Interdisciplinary Review of General, Forensic, Prison and Military Psychiatry and Psychology and the related subjects of Behavior and Law with the occasional notes and comments by Michael Novakhov, M.D. (Mike Nova).
Act III, scene 2. The players perform "The Murder of Gonzago." Hamlet brags to Horatio that he has exposed Claudius. Rosencrantz and Guildenstern come to tell him that his mother is looking for him. Part 2.
"GUILDENSTERNO, my lord, if my duty be too bold, my love is too
HAMLETI do not well understand that. Will you play upon
GUILDENSTERNMy lord, I cannot.
HAMLETI pray you.
GUILDENSTERNBelieve me, I cannot.
HAMLETI do beseech you.
GUILDENSTERNI know no touch of it, my lord.
HAMLET'Tis as easy as lying: govern these ventages with
your fingers and thumb, give it breath with your
mouth, and it will discourse most eloquent music.
Look you, these are the stops.
GUILDENSTERNBut these cannot I command to any utterance of
harmony; I have not the skill.
HAMLETWhy, look you now, how unworthy a thing you make of
me! You would play upon me; you would seem to know
my stops; you would pluck out the heart of my
mystery; you would sound me from my lowest note to
the top of my compass: and there is much music,
excellent voice, in this little organ; yet cannot
you make it speak. 'Sblood, do you think I am
easier to be played on than a pipe? Call me what
instrument you will, though you can fret me, yet you
Yes, but to a certain degree, and ultimately - not.
The various attempts at understanding it depend on a multitude of factors: from purposes and contexts of these attempts at understanding to various characteristics of subject and object: of what is attempted to be understood and who attempts it. The more complex they are, the more complex is the outcome of these attempts.
What is behavior and what is analysis?
Definitions of "behavior"
From Wikipedia (and similar definitions from other sources which are more or less the same):
Behavior in general is defined as "the range of actions and mannerisms made by organisms, systems, or artificial entities in conjunction with their environment, which includes the other systems or organisms around as well as the physical environment. It is the response of the system or organism to various stimuli or inputs, whether internal or external, conscious or subconscious, overt or covert, and voluntary or involuntary."
Human behavior is defined as "the range of behaviors exhibited by humans and which are influenced by culture, attitudes, emotions, values, ethics, authority, rapport, hypnosis, persuasion, coercion and/or genetics.
The behavior of people (and other organisms or even mechanisms) falls within a range with some behavior being common, some unusual, some acceptable, and some outside acceptable limits. In sociology, behavior in general is considered as having no meaning, being not directed at other people, and thus is the most basic human action. Behavior in this general sense should not be mistaken with social behavior, which is a more advanced action, as social behavior is behavior specifically directed at other people. The acceptability of behavior is evaluated relative to social norms and regulated by various means of social control.
The behavior of humans is studied by the academic disciplines of psychiatry, psychology, social work, sociology, economics, and anthropology."
From Encyclopædia Britannica:
"the potential and expressed capacity for physical, mental, and social activity during the phases of human life."
Can we accept these definitions as satisfactory? Hardly.
It seems to me that the cardinal feature of definition of behavior should be its overt, expressed character: actions and "mannerisms" which are evident to others (and usually, to some degree, to the subject also) and are directly observable, as opposed to various inner mental activities which are not directly observable, although might be hypothetically postulated based on observations. More precise term should be "overt behavior": by definitions (whatever unsatisfactory they are), it is always overt. When it is "covert", it is not behavior, it is "mental life", or "mental processes".
"It has sometimes been said that 'behave is what organisms do'." (Behaviorism - SEP)
We can rephrase it a bit: human behavior is what humans do. This leaves out of the equation all the rest: determinants, motivations, etc., which should be the subjects of separate considerations and studies. In a way "behavior" is a "black box":
"In science and engineering, a black box is a device, system or object which can be viewed in terms of its input, output and transfer characteristics without any knowledge of its internal workings. Its implementation is "opaque" (black). Almost anything might be referred to as a black box: a transistor, an algorithm, or the human mind."
