Personality Disorders: Researchers Continue to Make Misleading Assumptions

In this blog I have discussed several instances of researchers making unwarranted assumptions about both their study populations and in interpreting their results in a variety of ways. In this post, I’d like to focus on three recent articles about personality disorder research. The first is a possible refutation of a common presumption, while the second two assume facts not in evidence.

The difference between “cannot” and “do not:” Confusion based on lack of attention to subject motivation, and ignorance of the concept of “false self.”

Shane MS; Groat LL. “Capacity for upregulation of emotional processing in psychopathy: all you have to do is ask.” Social Cognitive & Affective Neuroscience. 13(11):1163-1176, 2018 11 08.

Could it be that a psychopath’s apparent lack of ability to be empathic stem from differences in motivation rather than ability? This article is certainly possible evidence that this is the case. Perhaps people who routinely engage in anti-social acts suppress empathic responses because that is their role in their family. That what has been observed results from subjects’ false selves? 

This study of course does not address that latter issue, but thinking about it certainly suggests something which could explain the results. (Of course, it would help in that endeavor if we could read minds, because the thing about a false self is that it is based on someone lying to themselves in order to fulfill a social function, so they are highly unlikely to tell experimenters the truth during a short interview).

In any event, in this study, high-psychopathy participants showed typical, significantly reduced neural responses in the brain on an fMRI to negatively-toned pictures under passive viewing conditions. However, this effect seemed to disappear when the subjects were instructed to try to maximize their naturally occurring emotional reactions to these same pictures!

The locations of these increased neural responses included several brain regions involved in the generation of basic emotional responses and which have often been shown to be reduced in psychopathic populations. Thus, despite baseline differences from non-psychopaths,  high-psychopathy participants appeared capable of deliberately manifesting emotional responses to the negatively toned pictures within several brain regions believed to underlie emotional processing. 

Of note was that the magnitude of these deliberately evoked emotional responses was comparable to levels exhibited by low-psychopathy participants’ during passive processing.

A high index of suspicion versus an “inability” to correctly read the mental states of others

Quek et. al., “Mentalization in Adolescents with Borderline Personality Disorder.: a Comparison with Health Controls.” Journal of Personality Disorders, 33 (2):145-165, April 2018.

Mentalization refers to an individual’s capacity to understand and interpret the meaning of one’s own and others’ behavior by considering underlying thoughts, feelings, intentions, and desire. As in other studies, this was “measured” in adolescent subjects with borderline personality disorder (BPD) and normal controls while interpreting the mental states of others shown in pictures, videos, and narrative vignettes of people in various social situations.

The authors of this paper mention almost in passing that the ability to mentalize  is thought to develop within the context of, and is dependent on, the quality of infant- parent interactions. In the experiment, the differences between the performance of the BPD subjects compared to the control group on the various tests became much greater when the material they interpreted suggested attachment-related stress or arousal. 

Additionally, the major differences between BPD subjects and controls seemed to primarily involve what the authors describe as hypermentalization (that is, making much more complex inferences than expected about social cues, signs, and mental states) by the BPD subjects, rather than through a loss of detail.

Despite all this, the authors don’t seem to consider the obvious possibility that attachment figures’ influence on their children’s ideas about the social behaviors of others continues unabated long after they are no longer infants.

So let’s do a mental experiment. How might you evaluate the motives of other people if you were to grow up in an family environment characterized by your being constantly invalidated and given highly confusing double messages about how you are supposed to think and behave, and even being verbally abused— if not physically or sexually abused—if you seem to have guessed wrong about that? Do you think you might have a higher index of suspicion about other people’s intentions than someone who did not grow up in that environment? Do you think you might have more difficulty making sense of other people's behavior? Ya think??

So, do kids with BPD grow up in that environment? Well, in addition to Linehan’s theory of an invalidating environment being part of the etiology of BPD, and my own paper from 2005 (Comprehensive Psychiatry, 46[5] pp. 340-352) which showed that adults with BPD reported about three times the number of double messages from their parents than non-BPD controls, consider the following paper.

