Evaluating Scientific Sounding Claims

Two stories on the radio this week got me thinking about the ways that we use science and how scientific discoveries are communicated to us. The first had to do with research on the toxoplasma parasite carried by cats (toxoplasma gondii). This parasite can cause toxoplasmosis in humans, an illness that can cause death in children and adults and birth defects in the fetus.  (If you have a cat litter box, wash your hands after cleaning it!) The argument went something like, toxoplasm is carried by cats. Cats began to be domesticated by humans and were very common at about the same time that rates of schizophrenia increased rapidly around the turn of the century, therefore there might be a relationship between keeping cats as pets and schizophrenia. The full episode of Radiolab, which aired the segment, can be found here.

Another story examined the role of microbes in human life.  Everything from the beneficial bacteria in our stomach to more esoteric microbes that can affect our behavior.  The point seemed to be that microbes could be the master controller of human behavior. The full NPR story is here.

Both stories are admittedly intriguing and the scientists interviewed are not crackpots.  So how do we really evaluate the science we hear and apply it sensibly in our lives?

One thing to keep foremost in our minds is that a relationship between two events does not tell us anything about the causality that may or may not link them.  Because schizophrenia increased when we started keeping cats as pets does not establish a causal relationship between cats and schizophrenia.  In fairness, the relationship between certain mental illnesses and toxoplasma has been reported elsewhere, I'm exaggerating somewhat to make a point.

The relationships between these issues is complex.  There is more interdependence, or what statisticians call covariance, than direct causal relationships among the variables.  It is more interesting to talk about the possibility of grand relationships and science fiction than to tackle the nuances of the relationships.  Who wants to read a dry science article when we can talk about protozoa taking over our minds.

So the point is to take science reporting at face value.  Dig deeper if a topic interests you and treat grandiose claims as what they are, bad science.

Tolerating Discomfort

"If some longing goes unmet, don't be astonished. We call that Life." - Anna Freud

This is essentially the argument for affect tolerance, the ability to tolerate all of our feelings and continue to function; being able to feel all our feelings without compulsively needing to anesthetize ourselves from them. There are always discomforts, disappointments and even tragedies in life. Our ability to bounce back from these experiences is resiliency. We can learn from our feelings, particularly the uncomfortable ones, so long as we are open to having them. If we choose to close ourselves off from these feelings we do so with the cost of impoverishing our genuine experience. 

So many of my patients come to me initially seeking relief from "anxiety" or "depression" by which they mean a subjective experience, a feeling, that is uncomfortable or unbearable. Our culture tells us that there is no need to tolerate an uncomfortable feeling. There are medications or new consumer products that can take these feelings away, banish them to the unknown.

But in doing so we flee the here and now for imagined comfort of somewhere else.  We trade our lived experience, the only true reality, for some imagined talisman that will end our suffering.

Michael Balint, a Hungarian psychoanalyst, argues that advertising, art, the longed for relationship, all depend upon our yearning for what he calls the transformational relationship. If we could possess that thing or relationship our lives would be transformed and made better. 

The hard sell in psychotherapy is that rather than taking uncomfortable feelings away, we work to increase the capacity to tolerate the full range of feelings, including the "bad" ones. So question is not "how can we take that feeling away?" but rather, "how much of that feeling can be tolerated?"

As you can imagine, not everybody wants to take that on. Why not just make the thing that causes discomfort go away? The point is that once a greater capacity to experience feelings without being overwhelmed is reached, greater emotional flexibility and resilience is attained, and that is the proper goal of growth oriented psychotherapy. 

Resilience from a psychoanalytic perspective

In 1932, addressing a gathering of medical students, Sigmund Freud made the famous and often quoted statement "where Id is, there ego shall be" (New Introductory Lectures). For a long time, before I read Freud more closely, I took this to mean that over time the ego could be trained to better dominate the unwieldy Id and that he was really talking about domination of the impulses.

As a review, the ego is that part of the mind with which we are most familiar. It is the seat of our conscious thoughts, sense of the here and now and the experience of the ourselves at any given moment.  The Id is the source of energy in the mind; all the instincts and drives as well as the parts of ourselves that we find uncomfortable or unacceptable. (As a side note, Freud's language was much more familiar and less scientific than the Latinized "ego" and "Id" suggest. Freud's translator, James Strachey, wanted the theory to sound more scientific and so dressed up the English translation using Latin terminology). 

