Saturday, 24 February 2007

Living a contradiction

Another review in today's Guardian, this one by Hilary Mantel. I'm very pleased that she notes "This is not a doctor-bashing book". I also like the way our book is reviewed together with an account by the Canadian novellist Jan Lars Jensen of an episode of mental illness he suffered.
As he feels his way back to reality, he takes charge of his own narrative again, a walking illustration of Leader and Corfield's thesis that healing occurs most readily when a patient can patch together his own story.
This points to perhaps the major target of our criticism in the book - a simplistic psychology of personality traits.

As I've note in an earlier post, the problem is not that psychosomatic research has disappeared. Far from it. An enormous number of papers are printed each year, the physiological ones providing great insight into the mechanisms underlying the mind-body relation. What we object to are the psychological models employed in the search for correlations between characteristics of people and types of ill health. These models see a human in terms of a list of traits. Each of us is captured by a series of numbers: how lonely, how time-anxious, how compliant to other's wishes, how many severe life events we've experienced, how emotionally close we were to our parents, how loving a relationship we are in, how able we are to name our emotional state, and so on. Having measured a few of these traits in a sample of subjects, and then perhaps made them undergo the 'same' experience (hug partner, give a speech, perform mental arithmetic in public,...), a physical measurement is then made (ability of blood vessels to dilate, activity of natural killer immune cells, cortisol levels,...) and correlations sought.

So what's wrong with this? Well, we believe that viewing people as lists of traits is wrong-headed. To put things as succintly as possible, what is required is that we attend to the contradictions in people's lives. Against the idea of a constant trait, we may find that a person's incompatible identifications make them behave differently according to the situation they are in.What they display in the experimental situation may be telling the scientists about only one small facet of their subject. But this idea of a tension or conflict goes deeper, and only emerges over a lengthy engagement with a person.

Let me illustrate one of these tensions by returning to Freud. In 'On the Universal Tendency to Debasement in the Sphere of Love', he discusses the problem caused by the impossibility for many men of having the "affectionate" and the "sensual" currents directed towards the same person. They cannot then both love and desire the same woman.

But we can go back further to Plato for a representation of the problem of competing demands. In The Republic Book VIII, Socrates is explaining how a city state descends fom the perfect form to a lesser one. He does so in parallel with a description of the formation of less than perfect individuals. Here is his explanation of the creation of a 'timocratic' citizen.
His origin is as follows: --He is often the young son of a grave father, who dwells in an ill-governed city, of which he declines the honours and offices, and will not go to law, or exert himself in any way, but is ready to waive his rights in order that he may escape trouble.

And how does the son come into being?

The character of the son begins to develop when he hears his mother complaining that her husband has no place in the government, of which the consequence is that she has no precedence among other women. Further, when she sees her husband not very eager about money, and instead of battling and railing in the law courts or assembly, taking whatever happens to him quietly; and when she observes that his thoughts always centre in himself, while he treats her with very considerable indifference, she is annoyed, and says to her son that his father is only half a man and far too easy-going: adding all the other complaints about her own ill-treatment which women are so fond of rehearsing.

Yes, said Adeimantus, they give us plenty of them, and their complaints are so like themselves.

And you know, I said, that the old servants also, who are supposed to be attached to the family, from time to time talk privately in the same strain to the son; and if they see any one who owes money to his father, or is wronging him in any way, and he falls to prosecute them, they tell the youth that when he grows up he must retaliate upon people of this sort, and be more of a man than his father. He has only to walk abroad and he hears and sees the same sort of thing: those who do their own business in the city are called simpletons, and held in no esteem, while the busy-bodies are honoured and applauded. The result is that the young man, hearing and seeing all these thing --hearing too, the words of his father, and having a nearer view of his way of life, and making comparisons of him and others --is drawn opposite ways: while his father is watering and nourishing the rational principle in his soul, the others are encouraging the passionate and appetitive; and he being not originally of a bad nature, but having kept bad company, is at last brought by their joint influence to a middle point, and gives up the kingdom which is within him to the middle principle of contentiousness and passion, and becomes arrogant and ambitious.
The exploration of lived contradictions is what takes place in psychoanalysis.


Andy said...

I need to think a bit more about what you have said. In the meantime, a short response.

Self-report questionnaires are, I think, interesting if one views them the right way. They're not a list of traits, predicates P of an individual i, such that you get a set P1(i) and P2(i) and ... and ... Pn(i). A more accurate story, and something which perhaps could be stuck at the top of questionnaires, is:

"We want you to tell us how you view yourself. Since we want to collect a lot of data about many people, we have to do this using a tick-box questionnaire. Sorry."

You then get a list

"i says that i believes Pk(i), at the time of completing the questionnaire" for each Pk of interest.

Interpersonal Perception by Laing, Phillipson and Lee (1966, pps. 49-72) develop an epistemic logic ("he thinks she thinks he thinks..." type stuff) and use it to construct a questionnaire about dyadic relationships. I think this is a step in the right direction, but sadly I haven't found anything which takes it any further. Do you have any ideas?

Now maybe the problem you have with questionnaires is how they are scored. If so, I share your concerns. I can't imagine characterising a mathematical space by the number of predictates (which I've chosen) that are true of it.

david said...

I should start by giving questionnaires their due in this field of medical psychology. That how much a (Hungarian) man agrees with the statement

"People are generally dishonest and selfish and they want to take advantage of others."

is a more important predictor of early death among men than smoking is surely surprising. It shows that a questionnaire is able to detect something highly relevant to health.

One would think that it was only picking up a person's willingness to appear distrustful. But still, the onus should then be on those who find such questionnaire measurements limited to devise something with greater predictive power.

Before the decline of the older style of psychosomatic medicine there were attempts to predict which disease a patient had from transcripts of interviews concerning their emotional life. With any reference to the condition removed, Franz Alexander and his team could significantly outperform doctors, based on his ideas about a correlation between types of conflict and illness.

It would be interesting to attempt this kind of research again. James Lynch in his book 'Broken Heart' spoke of a kind of idiom to be heard amongst heart patients, and imagined different idioms would be found in different departments. Nick Read, author of 'Sick and Tired', a former gasteroenterologist turned psychotherapist, remarked to me that the emotional language of his patients correlates with their gut complaint.