Lecture 7: The Brain in Contemplation of Itself: A Comment on Research and Statistics- Part 3: The Voodoo That You Do

Oh, for the halcyon days of yore—or would it be more accurate to say your Halcion® days?—when men were men and women were women and all knowledge could be reduced accurately and reliably to a number whether we were able to understand what that number meant or not. (Sigh!) When, in a criminal case, a judge would demand and get a digit or two that would tell him (or her) without undue complexity, deceit, or obfuscation whether a defendant was insane at the time of the offense and whether they were competent to stand trial.
My neighbor recently observed about life with all due solemnity, the answer is “42”. This was clearly a Shakespearian moment, whether it was to be or not was another question (entirely). I understood his meaning the way Jazz was understood in the fifties. Snap your fingers in agreement. Forty-two is a number and, therefore, reliable and certain. No need to bother one’s self with messy opinions from competing experts, just let the numbers answer the complex questions and move along.
None of this would have been possible if not for science and the role it plays in helping us understand our world. Science’s primary role these days is to get rid of the vagaries and dispatch problems so that we don’t have to trouble ourselves with thought. If a common measure could be applied to all phenomena, we wouldn’t have to think about anything, just look up the answer. “Forty-two, hell, I got 56 and I wasn’t even awake yet. At my best, I can get a 95. Whatchyou got?”

Probably our first conscious contact with numbers that we took as meaningful was our IQ. At least when I was growing up, we were given IQ tests, but the scores were never revealed, except by one kid who somehow penetrated the sanctum sanctorum of the office where the tests were kept. Then, everyone got to hear about the numbers because the kid would be spouting off about how gifted he or she (usually a he) was, while everyone else would guess about their own IQ. But, it was a valuable piece of information… or so we thought.
It’s true that IQ is valuable because IQ tests are the most stable, that is, they are more likely to give you similar results upon retesting than almost any other type of psychological test. Of course, what they don’t tell you is what the numbers really mean. The answer is simple enough. IQ correlates with academic success. The reason these tests were previously used in schools was to weed out those who would likely go on to college from those who likely would not. The reason that these tests stopped being used with the same frequency is that they are expensive and time consuming. More than that, the rules changed. With the proliferation of colleges and universities, education became democratized, which means that those who did not score so high on IQ tests might still excel by working harder.
Then, there is the pull from below, which has even less to do with IQ. Back in the day, we worried about grades. They still do where I live now, except now parents, friends, and family are more proactive, even aggressive, to insure academic success. I recently heard a story about a local community in which a principal tried to raise the quality of education at his school. The way the story was related to me was that the principal left town after a series of drive by shootings at his house when he was home with his family. He was demanding too much of students, apparently. “If you had just fixed the grades like your predecessor,” the message seemed to be, “everything would have been all right.” It’s simply amazing what can be done with numbers. You can even extend your life expectancy, although you may have to leave town to do it.
With this new creative use for numbers, we find that grades can be raised by first lowering the bar. Let the fat kid believe he is a great high jumper by changing the ruler to measure his leaps. His inch is everyone else’s millimeter. A little more fudging and he can be ready for the Olympics. The measuring is still accomplished with numbers, but they don’t have the same meaning they had before. Here is where the influence of voodoo is felt most strongly.
Physicians, too, give magic to numbers. Going back to TV advertising in the 1960s, one can see how many dentists recommended one brand of toothpaste over another, what the Journal of the American Medical Association said you should take to control your headache, or what doctors give to their families to treat stomach upset. Most of the advertising of the time included some numbers to impress us.
But, let’s look at academic research for a moment before we plunge in and look at the numbers ourselves to see what they tell us. First of all, consider the possibility that most physicians are just like you or me. They don’t want to read stuff that is extraneous, not if they can get the information quickly and without effort. Most of us would rather be doing something else. But keeping up on medical research is part of a physician’s livelihood.
How to save time? The answer is to read the abstract at the beginning of professional articles. This provides all necessary information about the contents of the article without undue thought. It will even give you a few numbers to demonstrate, albeit briefly, the strength of the research results. No muss. No fuss. Wow, that’s really impressive that they can do that. But how is it done?
This reminds me of the coffee commercial on TV in the 70s with the people in a well-known restaurant raving about the coffee. Just how did they do that? Come to find out years later that they offered a fancy meal to average folks with inexpensive tastes. They wined and dined them. Then, at the end of the meal they ask the question, “How did you like the coffee?” “It’s the best I ever tasted.” Then, they tell them what they were drinking, not Starbuck’s (which didn’t exist then), but the very same brand of instant coffee they would have every morning on their way to work. There’s a look of happy surprise. (Cut! It’s a wrap! This kind of stuff is ready for prime time.)
So, the physician is taking an idle moment in his/her office to skim the abstract of an article on how a medication for depression can be used for anxiety or psychosis, maybe even cancer. It finishes with some numbers about probability and effect size. (Effect size means, how strong is the effect of the treatment on the research subjects when compared to the controls, the amount of outcome data that is accounted for by that difference.) The doctor reflects aloud to himself, “Very impressive! Maybe I’ll use that drug for indigestion next time to see how it works. If the patient improves, I might include it in my list of treatments for indigestion and irritable bowel syndrome, too. It could be useful. Time to get back to work!”
What the doctor doesn’t know is how the research was done. That’s okay. They probably weren’t trained in statistics anyway. Maybe they don’t know how research is designed. When you think research design, think of that coffee commercial, that is, what were the conditions in which participants’ responses were measured. Were there any alternative explanations for the outcome that might explain what was really happening? Was the data gathering carefully controlled or might subjects have been influenced in some way?
But nobody has time to bother with that stuff. We all have other more important things to do. That’s how a doctor might prescribe a medication he knows next to nothing about and how a patient may demand the medication after watching the commercials that lard our favorite television shows. The side effects can be flu-like symptoms, migraine headaches, incontinence, death. No problem! “Ask your doctor if this might be the right treatment for you.” The doc might be watching the same TV show you are. Maybe he or she is thinking about how many people will be coming to the office the following day and asking for the medication they just heard about. And there are the numbers, always those darned numbers, incontrovertible proof. It’s hard not to be overwhelmed with the power of it all.

