Jimmy Cagney in White Heat (1949): “Made it, Ma! Top of the world!”

Jor­dan Ellen­berg has a great arti­cle up on Slate on “The Math­e­mat­ics of Nar­cis­sism.” There are two related themes run­ning through it.

One theme sur­rounds the over­haul of the cur­rent Diag­nos­tic and Sta­tis­ti­cal Man­ual of Men­tal Dis­or­ders, Fourth Edi­tion Revised (DSM IV-​​R), the “Bible” for psy­chi­atric pro­fes­sion­als. The DSM is the way in which psy­chi­a­trists and psy­chol­o­gists clas­sify men­tal dis­or­ders into clumps so that we can use a com­mon lan­guage in talk­ing about patients and dis­eases. The other is about the rank­ing of grad­u­ate pro­grams. Find­ing the com­mon­al­ity between these two themes is a great rea­son to read the arti­cle, which I highly recommend.

The over­haul of the DSM is an infre­quent and impor­tant event in psy­chol­ogy and psy­chi­a­try. In the immor­tal words of Vice Pres­i­dent Joe Biden, “It’s a big fuck­ing deal!” Basi­cally, the revi­sions in the DSM cod­ify and stan­dard­ize the cur­rent mod­els of how the mind works. In order to stan­dard­ize the clas­si­fi­ca­tion and treat­ment of psy­chi­atric dis­or­ders, we need a book that describes to the best of our cur­rent abil­ity what is wrong and what is right.

For exam­ple, homo­sex­ual behav­ior was removed from the DSM-​​IIR in 1973. This reflects not so much a change in how homo­sex­ual behav­ior is processed by the brain (at least, we would cer­tainly hope not) but rather a change in how sci­ence and sci­en­tists per­ceive the work­ings of the human brain. Are there pol­i­tics in such deci­sions? You betcha, and we’ve dis­cussed some of these in pre­vi­ous 538 Refugees posts. Still, one would hope that, over time, we develop mod­els of how the human mind works that do a bet­ter and bet­ter job of explain­ing exper­i­men­tal findings.

As we’ve dis­cussed before, sci­ence may progress by test­ing hypothe­ses (fine-​​grained, detailed), but it also works by com­ing up with explana­tory mod­els (coarse-​​grained, uni­ver­sal). As our tools and obser­va­tions improve, so do our explana­tory models.

The news that nar­cis­sism is to be removed from the next edi­tion (DSM-​​V) and the rank­ings of grad­u­ate pro­grams in Ellenberg’s view (and in mine) have sim­i­lar prob­lems. What we, as humans want, is a sim­ple rank­ing.  AFI has the Top 100 Movies of All Time. (White Heat doesn’t make the cut, but “Made it, Ma! Top of the world!” is the 18th best quote in the movies and Cody Jar­rett is the 26th most vil­lianous vil­lian.) Which is the “best” grad­u­ate pro­gram? Which is the “best” mea­sure of nar­cis­sism? (“He’s a 98% nar­cis­sist, but I’m only an 83% narcissist.”)

In polit­i­cal terms, who is the “best” Repub­li­can Pres­i­den­tial can­di­date in 2012? What is the “best” solu­tion to reduce the deficit?

In real­ity, that sort of analy­sis doesn’t do a very good job of what we need to do. We need to say, “these are char­ac­ter­is­tics most often shared by peo­ple who _​_​_​_​_​_​_​_​_​_​_​_​_​.” To wit:

Diag­nos­tic cri­te­ria for 301.81 Nar­cis­sis­tic Per­son­al­ity Dis­or­der
A per­va­sive pat­tern of grandios­ity (in fan­tasy or behav­ior), need for admi­ra­tion, and lack of empa­thy, begin­ning by early adult­hood and present in a vari­ety of con­texts, as indi­cated by five (or more) of the following:

  1. has a grandiose sense of self-​​importance (e.g., exag­ger­ates achieve­ments and tal­ents, expects to be rec­og­nized as supe­rior with­out com­men­su­rate achievements)
  2. is pre­oc­cu­pied with fan­tasies of unlim­ited suc­cess, power, bril­liance, beauty, or ideal love
  3. believes that he or she is “spe­cial” and unique and can only be under­stood by, or should asso­ciate with, other spe­cial or high-​​status peo­ple (or institutions)
  4. requires exces­sive admiration
  5. has a sense of enti­tle­ment, i.e., unrea­son­able expec­ta­tions of espe­cially favor­able treat­ment or auto­matic com­pli­ance with his or her expectations
  6. is inter­per­son­ally exploita­tive, i.e., takes advan­tage of oth­ers to achieve his or her own ends
  7. lacks empa­thy: is unwill­ing to rec­og­nize or iden­tify with the feel­ings and needs of others
  8. is often envi­ous of oth­ers or believes that oth­ers are envi­ous of him or her
  9. shows arro­gant, haughty behav­iors or attitudes

But peo­ple don’t do very well with such clas­si­fi­ca­tion schemes. They crave black-​​and-​​white answers in car­di­nal order (11th best quote: “What we’ve got here is fail­ure to com­mu­ni­cate.”). Unfor­tu­nately, in the real world of pol­i­tics, as in the real world of sci­ence, there are no such answers—only probabilities.

I believe that we need to work towards a world where we say, “these are the fea­tures we’re look­ing for in (health care reform/​tax policies/​deficit reduc­tion schemes)” and then pick the plan that comes clos­est to the ideal. Oth­ers may see it another way, which is why we have a dis­cus­sion section.

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