Colin DeYoung || Rethinking Mental Illness

[Music] today it's great to have colin deyoung on the podcast dr deyoung is a professor in the psychology department at the university of minnesota and the director of the personality individual differences and behavioral genetics program he researches the structure and sources of psychological traits using neuroscience methods to investigate their biological substrates he developed a general theory of personality cybernetic big five theory which identifies psychological functions associated with major personality traits as well as their connection to other elements of personality and various life outcomes including mental illness colin it's so good to chat with you again on the psychology podcast that's great to see you scott you are uh you may take the cake as top no you do take the cake as top five of my closest friends and collaborators who have appeared on the podcast all right so there you go it's an honor yeah well it's a real honor for me i uh uh it's it's been a nice uh a nice journey of getting to know you and all the topics that we debate and discuss and it's really you've really enriched my life i just want you to know that it's been it's been a while now all right what is it yeah it's like over 15 years almost that we've known each other decade and a half almost it's it's uh amazing and i i feel like while we both uh grown there's still this like little child that comes out when we get together like the playful you know that that part of us i think still there i hope so yeah i hope so too um but let's let's what what sir what you say i was gonna say we'll see how silly the uh podcast gets well yeah now we don't need to put pressure on ourselves to be silly but we should talk about all kinds of serious things yes well i want your new theory well your new theory of psychopathology is pretty serious i think so yeah yeah i mean it's uh it's hard to make too many jokes about that theory uh so what is mental illness like first of all shouldn't we as a field of psychologist and psychiatrist actually have a definition yeah that's a funny thing isn't it uh you'd think that we would know how to define the thing we're studying but well i mean you've done research in intelligence look how hard it is for people to agree on a definition of intelligence for example um but yeah mental illness i think that one of the reasons that there isn't as much focus as there might be on defining mental illness per se is that people usually think of it as a collection of more specific illnesses specific disorders and so they tend to look for definitions of schizophrenia or definitions of borderline personality disorder or definitions of ptsd right so the focus is often at the level of an individual disorder rather than stepping back and looking at the big picture and saying well what is mental illness in general yeah and also just when it comes to like psychological theories of mental illness impacting the psychiatric the psychiatry field um when i was looking into the literature and reading your paper it surprised me just the dearth of the extent to which psychiatry has adopted any of these psychological theories yeah well there's a lot that we could say about that just in terms of like the history of psychiatry and clinical psychology um i mean there have been times in the past where people have thought more actively about what mental illness is in a general way like you can go back to the anti-psychiatry movement from like the 50s and 60s you know people like thomas sas and rd lang and you know they're that's like the one polar extreme of thinking about definitions of mental illness which is that they are just purely social constructions right that there is no uh thing in nature that's a mental disorder it's all about the way in which society wants people to be certain ways doesn't want them to be other ways and then defines people who aren't the way that they want them to be as mentally ill i i mean i think that you know going to both extremes is problematic like i don't think that's the right way to think about uh mental illness either but you know that at some point that was a big topic of conversation like is mental illness something that's not just socially constructed we can we can think about it kind of systematically as one poll is just that it's purely socially constructed the other poll is that it is purely naturalistic like that there is something scientifically identifiable that is mental illness and it has nothing to do with societal norms or societal traditions or beliefs or anything like that and uh and then in the middle you have what are probably the more popular positions today when people do think about this which are described as hybrid positions where the idea is that there is something really going on you know there's some kind of dysfunction that we can point to from a naturalistic perspective but then that there's also some degree of societal judgment about uh you know like who is severely ill enough to get diagnosed um i'll give you an example that's an analogy to something that's really trivial in i mean it's not exactly true it's a serious problem for people but just in physical medicine which would be blood pressure right so you know we all know that having high blood pressure is a risk for various cardiovascular problems but where we say the line is where you have hypertension right where you get a diagnosis from your doctor that is a somewhat arbitrary line right blood pressure is a continuum you can have low blood pressure you can have high blood pressure it's on a spectrum and the medical establishment has picked a certain point at which they say like if you're above that now you have hypertension if you're below that you don't right so you know it's not and they acknowledge that there is a certain degree of trying to pick a reasonable threshold that is you know good for people's health nobody thinks that having a blood pressure of you know 159 is qualitatively different from having a blood pressure of 161 so you can see that there's this element like there's a real thing going on there there's differences in blood pressure associated with differences in risk and then there is also a bit of social construction which is to say well what's the level we're going to pick where we're going to give people a diagnosis we're going to start giving them drugs we're going to start treating them you know we're going to intervene um and all those same kinds of questions come up in in issues surrounding mental illness yeah as well as uh issues of gifted education like right 130 iq you're you're gifted 129.5 sorry you're on you're actually ungifted because there's going to only two categories we have right yeah yeah um so look uh when we apply this to mental illness we can see just how messy all this stuff gets and uh and what i like about your theory i like i i really do like a number of things about your theory it's not just because i'm friends with you i'm glad yeah um i was wondering if you could tell people um about uh the theory how your theory how you define mentalness because you have very specific definition that brings in cybernetic theory and then we'll unpack what cybernetic theory is yeah okay um and i think probably as i start to get into it it would probably it would be helpful to say a little bit about how our theory fits in with these general types of theory that i've just been describing that would be great and also maybe to say a little bit about what's been happening in the world of science around psychopathology and mental illness uh in the last you know like 20 years or so um i think the most important thing to understand is that it's pretty widely acknowledged at this point that the traditional diagnostic system that comes out of like the diagnostic and statistical manual from the american psychiatric association that's the dsm that system is not scientifically accurate um the probably the biggest problem with it is that it treats mental illness as if it was a categorically distinct phenomenon so some people have schizophrenia and some people don't some people have borderline personality disorder and some people don't um and so it's treated as if there's this kind of clear dividing line whereas if you look at the actual data more closely what you see is something a lot more like blood pressure people have various kinds of symptoms that cause them problems they have various kinds of uh you know unusual characteristics that can cause problems for them can cause dysfunction can cause impairment can cause suffering and there is no perfectly clear dividing line to say when those get severe enough that they actually count as a mental disorder or not because it's honest it's on a smooth spectrum right the the uh pattern of these qualities that