Lecture 7: The Brain in Contemplation of Itself: A Comment on Research and Statistics- Part 2: Stats on the Hoof: The Bart

I made my first serious attempt at interpreting statistics in the late 1970s. It started with a visit to my local race track. It was here that I got the misguided notion that, with so much available information about the horses, I would be able to earn an income. It seemed to me that, with a little brain work and a little common sense, I could figure it out. As anyone with true common sense knows already, the entire notion was false. I would soon discover this through experimentation, parting with a few hundred dollars along the way, but no more! The idea was to get some fresh air and sunshine and to see what I could learn, not to lose scads of money. I had no background in formal statistics at the time.
For those who have never been to the track, the tools of the trade are a program and the Racing Form. The program, much as a program at any concert, will tell you who is playing or, in this case, who is running. It includes an estimate of the odds when the race starts. (Odds fluctuate until the time of the race based on the cash amount of bets tendered.) The program also tells you who owns the horse, the stable, and who the jockey is, although jockeys may also change in advance of the race. It tells you each horse’s sire and dam. It will also give information about the race itself, that is, if the horses that are running can be claimed for purchase and how much it would cost to buy such an animal or if it is a stakes race for a cash prize with no opportunity for purchase.
By contrast, the Racing Form will tell you anything else you want to know about the horse… almost. This is where a naïve “investor” has the most opportunity to sucker himself with the available data. And this is where more than one would-be scientist has been born. The Form provides data on each horse’s history, where and when it ran, its position at every point in the race, the conditions of the track when it ran, who rode it etc. This is where one can test out theories, hypnosis by numbers I prefer to call it.
While it may be easy to dismiss this type of experience as useless, there are certain lessons that one may learn, some of which have nothing to do with horses. First, it is best to approach a set of data with a working hypothesis. This is no different than any other type of research—medical, psychological, actuarial, or whatever. If you don’t approach the Form with a theory you can lose track of what you are trying to discover. Approaching numbers with a theory is what scientific researchers do routinely. In fact, that is what they are trained to do. You put forth a research hypothesis, then determine how best to collect information and to interpret it. In this case, the information is collected for you. You just have to decide what kind of rational (or irrational grid) you want to put on it in order to draw your conclusions.
Where it applies to horses, I soon learned that there was not enough information available to me to allow me a reasonable guess as to which horse might win a race. For example, I developed hypotheses about whether a horse started fast, did better down the stretch, or was a good closer, hypotheses that were refuted almost as soon as the gate flew open. When my best reasoning was so easily refuted, I started wondering what the horse and jockey had for breakfast that morning, which side of the bed they got up on, whether they were in a good mood, were having a domestic squabble… or whether the horse may have been offered extra incentive that might affect the outcome.
I turned this thinking into a hypothesis during one trip to the track. On this outing, I inspected the horses before the race, albeit at a distance, with the notion that I might be able to tell how everyone was feeling and whether their mood might turn into a win. During one of the races, I saw a horse with his mouth taped, his tongue lolling out, and with a wild look in his eyes. I remember thinking how ill-bred and uncontrollable the horse looked. It seemed to me unlikely that a horse in this condition could possibly win. Of course, that horse won. And it was back to the drawing board.
At the time, I was working as a cook in a restaurant with counter service. It was around noon when a nicely dressed, older man sat down at the counter, then ordered a hamburger and a coffee. While he was waiting, he reached in his jacket pocket and pulled out a racing program and a pencil. His facial expression was thoughtful as he began scratching down numbers. I was particularly interested in the fact that he did not even have a Racing Form. This meant to me that he was not trying to figure anything out, but that he already knew what he was up to. I got up the courage to ask him what he was doing and he told me, “Parlaying my bets.” It didn’t take me long to turn that bit of information into the discovery that I was way out of my league if I thought I could win at the horses.
Parlaying, as I understood it, was to take one’s winnings from one bet and bet that money again, then continuing to turn any winnings into further bets. This presumes, of course, that you won some money in the first place and that you continued winning, which was something I had never done. This man was making that very assumption and he did it without any statistical data at all. Which led to my second lesson in statistics, which is, if you have direct experience of a phenomena, such that, you know how a thing operates, then you’ve got a leg up on anyone who is simply relying on numbers.
When the older man came back some time later for another hamburger and coffee, with another program open in front of him and with his pencil out, I asked him the two questions that were on my mind. First, whether he had won the last time I saw him, to which he answered that he had and quoted some figure in the thousands. Then I asked him what exactly a jockeys’ agent does. He explained that it was his job to arrange for horses to have jockeys and jockeys to have horses. That meant to me that he not only knew the horses and jockeys, but also the trainers and the owners. In short, he had all the information I could not get even with a program and Racing Form. Inside information, as we all know, is the best information, if reliable. (Shortly, I will describe how this affects issues of mental health.)
Still, with this new found knowledge, I decided to go to the track one more time just for fun. I recall that it was a cool Labor Day at Bay Meadows race track near San Francisco. It was getting on the end of the day and the feature race was about to go off. I think it was the Golden Gate Stakes (but, if it was called something else, please forgive me). I reviewed the Form to see how the field looked. Glancing up, I noticed that one of the horses was going off at less than even odds, meaning that, if the horse won, you might collect 75 cents for every dollar bet. I also noticed he only came in second in his last race. Thinking that I did not stand to win very much if I did bet on the favorite and that he did not win his last race anyway, I noticed another horse that had won his last few races. The odds on this particular horse were about 3 to 1, a better payday. Logic dictated that the second horse would be a better bet.
When the race started, my horse was ahead. Halfway through, he appeared to be about eight lengths ahead. Thinking I was doing pretty well, I asked the guy next to me why the horse running second posted less than even odds even though he lost his last race. The guy answered briefly, “That’s The Bart. He lost to John Henry by a nose.” “Oh,” I said, just as The Bart gave me my first real lesson in horse racing by taking off. He closed the eight lengths before I could breathe and won going away. It was common knowledge that he lost to John Henry, the same John Henry that had been Horse of the Year for two years running. It was common knowledge to everyone, but me. What I had never seen before nor did I appreciate until that moment was how exceptional a horse can be.
The Bart taught me my third lesson, that is, there are no statistics adequate to describe what is exceptional. I never saw John Henry run, but, considering what I had just witnessed, I could only imagine how fast he was. In a matter of seconds, I had learned to admire the speed and prowess of an exceptional horse, but I never went to a horse race or bet on a horse again.

