Against Personality and Mental Health Labels
Typologies can impose more liabilities than benefits.
Posted Sep 02, 2018
Alas, personality tests and their underlying typologies have been severely criticized for poor predictive validity. In employee selection, personality tests score at the bottom of criteria used--a correlation of 0.22 or less with workplace performance.
In short, personality tests don’t provide accurate-enough guidance. Yet their use persists. As with horoscopes and astrology, the promise is so seductive, the price and time commitment so trivial.
Even many mental health professionals have trouble resisting. After all, giving a test feels authoritative and yields pre-made recommendations with the credibility of a printout.
But it's wise to less-often rely on personality typologies. After all, even the publishers of personality tests warn that the results provide a mere a starting place for exploration. But because of their poor validity, which could well steer people down an ill-advised path, such results usually shouldn't be a starting place, a front-row seat, but one toward the back of the bus.
After all, if your starting framework is, for example, "S/he’s an INTJ," a “Blue” on the Birkman, or a NEO that deems you an introverted, low-agreeability, conscientious, neurotic, with low openness to experience, that could easily lead down a wrong path. What if, like most people, there are contexts in which you differ from those characterizations? What if on retest a week later, the results are different, as often is the case with personality measures? Starting your inquiries based on such a label could, if not wrong, be reductionistic and limiting.
Mental illness diagnostic labels
Similarly, the Diagnostic And Statistical Manual of Mental Disorders (DSM) categories should be viewed askance. Again, their use is understandable. They're seductive both to the mental health professional and to the client. The professional gets treatment options with some empirical basis and the diagnostic categories yield codes for insurance reimbursement. Clients like diagnostic labels because having an identified "disease" suggests that their bad behavior is not their fault, that the condition has been studied, treatments developed, and that similar sufferers can be connected with, for example, in a support group.
But labeling a person with a mental illness imposes serious disadvantages. Of course, labeling a person with "major depressive disorder, "borderline personality disorder," let alone “schizophrenia” can make the person feel like a profoundly defective organism. Plus, the labels can be so reductionistic. For example, in the real world, 10 people diagnosed with, say, schizophrenia, will likely have quite varied behaviors, feelings, traits, and environmental influences. Yes, a label could point to an appropriate treatment but, importantly, it often does not, and even more often tends to obfuscate approaches that, for that individual, may be better. Thomas Insel, former Director of the National Institutes for Mental Health, wrote that the agency would no longer rely exclusively on the DSM criteria due to lack of validity. For example, a study found that major depression disorder has a kappa of just 0.28, which means that clinicians frequently disagree on this diagnosis of the same patients.
Daniel Kahnemann, famed author of Thinking Fast and Slow, warns of our tendency to take easier options—in this case, to treat the client by the book—than to deeply enough probe for individual factors that might yield more helpful recommendations.
Without doubt, I would have been labeled ADHD had I grown up today. Back when I was a kid, I was simply deemed a behavior problem. That felt somewhat under my control, whereas if I had been labeled ADHD, I would have felt my behavior was quite immutable except by taking amphetamines for the rest of my life, which might have been a shorter life—Logically, it would seem that you can't take uppers for a lifetime without imposing cardiovascular costs, and some recent research supports that contention. Also, if diagnosed with ADHD, I would have felt less impetus to work on improving my behavior. I might well have accepted myself as having an incurable disease. Instead, over the years, I’ve self-taught compensatory behaviors and thought processes that have enabled me to have a good professional and personal life.
Of course, I am not advocating the total dismissal of personality and mental health typologies let alone suggesting that we stop research to discover more predictively valid labels. This essay merely attempts to reduce their over-use. For example, you might learn more about your personality by reviewing your life and finding threads in how you’ve spent your time, what have been your greatest accomplishments and failures, your times of greatest and least contentment. Doing that would use much more of your life's data, information that’s closer to who you really are, than in answering a set of questions generated to apply to the masses.
If you are a mental health professional, consider taking the hard way: As appropriate, play detective to unearth a fuller constellation of what’s going in within and external to your client. Develop your plan based on those factors. If that feels inadequate, then okay, you might opt to administer a personality instrument or to identify the best-fit DSM diagnostic label. But by not leading with an attempt to categorize the person, you've avoided being, from the start, tunnel-visioned by that label.
If you’re a client or patient of a mental health professional, if labeled, ask the practitioner for the labeling's basis, how solidly s/he believes it’s valid, and importantly, how the label is helpful in improving your life. Is it possible that rather than pathologizing you as diseased, you’d be wise to accept at least some of your non-standard behaviors as mere individual differences?