Everything you always wanted to know about self-esteem but were afraid to ask

Apart from problems that are biological in origin, I cannot think of a single psychological difficulty – from anxiety or depression, to fear of intimacy or of success, to alcohol or drug abuse, to underachievement at school or at work, to spouse battering or child molestation, to sexual dysfunctions or emotional immaturity, to suicide or crimes of violence – that is not traceable to poor self-esteem. Of all the judgments we pass, none is as important as the one we pass on ourselves. Positive self-esteem is a cardinal requirement of a fulfilling life.  Nathaniel Branden

Nothing builds self-esteem and self-confidence like accomplishment. Thomas Carlyle

Homework is bad for my self-esteem. It sends the message that I don’t know enough! So instead of trying to learn, I’m just concentrating on liking myself the way I am. Calvin and Hobbes

 

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I blame George Benson. Now I have nothing against the American musician, a ten-time Grammy Award winner. But he did sing The Greatest Love of All, which proclaimed that learning to love yourself is the greatest love of all.  It became an anthem of the self-esteem movement, which emerged in the 1970s. The movement’s practitioners proclaimed that low self-esteem was the cause of myriad psychological and societal problems. Increasing self-esteem would bring more successful, happier, balanced people. But the benefits would go way beyond this. Some of the more outlandish claims came from John Vasconcellos, a leading Democrat in Californian politics. He had a lifelong interest in psychology and championed the self-esteem movement in the Golden State. He proposed the State Task Force to Promote Self-Esteem in October 1986. He argued that it would help with problems such as crime, teenage pregnancy, drug abuse, school underachievement and pollution. He even floated the idea that it would help balanceCalifornia’s budget as people with high self-regard earn more than others and thus pay more in taxes. These are important claims, but is there any basis for them?

First we need to define our terms. In psychology, the term self-esteem is used to describe a person’s overall sense of self-worth or personal value. Psychologists distinguish between two forms of self-esteem: Trait self-esteem reflects how good you feel about yourself in general or on average, and state self-esteem, which involves how you feel about yourself at any particular moment in time.

Low self-esteem is often linked to undesirable behaviours and emotions. People with low self-esteem tend to be more dishonest and are more likely to engage in criminal activity. They are more like likely to fail in life. Just about every negative psychological condition you can name is more common among people with low self-esteem. On the other hand people with high self-esteem are more likely to be happy with their lives and less likely to become depressed, anxious or worried. What’s more they are better educated and have more successful careers.

After establishing a working definition of self-esteem I now want to challenge some widely-held beliefs. EVERYTHING YOU THINK YOU KNOW ABOUT SELF-ESTEEM IS WRONG! Contrary to the popular view, there’s almost no evidence that self-esteem actually causes anything. Years of research show that low self-esteem does not appear to cause the negative outcomes that have been associated with it. Nor does high self-esteem appear to cause the positive outcomes. Correlation does not mean causation and the self-esteem movement has got the causation the wrong way round. Self-esteem is usually the result of these outcomes and not the cause. Low self-esteem doesn’t cause depression; the life events that cause depression also often provoke low self-esteem.

Dr. Mark Leary, of Duke University has applied evolutionary psychology to turn conventional wisdom about self-esteem on its head. His central insight is that self-esteem does not exist in a bubble. Leary, director of the Social Psychology Program at Duke, is behind the concept of sociometer theory, which sees self-esteem as an internal, psychological meter that monitors the degree to which a person is being valued and accepted by the people around him. Being accepted has evolved as a universal human need. In our time as hunter gatherers anybody who was rejected by the group would have had a very difficult time surviving. Social rejection was often a death sentence. Because of this, we are highly attuned to the degree that other people accept or reject us. If we feel we are being valued and accepted by those around us our self-esteem also increases. However, if we get negative feedback, our self-esteem falls. Self-esteem is like a petrol gauge; it moves up and down depending on changes in perceived acceptance and rejection.

What should we be doing about the level of self-esteem in society? Self esteem is a by-product of a balanced life and not an end in itself. And if self-esteem is merely a by-product, trying to promote it in a vacuum will simply not work. What we need to avoid is trying to increase people’s self-esteem artificially—to build them up and make them feel that they are more socially acceptable than they actually are. If your petrol gauge says you are running out of petrol, then you need to fill up the tank. You don’t want to move the gauge to the right if you haven’t actually put any petrol in the tank. People who view themselves more positively than they should, become confused and angry when they discover that the rest of the world just doesn’t recognize their wonderfulness. It makes them less receptive to improving themselves. We may be a creating is a narcissistic generation with an inflated sense of their worth and importance.

The most widely used measure of narcissism in social psychological research is the Narcissistic Personality Inventory. It consists of forty pairs of statements. You have to  choose the one that best matches you, even if it’s not a perfect fit. Here are some examples:

• The thought of ruling the world frightens the hell out of me. / If I ruled the world it would be a better place.
• I insist upon getting the respect that is due me.  / I usually get the respect that I deserve.
• I like to look at myself in the mirror. /  I am not particularly interested in looking at myself in the mirror.

According to San Diego State University psychologist Jean Twenge, university students today are more narcissistic and self-centred than a generation ago. The study shows that scores on the Narcissistic Personality Inventory have been rising steadily risen since the test was first introduced 30 years ago. The researchers believe the phenomenon goes back the rise of the self-esteem movement. And now with Facebook, Twitter etc we have more channels available.

Narcissism can actually foment social problems. Jean Twenge, author of Generation Me: Why Today’s Young Americans Are More Confident, Assertive, Entitled–and More Miserable Than Ever Before and The Narcissism Epidemic highlights the dangers of this:

“Narcissism causes almost all of the things that Americans hoped high self-esteem would prevent, including aggression, materialism, lack of caring for others, and shallow values. In trying to build a society that celebrates high self-esteem, self-expression, and ‘loving yourself,’ Americans have inadvertently created more narcissists—and a culture that brings out the narcissistic behaviour in all of us.”

Education has been an area where the ideas about self-esteem have been implemented. The dominant idea was that there had to be prizes for everyone and that competition was bad.  Not only did self-esteem-based educational methodologies fail to produce excellence, they actually undermined it.

I am not arguing against self-esteem, but against the bogus claims that have been made about it over the last few decades. Bombarding kids with positive messages is not a solution. It’s necessary to focus on the real causes of people’s problems and not artificially increase their self esteem. People function best when they have a more realistic view of their strengths and weaknesses, Once again we see the law of unintended consequences – a measure producing the opposite results to those intended. I don’t think we need to follow the example of those Chinese tiger moms. But we need to recognise that this obsession with promoting self-esteem has singularly failed to deliver what it promised.

He had five personalities and they were all boring!

A sceptical take on multiple personality disorder.

