Discovering Sociology

CHAPTER1

A goal of this book is to take you on a sociological journey. But let’s begin with a basic question: What is sociology? First of all, sociology is a discipline of and for curious minds! Sociologists are deeply committed to answering the question, “Why?” Why are some people desperately poor and others fabulously wealthy? Why does racial segregation in housing and public education exist, and why does it persist half a century after civil rights laws were enacted? What accounts for the declining marriage rate among the working class and the poor in the United States? How can we explain the fact that low-income people are more likely to be overweight or obese than their middle-class counterparts? Why is the proportion of women entering and completing college rising while the proportion of men has fallen? Why, in spite of this, do men as a group still earn higher incomes than women as a group do? And how is it that social media are being simultaneously praised as instruments of transformational activism and criticized as causes of social alienation and civic disengagement? Take a moment now to think about some why questions you have about society and social life: As you look around you, hear the news, and interact with other people, what strikes you as fascinating—but perhaps difficult to understand? What are you curious about?

Sociology is an academic discipline that takes a scientific approach to answering the kinds of questions our curious minds imagine. When we say that sociology is scientific, we mean that it is a way of learning about the world that combines logically constructed theory and systematic observation. The goal of sociological study and research is to base answers to questions like those above on a careful examination of the roots of social phenomena such as poverty, segregation, and the wage gap. Sociologists do this with research methods—surveys, interviews, observations, and archival research, among others—which yield data that can be tested, challenged, and revised. In this text, you will see how sociology is done—and you will learn how to do sociology yourself.

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Unemployment is not equally distributed among U.S. demographic groups; those without a high school diploma or college degree have been hit hard by the loss of well-paying jobs in manufacturing since the late1970s. The cost of not getting an education increasingly includes not just higher rates of unemployment but also diminished earning power.

Concisely stated, sociology is the scientific study of human social relationships, groups, and societies. Unlike natural sciences such as physics, chemistry, and biology, sociology is one of several social sciences engaged in the scientific study of human beings and the social worlds they consciously create and inhabit. The purpose of sociology is to understand and generate new knowledge about human behavior, social relations, and social institutions on a larger scale. The sociologist adheres to the principle of social embeddedness: the idea that economic, political, and other forms of human behavior are fundamentally shaped by social relations. Thus, sociologists pursue studies on a wide range of issues occurring within, between, and among families, communities, states, nations, and the world. Other social sciences, some of which you may be studying, include anthropology, economics, political science, and psychology.

Sociology is a field in which students have the opportunity to build a broad spectrum of important skills, ranging from gathering and analyzing information to identifying and solving problems to effective written and oral communication. Throughout this book, we draw your attention to important skills you can gain through the study of sociology and the kinds of skills employers in different occupational fields are seeking in potential employees. Sociology opens the door to both greater understanding of the social world and a range of career and graduate study possibilities.

Doing sociology requires that you build a foundation on which the knowledge you gain will rest. Some of the key foundations of sociology are the sociological imagination and critical thinking. We turn to these below.

THE SOCIOLOGICAL IMAGINATION

As we go about our daily routines, we may forget that large-scale economic, political, and cultural forces shape even the most personal aspects of our lives. When parents divorce, for example, we tend to focus on individual explanations: A father was devoted more to his work than to his family; a mother may have felt trapped in an unhappy marriage but stuck with it for the sake of young children. Yet while personal issues are inevitable parts of a breakup, they can’t tell the whole story. When so many U.S. marriages end in divorce, forces larger than incompatible personalities or marital discord are at play. But what are those greater social forces, exactly?

As sociologist C. Wright Mills (1959/2000b) suggested half a century ago, uncovering the relationship between what he called personal troubles and public issues calls for a sociological imagination. The sociological imagination is the ability to grasp the relationship between individual lives and the larger social forces that shape them—that is, to see where biography and history intersect.

In a country like the United States, where individualism is part of the national heritage, people tend to believe that each person creates his or her life’s path and to largely disregard the social context in which this happens. When we cannot get a job, fail to earn enough to support a family, or experience marital separation, for example, we tend to see it as a personal trouble. We do not necessarily see it as a public issue. The sociological imagination, however, invites us to make the connection and to step away from the vantage point of a single life experience to see how powerful social forces—for instance, changes in social norms, ethnic or sex discrimination, large shifts in the economy, or the beginning or end of a military conflict—shape the obstacles and opportunities that contribute to the unfolding of our own life’s story. Among Mills’s (1959/2000b) most often cited examples is the following:

  Mill’s Sociological Imagination CLICK TO SHOW
  What is Sociology? CLICK TO SHOW

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PRIVATE LIVES, PUBLIC ISSUES

 

WHY ARE DIVORCE RATES SO HIGH?

 

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Marriage is one of the most private and personal forms of a relationship between two people. How can marriage—and divorce—be viewed through a sociological lens?

In the United States, the probability of a first marriage ending in separation or divorce within 5 years is 22%; after 10 years, it rises to 36%. Over the longer term, the rate of marital dissolution is closer to 50% (Goodwin, Mosher, & Chandra, 2010). Just half a century ago, most marriages were “’til death do us part.” What accounts for the change?

The sociological imagination shows us that marriage and divorce, seemingly the most private of matters, are as much public issues as personal ones. Consider the fact that when wages for working people lagged from the mid-1970s to the late 1990s, growing numbers of women went to work to help their families make ends meet. Many middle-class women also went to college and pursued careers as a means of personal fulfillment. In fact, today more women than men finish undergraduate degrees. As a result of trends like these, women today enjoy a higher measure of economic independence than ever before. The combination of educational attainment and satisfying careers reinforces women’s independence, making it easier for those who are in unhappy marriages to leave them. Greater social acceptance of divorce has also removed much of the stigma once associated with failed marriages.

Social trends like those described have made it more likely that an unhappy couple will divorce rather than stay in a failing marriage. Thus, this private trouble is in many respects strongly influenced by public issues such as women’s rising economic independence and the dynamism of cultural norms related to marriage and divorce.

THINK IT THROUGH

What other “private troubles” could sociologists identify as “public issues”?

 

 

When, in a city of 100,000, only one man is unemployed, that is his personal trouble, and for its relief we properly look to the character of the man, his skills, and his immediate opportunities. But when in a nation of 50 million employees, 15 million men are unemployed, that is an issue, and we may not hope to find its solution within the range of opportunities open to any one individual. The very structure of opportunities has collapsed. Both the correct statement of the problem and the range of possible solutions require us to consider the economic and political institutions of the society, and not merely the personal situation and character of a scatter of individuals. (p. 9)

To apply the idea to contemporary economic conditions, we might look at recent college graduates. If many of the young people who graduated from college in the middle years of the 2000s found the jobs they wanted, they may have accounted for their success by citing personal effort or solid academic qualifications. These are, of course, very important, but the sociological imagination suggests that there are also larger social forces at work—a booming economy in this period contributed to a low rate of unemployment among the college educated. Consider, for instance, that while unemployment among young male college graduates was just under 7% in 2007 (just before an economic crisis hit in the United States), by 2010 it had peaked at more than 12%. For young female college graduates, it grew from less than 5% in 2007 to a peak of more than 9% in 2011. In 2013, it took a downward turn for both groups before rising slightly in 2014 (Figure 1.1). If your friends or relatives who graduated into the labor market during the economic crisis or even the first years following that period encountered difficulties securing solid first jobs, this suggests that personal effort and qualifications are only part of the explanation for the success of one graduating class and the frustration of another.

  Sociological Imagination CLICK TO SHOW

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AP Photo/Patrick Semansky

C. Wright Mills highlighted the use of the sociological imagination in studying social issues. When 16% of urban residents are poor by the government’s official measure, we cannot assume the sole cause is personal failings but must ask how large-scale social and economic forces are implicated in widespread socioeconomic disadvantage experienced in many communities.

Understanding this relationship is particularly critical for people in the United States, who often regard individuals as fully responsible for their own successes and failures. For instance, it is easy to fault the poor for their poverty, assuming they only need to “pull themselves up by their bootstraps.” We may neglect the powerful role of social forces like racial or ethnic discrimination, the outsourcing or automation of manufacturing jobs that used to employ those with less education, or the poor state of education in many economically distressed rural and urban areas. The sociological imagination implores us to seek the intersection between private troubles, such as a family’s poverty, and public issues, such as lack of access to good schooling or jobs, to develop a more informed and comprehensive understanding of the social world and social issues.

It is useful, when we talk about the sociological imagination, to bring in the concepts of agency and structure. Sociologists often talk about social actions—individual and group behavior—in these terms. Agency can be understood as the ability of individuals and groups to exercise free will and to make social changes on a small or large scale. Structure is a complex term but may be defined as patterned social arrangements that have effects on agency—structure may enable or constrain social action. For example, sociologists talk about the class structure, which is composed of social groups who hold varying amounts of resources such as money, political voice, and social status. They also identify normative structures—for instance, they might analyze patterns of social norms regarding “appropriate” gender behaviors in different cultural contexts.

Sociologists take a strong interest in the relationship between structure and agency. Consider that, on one hand, we all have the ability to make choices—so we have free will and we can opt for one path over another. On the other hand, the structures that surround us impose obstacles on us or afford us opportunities: We can make choices, but they may be enabled or constrained by structure. For instance, in the early 1900s, we would surely have found bright young women in the U.S. middle class who wanted to study to be doctors or lawyers. The social norms of the time, however, suggested that young women of this status were better off marrying and starting families. There were also legal constraints to women’s entry into higher education and the paid labor force. So while the women in our example might have individually argued and pushed to go to college and have professional careers, the dreams of this group were constrained by powerful normative and legal structures that identified women’s place as being in the home.

 

FIGURE 1.1 Unemployment Rates Among Young College Graduates in the United States, 1989–2014

 

SOURCE: Shierholz, Heidi, Natalie Sabadish, and Hilary Wething. (2012). “The Class of 2012: Labor market for young graduates remains grim.” Briefing paper 340. Figure G. Washington, DC: Economic Policy Institute. Reprinted with permission.

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Consider the relationship between the class structure and individual agency as another way of thinking about social mobility in U.S. society. If, for instance, a young man today whose parents are well educated and whose family is economically prosperous wishes to go to college and become a doctor, his position in the class structure (or the position of his family) is enabling—that is, it makes it likely that he will be able to make this choice and to realize it. If, however, a young man from a poor family with no college background dreams of being an engineer and wants to study in college, his position in the class structure is likely to be constraining: Not only does his family have insufficient economic means to pay for college, but he may also be studying in an underfunded or underperforming high school that cannot provide the advanced courses he needs to prepare for college. His lack of college role models may also be a factor. This does not mean that inevitably the first young man will go to college and the second will not; it does, however, suggest that probabilities favor the first college aspirant over the second.

