Adventures in Old Age

A candid look at aging, old age, and eldercare.

Don't Jump The Gun On Diagnosing The Arizona Shooter

Are media psychologists more than high-concept "gossipologists"?

Oops! Perhaps that was an infelicitous expression, in light of the shooting in Arizona, but less infelicitous than some of the off-the-cuff, armchair diagnoses from my colleague psychologists.

And I'll throw myself on the mercy of the court of public opinion by pointing to the attention-getting quality of "Don't jump the gun." After all, the main point of our media is to grab attention, and rely on psychologists to be useful and willing fools.

When I looked at the alleged shooter's You Tube postings, I predicted to myself that someone is going to publicly diagnoses Jared Loughner as a paranoid schizophrenic, and, sure enough, only hours after the shooting, I read this in Andrew Sullivan's blog, "The Daily Dish," from the Atlantic:

"I'm a licensed psychologist with 20 years experience. I've watched the Jared Loughner Youtube videos. They show evidence of delusions of persecution. Loughner's less than coherent language also suggests a formal thought disorder. While Loughner can't be diagnosed without a full exam conducted in person, there are significant indications in the videos that he suffers from a psychotic disorder.

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"I would not rule out drugs as a factor, but he is within the age range that psychotic patients often suffer their first psychotic break. If I had to guess, I'd go with paranoid schizophrenia. If that's the case, his politics are irrelevant. He may not even be fit to stand trial unless and until his psychotic thinking is brought under control with medication."

Sure, he or she pays lip service to the idea that an in-person exam is required for a diagnosis, but this doesn't prevent a full-blown diagnosis of paranoid schizophrenia. As an aside, this leaves out the fact that schizophrenics in general, as well as paranoid schizophrenics in particular are too disorganized to organize premeditated, multi-step acts of violence. In fact, paranoid schizophrenics tend to isolate themselves and more likely become violent when they feel their personal space is being violated. They don't go out looking for trouble.

Sullivan's psychologist is not alone. Google "Loughner and schizophrenia," or "Loughner and diagnosis, and you will see the ubiquity of this type of armchair exercise.

But most studies conclude that substance abuse, which Sullivan's psychologist does mention, is more likely to be associated with violence, whether there is schizophrenia or not.

Paranoia is more likely to lead to violence as a personality trait of a more organized individual--what we call a personality disorder. Stalin, for instance, was very paranoid, very violent. Unfortunately, he had the means to eliminate any perceived or actual enemy. During the period while he purged and liquidated millions, he would obsessively doodle pictures of wolves in aggressive poses. But no examination of his life and writings could conclude that he had schizophrenia. Someone with schizophrenia would not be organized enough to plot and outmaneuver Trotsky, consolidate power, and defeat the Germans in World War II.

What does the American Psychologist Association's Code of Ethics say?

"When psychologists provide public advice or comment via print, Internet, or other electronic transmission, they take precautions to ensure that statements (1) are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice; (2) are otherwise consistent with this Ethics Code; and (3) do not indicate that a professional relationship has been established with the recipient."

And,

"...psychologists provide opinions of the psychological characteristics of individuals only after they have conducted an examination of the individuals adequate to support their statements or conclusions."

The psychiatrists are even more explicit in the American Psychiatric Association's Code of Ethics,

"On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement."

This would seem to preclude the promiscuous diagnosing we find in the media, but these provisions are never enforced. We don't want to get psychologists--or psychiatrists--off the gravy train of self-promotion.

I gave many interviews while promoting my book about my work in eldercare, and I always felt a tad uncomfortable when I was on call-in shows fielding questions such as "Should I put Mom in a nursing home?" or "How do I convince my sister she's wrong about Dad's dementia?" I much preferred to talk about my own experiences as a caregiver to my father, or why the Kant's Categorical Imperative was a guide to the organization of nursing homes, but I probably wouldn't have been booked if not for my supposed expert opinions on psychology.

Thankfully--although it's a thankless task, given the amount of air, print, and web space that needs to be filled--I'm not the only one who has a problem with vicarious diagnosis.

One psychologist, who writes a blog on privacy, comes down squarely on the side of keeping your mouth shut:"From my perspective, since there is no compelling reason to violate privacy or to engage in gossip, when the psychologist does not have detailed and in-depth information about the individual being discussed, psychologists should simply decline to comment specifically about the individual. Psychologists can still discuss general issues based on the professional literature and their relevant professional training and experiences, but an inquiry from a reporter or TV journalist is not a good enough reason to gossip or to ignore the importance of having an adequate assessment before offering an opinion." (http://www.pogowasright.org/blogs/dissent/?p=1697)

A UK psychologist, Gary Wood, decries what he calls gossipologists:

I've read of so-called reputable psychologists (read "gossipologists") offering mental health diagnoses of celebrities. I've also seem them discussing the mental states of celebrities' young children. Nothing they say is ever meaningful and it's certainly unethical. It's gossip, plain and simple! The fact that someone has a degree in psychology or a PhD in ‘the social impact of jogger's nipple' does not mean they have any valid insight into the mental state or deepest motivations of any celebrity. Psychologists should abide by a common set of values that shouldn't be prostituted for a one-liner in "Celebrity Life" magazine. Surely, these values should be higher than picking over the bones of skeletons in celebrities' closets. Where juicy, meaty titbits of gossip are concerned, shouldn't psychologists be "vegetarian"? (http://psycentral.wordpress.com/tag/gossipologists/)

With likely futility, I recommend that psychologists and other behavioral scientists could perform more of a public service by pointing out that vicarious diagnoses are ethically improper, misleading, and probably wrong.

We could expand on this in media appearances by outlining the facts on human violence and its causes. But such elocutions require speaking in paragraphs, when the media wants sound bites.

Although one historically great sound bite-from H. Rap Brown, founder of the Black Panther Party-observed that "Violence is as American as cherry pie," I'd counter that with "Loose lips sink ships!"

Or we could go with the words of noted ethicist, Joe Friday: "Just the facts, ma'am"

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My book, Nasty, Brutish, and Long: Adventures In Eldercare (Avery/Penguin, 2009), was a Finalist for the 2010 Connecticut Book Award. Click here to read the first chapter It provides a unique, insider's perspective on aging in America. It is an account of my work as a psychologist in nursing homes, the story of caregiving to my frail, elderly parents--all to the accompaniment of ruminations on my own mortality. Thomas Lynch, author of The Undertaking, calls it "A book for policy makers, caregivers, the halt and lame, the upright and unemcumbered: anyone who ever intends to get old."

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Ira Rosofsky, Ph.D., is a psychologist in Connecticut who works in eldercare facilities and the author of Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare.

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