This week I’m going to be looking at multiple personality disorder. Actually it’s no longer called that, but I’ll go into that later. The title of my piece comes from a quip I heard from a university professor talking about someone suffering from the condition. The idea that a rare mental illness in which multiple personalities can coexist within one person is one that has captured the public’s imagination. In 1957 Joanne Woodward won the Academy Award for Best Actress for her performance in the film The Three Faces of Eve, making her the first actress to win an Oscar for portraying three different personalities. Woodward, who was at the time a relative unknown in Hollywood, would later go on to play Dr. Cornelia Wilbur in Sybil, another movie about multiple personality disorder. Sybil, played by Sally Field, had no less than 13 personalities, including two male ones – Mike and Sid. The film was based on a book from 1973 by Flora Rheta Schreiber, which became a publishing phenomenon, selling some 6 million copies around the world.

Shirley Ardell Mason, who was the inspiration for Schreiber’s book, was born and grew up in Dodge Center,Minnesota. She came from a strict Seventh-day Adventist family. Her psychotic mother had allegedly sadistically abused her when she was growing up. This mistreatment had caused her consciousness to split into many different personalities to hold the trauma, so that she wouldn’t be aware of it. She decided to seek psychiatric help and she became a patient of Dr. Connie Wilbur, a Freudian psychiatrist who had a special interest in multiple personality disorder.

Once Mason had been diagnosed with MPD, she started generating more and more personalities including babies, little boys, and teenage girls. Mason probably wasn’t faking it – she was highly suggestible, and was giving Wilbur what she wanted. Wilbur began injecting Mason regularly with sodium pentothal, which at that time was used to help people remember traumatic events that they had repressed. Under the influence of drugs and hypnosis, the very suggestible Mason uncovered more and personalities.

IN 1958 Mason tried to retract what she had said. But it was too late. Wilbur had too much at stake. The doctor used the rationale that her patient was in denial about her problems. Wilbur had too much invested in her theories and Mason’s mental illness.

When people began to recognize her as the patient portrayed in the book, Mason left West Virginia and moved to Lexington,Kentucky, to be near Wilbur. There she taught art classes at a community college and set up a gallery at her house. Mason cared for Dr. Wilbur during her cancer until her death in 1992. Mason herself died at home of breast cancer in 1998, at the age of 75.

So what is multiple personality disorder?  As I said before, we no longer use the term. In 1994, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) it was rebranded as Dissociative Identity Disorder – DID. The rationale behind the name change was to emphasize the importance of changes to consciousness and identity rather than personality.

DID is a personality disorder in which a person has more than one discrete, separate identity. Each identity is unique, and has its own sets of memories, ideas, thoughts, ways of thinking, and purposes. The alter identities are completely unaware of the other identities, and switches between identities usually occur within seconds. The alters vary hugely both across and within individuals. The number of alters has been reported to range from one to hundreds or even thousands; one clinician reported a case of a patient with 4,500 alters. Only 200 cases of dissociative identity disorder could be found prior to 1979, whereas in 1999, more than 30,000 cases had been reported. One misconception which I would like to lay to rest is MPD is in any way connected to schizophrenia. People with schizophrenia do not have multiple personalities. They suffer from “a breakdown in the relation between thought, emotion, and behaviour, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.” Its most frequent manifestations are auditory hallucinations, paranoid delusions, and disordered speech and thinking.

While at the beginning dissociative identity disorder had many converts, in recent years growing scepticism has emerged. There are a number of reasons that have provoked this scepticism:

The dramatic epidemic in DID cases is I fear not the result of improved techniques in diagnosis and assessment, but from the actions of the therapists and the increased media attention. I am not arguing that DID patients have nothing wrong with them. There is strong evidence that many patents diagnosed with DID entered psychotherapy with psychological difficulties,. But it is the psychotherapists who have generated and maintained DID. Many of the patients had no memory of sexual abuse upon entering therapy. Only after the therapist encourages the patient, did memories of sexual abuses emerge. The late Nicholas J Spanos, a prestigious psychologist, was a DID sceptic. He argued that “patients learn to construe themselves as possessing multiple selves, learn to present themselves in terms of this construal, and learn to reorganize and elaborate on their personal biography so as to make it congruent with their understanding of what it means to be a multiple.”

Nowadays few of us would invoke demonic possession in order to explain such phenomena as epilepsy, brain damage, genetic disorders, neurochemical imbalances, or hallucinations. Yet, not too long ago, this would have been the explanation. What’s more there were experts who were able to identify these cases and exorcise the victims.  We know now that the possessed and those who “cured” them were enacting social roles. Of course to them it was all very real. What we seem to be seeing now is the latest incarnation of demonic possession.

Basic research into human memory has not uncovered any mechanism for repression and recovery of traumatic memories during childhood. The idea that memories can be recovered has been shown to have no scientific basis. Indeed it is extremely dangerous. It is incredibly easy to implant false memories. If you have a vulnerable patient, the inappropriate use of hypnosis can foster convincing pseudomemories for events that never occurred. Psychologists have implanted memories of past lives, UFO abductions satanic rites and sexual abuse. Parents have been arrested and sent to prison for abusing their children on the basis of these supposedly recovered memories. Of course childhood sexual abuse is very real, but these cases of recovered memories are based on completely unscientific methods.

But even if we assume that all the claims of abuse are true, there is a fundamental flaw in the claim that childhood trauma causes DID. If this were the case, the abuse of millions of children over the years would have caused many cases of DID. One obvious example would be the children who were brutalised by the Nazis in ghettoes, trains, and concentration camps all over Europe. However, no evidence exists that any developed it.

A cynic would argue that that this is another example of the psychology industry and its afan for manufacturing victims. Remember psychology critic Tana Dineen’s maxim: PERSON = VICTIM = USER/PATIENT = PROFIT. I have no doubt that economic incentives play a significant role but I think there is more to it than that. A crucial lesson is that beliefs can help to shape reality. Psychotherapists must therefore be aware of the possibility that their therapeutic practices may unwittingly worsen and perhaps even create psychological disorders in their patients.

Sum: a short story by David Eagleman

One of my favourite books of the last few years has to be David Eagleman’s Sum: Forty Tales from the Afterlives. Eagleman a neuroscientist by day has produced a fascinating collection of speculative fiction,  forty short stories which explore a wide variety of possible afterlives.  The title of the book, Sum comes from the Latin for “I am,” as in “Cogito ergo sum.” Here is the first story, which is also called Sum:

________

In the afterlife you relive all your experiences, but this time with the events reshuffled into a new order: all the moments that share a quality are grouped together.

You spend two months driving the street in front of your house, seven months having sex. You sleep for thirty years without opening your eyes. For five months straight you flip through magazines while sitting on a toilet.