Changing parent’s behavior towards BPD children can make those with BPD better—but their behavior apparently had nothing to do with their kids having developed the disorder in the first place

Grenyer et. al., “A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons with Borderline Personality Disorder.” Journal of Personality Disorders 33 (2):214-228, April 2018.

As mentioned in a post on my blog on Psychology Today, researchers into BPD have of late developed an interest in the “burdens” on parents and other caretakers (almost always other relatives) of having a child or adult child with the disorder. Such “carers” are the subject of this particular study, and were recruited through flyers distributed to mental health services, local media, patient advocacy groups, and patient family and support networks. The recruits were put into groups and given a lot of “psychoeducation” about their charges.

The first thing that jumped out at me in this paper was the fact that, even though the carers were evaluated for being critical and over-involved with their BPD children, there was nothing mentioned about seeing if the parents had been guilty of physically or sexually abusing their charges when the fledgling BPD patients were children. This, despite the fact that every empirical study done on this subject in BPD patients finds a high level of significant abuse history. Of course, parents who respond to flyers and volunteer to be research subjects in this sort of study are highly unlikely to have been seriously abusive. So right away, the experiments are selecting for a somewhat atypical sample of parents of children with BPD.

The second thing that jumped out at me was that the psychoeducation provided for the subjects was supposedly based on Bowen family therapy theory, when the researchers mentioned and seem to know absolutely nothing about one of the major tenets of that theory. You know, those that involve intergenerational transfer of dysfunctional family patterns. The researchers mention nothing about the parents being somewhat responsible for the development of the disorder in their kids in the first place!

That they seem to make this assumption is even more awe-inspiring when you look at what was being taught to the parents and which apparently led to improvement in the BPD child’s behavior as well as in the parent-child relationship. They were taught to:

1.      Be non-judgmental, validating, attentive and appropriate.

2.      Reduce their reactivity and try to remain calm and “mindful.”

3.      Attend to their own needs through staying connected with friends and family, attending to their own physical and mental health, and taking breaks.

4.      Model appropriate assertiveness and setting appropriate boundaries and ground rules for the relationship.

5.      Get outside help when crises arise and having a crisis plan.

So, if they had to be taught these things, and if doing those things leads to improvements in their children, maybe the fact that they were doing the opposite of those things all the time previous to the experiment was what was creating their child’s problems in the first place. Exactly what you would expect considering the family dynamics of BPD.

Differences in the Size and Activity levels of Brain Parts: Long-Term Potentiation

One of the ongoing themes of this blog is the nonsensical practice of some researchers in psychiatry of routinely labeling differences in size and activity levels of parts of the brain, as seen on brain scans such as fMRI scans, between various diagnostic groups and control subjects as abnormalities (See the posts http://davidmallenmd.blogspot.com/2010/03/neural-plasticity.html and http://davidmallenmd.blogspot.com/2013/02/neural-plasticity-and-error-management.html).

These researchers seem oblivious to a now well-established process within neurons called long term potentiation (LTP). Briefly, if a synapse – the point between two nerve cells at which a nervous electrical impulse passes from one neuron to the other – is stimulated by individuals’ interactions with the environment that leads to learning, this produces a long-lasting increase in signal transmission between the synapses of those two cells. In other words, the power of the connection starts to increase. Conversely, if such a connection is hardly ever stimulated, its power decreases. This is probably the way memory works. Hearing a fact once in a lecture may not lead to its being remembered for long, whereas if someone keeps studying the fact, the memory of it becomes stronger.

It is important to mention that structural changes in the size and shape of the pre- and post-synapse parts of neurons may mediate permanent or near-permanent changes in synaptic efficacy. Growth may allow for an increase in the size or number of active zones on both sides of the synapse. The “spines” of the cell can increase in volume after LTP induction. While the degree to which structural re-organization of synapses occurs in adult animals is not yet clear, the process seems to involve a neurotransmitter (a chemical substance that is released at the end of a neuron cell by the arrival of a nerve impulse and, by diffusing across the junction, causes the transfer of the impulse to another neuron) called brain-derived neurotrophic factor (BDNF).