At any rate, my initial understanding of this famous phrase could not have been more wrong. Freud was not suggesting that we increase our censorship and banish more of our experience to the Id, he meant the opposite; that as the ego grows stronger, more of the Id can be tolerated in our everyday lives. This enables us to benefit from all the energy of the Id and function more flexibly. 

Anger is a good example of this process. Many of us are uncomfortable feeling anger and even less comfortable expressing it directly. We are led to believe, through growing up, that it is impolite to express anger so we squelch it at every opportunity. The problem is, there is a lot of energy to be had in anger and anger can be an important signal that our needs are not being met. If we divert anger out of our awareness and into the Id, we loose this resource and impoverish our ego. 

This is not to say that we should be yelling at people all the time or making unreasonable demands. Rather, we should learn to tolerate anger (and all of out feelings) without resorting to defenses that negate reality and squelch anger. 

If the Ego can be strengthened so as to tolerate all our feelings, comfortable as well as ugly, then we expand the Ego and allow it occupy territory once claimed by the Id. We function more flexibly, get overwhelmed less easily, and experience life more fully.  That is resilience from an analytic perspective. 

A Brain Test for ADHD?

One the problems with psychiatric diagnosis is that we do not have "objective" measures that rule the diagnosis in or out in the same way that medical blood tests and the like do. I put "objective" in quotations because even blood tests are much more subjective than we might think.

A psychiatric diagnosis is made by identifying and categorizing behavioral symptoms.  For example, if a patient exhibits a certain number symptoms (five out of eight for example) listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for a given duration, they qualify for the diagnosis. Absent from this schema is any real understanding of the reason for the symptom, it's function as a coping strategy. At the turn of the century Freud wrote of the need to understand the "sense" or meaning of symptoms rather than their mere existence (Freud, 1920. Introductory Lectures on Psychoanalysis). 

A new "objective" test has been approved by the FDA for the diagnosis of ADHD:

From the New York Times http://www.nytimes.com/2013/07/16/health/brain-test-to-diagnose-adhd-is-approved.html?partner=rss&emc=rss&smid=tw-nytimes&_r=0

"The test uses an electroencephalogram, or EEG, with sensors attached to a child’s head and hooked by wires to a computer to measure brain waves. It traces different types of electrical impulses given off by nerve cells in the brain and records how many times those impulses are given off each second.The test takes 15 to 20 minutes, and measures two kinds of brain waves — theta and beta. Certain combinations of those waves tend to be more prevalent in children with A.D.H.D., the Food and Drug Administration said in a news release."

 So will this eliminate our uncertainty when making a diagnosis of ADHD?  Probably not.  Our diagnostic system or nosology rests on a false belief in the reality of diagnostic categories.  In reality there is no such thing as "depression"or "ADHD."  I do not mean to imply that people do not suffer or that their lives are not impacted by these disorders, only that as an objective reality, these diagnoses are just constructs, ways of organizing phenomena into categories.

Without getting too philosophical (professors can get that way), suffice it to say that EEG's and medical tests exaggerate the certainty with which we draw conclusions.  We still do not know that a patient has ADHD even if they test positively on this new procedure.  What is more important is understanding the context and function of the symptoms so that we can help the patient.  As Freud pointed out, we need to make sense of the symptom and not just categorize them.

Stop Bullying Website

The following info graphic was posted on www.stopbullying.gov

Bullying: What You Need to Know

Coping with adult ADHD

Impulsivity, a core symptom of attention deficit hyperactivity disorder (ADHD), can make life miserable for adults trying to cope with the disorder.  In an increasingly demanding world in which multiple sources vie for our attention and push us toward impulsive acts, we can have trouble sorting the "necessary" from the "appealing."  After all, that is exactly what advertising is all about.

Margarita Tartakovsky, M.S. (Original article here: http://tinyurl.com/n4dc8z2) suggests that each ADHD sufferer experiences his or her symptoms differently so it is important to really understand your specific manifestation of impulsivity.  She goes on to suggest that people with ADHD engage in the following three practices:

Practice being mindful.  This can help you respond rather than react.  Mindfulness helps center and keep you grounded.  If you are paying attention your level of arousal or excitedness you can monitor your reactions.  Impulsivity in many ways is the opposite of mindfulness in that when we are mindful our minds are calm while impulsivity requires that the mind act without reflection. 