You take all your pain at once, all twenty-seven intense hours of it. Bones break, cars crash, skin is cut, babies are born. Once you make it through, it’s agony-free for the rest of your afterlife.

But that doesn’t mean it’s always pleasant. You spend six days clipping your nails. Fifteen months looking for lost items. Eighteen months waiting in line. Two years of boredom: staring out a bus window, sitting in an airport terminal. One year reading books. Your eyes hurt, and you itch, because you can’t take a shower until it’s your time to take your marathon two-hundred-day shower. Two weeks wondering what happens when you die. One minute realizing your body is falling. Seventy-seven hours of confusion. One hour realizing you’ve forgotten someone’s name. Three weeks realizing you are wrong. Two days lying. Six weeks waiting for a green light. Seven hours vomiting. Fourteen minutes experiencing pure joy. Three months doing laundry. Fifteen hours writing your signature. Two days tying shoelaces. Sixty-seven days of heartbreak. Five weeks driving lost. Three days calculating restaurant tips. Fifty-one days deciding what to wear. Nine days pretending you know what is being talked about. Two weeks counting money. Eighteen days staring into the refrigerator. Thirty-four days longing. Six months watching commercials. Four weeks sitting in thought, wondering if there is something better you could be doing with your time. Three years swallowing food. Five days working buttons and zippers. Four minutes wondering what your life would be like if you reshuffled the order of events. In this part of the afterlife, you imagine something analogous to your Earthly life, and the thought is blissful: a life where episodes are split into tiny swallowable pieces, where moments do not endure, where one experiences the joy of jumping from one event to the next like a child hopping from spot to spot on the burning sand.

Three more thought experiments

I am a big fan of though experiments and in the past I have done a couple of posts about them: 1, 2. Here are three more:

Adventures in time travel

My first experiment actually comes from one of my students. Imagine you can travel back in time to the municipality of Braunau am Inn in Austria.  It is October 1889 and before you a young baby, Adolf Hitler, is sleeping peacefully. Would you pick up a pillow and quietly smother the infant. There are those who would make he case that murder is always wrong, especially if the victim is a baby. However, you would certainly save the world a lot of grief. Or would you? If we replayed Hitler’s life again would the result be exactly the same? Maybe worse things would have happened if Hitler had never been born. I will come back to Hitler soon but now I want to look at time travel itself.

Time travel presents a lot of hard questions. Indeed, it is the subject of a famous thought experiment known as The Grandfather Paradox. It was raised by René Barjavel in his 1943 book Le Voyageur Imprudent. In it Barjavel proposes that time travel is impossible. It goes like this:

Let’s say you travel back in and kill your biological grandfather before he has met your grandmother. Consequently your parents, and by extension you yourself would never been conceived. This would imply that you could not have travelled back in time after all, which means your grandfather would still be alive, and you would have been conceived allowing you to travel back in time and kill your grandfather. Each possibility seems to imply its own negation, creating a logical paradox. Despite the name this paradox is not exclusively about grandfathers. Rather it makes the case any kind of time travel is logically impossible. You could use scientific knowledge to invent a time machine, then go back in time and impede a scientist’s work that would eventually lead to the very information that you used to invent the time machine. And there is a specific variation on the Grandfather Paradox, autoinfanticide, in which you go back in time and kill yourself as a baby. This, of course, is a rather morbid, and potentially dangerous, thing to do. So please don’t try it at home.

So let’s go back to Herr Hitler because this kind of scenario is affected by the Grandfather Paradox. You actually manage to kill him. And although this is highly debateable, WWII is averted and millions of lives are saved. You are now faced with a temporal paradox: without the holocaust and the carnage of 1939-45, you will have no reason to go back in time and kill Hitler, so you don’t. This means Hitler will live, and millions will die in the world war and extermination camps. Consequently you will have to go back in time and kill Hitler… you get the idea.

Thomas Nagel’s bats

In 1974 philosopher Thomas Nagel published a famous article in Philosophical Review – What Is it Like to Be a Bat?  You may be thinking that Nagel had taken too much  LSD, but it is actually a fascinating experiment. Nagel argued that it is impossible for us to know what a bat feels. He was not referring to the sensations of being short-sighted, eating bugs, hanging upside-down in a cave with our mates. That would be describing what it would be like for US  to be bats.

Nagel was looking at how bats perceive the world. First we need to look at their   language, which consists of squeaks and cries. Nagel wasn’t interested in the public language they use to communicate with other bats. What he was interested in is their inner language. As far as we know bats do not possess an inner language that uses linguistic concepts. Secondly there is echolocation, those squeaks they emit work like radar, letting them know the location of objects. Humans have no comparable sensual experience. How can we possibly imagine what this is like?  What Nagel was arguing was that their sensory inputs give them a subjective experience that we are incapable of imagining.

The purpose of Nagel’s piece was not to look at the inner lives of bats, fascinating though that may be.  Nagel was using bats as a way of meditating on the mind-body problem. This is one of those intractable problems that philosophers love and the relationship between mind and brain has exercised them for centuries. How can something physical give rise to the subjective experiences of minds. Nagel wants to say that we may be good at describing how neurons fire off, but we are incapable of explaining consciousness itself. Science is good at describing things objectively. But Nagel believes there is something subjective that does not lend itself easily to scientific analysis. Nagel argues that consciousness has an essentially subjective character, a what it is like aspect:

“It seems unlikely that any physical theory of mind can be contemplated until more thought has been given to the general problem of subjective and objective.”

He is not anti-science nor is he a dualist, but he is anti-reductionist. He believes that we need to appreciate the fact that the whole is perhaps greater than the sum of its parts. I am a bit of a pessimist as to whether we’ll ever be able to understand such a fundamental question  Maybe our mind is just too limited a tool and the question too difficult.

A Picasso on the beach

This one I got from Julian Baggini’s The Pig That Wants To Be Eaten:

Roy looked down from the cliffs at the man drawing in the sand. The picture that started to emerge startled him. It was an extraordinary face, not realistically rendered, but seemingly viewed from many angles at once. In fact, it looked much like a Picasso. As soon as the thought entered his mind, his heart stopped. He lifted his binoculars to his eyes, which he then felt compelled to rub. The man on the beach was Picasso.. Roy’s pulse raced. He walked this route every day, and he knew that very soon the tide would sweep in and wash away a genuine Picasso original. Somehow, he had to try to save it. But how? Trying to hold back the sea was futile. Nor was there any way to take a cast of the sand, even if he had had the time he was actually so short of. Perhaps he could run back home for his camera. But that would at best preserve a record of the work, not the picture itself. And if he did try this, by the time he got back, the image would probably have been erased by the ocean. Perhaps then he should simply enjoy this private view as long as it lasted. As he stood watching, he didn’t know whether to smile or cry.