Lecture 7: The Brain in Contemplation of Itself: A Comment on Research and Statistics Part 1-How Numbers Are Used to Rock Your World

“There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy.”  William Shakespeare, Hamlet, Act 1, Scene 5

“One death is a tragedy, a million deaths are a statistic.”  Unknown source, attributed to Josef Stalin

            It would be my intention at this point to compare statistics to a world of dreams.  Dreams are infinite.  Statistics are static.  To the modern scientist, one size fits all under the Bell-Shaped (Gaussian) Curve.  Whatever size you are, we can find you a comfortable place under the Bell.  All we have to do is locate your particular place in it and you will see how well our product can work for you.  But—Believe me!—we will find a place for you and you will see how well our product really works.  Unfortunately for the scientist and sometimes for the dreamer, dreams like people are not static.  It is interesting to think that, considering the breadth of psychologists’ various practices, they may be educated in both worlds, the statistical world of phenomena and the mystical world of dreams.  Depending on the individual psychologist’s training, experience, and predilection, a practitioner may pursue interests in either or in both worlds.

            From my own world of dreams: I recall, as a child, being preoccupied with some real-life conundrums.  Around the third grade, we were given the task of writing a composition about how to get from one place to another in the neighborhood.  Someone wrote directions indicating that you “go straight”.  During the subsequent discussion of our papers, the teacher pointed out that this description was not correct because the road that we were discussing curved.  The question then became how you could write the directions accurately.  Several of us offered our attempts at an answer before the teacher informed us of the correct one, “You follow the road.”  I was involved in a similar exercise several years later, around the sixth grade, when I repeated what I had learned previously.  However, on this second occasion, the teacher informed me that it was perfectly acceptable to give someone the direction to “go straight”.  Wrong again! 

This example doesn’t differ much from statistics in which an irregular or curved line can be made mathematically straight and, once mathematically straightened, any straight line can be determined to have its rightful place under the Bell.  However you choose to analyze your walking in the real world, especially if you are seriously trying to go straight, you will find that your steps deviate somewhat, more if you have a limp or are dizzy.  In this case, your steps might deviate more than most and it would take increasingly complex formulas to straighten the line of your steps, but, happily, statistics can do this using formulas and constructs like Standard Deviation.  (At what point does any diversion from walking a straight line become significant?  Statistics can be used like this in order to tell how much of a limp is worth noting, how much a lack of equilibrium, or how intoxicated you are by analyzing how far you divert from a straight line.  You will need a tape measure or calipers to do the measuring and a calculator or computer to do the math.)

Considering how we can radically deviate despite the power of statistics, I am reminded of the girl in my second grade class who was making a Mother’s Day card along with the rest of us.  But, in her case, her mother had died.  At the time, I puzzled over why she was crying.  I was even more confused when the teacher had her staple a black paper flower to the card instead of a red one.  My puzzlement turned to concern when I saw that she was crying during the entire time that she was making the card.  She broke down when she attached the flower, finishing her work.  I am not aware of any scientific research that might help explain her upset. 

Statistically, as the only one in the class who was crying while doing the project, she would be considered an outlier, that is, someone who was way outside the norm.  Although statistics may not be able to analyze her plight, it should take little imagination for a sentient being to have some understanding of the girl’s dilemma.  How do you give a Mother’s Day card to someone who is no longer there?  Who is the card for?  How does a child of her age cope at all?  I am aware of no fixed parameters for grief.  The answer is qualitative, not quantitative.  For this reason, it cannot be answered statistically.  It can only be understood with life experience and with empathy, which one may be able to analyze statistically, but that would likely provide little useful information.

One more example, this one from high school, reminds one of the Zen koan about the sound of one hand clapping.  (In the case of the koan, I knew of a child schizophrenic years ago who like Alexander the Great and the Gordian knot conquered the riddle.  He did it by flapping his hand, making a clapping noise.  Everyone was intrigued by his novel solution.  Pretty soon, everyone was trying it.)  But, the question in high school was whether the number of grains of sand on a beach was infinite.  We said yes, the teacher, no.  This raised a series of additional questions some of which may be considered statistical.  To me, the most important was whether the beach was bounded.  How do we define the start and end of a beach?  The answer has more to do with language and the imprecision of our understanding of the concept of a beach.   How far does a beach extend into the water?  How deep does the sand go to the sea before we run out of it?  Does sand cease to be sand the deeper you go?  If so, what does it turn into?  How does a beach get there?  Does sand reproduce or increase somehow with the occurrence of natural phenomena?  Does it break down?  Is there natural fluctuation in its numbers and does any fluctuation contravene the law of its finiteness?