If a particular synapse is almost never stimulated, it can disappear altogether. Conversely, LTP is associated with an enhanced recycling of a part of the structure of the synapse, and this process could eventually result in the formation of a new, immature spine.

In other words, the more a part of the brain used for a particular purpose is used, the more likely it is to increase in size due to this process. When many synapses are involved in an individual's interactions with the environment, size differences in those parts of the brain can therefore easily be conditioned responses rather than abnormalities.

A Psychiatric Diagnosis: Behavioral Problem or Brain Disease?

When the first edition of the DSM (the manual of psychiatric diagnoses published by the American Psychiatric Association) came out in 1952, it listed about 100 different psychiatric diagnoses. By the time the fifth edition was published in 2013, it listed over 550 separate ones! One has to wonder if early psychiatrists were just missing a bunch of them, or if normal but repetitive everyday problems in living due to trauma, stress, and interpersonal dysfunction have been turned into diseases. I vote for the latter.

At any rate, the DSM uses the word “disorder” to fudge this question somewhat, leaving a “to be determined” answer as to whether any of the diagnoses are brain diseases or just psychological or behavioral problems experienced by normal brains. So how do we go about making an educated guess as to which it is?

The question is complex because the phenomena under discussion are very complex. While our understanding of the brain is increasing by leaps and bounds, it is still very rudimentary. That is because the brain is literally the most complicated and complex object in the entire known universe, with about a trillion constantly changing connections between nerve cells. Remember when computers would go crazy and produce the infamous “blue screen” when two programs would conflict, and you would have to restart it? Imagine what might happen if the computer were not hard wired!

A lot of people, including many in the various mental health professions, seem to be prone to highly simplistic “either-or” thinking. If even one of the 550 DSM diagnoses is a brain disease, then they all must be. Or if one is a behavioral/psychological disorder, then they all must be. That is just stupid. But throughout the history of psychology and psychiatry, the field has often lurched back and forth between brainlessness and mindlessness (as described in Chapter One of my last book), incorporating what turned out to be ridiculous or misguided theories.

Autism is caused by refrigerator mothers. Schizophrenia is just a different way of experiencing the world or due to being placed in a double bind by your family. Sexual promiscuity is a genetically determined trait, and certain races are genetically inferior to others. Acting out by children is caused by underlying bipolar disorder. Obsessive compulsive disorder is caused by harsh toilet training. A central part of women’s psychology is penis envy. The list of nonsensical and grossly mistaken theories like these is nearly endless. I’m surprised that no one ever theorized that the memory deficits in Alzheimer’s disease are really a result of the defense mechanism of repression.

But even without such simplistic thinking, determining which diagnoses are truly diseases and which are primarily behavior problems caused by problematic learning and stress is not easy. You cannot just do an fMRI brain scan, as I described in an earlier post, because that test alone does not distinguish an abnormality from a normal conditioned response to a particular social environment.

And even if something is a brain disease, family stress and dysfunction can make it worse – just like with many physical diseases. Then there’s this: having a parent who gets manic and runs naked through the streets creates huge stresses for a child who observes it. Such children are at risk both genetically and environmentally.

Not only that, but you get into a chicken and egg situation: does having a controlling family create anorexia nervosa, or is having a child who is starving herself to death lead parents to become overly controlling? A child who is more temperamental is often somewhat more difficult to raise than one who is not, leading some parents to engage in problematic parenting practices with one of their children but not others.

The whole question of “what causes” a disorder is further complicated by the fact that with the vast majority of psychiatric diagnoses, there are no necessary or sufficient causes of any sort – only risk factors that increase the odds someone will develop a disorder, and mitigating factors that decrease those odds. And there are usually hundreds of these factors operating over time.

So what standards do I use in forming my opinions about various disorders? To me, by far the most important metric is whether the symptoms of the disorder only appear under certain social conditions, and disappear when the social conditions change. Real brain diseases like schizophrenia do not do that; they are present almost all the time. You see victims “responding to internal stimuli” whether you are talking to them one-on-one or observing out of the corner of your eye on a ward in a state hospital them when they don’t realize they are being observed by staff. They show them no matter who is talking to them, or even if they are put alone in a room in a psychiatric ER with a hidden video camera keeping a watchful eye on them.

