change,  Secondly,  of justifying a while  almost  sense  all  of  of personal the  low risk  2 than  of  these  levels  1  subjects and 2  (13%) which  employed  suicidal  effectively  warrants discount  personal change. By contrast, 62% (18 of 29) of high school made  continuity  evidenced some strategy for conserving selfhood in the face of  only  sophisticated  means  themselves  use of warrants  beyond  level  2.  A version  more  or deny adolescents  of Cohen's Kappa  Table 7 Type of Continuity Warrant by S u i c i d a l Status  Type of Warrant  Suicidal Status  High Risk (n=l3)  total  Low Risk (n»16)  total  Control (n=29)  total  N=58  0. None  10  (77%)  10 (77%)  1 (6%)  1 (6%)  0 (0%)  0 (0%)  1. Simple Inclusion 2. Typological  3. E s s e n t i a l i s t 4. Functional  0 (0%)  0 (0%)  1 (8%)  2 (15%)  1 (8%)  2 (15%)  7 (44%)  2 (13%)  6 (37%)  0 (0%)  13 (81%)  2 (13%)  4 (14%)  15 (52%)  7 (24%)  3 (10%)  11  (38%)  18 (62%)  (Cohen, 1960) was used to test the specific predicted one-to-one association described  above  between  the suicidal  status  of these  subjects  and the  categories of warrants they were found to employ as arrayed in Table 7 (rows = totals category  of combined levels of continuity warrants).  agreement  was obtained (K = .71)  A high level of  which was significant at the  preset level of .05. It should be noted that the level of agreement as represented by the Kappa statistic probably underestimates the "true" level of agreement to prediction given that the testing of observations along the diagonal does not take into account the normatively expected, and obtained, variation among the differentially aged high school subjects. Two further observations of note first  is that  among the low risk  immature continuity warrants  are apparent  adolescents  in Table  7. The  who employed relatively  (n=13) more than half made use of the  most primitive of these claims (level 1 simple inclusion warrants) whereas only 4 of the 11 high school adolescents warrants  actually  relied on level  (36%) using the least  mature  1 justifications of personal continuity.  Finally, it is of interest that two of the three high risk adolescents who did manage to evidence any understanding of how it is that one could be said to persist as the self-same person despite radical personal change, did so  by  employing  warrants  equal  to  those  of  the  highest  scoring  non-hospitalized controls. Not only did these two adolescents fail to respond in the way anticipated, but the level of warrants which they employed set them quite apart from the rest of the high risk group. Conceptually, it would appear young  persons  that these at high  two subjects risk  represent  a separate  for suicide. In order  subgroup of  to justify such an  assumption, a post hoc discordancy test for k upper outliers in a gamma (or exponential) sample was conducted and the results of this test (p_<.01) indicated  that  these  two observations  statistical grounds as well.  would  be considered outliers on  All  of  the  results  detailed  above  were  based  on  individuals'  averaged scores across the three continuity measures. The high concordance rate among these three measures, differed  by  no  appropriateness  more  than  and the fact that within-subject scores  one  adjacent  category  of these summarial measures.  level,  There are,  support  the  however, good  reasons for going beyond such averaged scores and focusing attention upon the  specific  ways  in  which  subjects  warranted  their  own  personal  continuity across the changes that have occured in their own lives. The first, and perhaps most obvious, reason was that the self section of the continuity measure is most pertinent to the issue of interest here. From the  outset,  party  asking subjects  characters was  guarantee  that  each  about  the  continuities in the lives of third  adopted primarily as subject  would  be  a means  confronted  of providing some  with  at  least  some  unarguable character changes and forced to search for grounds upon which to argue for personal continuity however ready they might be to deny or minimize such changes in themselves. Previous research had also indicated that having first addressed the question of continuity in the lives of these fictitous characters,  subjects  were less inclined to discount the important  changes in their own lives. While the fact that most, but not all, subjects employed  the  same  generic  form  of  argumentation  when  seeking  to  warrant their own and other's continuity speaks against the need for any separate analysis, it still could be argued that the inclusion of questions about such third parties was largely procedural and that it is the self section of the continuity measure that should be of primary interest. On these grounds, separate analyses  were conducted that featured only the  self portion of the continuity procedure. Minor differences between the ways in which subjects argued their own and other's continuity did exist and investigating the possibility that these relatively small differences might be systematically related to their risk status seemed appropriate.  Table 8 arrays the types of warrants employed by subjects in each of the three measure.  risk  groups  only  on the self  section  of the continuity  As was the case with the averaged scores reported previously,  there was a significant relation between risk status and these more direct measures  of personal continuity (Kappa = .66, J3<.05). This  measurably  different  from  that  obtained  with  the  result is not  averaged  continuity  scores (Kappa = .71, _p_<.05). As can be seen in Table 8, over half (7 of 13) of the high risk suicidal adolescents continued to be unable to offer any  understandable  means  of justifying persistent  identity,  even when  focusing on the details of their own lives. Another three, also generally at a  loss,  did manage  to evoke  an immature  level  1 type  of continuity  warrant. Among the low risk hospitalized group, only one subject retreated from  a level 2 to a level  adolescents  1 continuity claim, whereas  four of these  were able to make use of some version of the more robust  essentialistic arguments (level 3) when dealing with the issue of their own personal continuity. Similarly, four of the six high school adolescents whose scores shifted on the self portion of the interview showed an increase in the  adequacy of their continuity warrants,  abandoning level 2 claims in  favour of level 3 essentialistic warrants. Two high school students did not complete the self section of the continuity measure due to time constraints and scheduling difficulties. Nascent Skeptical Doubt and Suicidal Risk  The Nascent Skeptical Doubt Interview A Kruskal-Wallis one-way analysis of variance by ranks on the 57 subjects'  averaged  doubt scores by suicidal risk  category  indicated that  there were significant differences between groups in the types of responses to emergent  doubt ()C'{2) = 14.36, _p_<.0009). The highest mean rank was :  obtained by the high school participants (36.59) followed by the low risk  Table 8 Type o f C o n t i n u i t y by S u i c i d a l Self  High Risk (n=13)  0.  None  7  (54%)  total  7  (54%)  Low R i s k (n*16)  1  (6%)  1  (6%)  0  (0%)  0  (0%)  total  Control (n=27)  total  N=56  1. 2.  Status  Only  Type o f  Suicidal Status  Warrant  Warrant  Simple I n c l u s i o n Typological  3. 4.  