The basis for Baggini’s experiment was a short story by Ray Bradbury, In a Season of Calm Weather. Its main character George Smith is taking a holiday in France. Smith is captivated by the work of Pablo Picasso. When he learns that the artist is visiting friends in a small fishing town only a few miles away, he is ecstatic. He secretly dreams of meeting the great artist and talking with him. One day late in the afternoon he is alone on the beach and he goes for a final walk. He spies an old man walking along the darkening shore, all alone. The man picks up a stick from the ground and begins to draw. Smith approaches him and on seeing the drawings he realises that this old man  is Picasso and he begins to tremble and he is incapable of articulating a word. It is then that the awful truth dawns on him – the tide is about to come in, and these works of art will be lost forever. He doesn’t have time to go back to the hotel to get his camera. There is no point trying to pick up a shovel to save a chunk of the crumbling sand? And it would be futile to find a workman to make a mould with plaster of Paris. As Picasso walks away I’ll let Bradbury take up the story:

George Smith stood looking after him. After a full minute he did the only thing he could possibly do. He started at the beginning of the fantastic frieze of satyrs and fauns and wine-dipped maidens and prancing unicorns and piping youths and he walked slowly along the shore. He walked a long way, looking down at the free-running bacchanal. And when he came to the end of the animals and men he turned around and started back in the other direction, just staring down as if he had lost something and did not quite know where to find it. He kept on doing this until there was no more light in the sky or on the sand to see by.

He then goes back to the hotel, but he doesn’t tell his wife of his encounter with genius.

There are a number of themes in this story. We have the fleeting nature of beauty, sometimes we try to capture it, but the best thing is to enjoy the moment. I often think about this when looking at a work of art. This summer when we were at the Courtauld Institute in London they were filming the visitors as they looked at the paintings. It would be interesting to discover the results of the experiment.

Can a work of time last for ever? We can make a distinction between the performative and the plastic. When you see a ballet or a concert you realise that you have to accept that what you are seeing or listening has to be appreciated in the moment. You can watch a recording, but you will never recreate the exact experience. But the plastic arts are not guarantee of permanence either. I have always been intrigued by ice sculptures. Why would someone put so much time and effort into something so ephemeral? Even a painting is not immune to this as pigments age.

Baggini argues that our desire to preserve art is a form of denial about our own mortality. Artists are seeking a form of proxy immortality through their oeuvre. It reminds me of the Shelley poem Ozymandias which I featured a few weeks ago in a post about architecture. Its central theme, the inevitable decline of everything that the Egyptians thought they had created for posterity, is pertinent to this discussion. There is something very poignant about a post-human world in which works of art remain but with no one to appreciate them. If we accept that nothing is immortal, we should be able to see that the value of both art and life itself is to be found: in experiencing them.

Two philosophy thought experiment videos

Here are a couple of videos that accompany this week’s post:

The first is from the Open University. 60-Second Adventures in Thought features the voice of actor, writer and comedian David Mitchell:

The second is an animated film A Picasso on the Beach. It was made by Greg Neri with music by Chick Corea:

Ice cream cones, frozen chickens and the meaning of disgust

Disgust, one of our most basic emotions, is fundamentally a biological adaptation which helps us to keep away from ingesting substances that could make us sick or even kill us – faeces, vomit, phlegm, blood, urine and rotten meat are universally seen as disgusting because they contain harmful toxins. One gram of human faeces can contain 100 million viruses and over a million bacteria. Steven Pinker has called this “intuitive microbiology“. Disgust is apparently unique to humans.  I do perhaps have an unhealthy interest in this subject – this summer I took my family to an exhibition, Dirt: the filthy reality of everyday life, at the Wellcome Collection in London. If you feel so inclined, you can see the exhibition here.

Some of our disgust is hard-wired – when disgust first emerges in young children, at the age of around three, it is a consequence of brain maturation, not early experience or cultural teaching. Disgust can also be learned, because while some things are universally dangerous, others vary according to the environment. A fascinating area is that of food taboos; one man’s meat is another man’s poison. Indeed animal flesh is especially susceptible to environmental pressures. Pork is the classic example. In the climate of the Middle East eating it was dangerous. Thus a religious taboo prohibiting it emerged both among Jews and Arabs. At least they can agree on that! Of course this taboo then takes on a life of its own. With modern refrigeration it is perfectly okay to eat pork anywhere in the world. However the taboo remains.

If disgust were limited to gastronomy it would more of a curiosity and it would have less social relevance. But, there has been what is known as an exaption. This is when a trait that evolved because it served one particular function, comes to serve another. They occur in anatomy; Bird feathers are a classic example: initially these may have evolved for temperature regulation, but later were co-opted for flight. And exaptions occur in behaviour. In this case disgust has entered the realm of morality. MRI studies have shown that lying, cheating, and stealing, behaviours that may threaten group cohesion or co-operation, activate areas in the brain associated with disgust. And these days there seems to be a lot of indignation going around.

Whenever I read about moral disgust two scenarios, involving incest and frozen chickens, often seem to crop up. There is an online survey called Taboo, which asks you to judge a number of controversial moral scenarios including these two:

Sarah and Peter were brother and sister. They were on vacation together away from home. One night they were staying alone in a tent on a beach. They decided it would be fun to have sex. They were both over 21. They had sex and enjoyed it. They knew that for medical reasons Sarah could not get pregnant. They decided not to have sex with each other again, but they never regretted having had sex once. In fact, it remained a positive experience for them throughout their lives. It also remained entirely their secret (until now!).

A man goes to his local grocery store once a week and buys a frozen chicken. But before cooking and eating the chicken, he has sexual intercourse with it. Then he cooks it and eats it. He never tells anyone about what he does, never regrets it and never shows any ill effects from behaving this way. He remains an upstanding member of his community.

Both scenarios involve no harm to its practitioners and third parties are not hurt. I won’t go into the chicken for now, but the first scenario is a particularly thorny question. The incest taboo is a human universal, which is so powerful it goes beyond blood relations. I am referring to the Westermarck effect, or reverse sexual imprinting. This kicks in when two people who live in close domestic proximity during the first few years in the lives of either of them become incapable of feeling sexual attraction. This phenomenon, first described by the Finnish anthropologist Edvard Westermarck, has been observed in many places and cultures, such in the Israeli kibbutz system.  In kibbutzim children are raised communally in peer groups, based on age, and not biological relation. One study showed that out of the nearly 3,000 marriages that occurred across the kibbutz system, only fourteen were between children from the same peer group. And of those fourteen, none had been reared together during the first six years of life.

How do we explain these taboos to ourselves? Jonathan Haidt, a professor of psychology at the Universityof Virginia, coined the term moral dumbfoundedness to describe our reactions. He found that when presented with these scenarios people give a reason. When that reason is stripped from them, they will find another one. When the new reason is stripped from them, they bring up another one. Only when they run out of reasons will they admit defeat – “I don’t know; I can’t explain it; it’s just wrong.” This is moral dumbfoundedness.