Challenge negative thoughts, and take action.

Ask yourself why you became impulsive.  What feelings or thoughts came right before the impulsive acting out?  Can you challenge those thoughts or feelings and learn to tolerate them rather than flee them?

Make it harder to act impulsively.

Tartakovsky asks "does your impulsivity lead to pricey shopping sprees? If so, “leave your credit card and checkbook at home. Put the items you’ve chosen on hold for 24 hours, so you can decide if you really do need or want them,” 

Two Psychological Theories All Leaders Should Know

Original article here:

http://tinyurl.com/lgq4xdw

Attend to observational learning and social contagion and you'll lead better.

Published on July 1, 2013 by Thomas G. Plante, Ph.D., ABPP in Do the Right Thing

All leaders, regardless of the nature of their organizations, should be well aware of two important social psychology theories that can help them be better leaders and run more effective organizations. These include observational learning theory and social contagion theory. Like so many behavioral science theories these have a common sense quality about them but don’t be fooled, neglect them and you can destroy an organization!

Research on observational learning well illustrates the notion that we tend to learn by watching others. Behavioral modeling is a powerful concept that leaders in business, government, sports, non-profits, and perhaps all organizations should be highly aware of. In a nutshell the motto here is, "Do as I do, not as I say." People have the tendency to observe the behaviors of others and then emulate them. This is especially true for highly valued and prestigious leaders. In small and big ways we closely model others. If you are a leader know that you are being closely observed (probably more than you know or feel comfortable with) and others will attend to and very likely model your behavior, attitudes, and manners.

Think of the organizations that you are affiliated with now that could include work, family, social, civic, sport, church and others groups. Now think about the leaders of these organizations. Don’t they set a tone in both small and big ways that trickle down to the rest of the organization or group? Change the leader and you likely change the culture of the organization. It may take some time of course but sooner or later leadership changes community culture.  

Here in Silicon Valley, where I live and work, many of the famous technology companies have had leaders with strong personalities, character styles, and behaviors that have created an almost cult like environment around them. For example, consider leaders such as Steve Jobs at Apple, Mark Zuckerburg at Facebook, and Larry Ellison at Oracle. They, among others, set a tone within a company that not only includes qualities like work ethic but also clothes, manner, and ways of relating to others.  A friend of mine who works at Apple commented that he wasn't too worried about the passing of Steve Jobs in terms of the future of the company since he said that there were many "little Steves" within the company. 

This is true even within psychology. For example, I can remember attending a psychoanalytic conference many years ago where several of the speakers looked a lotlike Sigmund Freud. Some even had a slight European accent yet they were born and raised in the United States to native English speaking parents! I also remember being interviewed for a position at a private psychoanalytic psychiatric hospital in New England years ago where the 12 or so psychology staff all (and I really do mean all) wore tweed jackets and had facial hair ... just like Freud!

So, if you are a leader, whether you like it or not, people within your organization are going to watch you very closely and more often than not, act like you do (for good or for bad). Therefore, you really do need to be mindful of the way you behave at all times (even while off duty) since you will be closely observed and your behavior and style will be replicated elsewhere.
Social contagion theory suggests that behaviors can spread like a highly contagious virus. Fashion trends are a good example. Research has found that even eating disorders can spread by social contagion in university dorm environments. So, as a leader, one has to be mindful of the spread of behavior within organizations. When some organization members behave in problematic ways (e.g., stealing, tardiness, rudeness) that behavior can spread quickly to others. Yet good behaviors such as hard work, attention to detail, and friendliness, can spread quickly by observational methods too. Thus, behavior that you like needs to be thoughtfully reinforced while behaviors that you dislike need to have immediate corrective feedback to nip in the bud. 

Being attentive to the power of observational learning and social contagion can help all of us, but perhaps especially leaders, be better at what we do. Take these theories seriously and I’ll guarantee that they’ll help you in any organization.
So, what do you think?

Please check out my web site atwww.scu.edu/tplante and follow me on Twitter @ThomasPlante.
Copyright 2013 Thomas G. Plante, PhD, ABPP

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