Measurement and meanings

The original version of the Life Events and Difficulties Schedule was developed to study schizophrenic episodes (29,,30) and there has since been a large amount of research dealing with psychotic patients.(31) An early achievement was to make clear that the amount of change in activity as such brought about by a life event appears to be irrelevant and that the impact of events results from their meaning. (32> It has also been clear that some attention needs also to be given to ongoing difficulties that can either be brought about by an event (e.g. the death of husband leading to financial problems), or lead to an event (e.g. a marital difficulty eventually ending in a separation).

In dealing with meaning, two perspectives have proved productive. The first is summed up by the statement that we cannot fully know the meaning of an event or set of circumstances until we relate it in some manner to our concerns. One way of conceiving of such concerns is in terms of the impact of a particular event on plans and purposes that stem from role activity caught up in the crisis: how, for example, being turned down for rehousing by a local authority thwarts a woman's wish to move from an overcrowded and damp flat to give her children 'a better start in life'.

A second perspective assumes that evolutionary-based response patterns that help to guide us in terms of what to want or to avoid are often involved, and that such behavioural systems are sensitive to a particular range of stimuli. The attachment system and fear responses are obvious examples. (33> Of course, such responses will be influenced by individual differences of various kinds and by cultural display rules concerning emotions, but there is good reason to believe that such behavioural systems are often involved in the development of psychiatric disorders. For example, the central importance in a number of cultures of 'critical comments' rather than 'dissatisfaction' in a schizophrenic relapse probably reflects an evolutionary-based sensitivity to emotionally toned criticism interacting with some constitutional predisposition to the disorder. (34>

The Life Events and Difficulties Schedule deals with both kinds of meaning. Blind consensus ratings usually based on 4-point scales, made by several investigators are employed to rule out reporting artifacts using 'edited' accounts supplied by the person who carried out the interview. General as well as specific kinds of threat are rated in this way. They are contextual in the sense of taking into account a person's likely concerns of relevance for the event in so far as these can be assessed from a person's current circumstances and biography. In making such ratings no account is taken of reported feelings or whether or not a disorder followed the event. As already noted, it has been possible in this way to deal with possible bias on the part of raters. It also deals with the problem that the cognitive processes involved in the appraisal of an event are not necessarily ones a person is willing or able to report. (35> General guidelines for rating severity of threat are given in an extensive manual containing thousands of examples listed in terms of a number of event categories (such as 'demotion at work' and 'unplanned pregnancy'). A similar procedure is followed for difficulties.

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