From a very superficial and preliminary review of sources, I got the impression that philosophers prefer to use the notion of "human nature" rather than "human behavior", and the notion of "human nature" appears to be much deeper, richer and ontologically oriented. Apparently, they are less interested in how humans behave and more in what they (really) are. This is a very interesting difference in approach to this subject. Probably overt behavior is viewed by philosophers as something that is too fluid, too passing, too secondary in comparison with its underlying primary "nature" and "essence".
Behavior is very changeable (at least and most of the time on a surface, sometimes - deeply, when someone appears to be a different person at various stages in his/her life), its nature and essence remain largely the same.
Now we have to turn to the "analysis of analysis": to what it is and how it impacts the subject of our discussion.
Comments on Richards Heuer's "Psychology of Intelligence Analysis"
Psychology of Intelligence Analysis - Richards J. Heuer, Jr. "What Heuer examines so clearly and effectively is how the human thought process builds its own models through which we process information. This is not a phenomenon unique to intelligence; as Heuer’s research demonstrates, it is part of the natural functioning of the human cognitive process, and it has been demonstrated across a broad range of fields ranging from medicine to stock market analysis." (p. ix) The common element is the need and the ability to "make judgments based on incomplete and ambiguous information..." (p. 2). The terms "ability" and "judgement" are in want of further elaboration.
PART I—OUR MENTAL MACHINERY Chapter 1: Thinking About Thinking "A central focus of this book is to illuminate the role of the observer in determining what is observed and how it is interpreted." (p. 4) "Before obtaining a license to practice, psychoanalysts are required to undergo psychoanalysis themselves in order to become more aware of how their own personality interacts with and conditions their observations of others. The practice of psychoanalysis has not been so successful that its procedures should be emulated by the intelligence and foreign policy community. But the analogy highlights an interesting point: Intelligence analysts must understand themselves before they can understand others. Training is needed to (a) increase self-awareness concerning generic problems in how people perceive and make analytical judgments concerning foreign events, and (b) provide guidance and practice in overcoming these problems." (p. 4)
These are very interesting analogy and point: "self-awareness" and "self-understanding" (of your own background, motivation, personality and reactions set and their impacts and influence on "analytical judgements" as a tool and a factor in improving their "objectivity", quality and "correctness" or veracity and hopefully diminishing the influence of various emotional, cognitive and logical biases. The question remains what are or should be the criteria for evaluating the outcome, "objectivity", quality and "correctness" of these judgements.
This quote also brings up the issue of general usefulness (or not usefulness) of various psychodynamic theories and practices in the light of their very questionable therapeutic "success" and a lack of true scientific basis.
"It is simply assumed, incorrectly, that analysts know how to analyze." (p. 5) This statement can be applied to any type of "analysts", be them "psychoanalysts" or stock traders. It also, and probably inevitably, brings us to the general issue of what "analysis" really is, to philosophical and epistemological aspects of it. The nature and the unique tool sets of any analytical activity is determined by its pragmatic scope; there are many very different analyses which are defined by practical needs for them. "The disadvantage of a mind-set is that it can color and control our perception to the extent that an experienced specialist may be among the last to see what is really happening when events take a new and unexpected turn. When faced with a major paradigm shift, analysts who know the most about a subject have the most to unlearn." (p. 5) This is also very interesting, important and correct point and observation. It is similar to the cognitive (and also emotional and other) difficulties in reevaluating and changing the initial or established diagnostic impressions in clinical medical practice, when the new data sets are accumulated. The true extent, impact and significance of this general problem probably is not known by us very well and it comes up mostly in medical malpractice situations. "Major paradigm shifts" definitely present challenges to their adherents, who are invested into them cognitively, emotionally and professionally. T. Kuhn, describing "paradigm shifts" in science, observed that most of the adherents of old paradigms do not really change their views, they continue to stick with the old paradigms and simply die with them. "If analysts’ understanding of events is greatly influenced by the mind-set or mental model through which they perceive those events, should there not be more research to explore and document the impact of different mental models?" (p. 5-6) Most definitely, it should be more research in this area. "The reaction of the Intelligence Community to many problems is to collect more information, even though analysts in many cases already have more information than they can digest." The so called "principle of parsimony (Occam's razor)" might be applicable in these situations. Chapter 2: Perception: Why Can’t We See What Is There To Be Seen? "Moreover, the circumstances under which intelligence analysis is conducted are precisely the circumstances in which accurate perception tends to be most difficult." (p. 7) "Perception implies understanding as well as awareness. It is a process of inference in