people have that we identify as symptoms of mental illness are actually just kind of distributed in the whole population and there's no clean separation of people who have the disease from people who don't right it's not like it's not like a flu it's not like covered where you either have the virus and it's infecting you or you don't right it's much more like blood pressure where you have a certain level of it and it gets to a certain level it starts to cause you other problems in your life and so we decide like we need to intervene in some way but there's this persistent fiction uh in psychiatry especially that these are somehow categorically distinct entities um so one of the things that's been happening in uh in research on mental illness is that people are trying to look at it more in terms of the spectrum or a lot of different spectra right because it's not just one spectrum you know we already see that in some areas of uh studying mental illness like we talk about the autism spectrum and people increasingly now talk about the schizophrenia spectrum um but really every common mental disorder is on a spectrum right and so that's one problem with the current system is this use of categories instead of dimensions now the other serious problem is that the way the categories are organized are not accurate in terms of describing how people's symptoms tend to go together and so what that means is that you end up with situations uh like within depression people can have extremely different sets of symptoms and still get the same diagnostic label for example like you can have uh weight loss or you can have weight gain and that could be a symptom of depression you can have uh insomnia or hypersomnia where you sleep all the time and both of those things can be a symptom of depression so it's also increasingly recognized that the current diagnostic categories don't do a very good job of actually identifying uh groups of people who have a a similar problem that would help us to figure out how to treat them and how to help them right because that's ultimately the whole purpose of diagnostic systems is to try to help people to figure out what is wrong with them as accurately as we can so that we can figure out as best we can how to help them and the current system isn't really doing that so uh one of the things that i'm a part of is uh this movement to try to create a new diagnostic system that would be based on dimensions instead of on categories so i'm part of this group that's called the uh consortium for the hierarchical taxonomy of psychopathology and that last part gets abbreviated as high top so what hightop is trying to do is basically use actual empirical data about patterns of symptoms that appear in people and which ones appear together to describe the range of different symptoms of mental disorders that there are and to group them together in ways that are actually based on real empirical data as opposed to just uh you know uh tradition and sort of medical intuition and expert opinion from doctors over 100 years um so uh then you also have in the world of scientific research on mental health uh the nimh which is the national institute on mental health and they do a lot of the funding of research for you know trying to figure out the causes of mental disorder and uh about 10 years ago or so they also came to the conclusion that they needed to reject the categorical system that appears in dsm and what they decided to do instead was to focus on specific what they call um biobehavioral systems right so trying to understand the underlying brain processes and the patterns of behavior and cognition and emotion that go along with those and to understand them again as a dimension just like blood pressure where you know you you might have a problem with your uh reward system or what they call your positive valence system and if that's hyperactive it could be associated with mania for example right so instead of saying well here's this thing uh bipolar disorder right and it it's got to have all these features uh instead what they say is no let's focus in on specific dimensions of symptoms like mania what are the system what are the psychological processes and brain systems that underlie it let's see if we can make progress on understanding mental illness that way so you've got people from the clinical side working on uh on this high top project to classify and describe mental illness in a dimensional way you've got people on the scientific and biological side trying to describe it in this dimensional way and so our theory is basically trying to come in and say uh it's great that we have all this progress toward these dimensional approaches that are more in keeping with what we actually know scientifically about mental illness but still not enough people are thinking about this more general question of what mental illness is because once you've got a dimensional system you still have to say okay what's the threshold where do you decide when somebody is mentally ill and what does that mean okay and so um i'll what i'll do is i will uh i'll read you our definition of mental illness and then i'll unpack it so what we say is that psychopathology is persistent failure to move toward one's goals due to failure to generate effective new goals interpretations or strategies when existing ones prove unsuccessful okay so there's a lot to unpack there obviously now um and so you know the way to understand this is in this in the context of this idea of of cybernetics which people now you hear that word you think like cyberspace cybersecurity you think artificial intelligence artificial intelligence absolutely you tend to think about things that are done with computers but cybernetics is actually a discipline that is broader than just artificial intelligence it also includes uh natural intelligence and it includes the way in which organisms function as well as the way in which uh computers function and it dates back to uh a scientist named norbert weiner in the late 1940s who had this this is i'm trying hard not to laugh um keep it up anyway so weiner had this idea he had this insight which is that um there's he was stop that he's operating in the context of the first like artificial control systems uh like for example in world war ii you might design an aircr anti-aircraft gun that is able to actually track a plane as it's coming in automatically to aim right in order to to track the the trajectory of the plane and to shoot at it accurately and then you get things like missile guidance systems um pretty soon you're gonna get things like uh chess computers and do we need to take a break here i'm trying i'm trying really hard i'm trying really hard yeah missiles okay yeah systems yeah get it go on there are all these artificial control systems that are basically appearing in technological development so in the in the middle of the 20th century you've got all of these artificial control systems being developed in different ways like the first computers um various things for you know uh weaponry etc and uh what weiner recognizes is basically that there have to be principles that are common to any kind of system that is able to pursue a goal based on feedback uh from what's happening from what it's tracking in the environment right so uh like a missile guidance system has to take feedback in order to correct the course of the missile uh a chess computer has to register what's happening in the game that it's playing in order to try to win the game and any organism has to pursue sources of nutrition and reproduction in order to be able to to survive and reproduce right in order to have fitness from an evolutionary perspective so what cyber analytics is basically is that it is the study of the principles that govern uh goal-directed systems that self-regulate via feedback so that are able basically to process input about the state of the world to compare it to some particular uh value that or goal that is represented within the system itself and then to act in various ways to enact a set of operators you know behaviors or cognitive operations or whatever they are to try to move toward their goals and in psychology we often think of goals as things like where you have a very concrete idea of the future that you're committed to working toward but in cybernetics a goal is something more abstract basically it is any representation within the system of a state that the system then works to bring about in the world so plants our cybernetic systems they they carry out processes you know to require nutrients and moisture and to grow in various ways and so that's the basic insight right is that there have to be a set of principles that are responsible for governing any kind of cybernetic system um whether it's you know a robot trying to accomplish