Someone with, say, a melancholic depression reacts at a snail’s pace compared to the way they usually react (psychomotor retardation) every waking moment no matter where they are or who they are with, and stay in that state all day every day, sometimes for weeks at a stretch. Luckily, when I trained we could keep patients in the hospital that long so we could see this; today’s trainees do not get to do that any more, so are more easily fooled.

On the other hand, borderline personality disorder symptoms are not like that at all. I would see patients with the disorder acting out with staff in a psychiatric hospital, but behaving completely appropriately with the other patients when they didn’t know I was observing them. In fact, they are famous for acting one way in the presence of certain staff members and exactly the opposite when in the presence of others, leading the two groups to fight with each other (the staff split)!

I’ve seen people I know who have the disorder out and about at music festivals and theaters acting as normally and appropriately as anyone else. In therapy, certain emotional reactions and provocative behavior would come out of them if the therapist did one thing, but would disappear quickly if the therapist changed to doing something else.

In looking at neuroscience evidence, an important metric in distinguishing disease from mere dysfunction is the sheer number of different types of brain anomalies and other neurological findings. As I said, a single fMRI finding alone tells you nothing. But a whole bunch of different fMRI abnormalities with some of them completely unrelated to the symptoms of the disorder suggests a brain disease. For example, people with schizophrenia tend to have a lot of different abnormalities, many of which have nothing to do with delusions or hallucinations. One cannot be certain, of course, but I would be hard pressed to explain many of these neurological findings in terms of conditioned responses to particular social environmental stimuli.

Some Questions Answered About Family Dynamics in Borderline Personality Disorder

"Letters, we get letters

We get lots and lots of letters"

I had an interesting exchange with a reader who asked me some questions about my ideas about the family dynamics of people with borderline personality disorder. I thought other readers may have similar questions, and she gave me her permission to reproduce the exchange in a blogpost. So here t'is, with my answers in blue:

I think my mother has BPD. I am trying to make sense of it, and I am digging into my family's history, to see if I can find a possible cause for her BPD.

The mother of my mother seems to be like the mother in the movie Thirteen, that you commented on in your article. She is always stating she would do anything for her children, but at the same time she sometimes drops things like, 'I sacrificed my life for them." Which pretty much sounds like playing the victim, to me.

It is new to me, that parents who are not physically or emotionally abusive, can also provoke BPD in their offspring. Thank you for attracting my attention to that.  Researching more about this, I read an article that stated that parents who are 'over-involved' can do the same, because they don't allow their children to grow into beings with clear boundaries. Do you agree on this statement? If this is true, than the hypothesis, that BPD patients always have poor attachment to their primary care givers, doesn't stand? 

One last question is: Can patients who have BPD get cured without professional help? I am asking this question, because I realize that I also have had several traits of BPD during the course of my life - although they never co-occurred. Coming to a point where I am realizing that my mother probably has BPD, I am also evaluating my own personality, and if I am honest, I can see that, especially during my twenties, I have had several symptoms, though never more than one at the same time.

Can you please provide me with some clarity ? I would be most grateful. I however will understand if you don't have the time to answer.

In answer to your questions as they apply in general - I am not able to speculate about your situation in particular without having seen and extensively evaluated you and your family situation:

1. The family dynamics of BPD involve the parents being conflicted over the role of having kids. They go back and forth between hostile under-involvement and hostile over-involvement. In a given family, one of these sides may predominate most of the time, but if one waits long enough, the other side shows up.

2. BPD is not a "disease" but a combination of traits by which someone adapts to the above family behavior. Some people have a lot of these traits, some many fewer. The traits can range from very mild to very severe, and severity levels can change dramatically in a short period of time. They can also appear and disappear depending on what is going on in a person's family life at any given moment.

Even in people who show these traits most of the time, many of the traits may start to get better on their own as the person gets older, although certainly not in all cases. Their relationships may continue to be poor, however.  Professional help can be very useful, but whether it's absolutely necessary in every case , the answer is that it depends on a lot of different factors.