Essentialist Functional  4  (31%)  1  (8%)  0  (0%)  1  (8%)  4  (31%)  2  (15%)  8  (50%)  6  (38%)  1  (6%)  0  (0%)  9  (56%)  6  (38%)  5  (19%)  19  (70%)  1  (4%)  6  (22%)  2  21  (7%)  (78%)  group  (22.97)  further  and the high risk  indicated  that  significant  group  (18.71).  differences  Mann-Whitney U-tests  existed  between  the doubt  scores for the high school group as compared with those for the low risk suicidal adolescents  (z_=-2.63, _p_<.009), but that the scores for the low  risk and high risk adolescents did not significantly differ (z==-0.65, _p_>.51). Table 9 displays the types of responses  employed by each of the three  subject groups. For the purposes of this table and all further  analyses,  individuals who scored at "transitional" levels were credited with their best efforts and categorized into the higher of the two levels. Two observations of Table 9. First,  of note are immediately apparent upon a review  not one of the suicidal adolescents  (high or low risk)  made use of post-skeptical rational solutions in contrast to 28% (8 of 29) of their high school peers who employed such level 3 strategies. Second, it is clear that among the hospitalized adolescents  only a few gave evidence  of appreciating the relativized character of the knowing process. only a single high risk subject  reasoned  In fact,  at a level beyond a level 1  (defended realism) strategy. Low risk suicidal adolescents showed a similar, though less dramatic, pattern with 69% (11 of 16) still employing level 1 (defended realism) strategies. In  order  to  assess  \ the  hypothesis  which  predicted  a  specific  association between suicidal behaviour and a posture of defended realism, a 2-by-2  contingency  table  was constructed.  For this  scored at level 1 (defended realism) were contrasted at  either  rationalism)  level  2  (dogmatism-skepticism  solutions  and then arrayed  axis) against  purpose,  responses  with responses scored  or level  3  (post-skeptical  risk status. Based upon  the previously reported Mann-Whitney U-test which indicated that the high and  low risk  groups  were not significantly different,  were combined to form levels  and contrasted  a single with  the  hospitalized high  school  group control  these two groups of varying suicidal group.  Table  10  Table 9 Responses to Nascent Skeptical Doubt by S u i c i d a l Status  Type of Strategy Defended Realism  DogmatismSkepticism  High Risk (n=12)  11 (92%)  (8%)  Low Risk (n=16)  11 (69%)  5 (31%)  Control (n»29)  7 (24%)  14 (48%)  Suicidal Status  N»57  Post-Skeptical Rationalism  1  8 (28%)  Table 10 Responses to Nascent Skeptical Doubt S u i c i d a l vs. Non-Suicidal  Type of Strategy  Suicidal Status  Hospitalized (high & low risk)  Non-Hospitalized (high school controls)  1.  Defended Realism  2. Dogmatic/Skeptical 3. Rational  22 (79%)  6 (21%)  7 (24%)  22 (76%)  (1)=14.781, M=57  B<.0002  illustrates  this  2-by-2  array.  A Chi-Square test of association indicated  that the two groups were significantly different in their responses to the prospect of emergent doubt CX (D= 14.78, _p_<.0002) with almost 80% of t  the suicidal adolescents  relying on level 1 defended realism strategies as  opposed to just under 25% of their age-matched high school peers. Of the six  hospitalized  strategies,  adolescents  who did make  use  of dogmatic/skeptical  two were male and four were female. This ratio conforms to  the general male female ratio of the sample (1:1.9). Interestingly, and in contrast to the normative sample, the use of higher level 2 strategies did not appear to be related to age in the hospitalized group with six of the high scorers occuring among 13-year-olds, two among the 14-year-olds, and only one from each of the 16- and 17-year-old groups. The Nascent Skeptical Doubt Questionnaire Averaged  questionnaire  scores  were  available  for  53  of the  adolescents otherwise tested. Two of the hospitalized volunteers and three of the high school students  did not complete this questionnaire. All but  four of the questionnaire respondents made use of the entire scale range (0-3) in their responses. The averaged scores were based on the original responses recoded according to the relativism key so that low scores were characterized by realistic views and high scores by more relativized views regarding the possibility of certain knowledge. On the rationale that the questionnaire was meant to serve as an adjunct measure to the Nascent Skeptical Doubt Interview procedure, the first investigative step taken was to assess the relation between these two doubt measures. categorize  Since there were no preset cut off scores by which to  individuals for comparison purposes according to their averaged  score on the doubt questionnaire, subjects were divided on a proportional basis to match the proportion of subjects coded at either level 1 (defended realism)  or  levels  2  and 3  (dogmatic/skeptical  and rational)  by the  interview procedure. No distinction was made between levels 2 and 3 since the  questionnaire  was  not  designed  to  discriminate  between  these  alternative strategies for dealing with recognized generic doubt. Of the 53 subjects for whom scores on both of the doubt measures 27  were available,  had been coded at level 1 and 26 coded at levels 2 or 3 on the  basis  of their  scoring  interview responses.  (most  individuals  realistic)  on  the  comparative categories.  and the  doubt  In symmetry, 26  highest  questionnaire  then,  scoring  were  the 27 lowest  (most  grouped  to  relativized) form two  The resulting 2-by-2 contingency table in displayed  in Table. 11. The evaluated  two doubt measures by a Chi-Square test  individuals coded at level  were found to be highly (% (l) = 9.97, _p_<.002).  sample. Similarly,  Almost 75% of  l  1 on the doubt interview also scored in the  lower portion of the questionnaire responses overall  associated as  approximately  as defined by the present  75% of level 2 and 3 subjects  scored in the higher portion of the questionnaire responses. The second step taken in an effort to evaluate the usefulness of the doubt questionnaire was to assess directly whether subjects' responses to this measure were related to their suicidal status in a consistent and interpretable  manner.  A one-way  scores by suicidal risk category the  overall  scores  across  the  _p_<.0001). Suicidal adolescents  analysis of variance  on the averaged  indicated significant group differences in 20-item  questionnaire  in the high risk category  (F(2,50) = 13.37, were found to  score significantly lower (toward the realistic end of the scale) than either the low risk or control groups as assessed by the Student Newman-Keuls method  at  the  .05  level  of significance.  The Newman-Keuls further  indicated significant differences between the low risk suicidal group and the high school controls {o<- =.05). The highest group mean of the averaged scores  was obtained  by the high  school  students  (X=1.92,  SD = .25),  Table 11 Scores on the Doubt Questionnaire Proportionally  Dichotomized  by Doubt Interview Responses  Doubt Questionnaire Scores (Dichotomized)  Response to Doubt Interview  Lower (absolutistic)  Higher (relativistic  1. Defended Realism  (74%)  20  7 (26%)  2. 3.  7 (27%)  19 (73%)  Dogmatic/Skeptical Rational  (D-9.97, M=53  B<.002  followed by the low risk adolescents (X=1.73, SD = .31), adolescents the  (X=1.43,  questionnaire  SD = .29).  