something or a human trying to accomplish something or a plant or a chest computer or whatever it is and so there you know that turned into a whole very successful field and it was more widely applied in uh you know in engineering and all of our computer technology basically or much of it uh is influenced by that field um but to uh an important extent it was also influential in psychology and so um so when i was on your podcast once before we talked a lot about my theory of personality in general which is a cybernetic theory it's called cybernetic big five theory and it's about the way in which personality traits these kinds of broad personality traits like the big five that we study represent variation in these general cybernetic mechanisms that allow us to pursue our goals and our needs effectively like we have to be able to be motivated by goals things that are going to reward us we have to be able to you know carry out actions that move us toward them and to avoid distractions from those from those actions and we have to be able to compare where we are with where we want to be or how we think things ought to be and so we have a set of mechanisms in the brain that enables us to do all those things now the connection between the personality theory and the theory of psychopathology is basically that the those same mechanisms that allow us to pursue our goals can break down in various ways and most common forms of mental illness we can trace back to specific ways in which those human functions that allow us to pursue our goals and our needs effectively tend to tend to break down and sometimes they break down because they are relatively extreme like somebody has a what we could describe as a relatively unusual or extreme level of some personality trait and it causes problems for them in their lives and that might lead to dysfunction but i think the important thing about the way in which we're defining psychopathology is that it hinges on this idea of cybernetic dysfunction right so what we're saying is basically no matter how unusual you are no matter how uh how weird your personality profile is uh you do not have a mental disorder unless about me yeah well i mean we could talk about your weirdness too if we want to i was like you better not be singling me out bro well we can do that later okay that's that's for the psychoanalysis part of the of the podcast the podcast yeah i don't want you psychologizing me yeah all right i won't not on air anyway um anyway so but the basic idea is that you don't have a mental disorder you don't have psychopathology on our definition until whatever your unusual qualities are uh cause you to be unable to meet your needs or to be able to pursue your goals in life effectively um and so in some ways that is already present in implicitly at least in the dsm because a lot of the diagnoses in the dsm uh emphasize that you're not supposed to give the person a diagnosis unless they uh meet the criteria for what it called impairment uh or distress so what does that mean well one of the things that it means is that you could have uh all the symptoms for example or you know you can have a set of symptoms that would qualify you for schizophrenia let's say and at some point i'll talk a bit about how from the perspective of our theory schizophrenia as a as a categorical entity doesn't really exist and it's not just from the perspective of our theory either as i was saying earlier it's this new emerging perspective in uh in clinical psychology as a whole that recognizes that the data say that these categories uh the categories don't really exist as categories and the symptoms aren't really organized in the way that the dsm says they are but just a shorthand for now let's say you have all the symptoms or a set of symptoms that would qualify you for schizophrenia but you're not impaired like your life is going along just fine and you know you may have challenges once in a while but you are able to overcome them and deal with them and so in that case and you're not particularly distressed either in that case you're not supposed to give a diagnosis now your first intuition when you might when you hear that might be to say how would that even be possible right schizophrenia that's supposed to be such a severe disorder that's you know there's that's psychosis right it's characterized fundamentally by you have delusions or hallucinations or both um and plus a bunch of other qualities that you might have there that are likely to be impairing so how could that not be impairing well there's a great study that we talked about in that paper that i sent you uh in which a group of uh psychics was compared to a group of square avoidable diagnosis they like to be called clairvoyance clairvoyance uh they were people who had uh auditory regular auditory hallucinations that was what qualified them to be in the study uh and they believed that those auditory hallucinations were uh them communicating with other realms you know whether that's with spirits of the dead or other spiritual realms or whatever um so from the standpoint of you know medical diagnosis if you take somebody who come who presents with those symptoms they that would classify as us as psychosis right because they have they have hallucinations they have auditory hallucinations and they have delusions yes um but uh the reason that you would not get a uh diagnosis of you know schizophrenia for example or some other psychotic disorder with those for those people is that you know they're not impaired some of them are maybe working professionally as psychics um or clairvoyance um or you know they could be um you know maybe that's just like a a side hobby of theirs but whatever it suggests that they are able to uh to pursue their lives effectively they can make a living they have uh normal social relations you know maybe some of their friends believe that they really do have these powers maybe they are um maybe they are humoring them who knows whatever but there is this crucial distinction that even the current system recognizes between uh whether you have uh some whether you have dysfunction or not hey everyone i'm excited to announce that the eight week online transcend 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transcendent possibilities for more on the center you can go to scienceofhumanpotential.com hey everyone doing this podcast for y'all is one of my greatest privileges but the cost of maintaining a professional production like this one really adds up i'm grateful to today's sponsors who help fund the show but if you'd prefer a completely ad-free experience you can join us at patreon.com psycpodcast you'll get completely ad-free episodes all while directly supporting the show for as little as five dollars a month that's patreon.com psych podcast hey colin i was wondering if you could tell me how your theory differs from uh the class of theories that rely on statistical deviance you know the extent to which you're you have a certain characteristic function that is way abnormal statistically how does your theory differ from all those class theories so the the issue when we get to this general question of like what is mental illness uh one of the ways that people have dealt with that is basically just to say that uh if you are far enough from the norm then you have a problem right you're right you're abnormal right so there's you know one of the one of the scientific journals that i've published papers in is called the journal of abnormal psychology and it's actually about to change its name to something else that doesn't use the word abnormal because the idea being that that word has become stigmatized but it's important i think to think about what that word actually means because it means away from the norm right ab means away from and you know it's so it's basically saying that people have mental health problems who are weird who are unusual who are different from the norm and that is a pretty common way of approaching thinking about mental illness even if it's not the official definition it is often implicitly the way that we approach people even the categories in the dsm are often that way right because they'll say uh so if you have some if you're having some kind of distress and you have five out of nine symptoms for example uh then you have this particular mental disorder so they're basically counting the number of symptoms you have and once you get extreme enough you know once you get far away from the norm because what's normal is for people to only have you know like zero symptoms or maybe one symptom of something but they're not gonna have like four or five or six or seven and so the idea is that as you get up to have enough symptoms then you're far enough away from the norm that we're going to say okay now you have a