There is a school of thought that believes that deep-seated revulsion should be seen as a sign that an activity is intrinsically harmful or bad. One proponent of this view is Leon Kass, who was chairman of President George W. Bush’s commission on bioethics. He argues that while disgust is not an argument, “In some crucial cases, however, it is the emotional expression of deep wisdom, beyond wisdom’s power completely to articulate it.” This is the wisdom of repugnance. This way of thinking has important practical implications: Kass argues that the idea of human cloning is disgusting, and therefore should be banned. Having said that, he also thinks that eating ice cream cones undermines our dignity:

“Worst of all from this point of view are those more uncivilized forms of eating, like licking an ice cream cone… This doglike feeding, if one must engage in it, ought to be kept from public view, where, even if WE feel no shame, others are compelled to witness our shameful behaviour.” What Freud would have made of this quote, I shudder to think. I don’t like psychobabble but this man definitely has some “issues”

While I am in favour of spontaneous order and organic change, I find Kass’s arguments unconvincing. I am especially worried about the danger of false positives. History is littered with examples of groups and individuals being considered disgusting. Philosopher Martha Nussbaum has critiqued disgust-based morality because it can become a justification for persecution of out-groups:

“Throughout history, certain disgust properties – sliminess, bad smell, stickiness, decay, foulness – have repeatedly and monotonously been associated with Jews, women, homosexuals, untouchables, lower-class people – all of those are imagined as tainted by the dirt of the body“.

Male homosexuals have been a traditional target and not just in the past. In From Disgust to Humanity, Nussbaum, a prominent professor of law and philosophy at the University of Chicago, explains that much of the political rhetoric around gay rights is bound up in the language of disgust, with words like vile, revolting, contaminate and defile being the currency.  In crude terms, much of the anti-gay argument is bound up in faeces and saliva, germs, contagion and blood. You may think that Nussbaum was exaggerating, but in the United States gay rights can inspire a very visceral response.  At a recent state Judiciary Committee meeting the New Hampshire state Representative, the Republican, Nancy Elliott, decided to enlighten us with her views on homosexuality. During a debate on a proposal to repeal the state’s same-sex marriage bill, she described anal sex “taking the penis of one man and putting it in the rectum of another man and wriggling it around in excrement.” You can see the video here.

The bottom line is that it is impossible to find a correlation between what disgusts us and any moral norms. If only it were that simple! As we have seen reactions of disgust often have their origin in our most atavistic prejudices. The more I look into the origins of morality, the more confused I get. Well that’s enough pontificating for today. I fancy a bite to eat. Kentucky Fried Chicken followed by a Cornetto would seem to fit the bill.

By coincidence Jonathon Haidt has a piece about the Wall Street protests at reason.com: The Moral Foundations of Occupy Wall Street.

Five famous psychological experiments #2

Last year I did a post about five famous psychology experiments. Here is another selection:

Blind to the unexpected

In 1999 cognitive psychologists Daniel Simons and Christopher Chabris came up with the so-called “invisible gorilla” test. Their volunteers had to watch a one-minute video where two groups of people — half dressed in white, the other half in black — are passing basketballs around. The volunteers were told to count the passes among players dressed in white shirts while ignoring the passes of those in black. During the video, a woman in a gorilla suit walked into the centre of the frame, pounded her chest and then walked off.  It would seem to be the most obvious thing in the world. However, about half the people missed it. This effect is known as inattentional blindness. When you are focussing on one activity you can become blind to the unexpected. Last year they repeated the study; they wanted to see if the people who had heard about experiment would notice other unexpected events in a new video. Like the first time those who hadn’t seen it had a 50% success rate. As you would expect, all 23 of the experimentees who knew about the original experiment saw the gorilla but only 17% saw one or both of the new unexpected events – the curtain changing colour and one player on the black team leaving the game. You may find this experiment trivial, but one done by NASA using commercial pilots with thousands of hours of flying experience in a state-of-the art flight simulator is more worrying. During a simulated landing in foggy conditions some of the pilots failed to notice a jet parked on the runway!

Clairvoyant rats and pigeons

Last week I wrote about the unreliability of expert predictions. There are experiments that show that animals can do better than humans some times. I’m not referring to Paul the Octopus, who was able to correctly predict the winner of each ofGermany’s seven matches in the 2010 World Cup, as well as the result of the final. In this case it was rats and pigeons. The experiment involved researchers flashing two lights, one green and one red, onto a screen. However, the exact sequence was kept random. The rats and pigeons were quick to discover that the optimum strategy was to always go for green, guaranteeing an 80 percent hit rate. Humans, on the other hand, tried to see a pattern where there was none and only achieved 68% success. What’s more they would persist in the erroneous strategy even after they had been told that the flashing lights were random. Another study with Yale students produced similar results; they couldn’t accept 40% error, so they ended up with almost 50%.

Frightening Little Albert

Behaviourist John Watson believed, following the principles of classical conditioning, that he could condition a child to fear a stimulus which normally would not be frightening. The subject of the study was a nine–month old baby called Albert. At the beginning of the experiment Little Albert was exposed, to a white rat, a rabbit, a dog, a monkey, masks with and without hair and burning newspapers among other things. During this phase Little Albert showed no fear toward any of these items. In later trials, Watson and his assistant Rosalie Rayner made loud sounds behind Albert’s back by striking a long steel pipe with a hammer when the baby touched one of the chosen items. Not surprisingly on these occasions, Little Albert cried and showed fear when he heard the noise. The final stage of the experiment was to present Albert with only the stimuli. He became very upset as the rat appeared in the room. He cried, turned away from the rodent, and tried to move away. Watson had show that emotional responses could be conditioned, or learned. Indeed, Little Albert seemed to generalize his fear to other furry objects so that when Watson sent a non-white rabbit into the room seventeen days after the original experiment, Albert also became distressed. He showed similar reactions when presented with a furry dog, a seal-skin coat, and even when Watson appeared in front of him wearing a Santa Claus mask with a white cotton beard. The story has a sad ending. Albert, whose real name appears to have been Douglas Merritte, was the son of one Arvilla Merritte, then an unmarried woman who was a wet nurse at the Harriet  Lane Home. Nothing is known about the long-term effects of Watson’s experiment on the child. Tragically he died at the age of six on May 10, 1925 and is buried in a cemetery in Maryland.