Put succinctly, in order to understand why some students go to college and others do not, sociologists would say that we cannot rely on individual choice or will (agency) alone—structures, whether subtly or quite obviously, exercise an influence on social behavior and outcomes. At the same time, we should not see structures as telling the whole story of social behavior, because history shows the power of human agency in making change even in the face of obstacles. Agency itself can transform structures (for example, think about the ways women’s historical activism has helped to transform limiting gender norms for women today). Sociologists weight both agency and structure and continue to seek to understand how the two interact and connect in affecting social behavior. For the most part, sociologists understand the relationship as reciprocal—that is, it goes in both directions, as structure affects agency and agency, in turn, can change the dimensions of a structure (Figure 1.2).

 

FIGURE 1.2 Structure and Agency

 

CRITICAL THINKING

Applying the sociological perspective requires more than an ability to use the sociological imagination. It also demands critical thinking, the ability to evaluate claims about truth by using reason and evidence. In everyday life, we frequently accept things as “true” because they are familiar, feel right, or are consistent with our beliefs. Critical thinking takes a different approach—recognizing poor arguments, rejecting statements not supported by evidence, and questioning our assumptions. One of the founders of modern sociology, Max Weber, captured the spirit of critical thinking in two words when he said that a key task of sociological inquiry is to openly acknowledge “inconvenient facts.”

Critical thinking requires us to be open-minded, but it does not mean that we must accept all arguments as equally valid. Those supported by logic and backed by evidence are clearly preferable to those that are not. For instance, we may passionately agree with Thomas Jefferson’s famous statement “that government is best that governs least.” However, as sociologists we must also ask, “What evidence backs up the claim that less government is better under all circumstances?”

To think critically, it is useful to follow six simple rules (adapted from Wade & Tavris, 1997):

1.  Be willing to ask any question, no matter how difficult. The belief in small government is a cherished U.S. ideal. But sociologists who study the role of government in modern society must be willing to ask whether there are circumstances under which more—not less—government is better. Government’s role in areas such as homeland security, education, and health care has grown in the past several years—what are the positive and negative aspects of this growth?

2.  Think logically and be clear. Logic and clarity require us to define concepts in a way that allows us to study them. “Big government” is a vague concept that must be made more precise and measurable before it provides for useful research. Are we speaking of federal, state, or local government, or all of these? Is “big” measured by the cost of government services, the number of agencies or offices within the government, the number of people working for it, or something else? What did Jefferson mean by “best,” and what would that “best” government look like? Who would have the power to define this notion in any case?

  Sociological Imagination Critique CLICK TO SHOW

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REUTERS/Charles Platia

Major metropolitan areas like New York City, Paris, and London are heavily monitored by security cameras, especially since the September 11, 2001, terrorist attacks. Defining the appropriate balance between privacy and increased security is a contemporary challenge for governments and societies.

3.  Back up your arguments with evidence. Founding Father Thomas Jefferson is a formidable person to quote, but quoting him does not prove that smaller government is better in the 21st century. To find evidence, we need to seek out studies of contemporary societies to see whether there is a relationship between a population’s well-being and the size of government or the breadth of services it provides. Because studies may offer contradictory evidence, we also need to be able to assess the strengths and weaknesses of arguments on different sides of the issue.

4.  Think about the assumptions and biases—including your own—that underlie all studies. You may insist that government has a key role to play in modern society. On the other hand, you may believe with equal passion that big government is one root of the problems in the United States. Critical thinking, however, requires that we recognize our beliefs and biases. Otherwise we might unconsciously seek out only evidence that supports our argument, ignoring evidence to the contrary. Passion has a role to play in research: It can motivate us to devote long hours to studying an issue. But passion should not play a role when we are weighing evidence and drawing conclusions.

5.  Avoid anecdotal evidence. It is tempting to draw a general conclusion from a single experience or anecdote, but that experience may illustrate the exception rather than the rule. For example, you may know someone who just yesterday received a letter mailed 2 years ago, but that is not evidence that the U.S. Postal Service is inefficient or does not fulfill its mandates. To determine whether this government agency is working well, you would have to study its entire mail delivery system and its record of work over time.

6.  Be willing to admit when you are wrong or uncertain about your results. Sometimes we expect to find support for an argument only to find that things are not so clear. For example, consider the position of a sociologist who advocates small government and learns that Japan and Singapore initially became economic powerhouses because their governments played leading roles in promoting growth of a sociologist who champions an expanded role for government but learns from the downturn of the 1990s in the Asian economies that some things can be better achieved by private enterprise. The answers we get are sometimes contradictory, and we learn from recognizing the error of our assumptions and beliefs as well.

Critical thinking also means becoming “critical consumers” of the information—news, blogs, surveys, texts, magazines, and scientific studies—that surrounds us. To be a good sociologist, it is important to look beyond the commonsense understanding of social life and develop a critical perspective. Being critical consumers of information entails paying attention to the sources of information we encounter and asking questions about how data were gathered.

THE DEVELOPMENT OF SOCIOLOGICAL THINKING

Humans have been asking questions about the nature of social life as long as people have lived in societies. Aristotle and Plato wrote extensively about social relationships more than 2,000 years ago. Ibn Khaldun, an Arab scholar writing in the 14th century, advanced a number of sociological concepts we recognize today, including ideas about social conflict and cohesion. Yet modern sociological concepts and research methods did not emerge until the 19th century, after the Industrial Revolution, and then largely in those European nations undergoing dramatic societal changes like industrialization and urbanization.

THE BIRTH OF SOCIOLOGY: SCIENCE, PROGRESS, INDUSTRIALIZATION, AND URBANIZATION

We can trace sociology’s roots to four interrelated historical developments that gave birth to the modern world: the scientific revolution, the Enlightenment, industrialization, and urbanization. Since these developments initially occurred in Europe, it is not surprising that sociological perspectives and ideas evolved there during the 19th century. By the end of the 19th century, sociology had taken root in North America as well; somewhat later, it gained a foothold in Central and South America, Africa, and Asia. Sociology throughout the world initially bore the stamp of its European and North American origins, though recent decades have brought a greater diversity of perspectives to the discipline.

  Sociology in Everyday Life CLICK TO SHOW

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PRISMA ARCHIVO/Alamy

The harnessing of waterpower and the development of the steam engine helped give rise to the industrial era and to factories, immortalized by writers such as Charles Dickens, in which men, women, and even children toiled for hours in wretched working conditions. Poet William Blake called these workplaces the “dark satanic mills.”

THE SCIENTIFIC REVOLUTION  The rise of modern natural and physical sciences, beginning in Europe in the 16th century, offered scholars a more advanced understanding of the physical world. The success of natural science contributed to the belief that science could also be fruitfully applied to human affairs, thereby enabling people to improve society or even perfect it. Auguste Comte (1798–1857) coined the term sociology to characterize what he believed would be a new “social physics”—that is, the scientific study of society.

THE ENLIGHTENMENT  Inspired in part by the success of the physical sciences, French philosophers in the 18th century such as Voltaire (1694–1778), Montesquieu (1689–1755), Diderot (1719–1784), and Rousseau (1712–1778) promised that humankind could attain lofty heights by applying scientific understanding to human affairs. Enlightenment ideals such as equality, liberty, and fundamental human rights found a home in the emerging social sciences, particularly sociology. Émile Durkheim (1858–1917), considered by many to be the first modern sociologist, argued that sociological understanding would create a more egalitarian, peaceful society, in which individuals would be free to realize their full potential. Many of sociology’s founders shared the hope that a fairer and more just society would be achieved through the scientific understanding of society.

THE INDUSTRIAL REVOLUTION  The Industrial Revolution, which began in England in the mid- to late 18th century and soon spread to other countries, dramatically changed European societies. Traditional agricultural economies and the small-scale production of handicrafts in the home gave way to more efficient, profit-driven manufacturing based in factories. For instance, in 1801 in the English city of Leeds, there were about 20 factories manufacturing a variety of goods. By 1838, Leeds was home to 106 woolen mills alone, employing 10,000 people.

Small towns, including Leeds, were transformed into bustling cities, showcasing extremes of wealth and poverty as well as opportunity and struggle. In the face of rapid social change and growing inequality, sociologists sought to gain a social scientific perspective on what was happening and how it had come about. For example, German theorist and revolutionary Karl Marx (1818–1883), who had an important impact on later sociological theorizing about modern societies and economies, predicted that industrialization would make life increasingly intolerable for the masses. He believed that private property ownership by the wealthy allowed for the exploitation of working people and that its elimination, and revolution, would bring about a utopia of equality and genuine freedom for all.

URBANIZATION: THE POPULATION SHIFT TOWARD CITIES  Industrialization fostered the growth of cities, as people streamed from rural fields to urban factories in search of work. By the end of the 19th century, more than 20 million people lived in English cities. The population of London alone exceeded 7 million by 1910.

Early industrial cities were often fetid places, characterized by pollution and dirt, crime, and crowded housing tenements. In Europe, early sociologists lamented the passing of communal village life and its replacement by a savage and alienating urban existence. Durkheim, for example, worried about the potential breakdown of stabilizing beliefs and values in modern urban society. He argued that whereas traditional communities were held together by shared culture and norms, or accepted social behaviors and beliefs, modern industrial communities were threatened by anomie, or a state of normlessness that occurs when people lose sight of the shared rules and values that give order and meaning to their lives. In a state of anomie, individuals often feel confused and anxious because they do not know how to interact with each other and their environment. Durkheim raised the question of what would hold societies and communities together as they shifted from homogeneity and shared cultures and values to heterogeneous masses of diverse occupations, cultures, and norms.

19TH-CENTURY FOUNDERS

Despite its largely European origins, early sociology sought to develop universal understandings that would apply to other peoples, times, and places. The discipline’s principal acknowledged founders—Auguste Comte, Harriet Martineau, Émile Durkheim, Karl Marx, and Max Weber—left their marks on sociology in different ways.

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As a founding figure in the social sciences, Auguste Comte is associated with positivism, or the belief that the study of society must be anchored in facts and the scientific method.

AUGUSTE COMTE  Auguste Comte (1798–1857), a French social theorist, is credited with founding modern sociology, naming it, and establishing it as the scientific study of social relationships. The twin pillars of Comte’s sociology were the study of social statics, the way society is held together, and the analysis of social dynamics, the laws that govern social change. Comte believed social science could be used effectively to manage the social change resulting from modern industrial society, but always with a strong respect for traditions and history.