was 1.75  The overall mean  (SD = .33)  with  and the high risk  across all subjects on  scores ranging from  .95 to  2.35. Table  12  illustrates  the distribution of individuals categorized by  suicidal risk who scored in either the lower or higher range of scores on the  questionnaire.  The questionnaire  scores  were  again  divided  on a  proportional basis as matched to the doubt interview responses. The actual cut-off score was 1.75 which was identical to the overall mean averaged score on the questionnaire. As can be seen from Table 12 almost all of the individuals at high risk to suicide (92%) showed close agreement with statements  espousing  absolutistic  views,  relativized views across a wide variety 70%  of the high school students  and less  agreement  with  of domains. In contrast,  more almost  favoured the more relativized response  alternatives. Low risk suicidal adolescents were almost evenly split between the  lower  (53%)  and  higher  (47%)  scoring  portions  of  the  doubt  questionnaire.  SUMMARY OF RESULTS As predicted, hospitalized adolescents found to employ  less  mature  warrants  at low risk for suicide were  of personal  continuity  than did  their high school age mates, while those subjects at high risk for suicide were generally found to be at a complete loss as to how to justify the conclusion of their same  pattern  subjects'  own or others'  of results  averaged  emerged  continuity  persistent whether  scores  identity analyses  across  the  across were three  time. The based  upon  warranting  opportunities, or their self scores alone. A small subset of the high risk adolescents pattern  (2 of 13) whose responses  did not conform to this  general  were found to make use of the most mature of the warranting  Table 12 Scores on the Doubt Questionnaire (Proportionally Dichotomized) by S u i c i d a l Status  Doubt Questionnaire Scores (Dichotomized)  S u i c i d a l Status  Lower (absolutistic)  Higher (relativistic  High Risk (n=12)  11 (92%)  (8%)  Low Risk (n-15)  8 (53%)  7 (47%)  Control (n»26)  8 (31%)  18 (69%)  (2)«12.23, N=53  1  B<.003  strategies employed by their high school peers.  These two subjects  were  considered outliers on statistical as well as conceptual grounds. Both low and high risk suicidal adolescents were far more likely to employ  immature  level  1  strategies  (defended  realism)  in  response  to  matters of uncertainty and doubt than were their high school age mates who, by contrast, were found to make use of increasingly more strategies for coping with such uncertainties  mature  with increasing chronological  age. Analyses of responses to the doubt questionnaire indicated that high risk subjects  agreed most strongly with absolutistic views while the high  school subjects were most in agreement  with more relativized statements.  Low risk' suicidal subjects' responses fell between these two groups with the mean score of the low risk group being somewhat closer to that of the high risk group versus the high school controls. The  approach  taken  throughout  this  results  section  has  been to  assess the relations between suicidal status and responses to the continuity and doubt measures measures  separately  may convergently  with little attention  relate to degree  given to how these  of suicidal risk. While this  approach has been adequate to test the specific. hypotheses of this study and perhaps most appropriate given the categorical  treatment of most of  the data, some means of viewing the data in an overall, collective manner would provide a more integrative With  this  goal  in mind,  a  picture than has so far been possible.  multiple discriminant function analysis  was  conducted with high risk, low risk, and control groups representing the three categories of the criterion variable and the continuity and the two doubt measures analysis,  as the three predictor variables. For the purposes of this  the original, noncollapsed scores from the  continuity and doubt  interviews were used and treated as continuous interval data.  The first step in this multiple discriminant function analysis was to determine  whether  the  three  predictor  variables  could,  as  a  set,  discriminate between the criterion groups. The Wilks' lambda statistic was calculated to be .415, which is equivalent to an F-ratio (p_<.0001),  (6,96) of 8.84  indicating that the predictor variables did discriminate among  the groups. Table 13 displays the standardized canonical coefficients and pooled within-group correlations  for each of the three variables. Subjects'  averaged continuity scores and scores on the doubt questionnaire were the two most discriminating variables followed by the more global epistemic level scores. Overall, 75.86% of grouped cases were correctly classified. The  classification  summary  table,  also  displayed  in Table  13,  indicated that the predictor vaiables were most accurate in classifying the high risk adolescents (86.2% correctly  (84.6% correctly  classified) whereas  were classified correctly.  classified) and the control  subjects  among the low risk group only 50%  It is of note that none of the control subjects  was misclassified as a high risk subject and only one (7.7%) of the high risk adolescents was misclassified as a member of the control group. The incorrectly classified low risk subjects were evenly divided among high risk (25%) and control (25%) subjects. and  doubt measures  clearly  Overall,  performance  differentiated  high  risk  on the continuity suicidal  adolescents  from their high school peers. Discrimination was less accurate for the low risk suicidal subjects. It seems that the pattern of responses by some of the low risk group resembled those of their high risk peers, while others responded much like the high school controls. The  results  of this  discriminant  function  analysis  need  to be  interpreted with some caution on several accounts.  First, the accuracy in  group  since  classification  may be somewhat  optimistic  the performance  criteria for group membership used in the analysis was derived from the performances of the same subjects who were then placed into the various  Table 13 Discriminant Function Analyses Classifying  Standardized Canonical Coefficients  Suicidal  Risk  Variable  Pooled Within-Group Correlation  .674  Continuity  .66  .628  Doubt Questionnaire  .63  .332  Doubt Interview  .50  C l a s s i f i c a t i o n Summary Table  Predicted Group Membership Actual Group  n  Control  Low Risk  Control  29  25 (86.2%)  4 (13.8%)  Low Risk  16  4 (25%)  8 (50%)  High Risk  13  1 (7.7%)  1 (7.7%)  High Risk  4 (25%) 11 (84.6%)  Grouped Cases C o r r e c t l y C l a s s i f i e d : 75.86%  groups. While proceeding in this manner is common practice, it does bias the  results  in favour  of group  membership  prediction  accuracy  (Huck,  Cormier, & Bounds, 1974). Second, the prediction of group membership on the  basis  of  performance  on  these  three  variables  should  not  be  interpreted as suggesting any strict correspondance between measure scores and suicidal status.  That is, the developmental nature  of the  measures  used must be taken into account. One means to accomplish this would be to  enter  a  preset  performance  incorporated the age-graded  criteria  appropriateness  for  group  membership  of various response  which  levels. In  addition, it would be helpful to approximate a match between the number of subjects  in each  of the  suicidal risk  categories  and  the  estimated  proportion of like individuals in the local population.  (  C H A P T E R 4: D I S C U S S I O N  The  general  aim  that  guided  this  study  was  to  make  some  contribution to the emerging field of developmental psychopathology through an  examination  of the  relations  between  progressive  movement  toward  social-cognitive maturity and socioemotional adjustment in adolescence. More specifically, the two developmental matters of particular concern were the contrastive ways in which suicidal and nonsuicidal adolescents undertake to secure a sense of their own personal continuity and a sense of conviction in the face of growing skeptical doubts. In order to explore these possible relations, a comparative analysis was undertaken which set in contrast a group of psychiatrically hospitalized adolescents  and a matched sample of  their high school peers. The central hypothesis tested in this study was that  the  understood  self-destructive as  tendencies  behavioural  of  the  manifestations  suicidal  subjects  of difficulties in  could  be  dealing with  matters of emergent skeptical doubt and personal continuity. The results of this study clearly demonstrate that, in comparison to their  nonhospitalized  age  adolescents  did evidence  how they  and others  mates,  the  psychiatrically  difficulties both in their  hospitalized suicidal  abilities to understand  could be said to remain continuous or  self-same  persons throughout time,  and in their ability to cope with questions of  uncertainty  Adolescents  and  doubt.  at  high  risk  for  suicide  were  distinguished from other psychiatrically hospitalized individuals at low risk to  suicide and  from their  high school age  mates by:  1) their unique  inability to find any workable means of justifying their persistent identity; and 2)  by their more extreme endorsement  face of uncertainty.  In  addition to  these  of absolutistic views in the contrastive  results,  the  data  generated by the normative sample were found to closely conform to that of previous studies, further documenting the ways in which individuals at  different time  developmental  stations  both  warrant  personal  (Chandler et al., 1987) and respond to issues  doubt (Boyes,  continuity  across  of uncertainty and  1987). The details and implications of these findings will be  discussed in the paragraphs that follow. Details and Implications of the Research Findings  Theoretical Implications Several important theoretical implications follow from the results of this  study.  First,  the replication of the normative  support to the following claims: strategies  to the problems  1) that the use of alternative  of numerical  doubt can be reliably and exhaustively typologies  laid  questions  concerning  consistent  manner  two  identity  and nascent  solution skeptical  identified in accordance with the  out in the introduction; these  data lends additional  2)  important  across multiple testing  that  individuals respond to  developmental response  issues  in a  opportunities;  and 3)  that progressively more adequate and mature responses are associated with increasing chronological age. Together  these findings strongly suggest that  the manner by which individuals warrant personal continuity, and contend with matters of doubt both follow an age-graded  developmental  sequence  leading to increasingly more adequate and mature levels of responses. Secondty,  the results  of the comparative  analyses  between  normative sample and the high and low risk suicidal adolescents  the  suggest  that important dimensions of developmental difference exist between these groups.  The nonhospitalized control  subjects tested in the present  were found to respond to the issues  of continuity and doubt in ways  typical of others of the same approximate (Boyes,  study  age, grade,  and social status  1987; Chandler et al., 1987). By contrast, the hospitalized subjects,  all of whom were to some extent suicidal, were found to lag behind their age-matched  peers,  and, as a group,  consistently  scored  at lower,  less  developmentally mature levels on measures of numerical identity and doubt. These  findings,  theoretical  while  attempt  difficulties  of  experienced  asynchrony  between  still  correlational,  this  thesis  lend  to  support  interpret  by  adolescents  as  their  progressive  movement  to  the  certain  arising from  general  socioemotional  a developmental  toward  more  abstract,  relativized, and self-reflective modes of thought and the task of securing more  mature  problems  strategies for dealing with the  reconceptualizations  continuity  these  of  and  doubt  which  cognitive  of the advances  necessitate. Third, the fact that young persons considered to be at high risk for  suicide  were  generally  distinguished  from  their  psychiatrically  hospitalized and nonhospitalized peers by their unique inability to voice any sort  of  possibility  justification  of  personal  continuity  of interpreting such serious  across  time  suicidal tendencies  suggests  the  as behavioural  manifestations of the complete loss of a sense of persistent identity. This finding underscores both the importance of achieving a sense of personal continuity to the adolescent identity formation process, and emphasizes the central role which the achievement of such a sense of numerical identity plays in the emotional lives of adolescents. some  distance  toward  explaining the  suicidal behaviour that characterizes suggested,  achieving  In addition, these results go  sudden and  dramatic  increase  in  the adolescent years. If, as numerous  theorists  have  a  sense  essential  to the identity formation process,  of  personal  continuity  is  and if, as findings reported  here indicate, adolescents who fail in this developmental task also tend to be those who make serious attempts on their own lives, then the prospect is opened up for explaining the high incidence of attempted  suicides in  this age group. It is also of theoretical importance to note that not all of the high risk  suicidal  adolescents  evidenced  difficulties  in  warranting  personal  continuity over time. In fact, two of these high risk subjects made use of continuity warrants as adequate as those of the most mature subjects of the  normative  sample.  This  finding  indicates  the  existence  of a small  subset of seriously suicidal young persons whose difficulties must reside in some  radically different quarter.  these other caution  While  difficulties is clearly  which their  presence  speculation as  beyond the  suggest  needs  scope to  to the  source of  of this  thesis,  the  be stressed.  There  are  obviously other ways for an adolescent to lose faith in the promise of his or her own future and continuity problems can not and should not be interpreted  as  providing  a  simple  and  sovereign  solution  to  the  interpretation of these difficulties. Fourth, support  the  results  based  view that  on the  dogmatic  Nascent  Skeptical Doubt  and skeptical responses  to  Interview matters of  uncertainty represent reasonably adaptive responses to issues of doubt, at least  during  adolescence,  or  until  the  need  to  make  life  commitments  becomes more pressing. Only one (of 12) high risk suicidal subject showed any evidence of having achieved such a skeptical or dogmatic solution for dealing with doubt. By contrast,  almost one third of the low risk group  and approximately one half of the normative sample did so. The fact that none  of  the  hospitalized  subjects  evidenced  a  post-skeptical  (level  3)  position, whereas approximately one quarter of the high school sample did so also is consistent with the argument presented in this thesis that such rational strategies represent  a more adequate  means for proceeding with  commitment in an uncertain world. This interpretation is further supported by the results of the doubt questionnaire which located respondents along an objectivism-relativism dimension. By were  most  in  agreement  with  this measure,  objectivist  views,  high risk  high  school  subjects subjects  expressed the most agreement with relativistic views, and low risk subjects appeared to fall somewhere between, though their responses were closer to those of their high risk peers.  