disorder and so our theory explicitly rejects that and i was talking a little bit about this earlier because of the idea that just being unusual shouldn't be enough to say that you have a mental disorder or a mental illness yeah and um it's often does so the the dsm often does require these additional components like uh the presence of impairment or dysfunction um but it's funny because in the in the book itself it says basically like that's just a uh that's just there because we don't have perfect diagnostic powers yet you know like once we know exactly what's going on in the brain that's making this person weird in this way then we'll be able to say okay this person's uh has a mental disorder without even asking whether they show impairment or distress and to me that's exactly backwards right i think we should focus less on statistical deviance whether you're unusual or not whether you're extreme on some dimension and focus more on whether you are impaired in your ability to uh pursue your goals in life and my goals from a cybernetic perspective as i was saying we use that broadly to include things like your basic needs and uh just whatever it is that people are trying to to get in life even if they don't necessarily know it themselves right goals can be conscious or they can be unconscious well that's that's the what confuses me and how you distinguish between competing goals like if there's no priority there because you know one could act a certain way that uh is getting them towards let's say their meeting goals but being catastrophic to their any other goals they have in their life right and that's yeah absolutely that's super important and you know so people often asked us about that in relation to theory like well what if somebody's an alcoholic and they're doing a really good job of you know their goal of staying drunk all the time right well right so the point is that from our perspective it's not enough just to consider one goal you have to consider you have to try to consider all the person's goals and how they prioritize them and how they're doing with that um and that would include you know basic needs that most people have like a certain degree of connectedness to others and um you know a sense of autonomy or whatever and so you know the person who's who's being successful at staying drunk right who's an alcoholic they are probably undermining some of their other goals like being able to earn a living effectively or maintaining good relationships with other people or even just maintaining their own health for example so what's really important is that you look at the whole collection of what people are pursuing and what they value in their lives and you look to see whether they are actually able to uh to pursue those things effectively great great um something that's interesting about your theory is that you distinguish between mental disorder and psychopathology isn't that right and i think yes this kind of relates to the kind of new way you're thinking about um the brain's role as there's not like a particular brain pattern you can find in the brain and say that person's mentally ill just because their brain shows it so can you elaborate sure yeah i mean and we think about that issue with uh with uh brain disease like one of the things we've said is that mental illness is not brain disease and you know that that doesn't mean we're duelists right we're not saying that there's some like you know the mind is separate from the brain obviously the brain is you know producing the mind the brain is doing the things um that the mind is but what we mean is that merely having some particular unusual pattern of brain function does not in and of itself mean that you're mentally ill it's just like having particular symptoms like we were talking about you know you could be a clairvoyant and hear voices and you know believe you're communicating with spirits and that doesn't make you mentally ill if your life is nonetheless going well in functional functioning normally in other regards right um and so uh the important thing is that um whatever your brain is doing it has to be causing you to not be able to pursue your goals effectively in life before we want to call it uh psychopathology in terms of this distinction that you were you brought up between psychopathology and a mental disorder like so far in our conversation i haven't been very careful about distinguishing between those two things uh and you know many people in the field just use those interchangeably but we think it's important to that there could be a distinction between uh something that is relatively naturalistic that we could you know from a scientific perspective say okay this person is not only having trouble pursuing their goals but then they're also unable to adapt and to come up with new ways to live or new ways to interpret their situation uh that would enable them to come up with new strategies for pursuing their goals or even to just develop new goals that would be better than the old goals right so one of the things about a cybernetic system is that it's not we can't really say it's dysfunctioning just because it's temporarily off course because the whole point of cybernetic systems is that they can correct their course right they use feedback basically to when they're veering off course to get back on course so they adapt and so we all know that you're not going to say that somebody has a mental illness just because they have a bad day or even a bad week right or things go really wrong for them or you know some project that's really important to them gets undermined in some way and they might be depressed for a little while that's totally normal and totally healthy even when we start to be concerned about people and mental illness is when something like that happens and they can't figure out new goals or a new strategy to pursue their own goals or a new way of thinking about the world that would allow them to bounce back and get on course right and to start pursuing their needs and goals again effectively so that's why that other there's that other part of our definition which is that it's not just about uh your ability to uh it's not just whether you are having trouble pursuing your goals it's also then you are not able to develop new strategies or new goals or whatever that would allow you to get back on course and so and we think that that's fundamentally something that is objectively true or not like a person has a set of goals people aren't necessarily totally conscious of all aspects of their goals or their needs but they're in there right they're represented in the brain and whether they're actually able to pursue those effectively or not or to bounce back and get back on course when things go when things get challenging that is uh that's like a matter of fact right it's objectively true or not whether that's whether that's possible um but then there's another level which is that we have to figure out how severe does that have to get before we intervene right and that's where we use the term mental disorder because that's sort of the term that's typically used in psychiatry like for a diagnosis then you officially have a mental disorder so we kind of we recognize that there's still going to be some kind of discussion that's going to go on negotiations right between different players and in medicine and in politics or whatever that sets the threshold for when uh somebody is said to have a problem that's severe enough that then we're going to spend resources to intervene it's just like blood pressure right we know that the higher your blood pressure is the more risk you have but we pick a level at which we're going to intervene and so basically we say psychopathology is just this fact that you're not able to pursue your goals effectively um whereas mental disorder is you know whatever decisions get made about when we're going to give somebody a diagnosis good i really like this distinction um quite a bit um you know in a lot of way your whole theory is it's very like neurodiversity friendly you know it's like you know like that world would embrace it you know because there's lots of different um forms of neurodiverse as you know that i'm very interested in like autism a lot of different kind of spectrums and the the whole movement is moving towards this idea that like not to pathologize it just because it exists right i think this is very much in line with with your theory i think and further unpacking your theory and i want to i'm trying to do a bit by bit here i want to uh there's another piece i want to pull out and that's the difference between uh character um uh characters what do you call characteristic adaptations yeah personality traits yeah okay can you define both and the difference yeah and this is this is like