Family-oriented psychotherapy is hard to find.  The models I recommend are listed at the end of the post:  http://www.psychologytoday.com/blog/matter-personality/201205/finding-good-psychotherapist. I'm not sure which ones might be available where you are. In England, the most common one is cognitive-analytic therapy (CAT).

What if no other siblings had symptoms while living in this 'borderline producing family?' Does it make sense to develop symptoms only after having left the parental nest? (Because in this case, the 'spoiler' doesn't develop his behavior to balance the mother's moods: instead she only starts to be a spoiler once married, like my mum ... Then this behavior is of no use? (only to act out own frustrations maybe .. but it is not in the interest of balancing the family system). Does this make sense then ?

(Going to a family therapist in my/my mother's case is a non-option for my mother, so unfortunately I have to kind of figure these things out by myself.)

Again, many possible explanations, so I can't say anything about your situation in particular.

In general, in the type of situation you are describing, the person's spoiling behavior with the new spouse stabilizes his/her parents in some way, but is only needed by those parents when the adult child is in the context of a marriage. Often gender role conflicts and repressed anger are at the root of such a pattern - for example, a daughter might act out the mother's repressed rage about having to cater to her (the mother's) own inadequate husband (the daughter's father or step father). Through the daughter's behavior, the mom experiences vicarious satisfaction of her own rage as she watches her daughter frustrating the daughter's husband efforts to "take care" of her.

If a mother acts in a way that produces BPD in her offspring, is it always the case that the child will become a spoiler? In the particular case of my mother, everyone from her family of birth tells me how "good, quiet, well behaved..." she was. It is like she only started to have BPD symptoms when she got married and had kids. Does that make sense? 

No, not always. In fact, family dynamics are like the proverbial true-false test: nothing happens "always" or "never." There are an almost infinite number of other factors which may alter the developmental course of a child - especially other relationships including the other parent, other relatives, or supportive mentors. There is what they call a "chaos" effect - small differences in initial conditions can multiply into big differences later on. Also, in some families, only one sibling will volunteer and/or be chosen to be "it," while the others remain relatively unaffected. If the "it" child stops playing the spoiler, one of the other siblings may suddenly step into that role ("sibling substitution").  The more severe the parental internal conflict, the more additional siblings will be affected or recruited at the outset.

If BPD is not a disease, how is it that the amygdala in people with BPD seems to be different ?

The amygdala is subject to neural plasticity like many areas of the brain, which means that it normally changes in size and activity as it adapts to the environment - especially the social environment.  It's one of the bases for conditioned responses. See http://www.davidmallenmd.blogspot.com/2014/05/borderline-personality-disorder-why.html and http://www.davidmallenmd.blogspot.com/2013/02/neural-plasticity-and-error-management.html

Why do almost all of the experts state that BPD is as good as is incurable, even if the patient is willing to cooperate?

"Cure" is a strange word to use since it's not a disease. Borderline traits absolutely can go away, and the relationships of someone with BPD can change for the better, especially with treatment that focuses on family-of-origin behavior.

You say that the traits of BPD sometimes disappear with aging, as they are not needed anymore. But I thought that BPD primarily stems from a fear of abandonment. So I don't see how someone can get rid of this deeply rooted feeling, even when he doesn't live with his parents anymore / is not being abused by them anymore / or maybe they even died. If there is a 'hole' inside you because of non-attachment with your parents, I thought that this emptiness will always be there, and it will just manifest itself by clinging to - pushing away spouses instead of the parents, or the same behavior towards offspring.

The issue of what happens after the parents die is still somewhat of an open-ended question for me.  For some people, they are freed up for the most part, although the "emptiness" never completely goes away. Other people get worse than ever after the parents die, even if other family members do not seem to be feeding into their problems. I think it has something to do with PTSD-like effects. The more obsessive a patient starts out, the more likely they are to obsessively recreate conversations with their parents in their heads. 

I had one patient who got a lot better after seeing the movie A Beautiful Mind. She realized that even though she couldn't stop hearing those conversations in her head, she didn't have to believe them. She discovered the secret of "Acceptance and Commitment Therapy" (ACT) before it had been "discovered" and written about - although I don't think ACT really works if the parents are still feeding into the problem, as they are more powerful in shaping a person's behavior than any therapist.

