Like staring at a Rorschach Inkblot

Two times in the past year, I’ve had to defend the field of psychology to a graduate student of some other persuasion. The first, a philosophy grad student, commented to me politely that psychology was not science because it was never based in hard fact. I quickly replied that actually, we use many physiological measures nowadays that bridge the gap between incredibly subjective judgments and implicit experience or otherwise undetectable behavioral patterns. Actually, we were at a show at Starr Hill, and we were yelling really loud in order to combat the noise from the band, so I probably said something more along the lines of “naw, dude, we do MRI and shit!” And he said something along the lines of “oh, nice.”

The second time this happened, I had been babbling to a good friend, who happened to be a Ph.D candidate in English literature, about the validity of a certain study that I was working on. After I concluded that we should probably do it a certain way for the sake of the scientific method, he replied, “well, it doesn’t matter anyway, because psychology is not real science,” as he smiled back at me, knowing this comment would get me riled up. I turned to him, my eyes got big, and I got so mad that all I could say was “you read books. You. Read. Books. YOU READ BOOKS!! YOU GET TO BE CALLED A DOCTOR AND YOU DON’T EVEN KNOW CPR!”

I enjoyed this week’s readings because I agreed with pretty much everything that was said in them. Garb (1999) very eloquently begged the psychological community to stop using those darn pictures for anything consequential: “Trying to decide whether the Rorschach is valid is like looking at a Rorschach inkblot.” Sechrest & Coan (2002) admirably argue against allowing the field to give people like themselves the power to prescribe medicine. Coan (1997) told an entertaining, yet disturbing, story about what happens when you have no one rooting for you in the field. Lilienfeld (2007), for the sake of identifying potentially harmful treatments, proposed a “centralized databank that is publicly accessible…[to] increase the likelihood that all relevant results from these studies are reported.” (Open-source data sharing! Woo hoo!) And finally, Dawes, Faust & Meehl (1989) informed us that actuarial judgment always (not sometimes, but always) beats clinical judgment. My favorite quote from this article is a disclaimer that should probably come at the beginning of every research article written: “Lacking complete knowledge of the elements that constitute this universe, representativeness cannot be determined precisely” (p. 1670).

But, hmm. What’s the lesson here? Initially, it might seem that theory and researcher bias has, for various reasons, tainted this science in a way that can only be emphasized by the fact that it is almost 2008 and legitimate psychologists are stilling using pictures of inkblots for diagnosis. Blots of ink, on paper, and a client’s reaction to them, are determining the diagnosis for some poor soul sitting at a desk in a cinder block room. I guess my comment to that guy at Starr Hill was naïve: we’re not all using physiological, actuarial, or even the sparse collection of ESTs available when the need arises. Some people are stuck in a time warp, I guess.

Though Coan (1997) shows that this is not correct: theory can and has worked in the past. A mangy kid, playing a few tricks on his family, can take a hunch and produce actual results – even fun, controversial ones. And this makes total sense! Psychology is interesting because it allows us to study passing, fleeting moments of human behavioral paradox, things that catch our eye and make us think “I want to know a little more about that.” Even though people complain about it, and bash it as not a “real science,” they still desperately want to know what it is that we found out from our studies. Even those who distain going to psychologists still seem to not mind being psychoanalyzed every now and again – because it’s fun to know about yourself and know more about humanity as a whole. The English and philosophy fields talk about it, but we actually do it, and we strive to explain why we do it, and why we might do it again and again! I’m not sure what more you could ask for in a science!

“The only people for me are the mad ones.”

There’s something about the borderline personality that I adore. I have a few very close friends that have been officially diagnosed with borderline, usually during a point of hospitalization. These friends of mine are the type that yell and scream and dramatize and love very intensely, and are a thrill to be around. I have clung to them over the years as Kerouac must have clung to Cassidy, desiring to get saturated in moments of pure, intense, fiery life interaction.

But, despite my experience with said personalities, I will not claim to understand them in the least. (And in many ways, that’s part of why I adore them still.) Trouble once came when I began rooming with a good friend at the age of 20. Doctors had been going back and forth about whether she qualified as bipolar or something else, and much of our friendship centered around talking about our feelings and relationships. I credit her for turning me on to feminism and healthy eating, and that was the year that I switched my major from English to psychology, partly because she revealed to me the amazing world of neuropsychology.

But then winter set in, and the apartment began to lose the flare it had previously held. She gradually began to recess into her room and refuse all efforts to get her to go out or experience life. Much to my surprise, she stopped listening to encouraging words, often turning away from me in an air of malice and contempt for anything I had to say. Her room turned into a womb: uncharacteristically warm for the winter, and dark. She would put sweatshirts over her monitor to dim the light, and blankets over the windows so that she never knew what time of day it was. When walking into the apartment during the months of February and March, the charge in the air made you stiff upon entry, and each step inside had the potential to set off an IED. By April, her addiction to cutting herself became as intense as an alcoholic’s addiction to his hidden whiskey bottle.

