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Libel in Fact: Aspiring to Rational Judgments Using DSM-I

Psychiatric diagnoses in the Fact poll.

An example of a likely intuitive reaction was a respondent's comment regarding the Senator: "He frightens the hell out of me."

In contrast to such intuitive reactions, diagnostic evaluations of Senator Goldwater ought to be more logical and analytical. Psychiatrists are trained in diagnosis, and to diagnose successfully requires both experience and expertise. Although the Fact poll did not specifically request diagnoses of the Senator, a number of psychiatrists volunteered their diagnostic impressions.

Today, psychiatrists diagnose mental disorders by using the Diagnostic and Statistical Manual of the American Psychiatric Association, 4th Edition Text Revision (DSM-IV-TR). The DSM-IV and the edition before it, DSM-III, were developed in part to promote agreement as to when a disorder is present or not in a patient.

To attain reasonable agreement, the DSM-IV includes both definitions of disorders, and lists of specific symptoms for a disorder. The diagnosis for schizophrenia, for example, includes such manifestations as delusions, hallucinations, disorganized speech, and affective flattening.  Schizophrenia is diagnosed only if a certain number of symptoms are present in a combination specified by the manual.

Earlier manuals, such as DSM-I (PDF) and DSM-II had relied solely on carefully conceived definitions of each disorder, but without such symptom checklists.  The manuals' authors had assumed that good definitions would be sufficient to attain diagnostic agreement.  After the publication of those two manuals, however, researchers delivered a rude shock: Agreement as to diagnosis based on definition alone was quite low. By the mid-sixties, the implications of such findings were just beginning to be appreciated.

The psychiatrists who replied to the Fact poll were using the DSM-I (published in 1952).  DSM-I represented an advance over earlier diagnostic systems in drawing together, defining, and organizing the psychiatric nomenclature of the time. Without symptom checklists, however, diagnostic agreement among those who used DSM-I was often poor, and patients were often misdiagnosed.  The diagnoses offered for Senator Goldwater in the Fact poll reflected this issue as well: there were widely varying assessments. 

Regarding Senator Goldwater, some saw him as normal: One concluded, "He is a sane man."  Some psychiatrists ascribed only problematic disorders to him that were mild-to-moderate in severity: "...an anal character", or "...has a severe obsessive-compulsive neurosis...", or was "...a narcissistic character disorder with not too latent paranoid elements...".

A number of the psychiatrists were concerned about more serious issues such as paranoia; one remarked: "he is paranoid..."; others labeled Goldwater "...a paranoid personality..., compensated at present...", and "...a paranoid personality or a schizophrenic, paranoic type."

DSM-1 described paranoid personalities as marked by social withdrawal characteristic of Schizoids, but included as well: "an exquisite sensitivity... suspiciousness, envy, extreme jealousy and stubbornness." I wonder how typical this description might be of the average shy or introverted person without paranoia. Aside from the "extreme jealousy," many people are suspicious at times, experience envy, and could appear stubborn to those who disagree with them. 

Still more severe diagnoses appeared in the poll as well: "I believe Goldwater to be suffering from a chronic psychosis...," "is grossly psychotic," or was a "...chronic schizophrenic...".

Psychosis refers to being out of touch with reality, to disorganized behaviors such as shouting or arguing with oneself out loud, or being entirely mute. DSM-1 defined psychotic reactions as:

...one in which the personality, in its struggle for adjustment to internal and external stresses, utilizes severe affective disturbance, profound autism and withdrawal from reality, and/or formation of delusions or hallucinations.

It seems incongruous that Senator Goldwater, then conducting a national campaign as the Republican candidate for US President, had a mental state in any way close to psychotic. 

DSM-I, although defining diagnoses, failed to provide the methods necessary to accurately perceive others -- methods which, at the time, were largely unknown. As a consequence, DSM-I's limitation undermined the mental health professionals who used it. 

The Fact poll may not have provided a good sense of Senator Goldwater's true character, but some of the issues of judging personality are clarified by examining the published responses to the poll.

Intuitions may reveal some truths about a person, but it is useful to add a logical, analytic check as to the accuracy of one's reactions.

Even highly perceptive, empathic, and experienced psychiatrists require empirically valid methods and procedures when judging the personality of another person. Without good procedures and sound research, even very smart people may be readily led astray.

Notes

The definition of psychotic is from p. 12, and the description of paranoia is from page 36 of the Committee on Nomenclature and Statistics of the American Psychiatric Associaiton. (1952). Diagnostic and Statistical Manual: Mental Disorders. Washington, DC: American Psychiatric Association.

The psychiatrist's assessments all appeared in Boroson, W. (1964, September/October).  What psychiatrists say about Goldwater.  Fact, 1, 24-64.  These included that, "He is a sane man." (p. 42), "...an anal character" (p. 42), or "...has a severe obsessive-compulsive neurosis..." (p. 37), or is a "...a narcissistic character disorder with not too latent paranoid elements..." (p. 26).
Paranoia was a common concern; for example, Goldwater was labeled:...a paranoid personality..., compensated at present..." (p. 27), "...a paranoid personality or a schizophrenic, paranoic type," (p. 55) and simply, "he is paranoid..." (p. 62)
Still more severe diagnoses appeared in the poll as well: "I believe Goldwater to be suffering from a chronic psychosis... (p. 38)" "I believe Goldwater is grossly psychotic" (p. 63) "I get the clinical impression that Goldwater may be a chronic schizophrenic...Covert-psychotics-which Goldwater probably is-never get picked up by superficial Armed Services tests..." (p. 57). Senator McCarthy...was a slowly decompensating paranoid schizophrenic. Goldwater's general views and behavior mark him as cut from essentially the same mold." (p. 41).

Edits: Plus 6 days, light editing.

Copyright © 2009 John D. Mayer

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