Finally, the implications of the negative results obtained from the use of the Hopelessness Scale need to be mentioned. The most obvious conclusion  to  draw  from  the  negative  and  statistically  correlation obtained between individuals' assessed their  degree  of hopelessness  as  measured  nonsignificant  level of suicide risk and  by Beck's  scale  is that the  Hopelessness Scale is not an appropriate measure for the assessment of suicide  risk in adolescents.  purpose  of assessing  Given  clinical  that  the  scale  was  derived for  populations, it cannot be argued  the  that the  hospitalization of these subjects per se contributed to the ineffectiveness of this  measure.  setting,  It  could,  however,  be  argued  that  once  the initiation and/or promise of therapeutic  in the hospital  assistance  encouraged  an optomistic outlook on the part of these troubled individuals. This is a problematic explanation for the following reasons: from  which  the  hospitalized  subjects  were  1) the Adolescent Unit  drawn  is  primarily  an  assessment rather than a treatment facility; 2) the ratings of suicide risk were based on information contained in individuals' hospital records and discharge summaries and high risk ratings were dependent upon evidence of a continuing and substantial degree of concern over the possibility of suicide; and 3) no association was found between the length of time (in days)  in hospital prior to testing and scores on the Hopelessness Scale  (rho = .09,  _p_>.32).  In  addition,  the  conceptual  association  between  an  overwhelming sense of hopelessness and unadulterated skepticism, combined with  the  posture suggests  results  of  the  doubt  interview  of skepticism did not characterize  indicating that  an  epistemic  these troubled youths further  that, whatever its merits when applied to an adult population,  the Hopelessness Scale is not a sensitive measure for the assessment of suicide risk in adolescents.  Diagnostic and Treatment Implications The  most important  diagnostic  implication of the  results of this  study is that hospitalized adolescents who are unable to maintain a sense of persistent identity across time should be regarded as being at high risk to suicide. persons  Conversely,  however,  who do not appear  necessarily  it is not  safe to conclude  that young  to be suffering such a loss of identity  are  free of the risk of suicide. In other words, the present data  suggest that the assessed inability to warrant personal continuity implies the  likelihood of serious  suicidal tendencies,  route to such suicidal behaviours.  Still,  but it is not  an  exclusive  given the difficulty of identifying  persons who pose a serious suicide risk, procedures for assessing personal continuity persons  promise  in this  to  risk  provide group.  a  valuable  diagnostic  In addition to  the  tool  for identifying  possibility of identifying  individuals who are highly suicidal, the findings of this study suggest that, in the process, such identification may also be discriminating a particular subgroup of suicidal individuals who share a certain  "suicidal syndrome",  different from those identified above. If,  as  it  appears  from the  results  of this  study,  a  substantial  number of seriously suicidal adolescents lack the ability to understand how they can change over time without losing their identity, this fact further suggests a set of reasons as to why such individuals might be especially resistant  to  therapeutic  achieved  an  adequate  identical are aimed  at  change. means  That of  is,  persons  counting  themselves  likely to be slow to participate  changing  them  in radical  ways.  who  in any  as  not  yet  numerically  treatment process  This negative  tempered, however, with the positive therapeutic  have  implication is  potential imbedded in the  identification of developmentally appropriate warrants of continuity routinely employed by  typical  adolescents.  The normative  developmental  understanding personal continuity provides both a standard  course of  and a possible  goal for such intervention. Furthermore, the fact that almost all of the high risk (92%) and a majority  of the low risk  (69%)  subjects  held  to positions  of defended  realism suggests that, for such individuals, therapeutic interventions aimed at elucidating alternative courses of action are also likely to be met with frustration and rejection. That is, for such adolescents, steeped in a world view that understands different interpretations of reality as the product of vested interests, all attempts to encourage such alternative views are likely to be treated with suspicion. This result partially echoes findings reported by  Shneidman (1985),  who stresses that  suicidal persons  are especially  prone to a kind of dichotomous thinking that allows only one solution to every problem. As previously discussed in the introduction, a number of cognitively oriented  researchers  have  identified  an  association  between  suicidal  behaviour and rigid, dichotomous thinking (Arffa, 1983; Beck et al., 1984;. Faberow,  1985; Neuringer, 1961, 1964, 1967; Neuringer & Lettieri, 1982;  Patsiokas  et al., 1979;  Shneidman, 1985).  While consistent  with these  findings, the cognitive-developmental account presented in this thesis offers an interpretation that 1) distinguishes two very distinct modes of thinking, both of which display components of rigidity; 2) describes how these two different each  epistemic  positions would be differently manifested;  3) situates  along a developmental trajectory; and, by doing so both 4) makes  more comprehensible the high incidence of suicidal behaviour in this period; and 5) provides therapeutically relevant age-graded developmental standards for evaluating strategies in dealing with issues of uncertainty and doubt. Of course, the diagnostic and therapeutic implications extrapolated from the present  study  must  be considered  highly  speculative  and in need of  investigation in their own right. In addition, the relevance of the obtained results need to be viewed in light of the shortcomings and limitations of  this particular study detailed below.  Limitations and Suggestions for Future Research Although the findings of the present study indicate clear differences between  the  groups  tested,  the  small sample  sizes  make  these  results  rather tentative. This is particularly true in regard to distinctions among the psychiatrically hospitalized adolescents  who were subdivided into high  and low suicidal risk groups. Greater confidence could be placed in results obtained if they were confirmed by the testing of a larger sample of both high and low risk suicidal adolescents. A concerns  second issue pertaining to the generalizability of these results the  demonstrated  choice  of  appropriate  control  groups.  