Life as a Nonviolent Psychopath
theatlantic.com
theatlantic.com
* that the "warrior gene" thing == psychopathy,
* that your genes determine your personality, except when they don't,
* that your behavior is determined by your biology, except when it isn't,
* that lack of affect == Buddhism,
* that "looking at brainscans" is a valid step in judicial sentencing,
* that you can claim to be a person who suffers from an impairment of empathy, who at the extreme, might well not see the difference between a person and a block of wood, and still be taken seriously when you say "that genetics were very, very dominant in who people are—that your genes would tell you who you were going to be",
* that neuroscientists aren't all that spectacular about keeping their data sets neat and orderly; in particular, they don't see a big deal mingling the results of several different experiments, and
* that claiming to have a Big Evil background, that you have to struggle with every day, is still a great way to get publicity.
I laughed, I cried, it changed my life. Two thumbs up.
By the way, have I mentioned that I am of somewhat Nordic descent; every day, I have to fight off the urge to raid the coastlines of Europe, to pillage and plunder the tender and peaceful farmsteads and towns?
Interestingly, the director of the NIMH has recently taken the same position, ruling that that DSM (psychiatry and psychology's "bible") can no longer be used as the basis for scientific research proposals, for the simple reason that it has no scientific content:
http://www.nimh.nih.gov/about/director/2013/transforming-dia...
Quote: "... each edition [of the DSM] has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."
That said - and let me qualify this by saying I have many complaints with the DSM (particularly the DSM V) - the fact that the DSM classifications may not be helpful for research purposes does not mean that they are not helpful for clinical treatment. Clinicians who use it properly (a big caveat) use it to ensure that they are all using a common vocabulary, though with an understanding that the vocabulary is imperfect.
This is why I get very frustrated when I see online discussions about mental disorders devolve into recitations of the DSM diagnostic criteria as if they were checklists. The DSM provides a convenient library, but the clinician still has to identify which portions are relevant and which are not, and to write the "code" that glues those relevant portions together.
[0] Not that they weren't without fault, but they were an important early effort that has been revised in modern day.
One of my biggest frustrations is that except for a subset of neuropsychologists, they have very poor understanding of how neurophysiology correlates with various "diagnosis".
Not yet, anyway. In the long term, there's hope that neuroscience will uncover root causes in genetics and other objective disciplines, thus moving beyond psychology entirely. This is a future goal, not at all something just around the corner. On the other hand, psychology has been trying to crack this egg since before the Civil War and has gotten nowhere.
Notice that, when President Obama launched his new research program, he called it the "brain initiative", not the "mind initiative". This was a not-so-subtle signal that psychology is no longer looked on as the cutting edge of mental research.
> That said - and let me qualify this by saying I have many complaints with the DSM (particularly the DSM V) - the fact that the DSM classifications may not be helpful for research purposes does not mean that they are not helpful for clinical treatment.
That's true, but clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address. This issue is discussed in the NIMH link I provided in my prior post, where the NIMH director provides much detail on the problems caused by addressing only symptoms, not causes.
> The DSM provides a convenient library, but the clinician still has to identify which portions are relevant and which are not, and to write the "code" that glues those relevant portions together.
But whenever a clinician goes beyond the DSM, s/he enters uncharted territory. This subjective territory led Tom Widiger, who served as head of research for DSM-IV, to say, "There are lots of studies which show that clinicians diagnose most of their patients with one particular disorder and really don't systematically assess for other disorders. They have a bias in reference to the disorder that they are especially interested in treating and believe that most of their patients have."
The idea that understanding the biological/physiological basis of behavior is part of psychology has been part of the field since the 19th century. Establishing those things -- whether under the comparatively new label of neuroscience or any of the older labels under which such exploration have been done (e.g., "psychobiology") -- isn't "moving beyond psychology", its just grounding psychology in the same way that physics grounds chemistry, and establishing that grounding has always been understood to be part of chemistry.
> That's true, but clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address.
This is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases.
Yes, but as an unrealized goal. William James stated that it was an unrealized goal in the late 19th century, and the director of the NIMH mentioned the same issue a few months ago as he ruled that the DSM would no longer be accepted as the basis for scientific research proposals, for the simple reason that it has no scientific content:
http://www.nimh.nih.gov/about/director/2013/transforming-dia...
>> ... clinical treatment can't go anywhere without knowing causes, which the DSM -- and psychiatry and psychology -- don't address.
> This is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases.
Tell that to the NIMH, which has ruled against use of the DSM for the best of reasons -- the claim is false. A quote from the above link:
"The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."
"Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment."
So tell me -- which word didn't you understand?
Right. So what? You are falsely asserting that this is a separate domain, rather than just an area in which results have been incomplete. This is false -- neuroscience is a new name for something that has always been part of the domain of exploration of psychology, and in which important results have been made -- though not broad and deep enough to be widely useful across the field -- for a long time, even before the name "neuroscience" was applied to them.
