Thursday, April 21, 2011

May We Believe Our Thoughts? Part II

I have multiple posts on this now complete. I'm figuring I'd better spread them out over several days, or they will be rather tedious.

Multiple posts, but still no discussion how this relates to Christian belief, salvation, or election. Ah well, it will come.

Symptoms and insight.

If you have Obsessive-Compulsive Disorder, you have full insight – overfull insight – into the fact that you have symptoms. I keep thinking I have hit someone with my car when I know I haven’t. It’s a crazy thought, but I can’t get it out of my mind. I know intellectually that my hands are clean. But the certainty that they are dangerously germ-ridden is sometimes overwhelming. If you have OCD, you know you have symptoms. People might have any of a hundred understandings of how the symptoms arose, but there is no doubt of their existence. Anxiety disorders in general are perceivable to the patient as symptoms. Yeah, I have phobias. That’s why I’m here, doctor.

Contrast this, as we have, with schizophrenia, where insight is always impaired when the illness is untreated, and may continue even after treatment. Plenty of schizophrenics take the medications because it makes other people happy, even though they don’t believe they need them; or will take them for other symptoms, such as getting more sleep, or take them because they are under court order or guardianship. Some never believe that the voices are not real.

There’s a full spectrum in between. People who are depressed may not have insight into that at first, they may just think that life sucks and everything is hopeless. But they can often, if the depression is not severe, accept the explanation from others, and be cued into it. Yeah, I’m depressed. People who are irritable don’t see it that way at first, they just think that a lot of other people are being jerks. Yet they can sometimes be cued into the understanding as well: Have you been more irritable lately? “Y’know, I have. Small stuff bothers me more than it usually does.” A patient’s understanding of mania is more varied, but generally, the more severe the symptoms, the less likely the patient will perceive them as symptoms. The sicker one is, the less insight, which is both infuriating and tragic. Hold that point in mind.

Borderline personality disorders can learn over time, whether by specific instruction or by hard-knocks trial and error, which feelings and responses should be classified as symptoms. Until then “feelings are facts” to them. Their present feeling of being nonsuicidal and safe trumps the fact that they tried to OD just two hours ago. They are not attempting to manipulate others with this. This triumph of current feeling over all fact is their reality. They can go to the other extreme in crisis as well, being unable to understand feelings of despair or anger as temporary phenomenon. They seem world-consuming. Similar uneven insight prevails in the other personality disorders as well.


There is another anosognosia we have not yet mentioned as well. Some people are unable to perceive their incompetence regardless of the outside cues. I saw a backstage American Idol segment a few years ago while in a lobby somewhere. The girl had sung and was terrible. The judges had told her she was terrible and to give it up. She refused to believe it. She just knew that she was a great, absolutely great entertainer, and she wasn’t going to give up her dreams on their say-so. (I have since learned that this happens on American Idol all the time. Or Bulgarian Idol. Or Serbian Idol. This is why people need to stop telling elementary school children to follow their dreams, they can be anything they want to be. Despair, Inc. has it better.*
There is the more general case, the Dunning Kruger effect Here’s the money quote:
poor performers do not learn from feedback suggesting a need to improve.
The same as with the serious mental illness – the more intense the symptoms, the less the insight. Learning does not take place. Feedback has no effect. Here’s an irony from Dunning and Kruger’s work, BTW. They quote Bertrand Russell with approval on the subject. One of the painful things about our time is that those who feel certainty are stupid, and those with any imagination and understanding are filled with doubt and indecision. And as if to illustrate this, he became quite sure of several things he proved to be entirely wrong about over the course of his career. Perhaps no worse than other opinionated folk, though.

You know people like this - coworkers who who believe they are the most competent in the shop but are really a drag on the rest; choir members who cannot sing, but tell everyone else what they are getting wrong; 50% of all hockey fans calling in to sports shows; nightmarish parents who hold court on their philosophy of childrearing; all manner of showoffs and snobs. One keeps thinking that a spectacular failure will finally get the message through to them, that they will now just have to at least have a moment of doubt. But it doesn't. If anything, they get worse.

Next up, more Dunning-Kruger, this time with dictators, the confidence of prognosticators, and how in the world this foolishness can be adaptive.

*And while we’re at it, stop telling teenagers these are the best years of their lives. Great way to increase suicidality, I would think.

13 comments:

Dubbahdee said...

Is self-blindness hereditary, like color-blindness?

Assistant Village Idiot said...

I know of no research on that. It certainly seems as if it is either genetic or learned early.

Europeans have the same pattern as Americans, but less pronounced. East Asians have a mild reversal of the pattern. So.

Texan99 said...

"The best lack all conviction, while the worst / Are full of passionate intensity"

karrde said...

Strange.

I do know that color-blindness (also A/B/O blood-type, earlobe-attachment, sickle-cell anemia, and hemophilia, among others) can be traced with incredible accuracy. All of these, however, are binary states: they either exist, or they don't.

Anosognosia, as described, is more of an extreme on a continuum than a binary state. I would doubt that it could be diagnosed as hereditary.

However, that is just my impression.

jaed said...

This is why people need to stop telling elementary school children to follow their dreams, they can be anything they want to be.

Noooooo!

(People need to be realistic about their level of skill, and be willing to work to improve where needed. But telling them "You can do anything if you're willing to work at it" is far, far, far less harmful than "You can only do things if you are talented, and talent is something you either have or don't have and cannot affect by yourself." The idea that your success is determined by your intrinsic talent (and the corollary: that you can't do anything well unless you have preexisting talent at it) is possibly the most destructive childrearing idea of the 20th century. And that's a target-rich environment.)