What  has  been  here is that within a sample of psychiatrically hospitalized  adolescents, all of whom were to some degree suicidal, those at high risk to suicide evidenced unique difficulties in dealing with certain developmental matters matched  as  compared  sample  with  their  low risk  of normal controls.  It  suicidal counterparts  is not clear,  however,  and a how a  matched sample of equally troubled but nonsuicidal young persons would respond to the measures.  The arguments presented in this thesis would  lead to the prediction that all nonsuicidal psychiatric controls would score somewhere between the performances of the normal subjects and the low risk  suicidal  representative  group.  It  is  possible,  however,  that  a  more  broadly  psychiatric control group would subdivide along some other  important dimension of difference and that a portion of such individuals would respond in ways  more  similar to the high risk subjects  in this  study. If this were the case, then the failures of the high risk subjects, while still having important implications for understanding and dealing with seriously  suicidal  young  persons,  would  hallmark of adolescent suicidal behaviour.  not  represent  such  a  unique  The fact that almost all of the hospitalized adolescents tested were found to have caused some level of concern regarding the possibility of their being suicidal also raises troubled  youth  adolescents.  were  It  of  a  the question of how representative  larger  may be the  population of  case that at  least  these  psychiatrically troubled some degree  of suicidal  ideation tends to accompany almost all of the problems likely to result in young  persons  being placed in a  closed psychiatric  setting.  It  is also  possible that some sort of identified risk to suicide was a tacit part of the  selection criteria employed by the particular facility from which the  subjects for this study were drawn. A sensible extension of the present work, then, would involve an attempt to establish whether a non-suicidal adolescent psychiatric population could be identified and subsequently used as  a control group. Failing the identification of such a group, a second  option might be to include a group of nonpsychiatric, but still problematic young persons of the sort that might exist institutionalized  for  reasons  associated  in a sample of adolescents  with  antisocial  or  delinquent  behaviours. While it would be reasonable to assume that at least some of these individuals  would have  prompted concerns  their  also  reasonable  suicide,  it  seems  to  over  assume  the that  possibility of a  substantial  proportion of such young persons would be relatively free of suicidal risk. Another  important  around the interpretation  issue  which needs  to  of the scores on the  be  addressed  revolves  continuity measure. The  high risk suicidal subjects who were found to be at a complete loss as to how to warrant personal continuity over time essentially scored off the scale  of hierarcharized levels of such continuity warrants.  that  this  failures  to  continuity represent  raises  is  warrant task.  whether persistent  That  individuals'  is,  such  responses  identity,  there  is  the  or  should failures  possibility  unwillingness or inability  to  be to  The question interpreted  respond  that  such  be responsive  to  as the  failures to  the  test-taking situation itself. While this possibility needs to be kept in mind,  the responses of the high risk group have been interpreted here as actual failures  to  conserve  interpretation  stem  identity  from the  across  time.  facts that:  1)  The  each  reasons  subject  was  for  this  presented  with several different measures all of which were administered during the same interview session yet it was only on the continuity measure  that  such "off scale" results were apparent; 2) 74% (20 of 27) of responses in the failed scoring category involved initial attempts at justifying personal continuity  which  were  subsequently  discounted  as  inadequate  by  the  subjects themselves; and 3) although the length of the continuity interview varied widely across subjects,  it was not the case that those who had  less  those who scored  to  say  were  necessarily  at  the  lowest  levels of  continuity warrants. In  addition to  increasing  the  sample  sizes  control group of nonsuicidal but troubled adolescents,  and  incorporating  a  the findings of this  study suggest several directions in which future research could be fruitfully taken. indicate  The results that  the  based on the high  risk,  low  Nascent risk,  Skeptical Doubt Questionnaire and  control  groups  could be  distinguished by their scores along an objectivist-relativist dimension. These encouraging results can be taken to justify continued efforts to refine and test the doubt questionnaire which is still in a relatively early stage of development. As it stands, the questionnaire appears to have the potential to discriminate important differences between  groups of adolescents  with  reference to certain of their epistemological assumptions and the degree to which these assumptions permeate different areas of their understanding. 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British Journal of Psychiatry,  and comparisons 132, 180-185.  with  international  88  APPENDICES  Appendix A Numerical Identity Interview Procedure  Now that you have read the story of Ebenezer Scrooge/Jean Valjean, I'd like to ask you some questions about him. 1.  First of all, tell me what Scrooge was like at the beginning of the story.  2.  What was Scrooge like at the end of the story?  3.  How else might you describe Scrooge at the beginning and at the end of the story?  4.  In summary, then, how would you say that he has changed from the beginning to the end of the story?  5.  You have now told me a lot of ways that  Scrooge has changed  from the beginning to the end of the story. You've told me (how he's gone from being mean and stingy to being kind and generous) (how he used to have no friends and now he has lots of friends and everyone likes him). So it seems that Scrooge has changed alot and in some pretty important ways, yet we know, even though he seems so different, that the person described at the beginning and at the end of the story  are both the same person. Does that seem  right to you? 6.  Given all the changes and the ways in which he seems so different, what is it that makes Scrooge one and the same person throughout the story?  7.  (Assuming only a list of similarities is offered) You are right - those are things which are the same at the beginning and at the end of the  story.  Are  there  other  ways  in  which  we  can understand  Scrooge to be one and the same person throughout the story, despite all the changes that you have mentioned?  8.  What if Scrooge (did change his name) (did move to another house), would that make him another person? What is it, then, that makes him the same person?  9.  What about Scrooge himself - does Scrooge think he is the same person? That is, when Scrooge in the end remembers Scrooge in the beginning,  does  he  think  that  those  things  that  happened then  actually happened to him? 10.  