which people construct their own version of reality on the basis of information provided through the five senses." (p. 7) "We tend to perceive what we expect to perceive." (p. 8) Perceptions, simple and complex (not just simple sensory - this is what is usually meant by perceptions in psychiatry and psychology, but complex, mental, "informational", so to speak, perceptions; which are completely different phenomena by their nature) are processed in "gestalts": patterns, perceptual mini-concepts, perceptual frameworks, perceptual mini-paradigms, if you will; which include the perceptual mental set and expectations: "...what people in general and analysts in particular perceive, and how readily they perceive it, are strongly influenced by their past experience, education, cultural values, and role requirements, as well as by the stimuli recorded by their receptor organs." (p. 8) "Expectations have many diverse sources, including past experience, professional training, and cultural and organizational norms." (p. 9) "Perception is also influenced by the context in which it occurs. Different circumstances evoke different sets of expectations." (p. 9) The role and purpose of these perceptual gestalts or perceptual mini-paradigms (just like for any paradigm as a conceptual framework in general), besides the inherent phenomenon of "mental economy" (organisation of mental processes in a most efficient way) is to provide us with the complete perceptual picture, to compensate and to fill out for missing perceptual elements and parts (this process is based on perceptual mental set, previous experiences and expectations) , for no perception is absolutely and entirely complete in its process. The role of a paradigm in general as a cognitive device is to compensate the lack of exact, precise, detailed and complete knowledge by adding the unifying, all-encompassing and cementing element of belief into this complex cognitive system, and belief becomes its affective, emotional component. That is why people hold on to their paradigms or belief systems so tenaciously: they are strongly invested into them affectively, emotionally.In other words, if we do not know something exactly, very often we simply believe that we do, rather than to face the unknown.
Heuer's definition of a "mind-set": "Patterns of expectations tell analysts, subconsciously, what to look for, what is important, and how to interpret what is seen. These patterns form a mind-set that predisposes analysts to think in certain ways. A mind-set is akin to a screen or lens through which one perceives the world." Heuer's "mind-sets" might be defined more accurately (arguably) as "perceptual mental sets". "Actually, mind-sets are neither good nor bad; they are unavoidable." (p. 10) "Analysts do not achieve objective analysis by avoiding preconceptions; that would be ignorance or self-delusion. Objectivity is achieved by making basic assumptions and reasoning as explicit as possible so that they can be challenged by others and analysts can, themselves, examine their validity." (p. 10) I think that the more exact way of putting it would be that "making basic assumptions and reasoning as explicit as possible" does not achieve objectivity itself but is simply an attempt at achieving it. Objectivity itself might be an ever elusive goal and, which is more, might be in principle, inherently antithetical to the nature and purposes of intelligence analysis.
Characteristics of Heuer's "mind-sets: They are relatively stable and adhere to initial impressions: "mind-sets tend to be quick to form but resistant to change." (p. 10) New data sets tend to be "auxillary", additional to already existing and perceptually established sets: "new information is assimilated to existing images", "... gradual, evolutionary change often goes unnoticed." (p. 11) In other words, in order for newly added information to acquire proper significance and value, it might take a "paradigm change or shift" (of various magnitudes and hierarchies), it has to be evaluated properly within a new conceptual framework or by a new evaluator who uses this framework without preexisting misconceptions and biases that come with the old paradigm. "A fresh perspective is sometimes useful; past experience can handicap as well as aid analysis." (p. 11) The ambiguity of newly added information contributes to its "additional, auxillary" character and probably to some depreciation of its true significance and value because this ambiguity does not allow the new information to fit easily into existing conceptual framework and might require a new one, a new paradigm, a new thinking or a new thinker (which are the same) in order for it to be appreciated fully or more correctly. "This tendency to assimilate new data into pre-existing images is greater “the more ambiguous the information, the more confident the actor is of the validity of his image, and the greater his commitment to the established view.” (p. 11-12) One might recall an old and trite adage: what we see or able to see depends on our points of view. "One of the more difficult mental feats is to take a familiar body of data and reorganize it visually or mentally to perceive it from a different perspective. Yet this is what intelligence analysts are constantly required to do. In order to understand international interactions, analysts must understand the situation as it appears to each of the opposing forces, and constantly shift back and forth from one perspective to the other as they try to fathom how each side interprets an ongoing series of interactions." (p. 13) The more points of view we have, the fuller and more comprehensive is the picture. "Initial exposure to blurred or ambiguous stimuli interferes with accurate perception even after more and better information becomes available" (p. 13): the first impression is the strongest and might skew the evaluation of the newly acquired and better information.