If you can answer any of these questions to your own satisfaction, then you will likely have the makings of a modern scientist or statistician.  I am sure that my high school science teacher’s answer would have been that, because the Earth is bounded, the number of grains of sand is finite, even if we don’t have the means to count them.  Because the answer involves a definition, it borders on philosophy.             

Indeed, I would argue that the Bell curve is a useful philosophical construct, but does not fit all the data to which it is applied, probably not even most of it.  Still, I recall us discussing with the same high school science teacher whether we will run out of air one day.  He hesitantly said, yes.  In light of recent circumstances, it would appear that he might have been right about that as well.  Maybe there are a finite number of grains of sand on a beach even though the number seems infinite to me because I am unable to count them.  Maybe we will run out of air one day.  (Inhale!)  I get a headache whenever I think about it.  Not much different than the headache I got while studying statistics.

ANOTHER NOTE BEFORE RETURNING TO THE DISCUSSION

I have not posted any new Blog entries for about two months.  I did this, first, because I ran out of text and did not have the time to write while earning a living.  Second, because I was not sure who was out there and to whom I was writing.  Third, I was also about to discuss statistics, a task that I found particularly challenging because I was having difficulty expressing my thoughts in a way that made sense while being both interesting and entertaining.  Fourth, I was hoping to find a web designer to change the presentation to conform to my ideas about the web, i.e., that it is theater.

 

“Well, young man,” I says to myself, “What have you done with your time?”  The answer, dear reader in cyberspace, is that I did not find a designer.  Strangely, no designer responded positively to my queries, if they responded at all.  I did sign up for a class to learn how to design my own website, but something came up in the meantime.  I received an email from Amazon.com inviting me to enter their Amazon Breakthrough Novel Award contest.  Either in a bout of madness or in a moment of inspiration or both, I was able to get a clear view of how to solve some problems with my only manuscript and the race was on.  Between working and preparing my manuscript, I had neither time for my XHTML class nor to write any new Blog entries.

 

The contest deadline is past.  My novel, NORTH HALL, has been submitted.  Those of you who enjoyed my short story, The Grand Inquisitor Revisited, which I posted on this site, may wish to have a look at my contest submission on Amazon.com if and when it is made available.

 

Regarding new blog entries, I have decided to carry my argument a little farther even without any assistance from a web designer and even though I still have no idea who is out there reading if anyone at all.  I will not be doing this for personal therapy.  I will be doing it for… just because.

 

If you read to this point, you must have found something of interest.  That being the case, you may wish to stay tuned.

 

NEXT: The Brain in Contemplation of Itself: A Comment on Research and Statistics- How Numbers Are Used to Rock Your World

THE INCREDIBLE TWO HEADED TRANSPLANT: THE ART OF SURVIVAL IN HARD TIMES WITH A CONFLICTED BRAIN

The Honeymoon of the Hemispheres.  Among the many gifts that have been given us, we have two of almost everything—two arms, two legs, two lungs, two kidneys, two eyes etc.  As lovely as this arrangement is, allowing us to have binocular vision, directional stereophonic hearing, and a backup for everything, the situation often has undesirable effects. 

Sometimes we trip over our own feet.  There are occasions the left hand does not know what the right hand is doing.  People are also known to speak with a forked tongue, that is, they say one thing and mean another.  There are still other people who have been more experimentally daring and split their tongues along the median to find they can move the two halves independently. 

In short, our bilateral symmetry may appear to be both convenient and elegant, but the two parts don’t always work in tandem.  It is through this arrangement that we often get in our own way when we want to accomplish something.  We drop things.  We miss our mouth with a fork while eating, usually when we are out in public.  Our words don’t come out right.

When this kind of thing occurs, we can look to the brain as the true culprit.  If the two hemispheres were only coordinated, we could overcome these flaws. The problem is that, if the two hemispheres mirrored each other’s actions perfectly, we would be able to accomplish only half as much because both halves would be doing the same thing at the same time causing us to lose much of the elegance that we have as human beings.  It would also limit our repertoire of behavior as the actions of each hemisphere would be necessarily limited by the other.  It is a result of the uncertainty of action of both sides of the body and both sides of the brain that we find that we have to do work to achieve coordination and elegance if we are to overcome our inherent clumsiness.  It is through our efforts to coordinate both halves that we are able to discover new solutions to achieve desired goals.  It is also as a result of this effort that we discover both beauty and originality. 

By working to resolve the differences in our two halves, we can learn to move more purposefully and deliberately in the world.  This is possible because, whatever the differences or conflicts, the two hemispheres have essentially the same purpose, to allow us to orient to the larger environment so that we can accomplish our goals, whether it is to grasp an object, perform in Swan Lake, or ace our final exam.  The kinds of errors that we make serve as an impetus for us to resolve our lack of coordination so that we can achieve goals.  The fact that we are able to make both halves work together is a wonder and a true gift.  The lack of coordination may be an inconvenience, but it is not a handicap.

The Incredible Two Headed Transplant.  A second head transplanted to the body of another.  This is something that only Hollywood could dream up.  Right?

Think about it!  One head would have to be a psychopath and the other head would be fundamentally good, but helpless to stop it.  Wow!  What theater!  It’s unusual!  It’s amazing!