a throwback to our last podcast that we did together probably where we were talking about the personality theory because that's kind of the center of that theory too so the idea is basically that um i think i said earlier even in this conversation that traits we think represent uh variation in these basic mechanisms that everyone has like everybody has the capacity uh to experience being motivated by something at least to some extent uh everybody has the capacity to experience um fear at least to some extent although you can find people who are relatively fearless right everybody is averse to certain things so there are these universal properties and there's variation in them and that's what personality traits are fundamentally so the way that i think about this is the test is would this make sense to describe differences between people in any culture at any time in human history right like if you go back to you know prehistoric times i'm sure you know you have 100 gatherers sitting around the fire and some of them would want to argue with each other and some of them would not right argumentativeness is probably something that's been different between people and useful for characterizing people for all of human history and so anything that you can use in any human context like that is a personality trait but then we have these ways that we specifically adapt to our own life circumstances into the specific culture that we're a part of and those are what we call characteristic adaptations right so they require learning they're characteristic of us because they're persistent over time right like i'm uh i'm a professor that is you know part of my persistent identity and my behavior it shapes what i do it's a role that i have right just like you know being a lawyer would also be a different characteristic adaptation it's a way that somebody has adapted to make do in their particular situation and so um characteristic adaptations are the parts of personality that aren't really universal but that represent variation between people that have to do with what we've learned and the circumstances that we're in you know what do you think about this density distribution model uh like the fleece and sort of way of thinking about it i think that's exactly the way that i would think about personality that when we think about what a trait is it is uh a tendency to be in a particular type of state but it doesn't mean that you're always that way all the time right like you know an extrovert isn't talking 100 of the time uh even though extroverts are more you know talkative in general uh somebody who has an anxious temperament isn't experiencing anxiety every moment of their lives but when we say somebody has the trait we're saying that they're more likely to experience those things more often more intensely in more situations and so the density distribution you know that's just saying that there's an average and that's where uh the person spends more of their time but there's still a whole distribution right like so even the extrovert is acting introverted some of the time but on average they're acting more extroverted more outgoing more talkative than somebody who is relatively introverted right so but yeah so it leaves room for variation within the person for their behavior but points to the fact that people have these kinds of stable average tendencies over time right so i'm glad that we talked about that and hopefully didn't lose our audience you can you can cut it if you need to no no no no no this is technical stuff this is real technical stuff you know characteristic most people aren't probably aren't familiar with the term characteristic adaptations they're maybe more familiar with personality so so but this is central to your argument like we really have to make sure that that uh people understand this you know you're saying that people can use characteristic adaptations to help them manage or even thrive with the kind of brain imprint imprint imprint that the dsm could even currently classify as a mental illness so uh you know what you know what another good term for characteristic adaptations is that i've been using a lot lately habits well that's much better it's a lot shorter right you know and i i've just got to say i didn't invent the term characteristic adaptations okay that's not my fault no that's fair enough that's fair enough i'm not blaming you i i like it because it actually has a good description of what it is it's like we adapt to our situation in certain ways and then those adaptations become habitual right and so we have habits of acting we have habits of thinking um and those habits those ways that we you know habitually act and think and habitu things that we habitually strive for right our goals are habits in a certain sense too once they're concrete enough um you know those are these characteristic adaptations and yeah people can have um very unusual profiles and they can have experiences that would be classifiable as psychiatric symptoms uh like those uh clairvoyance for example hearing voices turns out that hearing voices is a lot more common than you might expect and it and it's actually a lot of voice right now [Music] [Laughter] no come on that's that joke had to be made because you you literally said you know people hearing voices is more common than you would think sometimes out in there right in their ears as if somebody's just speaking in their ears yeah um yeah i realized i took out my headphones at some point so hopefully the sound's not uh now you still sound good but you sound good to me oh yeah anyway yeah so like let's just imagine that you were somebody who heard voices well first of all why do you do that that's because your brain is designed to simulate the social world right it's designed to understand other people part of what you do is by imagining other people talking so if you're the kind of person who spontaneously hears voices that's just your brain running its simulation programs and you know we've been talking a lot lately in other contexts about consciousness and free will and things and uh you know a lot is going on in your brain that you don't have voluntary control over right and so let's say you are somebody who spontaneously hears voices that you can't control very well how do you deal with that right well you can get really panic because we associate that with schizophrenia and we stigmatize it or you could have a number of different possible ways of adapting to that you could just accept like oh i've got an act of imagination that sometimes you know talks to me and i'm gonna i don't know maybe i'm gonna turn that into something that helps me write novels for example because it's like i have dialogues with uh you know characters in my head um or maybe the way that you adapt is that you come to believe that you are communicating with other spiritual realms right and you launch a business as a psychic um and maybe that allows you to to make a living and to get along with people those are all different patterns of characteristic adaptations right they're all different habits of thinking and acting and pursuing goals in the world and they can be effective to allow people to to meet their various needs and to coordinate all their various goals together adequately to uh to get by and even to thrive in the world right and so to us merely being unusual um is not enough to indicate that you have a problem because there's so many different ways that people can adapt there's so many different habits that people can develop that can potentially allow them to you know manage their own uh unusual qualities right and to even have them be to even have them be benefits or gifts right that allows them to function well um so don't take this the wrong way colin um but what you your theory is revolutionary i think it's revolutionary but it really shouldn't be yeah i know because 100 percent because because what you're saying to me i'm like well duh like but but it's so weird that something where i would respond yeah duh is is the complete opposite from a the structure that that has existed for for almost 100 years you know um uh well i don't know when the first dsm came out but well right well the dsm changed radically in 1980 right so there was dsm-1 and dsm-2 uh which were basically um freudian psychoanalysis manuals that had lengthy descriptions about what different kinds of mental problems looked like and how they worked that were all based on like you know freudian interpreting freudian mechanisms in the brain and then in 1980 what you had was a group of psychiatrists who got together and said we can do this better we can do this in a more scientific way and they created these you know sets of checklists for what are the symptoms going to be for each diagnosis that did not require