How might Scrooge explain to someone else that one and the same person could act in all the different ways that he acted througout the story?  We have been discussing changes in the lives of two story characters Jean Valjean and Ebenezer Scrooge - and my questions have been about how  these  characters  can  be  understood to  be  the  self-same  persons  despite the fact that they went through a number of important changes in the course of their stories. Now I want to ask some similar questions about you and your life. 1.  First, I would like you to describe what you were like about five years ago, when you were (10).  2.  How would you describe yourself now?  3.  So, in what important ways do you think you have changed from when you were (10) to the (15) year old you that you are now?  4.  You've told me some important ways in which you have changed since you were (10).  In addition, there  are probably  other things  that you could list which have changed such as (the way you look) (what you like to do) (some of your attitudes and beliefs). Are there things like this that you could name that you feel have changed? 5.  Okay. You have told me a lot of important changes that you feel have taken place in your life and that have happened to you. In all the ways that you have mentioned, you are now very different than  you were five years ago. Still, like Valjean and Scrooge, the story you have told me about your life is a story about one person. What I now want you to explain is why you think you are the self-same person that you were five years  ago. What makes you the same  person? If you (didn't still live in the same house) would that make you a different person?  What is it,  then, that makes you one and the  same person even though you have changed in all these important ways?  How is it that you can still consider yourself one and the  same person? How would you answer someone who pointed to all of the changes in your life and claimed that it would be better  to think of the  person you are now and the person you were five years ago as two completely different people? Think about your best friend and all the ways that you and s/he are  alike.  In many  ways  you are  probably more  like your best  friend right now than you are like the person you were five years ago. Wh}' do you say that you are still the same person, but that your friend is a different person?  Appendix B Nascent Skeptical Doubt Stories and Interview Procedure  Driving Age In a small town in British Columbia a meeting had been called about whether the local high school should continue to offer a driver's education course.  Many  parents were against the  school offering this  course and  many students wanted the course to continue. A committee of parents and a  students'  paper  committee both  before  the meeting  wrote articles  took place.  which appeared  in the  local  Parts of these articles are shown  below. Report by The Parents' Committee for Safe Driving We  are  opposed  course for its students.  to  the  high school  offering  Scientific information presented  a  driving  training  in this paper over  the past few weeks clearly shows that 16-year-olds, as a group, are not responsible enough to be trusted While the law now permits parental are  with the handling of a  motor  vehicle.  16-year-olds to obtain a driver's license, with  permission, teenagers should not be allowed to drive until they  at least 19 years old. Offering a driver training course through the  school puts unfair pressure on parents to let their children learn to drive before they are  19-years-old.  The course must be taken out of the school  immediately for the safety of all concerned. Report by The Students' Committee for Young Drivers We are high  school.  in favour of continuing the driver training course in our The  scientific  information  that  has  been  printed  in  this  newspaper  and elsewhere  responsible  as  adults  support the view that 16-year-olds are just as  and should be able to learn to drive as  soon as  they are legally allowed to do so. The driver training course in the high school encourages students to follow a proper training program and become better drivers. The law allows us to drive at  16 years of age and we  should have a training course in our school for everyone to take.  Native Lifestyles  Recently, sociologists who have spoken to West Coast Indians and studied their society, published two new books about the West. Coast Indians and their relation to our non-native society. What follows are paragraphs from the first page of each of these new books. Cultural Independence and the Coastal Indians We  have  interviewed,  lived  with,  and  studied  the  West  Coast  Indians, and their culture, and have found that they led happier, richer, more  meaningful lives when they  than  they  settled  did after  they  lived on their  own, in tribal groups,  had contact with Europeans  and others who  North America. Even though modern influences have improved a  few things overall, however, contact with non-native people since pioneer times has brought the Coastal Indians many problems. These problems are so serious that the  best thing that could happen would be for native  people to become more independent of non-native groups. West Coast Indians: A Case for Cultural Integration Based  on a  large  research  project  in which we lived with and  interviewed West Coast Indians, and studied their culture, we found that their  lifestyle today  Modern  knowledge  modern technology  is happier and more prosperous than it ever in  such  areas  as  health  care  and  in the fishing industry and other  increased the standard of living, financial security,  education,  areas, has  was. and  greatly  and happiness of the  West Coast Indians. Even though a few problems have been created in the course  of the many changes  that have taken place as  a result of  contact with the non-native society, overall the benefits far outweigh these temporary adjustment issues. The best thing that could happen would be for native people to increase their contact with the non-native population.  Now that you have read the reports by the parents' and the students' committees/ the two sociologists, I'd like to ask you some questions about them. 1.  First of all, on the basis of what you've read, tell me what the parents' and students' committees said about the issue of 16-year-olds being responsible enough to drive.  2.  Are the arguments and conclusions of the two committees different in any important ways? How are they different?  3.  How could these two committees end up having such different things to say about the issue of 16-year-olds being responsible enough to drive?  4.  Why  do  you  think  these  two  committees  wrote  such  different  articles? 5.  Do you think that one of the committees has got the facts wrong? How  important  is  that  to  the  disagreement?  (Would  that  be  important to the disagreement?) 6.  If these  two groups had all of the  very same information, might  they still disagree? How is that possible? (Why is that not possible?) 7.  It sounds as though you're saying that people can view things in any way that they want. Is that what you are saying?  8.  What if another group reviewed the  same information and decided  that kids should be allowed to drive when they were  12-years-old,  would that be an okay opinion to have? Why (or why not)? 9.  What if a group of specialists reviewed the positions of the parent and  student  committees.  