Besides the fact that it was already made into a movie twice, it is also something that we live with everyday.  The monster is within us already.  It is our limbic system, what writer and philosopher Arthur Koestler dubbed “the ghost in the machine” and is sometimes called the reptilian brain because, along with us, all animals down to the lowest reptiles have one.  It is the origin of our fight and of our flight.  It is the part that chases and eats us in our dreams.  It is the part that makes us want to hide in our houses or want to (or actually) kill someone when they threaten us. 

Is it surprising, then, that most people who have fought off everyone and taken everything that they wanted, who have licked their plates clean, then eaten more, those who have accumulated their own wealth, then found a way to strip everyone else of theirs, should have more anxiety than the rest of us who have far less?  But it should not be terribly surprising, especially if you consider that an all-consuming motive such as insuring survival and fending off competition is not likely to go away simply because you have achieved an interim goal.  After all, to someone who is paranoid, the best way to insure that no one will get you is to insure that you have removed everyone who poses a threat. 

(Strange to consider, it is the paranoid mentally ill who are perfectly happy being left alone once they have removed certain specific parties who cause them fear.  Only non-psychotic people are so deluded to think they need to remove all threats to feel secure.  It is because they do not suffer from a major mental illness, yet still commit heinous crimes to eliminate competition in order to insure survival and enhance prestige that we have given them a special category and have dubbed them psychopaths.)

What is interesting about that other division in our brains, the separation between the cerebral cortex and our primitive reptilian brain is that the limbic system almost has a life of its own.  It is like the Tingler in the Vincent Price movie.  It has its own responses to stimuli that may be very different from what our enlightened nature would like us to do. But, like the Tingler, it takes precedence.  For us to take advantage of its benefits, it needs to be trained.  It requires discipline, management, and occasionally cajoling if it is to support the efforts of the cortex.  (This often occurs later on in life, sometimes in Boot Camp or in prison.) Without training, it runs roughshod over our better natures, for those of us who have one.  It can lead us to unrestrained fight or flight or both.

It may be unproven, but I would suggest that the limbic system is the origin of not only our nightmares, but also of our dreams.  I think of a reptile that, after spending a busy day ingesting a rodent, basks in the sun.  Reptiles often act much like people around a swimming pool, sunning themselves, and they may have similar interests.  I would expect that they have reptilian dreams just as we have our own dreams of success in all those areas that offer us pleasure and power.

But there is something about certain people that make their desires and their dreams unquenchable.  They seem to worship what their feral natures can do and what their uncontrolled natures can acquire for them.  They seem to worship it more than the sanctity of life or of any religious belief.  In their worship of their reptilian natures, they leave the cortex unchecked, to say or do whatever it needs to do in order to navigate in the world.  When the opportunity arises, however, when it becomes a question of survival of the fittest, asserting dominance in a dog-eat-dog world, Godzilla raises its head and roars, breathing fire, to take what it can.

For those of us with a well-developed cortex and perhaps an underdeveloped limbic system, we are surprised by the changes in our peers’ behavior when Godzilla raises his head.  When the press finally arrives after a cache of bodies is found next door in the basement, we say, “I knew him all my life.  He was a good neighbor, a real family man.  He gave more than his share when he tithed at our church.  I can’t believe he could do anything like this!  Bury bodies in the basement!  Surely, you must be referring to someone else.”

In these situations, we think instinctively, having some understanding because we have our own reptiles inside us, “How did he live his life?  Did he treat people in the way he would like to be treated himself?  Or did he walk over people in his business dealings?  Did he beat his wife or his kids?  Did he kick his dog?”

Somehow we know that anyone who can take advantage of others or flaunt or overturn the rules is capable of breaking other rules as well, rules that may be more fundamental to existence.  So, we may demand more exemplary behavior of others, while we do not make the least effort to apply those same rules to ourselves.  We all have our own snake to feed! 

I would argue that, if we can repair the rift between our thoughts, impulses, and actions, we can work toward a greater harmony within us and we might be able to fulfill dreams that are more personally gratifying than the mere elimination of competition.  Unfortunately, there are few role models and even fewer guides to show us how to accomplish this.  Nevertheless, it can and should be done, if we are able to establish some order in a world that is rapidly declining into chaos.  But still, it’s naïve to anticipate that anyone should act any other way outside of serving their self-interest.  The real question is, whom have they harmed and whom have they helped along the way.  If the balance is unfairly tipped, we may want to know why and we may find it more preserving to demand that they be checked and treated as uncivilized.

TO MY READERS (HOWEVER MANY [or few] OF YOU ARE OUT THERE):

I would like to take this opportunity to catch my breath in the presentation of my Mental Health play as I prepare for Act 2.  If this is all to be done well, that is, if my arguments are to be presented convincingly and in a way that entertains, then I need to resolve some issues of presentation. 

 

I have been concerned that the Blog is a bit disorganized and that its appearance does not stand up to its content.  It has been my hope to remedy this problem.  To this end, I have been in contact with a web designer to get a more appropriate look.

 

This seems like a good time to spruce up the look of the Blog as I compose the most important part of my presentation, the part of psych survival that has to do with statistics, testing, and research.  You may not be aware of it, but most of mental health treatment is supposed to be based on numbers and research, except for psychotherapy, which is more personalized and theoretical.  Statistics are supposed to be what drives psychiatric diagnosis.  Statistics are also supposed to be used in determining the use and effectiveness of medications.  Further, statistics are used by HMOs to determine who will be approved for treatment and what kind of treatment they will receive.  Now, I personally don’t believe that you need to know the numbers, but it would be helpful to understand how the numbers work and what they can tell you and what they do and don’t tell the Decider of your treatment.

 

When I first began the task of writing Survival Psych 101, I thought I might present some important issues of mental health that I discuss in my office on a regular basis and that people need to know about.  If all went well, I might arrive at a point where I could articulate some of my most important beliefs about how people’s minds work, proposing a theory if you will.  What I did not anticipate was how the Internet and Blogs work and how they communicate.