Heuer cites the results of a psychological experiment: "In other words, the greater the initial blur, the clearer the picture had to be before people could recognize it. Second, the longer people were exposed to a blurred picture, the clearer the picture had to be before they could recognize it." (p. 14) "The early but incorrect impression tends to persist because the amount of information necessary to invalidate a hypothesis is considerably greater than the amount of information required to make an initial interpretation." (p. 14) Refutation of the preformed or preexisting "perceptual hypothesis" might require not only the greater amount of information but also the newer and better ways of processing it, a new "perceptual paradigm", a new perceptual framework. However the qualitative paradigmatic switch will require the adequate, sufficient and convincing quantitative accumulation of the new data. Implications for Intelligence Analysis "Comprehending the nature of perception has significant implications for understanding the nature and limitations of intelligence analysis. The circumstances under which accurate perception is most difficult are exactly the circumstances under which intelligence analysis is generally conducted—dealing with highly ambiguous situations on the basis of information that is processed incrementally under pressure for early judgment. This is a recipe for inaccurate perception." (p. 14) "Intelligence seeks to illuminate the unknown. Almost by definition, intelligence analysis deals with highly ambiguous situations. As previously noted, the greater the ambiguity of the stimuli, the greater the impact of expectations and pre-existing images on the perception of that stimuli. Thus, despite maximum striving for objectivity, the intelligence analyst’s own preconceptions are likely to exert a greater impact on the analytical product than in other fields where an analyst is working with less ambiguous and less discordant information." (p. 14) "Once an observer thinks he or she knows what is happening, this perception tends to resist change. New data received incrementally can be fit easily into an analyst’s previous image. This perceptual bias is reinforced by organizational pressures favoring consistent interpretation; once the analyst is committed in writing, both the analyst and the organization have a vested interest in maintaining the original assessment." (p. 16) We might call this observation and phenomenon "institutional perceptual bias". "Given the difficulties inherent in the human processing of complex information", Heuer recommends:
to "clearly delineate ... assumptions and chains of inference and that specify the degree and source of uncertainty involved in the conclusions."
to "re-examine key problems from the ground up in order to avoid the pitfalls of the incremental approach."
to "expose and elaborate alternative points of view."
to "define a set of realistic expectations as a standard against which to judge analytical performance."
My conclusions: always doubt, always be ready for change, always consider the alternative ways of looking at things.
Sexual assault has emerged as one of the defining issues for the military this year. Reports of assaults are up, as are questions about whether commanders have taken the problem seriously. Bills to toughen penalties and prosecution have been introduced in Congress.
But in a debate that has focused largely on women, this fact is often overlooked: the majority of service members who are sexually assaulted each year are men.
In its latest report on sexual assault, the Pentagon estimated that 26,000 service members experienced unwanted sexual contact in 2012, up from 19,000 in 2010. Of those cases, the Pentagon says, 53 percent involved attacks on men, mostly by other men.
“It’s easy for some people to single out women and say: ‘There’s a small percentage of the force having this problem,’ ” said First Lt. Adam Cohen, who said he was raped by a superior officer. “No one wants to admit this problem affects everyone. Both genders, of all ranks. It’s a cultural problem.”