drawing any inferences about what was going on in people's unconscious minds so you know they were trying to make a more systematic process and a a better system for diagnosis and you know and i think in many ways that they did but the fact remained nonetheless that the kind the sets of criteria they came up with in the categories and the list of symptoms were really just based on uh you know the experience of people's in the in the medical profession psychiatrist experience so you could think of it as like the accumulated wisdom of psychiatry it still wasn't very scientific by our standards today and so the you know the new movement to move toward these dimensional systems is because now we have enough actual data that we can see uh how different symptoms are likely to present together and to develop over time and all these things yeah i know i i love it and i don't know if you've you've noted if you've noticed the similarity um to my theory of personal intelligence you know and ungifted arguing that we need to move away from intelligence models um that are based solely on the decontextualized iq test and look at the person's personal goals you know yeah absolutely i mean and you know you and i have talked a lot about that of course because i think we don't necessarily agree on um you know whether intelligence should be or needs to be redefined um but that's only because we have you know we're just thinking about different kind of uh perspectives let's say like i'm thinking about it in terms of the scientific tradition of researching intelligence whereas you're thinking about the way in which the concept of intelligence gets used in policy and in popular culture and is you know constraining on people uh who could potentially be facilitated to well you know live their best life as you would probably say right and so you know i absolutely see the parallels between what we're saying about mental disorder and what you're saying about how we should uh help people to achieve well-being um i guess we're probably not going to talk about this today but as you know i've also been developing this the cybernetic theory to be a theory of of well-being too because we've got you know moving to try to take in uh mental health problems on one side but then you know the mere fact that you don't have psychopathology doesn't mean that you have you know the optimal amount of well-being um and so you know there again our theory of well-being is all about looking at what individual people value and what works for them as a set of values and goals uh in coordination with each other that's what you're doing with valerie tibberus right valerie tiberius yeah who's a friend of mine yeah yeah so an idea of well yeah going i just suddenly realized i never gave a shout out to bob kruger who's my you know i keep saying we when i'm talking about our theory of psychopathology um but i should obviously uh you know recognize bob who is really um brilliant uh clinical psychologist and has been uh you know so involved in this whole movement toward better classification systems for psychopathology and understanding it better this really is revolutionary stuff i mean i hope the the listener understands the gravity of what you're proposing because it would really shake things up in the field of psychiatry and psychology yeah well so there's there's kind of like levels of uh of radical in terms of the of changes that are being proposed um so first of all you've got this hierarchical taxonomy of psychopathology high top right this new this new model that uh people in that consortium including me we would like that to replace the dsm right so instead of those categories uh you get described as having levels of you know a set of different dimensions um they're sort of analogous to the big fi actually quite a lot of them are quite analogous to the big five and personality where you have different levels of different potential you know symptoms that could be used to characterize people who are having problems um but even some of the people who are working on that then they still want to say like well when you reach a certain level of symptoms then we're going to give you the diagnosis right right and so i think what's most radical about the the theory that we're working on is that it even goes beyond that to say that no matter what level of these symptoms you have it doesn't count as a mental disorder unless you have cybernetic dysfunction right unless you're not able to pursue the things that you value and need in life um and so you know one way to describe i guess just how radical this theory is is that in some sense there would only be one diagnosis that would be you have you know you have psychopathology you're having some kind of you're having a problem in your life and then we can go to try to figure out what's it like right and we can say well you know you have on you you have these unusual characteristics and those seem to be inter help you know causing you trouble in these ways um and you've got these habits that are really kind of counterproductive and that are undermining you that you know maybe we can figure out where you pick them up maybe we can figure out why maybe we can figure out how to help you change them um so yeah in some ways but you know what's really interesting thinking about this scott uh my observation is that in some ways this is what people in the clinic typically do already like you know not the people who are writing the dsm um or you know funding scientific research but just clinical psychologists who are interacting with people somebody comes in what do you do uh you try to you say what's wrong you try to understand their problems you try to understand like the pattern of their lives the specific ways they think about things the specific you know personality profile that they have that might be like helping or hindering them and then you know you deal with that person as an individual so in some ways i don't think it's that weird it's just so counter to the way in which everybody is obsessed with uh you know identifying labels for people and slotting them into the right boxes because that's how you know what to put on the insurance form and in theory that's how you know what pills to give people right because that's another thing we haven't even touched on yet is the current obsession in psychiatry with treating everything with pills well that's a whole different conversation but yeah i hear you i just i want to ask a follow-up question um because you've talked a lot about uh trying to understand and move us move us away from thresholds of the actual uh characteristics themselves but i want to talk about the other end how do you find the cutoff for cybernetic dysfunction you know i mean you know you won't you haven't we haven't focused on that question as much as right so that gets us back again to this distinction that you brought up between psychopathology and mental disorder and so what we think is that actually again it's an objective question or not whether somebody is has cybernetic dysfunction um because remember that requires two things first that you are uh you know you're blocked from moving towards you know some of your important goals um and then the second thing is that you're unable to engage in the process that allows you to explore new possibilities right like swapping in new goals or finding new strategies to pursue the old goals or just thinking about the world in a different way that would allow you to get past whatever you're stuck in and as soon as you've got that being blocked and then also not being able to engage in effectively in the process of developing new strategies and new goals then you've got psychopathology so i think that that's i think it's reasonable to think about that as something that you do have or you don't but of course you could have a very you could have a pretty mild version of that right where you know somebody um might just i don't know be really depressed and stuck in a way for a couple of weeks and maybe if you went into the doctor at that point said i'm super depressed things going badly i don't know what to do um you know let's say it's lasted for a month rather than two weeks like eventually you're going to get to the threshold where even the dsm would say okay now we're diagnosing you with the depression but remember for them too it's pretty arbitrary exactly how long that has to be and so what we're saying basically is that whether or not you have psychopathology is something that we should be able to say pretty clearly but that doesn't mean we want to give you a diagnosis right because the diagnosis has to do with whether you need treatment or not or whether we're just going to you know see whether you can you know whether you can get by on your own or maybe