The coming fifth edition of the Diagnostic and Statistical Manual (DSM-V) has rekindled debate over the legitimacy of the very concept of “mental illness.” A recent article by Peter Kinderman, a professor of clinical psychology, takes a strong position against the “mental illness” approach, writing:

But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

This is a healthy debate to have, as the concepts involved are tricky and there are real implications for societal perception, insurance coverage, and treatment strategies. I do not, however, share Dr. Kinderman’s position, which in my experience is fairly typical for a clinical psychologist. He is essentially saying that his profession’s approach to the question of mental illness is superior to the psychiatric profession. While the debate is legitimate and important, I can’t help feeling that there is a major component of a turf battle here also.

The question is essentially how we should think about symptoms of mood, thought, and behavior. At one extreme we night consider all aspects of human mentality as being part of the normal spectrum, with differences being just that – differences. Those who follow the position of Thomas Szasz consider labels on mental differences to be largely politically and culturally motivated forms of repression.

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I received an automated message on Sunday that there will be enhanced security at my daughter’s elementary school. The doors to the school are already locked, requiring someone in the front office to buzz visitors in. The school will now no longer grant admittance to any unannounced visitor, even a parent. Any visitor must call or write ahead of time with the time and purpose of their visit.

This is fine, and probably a reasonable security policy for a school, but it would not have stopped the shooter from carrying out the horrific killings that took place four days ago in Newtown, CT. The killer apparently shot his way into the school.

It’s difficult to process the events that occurred in Sandy Hook Elementary School. A 20 year old gunman entered the school with an assault rifle, large capacity clips, with hundreds of total rounds, and two additional pistols. He went to the principal’s office and killed everyone there, then proceeded to classrooms to kill as many children as he could. (Correction – the news report now is that the principal, Dawn Hochsprung, went to investigate the gun shots and was killed while rushing the shooter.) In the end he killed 20 children, all aged 6-7, and 6 adults. This was after shooting and killing his own mother at home. The gunman’s last victim was himself, committing suicide when his spree was done (it’s possible he killed himself when he heard the sound of approaching sirens).

I understand the emotions of such an event. I am a parent, and one of my daughters is still in elementary school. This scenario is every parent’s unthinkable nightmare. We send our kids off to school and trust they will be safe.

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We all make decisions every day. I started out my day deciding what to wear, following by a decision of what to write about for this morning’s blog post.  Most decisions are small and likely have insignificant consequences, but even small decisions can have a large cumulative effect. Some decisions are huge and can have dramatic effects on the course of our lives or the lives of others. Studying human decision-making, therefore, seems to be a useful endeavor, one likely to have implications for critical thinking.

The current dominant model of decision making is the so-called dual-process approach. Decision-making is seen as coming in two flavors: intuitive-affective, or system I, decision-making is based upon our “gut-feelings”, while analytical system II processing is based upon careful analysis. There are advantages and disadvantages to both, and researchers are busy trying to  sort out which approach is superior in which circumstances.

Intuitive decision-making has the advantage of being quick. We get an overall feeling for a situation, based upon evolved emotions and heuristics and modified by our own experiences, and can act quickly on such feelings. The disadvantage of this approach is that it is highly susceptible to bias and may not properly weigh important details.  The analytic approach has the advantage of being detail-oriented, logical, and quantitative and can be highly evidence-based, given a statistically accurate weight to each factor considered. The analytic approach is specifically designed to weed out bias and faulty thinking. The disadvantage of the analytic approach is that it is time and effort intensive, and it is only as good as the evidence that feeds into it.

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It is my contention that scientific skepticism is an intellectual discipline and a cognitive skill set more than anything else. It is also a philosophy, a value system, and an approach to knowledge – but these are hollow without the knowledge and skills to apply that philosophy.

This is especially true in our complex world, with sophisticated pseudoscience alongside mature and highly technical real science, ideologies of every stripe pushing their agenda, governments with power to protect, and markets and corporations with a profit motive to deceive. The internet is also drowning us in information, much of it dodgy.

It is therefore not enough to have a generally skeptical outlook, or even to call oneself a skeptic. Skepticism is a journey of self-knowledge, exploration, and mastering the various skills that comprise so-called metacognition – the ability to think about thinking. <shameless plug> For a thorough discussion of metacogntion, you can check out my Teaching Company course: Your Deceptive Mind: A Scientific Guide to Critical Thinking Skills. I also understand it makes a wonderful gift.</shameless plug>

As an example of the need for metacognitive skills in navigating this complex world there is confirmation bias. This is definitely on my top 5 list of core skeptical concepts, and is a major contributor to faulty thinking. Confirmation bias is the tendency to perceive and accept information that seems to confirm our existing beliefs, while ignoring, forgetting, or explaining away information that contradicts our existing beliefs. It is a systematic bias that works relentlessly and often subtly to push us in the direction of a desired or preexisting conclusion or bias. Worse – it gives us a false sense of confidence in that conclusion. We think we are following the evidence, when in fact we are leading the evidence.

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“I’m Good Enough, I’m Smart Enough, and Doggone It, People Like Me!”
- Daily Affirmations With Stuart Smalley.

Self-help books are full of advice for thinking positively, and using affirmations to tell ourselves that the reality we wish to be true is in fact true. This is interesting because psychologists have discovered that people in general have a large positive cognitive bias – a wishful thinking bias. All other things being equal, we will tend to assume that what we wish to be true is actually true. Sometimes we can maintain this belief despite significant contradictory evidence.

It may be that this bias exists because it relieves cognitive dissonance. Essentially, it makes us feel better, and that may be sufficient. However, there is also a theory that such wishful or positive thinking is, to an extent, self-fulfilling. People who think they will be successful will take advantage of opportunities and work harder to make that success a reality. Expectations can even affect other people, the so-called Pygmalian effect. If teachers believe that a student will perform better, that expectation may improve the student’s performance.