Are there cases in which a person with BPD manifests traits towards her spouse, but not towards her children? What does it mean?

There are all kinds of different permutations and combinations, and plenty of traits of other personality disorders that can co-exist and come and go with any patient. The family issues that the patient's behavior is designed to solve determines this, and every family is different. The details matter.  The stuff I write about only represents prototypes or the most common patterns.

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.

If Free Will Does Exist, How Often Do We Employ it in Our Daily Lives?

In my post of 7/31/10 I discussed a somewhat widely-publicized study published in 2008 in Nature Neuroscience, in which researchers using brain scanners could predict people's very simple decisions seven seconds before the test subjects were even aware of what their decision was. 

The concern raised at that time was whether some totalitarian government might start arresting people based on a determination of what they were going to do at some time in the future, like the precrime unit in the movie Minority Report.

This study still comes up in philosophical discussions of a different issue - whether people even really have free will at all, or if we are more like pre-programmed robots.

The decision studied in the experiment — whether to hit a button with one's left or right hand —may not be representative of complicated choices that are more integrally tied to our sense of self-direction. Regardless, the findings raise interesting questions about the nature of self and autonomy: How free is our will? Is conscious choice just an illusion?

"Your decisions are strongly prepared by brain activity. By the time consciousness kicks in, most of the work has already been done," said study co-author John-Dylan Haynes, a neuroscientist who was at the Max Planck Institute. Haynes updated a classic experiment by Benjamin Libet, who showed that a brain region involved in coordinating motor activity fired a fraction of a second before test subjects chose to push a button. Hayne's study showed a much large time gap between a decision and the experience of making it.

In the seven seconds before Haynes' test subjects chose to push a button, activity shifted in their frontopolar cortex, a brain region associated with high-level planning. Soon afterwards, activity moved to the parietal cortex, a region of sensory integration. Haynes' team monitored these shifting neural patterns using a functional MRI machine.

Taken together, the patterns consistently predicted whether test subjects eventually pushed a button with their left or right hand -- a choice that, to them, felt like the outcome of conscious deliberation. In fact, their decision seems to have been made before they were aware of having made a choice.

So does this mean the feeling and belief we have that we have free will is just an illusion?

Well possibly, but probably not. For one thing, as mentioned, the experiment may not reflect the mental dynamics of much more complicated and/or emotionally meaningful decisions. Also, the predictions were not 100% accurate. Might free will enter at the last moment, allowing a person to override a subconscious decision?

But there is a much bigger problem with drawing conclusions about free will from this type of experiment. We usually do not employ free will in the sense of making conscious choices when we engage in the vast majority of our usual daily activities. If individuals had to weigh the pro's and con's of their every move as they negotiated their lives, or if they had to stop and think about how to behave before doing the most routine activities, so much time would be spent on that that they would be nearly paralyzed. 

Most of our "decisions" are based on environmental cues which are processed subconsicously and which then trigger habitual behavior without requiring any thought on our parts at all. 

Through our life experiences, we all build mental models of our environment called schemas which then, when cued by environmental triggers, automatically kick in. Cues elicit a certain well-rehearsed repertoire of responses.

To understand this, think of your daily drive to work. Most drivers, while negotiating a familiar route, have at one time or another come to the realization that they had not been paying the least attention to what they had been doing for several minutes. Nonetheless, they arrived at their destination, with almost no recollection of any of the landmarks that they had passed.

Surely, we have the option to choose to make a turn that would take us away from our intended destination, but, under most circumstances, why would we waste our time even considering something like that?

A lot of predictable situations like this are handled on "automatic pilot." Gregory Bateson observed that ordinary situations and "constant truths" are assimilated and stored in deep brain structures, while conscious deliberation is reserved for changeable, novel, and unpredictable situations.

This does not mean, however, that rigid behavior cannot be overcome by conscious deliberation. In neurologically intact individuals, the more evolutionarily-advanced part of the human brain, the cerebral cortex, can override even the most reflexive of gross motor behavior.