Comte proclaimed that his new science of society was positivist. This meant that it was to be based on facts alone, which should be determined scientifically and allowed to speak for themselves. Comte argued that this purely factual approach was the proper method for sociology. He argued that all sciences—and all societies—go through three stages. The first stage is a theological one, in which key ways of understanding the world are framed in terms of superstition, imagination, and religion. The second stage is a metaphysical one, characterized by abstract speculation but framed by the basic belief that society is the product of natural rather than supernatural forces. The third and last stage is one in which knowledge is based on scientific reasoning “from the facts.” Comte saw himself as leading sociology toward its final positivist stage.

 

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Interestingly, Harriet Martineau translated into English the work of Auguste Comte, who dismissed women’s intellect, saying, “Biological philosophy teaches us that . . . radical differences, physical and moral, distinguish the sexes . . . biological analysis presents the female sex . . . as constitutionally in a state of perpetual infancy, in comparison with the other” (Kandal, 1988, p. 75).

Comte left a lasting mark on modern sociology. The scientific study of social life continues to be the goal of sociological research. His belief that social institutions have a strong impact on individual behavior—that is, that our actions are the products of personal choices and the surrounding social context—remains at the heart of sociology.

HARRIET MARTINEAU  Harriet Martineau (1802–1876) was an English sociologist who, despite deafness and other physical challenges, became a prominent social and historical writer. Her greatest handicap was being a woman in male-dominated intellectual circles that failed to value female voices. Today she is frequently recognized as the first major woman sociologist.

Deeply influenced by Comte’s work, Martineau translated his six-volume treatise on politics into English. Her editing helped make Comte’s esoteric prose accessible to the English-speaking world, ensuring his standing as a leading figure in sociology. Martineau was also a distinguished scholar in her own right. She wrote dozens of books, more than a thousand newspaper columns, and 25 novels, including a three-volume study, Society in America (1837), based on observations of the United States that she made during a tour of the country.

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Martineau, like Comte, sought to identify basic laws that govern society. She derived three of her four “laws” from other theorists. The fourth law, however, was her own and reflected her progressive (today we might say feminist) principles: For a society to evolve, it must ensure social justice for women and other oppressed groups. In her study of U.S. society, Martineau treated slavery and women’s experience of dependence in marriage as indicators of the limits of the moral development of the United States. In her view, the United States was unable to achieve its full social potential while it was morally stunted by persistent injustices like slavery and women’s inequality. The question of whether the provision of social justice is critical to societal development remains a relevant and compelling one today.

 

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Émile Durkheim pioneered some of sociology’s early research on such topics as social solidarity and suicide. His work continues to inform sociological study and understanding of social bonds and the consequences of their unraveling.

ÉMILE DURKHEIM  Auguste Comte founded and named the discipline of sociology, but French scholar Émile Durkheim (1858–1917) set the field on its present course. Durkheim established the early subject matter of sociology, laid out rules for conducting research, and developed an important theory of social change.

For Durkheim, sociology’s subject matter was social facts, qualities of groups that are external to individual members yet constrain their thinking and behavior. Durkheim argued that such social facts as religious beliefs and social duties are external—that is, they are part of the social context and are larger than our individual lives. They also have the power to shape our behavior. You may feel compelled to act in certain ways in different contexts—in the classroom, on a date, at a religious ceremony—even if you are not always aware of such social pressures.

Durkheim also argued that only social facts can explain other social facts. For example, there is no scientific evidence that men have an innate knack for business compared with women—but in 2012, women headed just 18 of the Fortune 500 companies. A Durkheimian approach would highlight women’s experience in society—where historically they have been socialized into more domestic values or restricted to certain noncommercial professions—and the fact that the social networks that foster mobility in the corporate world today are still primarily male to help explain why men dominate the upper ranks of the business world.

Durkheim’s principal concern was explaining the impact of modern society on social solidarity, the bonds that unite the members of a social group. In his view, in traditional society these bonds are based on similarity—people speak the same language, share the same customs and beliefs, and do similar work tasks. He called this mechanical solidarity. In modern industrial society, however, bonds based on similarity break down. Everyone has a different job to perform in the industrial division of labor, and modern societies are more likely to be socially diverse. However, workers in different occupational positions are dependent on one another for things like safety, education, and the provision of food and other goods essential to survival. The people filling these positions may not be alike in culture, beliefs, or language, but their dependence on one another contributes to social cohesion. Borrowing from biology, Durkheim called this organic solidarity, suggesting that modern society functions as an interdependent organic whole, like a human body.

Yet organic solidarity, Durkheim argued, is not as strong as mechanical solidarity. People no longer necessarily share the same norms and values. The consequence, according to Durkheim, is anomie. In this weakened condition, the social order disintegrates and pathological behavior increases (Durkheim, 1922/1973a).

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© Stefano Bianchetti/Corbis

Karl Marx was a scholar and critic of early capitalism. His work has been thoroughly studied and critiqued around the world.

Consider whether the United States, a modern and diverse society, is held together primarily by organic solidarity, or whether the hallmark of mechanical solidarity, a collective conscience—the common beliefs and values that bind a society together—is in evidence. Do public demonstrations of patriotism on nationally significant anniversaries such as September 11 and July 4 indicate mechanical solidarity built on a collective sense of shared values, norms, and practices? Or do the deeply divisive politics of recent years suggest social bonds based more fully on practical interdependence?

KARL MARX  The extensive writings of Karl Marx (1818–1883) influenced the development of economics and political science as well as sociology. They also shaped world politics and inspired communist revolutions in Russia (later the Soviet Union), China, and Cuba, among others.

Marx’s central idea was deceptively simple: Virtually all societies throughout history have been divided into economic classes, with one class prospering at the expense of others. All human history, Marx believed, should be understood as the product of class conflict, competition between social classes over the distribution of wealth, power, and other valued resources in society (Marx & Engels, 1848/1998).

In the period of early industrialization in which he lived, Marx condemned capitalism’s exploitation of working people, the proletariat, by the ownership class, the bourgeoisie. As we will see in later chapters, Marx’s views on conflict and inequality are still influential in contemporary sociological thinking, even among sociologists who do not share his views on society.

Marx focused his attention on the emerging capitalist industrial society (Marx, 1867/1992a, 1885/1992b, 1894/1992c). Unlike his contemporaries in sociology, however, Marx saw capitalism as a transitional stage to a final period in human history in which economic classes and the unequal distribution of rewards and opportunities linked to class inequality would disappear and be replaced by a utopia of equality.

Although many of Marx’s predictions have not proven to be correct, his critical analysis of the dynamics of capitalism proved insightful. Among other things, Marx argued that capitalism would lead to accelerating technological change, the replacement of workers by machines, and the growth of monopoly capitalism.

Marx also presciently predicted that ownership of the means of production, the sites and technology that produce the goods (and sometimes services) we need and use, would come to be concentrated in fewer and fewer hands. As a result, he believed, a growing wave of people would be thrust down into the proletariat, which owns only its own labor power. In modern society, large corporations have progressively swallowed up or pushed out smaller businesses; where small lumberyards and pharmacies used to serve many communities, corporate giants such as Home Depot, CVS, and Best Buy have moved in, putting locally owned establishments out of business.

In many U.S. towns, small business owners have joined forces to protest the construction of “big box” stores like Walmart (now the largest private employer in the United States), arguing that these enormous establishments, while they offer cheap goods, wreak havoc on local retailers and bring only the meager economic benefit of masses of entry-level, low-wage jobs. From a Marxist perspective, we might say that the local retailers, in resisting the incursion of the capitalist behemoth Walmart, are fighting their own “proletarianization.” Even physicians, many of whom used to own their own means of production in the form of private medical practices, have increasingly been driven by economic necessity into working for large health maintenance organizations (HMOs), where they are salaried employees.

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The Granger Collection, NYC—All rights reserve

Max Weber made significant contributions to the understanding of how capitalism developed in Western countries and its relationship to religious beliefs. His work on formal rationality and bureaucracy continues to influence sociologists’ study of modern society.

Unlike Comte and Durkheim, Marx thought social change would be revolutionary, not evolutionary, and would be the product of oppressed workers rising up against a capitalist system that exploits the many to benefit the few.

MAX WEBER  Max Weber (1864–1920), a German sociologist who wrote at the beginning of the 20th century, left a substantial academic legacy. Among his contributions are an analysis of how Protestantism fostered the rise of capitalism in Europe (Weber, 1904–1905/2002) and insights into the emergence of modern bureaucracy (Weber, 1919/1946). Weber, like other founders of sociology, took up various political causes, condemning injustice wherever he found it. Although pessimistic about capitalism, he did not believe, as did Marx, that some alternative utopian form of society would arise. Nor did he see sociologists enjoying privileged insights into the social world that would qualify them to wisely counsel rulers and industrialists, as Comte (and, to some extent, Durkheim) had envisioned.

Weber believed that an adequate explanation of the social world begins with the individual and takes into account the meaning of what people say and do. While he argued that research should be scientific and value-free, Weber also believed that to explain what people do, we must use a method he termed Verstehen, the German word for interpretive understanding. This methodology, rarely used by sociologists today, sought to explain social relationships by having the sociologist/observer imagine how the subjects being studied might have perceived and interpreted the situation. Studying social life, Weber felt, is not like studying plants or chemical reactions, because human beings act on the basis of meanings and motives.

Weber’s theories of social and economic organization have also been highly influential (Weber, 1921/2012). Weber argued that the modern Western world showed an ever-increasing reliance on logic, efficiency, rules, and reason. According to him, modern societies are characterized by the development and growing influence of formal rationality, a context in which people’s pursuit of goals is increasingly shaped by rules, regulations, and larger social structures. One of Weber’s most widely known illustrations of formal rationality comes from his study of bureaucracies, formal organizations characterized by written rules, hierarchical authority, and paid staff, intended to promote organizational efficiency. Bureaucracies, for Weber, epitomized formally rational systems: On one hand, they offer clear, knowable rules and regulations for the efficient pursuit of particular ends, like obtaining a passport or getting financial aid for higher education. On the other hand, he feared, the bureaucratization of modern society would also progressively strip people of their humanity and creativity and result in an iron cage of rationalized structures with irrational consequences.

Weber’s ideas about bureaucracy were remarkably prescient in their characterization of our bureaucratic (and formally rationalized) modern world. Today we are also confronted regularly with both the incredible efficiency and the baffling irrationality of modern bureaucratic structures. Within moments of entering into an efficiently concluded contract with a wireless phone service provider, we can become consumers of a cornucopia of technological opportunities, with the ability to chat on the phone or receive text messages from virtually anywhere, post photographs or videos online, and pass the time playing downloaded games. Should we later be confused by a bill and need to speak to a company representative, however, we may be shuttled through endless repetitions of an automated response system that never seems to offer us the option of speaking with another human being. Today, Weber’s presciently predicted irrationality of rationality is alive and well.