Though women, who represent about 15 percent of the force, are significantly more likely to be sexually assaulted in the military than men, experts say assaults against men have been vastly underreported. For that reason, the majority of formal complaints of military sexual assault have been filed by women, even though the majority of victims are thought to be men.
“Men don’t acknowledge being victims of sexual assault,” said Dr. Carol O’Brien, the chief of post-traumatic stress disorder programs at the Bay Pines Veterans Affairs Health Care System in Florida, which has a residential treatment program for sexually abused veterans. “Men tend to feel a great deal of shame, embarrassment and fear that others will respond negatively.”
But in recent months, intense efforts on Capitol Hill to curb military sexual assault, and the release of a new documentary about male sexual assault victims in the military, “Justice Denied,” have brought new attention to male victims. Advocates say their plight shows that sexual assault has risen not because there are more women in the ranks but because sexual violence is often tolerated.
“I think telling the story about male victims is the key to changing the culture of the military,” said Anuradha K. Bhagwati, executive director of the Service Women’s Action Network, an advocacy group that has sharply criticized the Pentagon’s handling of sexual assault. “I think it places the onus on the institution when people realize it’s also men who are victims.”
The Department of Defense says it is developing plans to encourage more men to report the crime. “A focus of our prevention efforts over the next several months is specifically geared towards male survivors and will include why male survivors report at much lower rates than female survivors, and determining the unique support and assistance male survivors need,” Cynthia O. Smith, a department spokeswoman, said in a statement.
In interviews, nearly a dozen current and former service members who said they were sexually assaulted in the military described fearing that they would be punished, ignored or ridiculed if they reported the attacks. Most said that before 2011, when the ban on openly gay service members was repealed, they believed they would have been discharged if they admitted having sexual contact — even unwanted contact — with other men.
“Back in 1969, you didn’t dare say a word,” said Gregory Helle, an author who says he was raped in his barracks by another soldier in Vietnam. “They wouldn’t have believed me. Homophobia was big back then.”
Thomas F. Drapac says he was raped on three occasions by higher-ranking enlisted sailors in Norfolk in 1966. He said he had been drinking each time and feared that if he told prosecutors they would assume it was consensual sex. Parts of his story are corroborated in Department of Veterans Affairs records.
“If you made a complaint, then you are gay and you’re out and that’s it,” he said.
Mr. Drapac, 66, said that over the coming decades he kept the rapes to himself, combating recurring nightmares and doubts about his sexuality with alcohol and drugs. But he began seeing a Department of Veterans Affairs therapist several years ago, and decided to tell his story recently after seeing accounts of female sexual assault victims.
“The best thing going on right now is that the women’s issue is coming to the fore and you see some mention about male rapes,” he said.
Many sexual assaults on men in the military seem to be a form of violent hazing or bullying, said Roger Canaff, a former New York State prosecutor who helped train prosecutors on the subject of military sexual assault for the Pentagon. “The acts seemed less sexually motivated than humiliation or torture-motivated,” he said.
But such attacks can be deeply traumatizing, causing men to question their sexuality or view themselves as weak. Some said their own families seemed ashamed of them.
“Being a male victim is horrible,” said Theodore James Skovranek II, who said he was sexually hazed in the Army in 2003. Some people told him the attack, in which another soldier shoved his genitals in his face after they had been drinking with friends, was not a big deal. But it made him question his manhood.
“I walked around for a long time thinking: I don’t feel like a man,” said Mr. Skovranek, who left the Army in 2005. “But I don’t feel like a woman either. So there’s just this void.”
Rick Lawson said that while he was in the Army National Guard in Washington in 2003 and 2004, he was repeatedly sexually bullied by a group of soldiers, including a sergeant who rubbed his groin into Mr. Lawson’s buttocks and jumped into his bunk and pretended to cuddle with him. Later, during preparations for deployment to Iraq, one sergeant handcuffed him and put him in a headlock while another pretended to sodomize him, Mr. Lawson said.
Several months after his unit arrived in Iraq in 2004, Mr. Lawson decided to report the bullying. His assailants were punished with reduced rank, Army records show, but he had to finish his deployment while living near them on the same base.