Do you think  that the  specialists might  know what was best to do? What makes you say that? 10.  Is  there  a  way of deciding which  of these  reports  the  principal  should pay the most attention to in deciding the fate of the driver training course? Could you explain why you think that? 11.  What  sorts  of  things  should  the  principal  consider  in  order  to  96  determine what best to do about the driver education course?  General Section  1.  What is it about these situations that makes finding out or deciding what is right or best so hard?  2.  Is that true just for these situations or is it generally true? That is, are these just wierd situations, or are there a lot of situations like these in life and in the world?  3.  How should we approach these sorts of situations, what should we do? How should we decide what to believe and what to do?  4.  We could just decide to go our own ways when we disagree but, as in these situations, we often cannot do that. What then shall we do? How do we decide what to think in these sorts of situations?  Appendix C Nascent Skeptical Doubt Questionnaire  This questionnaire consists of 20  statements.  Please read each statement  and rate it in terms of how similar it is to your own views. Using the following rating scale, CIRCLE the number that best represents how close that view is to your own.  Similarity Rating Scale:  1.  When  I  hear  0 =  very dissimilar  1 =  somewhat dissimilar  2 =  somewhat similar  3 =  very similar  that  some  experts  think  parents  should  be  very  permissive with their children, and that others think they should be very strict, I think that both these views amount to little more than preferences for one style of raising children over another, and neither one can be said to be better than the other. How similar: 0 1 2 2.  3 -circle one  Over the ages, different countries have had, and many people have preferred, very different forms of government. I would say  that if  people were more aware of what was in their best interests,  they  would be able to see which form of government is the best.  3.  How similar: 0 1 2  3 -circle one  When it comes  interpreting dreams,  to  I think that some people  seem to be able to decide what a dream really means. How similar: 0 1 2 4.  3 -circle one  For everj' piece of art,  there are always some people who think it  is good, and others who do not. This suggests to me that all claims about  good  and  bad  art  are  nothing more  than  expressions  of  personal taste. • How similar: 0 1 2 5.  When I read movie critics  3 -circle one  reviews  of movies in the  newspaper,  I  simply give their own opinions, which are  think that really no  better or worse than anyone else's.  6.  How similar: 0 1 2  3 -circle one  Some  that  people  think  the  universe  was  created  suddenly, and  others think it came into being over a long period of time. It seems that one of these theories must necessarily be wrong. How similar: 0 1 2 7.  3 -circle one  The fact that the same bible passages are often interpreted in very different ways suggests to me that biblical texts are often written in such a way that you can find almost any meaning in them you want. How similar: 0 1 2  8.  3 -circle one  Most of the basic uncertainties of modern life could be eliminated if people would only make greater efforts to pay careful attention to the facts. How similar: 0 1 2  9.  Some  experts  parents,  3 -circle one  claim  while others  one has.  It  that  you inherit your  intelligence  from your  think intelligence depends on the  experiences  seems to me that both these views amount to little  more than hunches, because you can view intelligence in almost any way you want. How similar: 0 1 2 10.  3 -circle one  Wine experts argue over which vineyards produce the finest wines. I would  say  eventually  that if one made become  apparent  a careful which  study of wines, it would  vineyards  produced  the  finest  wines. How similar: 0 1 2 11.  Different  3 -circle one  sportscasters  sometimes  what a particular athlete really  make very different claims about  is like. From this I conclude that what  distinguishes good from bad sportscasters  is  the  degree  to  which they stick to the facts. How similar: 0 1 2 12.  3 -circle one  When it comes to interpreting dreams, I think that nobody has any way of knowing  what  a dream  might really mean,  and so you  might as well believe whatever you like. How similar: 0 1 2 13.  3 -circle one  Truth amounts to nothing more than a word people use to make their own view seem more respectable. How similar: 0 1 2  14.  When  I  hear  3 -circle one  that  some  experts  think  parents  should  be  very  permissive with their children, and that others think they should be very strict, I think that with a little more effort, the experts who study such things could determine which of these is the best way to go about raising children.  15.  How similar: 0 1 2  3 -circle one  Some people think  that  the  universe was creeated  Suddenly, and  others think it came into being over a long period of time. It seems that we'll never know what happened millions of years ago, so most people should believe whatever suits them. How similar: 0 1 2 16.  3 -circle one  Behaviours which are thought to be wrong in one country are often judged to be right by other these  groups  are  obviously  groups. This tells me that some of confused about what right and wrong  really mean. How similar: 0 1 2  3 -circle one  17.  For every piece of art there are always some people who think it is good art and others who do not. This suggests to me that while some people are able to judge artwork accurately, other people can't tell good art from bad. How similar: 0 1 2  18.  3 -circle one  Wine experts argue over which vineyards produce the finest wines. I would say that these arguments will probably continue because people have no good grounds for determining which wines are best. How similar: 0 1 2  19.  3 -circle one  There are many changes in musical preferences from one generation to the  next.  This  suggests  to me that some generations  tend to  reject good music and are attracted instead to music which has no real quality. How similar: 0 1 2 20.  3 -circle one  Most of the basic uncertainties of modern life will always be with us,  so for many important decisions the choices we make are no  more than guesses. How similar: 0 1 2  3 -circle one  Appendix D Suicidal Risk Rating Scale  Level 1. No real concern over the possibility of suicide is expressed by others. There may be some talk of suicide on the part of the patient but this talk appears to be the product of psychosis or has occured in the distant past. Level 2. Suicidal talk is present on the part of the patient. The patient may  have  taken  circumstances  of  some the  mild  action(s)  (ie.  low  they  lethality)  were  action  considered  by  but  given  others  the  to  be  expressed  by  primarily hystrionic and/or manipulative. Level  3.  Real concern  over  the  possibility of suicide is  others. Patient may or may not have acted but threats are believed and any actions taken appear to have been carried out in all seriousness. Level  4.  Patient talks and demonstrates  serious suicide intent.  At least  one serious life-threatening attempt has been made and there continues to be a high level of concern over the possibility of suicide expressed by others.  


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