Make me straight

Dr. Robert Galbraith Heath, founder and chairman of the Department of Psychiatry and Neurology at Tulane University in New Orleans, Louisiana, did research, partially financed by the CIA and the US military, which involved stimulation of the brains using surgically implanted electrodes. His subjects were institutionalized psychiatric patients, often African Americans. He wanted to use this brain stimulation relieve the symptoms of major psychiatric disorders such as severe depression and schizophrenia. However despite this laudable desire, his methods left a lot to be desired. One of his collaborators was the Australian psychiatrist Harry Bailey, who later recalled that they had used African Americans as subjects because “they were everywhere and cheap experimental animals“  His most infamous  experiment was on Patient B-19, a 24-year-old gay man who wanted Heath to make him straight. Heath implanted electrodes in his head, showed him straight porn movies, and then activated the pleasure centres of the brain via the electrodes. A prostitute was hired to see if his treatment had worked. Did patient B-19 actually become heterosexual?  Following discharge from the hospital, he had a sexual relationship with a married woman for almost 10 months. His homosexual activity was reduced during this period, but did not stop completely.  I couldn’t find any long-term follow-up information. Heath seemed excited about the prospects for this therapy, but fortunately homosexual conversion therapy with brain surgery and pleasure centre stimulation did not catch on.

The monster study

Most of us are familiar with the film The King’s Speech. At the beginning of the film a therapist has the future king put seven pebbles in his mouth to get him to take his mind off stuttering. This goes back to ancient Greece where the famous orator Demosthenes is said to have used the same treatment. Anyway it didn’t work out; George spat them out and the hapless therapist was promptly sent packing. On the other side of the Atlantic, at more or less the same time, an infamous experiment was taking place. The year was 1939 and the place,  Davenport,Iowa. The aim of the experiment was to make kids stutter. The intentions were noble; Dr. Wendell Johnson, a speech pathologist believed that stutterers were not born and the stigma of being labelled a stutterer d actually make them worse, and in some cases caused ‘normal’ children to start stuttering. To prove his point, he ran an experiment which has since become known as the ‘Monster Study’. The 22 youngsters from a veterans’ orphanage who were recruited to participate in the experiment were divided into two groups. The first were labelled ‘normal speakers’ and the second ‘stutterers’. In reality only half of the group labelled stutterers had actually shown signs of stuttering. During the course of the experiment, the normal speakers were given positive encouragement. But what made the study so notorious was what happened to the stutterers’ group. They received negative reinforcement – they were lectured about stuttering and constantly reminded not to repeat words. And the rest of the teachers and staff at the orphanage were told them the whole group were stutterers.  Although none of the test subjects actually became stutterers they became very embittered when they discovered in 2001 what had been done to them.  The quality of their schoolwork fell off and they would suffer a number of psychological and emotional scars later in their lives. The university issued an apology after the study was made public in news reports. On 17 August 2007, six of the orphan children were awarded $925,000 by the State of Iowa.

_________

So there you are. These are some of the things psychologists got up to. One would assume that they don’t do some of the more ethically questionable things that I have described above. They were different times. I could have mentioned Pavlov, who experimented on humans as well as dogs. Watching the videos can be quite painful. The uncomfortable fact is that we did learn a lot from these experiments and others carried out in those years. There were some pretty terrible experiments going on in other fields. One of the most shocking must surely be Tuskegee syphilis study conducted between 1932 and 1972 in Tuskegee,  Alabama by the U.S. Public Health Service on poor, rural black men. They received free health care, but they were never told they had syphilis, nor were they ever treated for it. The aim was to see what would happen if the disease went untreated. I hope in 2050 a future blogger will not have to write about what we were doing in the 21^st century.

A list of cognitive biases

Wikipedia has a list of the most important cognitive biases. Here is my selection:

Anchoring – the common human tendency to rely too heavily, or “anchor,” on one trait or piece of information when making decisions.

Attentional Bias – implicit cognitive bias defined as the tendency of emotionally dominant stimuli in one’s environment to preferentially draw and hold attention.

Availability cascade – a self-reinforcing process in which a collective belief gains more and more plausibility through its increasing repetition in public discourse (or “repeat something long enough and it will become true”).

Availability heuristic – estimating what is more likely by what is more available in memory, which is biased toward vivid, unusual, or emotionally charged examples.

Backfire effect – Evidence disconfirming our beliefs only strengthens them.

Bandwagon effect – the tendency to do (or believe) things because many other people do (or believe) the same. Related to groupthink and herd behaviour.

Bias blind spot – the tendency to see oneself as less biased than other people.

Choice-supportive bias – the tendency to remember one’s choices as better than they actually were.

Clustering illusion – the tendency to see patterns where actually none exist.

Confirmation bias – the tendency to search for or interpret information in a way that confirms one’s preconceptions.

Congruence bias – the tendency to test hypotheses exclusively through direct testing, in contrast to tests of possible alternative hypotheses.

Endowment effect – the fact that people often demand much more to give up an object than they would be willing to pay to acquire it.

Experimenter’s bias – the tendency for experimenters to believe, certify, and publish data that agree with their expectations for the outcome of an experiment, and to disbelieve, discard, or downgrade the corresponding weightings for data that appear to conflict with those expectations.

Focusing effect – the tendency to place too much importance on one aspect of an event; causes error in accurately predicting the utility of a future outcome.

Framing effect – drawing different conclusions from the same information, depending on how that information is presented.

Fundamental attribution error – the tendency for people to over-emphasize personality-based explanations for behaviours observed in others while under-emphasizing the role and power of situational influences on the same behaviour.

Halo effect – the tendency for a person’s positive or negative traits to “spill over” from one area of their personality to another in others’ perceptions of them.

Hindsight bias – sometimes called the “I-knew-it-all-along” effect, the tendency to see past events as being predictable at the time those events happened.

Illusion of control – the tendency to overestimate one’s degree of influence over other external events.

Illusory correlation – inaccurately perceiving a relationship between two events, either because of prejudice or selective processing of information.

Illusory superiority – overestimating one’s desirable qualities, and underestimating undesirable qualities, relative to other people.

In-group bias – the tendency for people to give preferential treatment to others they perceive to be members of their own groups.

Just-world phenomenon – the tendency for people to believe that the world is just and therefore people “get what they deserve.”

Moral luck – the tendency for people to ascribe greater or lesser moral standing based on the outcome of an event rather than the intention.

Normalcy bias – the refusal to plan for, or react to, a disaster which has never happened before.

Omission bias – the tendency to judge harmful actions as worse, or less moral, than equally harmful omissions

Ostrich effect – ignoring an obvious (negative) situation.

Outcome bias – the tendency to judge a decision by its eventual outcome instead of based on the quality of the decision at the time it was made.

Out-group homogeneity bias – individuals see members of their own group as being relatively more varied than members of other groups.

Overconfidence effect – excessive confidence in one’s own answers to questions.

Pareidolia – a vague and random stimulus (often an image or sound) is perceived as significant, e.g., seeing images of animals or faces in clouds, the man in the moon, and hearing hidden messages on records played in reverse.