So perhaps the brain processes described in this study are the ones that determine whether or not an individual goes on automatic pilot, or has to stop and think about potential unanticipated consequences. React in the usual habitual way, or re-assess? When it comes to pushing an inert button in a lab, the consequences for the subject are pretty predictable: there will not be any.

Unless the subject were purposely trying to foul up the experimenter's protocol, which would be a strange thing to want to do in an experiment with no social consequences to the subject, why would they extend brain energy in making a choice? They would not. They would just "go with their gut."

Therefore, from the data in this study alone, it is not possible to know which interpretation is correct: the experimenter's, or the one I just suggested.

Maybe you don't have free will, maybe you do. As I said in the earlier post, I am pretty sure I do.

Pathological Altruism

Pathological Altruism is the first book I have come across (thanks to an anonymous commenter on my blog) that deals broadly with a subject that has been near and dear to my heart. I have been writing about its manifestations in families for almost thirty years.

Pathological altruism is defined as actions designed by someone to help others at one’s own expense that, in the long run, harm not only the giver but the recipient as well. I first thought about it way back in 1985 as I was writing my first book, which was eventually published in 1988.

My ideas stemmed from the writings of family systems therapy pioneer Mara Selvini Palazzoli and her group in the book Paradox and Counterparadox. She described how children are willing to sacrifice their own well being in order to stabilize emotionally dysregulated parents and to preserve family homeostasis - the rules upon which family interactions are regulated and made predictable.

I noted that this sort of self-sacrifice led to a paradox, which I called the altruistic paradox. I got braver later on and re-named it with the moniker I originally had in mind, the Mother Theresa Paradox. Although the altruistic actions of family members would calm things down in the short haul, in the long run they would backfire. This happened for a number of reasons. 

First, such acting out would usually prevent family members from actually discussing mutual dilemmas and intrapsychic conflicts with one another in a way in which problems might be resolved.

Second, in cases in which parents would overly sacrifice themselves for their children in order to follow the homeostatic rules within the family of origin they themselves had grown up in, they would prevent their children from developing skills such as frustration tolerance that would allow their children to eventually function independently. The kids would never seem to grow up. I believe that refusing to grow up eventually becomes their choice and is also, in fact, a major act of self-sacrifice in a culture which values independence.

Third, an imbalance between giving and receiving in which the former is considered a virtue and the latter a vice creates a situation in which group members all become frustrated because no one is willing to receive what the others have to give!

The altruistic behavior within the group is described and explained by evolutionary biologists using the concept of kin selection.

The book Pathological Altruism is an edited collection that includes many different perspectives from a wide range of academics. Although I disagreed with many of the chapter authors, I am certainly delighted that this topic is being tackled, and I was indeed thrilled when the reader told me about the book's existence. As the editors of the book say in their introduction, perhaps pathological altruism has been so little discussed for pathologically altruistic reasons.

As the book illustrates, the concept of pathological altruism certainly can provide powerful answers to such questions as why some people become "co-dependent," why the most difficult patients to treat on a cancer ward are often former cancer ward nurses, and why some people seem to be victimized by criminals far more than the average Joe.

Some of the authors question whether pure altruism even exists – maybe all behavior is performed in order to make one's self feel better, not the other guy. If it does exist, how can we even know that it is pathological?

We can never be certain about the motives behind any human action, as people can be dishonest about that not only with others but with themselves. And maybe they sometimes do not understand their own motives, or they are under the sway of genetically determined processes over which they have no control. As Joseph Miller was quoted as saying, “It is orders of magnitude more difficult to study internal than external stimuli.”

In the book's discussions about making determinations of the motives behind the behavior of another person, one major omission is a pattern that I think is perhaps the most important. While many of the authors wrote about how apparently altruistic behavior can be used to mask covert or hidden selfish intentions, none of them discussed the opposite: how apparently selfish behavior can be used to mask covert or hidden altruistic intentions. For illustrations of how and why this happens, see my posts, The Language of Love from 4/17/10, and my two posts on dysfunctional family roles, Part I and Part II.