 

As a writer, I thought the task was simple.  You just write like you always do.  If somebody reads it and likes it, that’s good.  If nobody reads it, that’s bad.  If people read it and don’t like it, that’s good because at least they are reading it.  That perception changed as I realized that I wasn’t just writing.  I was also posting, which adds an additional step.  Once you take that step of posting, I learned, it takes you into an entirely new arena.  You are now on a soapbox.  You are no different from someone ranting and raving and pounding a Bible on a street corner to get people to see the light in your argument.  Then, the more I got into it, I realized that a Blog is a bit of theater that can not only inform, but also entertain.  Although I never thought of myself as an entertainer, I do take my work seriously, both as a writer and as a psychologist.  While I sit and compose these words and as I prepare to post them, I can’t help but think that the theater I am playing in is quite dark.  I don’t know who, if anyone, is out there.  I don’t know how anyone thinks about what I am presenting.  Which leads to still another metaphor about Blogging, it is like throwing out messages in a bottle… but then if a Blog works well it is should establish a community. 

 

So, I would ask you reader, you who are wandering on the vast beach that is the Internet, if you are reading these messages, would you kindly let me know that you found my bottle with a message in it.  And let me know what you think.  The writing itself is no burden.  The posting is easy… but it is rather burdensome (read embarrassing) to play to an empty house or pound my Bible on an empty street corner.

 

With luck you may see this Blog reborn as “The Mental Health Circus Guide” in which I will undertake to explain the practical side of statistics. 

Lecture 6: The Making of a Psychologist: Fester Bestertester Returns! (In Memory of Don Martin, MAD magazine, and my mad, pre-pubescent youth.)- Part 2

So, a man walks into a doctor’s office and he says, “Doctor, help me!  I’m depressed and want to kill myself.”  What is the first thing the doctor is supposed to say?  “Tell me about it?  How do you feel about that?”  No, you are supposed to ask, “Do you have a plan?”  If he has a plan, you have to call the police.  This has become universal truth among mental health professionals because it is the law. 

Some of the more enterprising of us would give that man a Beck Depression Scale.  Considering the Beck in light of the best made plans of mice, men, and psychologists, this guy is just as likely to answer all the questions in such a way as to produce a low score, meaning that he is a happy guy and has lots to look forward to in life, even though he may not really be.  Why might a test score not be consistent with his complaints upon interview?  Because the Beck has high face validity, meaning that almost anyone would know what the questions are getting at because no effort has been taken to conceal the purposes of the test items. 

Why would a person not want to answer questions honestly?  Maybe because the man is concerned about leaving a paper trail so that someone can use the results against him.  Maybe because he came to see a therapist as to a priest and expects both confidentiality and sanctity to be displayed in his treatment, but will present the better side of his nature, however insincere, if he thinks his answers may be viewed by others outside his therapist’s office.  He might also adulterate his responses to the Beck because he was raised to believe that you should not complain because people don’t really want to know about your problems.  (“How are you today?”  “Fi-i-ine.”  Insert smile here.)

I should add at this point that the reason most mental health professionals administer the Beck in clinical practice is to cover their bum.  That way, if the man does something stupid, like attempt suicide after you discharge him from your care, you have a piece of paper that will say to any licensing board or court of law that he was not depressed at the time he left your care.  See, the test proves it!  This, incidentally, is frequently what happens in psychotherapy.  A patient will lie to a therapist or reveal less than the truth with the idea that he only wants therapy to find a solution to a very restricted area of stress. 

Take as another example, the patient who sees a mental health practitioner for depression for years, takes a variety of pills from a psychiatrist and/or does behavioral or insight oriented therapy with a psychologist or counselor, but never reveals that he was severely abused sexually and physically because it is both too embarrassing and too painful to discuss even with the treating doc. 

“So, what is testing supposed to do?” you or someone might sneeringly ask who has had his or her deepest, darkest secrets revealed by some yokel writing a blog in the middle of nowhere with a Doctor of Philosophy degree from some Podunk town in Indiana.

Testing is supposed to reveal things about you, in this case about your personality, which cannot be revealed in any other way.  It is meant to be a way to shed light on a set of psychiatric symptoms, to provide additional information about your clinical picture.  It is not meant to be the picture itself.  For this reason, the Beck is not expected to replace the way you report your own symptoms in therapy, but to provide some basis to view progress in treatment.  It is no better than a snapshot of someone who is smiling for the camera.  The subject knows that a picture is being taken and smiles accordingly, even if he has a plan to commit suicide afterward. If the patient reports severe depression, but the test says that person is happy, you have something meaningful to work with because it gives you the opportunity to explore the reason for the discrepancy, an exploration that can be very meaningful.  It should not work as a defense in court, if a patient discharged from the hospital with a normal Beck score, walks onto the freeway during rush hour and is returned to the hospital in a mangled state or else deceased.  However, there are always exceptions.  A court may see the results of this test as proof that the patient became suicidal after, not at the point of discharge.

Regardless of what we know about psychological tests and the Beck in particular, psychiatrists frequently want to use the Beck in this way.  Anytime there is a question of self-harm upon discharge, the question most frequently asked by MDs is, “Did you give him the Beck?” 

Lecture 6: The Making of a Psychologist: Fester Bestertester Returns! (In Memory of Don Martin, MAD magazine, and my mad, pre-pubescent youth.)- Part 1

From the above arguments, one may well conclude that MDs don’t know what a Psychologist is supposed to do or what they know how to do.  In most cases, this is correct.  However, in defense of my professional antagonists, I can report on good authority that many aspiring Psychologists don’t know what they are doing either or what they are getting into, that is, until they arrive at the university where they are to be trained, the truck pulling up packed with furniture and dishes, suitcases in hand, with their spouses and pets about to enter a new house in a new town, sometimes thousands of miles from their home.  And, depending on your previous training, the change can be overwhelming especially when you discover that everything you learned previously no longer applies.