She was eventually diagnosed as having borderline PD, and I regret to say that she and I are not friends anymore. This is very upsetting to me, as I was quite accepting of her and not at all afraid or shocked by her actions (which seemed designed to be shocking). In many ways, I feel that I failed her. However, my hindsight analysis of this situation, based on Linehan’s (1993) definition of borderline PD and the therapy required to help it, makes me think that I was just not the right person to help her. In truth, based on the transient and silly pejorative basis for such diagnosis as “personality disorders” (see Allison’s brilliant assessment of the ridiculousness of PDs), I’d bet that the chances were more likely than not that, whoever I was, I was not going to be able to help her. Assuming someone with a “personality disorder” wants to be helped, it takes a special person, a special therapist, to work with people in such states of distress. Linehan (1993) proposes DBT, based on Zen principles, but no matter what you call it or how you frame it, I bet Linehan is just great at therapy.

I bet Norman Mailer was high on factor 1.

Moffitt (1993) proposes two distinct pathways for the development of antisocial behavior. The first path, life-course-persistent, begins in early childhood, continues throughout the life, and is probably genetic. The second, adolescent-limited, is a natural, normative reaction that many teens have to the maturity gap that has evolved since the industrial age. Adolescent-limited delinquents are stuck in state of biological maturity without the benefits and cues associated with social maturity. During this maturity-gap, these youths tend to mimic their life-course-persistent counterparts in an effort to cope with the discontinuity of their physical and social age, as the life-course-persistents seem to make their own rules and have it all. These adolescent-limited youths also tend to remit their antisocial behavior once placed in an environment where they have an opportunity to accept responsibility or are given something to lose as a result of antisocial behavior. Moffitt concludes the article by outlining what future research will find, if her theory is correct, while noting that we should distinguish between the two types when studying antisocial behavior in youths.

The theory that Moffitt proposes is intricate and, in many ways, quite beautiful (such as when she likens the mimicking behavior of teenagers to the mimicking behavior of hungry tamarin monkeys, p. 687). However, by restricting her discussion to antisociality as defined by the DSM-IV, Moffitt is missing a huge chunk of the literature that examines covert personality traits versus overt behavioral features of antisociality. In contrast to the DSM’s definition of antisocial personality disorder, the psychopathy literature separates antisocial characteristics (“factor 2”) from interpersonal/affective characteristics (“factor 1”) when making a diagnosis using the Psychopathy Checklist-Revised (Hare, 1990). By further investigating the antisocial behavior factor in contrast to the interpersonal factor, it has been found that the two factors are differentially related to anxiety and fear: greater antisocial features are associated with higher anxiety levels and interpersonal/affective features are associated with low fear levels, but normal anxiety levels (Fowles & Dindo, 2006). Put another way, those who exhibit a need for stimulation, have poor behavioral controls, are impulsive, and break the law repeatedly tend have anxious apprehension about potential future threats, whereas those who are manipulative, pathologically lie, and lack remorse or guilt tend to lack fear, which is can be defined as the activation of the autonomic nervous system in order to deal with imminent threat. My qualm with Moffitt’s (1993) approach to antisocial behavior in youth is that she looked at it in terms of antisocial behavior as a whole, addressing it as a neuropsychological deficit originating in childhood based on the presence of a broad definition of antisocial behavior (p. 680). However, just as she calls for a differentiation of life-course persistent vs. adolescent limited teenagers in addressing pathological antisociality, she needs to differentiate, within the life-course persistent group, between children high on the behavioral versus interpersonal features of the construct. One reason for this is that the interpersonal feature as found in psychopaths is much more robustly related to long-term criminal activity than the behavioral feature alone: of the 80% of incarcerated criminals that qualify for a diagnosis of APD according to the DSM, 20% of those qualify for a diagnosis of psychopathy based on the PCL-R, and that 20% commits 50% of the overall crime (Hare, 1993). Moffitt’s (1993) statistics for this are a bit more dramatic, as she cites an even smaller 5% or 6% of criminals being responsible for 50% of the crime. I’m pretty sure there have been studies linking psychopaths high on the interpersonal factor alone as having committed more crime, but I do not have a book handy to cite this.

I am not sure that Moffitt would entirely disagree with me when it comes to the interpersonal factor, as I just found a more recent article of hers (Viding, Blair, Moffitt, and Plomin, 2005), researching interpersonal callous-unemotional traits in 187 5-to-7-year-old twin pairs. They found that callous-unemotional traits in children are under strong genetic influence but under no environmental influence, compared to antisocial behavior, which is under moderate genetic and environmental influence. This goes along with Moffitt’s (1993) theory, but integrates the interpersonal feature nicely.

The interesting thing about this, for me, is that the defining feature of dangerous criminals is their lack of remorse and their manipulative ways, not their criminal acts. This means that, if put in the wrong environment as a child, that two-faced ass hole you knew in high school could have turned into Jeffrey Dahmer. But he had an attentive mother, so he didn’t. Now he’s just a two-faced ass hole that you want to have thrown in jail, but you can’t, because we have yet to create an “ass-hole personality disorder” in the DSM.

For the eleven of you who read my previous post (which has been removed), I apologize. It was based on nothing scientific or rational, and had no citations or sense. In case you missed it, my last post made grandiose claims like, “fear is the only emotion worth researching.” I might as well have been George W. Bush claiming that global warming does not exist, or Mahmoud Ahmadinejad claiming that there are no homosexuals in Iran. Maybe the fleeting, flamboyant world of the blogosphere went to my head, or maybe it was some sort of subconscious performance art based on that class’s readings about anxious apprehension. Regardless, I promise to never again blog while grumpy.