  Weber and Marx CLICK TO SHOW

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Public domain—Library of Congress

W. E. B. Du Bois, the first African American to receive a PhD from Harvard, wrote 20 books and more than 100 scholarly articles on race and race relations. Today many of his works are classics in the study of African American lives and race relations in the United States.

EARLY 20TH-CENTURY U.S. SOCIOLOGY

Sociology was born in Europe, but it took firm root in U.S. soil, where it was heavily influenced by turn-of-the-century industrialization and urbanization, as well as by racial strife and discrimination. Strikes by organized labor, corruption in government, an explosion of European immigration, racial segregation, and the growth of city slums all helped mold early sociological thought in the United States. By the late 1800s, a number of universities in the United States were offering sociology courses. The first faculties of sociology were established at the University of Kansas (1889), the University of Chicago (1892), and Atlanta University (1897).

ROBERT EZRA PARK  The sociology department at the University of Chicago, which gave us what is often known as the “Chicago School” of sociology, dominated the new discipline in the United States at the start of the 20th century. Chicago sociologist Robert Ezra Park (1864–1944) pioneered the study of urban sociology and race relations. Once a muckraking journalist, Park was an equally colorful academic, reportedly coming to class in disheveled clothes and with shaving soap still in his ears. But his students were devoted to him, and his work was widely recognized. His 1921 textbook An Introduction to the Science of Sociology, coauthored with his Chicago colleague Ernest Burgess, helped shape the discipline. The Chicago School studied a broad spectrum of social phenomena, from hoboes and flophouses (inexpensive dormitory-style housing) to movie houses, dance halls, and slums, and from youth gangs and mobs to residents of Chicago’s ritzy Gold Coast.

Park was a champion of racial integration, having once served as personal secretary to the African American educator Booker T. Washington. Yet racial discrimination was evident in the treatment of Black sociologists, including W. E. B. Du Bois, a contemporary of many of the sociologists working in the Chicago School.

W. E. B. DU BOIS  A prominent Black sociologist and civil rights leader at the African American Atlanta University, W. E. B. Du Bois (1868–1963) developed ideas that were considered too radical to find broad acceptance in the sociological community. At a time when the U.S. Supreme Court had ruled that segregated “separate but equal” facilities for Blacks and Whites were constitutional and when lynching of Black Americans had reached an all-time high, Du Bois condemned the deep-seated racism of White society. Today, his writings on race relations and the lives of U.S. Blacks are classics in the field.

Du Bois sought to show that racism was widespread in U.S. society. He was also critical of Blacks who had “made it” and then turned their backs on those who had not. One of his most enduring ideas is that in U.S. society, African Americans are never able to escape a fundamental awareness of race. They experience a double consciousness, as he called it—an awareness of themselves both as Americans and as Blacks, never free of racial stigma. He wrote, “The Negro is sort of a seventh son… gifted with second-sight… this sense of always looking at one’s self through the eyes of others” (Du Bois, 1903/2008, p. 12). Today as in Du Bois’s time, physical traits such as skin color may shape people’s perceptions and interactions in significant and complex ways.

THE MID-20TH CENTURY IN U.S. SOCIOLOGY

After World War II, sociology began to apply sophisticated quantitative models to the study of social processes. There was also a growing interest in the grand theories of the European founders. At Columbia University, Robert K. Merton (1910–2003) undertook wide-ranging studies that helped further establish sociology as a scientific discipline. Merton is best known for his theory of deviance (Merton, 1938), his work on the sociology of science (Merton, 1996), and his iteration of the distinction between manifest and latent functions (Merton, 1968). He emphasized the development of theories in what he called the “middle range”—midway between the grand theories of Weber, Marx, and Durkheim and quantitative studies of specific social problems.

  Tuskegee Airmen & Double Consciousness CLICK TO SHOW

p.16

 

Fritz Goro/Contributor/Getty Images

The “sociological imagination” involves viewing seemingly personal issues through a sociological lens. C. Wright Mills is best known for coining this catchy and popular term.

Another Columbia University sociologist, C. Wright Mills (1916–1962), renewed interest in Max Weber by translating many of his works into English and applying his ideas to the contemporary United States. But Mills, who also drew on Marx, identified himself as a “plain Marxist.” His concept of the sociological imagination can be traced in part to Marx’s famous statement that “man makes history, but not under circumstances of his own choosing,” meaning that while we are agents of free will, the social context has a profound impact on the obstacles or opportunities in our lives.

Mills synthesized Weberian and Marxian traditions, applying sociological thinking to the most pressing problems of the day, particularly inequality. He advocated an activist sociology with a sense of social responsibility. Like many sociologists, he was willing to turn a critical eye on “common knowledge,” including the belief that the United States is a democracy that represents the interests of all the people. In a provocative study, he examined the workings of the “power elite,” a small group of wealthy businessmen, military leaders, and politicians who Mills believed ran the country largely in their own interests (Mills, 1956/2000a).

WHY SO FEW FOUNDING MOTHERS?

Why did so few women social scientists find a place among sociology’s founders? After all, the American (1776) and French (1789) revolutions elevated such lofty ideals as freedom, liberty, and equality. Yet long after these historical events, women and minorities were still excluded from public life in Europe and North America. Democracy—which gives people the right to participate in their governance—was firmly established as a principle for nearly a century and a half in the United States before women achieved the right to vote in 1920. In France, it took even longer—until 1945.

Sociology as a discipline emerged during the first modern flourishing of feminism in the 19th century. Yet women and people of non-European heritage were systematically excluded from influential positions in the European universities where sociology and other modern social sciences originated. When women did pursue lives as scholars, the men who dominated the social sciences largely ignored their writings. Feminist scholar Julie Daubié won a prize from the Lyon Academy for her essay “Poor Women in the Nineteenth Century,” yet France’s public education minister denied her a diploma on the grounds that he would be “forever holding up his ministry to ridicule” (Kandal, 1988, pp. 57–58). Between 1840 and 1960, almost no women held senior academic positions in the sociology departments of any European or U.S. universities, with the exception of exclusively women’s colleges.

A number of woman scholars managed to overcome the obstacles to make significant contributions to sociological inquiry. For example, in 1792 the British scholar Mary Wollstonecraft published A Vindication of the Rights of Women, arguing that scientific progress could not occur unless women were allowed to become men’s equals by means of universal education. In France in 1843, Flora Tristan called for equal rights for women workers, “the last remaining slaves in France.” Also in France, Aline Valette published Socialism and Sexualism in 1893, nearly three-quarters of a century before the term sexism found its way into spoken English (Kandal, 1988).

One of sociology’s most prominent early figures, Jane Addams (1860–1935), never won a full-time position at the University of Chicago in spite of the school’s “progressive” leanings. The University of Chicago even denied her an honorary degree—though she wrote 11 books and hundreds of articles and was awarded the Nobel Peace Prize in 1931 for her dedication to social reform.

Addams is best known as the founder of Hull House, a settlement house for the poor, sick, and aged that became a center for political activists and social reformers. Less well known is the fact that under Addams’s guidance, the residents of Hull House engaged in important research on social problems in Chicago. Hull House Maps and Papers, published in 1895, pioneered the study of Chicago neighborhoods, helping to shape the research direction of the Chicago School of sociology. Following Addams’s lead, Chicago sociologists mapped the city’s neighborhoods, studied their residents, and helped create the field of community studies.

p.17

 

The Granger Collection, NYC—All rights reserved.

Underappreciated during her time, Jane Addams was a prominent scholar and early contributor to sociology. She is also known for her political activism and commitment to social reform.

As sociologists like Harriet Martineau, Jane Addams, Julie Daubié, and others experienced, early female sociologists were not accorded the same status as their male counterparts. Only recently have many of their writings been “rediscovered” and their contributions acknowledged in sociology.

SOCIOLOGY: ONE WAY OF LOOKING AT THE WORLD—OR MANY?

Often, multiple sociologists look at the same events, phenomena, or institutions and draw different conclusions. How can this be? One reason is that they may approach their analyses from different theoretical perspectives. In this section, we explore the key theoretical paradigms in sociology and look at how they are used as tools for the analysis of society.

Sociological theories are logical, rigorous frameworks for the interpretation of social life that make particular assumptions and ask particular questions about the social world. The word theory is rooted in the Greek word theoria, which means “a viewing.” An apt metaphor for a theory is a pair of glasses. You can view a social phenomenon such as socioeconomic inequality or poverty, deviance, or consumer culture, or an institution like capitalism or the family, using different theories as lenses.

As you will see in the next section, in the discipline of sociology there are several major categories of theories that seek to examine and explain social phenomena and institutions. Imagine the various sociological theories as different pairs of glasses, each with colored lenses that change the way you see an image: You may look at the same institution or phenomenon as you put on each pair, but it will appear different depending on the glasses you are wearing. Keep in mind that sociological theories are not “truths” about the social world. They are logical, rigorous analytical tools that we can use to inquire about, interpret, and make educated predictions about the world around us. From the vantage point of any sociological theory, some aspects of a phenomenon or an institution are illuminated while others are obscured. In the end, theories are more or less useful depending on how well empirical data—that is, knowledge gathered by researchers through scientific methods—support their analytical conclusions. Below, we outline the basic theoretical perspectives that we will be using in this text.

The three dominant theoretical perspectives in sociology are structural functionalism, social conflict theory, and symbolic interactionism. We outline their basic characteristics below and will revisit them again throughout the book. Symbolic interactionism shares with the functionalist and social conflict paradigms an interest in interpreting and understanding social life. However, the first two are macro-level paradigms, concerned with large-scale patterns and institutions. Symbolic interactionism is a micro-level paradigm—that is, it is concerned with small-group social relations and interactions.

Structural functionalism, social conflict theory, and symbolic interactionism form the basic foundation of contemporary sociological theorizing (Table 1.1). Throughout this book we will introduce variations on these theories, as well as new and evolving theoretical ideas in sociology.