I did find much to admire in the writings of many of the authors, but in general I found that a lot of them make the same kinds of errors in thinking that I have brought up in this blog. For instance, they often have very simplistic understanding of what heritability means, or what the differences seen on fMRI scans between various people while doing certain tasks mean. They far overstate genetic influences on behavior.

On a related issue, as author Joachim I. Krueger points out in Chapter 30, there is a tendency of many of the authors to ignore social psychological influences, and think that a lot of the motivation behind pathologically altruistic behavior stems from one’s own internal predispositions rather than from being reactive to environmental contingencies.

These two errors come together in discussions by some of the authors of the "five factor" model for personality. These factors represent behavioral tendencies that may stem mostly from genetic predispositions. Someone may naturally be more agreeable than most others, for instance, and if all environments were the same in regards to the consequences of being agreeable, such a person would be more likely to be agreeable than someone without this genetic predisposition.

Of course, we all operate within many different environments, each of which is constantly subject to change due to the operation of a literally infinite number of variables. People who are agreeable, if they see that such behavior will lead to adverse consequences, will not be so likely to be agreeable than they would be if left purely to their own devices. When an fMRI scan is done, for instance, that is a measure of the brain’s reactivity within only one of a myriad of other contextual possibilities. In other words, context is everything.

Motivated people can easily defy their own natural inclinations when they see that it is in their or their family's interests to do so. In fact, if there's one thing I have learned in doing psychotherapy for close to 40 years, it is that people can construct a very complicated false self, as first discussed by psychoanalysts Jung and Winnecott, in which they completely submerge many of their own strong inclinations. 

In chapter 29 by Marc Hauser, he points out that from an evolutionary standpoint, it may be advantageous for a person to appear tougher, sexier, or more caring than they actually are. Primatologists have long known about the prevalence of and advantages of being able to deceive other members of one's own species. Hauser also talks about what I refer to as the Actor's Paradox: The act of deception is more convincing if the actors can convince themselves that they really are the character they are playing.

Paradoxically, the tendency of humans to use deception in the act of sacrificing oneself for the sake of their kin group may itself have a very powerful genetic component. This genetic tendency is probably far more powerful that any genetic influences on the five factors, if I had to guess.

The logical error of genetic determinism can be illustrated with an article that was cited by chapter 21 author John W. Traphagan (Freeman, J.B. et. al., “Culture shapes a mesolimbic response to signals of dominance and subordination that associates with behavior,” Neuroimage 47 (2009) 351-359). The brains of Japanese and Americans were scanned while the subjects reacted to photographs of people acting in dominant and subordinate ways, with the nationality of the subjects in the photographs being ambiguous. Statistically significant differences on the scans emerged.

It seems to me that it is highly unlikely that the distribution of genes creating each of the five factors of personality would be hugely different in Japanese or Americans, so this study shows that cultural training affects brain function during certain tasks. It probably does not reflect genetic differences to any significant degree. Of course, if this was a study done by psychiatrists, who always declare differences to be abnormalities, being Japanese would be called a disease!

Of course, it could be that the distribution of genes does vary markedly in different populations. But I doubt it. In Chapter 22, Joan Y. Chiao et. al. opine that empathy and altruism differ in different cultures because of such discrepancies in gene distribution. They chart different countries that vary on the balance between individuality versus collectivism within their cultures versus the percentage of different alleles (versions) of a gene that affects serotonin. 

Although a few seemingly highly collectivist cultures had significantly more of one allele than the other, in fact almost all of the countries had a very similar distribution. In fact, the USA and Brazil, rated vastly different on the individualism-collectivism scale (10% versus 70%), had almost exactly the same allele distribution. 

One wonders if perhaps there might be other more collectivist countries that were not included on the graph that would have been outliers in the opposite direction. This reminds me of a famous old study that showed heart attacks were more common in countries in which there was a higher fat intake in the average diet – a study which for some reason completely left out France. The French eat a lot of fat and have a relatively low incidence of heart attacks.

Some of the chapters in the book seemed to me to be overly academic or discuss arguments that seem to boil down to semantics. The book is probably not meant for lay readers. However, despite all of these reservations, the book has enough great stuff in it for me to recommend it to anyone with an interest in this fascinating subject.