Performance versus Ability: Another Issue Frequently Ignored in Psychiatry Research

In previous posts, I have discussed some bizarre assumptions made in psychiatry research papers when the data is analyzed. I wrote about how, for example, differences in brain area size and functioning between different groups on fMRI scans are automatically interpreted as abnormalities.

Nassir Ghaemi, a blogger on Medscape with whom I have had some strong disagreements about borderline personality disorder and bipolar disorder, nonetheless had a great quote on this with which I wholeheartedly agree:
             

"All things biological are not disease, even though we can define disease in such a way that all diseases are biological. This matter is obvious once pointed out. A few assumptions,  which seem either patently true or very likely: all human psychological experience is mediated by the brain; each person only has one brain; therefore the brain will always be biologically changing as we have psychological experiences. Reading a blog post about the brain is a psychological experience. Having delusions from schizophrenia is a psychological experience. The first brain change does not reflect disease; the second does. So showing MRI changes with adult ADHD or borderline personality does nothing to demonstrate that those conditions are diseases. If you watch TV and play video games inordinately, you will have changes in your brain, and you might also develop clinical symptoms of ADHD. If you are repeatedly sexually abused, you will have changes in the brain, and you might also develop clinical symptoms of borderline personality. But those changes in the brain do not have the same causal role as the neuronal atrophy that happens with trisomy 21, or with schizophrenia, or bipolar illness..."

Another major nonsensical assumption that litters the psychiatric literature (the literature littering alliteration?) is that one can totally disregard the motivations of research subjects as well their past experiences and the environmental context in which they live when evaluating their performance on psychological tests. 

I mentioned an example of how this is utter nonsense in a previous post: The performance of African-Americans on IQ tests just might be related to the fact that for several generations Blacks who looked too smart were at high risk of being lynched. Do you think they are just as motivated as other folks to want to look smart on an IQ test which is being administered by White researchers?

What I have seen more and more lately, particular in the personality disorders literature, are studies that look at differences between various diagnostic groups on such issues as how much "impulsive aggression" they show, or how and how well they read the emotional state of ambiguous faces of strangers in photographs. When differences are found, once again the "lower" performing groups are just assumed to be "impaired" or "abnormal."

This, of course, confuses performance with ability. Without knowing anything about what the subjects in the experiments are motivated to do in their daily lives on any particular dimension for whatever reason, or what environmental contingencies they are worried about that may relate to the task at hand, it is literally impossible to say for sure whether any difference in their performance is related to what they would be able to do if those other issues were not operative.

Patients with borderline personality disorder, for example, grow up in families in which double messages are flying in all directions, and with parents who can switch from being over-involved to neglectful at the drop of hat. They are bound to have a higher index of suspicion about what facial expressions on strangers might mean than someone who grew up in a more consistent and predictable environment. If they did not, they would be morons.

Another major issue ignored in the literature is the difference between a research subject's real self versus their persona or false self in certain social situations. We all present different "faces" to the outside world depending on social context. Researchers who do not consider this must think that men, for example, present themselves exactly the same way around their children, their bosses, and their mistresses. Really?

With personality disorders, as I described in several previous posts, people play social roles designed to stabilize family homeostasis. These roles are merely a much more pervasive version of the different roles played by the above "normal" man interacting with different people. So someone with antisocial tendencies, for example, which are part of the role of avenger, are motivated to show more impulsive aggression than other people - on purpose - and have literally trained themselves to be like that. They do so habitually, automatically, and without thinking. Of course they will show more impulsive aggression in the experiment! Why wouldn't they? 

In fact, showing a lot of impulsive aggression might be considered to be part of the definition of antisocial behavior. The experiments therefore do nothing more than prove that anti-social people act habitually in an anti-social manner. Like, duh!

These types of results in no way indicate any "deficits," "deficiencies," or "abnormalities." One wonders how people who make these ludicrous assumptions ever manage to get through medical or graduate school.

Getting Significant Others to Tell You the Truth, Part II: Descriptions Masquerading as Explanations

Descriptions Masquerading as Explanations

In part I of this series of two posts, I introduced them with the following:

As I have mentioned in many posts in this blog, the key to effective problem solving for dysfunctional families is to initiate metacommunication (talking about the nature and manifestations of rules by which the family operates, as well as talking about the way the family communicates), and then learning how to do it effectively.  Many strategies were discussed previously in my two series, Ve Have Vays of Making You Talk and How to Disarm a Borderline. 

In this new series of two posts, I will describe situations in which individuals with whom one is attempting metacommunication seem to be answering the questions that have been posed to them but are, in actuality, avoiding answering the questions.

In the previous post, I covered a problem that crops up when one family member questions another family member about his or her relationship with a third party:  judgments masquerading as descriptions.  


In this post, I will describe a strategy used by people who do not want to tell you their real motives for why they did or did not do something – for any of a variety of reasons – and therefore block your efforts to understand them and their motives better by confusing the issue: descriptions masquerading as explanations.

