James Mullaney
St. Francis Day Hospital, Dublin 5, Ireland
There are widespread misapprehensions and misinterpretations regarding the validity of measures of anxiety and depression. This article aims to clarify some aspects of the measurement of clinical anxiety and clinical depression and briefly indicate how such measurements may be greatly enhanced. It is helpful to recall that most of our commonly designated diagnostic groupings in psychiatry were first described over three-quarters of a century ago, and that these entities were described with the aid of clinical observations alone. In the classical description of manic-depressive illness or anxiety neurosis, no sophisticated statistical or computer aids were employed by Kraepelin or Freud. However, the robustness of earlier descriptions has tended to cloud two vitally important issues. These are (a) distinguishing between classifying and measuring psychopathological attributes people may possess, i.e., syndromes, and (b) classifying patients into diagnostic groups. Since the path physiological causes or mechanisms of most psychiatric conditions have not been isolated, we must first concentrate on the establishment of clinical syndromes. In essence this means classifying symptoms (and perhaps other features) into groups to form syndromes, in which a syndrome is defined as a group of correlated symptoms (and other features that are correlated among themselves, but are relatively uncorrected with other symptoms or features). There has been an unfortunate tendency in recent times to lose interest in the isolation of syndromes because, particularly in the affective disorders, no easy relationship between symptoms and physiological indices or treatment has been readily apparent.