Richard Wiseman points out, however, that visualizing the goal (“I am a success in my business”) does not work (so much for positive affirmations). What is helpful is visualizing the process by which a goal can be achieved.

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Quick – think of the location of the nearest fire extinguisher to where you work (your office, desk, station, or whatever). Fire extinguishers are fairly large and usually conspicuously red objects that are deliberately placed in an obvious and accessible location. Their design and placement is meant to make you notice them, so that you know where they are in an emergency.

However, in a recent study, only 13 out of 54 subjects (24%) we able to recall the location of the nearest fire extinguisher to their office. In some cases subjects worked in the same location for years and walked by the fire extinguisher multiple times per day. How could they not notice something so obvious after hundreds of encounters?

Psychologists have identified a number of phenomena related to how people attend to the world around them. By now you have probably seen the famous basketball passing video (if not, take a look before reading further). This is an example of inattentional blindness – we can only attend to a small percentage of all the sensory information that is coming our way. Our brains evolved to sift through this information and pick out the bits that are likely to be important or relevant. Further, we can consciously direct our attention at certain details of the environment, and when we do we become relatively blind to other aspects of our environment to which we are not attending.

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What is happening when a medium claims to be channeling or speaking to spirits? Believers claim that they are actually contacting non-physical entities, and that their channeled words and actions come from a place other than their brain. The skeptical interpretation is that the mediumship, of whatever flavor, is nothing more than a performance. The truth lies in the brain of the medium, and since we cannot read minds it seems there will always be room for interpretation.

This may be changing, however, as we develop the technology to peek directly at brain activity. Electroencephalogram (EEG), functional MRI scanning (fMRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT) are all methods for looking at brain function. A recent study used the latter technique, SPECT, to look at the brains of mediums while performing psychography – automatic writing that they claim has an external source, that of spirits.

The study involved only 10 subjects, 5 novice and 5 experienced psychographers (with from 15 – 47 years of experience). They had each subject generate normal writing, then they had them generate “automatic” writing while allegedly in a trance-state. The researchers found two things – that the writing of the experienced (but not novice) psychographers were more complex in the trance state than the control state, and the experienced (but not novice) psychographers had decreased activity in certain parts of the brain related to higher cognition while writing in the trance state. Specifically:

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A BBC program, Panorama, will soon air a show in which they explore a new technique for communicating with people who were believed to be in a vegetative state. The technique is based on research published in 2010 in the NEJM: Willful Modulation of Brain Activity in Disorders of Consciousness.

This is an intriguing area of research that I have been following and writing about here for the past few years. For background, vegetative patients are those who have suffered a brain injury of some sort and are no longer able to display any outward sign of consciousness. They tend to go through sleep-wake cycles, they open their eyes and have roving eye movements, but there is no indication on exam of purposeful activity or any objective response to their environment (this is by definition). If such patients show some signs of consciousness or response to external stimuli then they are deemed to be in a minimally conscious state.

One challenge is that such patients are unable to communicate directly. We have to infer their consciousness (or lack thereof) from the neurological exam. Even an enhanced exam designed to look for subtle signs of consciousness is still a crude instrument. We have no way of directly looking at the “mind” of the patient to see what their experience of consciousness is. There is some utility to such exams, however. In one study 40% of patients thought to be in a persistent vegetative state by routine evaluation were found to be in a minimally conscious state by a more elaborate neurological exam.

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Facilitated Communication (FC) is a technique for allegedly aiding those with communication impairment, such as some people with autism, to communicate through typing or pointing at a letter board. The idea is that some children have greater cognitive ability than is apparent through their verbal skills, but they lack the motor skills to type or write. The facilitator in FC is trained to hold and support their client’s hand, to help stabilize it, so that they can type out their thoughts.

FC was enthusiastically embraced by the special education community in the late 1980s and early 1990s but problems quickly emerged, namely the question of authorship – who is doing the communicating, the client or the facilitator?

The scientific evidence came down clearly on one side of that debate – it is the facilitator who is the author of the communication, not the client. The American Psychological Association has reviewed the available evidence and produced a position statement that concludes:

The short version of this long story is that study after study showed that facilitated communication didn’t really work. Apparently, the positive results that had generated so much enthusiasm were the results of a subtle process in which well-intended facilitators were answering questions themselves – without any awareness that they were doing so.

A 2001 review by Mostert came to the same conclusion – that the evidence supports the conclusion that the facilitators are the authors of communication in FC. He also points out that there is a relationship between the rigor of the studies and the results. The most rigorously blinded studies are all negative, studies with some blinding but also with problems are mixed and often show some positive results, and unblinded studies are all positive, showing dramatic effects. This pattern mirrors that of ESP and many other pseudosciences that are primarily the result of self deception.

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The comic book hero Daredevil was blinded by a splash of radioactive waste, but the radioactivity (a common plot device of the time) also heightened his remaining senses. In addition to a form a echolocation, Daredevil was able to “see” by feeling his environment. How plausible is this idea?

While obviously not resulting in super powers, humans may have the ability to learn new senses. Researchers at the Weizmann Institute recently investigated whether or not people could learn to sense their environment with artificial “whiskers.” Rats and some other animals have a sensory organ humans do not, whiskers, with which they probe their environment. Researchers attached artificial whiskers with position and force sensors to the index fingers of subjects. They then sat the subjects between two vertical poles and asked them to detect with the whiskers which pole was farther back.

On the first day of testing the subjects were able to detect a difference in pole position of only 8cm. On the second day they learned to refine their probing techniques in order to detect a difference as small as 3cm.

I also have previously written about human echolocation – people who have learned to use a functional, if crude, form of echolocation to sense their surroundings.

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