After he returned to Washington, he received a diagnosis of post-traumatic stress disorder and was discharged from the Army in 2006. He struggled with depression and lost a job, then decided to start an advocacy group for veterans.
“A lot of people say this problem exists because we are allowing women into the military or because of the repeal of ‘don’t ask, don’t tell,’ ” he said, referring to the ban on openly gay service members. “But that is absurd. The people who perpetrated these crimes on me identify as heterosexual males.”
Although the vast majority of military sexual assaults are by men, a small number of men have reported being raped by women.
Richard H. Ruffert, 50, said his boss in an Army reserve unit in Texas forced him to have sex with her by threatening to give him poor reviews. He said the sex continued for about two months in the late 1990s, until he attempted suicide. He then told a commander and, after a lengthy investigation, his boss was transferred. But he believes that she was never punished.
He retired from the military in 2004 and spent several years struggling with nightmares, drug addiction and homelessness, which he blames on the sexual assault. Therapy and working with veterans have helped him, he said.
But he does not feel comfortable dating women anymore. “This has completely changed my life,” said Mr. Ruffert, who appears in the film “Justice Denied.”
Many experts believe that the repeal of “don’t ask, don’t tell” will cause many more men to report sexual assault. That was the case with Lieutenant Cohen, who says he was raped in 2007 by an Army officer he had met in graduate school. At the time, Lieutenant Cohen was preparing to join the Air Force.
After initially remaining silent about the episode, he filed a complaint with Air Force investigators in late 2011, after the ban was rescinded. But the investigation took a surprising turn: after Lieutenant Cohen returned from a five-month tour in Afghanistan, he learned that he had become the subject of the investigation and was no longer viewed as a victim.
The lieutenant, 29, now faces a court-martial trial on multiple charges, including conduct unbecoming an officer. Lieutenant Cohen’s special victims counsel, Maj. John Bellflower, said the Air Force investigators apparently used information provided voluntarily by the lieutenant in bringing the charges against him, a possible violation of his rights.
The military recently told Lieutenant Cohen that it was reopening the sexual assault case. In the meantime, he faces a trial in July that he views as punishment for filing a criminal complaint against a superior officer. The Air Force denies that.
“I think the attention to this issue is absolutely needed,” Lieutenant Cohen said. “But it’s a little bit late. We still have attacks, and we still have retaliation.”
Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106. firstname.lastname@example.org.
In 1692 and 1693, in Salem, Massachusetts, more than 150 colonists were accused of witchcraft, resulting in 19 being hanged and one man being crushed to death. Contributions to these events included: historical, religious and cultural belief systems; social and community concerns; economic, gender, and political factors; and local family grievances. Child witnessing, certainty of physician diagnosis, use of special evidence in the absence of scholarly and legal scrutiny, and tautological reasoning were important factors, as well. For forensic psychiatry, the events at Salem in 1692 still hold contemporary implications. These events of three centuries ago call to mind more recent daycare sexual abuse scandals.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) marks the first significant revision of the publication since the DSM-IV in 1994. Changes to the DSM were largely informed by advancements in neuroscience, clinical and public health need, and identified problems with the classification system and criteria put forth in the DSM-IV. Much of the decision-making was also driven by a desire to ensure better alignment with the International Classification of Diseases and its upcoming 11th edition (ICD-11). In this paper, we describe select revisions in the DSM-5, with an emphasis on changes projected to have the greatest clinical impact and those that demonstrate efforts to enhance international compatibility, including integration of cultural context with diagnostic criteria and changes that facilitate DSM-ICD harmonization. It is anticipated that this collaborative spirit between the American PsychiatricAssociation (APA) and the World Health Organization (WHO) will continue as the DSM-5 is updated further, bringing the field of psychiatry even closer to a singular, cohesive nosology.
We already had a crisis in psychiatric diagnosis before DSM-5. It is a sure sign of excess that 25% of us reportedly qualify for a mental disorder and that 20% are on psychiatric medication. Unless checked, DSM-5 will open the floodgates and may turn current diagnostic inflation into future hyperinflation.