In attempting to obtain an undistorted or honest explanation of a family member’s conscious reasons for engaging in a particular course of action, a metacommunicator should be alert to instances of this. Often, when a metacommunicator asks family members to explain their motives for certain behavior or the reasons they are fearful of some action, they respond by paraphrasing an earlier description of their state of mind. 


The response sounds like an explanation for their motives or fears but in fact explains absolutely nothing. Here once again, the use of follow-up questions is essential in clarifying what the family member’s actual motives are.

The most common example of a description masquerading as an explanation is the statement, "I won’t do such and such because I don’t like doing that" or “I do that because I like to." This sort of “explanation” might be used to explain away extremely self-defeating acts such as frequent confrontational behavior with bosses at work that causes the speaker to get fired from jobs, or habitually avoiding intimacy and ending up alone in life. In such cases, the family member seems to be saying that the decision to choose or avoid a course of action is based merely on a personal idiosyncrasy, on the order of not particularly enjoying the sport of bowling.

It is far more likely in such cases that the decision is based on past experiences with the course of action in question. Usually there was a history of unintended adverse consequences to making the “healthier” choice. The metacommunicator needs to ask family members specifically what they think might happen if they were to make a different choice. What are the plusses and minuses that went into the family member’s decision, and what makes the family member give a lot of weight to some of them and little weight to others? Are the feared consequences sufficiently onerous to account for the family member’s behavior?

To consider an example from a client in psychotherapy, let us look at the case of a lonely woman who explains her isolation by saying, “I prefer to live alone; I like it better." On the surface, this answer does seem to provide an explanation, albeit one with which a therapist can do very little. The client has indicated that she is basing her choice to live alone on personal preference, much as one might like chocolate ice cream while disliking mocha. One's preferences have to do with the tastes of one's true self, and are otherwise inexplicable.

On further inspection, however, it became clear that the patient was being evasive in answering the question. Choosing isolation over relationships is not a simple choice, but one based on a relative preference. Adults do not dislike living together in the same way that they dislike liver. There are pro's and con's which must be appraised individually and then balanced against one another. Yes, descriptively, the client did prefer to live alone, but why was that? What were the pro's a con's upon which she based her decision? More importantly, if something can be done about the con's, would she make a different choice?

A variation on this theme is the family member who attributes an aversion to an essential course of action to having a simple phobia, perhaps based on a single disturbing incident in the past.  I call such a proposed "reason" the single traumatic event hypothesis.

For example, one woman refused to go to school to get retrained in a new occupation after an on-the-job injury halted her previous career. She said she was just “uncomfortable in classrooms” - all because of an incident in which her seventh grade English teacher embarrassed her in front of the class.

The problem with this “explanation” is that just about everyone has been embarrassed by his or her seventh grade English teacher at one time or another. While the event probably had something to do with her apparent aversion to school, there just had to be something more than that in order to cause what appeared to be a full-blown school phobia. The extent of her "trauma" was in no way commensurate with a fear that was so all encompassing that she was prepared to live a life of poverty rather than get retrained.  To use a term used in psychology studies, the traumatic event does not account for the variance.


Follow-up questions might include: Did something else happen after the event? What was the reaction of your parents to what your teacher did? What seems to make you focus only on this event? Why do you think you are unable to overcome it? What have you done to try to overcome the problem, and if nothing, why? 


If the family member replies to the latter question with, “I just didn’t think there was anything I could do about it,” the metacommunicator should inquire if the family member had even looked into possible solutions, and if not, why not.

Another example of a description masquerading as an explanation, in this case for a family member’s lack of assertiveness was, "I always keep my anger to myself because I have trouble dealing with angry feelings." This is obviously no explanation at all. It is probably true, but it clarifies nothing. In fact, it is merely another way of describing the very state of affairs it purports to explain. 


The person and his or her audience probably both presuppose that someone who has difficulty dealing with anger either has trouble appropriately expressing it, or flies off the handle too readily.  We already know that this guy is explaining his passivity.  Therefore, for him to say that he has trouble dealing with his angry feelings means the same thing, in essence, as the statement that he always keeps his anger to himself.

For another example, a metacommunicator might ask a family member whose career might be adversely affected why he or she is refusing to make an important business presentation. If the family member answers, “I am afraid of public speaking,” the family member seems to be saying that he or she has a very common simple phobia, and that is all there is to it.  After all, public speaking fears are common; almost anyone might be completely paralyzed by them. 

What remains unexplained, however, is both the true source of the family member’s anxiety, and the reasons why the family member has not yet done anything to remedy it.  As we know from cognitive therapy, there is usually an underlying automatic cognition that is an assessment of what might happen in a feared situation.  What is it?  If the feared consequence the family member reports is highly unlikely, what makes the family member focus on it? 

In addition, successful business people who have troubles with public speaking will usually search actively for solutions; they may ask for medication, practice speaking at Toastmasters, read books about others who have overcome similar troubles, and so forth. What has the family member done?

Upon hearing someone volunteer such a pseudo- explanation, a family member should pursue the questions of what thoughts the phobia is based upon and what the family member has done previously to get over the phobia.  If the problem is long standing and the family member has done nothing about it so far and refuses to go to therapy, what exactly has been stopping him or her? 


Inquiring minds want to know.