THE FUNCTIONALIST PARADIGM

Structural functionalism (or functionalism—the term we use in this book) seeks to explain social organization and change in terms of the roles performed by different social structures, phenomena, and institutions. Functionalism characterizes society as made up of many interdependent parts—an analogy often cited is the human body. Each part serves a different function, but all parts work together to ensure the equilibrium and health of the entity as a whole. Society too is composed of a spectrum of different parts with a variety of different functions, such as the government, the family, religious and educational institutions, and the media. According to the theory, together these parts contribute to the smooth functioning and equilibrium of society.

p.18

TABLE 1.1   The Three Principal Sociological Paradigms

Topic Folder Discovering Sociology 7 unread of 7 messagesView Full Description

Choose one of the following questions:
1. Social life can be interpreted from one of the three major theoretical frameworks or perspectives. Describe the major points of each framework/perspective and discuss which perspective you think provides a more accurate or complete view of the social world and why.
2.  What does it mean to have a “sociological imagination?”  How does this relate to what Mills refers to as private troubles and public issues?  Share an example of an issue that might be considered by sociologists to be both a private trouble as well as a public issue. [Hint: How do media and/or culture link private troubles and public issues, OR make private troubles become public issues? Look to chapter 3 for support]
The Week 1 Forum meets the following course objectives:
  • Apply a sociological perspective to the social world
  • Analyze contemporary social issues using the sociological imagination and use sociological theories and concepts to analyze everyday life.
  • Describe culture and socialization.

 

 

Instructions for all Forums:

Each week, learners will post one initial post per week.  This post must demonstrate comprehension of the course materials, the ability to apply that knowledge in the real world.  Learners will engage with the instructor and peers throughout the learning week.  To motivate engaged discussion, posts are expected to be on time with regular interaction throughout the week.  All posts should demonstrate college level writing skills. To promote vibrant discussion as we would in a face to face classroom, formatted citations and references are not required.  Quotes should not be used at all, or used sparingly.  If you quote a source quotation marks should be used and an APA formatted citation and reference provided.

 

 

 

Points

 

Exemplary (100%)

 

 

Accomplished (85%)

 

 

Developing (75%)

 

Beginning (65%)

 

Not Participating (0%)

 

Comprehension of course materials

 

4

Initial post demonstrates rich comprehension of course materials.  Detailed use of terminology or examples learned in class.  If post includes opinion, it is supported with evaluated evidence. Initial post demonstrates clear comprehension of course materials.  Use of terminology or examples learned in class. If post includes opinion, it is supported with evaluated evidence. Initial post demonstrates some comprehension of course materials.  Specific terminology or examples learned in class may be incorrect or incomplete.  Post may include some opinion without evaluated evidence. Initial post does not demonstrate comprehension of course materials.  Specific terminology or examples learned in class are not included.  Post is opinion based without evaluated evidence. No posting, post is off topic, post does not meet minimum criteria for demonstrating beginning level of comprehension. Post may be plagiarized, or use a high percentage of quotes that prevent demonstration of student’s comprehension.
Real world application of knowledge

 

2

Initial post demonstrates that the learner can creatively and uniquely apply the concepts and examples learned in class to a personal or professional experience from their life or to a current event. Initial post demonstrates that the learner can apply the concepts and examples learned in class to a  personal or professional experience from their life or to a current event. Initial post does not clearly demonstrate that the learner can apply the concepts and examples learned in class. Unclear link between the concepts and examples learned in class to personal or professional experience or to a current event. Initial post does not demonstrate that the learner can apply the concepts and examples learned in class. No link to a personal or professional experience or to a current event is made in the post. No posting, post is off topic, post does not meet minimum criteria for demonstrating beginning level of application. Post may be plagiarized, or use a high percentage of quotes that prevent demonstration of student’s ability to apply comprehension.
Active Forum Engagement and Presence

3

Learner posts 4+ different days in the learning week.

 

Replies to at least one response from a classmate or instructor on the learner’s initial post to demonstrate the learner is reading and considering classmate responses to their ideas.

 

Posts two or more 100+ word responses to initial posts of classmates.  Posts motivate group discussion and contributes to the learning community by doing 2+ of the following:

  • offering advice or strategy
  • posing a question,
  • providing an alternative point-of-view,
  • acknowledging similar experiences
  • sharing a resource
Learner posts 3 different days in the learning week.

 

Posts two 100+ word responses to initial posts of classmates.  Posts motivate group discussion and contribute to the learning community by doing  2+ of the following:

 

  • offering advice or strategy
  • posing a question,
  • providing an alternative point-of-view,
  • acknowledging similar experiences
  • sharing a resource
Learner posts 2 different days in the learning week.

 

Posts one 100+ word response to initial post of classmate.  Post motivates group discussion and contributes to the learning community by doing 1 of the following:

 

  • offering advice or strategy
  • posing a question,
  • providing an alternative point-of-view,
  • acknowledging similar experiences
  • sharing a resource
Learner posts 1 day in the learning week.

 

Posts one 100+ word response to initial post of classmate.  Post does not clearly motivate group discussion or clearly contribute to the learning community.

 

Responses do not:

  • offering advice or strategy
  • posing a question,
  • providing an alternative point-of-view,
  • acknowledging similar experiences
  • sharing a resource
Learner posts 1 day in the learning week, or posts are not made during the learning week and therefore do not contribute to or enrich the weekly conversation.

 

No peer responses are made.  One or more peer responses of low quality (“good job, I agree”) may be made.

Writing skills

1

Post is 250+ words.  All posts reflect widely accepted academic writing protocols like using capital letters, cohesive sentences, and no texting language. Dialogue is also polite and respectful of different points of view. Post is 250+ words.  The majority of posts reflect widely-accepted academic writing protocols like using capital letters, cohesive sentences, and no texting language. Dialogue is polite and respectful of different points of view. Post is 175+ words.  The majority of posts reflect widely-accepted academic writing protocols like using capital letters (“I am” not “i am”), cohesive sentences, and no texting language. Dialogue may not be respectful of different points of view. Post is 150+ words.  The majority of the forum communication ignores widely-accepted academic writing protocols like capital letters, cohesive sentences, and texting; Dialogue may not be respectful of different points of view. No posting, post is off topic and does not meet minimum criteria for demonstrating beginning level of comprehension.

Psych 640 History Of Cognitive Psychology Lecture

Create a 10- to 15-slide Microsoft® PowerPoint® presentation lecture for your class in which you address the following:

 

  • Describe the history of cognitive psychology.
  • Explain how and why psychometric studies are used to study cognitive psychology.
  • Discuss the benefits of research in psychometrics.

 

Include at least two scholarly articles.

Include speaker notes with your presentation.

Format your presentation consistent with APA guidelines.
Clickthe Assignment Files tab to submit your assignment

History of cognitive psychology lecture

Mary Oliver

Psych 640

Ms. Paulette pitt

March 9, 2015

Week I Individual Assignment

1

Introduction

History of cognitive psychology

 

Psychometric studies

 

Benefits of psychometric research

Uric Neisser is known as the father of cognitive psychology as well as an advocate for cognitive research. During his career he published Cognitive Psychology (1967) in which he brought research together pertaining yo perception, pattern recognition, attention, problem solving, and remembering (APS, 2012). Cognitive psychology is the broad name give to the field of psychology that examines attention, consciousness, information processing, and memory. Researchers in cognitive psychology and sensation perception are sometimes call experimental psychologist. This presentation will describe the history of cognitive psychology. It will explain how and why psychometric studies are used to study cognitive psychology. Finally this presentation will discuss the benefits of research in psychometrics.

2

Cognitive Psychology History

Cognitive Psychology makeup

Cognitive psychology focuses on a higher mental processes, including thinking, memory, reasoning, problem solving, judging, decision making and language. It focuses on the study of higher mental processes. Cognitive psychology centers on three major topics: thinking and reasoning, problem solving and creativity, and language. In the 1950s, researchers speculated that some mental operations might be modeled by computers, and they believed that  such modeling might shed light on how the human mind work (Marcus, 2001). Cognitive psychologists often use the computer as an analogy to help explain the relationship between cognition of the brain.  They explain the physical brain as the computer’s hardware, and cognition as its software. The human brain also has an incredible ability to learn new rules, relationships, concepts, and patterns that it can generate to novel situations. The term cognitive psychology became a label for approaches that sought to explain observable behavior by investigating mental processes and structures that we cannot directly observe (Ashcraft & Radvansky, 2009).

3

Major Topics

 

Thinking/Reasoning

Problem Solving

Decision Making

 

The brain’s processing is the silent operation of thinking. Psychologist define thinking as the manipulation of mental representations of information. The representation may take the form of a word, a visual image, a sound or data in any other sensory modality stored in memory. Thinking transform a particular representation of information into new and different forms, allowing one to answer questions, solve problems, or reach goals. Thinking also involves manipulating information mentally by forming concepts, solving problems, making decisions, and reflecting in a critical or creative manner. In the past Philosophers have considered the foundations of reasoning for some time, it is only recently that cognitive psychologist have begin to investigate how people reason and make decisions. There work has contributed to our understanding of formal reasoning processes as well as shortcuts often used. Reasoning is the mental activity of transforming information to reach conclusions. Reasoning is involved in problem solving and decision making. It is also a skill closely related to critical thinking. It can also be inductive or deductive. Inductive reasoning involves reasoning from specific observations to make generalizations (Tenenbaum, Griffiths, & Kemp, 2006). Deductive reasoning is reasoning from a general case that one know to be true to a specific instance (Demeure, Bonnefon, & Raufaste, 2009). Some psychologist have found that problem solving typically involves three steps: preparing to create solutions, producing solutions, and evaluating the solution that have been generated. When approaching a problem most people begin by trying to understand the problem thoroughly. If the problem is a novel one, they may pay closer attention to any restrictions placed on coming up with a solution. If by chance, the problem is a familiar one, they are apt to spend considerably less time in it preparation stage. Problems vary from well defined to ill defined. Despite obstacles to problem solving people are very skilled at discovering creative solutions to the problems. Reasoning is the mental activity of transforming information to reach conclusions. Decision making involves evaluating alternatives and choosing among them. Reasoning uses establishes rules to draw conclusion, decision making these rules are not established, and one may not know the consequences of the decisions.

4

Psychometric Studies

 

How its used

Psychometric is the study concerning theory and techniques of psychological measurement, that involves the measurement of knowledge, abilities, attitudes and personality traits. This field primary deals with the study of differences within or between individual. It also involves two major research tasks such as construction of instruments and procedures for measurement, and development and refinement of theoretical approaches toward measurements (Tenenbaum, Griffith, & Kemp, 2006). When psychometric is used together with other information outlets they provide a powerful insight into why people make the decisions they often make or why they behave they way that they do. Futhermore, psychometrics helps to predict a individuals future behavior and performance. Some of the earliest psychometric instruments were used initially to test intelligence. It ha been applied in educational assessment to measure such things as reading and writing, and intelligence test .

5

 

Why its Used

The use of psychometrics has steadily grown over the last 50 years but has really flourished over the last 10 to 15 years. The majority of psychometric tests have been designed by occupational psychologist to guarantee the tools have scientific reliability and normative information from which they can compare the results against (Tenenbaum, Griffith, & Kemp, 2006). The resurgence of research in laboratory environments use structured psychometric instruments, questionnaires and performance test designed to reveal the mechanisms underlying human behavior. When looking at the use of psychometrics it is cost efficient and cost control thus reducing the budget for testing (Feldman, 2009).