Pessimism bias – the tendency for some people, especially those suffering from depression, to overestimate the likelihood of negative things happening to them.

Positive outcome bias – the tendency of one to overestimate the probability of a favourable outcome coming to pass in a given situation.

Primacy effect – the tendency to weigh initial events more than subsequent events.

Projection bias – the tendency to unconsciously assume that others (or one’s future selves) share one’s current emotional states, thoughts and values.

Recency effect – the tendency to weigh recent events more than earlier events.

Selective perception – the tendency for expectations to affect perception.

Self-serving bias – the tendency to claim more responsibility for successes than failures. It may also manifest itself as a tendency for people to evaluate ambiguous information in a way beneficial to their interests (see also group-serving bias).

Semmelweis reflex – the tendency to reject new evidence that contradicts an established paradigm.

Status quo bias – the tendency to like things to stay relatively the same

Subjective validation – perception that something is true if a subject’s belief demands it to be true. Also assigns perceived connections between coincidences.

System justification – the tendency to defend and bolster the status quo. Existing social, economic, and political arrangements tend to be preferred, and alternatives disparaged sometimes even at the expense of individual and collective self-interest.

Ultimate attribution error – similar to the fundamental attribution error, in this error a person is likely to make an internal attribution to an entire group instead of the individuals within the group.

The psychopaths have taken over the asylum

The other day one teacher took issue with me for using the term sociopath in my post about Bernie Madoff, The sociopath with his name on the door. In the article I did try to reflect how we struggle to find the right words to describe such people. This theme came to my mind again after reading Jon Ronson’s latest book The Psychopath Test. The journalist, documentary filmmaker, radio presenter and nonfiction author has carved out a niche for himself as a chronicler of eccentricity. He has written four books, of which his previous one, The Men Who Stare at Goats, is the most famous. His latest book gets its title from a diagnostic tool, used to identify psychopaths created by the psychologist Robert Hare – the Hare Checklist. The Psychopathy Checklist-Revised (PCL-R) is a clinical rating scale of 20 items, which has to be administered by a suitably qualified and experienced clinician under controlled conditions.

Defining what a psychopath is can prove difficult. Psychopathy is a personality disorder characterized by an inability to form human attachment and an abnormal lack of empathy, which can be hidden behind an apparently normal outward appearance. The current definitions seem to be more concerned with the emotional rather than behavioural elements. These are people who don’t do regret, remorse or responsibility; they have different emotional responses to the rest of us. Somebody may be a psychopath, but that doesn’t mean they are going to eat somebody’s liver with some fava beans and a nice Chianti. Is there really a cure for psychopaths? How do you instil empathy? Talk therapy may actually be counterproductive, making them more skilled at manipulating others.

The difference between a psychopath and a sociopath is somewhat blurred. They are often used interchangeably; both are listed together in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV under the heading of Antisocial Personalities because they share many common traits. It is a complicated dispute for an outsider like me to grasp. Not only do experts dispute if the two terms are different, but those who believe that there is a difference argue over what those differences are.

The problems of diagnosis of mental illnesses came sharply into focus in a famous experiment from the 1970s. Psychologist David Rosenhan and seven other normal people, none of whom had ever had any psychiatric problems, got themselves admitted to various psychiatric hospitals in the USA. The only serious problem they had was getting out. Only by accepting that they were mentally ill and then pretending that they were getting better were they able to get released. The hospital staff had been unable to detect a single pseudopatient. And it got worse. Rosenhan was challenged to repeat the experiment. Only this time he didn’t send any fake patients. Nevertheless, the staff still detected large numbers of patients as impostors when they were genuinely ill. On Being Sane in Insane Places was considered a landmark study of psychiatric diagnosis. But it also took a lot of flak from the psychiatric profession. One doctor, Robert Spitzer, lambasted Rosenhan in a speech:

“If I were to drink a quart of blood and, concealing what I had done, come to the emergency room of any hospital vomiting blood, the behaviour of the staff would be quite predictable. If they labelled and treated me as having a bleeding peptic ulcer, I doubt that I could argue convincingly that medical science does not know how to diagnose that condition.”

Robert L. Spitzer is another of the key figures in Ronson’s tale. This retired professor of psychiatry was a major architect of the modern classification of mental disorders, and was undoubtedly one of the most influential psychiatrists of the 20th century. He was instrumental in getting homosexuality removed as a mental disorder.

In the early 1970s psychiatry was in a state of flux. What Spitzer wanted was to make it as objective as possible. In 1974 he was put in charge of the APA task force preparing the third edition of the DSM. Spitzer wanted to get rid of all the Freudian nonsense about the subconscious and create a common worldwide language for all. Patients for the first time could enter a clinician’s office with the reasonable expectation of an accurate diagnosis and the appropriate treatment. The key tool would be the checklist – Spitzer had been inspired by pioneers like Bob Hare.  Any psychiatrist could pick up the DSM-III—and if the patient’s overt symptoms coincided with the checklist – they would be to provide a precise diagnosis-

The DSM-III became a worldwide success, helping to shape our culture and society profoundly. The idea was to make it objective. But maybe that goal was just too ambitious. Is this really science or is it the mere pretence of knowledge? Robert Spitzer’s successor, Allen Frances, continued the tradition of welcoming new mental disorders, with their corresponding checklists, into the manual. The first edition of DSM, which first came out in 1953, had had sixty-five pages. DSM-IV has 886 pages.  DSM-V is in the pipeline for 2013. I just wonder if the Amazon will be able to survive. You can actually consult it online here.

Ronson consulted the list and found that “I instantly diagnosed myself with twelve different ones. … I was much crazier than I had imagined.”  They seem to want to label life itself a mental disorder. Reviewing the DSM-IV for Harper’s in 1997, writer L.J. Davis was sceptical

Has there ever been a task more futile than the attempt to encompass, in the work of a single lifetime, let alone in a single work, the whole of human experience? For roughly five thousand years, poets, playwrights, philosophers, and cranks have incinerated untold quantities of olive oil, beeswax, and fossil fuel in pursuit of this maddeningly elusive goal; all have failed, sometimes heroically. Not even Shakespeare could manage it; closer to our own times, Dickens, a sentimental Englishman, the son of a clerk, perhaps came closest, though he believed in spontaneous human combustion and managed to miss the entirety of the twentieth century. Despite the best efforts of minds great, small, and sometimes insane, the riddle of the human condition has remained utterly impervious to solution. Until now. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (popularly known as the DSM-IV), human life is a form of mental illness.

Here are a few of 374 known mental disorders listed in DSM IV: Disorder of Written Expression, Oppositional Defiant Disorder, Selective Mutism and Arithmetic Learning Disorder. After studying the Hare checklist, Ronson began to see psychopaths lurking in every corner of society—from maximum-security prisons to the corridors of power.