(Of course, the success of telling children they can do anything rests on their ability to work to improve, and recognize when they need improvement. But I don't think telling the girl you're speaking of that "You can't do anything at all, and only specially talented people can make music professionally would have helped. She would simply have concluded that she was in that small group.)

Assistant Village Idiot said...

I am likely to disagree jaed. I don't think everyone can be a professional musician if they just work hard enough, or a professional athlete, or a neuropsychiatrist.

I do think that having a dream and working hard can open up other doors for you. Singers with below-average pipes, putting in great effort, may find that they can compose, or teach, or direct, and find something they can be satisfied with, or even like better. So too with other professions.

But ghettos are littered with athletes who worked just as hard, or harder, than those who got offered scholarships or even professional careers. Actors, poets, doctors - in some fields there are limited slots, and you'd better have a Plan B and a Plan C.

jaed said...

Hmmm. On the one hand I'm inclined to agree intuitively that the capacity has to be there first.

On the other hand... we have a kind of cultural myth, a wrong approach to these things, and particularly to artistic talent. The mythology goes something like: there are people with Talent, and people without it. Those with Talent just naturally know how to do art. Someday they will, for example, find themselves accidentally encountering a famous single, and they will sing something, and the famous singer will be awestruck at their natural talent. Following is a montage showing a few lessons, plus a rant by the famous singer. Next they're singing at Carnegie Hall and the audience is rising in wild applause. The End.

On the other hand, if you don't have Talent, there's no place to start (since the famous singer scene isn't likely to happen) and no point in learning music if you are not Talented. The arts are for special people, and you are not one of them. The End.

This serves everyone ill. Those with obvious talent (or those who merely think they have it) are encouraged to believe all they need to develop it is a ten-minute training montage (and if they need more, they didn't have the talent to start with). Those who don't (or who merely think they don't) are discouraged from pursuing their goals at all. Everyone gets the message that there's no real reason to work at it, because one's success is not conditioned on work. (And also that there are only two extremes: world-famous prima diva, or not being able to sing at all. That's a whole nother rant.)

This attitude is particularly noticeable in art, but it also applies to intellectual endeavors. (Bad at math? You just don't have a head for math, dear. There's no point in doing more work or hiring a tutor; best to concentrate on something else.) I've known people who have been badly harmed by it, who have put aside - for decades - things that they actually were good at because they were told that if success didn't come immediately it was out of reach. Some days I think I'm one of those people myself.

Telling people that they can do anything if they try seems somewhat fallacious, but far less harmful than the opposite extreme of telling them that they can't do anything without inborn talent, and that that's all they need. Erring on the side of encouraging work and discouraging losing heart before you start seems like a better idea to me.

terri said...

I'm going to have to side with Jaed on this one! ;-)

The problem that I see running through this and the other posts about free will and intrinsic traits is that even if it it's true, which I won't completely concede but for the sake of the argument I will pretend......even if it's true....we suck at recognizing talent, potential and imagining the future.

We must live as if we have free will and as if we can do the things we want to career-wise, hobby-wise, life-wise....etc..because we don't know enough to know the end from the beginning. WE must go through whatever process there is for us to accept the idea that maybe we weren't cut out for career A, or skill B.

It's like the sword in the stone.....you must give it a try even if the possibility that you're the one who'll be able to draw it out is small.

Your concern in these posts is that people will never recognize, even after repeated attempts, that they are not the person to draw it out and will just waste their lives attacking an unmoving stone, feeling frustrated, unfulfilled and missing out on better things.

But this concern itself rests on the idea that it's possible for people to do something other than trying to draw out the sword, that if we tell them at the outset, "It's not for you," that we could mitigate their attempts....and yet you're also arguing that some(most?) people wouldn't listen anyway.

So we have come round the circle again.

********

It is a common theme in most major religious movements that awareness, self-awareness and awareness of the Divine, are the keys to enlightenment of some sort.....recognizing the futility and illusion of this world and in doing so rising above it and being conscious of the choices we make in light of this awareness.

Really...the religious impulse is the impulse to break free from the conventional wisdom and "natural" laws governing our behavior and provide a new way to live that rests entirely on our ability to make choices, conscious choices that override our default programming.

hehehe...my word verification is "tries"

Assistant Village Idiot said...

Yes, I have emphasised that side of things thus far, and certainly don't want to move to an elitist stance that says only the few may dare to try. I think terri's thought that we do not notice and evaluate talent very well is key. Much of what we call evaluation is based on trappings and accidents, not real abilities.

We'll see how it goes from here.

jaed said...

I think terri's thought that we do not notice and evaluate talent very well is key.

Yes, I agree. Building on that, I think we have an oddly ambivalent attitude toward talent in others, especially children. We laud it as all-important at the same time we show a bad tendency to suppress its expression as "a waste of time", "bad for your character", "will end up thinking he's better than other people if we don't discount it", etc. I've noticed this in particular in thinking about how public schools deal with unusually intelligent students, but there's also an element of it in the reaction to other talents. Young people who show talent at sports, for instance, are often quashed for showing up the other kids (even if this isn't deliberate or malicious in any way).

terri suggests the problem's a failure of imagination, which is an idea I find really compelling the more I think about it. Failure of vision.

Assistant Village Idiot's wife said...

Having worked with different levels of students for years, I would far rather work with level B students who know how to and want to work than with the smartest to whom everything has been easy and don't know how to put in effort when needed.

Jonathan said...

so Mom, you like working with me better than Ben?

Jonathan said...

I guess I am the favorite!