6

Benefits of Research

 

Psychometrics offer the following benefits such as efficiency and confidentiality that secures collection of feedback for the individual and proven methodology. Furthermore, there are three different types of psychometric: ability/intellectual capability, personality, ad motivation. Psychometric as been used to lead scientific credibility for classification. Psychometric can be use in the research of cognitive psychology as well in employment recruitment.

7

Benefits of Psychometrics

 

It is clear the important implications with respect to psychometric approaches to the measurement of personality traits. According to this view, behavior is negotiated between participants in a social exchanges, and operates as a function of the situational and intrapersonal requirements. Qualitative methods are important because they attempt to understand the nature of this exchange, rather that simply reducing it to single numbers such as the score on a personality questionnaire or test. The principles of psychometrics guide the development and use of instruments and procedures used in the measurement of psychological traits (Anderson, 2009).

8

Conclusion

History of Cognitive Psychology

How and Why Psychometric Studies are Used

Benefits of Research

 

 

Psychometrics has been applied extensively to the measurement of personality, attitudes, mood, intelligence, cognitive ability, etc. The inherent difficulty in measuring these constructs, which lack a tangible physical correlate, drives the uses of psychometrics, which attempts to properly quantify and define these constructs. The earlier psychometric instruments were designed to measure intelligence, the best known of which is the Stanford-Binet IQ test developed originally by Alfred Binet, and psychometric instruments continue to be used widely within education and educational psychologist. Another major area of study in psychometrics relates to personality, and a large number of personality measures and related models and theories. Healthy psychology relies heavily on psychometric instruments, including questionnaires but also interview instruments, to quantify the constructs which are central to many of the research questions studied. It is therefore important that these measures are both reliable and valid. For this reason, researchers generally use instruments that have undergone an extensive and stringent process of reliability and validity test. The use of instruments which have not gone through this process is discouraged (Albery & Munafo’, 2008).

9

References

Albery,I.& Munafo’, M. ((2008). Key Concepts in Health Psychology. Sage Publications

Anderson, J. (2009). Cognitive Psychology and its Implications. (7th ed.) Wroth Publishers

Ashcraft, M., & Radvansky, G. (2009). Cognition (5th ed.) Upper Saddle River, NJ: Prentice-Hall

Association for Psychology Science (APS). (2012). Remembering the father of cognitive psychology. Vol.25 No.5 Retrieved from http://www.psychologicalscience.org/index.php/publications/observer/2012/may-june-12/remembering-the-father-of-cognitive-psychology.html

Demeure, V., Bonnefon, J., & Raufaste, E. (2009). Politeness and condiitioned reasoning: Interpersonal cues to the indirect suppression of deductive inference. Journal of Experimental Psychology: Learning, memory, and cognition 35, 260-266

Feldman, R. (2009). Understanding Psychology (9th ed.) New York, NY: McGraw Hill

Marcus, J. (2001). The algebraic mind. Cambridge, MA: MIT Books

Tenebaum, J., Griffiths, T., & Kemp, C. (2006). Theory-based Bayesianmodels of inductive learning and reasoning. Trends in Cognitive Science, 10, 309-318

 

 

 

 

10

Mental Health Quiz

QUESTION 1

1. __________ is the ability of professionals to move their licensed status from state to state.

  a. Anonymity
  b. Communicability
  c. Transferability
  d. Portability

0.5 points   

QUESTION 2

1. Divisions can be categorized as __________ divisions or __________ divisions.

  a. specialty; preferred
  b. passion; work setting
  c. passion; specialty
  d. work setting; specialty

0.5 points   

QUESTION 3

1. Which of the following is NOT one of the four ACA regions?

  a. North Atlantic
  b. Eastern
  c. Midwest
  d. Southern

0.5 points   

QUESTION 4

1. Portability allows

  a. a multicultural approach to counseling.
  b. professionals to use standardized practices.
  c. professionals to move their license from state to state.
  d. the public to know that they are protected.

0.5 points   

QUESTION 5

1. The American Mental Health Counselors Association (AMHCA) is an example of a

  a. Both of the above
  b. work setting division.
  c. None of the above
  d. passion division.

0.5 points   

QUESTION 6

1. ____________ was the final state to issue licenses for professional counselors.

  a. California
  b. Florida
  c. Maryland
  d. Virginia

0.5 points   

QUESTION 7

1. Which ACA division is nicknamed “the heart and conscience of the counseling profession”?

  a. Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC)
  b. Counselors for Social Justice (CSJ)
  c. International Association of Marriage and Family Counselors (IAMFC)
  d. Association for Humanistic Counseling (AHC)

0.5 points   

QUESTION 8

1. Credentialing laws for the counseling profession have been left to the

  a. school districts.
  b. state legislatures.
  c. national government.
  d. county/city legislatures.

0.5 points   

QUESTION 9

1. Which of the following is NOT true about the National Board for Certified Counselors (NBCC)?

  a. NBCC recruits non-profit organizations to sponsor certification testing.
  b. NBCC manages specialty certifications for clinical mental health and addictions counselors.
  c. NBCC oversees the national certification process.
  d. NBCC manages certification examinations.

0.5 points   

QUESTION 10

1. Title acts differ from practice acts in that title acts

  a. allow graduates of counselor education programs to call themselves licensed professional counselors.
  b. prohibit individuals from performing the activities associated with professional counseling.
  c. require individuals to meet state licensure requirements.
  d. allow individuals to practice the profession of counseling so long as they do not call themselves licensed professional counselors.

0.5 points   

QUESTION 11

1. The four levels of credentialing procedures, ranging from least prestigious to most prestigious, are ______________.

  a. certification, inspection, licensure, and registration
  b. inspection, registration, certification, and licensure
  c. inspection, licensure, certification, and registration
  d. registration, certification, inspection, and licensure

0.5 points   

QUESTION 12

1. Which of the following statements is NOT true about credentialing laws for the counseling profession?

  a. Many states accredit graduate school counseling programs in conjunction with national accreditation processes.
  b. Credentialing procedures are different from state to state.
  c. Credentialing laws are established by the national government.
  d. Professional policies and laws, particularly credentialing, are still being established.

0.5 points   

QUESTION 13

1. The process by which states reach agreements that allow for out-of-state licenses to be accepted so long as all state fees are paid is known as

  a. portability.
  b. certification.
  c. cross certification.
  d. credentialing.

0.5 points   

QUESTION 14

1. Decisions of the CACREP board regarding accreditation of a program can include all of the following EXCEPT

  a. denial of accreditation.
  b. 8-year accreditation.
  c. permanent accreditation.
  d. 2-year provisional accreditation.

0.5 points   

QUESTION 15

1. __________ protects public interest, ensures that graduate students have met high standards, and identifies educational programs that meet minimum standards for faculty composition, curriculum, and student services.

  a. Accreditation
  b. Licensure
  c. Certification
  d. Maintenance

0.5 points   

QUESTION 16

1. The minimum number of supervised clinical hours an applicant must accumulate before applying for a counseling license

  a. is 4,000 hours.
  b. is 5,000 hours.
  c. is 3,000 hours.
  d. varies by state.

0.5 points   

QUESTION 17

1. __________ is NOT a level of credentialing procedures.

  a. Inspection
  b. Accreditation
  c. Certification
  d. Licensure

0.5 points   

QUESTION 18

1. Licensure and national certification

  a. support future skill development.
  b. are costly and sometimes unnecessary.
  c. guide counseling students through their respective graduate programs.
  d. allow professionals to use their leadership and advocacy skills.

0.5 points   

QUESTION 19

1. The __________ is a voluntary, non-profit, non-governmental, independent corporation that advances professional counselor credentials.

  a. National Board for Certified Counselors (NBCC)
  b. American Counseling Association Foundation (ACAF)
  c. Chi Sigma Iota
  d. Council for Accreditation of Counseling and Related Educational Programs (CACREP)

0.5 points   

QUESTION 20

1. Licenses and certifications require

  a. qualification by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).
  b. continuing education.
  c. a minimum of 3.0 as a graduate GPA.
  d. 3 years of graduate education.

Case Studies In Assessments

Prior to beginning work on this discussion, read the assigned chapters from the text. It is highly recommended that you review each of the brief Blumenfeld (2012) video clips demonstrating the administration of a mental status examination. These are listed in the recommended resources and may require that you download Quicktime in order to view them. Although not required, these videos show the administration of a mental status exam and may prove helpful in this discussion.

Access the Barnhill (2014) DSM-5 Clinical Cases e-book in the DSM-5 library, and select one of the case studies. The case study you select must be one in which the client could be assessed using one or more of the assessment instruments discussed in this week’s reading.

For this discussion, you will take on the role of a psychology intern at a mental health facility working under the supervision of a licensed psychologist. In this role, you will conduct a psychological evaluation of a client referred to you for a second opinion using valid psychological tests and assessment procedures. The case study you select from the textbook will serve as the information provided to you from the professional who previously evaluated the client (e.g., the psychologist or psychiatrist).

In your initial post, begin with a paragraph briefly summarizing the main information about the case you selected. Evaluate and describe the ethical and professional interpretation of any assessment information presented in the case study. Devise an assessment battery for a psychological evaluation that minimally includes a clinical interview, mental status exam, intellectual assessment, observations of the client, and at least two assessment instruments specific to the diagnostic impressions (e.g., attention deficit/hyperactivity disorder, post-traumatic stress disorder, autism spectrum disorder, etc.). The assessment battery must include at least one approach to assessing your client which is different from the assessments previously administered. The assessment plan must be presented as a list of recommended psychological tests and assessment procedures with a brief sentence explaining the purpose of each test or procedure. Following the list of tests and assessment procedures you recommend for your client, compare the assessment instruments that fall within the same categories (e.g., intellectual or achievement), and debate the pros of cons of the instruments and procedures you selected versus the instruments and procedures reported by the referring professional.

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Chapter 18. Personality Disorders https://doi-org.proxy-library.ashford.edu/10.1176/appi.books.9781585624836.jb18

Introduction

John W. Barnhill, M.D.

Personality is the enduring pattern of behavior and inner experience. It underlies how we

think, feel, and act and frames how we view ourselves and the people around us. When we

think of who we are, we often think of personality as the central defining characteristic.

Psychiatrists and other mental health practitioners spend considerable time thinking about

personality and the ways in which dysfunctional personalities cause distress and

dysfunction in individuals and in the people around them. Disorders of personality are, in

some ways, as complex as humanity, itself full of idiosyncrasies, half-articulated conflicts,

and unknowable complexities.

