Different Ethics

I was watching a TED talk on the power of introversion by Susan Cain and feeling good about the fact that someone had finally given introverts a reason to feel positive about a form of behaviour that, traditionally, has been tolerated but never encouraged. Indeed, as Cain points out, social, educational, and workplace settings favour extroverts over introverts even though skills, knowledge and abilities may be on a par, or even superior in introverts. Of course introverts are a minority but not so small a minority that anyone could attempt to use it as some sort of justification for overlooking us.

Susan Cain champions introverts eloquently, entertainingly, and bravely – given that she does not favour the lime light – but, worthy as I may think the cause to be, it is not really what captured my attention. It was an almost off the cuff remark she makes quite early in her talk when she differentiates introversion from shyness: “it’s different from being shy. Shyness is about fear of social judgement. Introversion is more about how you respond to stimulation”.

That statement hit me like a sledge hammer! Why did the speaker feel it necessary to make that distinction? I have no difficulty with the definition, but what purpose was there in differentiating shy people from introverts? In doing so, has she not done exactly what others have done in differentiating introversion from extroversion? Isn’t it the case that she has created an opportunity to favour introversion over shyness in much the same way that extroverts have been favoured over introverts? Do we have to wait now for a champion of the shy to point out that shy people too have a lot to offer if we could just get society to stop putting us in the pigeon hole labelled “fearful of making a fool of themselves in public”. It might be useful to a circus administrator charged with the job of hiring clowns, but then some shy people function very well in public behind a mask and those that don’t probably wont be applying anyway.

Every time we make a distinction, we are creating an opportunity to treat one group differently from another. Tension and conflict cannot exist unless differences are identified. That doesn’t mean we should never make distinctions but I think it does mean that we have an ethical responsibility to think very carefully about the potential consequences of our desire to sub-divide and categorise. Even though a desire to taxonomise may have the most benign of motives (eg the desire to better understand), we have to consider unanticipated outcomes of exposing differences and if there is potential for negative consequences to any part of the domain of interest, then we have an obligation to consider the harm we might do even when a holistic net benefit can be demonstrated.

Of course, differentiation is not always done consciously and deliberately and it may take not much more than the attachment of a label to turn something we already know subconsciously and informally, into a concrete difference. It’s in our nature to try to simplify complex things by categorisation and labelling, and I’m not sure if it’s possible to stop doing that but the collateral damage that can result from our desire to control complexity suggests to me that we must, at least, start to quantify that potential for incidental harm and take steps to minimise the threat when the risk of harm passes some threshold. Incidental harm, in this context, includes the effect of putting a target (in the form of the label) on members of the group in much the same way that some ethnic, religious, and other psychosocial minorities have been targeted for negative attention. I was tempted to include a more detailed list of what I consider to be psycho-social minorities here until I realised I was falling into the same pigeon holing practices I am baulking at!

Let me return to what prompted this musing and say that I am not opposed to differentiating shyness from introversion if, in doing so, both groups derive some benefit. I simply could not see what benefit was gained, other than the purely didactic satisfaction accruing to the speaker. Imagine an article in ‘Good Housekeeping’ discussing what its house proud readers contribute to a happy family and pointing out that having an impeccably clean home is not the same as being obsessive compulsive in your behaviour. So being house proud does not mean you are obsessive compulsive (though you probably are) and being introverted does not mean you are shy (though you probably are). Perhaps the distinction is intended to be a diagnostic aid. We don’t typically seek treatment for ‘house proudness’ but we might if it was called an obsessive compulsive disorder and we might think introversion is more akin to eye colour or height and not something that is amenable to treatment. On the other hand, shyness, like OCD, is something people do seek treatment for so maybe that’s why it’s worth differentiating it from intractable introversion.

I thought about this and wondered if there could be clinical advantages in knowing whether someone is shy or simply introverted. Clearly, there are significant advantages in providing targeted treatments to patients whenever possible. We would start to have grave doubts about the competence of a medical profession that prescribed two Bex, a cup of tea, and a good lie down for every patient regardless of symptoms. So, I did a quick literature search to establish what can be done for shyness in particular. The first thing to contend with is more differentiation. Shyness is social phobia, more or less! They are so closely related, I find it difficult to understand the need for the distinction. At least, the distinction between introversion and shyness is clear and my only quibble is over the circumstances in which we feel the need to make it. If there is any difference between shyness and social phobia (or social anxiety disorder as it is also called – SAD really!), it would appear to be in terms of the degree to which ‘sufferers’ suffer with it. Alarmingly, social phobia is also called ‘avoidant personality disorder’ which, it seems, was thought to be a different condition until some researchers reported this (Acta Psychiatr Scand.2005 Sep;112(3):208-14):

Avoidant personality disorder and social phobia: distinct enough to be separate disorders?