This was my situation and also the situation of most of my peers.  Much like in the military, we were about to be transformed from couch potatoes, drones of the hive as it were, then broken down, to be built up again as fully functioning, worker Psychologists to go out to the field to extract knowledge like honey.  Well, this may be true for some people anyway…

In the Beginning, most people enter this field because they want to help people.  At least in my case, my master thesis was not taken seriously and, indeed, it embarrasses me even now, although I still keep a copy of it.  In an essentially non-academic Master’s program, such as mine, they teach you various methods of counseling and counseling theories.  The statistical requirements are minimal.  You are given enough information to know how to read a bar graph or pie chart.  In short, by the time you finish a Master’s degree in psychology from a program that is not tracked for further education, you are trained to counsel and, it is hoped, pass an exam to be a counselor.

Contrast this with Ph(ony) D(octor) training in Psychology.  By the time they finish with you, you are trained to study human behavior with a microscope and may even know something about the functioning of the brain itself.  This can be a little disconcerting if you have the notion that you are studying Psychology for some other reason.  At least in my doctoral program, if you had the idea that you were training to be a PhD because you wanted to find out more about how to help people survive or do anything else useful for them, you were very soon disavowed of this notion.

What does a psychologist learn? one may well ask.  Why, testing of course!  A good doctoral program will teach you how to do psychological research and testing, which you will realize if you think about it for any length of time, are both essentially the same thing, one applied to groups and the other to individuals.

I remember well how this bit of information met my ears and bore into my brain.  “Testing?” I said to myself incredulously.  “What in blazes does that tell you?”  I have since found out the answer to that question because I had become so disoriented by the unexpected and overwhelming situation in which I found myself that I did my cognate (minored) in Psychological Testing.  Frankly, I didn’t know what else to do my cognate in.

So, when you look at me now almost 20 years after completing my degree, what do you see?  A psychologist who understands what testing is for and how it all works.  I use very few tests with regularity now.  I can approach research in a way that allows me to understand the sleight of hand that gives it meaning.  But, the thing that fascinates me now is the very same thing that has fascinated me since I was a teenager—how can we make something of ourselves as human beings and how can we solve even the seemingly insurmountable problems in our lives.  And I hate to say it, but I still do not consider myself particularly good at testing even though I know how to do it.

 

Lecture 5: The mental health wars: Money Doctors versus Phony Doctors. (Raise your hand if you know anything!)-Part 2

As I entered the Kahuna’s office, I was well aware that my research ideas were too early in their development for me to discuss with him.  Rather, I was told, amidst some snickering, that the meeting was for the Kahuna to get to know me.  I could tell from the smiles that they were questioning whether I would survive the Kahuna’s implacable gaze.

The meeting included three of us—Kahuna, the PSU psychiatrist, and me, the only non-medical person in the room.  Almost immediately upon seating myself, Kahuna shoved a paper at me and asked me in the sonorous Kahuna voice what I thought of its contents.  What he had given me was the first page of an article which contained the abstract of a research study in which two personality tests were structurally analyzed and compared.  Both are still in frequent use today.  As the abstract informed me, the construct “Depression” in each test, which should have been identical or nearly-identical by definition, was shown to be unrelated.  Each measured Depression in a way that was unrelated to the other and, if the construct of their factors was different, meant that they have nothing in common at all.  (If true, these results would undermine the validity of the construct “Depression” in either or both tests, raising questions about both, if not rendering each test useless.) Having read the abstract while the two MDs conversed, I waited for a break in their discussion and the re-focusing of the Kahuna eyeball on me so that I could inquire, “Are you asking me to respond to this?”  Kahuna offered a brief shake of the head, and then returned to his discussion.

(I have since added Kahuna’s abbreviated head shake to my informal list, which is rather extensive at this point, of the number of ways that one can say, F*** you!)

 This long introduction is not to denigrate the person or office of Kahuna, but rather to dramatically illustrate the state of mental health today and show why it is hard to survive in the mental health system, not to mention be successfully treated. 

First, be aware that most, but not all M(oney) D(octors) have little training in research and statistics and that, if they participate in development of medicines at all, their involvement is indirect.  As a result, when physicians review articles, they mostly are looking at abstracts, more specifically at the results, not at the way the research is designed.  It is as if they have no idea that a study’s design can influence outcome or that a design can be so flawed that no question is answered.  The results of such flawed research may in itself be useless, but may nevertheless be published. 

But, Kahuna showed no interest in my thoughts about the abstract nor was he interested in what my years of study in research and statistics informed me about the merits of the abstract he had given me.  Given the easy with which he handed me the abstract, I suspected that he kept several copies in the top drawer of his desk to dispense to psychologists under his supervision as a reminder to them of how irrelevant their profession is, at least to him.  As my imagination was running away with me at that point, I also thought that he must have had a drawer full of multicolored, multi-shaped pills to pull out so that any upstart psychologist might better understand what he or she was truly up against, the entire medical profession and the drug companies. 

Compared to physicians, most psychologists have to take a year of statistics along with classes in research development.  All this to learn methods that may permit light to be shed on a grain of sand that sits somewhere on a beach among other similar grains so that, in the end, a Ph(ony) D(octor) may be eligible to provide some sort of therapy to patients, an exercise which many  psychiatrists see as useless when compared to the more effective pill-swallowing procedure.  The techniques or therapy, even as practiced by a psychologist, is most often just loosely related to anything they may have studied and almost certainly is unrelated to any research they may have done to earn their degree.