One fascinating part of the book is where he deals with capitalism and psychopathy. This is not a new theme in popular culture. In Alan J. Pakula’s 1974 film, The Parallax View, the evil Parallax Corporation uses a questionnaire to recruit potential assassins. Joel Balkan’s The Corporation linked the way corporations behave to the DSM-IV’s symptoms of psychopathy. The ruthless competitiveness of modern capitalism with constant downsizing and hostile takeovers provides a perfect environment for a psychopath. Individuals who ignore the rules and are good at conning and manipulating people can thrive here. Hare expressed it like this:

”If I couldn’t study psychopaths in prison, I would go down to the Stock Exchange.”

Ronson introduces us to Al Dunlap, a retired corporate executive, best known as a turnaround specialist and downsizer. His nicknames, Chainsaw Al and Rambo in Pinstripes, will give you an idea of his fearsome reputation. A massive accounting scandal at Sunbeam-Oster led to his retirement under a cloud of suspicion.

Ronson goes down to Dunlap’sFloridamansion to do the psychopath test on him. His description is very revealing:

The first obviously strange thing about Al Dunlap’s grand Florida mansion and lavish, manicured lawns was the unusually large number of ferocious sculptures there were of predatory animals. They were everywhere: stone lions and panthers with teeth bared, eagles soaring downward, hawks with fish in their talons, and on and on, across the grounds, around the lake, in the swimming pool/health club complex, in the many rooms. There were crystal lions and onyx lions and iron lions and iron panthers and paintings of lions and sculptures of human skulls.

Dunlap’s score on the test, in the low 20s, was below the score of 30 or more which experts consider symptomatic of psychopathy. Of course here we are in the terrain of emotive conjugations. I am a leader; you are authoritarian; he is a psychopath. Ronson shows how Dunlap spins the negative traits; he turns the psychopath checklist into Who Moved My Cheese?

Of course I wouldn’t limit my analysis to capitalism. We don’t have to look too hard to find communist psychopaths. Maybe psychopathy should be seen as an evolutionary adaptation, a complex survival mechanism.  I will close with a graffito at a Liberal Party conference many years ago:

“Power corrupts and absolute power is even more fun“

The Hare Checklist

Are you a psycho? Now you can try this fun test at home. These items cover the affective, interpersonal, and behavioural features of psychopathy. Each item is rated on a score from zero to two. The sum total determines the extent your psychopathy.

1. GLIB and SUPERFICIAL CHARM — the tendency to be smooth, engaging, charming, slick, and verbally facile. Psychopathic charm is not in the least shy, self-conscious, or afraid to say anything. A psychopath never gets tongue-tied. They have freed themselves from the social conventions about taking turns in talking, for example.

2. GRANDIOSE SELF-WORTH — a grossly inflated view of one’s abilities and self-worth, self-assured, opinionated, cocky, a braggart. Psychopaths are arrogant people who believe they are superior human beings.

3. NEED FOR STIMULATION or PRONENESS TO BOREDOM — an excessive need for novel, thrilling, and exciting stimulation; taking chances and doing things that are risky. Psychopaths often have a low self-discipline in carrying tasks through to completion because they get bored easily. They fail to work at the same job for any length of time, for example, or to finish tasks that they consider dull or routine.

4. PATHOLOGICAL LYING – can be moderate or high; in moderate form, they will be shrewd, crafty, cunning, sly, and clever; in extreme form, they will be deceptive, deceitful, underhanded, unscrupulous, manipulative, and dishonest.

5. CONNING AND MANIPULATIVENESS- the use of deceit and deception to cheat, con, or defraud others for personal gain; distinguished from Item #4 in the degree to which exploitation and callous ruthlessness is present, as reflected in a lack of concern for the feelings and suffering of one’s victims.

6. LACK OF REMORSE OR GUILT — a lack of feelings or concern for the losses, pain, and suffering of victims; a tendency to be unconcerned, dispassionate, cold-hearted, and unempathic. This item is usually demonstrated by a disdain for one’s victims.

7. SHALLOW AFFECT — emotional poverty or a limited range or depth of feelings; interpersonal coldness in spite of signs of open gregariousness.

8. CALLOUSNESS and LACK OF EMPATHY — a lack of feelings toward people in general; cold, contemptuous, inconsiderate, and tactless.

9. PARASITIC LIFESTYLE – an intentional, manipulative, selfish, and exploitative financial dependence on others as reflected in a lack of motivation, low self-discipline, and inability to begin or complete responsibilities.

10. POOR BEHAVIORAL CONTROLS — expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper; acting hastily.

11. PROMISCUOUS SEXUAL BEHAVIOR – a variety of brief, superficial relations, numerous affairs, and an indiscriminate selection of sexual partners; the maintenance of several relationships at the same time; a history of attempts to sexually coerce others into sexual activity or taking great pride at discussing sexual exploits or conquests.

12. EARLY BEHAVIOR PROBLEMS — a variety of behaviours prior to age 13, including lying, theft, cheating, vandalism, bullying, sexual activity, fire-setting, glue-sniffing, alcohol use, and running away from home.

13. LACK OF REALISTIC, LONG-TERM GOALS — an inability or persistent failure to develop and execute long-term plans and goals; a nomadic existence, aimless, lacking direction in life.

14. IMPULSIVITY — the occurrence of behaviors that are unpremeditated and lack reflection or planning; inability to resist temptation, frustrations, and urges; a lack of deliberation without considering the consequences; foolhardy, rash, unpredictable, erratic, and reckless.

15. IRRESPONSIBILITY — repeated failure to fulfil or honour obligations and commitments; such as not paying bills, defaulting on loans, performing sloppy work, being absent or late to work, and failing to honour contractual agreements.

16. FAILURE TO ACCEPT RESPONSIBILITY FOR OWN ACTIONS — a failure to accept responsibility for one’s actions reflected in low conscientiousness, an absence of dutifulness, antagonistic manipulation, denial of responsibility, and an effort to manipulate others through this denial.

17. MANY SHORT-TERM MARITAL RELATIONSHIPS — a lack of commitment to a long-term relationship reflected in inconsistent, undependable, and unreliable commitments in life, including marital.

18. JUVENILE DELINQUENCY — behaviour problems between the ages of 13-18; mostly behaviors that are crimes or clearly involve aspects of antagonism, exploitation, aggression, manipulation, or a callous, ruthless tough-mindedness.

19. REVOCATION OF CONDITION RELEASE — a revocation of probation or other conditional release due to technical violations, such as carelessness, low deliberation, or failing to appear.

20. CRIMINAL VERSATILITY — a diversity of types of criminal offenses, regardless if the person has been arrested or convicted for them; taking great pride at getting away with crimes.