> and the director of the NIMH mentioned the same issue a few months ago as he ruled that the DSM would no longer be accepted as the basis for scientific research proposals, for the simple reason that it has no scientific content
The "no scientific content" claim you make is not, in fact, contained anywhere in Director Insel's announcement regarding RDoC that you link.
A better description of Insel's position (and the one that is consistent with his later statement on the relation between DSM and RDoC [1]) would be that RDoC was announced because the tools for the investigation of the physical causes of mental illness have progressed to the point where it seems likely that we can productively move toward a better model of diagnosis with a fresh look unconstrained by symptom-based descriptive categories, which have always (as is the case with syndrome-based diagnoses elsewhere in health where causes are not well-established) been recognized as troublesome but have been the best that the science to date has been able to support.
> > his is simply false: psychology and psychiatry do address causes, and even the DSM does in some cases.
> Tell that to the NIMH, which has ruled against use of the DSM for the best of reasons -- the claim is false.
You can keep saying that, but its not going to make it true; psychology and psychiatry do address causes, as does, in certain cases, the DSM. For instance, the different neurocognitive disorders identified in the DSM-5 are differentiated by causes. You can pick up a copy and look it up, or you keep repeating the same ignorant statements you make in every discussion which touches on psychology on HN.
[1] http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdo...
> You can keep saying that, but its not going to make it true ...
Which part of this are you not getting? I'm not saying it, the NIMH is saying it. The NIMH has ruled that the DSM can no longer be used as the basis of scientific research proposals because it only lists symptoms, not causes.
> ... psychology and psychiatry do address causes ...
You need to locate some evidence for this claim. Psychiatry and psychology deal in symptoms, not root causes. Don't bother to tell me how wrong you think this is, just write directly to the director of the NIMH, whose recent ruling is based on this uncontroversial fact.
In the 1950s, schizophrenia was blamed on refrigerator moms (among other things). Now it's thought to have roots in genetics, but no one knows for certain. All that is certain is that its root cause is unknown. I choose schizophrenia for this example because, among the many disorders listed in the DSM, it's one of the better-understood. But its actual cause is unknown, as is true for all the other disorders listed there.
In his recent book "Book of Woe", psychoanalyst Gary Greenwood reports that melancholia was proposed for DSM-5 but was turned down because its cause really is known, and the committee members realized this would represent the single exception to the rule that none of the listed conditions include a cause, and this would undermine the editorial scheme. So they voted it out, leaving the new DSM in a pure state -- all symptoms, no causes.
I ask that you think a bit more deeply about this. Why did the DSM committees vote disorders into and out of the text? Why didn't they instead use scientific results that prove an association between causes and symptoms? The answer is that no such results exist.
> ... you keep repeating the same ignorant statements ...
Nice argument. Do you have any idea how this makes psychiatry and psychology look? Are you familiar with the term argumentum ad hominem?
One parallel is that humans were able to observe and accurately predict the movement of the stars before they ever knew what stars were. In fact humans were able to use stars for navigation long before anyone had the slightest idea of the actual physical nature of a star, or could offer any plausible explanation as to why a star moves a certain way.
Furthermore, observations can be tested and supported by empirical evidence. You can for example run brain scans for criminals and see if the psychopath brain pattern has higher incidence among prison populations (it definitely does).
Of course you cannot perform the types of precise tests on humans one performs with atoms, but psychology there are scientific tests and studies you can do.
All right, let's submit your idea to a scientific thought experiment -- let's imagine we can do without any attempt to explain an observation, and call it science. Let's say I'm a doctor who believes I have cured the common cold. My cure is to shake a dried gourd over my patients until they get better. The treatment sometimes takes a week, but it always works. It's repeatable and reliable. Since psychologists don't have to explain their results, I don't have to either.
So -- where's my Nobel Prize?
Second example. I go outside and see little points of light in the night sky. I describe this -- I write a paper and say the night sky is filled with little points of light. Another person, who calls himself a scientist, says those points of light are actually distant thermonuclear furnaces like our sun, a claim that can be tested and potentially falsified. Is my observation science, or is his theory science?
(Observation by itself is not science -- empirically testable, falsifiable theories are required.)
> Furthermore, observations can be tested and supported by empirical evidence.
Not in mind studies. The mind is not accessible to empirical observation. The brain is, the mind is not. This issue is separate from the issue of whether observation without explanation is science.
> Of course you cannot perform the types of precise tests on humans one performs with atoms, but psychology there are scientific tests and studies you can do.
False. Psychology is not science unless and until empirical, falsifiable explanations are proposed and then tested, regardless of how many white lab coats and clipboards are on display.
Let's say I'm an astrologer and I'm really annoyed that people don't think my field is a science. So I hire a bunch of scientists who perform statistical studies, for example, how many people are Geminis and how many are Tauruses -- perfectly scientific, perfectly reliable. By doing this, have I made astrology a science? Why not? Some people claim this works for psychology, so why not for astrology too?