 

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Like many other complex systems, however, personalities and personality disorders tend to

fall into patterns, and, for generations, clinicians and personality researchers from a variety

of fields have searched for a holy grail: a nosological system that is both simple to use and

sophisticated enough to capture the nuances and paradoxes of human personality.

Traditionally, the field of psychiatry has conceptualized personality disorders categorically,

as reflecting distinct clinical syndromes. In another paradigm, personality disorders are

conceptualized dimensionally, as dysfunctional variants of human personality traits that

exist on a gradient from maladaptive to normal. As part of the DSM-5 development

process, a team of personality researchers explored multiple ways to incorporate both

paradigms, and as a result created a new hybrid categorical-dimensional model.

After vigorous debate among team members, the DSM-5 text includes the traditional

categorical model of personality disorders as well as the new hybrid categorical-

dimensional model. It is the traditional categorical perspective that is included in the main

body of the text, while the alternative DSM-5 model for personality disorders is described

in Section III, “Emerging Measures and Models.” This decision means that the 10 DSM-IV

personality disorders—and their criteria—remain essentially unchanged. The primary

substantive change is that as part of the removal of the axial system, the personality

disorders are no longer listed separately from other DSM-5 diagnoses.

To better understand the similarities and differences of the two models, it may be useful to

explore how the two DSM-5 diagnostic systems recommend that a clinician assess a patient

with, for example, obsessive-compulsive personality disorder (OCPD). From a categorical

perspective, the individual would receive a diagnosis of OCPD when certain criteria were

met. First, the clinician should identify a persistent, dysfunctional pattern of, for instance,

perfectionism at the expense of flexibility. The clinician would then identify at least four of

seven specific symptomatic criteria (preoccupation with lists, inability to delegate tasks,

stubbornness, etc.) and search for disorders that might be responsible for the same

symptoms (and that could lead to either the coding of the other diagnosis only, such as

when schizophrenia causes symptoms akin to those found in OCPD, or the coding of both

diagnoses, such as when the person also meets criteria for another personality disorder).

The new DSM-5 hybrid model reshapes the 10 DSM-IV personality disorder categories into

a roster of six redefined categories (antisocial, avoidant, borderline, narcissistic, obsessive-

compulsive, and schizotypal). For each of the six, the hybrid model requires two

 

 

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assessments. The first involves a determination that the individual has significant

impairment in at least two of four personality functioning areas: identity, self-direction,

empathy, and intimacy. For each of the six personality disorders, these personality specifics

differ. For example, to qualify for OCPD, an individual might be found to have significant

impairment from a sense of self excessively derived from work (identity) and from rigidity

and stubbornness negatively affecting relationships (intimacy).

The new hybrid model then requires an assessment of personality traits that are organized

under five broad trait domains. As shown in 18-, these traits and trait domains exist on a

spectrum; for example, for one of the five trait domains, antagonism lies on one end of the

spectrum and agreeableness on the other. These five broad trait domains are new to many

psychiatrists, but they have been rigorously studied for several decades within academic

psychology under the rubric of the Five Factor Model, whose personality dimensions

include neuroticism, extraversion, agreeableness, conscientiousness, and openness. For

each of these personality dimensions, there are clusters of related personality traits.

Applied to a particular person, the Five Factor Model can assign a percentile score for each

trait. For example, the theoretical person with OCPD might score in the 95th percentile for

conscientiousness and in the 5th percentile for openness. DSM-5 adapted these personality

dimensions and traits in order to more specifically focus on psychiatric disorder.

Alternative DSM-5 model: pathological personality trait domains

Enlarge table

Twenty-five specific pathological personality traits are included under the umbrella of these

five negative trait domains. For each of the personality disorders, DSM-5 requires that the

individual demonstrate most of the typical personality traits. For example, the patient with

OCPD must demonstrate the trait of rigid perfectionism (an aspect of the trait domain of

conscientiousness) as well as at least two of the following three traits: perseveration (an

aspect of negative affectivity), intimacy avoidance (an aspect of detachment), and restricted

affectivity (also an aspect of detachment).

The DSM-5 hybrid model also specifies that specific traits can be recorded even if not

recognized as part of a diagnosed personality disorder (e.g., hostility, a trait associated with

the trait domain of negative affectivity, could be listed alongside any DSM-5 diagnosis and

not be considered just a trait associated with, for instance, antisocial personality disorder).

 

 

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Both of the DSM-5 models have advantages and disadvantages. The new DSM-5 hybrid

model might contribute to a more nuanced understanding of patients, and its approach

takes advantage of decades’ worth of personality research. Its current complexity is

daunting, however, even to seasoned clinicians, and the use of a new system would

potentially reduce the usefulness of existing research data within psychiatry.

The traditional categorical paradigm has been critiqued for excessive comorbidity and

intradisorder heterogeneity, as well as for the fact that one of the most common personality

disorder diagnoses in the past has been “personality disorder not otherwise specified,”

which is clarified only marginally by the DSM-5 use of “other specified” and “unspecified”

personality disorders. On the other hand, the categorical approach is relatively

straightforward to use, is familiar from DSM-IV, and follows the categorical structure used

throughout the rest of DSM-5. It is also the personality model included in the main body of

the DSM-5 text and, as such, remains the American Psychiatric Association’s official

perspective on personality disorders.

Suggested Readings

MacKinnon RA, Michels R, Buckley PJ: The Psychiatric Interview in Clinical Practice, 2nd

Edition. Washington, DC, American Psychiatric Publishing, 2006

Michels R: Diagnosing personality disorders. Am J Psychiatry 169(3):241–243, 2012

PubMed ID: 22407109

Shedler J, Beck A, Fonagy P, et al: Personality disorders in DSM-5. Am J Psychiatry

167(9):1026–1028, 2010 PubMed ID: 20826853

Skodol AE, Bender DS, Oldham JM, et al: Proposed changes in personality and

personality disorder assessment and diagnosis for DSM-5, part II: clinical application.

Personal Disord 2(1):23–30, 2011 PubMed ID: 22448688

Skodol AE, Clark LA, Bender DS, et al: Proposed changes in personality and personality

disorder assessment and diagnosis for DSM-5, part I: description and rationale. Personal

Disord 2(1):4–22, 2011 PubMed ID: 22448687

Westen D, Shedler J, Bradley B, DeFife JA: An empirically derived taxonomy for

personality diagnosis: bridging science and practice in conceptualizing personality. Am J

 

 

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Psychiatry 169(3):273–284, 2012 PubMed ID: 22193534

Case 18.1 Personality Con�icts

Larry J. Siever, M.D.

Lauren C. Zaluda, B.A.

Frazier Archer was a 34-year-old single white man who called a mood and personality

disorders research program because an ex-friend had once said he was “borderline,” and

Mr. Archer wanted to learn more about his personality conflicts.

During his diagnostic research interviews, Mr. Archer reported regular, almost daily

situations in which he was sure he was being lied to or deceived. He was particularly wary

of people in leadership positions and people who had studied psychology and, therefore,

had “training to understand the human mind,” which they used to manipulate people.

Unlike those around him, Mr. Archer believed he did not “drink the Kool-Aid” and was able

to detect manipulation and deceit.

Mr. Archer was extremely detail oriented at work, and had trouble delegating and

completing tasks. Numerous employers had told him that he focused excessively on rules,

lists, and small details, and that he needed to be more friendly. He had held numerous jobs

over the years, but he was quick to add, “I’ve quit as often as I’ve been fired.” During the

interview, he defended his behavior, asserting that unlike many people, he understood the

value of quality over productivity. Mr. Archer’s wariness had contributed to his “bad

temper” and emotional “ups and downs.” He socialized only “superficially” with a handful

of acquaintances and could recall the exact moments when previous “so-called friends and

lovers” had betrayed him. He spent most of his time alone.

Mr. Archer denied any significant history of trauma, any current or past problems with

substance use, and any history of head trauma or loss of consciousness. He also denied any

history of mental health diagnosis or treatment, but reported that he felt he might have a

mental health condition that had not yet been diagnosed.

On mental status examination, Mr. Archer appeared well groomed, cooperative, and

oriented. His speech varied; at times he would pause thoughtfully prior to answering

questions, causing his rate of speech to be somewhat slow. His tone also changed

 

 

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significantly when he discussed situations that had made him angry, and many of his

responses were lengthy, digressive, and vague. However, he seemed generally coherent and

did not evidence perceptual disorder. His affect was occasionally inappropriate (e.g.,

smiling while crying) but generally constricted. He reported apathy as to whether he lived

or died but did not report any active suicidal ideation or homicidal ideation.

Notably, Mr. Archer became irritated and argumentative with research staff when he was

told that although he could receive verbal feedback on his interviews, he could not receive a

copy of completed questionnaires and diagnostic tools. He commented that he would

document in his personal records that research staff were refusing him the forms.

Diagnoses

Paranoid personality disorder

Obsessive-compulsive personality disorder

Discussion

Mr. Archer describes a long-standing, inflexible, dysfunctional pattern of dealing with the

world. He demonstrates an enduring pattern of distrust and suspiciousness. He believes

that others are exploiting or deceiving him; doubts the loyalty of friends; bears grudges;

and recurrently mistrusts the fidelity of sexual partners. This cluster of symptoms qualifies

him for DSM-5 paranoid personality disorder (PPD).

A second cluster of personality traits relates to Mr. Archer’s preoccupation with

perfectionism and control. He is excessively focused on rules, lists, and details. He is

inflexible and unable to delegate. In addition to PPD, he has DSM-5 obsessive-compulsive

personality disorder (OCPD).

For any of the personality disorders, it is important to exclude the physiological effects of a

substance or another medical condition; neither of these appears likely in Mr. Archer, who

denied all substance abuse, medical illness, and head injury. Furthermore, his patterns of

behavior appear to be enduring and not related to either a major change in life

circumstance or another psychiatric disorder.

It is unsurprising that in addition to the PPD and OCPD diagnoses, Mr. Archer meets

partial criteria for other personality disorders, including schizotypal, borderline,

 

 

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narcissistic, and avoidant personality disorders. Personality disorders are frequently

comorbid, and if a patient meets criteria for more than one disorder, each should be

recorded. PPD is especially unlikely to be an isolated diagnosis, in either clinical or

research populations. PPD is often comorbid with schizotypal personality disorder and/or

other schizophrenia spectrum disorders, a finding attributable to overlapping paranoia-

related criteria. In Mr. Archer’s case, his emotional instability, anxiety, anger, and

arrogance are symptoms often found in a personality cluster that includes borderline

personality disorder and narcissistic personality disorder. Because of the relative

infrequency of PPD as an “isolated” disorder, current research is pointing toward the

possibility that some personality disorders, including PPD, could be consolidated to create

more inclusive diagnoses. Paranoia would then be viewed as a specifier or modifier for

other disorders. That is not the situation with DSM-5, however, and PPD should continue

to be listed as a comorbid condition when criteria are met.

