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“That’s Not OCD” Revisited

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Yesterday’s posting, That’s Not OCD, You’re Just a Slacker, garnered quite a few comments. You should check them out if you haven’t already read them.

The most informative and extensive response comes from a commenter named “Another psychologist”, who sums up the problem with the multiple-choice question in the textbook quite well. It covers a number of issues with the question, including:

  • The DSM. Look hard enough, and you’ll find something that you’ve got.
  • Introverts vs. extroverts. North American society favours and rewards extroverts (and yes, a good chunk of my career as a tech evangelist is based on cashing in on this trait, a relative rarity in high tech).
  • “Normal” vs. “abnormal” behaviour. A tricky thing, and I remember a lecture on cognition where a psych prof told our class that being slightly manic is probably a good trait for living in 21st-century North America.
  • The importance of “It depends,” the most important phrase in consulting. Without knowing a little bit more about the back story of the medical student in the question, it’s hard to make a good diagnosis. Sometimes there’s little to distinguish someone having a bad day and someone who’s bipolar (it’s also hard to distinguish between “bipolar” and “asshole” at first glance).

Here’s the comment:

I’d be wary of labelling this chap as possessing “obsessive-compulsive traits” without more information than the vignette provides. His lack of delight in partying may simply be because he is relatively introverted, rather than extroverted. Another normal trait.

The problem with the Diagnostic and Statistical Manual of mental disorders (The DSM) is that there is no entry for “Normal Personality”.

If the mythical medical student did happen to have OC traits then he was using them constructively. Perhaps this was the point the examiner wished the students to understand, but there is insufficient context to know whether this is true.

As a health professional I would certainly not want to “treat” this apparently well-functioning individual unless his “traits” caused some problem that was not included in the brief description.

One of the things I tried to teach my interns was a healthy skepticism about what was “abnormal” behavior, given the environment and the circumstances of the situation in which it was expressed, and a health skepticism about interpreting elevations on standard personality scales without knowing the patient’s history and background.

If a patient throws a tantrum in a waiting room when told that this Xray has been cancelled again (for the fourth time) this does not necessary mean that the patient is suffering from a personality disorder or impairment of the parts of the brain that regulate behavioural expression. A sick person who is struggling with pain and indignity is entitled to this type of behaviour in the circumstances.

When a group of intern psychologists, but not the intern medicos, get blips on the personality disorder scale of a well-known test it does not mean that the psych group are all deviants who should not be practising psycyology. It probably means that they are good researchers who have been trained to question authority.

I hope the professor who set the test made this kind of thing clear.

Thanks for the comment, Another psychologist! And to all of you, please feel free to keep the discussion going.

This article also appears in The Adventures of Accordion Guy in the 21st Century.

8 replies on ““That’s Not OCD” Revisited”

maybe go out and have some fun…stop being a fucking dork and don’t take yourself so seriously. if you’re deeming everyone a slacker in relation to you, chances are you’re not a whole lot of fun to be around.

hmm.. my comment went missing, won’t use disorderly language this time.

given that the guy doesn’t go out, appears to be a total loner except for his work and making notes….. where in the world did that Girlfriend come from?

Which leaves d: open, depending on who reported what… Girlfriend a delusion as could doing fine be. All the scitzoid people I know are intent on doing things themselves and the importance of the origin of the material.

I still think the person who wrote in the picture is right. I’m a medical student myself and I and pretty much every single one of my classmates live a lifestyle almost identical to the one described in the question. Normal? I guess that depends on who you live your life around.

Good on Another Psychologist for the comment. Supports what I had to say in my comment on that article.

Just a couple of notes:

In many states, it is considered unethical for someone without a doctorate and a license to practice to call himself a psychologist. While this is perhaps not universally true, it’s worth considering when assessing the quality of comment from someone without _any_ degree in psych.

The photographed example seems to come from a study guide for an exam, not a textbook or an exam.

That’s why students and teachers should be extremely discerning in the study guides that they use/approve.

Another note, I wonder how the DSM will change with it’s new revision. I saw Richard McNally speak at this year’s EPA mtg. He repeated pretty much what he talked about in his book “What is Mental Illness?”.

In many states it can be a criminal offense to practice as a psychologist.
And it is a shame that while other sciences have been disseminated to the general public and there is a general understanding of the major tenets of multiple fields, there is a definite lack of knowledge and serious stigmas in regards to psychology and the professionals that work hard in that field.

It is also better to try to present information to individuals rather than just brush off their comments. I would rather try to inform where I may have more knowledge and perhaps someone will educate me in areas that I know nothing about. We need to socially push open-mindedness about education rather than have people regard those with higher education as elitist. We need to be inclusive, and the first step is understanding.

Let me amend. It can be a criminal offense, not just an ethical concern, when a person misrepresents themselves as a licensed psychologist.

And for all of you don’t know who Richard McNally’s book was about:

It’s about the DSM and the upcoming revision. He was talking about how the definitions of somethings will be narrowed, other things will be droppped, and perhaps a new approach towards the whole thing.

/end amendment

Hornbeck: “In many states, it is considered unethical for someone without a doctorate and a license to practice to call himself a psychologist.”

Indeed. In the US.

In the UK, where I am from and where I trained (in psychology), it is not. If one has eligibility for Graduate Membership of the BPS, even if not eligibility for Graduate Basis fo Chartership, they will accept one’s right to be called a ‘psychologist’ (although protected titles are obviously out of bounds). In Finland, where I live (and where I did a huge chuck of my undergrad psychology studies), it only needs a master’s degree. Again, one cannot say ‘laillistettu’ in connection with being a psychologist if one is not ‘laillistettu’. But, based on the EU systems, my right to be called a ‘psychologist’ is still to be respected in Finland. Here I cannot work in the health care system, but I didn’t train for health care work: I trained for issues involved in teaching, learning and development.

If I were in the US, though, it would be totally different (as far as I can tell). I’d qualify for ‘psychological assistant/associate’. In Canada, it’s even weirder still: but they have an interesting concept there: psycho-educational consultant. Since it fits in with the picture of the work I do as a freelancer here in Finland, that’s what I use as my title here. Good way to avoid bother.

“While this is perhaps not universally true, it’s worth considering when assessing the quality of comment from someone without _any_ degree in psych.”

This is a seriously good point. Psychology, at any meaningful level, is not very simple or straight-forward. Because I have the background knowledge to assess the content of the vast majority of comments, I’m okay… but not everybody has that. So, a lot of misinformation can spread that way. And this is why I brought up the Dunning-Kruger thing some days ago on the other thread.

I’ve put this here for clarity, really. A nasty handful are probably prepared to jump to incorrect assumptions about what I might understand… Basically, I’m agreeing with what you said.

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