I heard about the NIMH director's letter on research priorities[2] first from behavior-genetics-informed research and clinical psychologists whom I meet in a "journal club" weekly during the school year. The DSM framework involves a lot of log-rolling among various kinds of psychologists and psychiatrists, several of whom depend for their living on being known as "experts" on "disorders" that may not have any real existence. That said, there is an active research program all over the world based on a variety of different paradigms, with very widely followed journals, trying better to understand healthy human behavior and debilitating human behavior that results from brain abnormalities, diseases, psychological stress, and other causes. Straight-up psychology still has a lot to contribute to this study. The psychologists I know best are very aware of critiques of their own discipline[3] through the readings we discuss in the journal club, and more generally aware of the general critique of the current conduct of science,[4] so they redouble their efforts to do their science better, and to check their methodology as they try to tease out the complex web of causes of human behavior.
[1] http://www.amazon.com/Brainwashed-Seductive-Appeal-Mindless-...
[2] http://www.nimh.nih.gov/about/director/2013/transforming-dia...
[3] http://opim.wharton.upenn.edu/~uws/
[4] https://med.stanford.edu/profiles/john-ioannidis?tab=publica...
-- http://www.skepticalraptor.com/skepticalraptorblog.php/pseud...
The first half is 5 variations of "he doesn't give us the full medical data for his diagnosis" [in a magazine article or a tv interview, no less].
The second part is some lame assumptioms on what Dr. Fallon did.
And the conclusion builds up on the first part: "I am arguing that the news articles covering his story do not provide enough details to support his claims.".
No shit Sherlock. It's a news article, not a paper.
The twist in all this story is that the divorce was initiated by him, not his wife. She was a nice and very normal person, and to her, staying married and having a father for their child was probably more important. The point is that many people will try and hold a marriage together for all sorts of reasons.
There are 100 000 000 000 neurons in brain, we can not even count number of connections. We are very very far from understanding it.
In my experience it's usually the people who know the least about psychology or cognitive science claiming that the least can be known about psychology and cognitive science. The people who know the most about psychology and cognitive science will also tell you how little we currently know, but the context is very different, sort of like when you're at a party and get cornered by a Shakespeare scholar who for the next three hours tells you in explicit detail how little is known about Shakespeare.
Of course the brain is complicated, and of course we're a long way from understanding it, and yet I could look at a scan that showed hypometablism in your anterior temporal lobes and be able to tell you with great specificity about the symptoms I would expect you to manifest, a diagnosis which would be drawn from a mountain of data that is often, admittedly, observational; and yet using a confluence of imaging methods and single cell recordings and anatomical studies and animal homologies, which collectively have given rise to theoretical models, the predictions are as scientific as those that arise in any other kinds of science. Doesn't mean they're always right, but there's rigorous and principled methodology at work, results shift belief in the explanatory power of this model or that, and the field moves forward.
So yeah, there are bad practitioners and bad papers and overbroad explanations, but that doesn't mean that nobody knows anything.
Perhaps, but in this specific example, the people who know the most about the topic agree that we don't know anything, and that a new approach is required. As one example, the director of the NIMH recently ruled that the DSM can no longer be used as the basis for scientific research proposals, for the simple reason that it has no scientific content.
http://www.nimh.nih.gov/about/director/2013/transforming-dia...
Quote: "... each edition [of the DSM] has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."
> Of course the brain is complicated, and of course we're a long way from understanding it, and yet I could look at a scan that showed hypometablism in your anterior temporal lobes and be able to tell you with great specificity about the symptoms I would expect you to manifest ...
This is exactly the problem that the NIMH's new ruling is meant to address -- a focus on symptoms rather than causes. Until we can explain these symptoms, until we can move beyond simple description, mental research will remain a subjective dead end.
> So yeah, there are bad practitioners and bad papers and overbroad explanations, but that doesn't mean that nobody knows anything.
As long as vestal virgins can claim to have been raped and destroy their families without anyone asking some obvious questions, yes, no one knows anything: http://arachnoid.com/trouble_with_psychology
> For instance, go ahead and take a quarter out of our your pocket, flip it into the air and see how it lands on the floor. It's pretty easy to predict whether it comes up heads or tails, right? Except no, it isn't ...
Of course it is, the outcome is perfectly reliable if the coin is fair -- the probably is 1/2 that the result will be heads. No clean room or robot are required. I mention this to emphasize the difference between observation and theory -- the theory is perfectly reliable.
After he kept mentioning it, I was curious and a bit skeptical as to what horrible things he could have admitted to and yet still be free and employed. The incident with the Marburg virus is pretty chilling, though, if you think it through. It's the sort of thing only a brilliant psychopath could come up with or be proud of. I'd keep my distance, frankly.