Ralevski ESanislow CAGrilo CMSkodol AEGunderson JGTracie Shea MYen SBender DSZanarini MCMcGlashan TH.

Source

Yale University School of Medicine, New Haven, CT 06519, USA.

Abstract

OBJECTIVE:

Existing evidence from anxiety disorder research indicates that social phobics (SP) with avoidant personality disorder (AVPD) experience more anxiety and show more impairment than patients with SP alone. The purpose of this study was to examine whether in patients diagnosed with AVPD, the co-occurrence of SP adds to its severity. We hypothesized that the addition of SP will not add to the severity of AVPD alone.

METHOD:

Two groups of patients (AVPD=224; AVPD/SP=101) were compared at baseline and 2 years later on multiple demographic and clinical variables.

RESULTS:

Patients with AVPD and an additional diagnosis of SP differed little from patients with AVPD alone.

CONCLUSION:

These findings suggest that AVPD and SP may be alternative conceptualizations of the same disorder.

Alternative conceptualisations of the same disorder‘ illustrates the parallel universes in which different clinicians live and the reason we should take greater care with our attempts to better understand our world and avoid unnecessary divisions within it. There is no specific treatment for shyness and it is treated in the same way that any other anxiety disorder is treated, including obsessive compulsive disorder! The approach to treatment may vary but not because of any refinement of the classification beyond the broad class of ‘anxiety’. If it differs, it will be because of individual differences between people and the last thing a person seeking treatment needs at that point is to be pigeon holed as being the same as a million other people and treated in the same way. Therefore, I would argue that, once a process of classification has reached the goal of ensuring a person gets to see the appropriate specialist, any more refined classification is actually counter-productive and leads me to the same conclusion in a medical context as I had reached regarding taxonomies in general. If there is no benefit or, more importantly, if there is the potential for harm by exposing differences, then do not do it.

Serendipitously, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has just been released (replacing the 20 year old fourth edition) and I sought to reference it as part of the literature search for this musing. Unfortunately, it is not yet accessible (at least to lay people) but I did come across a news item in the Canadian Medical Association Journal (CMAJ) about it dated 15th May, 2013. It includes this paragraph:

The changes have already provoked criticism from a previous editor of the manual and other leading psychiatrists (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-4371). They contend the new edition will pathologize normal emotional reactions. The new manual, for example, opens the possibility for doctors to diagnose grief following bereavement as a depressive disorder.

The article referenced in the above quote is accessible only to subscribers but it is by Paul Kudlow and titled “The perils of diagnostic inflation”. Diagnostic inflation refers to increasing the numbers of people falling within specific classifications by changing the boundaries of the classification or by introducing new classifications to capture areas not previously classified. An example is given in the quote above.

Allen Frances (chair of the DSM-IV Task Force) expresses his concern in the following terms:

Unless corrected, DSM 5 may create millions of newly mislabeled ‘patients,’ with resulting unnecessary and potentially harmful treatment, stigma, and wasteful misallocation of scarce resources.

His concerns are about mislabelling and, of course, they are specific to diagnostic classifications but they reflect my concerns about unnecessary labelling in the more general context. I might mention, in closing, that my partner in life has had the benefit of reading Susan Cain’s book ‘Quiet – The Power of Introverts’ and she assures me that Ms Cain’s differentiation of shyness from introversion is justified by a thorough explanation of the distinction not evident in the casual aside she makes of it in her talk. I  accept that she may have good reason for the distinction but the fact remains that it isn’t evident in her talk and that emphasises the need to explain the necessity whenever we feel compelled to highlight differences. There need be no question of mislabelling and there may be positive value in the distinction, but my point is simply that the value must be clear or the distinction should not be made.

Belief Instinct

This is the title of a book I read recently by research psychologist Jesse Bering. Subtitled ‘The Psychology of Souls, Destiny, and the Meaning of Life’, it’s published by Norton in 2012 as a paperback and, even if you aren’t looking for more grist for the atheist mill, it is still a very entertaining read. I wont do a full review because it’s already been done (and much better than any amateur attempt of mine), but I will highlight Bering’s primary thesis so that you can see how easy it might be for ambivalence and doubt to niggle in the dark recesses of the staunch anti-theist’s mind.

