Diagnostic Decision Making in Psychiatry

THERE HAS been increasing concern within lay and scientific circles about how people proceed in making decisions.2A survey of the experimental literature8reveals that the majority of investigations have been carried out under somewhat artificial experimental conditions where the investment of the subject in the decision making process is questionable. Typically, subjects have been asked to participate in experiments which resemble game situations with monetary rewards provided for good performance.5However, it is difficult to see how a subject can be greatly concerned about the consequences of his decision in a situation where he is asked, for example, to decide whether there are more black or more white balls in a container. Studies in which the subject is engaging in a decision-making process which is not foreign to him and in which the rewards are personally and internally provided would therefore seem