“So”, you might ask, “who is better trained?”  I still recall the startling argument rom one of my professors that PhDs were better trained.  He said that Medical Doctors are technicians who study the body, much in the same way that a mechanic fixes on a car, while we Doctors of Philosophy, no matter the field, are trained in the philosophical discipline underlying our area of study and are, therefore, better able to do research and to reveal new knowledge, knowing how to approach a problem progressively, logically, and syllogistically, from x to y to z etc., with greater discipline.

 “So, who is better trained?”  Well, it sort of depends doesn’t it?

For the layperson, almost certainly, it depends on which profession is better positioned politically and who is paid more money.  Ask Kahuna!  If he says psychological testing and research is ridiculous, then there is an entire institution that will follow him in that assertion.  But the best answer is that sometimes Kahuna’s nostrums will work as promised and other times they won’t. However, occasionally something else less intrusive is required, maybe a little sound advice about how to weather an emotional storm or what to look for to make better judgments in order to increase the possibility of Survival. 

If we were all so dependent on pills to manage our moods with the purpose of making us better adapted as survivors, we would never have left the caves, but may still be waiting for extra-terrestrials to deliver our medication on time and in the proper dose so that we may continue in our evolution to our rightful place at the top of the food chain in front of the television.

Lecture 5: The mental health wars: Money Doctors versus Phony Doctors. (Raise your hand if you know anything!)- Part 1

In the late 1990s, this fearless author took work as a psychologist at the Psychiatric Services Unit (PSU) of his local jail, a service that was provided by our State University, through a Federal court order.  (See “Jail as a Psychiatric Emergency Room” in American Jails, September/October 1998.)  It was his job to clinically supervise counselors and social workers in the provision of mental health services to jail inmates.  Services included intake evaluation to insure that mentally ill jail inmates got necessary treatment from the time they were received into the facility until discharge.  It included crisis intervention and counseling in order to minimize risk to inmates and correction officers.  At the beginning of the University’s involvement in PSU, there was some enthusiasm for the new program.  The PSU psychiatrist was especially enthusiastic about doing research among the jail population and he actively encouraged me to think about the kind of research I would like to do.

For those readers who are unaware, research in most fields is typically framed in response to previous research in that field.  To begin a study, a researcher does what is called a literature review, that is, a survey of research that preceded and is relevant to the topic of interest so that previous knowledge can be extended through your efforts.  If you have ever wondered why so much scientific literature, particularly in psychology, seems overly precious, abstract, and not practical, it is because this attention to previous research to formulate future research projects causes researchers to study individual psychology through a lens that is ground in an academic environment rather than in the real world.  After all, that is where scientific literature mostly comes from.  The faculty is required to research (publish or perish!) and graduate students are trained to do research with the idea that they will first join the faculty in their efforts, then replace them.  For this reason, one may think of a university as a research factory.

Perhaps more than in most fields, psychological research is scrupulous in the use of research and statistical controls in order to obtain reliable results in an area of study.  To accomplish this, any investigation must control for the effects of extraneous and random variables.  The problem is, of course, that the researcher is trying to control variables that are in all likelihood represented chaotically in subjects’ brains as a result of daily experiences that have occurred throughout individuals’ lifetimes.  For a researcher, this is almost like a judge directing jurors not to discuss a case during criminal proceedings.  The jurors may comply with the order, but there is an equal likelihood that they will not.  The same is true when applying rigorous research procedures to the chaos of the human brain. 

(I recall, as a young man, being called for jury duty on a celebrated murder case, one that I had not followed in the media, but of which I knew some details.  The judge directed the prospective jurors not to discuss the case as we waited to be called into the courtroom in groups of 12 for voir dire.

 [http://www.legal-explanations.com/definitions/voir-dire.htm] 

Most of us went onto the balcony for air.  Within minutes, I heard someone in our group proclaim with more than a little irritation, “I know he’s guilty!”  So much for the sanctity of the judicial system!  Just think of all those brains laboring under the order of that particular judge.  Then, imagine those same brains laboring under the scrutiny of a researcher trying to follow predetermined procedures to ensure that the influence of extraneous or random factors are controlled or eliminated.)

Despite all this, in response to our psychiatrist’s excitement, I began to think about the kind of research that would be useful and that I would find interesting.  Strangely, I found that my thinking drifted more into the area of economics than psychology.  Specifically, I began to think about jail economics with an eye for how a very restricted economy would affect individual and group decision-making.  My thinking was that, if a comprehensive list of valued commodities in the jail could be derived– for example prescribed and contraband drugs, shanks and other weapons, and sex toys (human and otherwise), for example– and the flow of commodities somehow tracked, that a number of important socio-economic and psychological issues would emerge, including power differentials, affiliations, and community stressors that impact inmate psychology.  In my imagination, this type of information would be useful in doing psychological assessments and providing treatment at the jail.  It may also, according to my thinking, allow rare insight into environmental stressors that could possibly be used to reduce discontent among the inmates and prevent riot.

The idea, I knew, was creative and was likely not doable.  But, as I thought, the attempt alone would be useful in uncovering important variables that contribute to the uniqueness of the jail community and that influence the various psychologies of inmates, officers, and staff, everyone in the jail community.  As I was lost in contemplation of how I would proceed with this innovative research topic, the psychiatrist said that I had to meet the Great Kahuna, the feared psychiatrist who supervised him and ultimately the entire PSU project.

NEXT:  The mental health wars: Money Doctors versus Phony Doctors. (Raise your hand if you know anything!)- Part 2.  Meeting the Great Kahuna