Blame ‘theory of mind’ for the fact that even Michael Shermer has an explanation ready for St Peter if it ever comes to that. He’s not being hypocritical, he’s being human and experiencing the evolutionary adaptation that has lead all of us to behave less animalistically than our ancestral cousins, even though we are sorely tempted.

Without wanting to steal any of Bering’s thunder, human’s have an innate ability to stand in the shoes of others. Not only do we think we know what other people might be thinking in various situations, but we have extended that belief to anything that moves and a lot of things that don’t. We assign agency to things and, along with that, we make an assumption of intensionality (philosophers refer to it as teleo-functional reasoning). It comes naturally to us, from a very young age, to give purpose to things that, rationality, we know can have no purpose – like a leaf following a twig down a stream. We know in our heads that there is no relationship between these two inanimate objects and yet we can’t help thinking a race is on. Who will be the winner?

Is it any wonder, then, that a non-existent entity would dog our lives to keep us on the straight and narrow or, at least, make us think twice before engaging in some reputation shattering behaviour that would cruel our chances of becoming, or remaining, a reproductive, contributing member of the community to whom we owe our well-being?

It used to be that our gossipy neighbours in the tribe would do the job but, over time, as tribes coalesced and grew, we could more easily get lost in the crowd (or at least raise enough uncertainty as to whether evidence of our transgressions had any substance). It was to our reproductive advantage that there evolved a moral monkey on our backs to keep us respectable and in sweet with society’s power brokers. If the gossips in the community were no longer able to keep tabs so easily in the new complexities of social life, a nebulous, omniscient entity certainly could and the possible punishments were downright intimidating.

Bering fleshes out his thesis very convincingly with other concepts that explain, for example, why we seem so willing to accept that there could be life after death even though we have no problem with understanding that our bodies die. In a nutshell, it turns out that it’s because an understanding of bodily death contributes to our chances of survival – you need to know what to look for if you plan to approach the body of a lion that isn’t going to leap to it’s paws and tear you limb from limb. As long as the body is no threat, we don’t really care what’s happening with the mind (or the soul) of the animal because it presents no threat and, if it continues to do whatever it has always done, we are not too bothered. For all our ancestors knew, the soul continued on even after our bodies stopped.

The presentation is not heavily academic and when complex terms are introduced, Bering is able to explain them in an easy to understand, conversational style. This book has reaffirmed by belief that evolution is God and it’s provided a few good laughs along the way. Anti-theism is a rational exercise supported by science but, just as you might scream  and duck for cover as a jet fighter with guns ablazing comes roaring out of a 3D movie screen at you, you can’t help believing “something” has your destiny in hand!

Insignificance

To reinforce my view about life and meaning, and particularly about life on Earth, I offer a graphical representation of planet Earth and its place in the observable universe. In the belief that a picture paints hundreds of billions of galaxies (well, at least one hundred billion and up to five hundred billion by some estimates) I’ve adapted the ubiquitous images by Andrew Z. Colvin. The originals are much superior and all I have done is attempt to emphasize the relationship of each image to its parent by, for example, showing the mighty Milky Way as but a pin prick within the vastness of its Local Galactic Group. Starting with the observable universe on the right, each image represents a massive magnification of a speck on the previous image. I hope it takes your breath away and makes you think why on Earth (pun intended) we would consider ourselves the focus of some omniscient and omnipotent entity that has the entire universe to play with.

Our Place in the Universe

Indulgent or what?

I hope this site offers more than just a means of indulging myself since I do not think I am a selfish person and if indulging myself were all this is about, I can think of better ways!

So, while I will express my views on things I think are worth a comment, I’ll try hard to ensure it’s not a public diary about me and what I did today and what I might do tomorrow.

While I’m not averse to bloggers who write about themselves, I do have expectations regarding the entertainment value they offer and, if they don’t lead the sort of life that movies are based on, I will be disappointed as well as bored.

I assume you have the same level of expectation and, since my life is far from inspirational or exciting, I’ll keep it to myself. Please let me know if bits of myself inadvertently dribble out unpleasantly and I’ll mop up the mess and strive for greater vigilance against a resurgence of me.

This post is really just a pointer to something I’ve been working on for a while (irony intended) which is my perspective on the meaning of life If you are struggling with why you are here (on Earth as opposed to this blog, although you might be struggling with that too – and I wouldn’t blame you), I hope there is something in what I have to say that is helpful to you or, at least, provocative enough for you to want to respond. Praise would be good but, I am genuinely interested in where I might be misguided and I would appreciate sincere and thoughtful arguments that could extend my understanding and clarify my view.