we give you just a little bit of advice or counseling or whatever i mean it's like it's rare that somebody goes in to see like a a counselor or a therapist and they get nothing right they're not gonna say they're gonna say well you know talk to me and i'll see how i can help you but you know maybe just that little bit of help might be enough um and so uh figuring out how much cybernetic dysfunction somebody has to have before we're going to give them a diagnosis that's a tricky question right and that's not really the business that we're in because that's something that has to be worked out with the medical establishment and you know even sadly with things like insurance and all these things they're all these players that come in to defining exactly when somebody needs treatment and i don't think that ultimately that can be a purely objective question yeah right because there's always judgments about when to when you should help this is a basic issue with medicine it's not it's not just a science because there's this there's impera there's the imperative to treat well also i mean if if you have the money you you can get service from someone it's not like psychologists are turning people where they're like you're not messed up enough to see me you know you know right we're talking about psychoanalysis you can go pay to lie on the couch for five years yeah yeah yeah so it's we don't get that precise it's just like the pace the patient has to reach a point in their life where they're motivated to change in some way or yeah um i mean one interesting question is what do you do with people who have a problem but aren't motivated to change and they're and they're destroying society and or become like uh president right right well so there's an interesting thing about narcissism and antisocial personality disorder uh which is that those people who have those problems often don't think they have a problem i know uh and so you know one question we always get with our theory is like well how do you say when those people have a problem because what if they are pursuing their goals effectively and what we usually say is that well most of the time they're not even if they think they are right like if you are constantly stressed out and constantly in a rage because people aren't giving you the admiration that you feel you deserve then you are not actually successfully pursuing your goals right so you know you can still you can potentially diagnose people who don't want to be diagnosed even using our theory that's funny you say you say to a narcissist you have some serious cybernetic dysfunction going on there yeah well and they'll say you know screw you right i'm the greatest i'm the greatest at cybernetic dysfunction well right well i wouldn't say that but um i'm joking but right but that's you know again when we say that it's an objective question like they have a set of goals and whether or not they're actually effectively pursuing them is an objective question whether or not they recognize it whether or not you know they're deluded about how their lives are going or not um so you know i think that's a really interesting point another interesting one is what do you do with the what what people have called a successful psychopath you know like the person who is uh not in jail but making people making people miserable making people suffer to get what they want um you know is that person you know they're very callous they have no consideration of other people's uh other people's feelings or other people's needs happy to hurt people to get what they want is that person mentally ill or not and there our take on it is basically that if the way that they treat other people is interfering with some of their goals or needs again regardless of whether they recognize it or not then we can say that yes they do have psychopathology they do have cybernetic dysfunction but in the very rare case where they are actually meeting all of their own you know values and needs while causing other people to suffer they're not mentally ill but that's a question for you know for the law probably like we need to use other societal mechanisms and we often do that of course right because we often say well you're not mentally ill but i'm sending you to jail because you did things that are causing other people to suffer so totally yeah diagnosing mental illness is not the only way to deal with people who cause suffering yeah and their own personal goals might be being met at the expense of society and i think your theory needs to take that into account as well yeah well i'm you know and the way that it does that is to say that some things are a matter for uh for for the law right for legal enforcement or societal enforcement in some other way and not for uh the mental health profession um yeah you know unless they're at risk you can still report there's still certain rules yeah you read my mind i was just gonna think about risk right because you know like our theory i think also lends itself to thinking about ways to intervene for people who have risky personality profiles without you know stigmatizing them by saying they have a mental disorder but saying like with that particular profile that you have uh you are at serious risk for things going badly down the road um right and so maybe we want to intervene in certain ways like you know uh young like if you have kids for example who show what are called callous and unemotional traits uh which are uh essentially the antecedents uh to um to psychopathy right to having this kind of total callous uh disregard for other people and uh you know fearlessness and meanness and disinhibition if you see kids who have those traits uh you might want to figure out if there's something that you can do to steer them in a way that will not lead to um to something that might later be called psychopathy right but there's also a cause that psychologists have that if you're a risk of uh hurting like children or killing yourself you know i'm also thinking about those which which your theory is not going to change the some of the basic fundamental principles there right because i mean you know people who are at risk of hurting themselves generally you know want generally want to live like yeah i mean it's it becomes tricky when you get into questions like around suicide right because um you know i mean i guess one of the things that our theory would uh would say was possible was that there you could that you could make a case for uh a justified uh allowing of uh of of people ending their own lives right like with terminal illness some countries already have this i think that it if it when it's done right it is it is very enlightened and if you're saying i'm gonna i'm gonna be suffering i'm going to be you know dead in five years from this terminal illness uh i want to end my own life i don't think that you should be considered to have a mental illness right i think that there's there are circumstances under which that might be uh reasonable and yeah and not a sign of um bad mental health well but in most circumstances when people are suicidal it's a symptom of a lot of things going wrong for them and they're and that they're not able to you know get what they want or need in life and so you know then it clearly is indicative of psychopathology from our perspective i hear you i i i should have not even brought the suicide one because that that's the one you double clicked on but i'm thinking harm to others you know criteria like pedophiles who might you know are at risk of acting on it you know the urges or other things like that yeah yeah um right and so i think that's a clear case where somebody um is putting themselves at risk you know so pretty much nobody wants to go to jail right if you're going to jail like that's probably going to thwart a lot of your uh your goals things you value what you want in life and you know so sometimes let's say somebody makes a mistake does something illegal goes to jail they might be able they can avoid mental illness potentially by temporarily adjusting their goals trying to adapt to their situation uh you know when they get out of jail they might go back to pursuing some of the former values hopefully they've also maybe changed some of their goals to avoid getting that kind of trouble again you know so we can think about that process of adaptation but when you've got somebody who is at risk of destroying their own lives not to mention the lives of others like somebody with pedophilic tendencies for example then certainly there could be good reason to intervene right um and so you know that's a situation where you've got both the mental health issues coming up with somebody whose characteristics are putting them at risk and you've got legal issues where their characteristics are putting other people at risk yeah that's right that's exactly right well something i really like about your theory though is that it even just recognizes uh fundamentally that different people have different goals i mean even that's a revolutionary reframe [Laughter] yeah yeah i mean i guess we try to strike a balance between the fact that there are some goals that are pretty universal to human beings uh right this is like the whole idea of basic needs right i don't need to tell you about basic needs i know something about that yeah um but yeah so we reckon but then even there like we put more emphasis on the possibility for those to vary than some theorists would uh right like for example you know the need for uh relatedness or connection or belonging or whatever you want to call it um you know maybe there's somebody uh who's a hermit who's been living in the woods for 20 years do you ever read that story about it's like the last hermit this guy who lived in maine in the woods no that's a really fascinating story i'll send it to you um but uh you know so there are real people like this who are happier without human contact and who seem to have you know minuscule amounts of what is supposedly this universal human need for affiliation and to us you know that doesn't mean that they are defective or mentally ill or disordered or whatever because it might be that they just have a really unusual personality profile and if they can figure out a way to live that satisfies their other goals um you know then they can be healthy more power to them but most people obviously have more of a need for affiliation than that and so it is important like if i was thinking about this clinically i would say well you want to check in on the things that people have uh you know most people have or have a need for like connection to other people and sense of autonomy and sense of you know competence or capability or you know esteem or you know could use anything on on maslow's list or your updated version of maslow's list yeah i mean if you do ever write more on a specific uh you know elaboration of the interventions um that uh are implied by your theory um i would like to please consult me because i think we can we can we can bring in a lot of uh humanistic psychology and and the kind of things i've been thinking about in terms of how uh the goal of self-actualization and actually not forgetting that transcendence is a need among many humans as well you know right so yeah absolutely um so yeah we should keep talking i guess is what all i'm saying uh there um yeah so let's just end with um just a couple more um of the implications for intervention you know um i can even read quotes from you you say because our theory defines no because you say it so well here because our theory defines psychopathology in terms of failure of characteristic adaptations behavioral and talk therapies um most act direct act most directly on the problem and biological interventions are effective only in as much as the changes they make to cybernetic mechanisms subsequently allow people to develop and maintain effective characteristic adaptations but once we unpack what that means i think that's a really good suggestion for clinical psychologists who want to apply your theory yeah um right so one of the things that we are is uh skeptical about the amount that pharmaceuticals are used to try to help people with mental health problems and you know to be clear we think that there's always going to be a place for pharmaceuticals for some types of problem um you know controlling uh mania for example uh you know people use lithium to do that with a fair amount of success for many people uh you know those there are things where their the system some of these basic mechanisms of the system may be so extreme that if you don't intervene directly on them uh with drugs it may be really hard for the person to maintain stability and to be able to pursue their goals effectively in life but for many problems i think we should be paying more attention to what we can do with behavioral interventions talk based interventions you know things like cbt dbt act all the all the acro or abbreviations cbd oil cbd well that's a drug intervention my friend i'm joking i'm joking yeah which again i haven't i'm not i have no opposition to cbd oil or thc any other drug but i think that um when we are talking about what people need we often intervene with drugs that um well sort of like driving a nail with a sledgehammer right we we use these drugs that have extremely uh dramatic consequences on brain function um they're not targeted they're generally developed through trial and error um they work for some people but not for many people the success rates on them are you know only marginally better than placebos for a lot of commonly prescribed drugs so uh i think that if we focused more on figuring out how to basically uh help people to reshape their own uh habits fundamentally right they're the ways that they think about the world the ways that they act the strategies that they use to manage some of their own idiosyncrasies and unusual qualities without pathologizing them without stigmatizing them you know i just think that i think we could be doing a lot better job of helping people um and i think we could be you know it's funny i say this because a lot of my own research is neuroscience oriented right i'm very interested in the brain systems that are involved in uh different personality traits and risks for different kinds of uh mental illness but at the same time i think that we should actually be spending a lot more money um in research on interventions that are not based on uh on drugs and on biological mechanisms because i think that um there's this sort of general belief that the biological mechanisms are what are the real problem right there's a brain disease but i don't think that's right at all i think the the brain whatever the patterns of brain function they're just creating risks for people and that their real disease if you will is that uh people can't figure out what are the right things to be pursuing in life and the right ways to pursue them and the right ways to understand their existence that was beautiful um yeah you know this makes a lot of sense what you're saying because the things at the the particular methods that psychologists can use for helping people to change those goals and interpretations of the world and and to learn the strategies to be resilient and to reach those goals are more efficiently changed by behavioral or talk therapies than by biological interventions right yeah so that really explains it i want to end our chat today with a quote of yours you say ultimately psychopathology can be overcome only by helping people to set aside characteristic maladaptations that prevent them from from pursuing their goals effectively and to adopt new adaptations that become persistent elements of their personalities or habits as you said right or we're new habits um get rid of your back you can sum this up as like you know figure out how to get rid of your bad habits and develop better habits correct that's what we would say in layman's way person language but but but i want to enter this note because i think that it's a really exciting new area that you're going into with your work you know you've done such great work on understanding the neuroscience of personality understanding biological substrates of behavior cognition and personality but to move more in this direction of trying to actually impact the um day-to-day work that psychologists you know practitioners and psychiatrists are doing informed by real psychological theory i think is quite revolutionary so i just want to thank you colin for coming on my podcast today and for unpacking all the complexities because it is a very complex theory for our uh unpack them with our audience yeah well i hope um i hope the unpacking was uh comprehensible um i assume you'll put up some links you can probably link to some of the the papers if people want to read more um yeah i know it's been fun and it's fun to talk about these things i think with you is special for sure thanks colin thanks for listening to this episode of the psychology podcast if you'd like to react in some way to something you heard i encourage you to join in the discussion at the psychologypodcast.com that's the psychologypodcast.com also if you'd prefer a completely ad-free experience you can join us at patreon.com psycpodcast thanks for being such a great supporter of the show and tune in next time for more on the mind brain behavior and creativity

Channel: The Psychology Podcast

Views: 3,866

Rating: 4.9759035 out of 5

Keywords: psychology, podcast, Scott Barry Kaufman

Id: TQKQAdY18j0

Length: 76min 23sec (4583 seconds)

Published: Mon Aug 09 2021