A second interesting diagnostic issue related to PPD is the concern among some clinicians

that diagnosing PPD is tantamount to trying to identify an early stage of schizophrenia.

There is genetic, neurobiological, epidemiological, and symptomatic evidence that PPD,

like schizotypal personality disorder, is related to schizophrenia and lies on the

schizophrenia spectrum. However, PPD is not a precursor to schizophrenia, and its

symptoms are not indicative of the prodromal phase of schizophrenia. Prodromal

schizophrenia is best characterized by early psychotic symptoms, including disorganized

thoughts and behavior, whereas the thought patterns in PPD are generally more similar to

those of delusional disorder and related thought disorders.

Suggested Readings

Berman ME, Fallon AE, Coccaro EF: The relationship between personality

psychopathology and aggressive behavior in research volunteers. J Abnorm Psychol

107(4):651–658, 1998 PubMed ID: 9830252

Bernstein D, Useda D, Siever L: Paranoid personality disorder, in The DSM-IV

Personality Disorders. Edited by Livesley WJ. New York, Guilford, 1995, pp 45–57

Kendler KS: Diagnostic approaches to schizotypal personality disorder: a historical

perspective. Schizophr Bull 11(4):538–553, 1985 PubMed ID: 3909377

 

 

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Kendler KS, Neale MC, Walsh D: Evaluating the spectrum concept of schizophrenia in the

Roscommon Family Study. Am J Psychiatry 152(5):749–754, 1995 PubMed ID: 7726315

Siever LJ, Davis KL: The pathophysiology of schizophrenia disorders: perspectives from

the spectrum. Am J Psychiatry 161(3):398–413, 2004 PubMed ID: 14992962

Siever LJ, Koenigsberg HW, Harvey P, et al: Cognitive and brain function in schizotypal

personality disorder. Schizophr Res 54(1–2):157–167, 2002 PubMed ID: 11853990

Thaker GK, Ross DE, Cassady SL, et al: Saccadic eye movement abnormalities in relatives

of patients with schizophrenia. Schizophr Res 45(3):235–244, 2000 PubMed ID:

11042441

Triebwasser J, Chemerinski E, Roussos P, Siever L: Paranoid personality disorder. J Pers

Disord August 28, 2012 [Epub ahead of print] PubMed ID: 22928850

Zimmerman M, Chelminski I, Young D: The frequency of personality disorders in

psychiatric patients. Psychiatr Clin North Am 31(3):405–420, 2008 PubMed ID:

18638643

Case 18.2 Oddly Isolated

Salman Akhtar, M.D.

Grzegorz Buchalski was an 87-year-old white man who was brought to the psychiatric

emergency room (ER) by paramedics after they had been called to his apartment by

neighbors when they noticed an odd smell. Apparently, his 90-year-old sister had died

some days earlier after a lengthy illness. Mr. Buchalski had delayed reporting her death for

several reasons. He had become increasingly disorganized as his sister’s health had

worsened, and he was worried that his landlord would use the apartment’s condition as a

pretext for eviction. He had tried to clean up, but his attempts consisted mainly of moving

items from one place to another. He said he was about to call for help when the police and

paramedics showed up.

In the ER, Mr. Buchalski recognized that his actions were odd and that he should have

called for help sooner. At times, he became tearful when discussing the situation and his

sister’s death; at other times, he seemed aloof, speaking about these in a calm, factual way.

 

 

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He also wanted to clarify that his apartment had indeed been a mess but that much of the

apparent mess was actually his large collection of articles on bioluminescence, a topic he

had been researching for decades.

A licensed plumber, electrician, and locksmith, Mr. Buchalski had worked until age 65. He

described his late sister as having been always “a little strange.” She had never worked and

had been married once, briefly. Aside from the several-month marriage, she and Mr.

Buchalski had lived in the family’s two-bedroom Manhattan apartment their entire lives.

Neither of them had ever seen a psychiatrist.

When questioned, Mr. Buchalski stated that he had never had a romantic or sexual

relationship and had never had many friends or social contacts outside his family. He

explained that he had been poor and Polish and had had to work all the time. He had taken

night classes to better understand “the strange world we live in,” and he said his intellectual

interests were what he found most gratifying. He said he had been upset as he realized that

his sister was dying, but he would call it “numb” rather than depressed. He also denied any

history of manic or psychotic symptoms. After an hour with the psychiatric trainee, Mr.

Buchalski confided that he hoped the medical school might be interested in some of his

papers after his death. He said he believed that bioluminescent and genetic technologies

were on the verge of a breakthrough that might allow the skin of animals and then humans

to glow in subtle colors that would allow people to more directly recognize emotions. He

had written the notes for such technology, but they had grown into a “way-too-long science

fiction novel with lots of footnotes.”

On examination, Mr. Buchalski was a thin, elderly man dressed neatly in khakis and

button-down shirt. He was meticulous and much preferred to discuss his interests in

science than his own story. He made appropriate eye contact and had a polite, pleasant

demeanor. His speech was coherent and goal directed. His mood was “fine,” and his affect

was appropriate though perhaps unusually cheerful under the circumstances. He denied all

symptoms of psychosis, depression, and mania. Aside from his comments about

bioluminescence, he said nothing that sounded delusional. He was cognitively intact, and

his insight and judgment were considered generally good, although historically impaired in

regard to his delay in calling the police about his sister.

Diagnosis

 

 

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Schizoid personality disorder

Discussion

Mr. Buchalski’s aloof, taciturn, and asexual lifestyle certainly fit the diagnostic criteria for

schizoid personality disorder; his explanation that he has been friendless because he is

Polish and poor is a weak rationalization for his psychosocial deficits. The eccentricity of

his interest in bioluminescence, the exaggerated estimation of the value of his “papers,” and

the fact that he has lived pretty much all his life in the family’s residence with his sister give

further evidence of his inward preoccupation and lack of social engagement. The striking

poverty of his emotional response at his sister’s passing away and his failure to make any

sort of funeral arrangements are confirmatory of a flattened affective life and weak ego

skills. The fact that he is cognitively intact rules out a gradually occurring, dementing

etiology for his withdrawal and “confirms” the diagnosis of schizoid personality disorder.

Such a diagnosis has a long history in psychiatry and psychoanalysis. In psychiatry, its

origins go back to Eugen Bleuler, who coined the term schizoid in 1908 to describe a natural component of personality that pulled one’s attention toward one’s inner life and

away from the external world. He labeled a morbid exaggeration of this tendency as

“schizoid personality.” Such individuals were described as quiet, suspicious, and

“comfortably dull.” Bleuler’s description was elaborated upon over the next century, and

many features were added to it. These included solitary lifestyle, love of books, lack of

athleticism, tendency toward autistic thinking, poorly developed sexuality, and covert but

intense sensitivity to others’ emotional responses. This last feature, however, got dropped

from the more recent portrayals of schizoid personality, including the ones in DSM-III and

DSM-IV. Despite the reservations of many investigators (e.g., Otto Kernberg, John

Livesley, and myself), “lacking desire for close relationships” became a prime criterion for

the schizoid diagnosis. Among other factors that were emphasized were asexuality,

indifference to praise or criticism, anhedonia, and emotional coldness. The hypersensitivity

criterion and the ostensible link to schizophrenia were assigned, respectively, to the

categories of “avoidant” and “schizotypal” personality disorders.

Within psychoanalysis, the schizoid condition was best described by W. R. D. Fairbairn and

Harry Guntrip. According to them, intense sensitivity to both love and rejection and a

propensity to readily withdraw from interpersonal relatedness lay at the core of schizoid

pathology. The individual thus afflicted oscillated between wanting closeness and dreading

 

 

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it; feared the vigor of his or her own needs and their impact on others; and was attracted to

literary and artistic activities because these were avenues of self-expression without direct

human contact. Schizoid personality evolved from one or more of the following scenarios:

1) tantalizing refusal by early caretakers that aroused frightening amounts of emotional

hunger; 2) chronic parental rejection, which resulted in compliant apathy and lifelessness;

and 3) sustained neglect by parents, which led to retreat into the fantasy world.

The absence of developmental history and of any data about Mr. Buchalski’s childhood

weakens a psychodynamic understanding of Mr. Buchalski’s schizoid personality. However,

developmental history is not a required criterion for a descriptive diagnosis; this criterion

is primarily utilized by psychodynamically oriented psychiatrists. All in all, the diagnosis of

schizoid personality disorder seems reasonable for Mr. Buchalski, although some might

argue in favor of a schizotypal personality disorder diagnosis given the oddity of his

interests. If further exploration yields information that qualifies this patient for both

personality disorders, then both should be recorded.

In regard to other comorbidities, the most likely appears to be hoarding disorder, a

diagnosis new to DSM-5. Mr. Buchalski indicates that he delayed calling the police after his

sister died because he was worried that his landlord would use the condition of the

apartment as a pretext for eviction. He describes a large collection of bioluminescence

papers, for example, a statement that could mean a 2-foot-tall stack of manuscripts or an

apartment crammed to the ceilings with decades’ worth of newspapers, magazines, and

scribbled notes, saved because of their potential usefulness. Clarifying the presence of this

(or any other) comorbid condition would be crucial to the development of a treatment plan

that tries to maximize the likelihood of independent happiness for this patient.

Suggested Readings

Akhtar S: Schizoid personality disorder: a synthesis of developmental, dynamic, and

descriptive features. Am J Psychother 41(4):499–518, 1987 PubMed ID: 3324773

Livesley WJ, West M, Tanney A: A historical comment on DSM-III schizoid and avoidant

personality disorders. Am J Psychiatry 142(11):1344–1347, 1985 PubMed ID: 3904489

Triebwasser J, Chemerinski E, Roussos P, Siever LJ: Schizoid personality disorder. J Pers

Disord 26(6):919–926, 2012 PubMed ID: 23281676

 

 

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Case 18.3 Worried and Oddly Preoccupied

Kristin Cadenhead, M.D.

Henry, a 19-year-old college sophomore, was referred to the student health center by a

teaching assistant who noticed that he appeared odd, worried, and preoccupied and that

his lab notebook was filled with bizarrely threatening drawings.

Henry appeared on time for the psychiatric consultation. Although suspicious about the

reason for the referral, he explained that he generally “followed orders” and would do what

he was asked. He agreed that he had been suspicious of some of his classmates, believing

they were undermining his abilities. He said they were telling his instructors that he was “a

weird guy” and that they did not want him as a lab partner. The referral to the psychiatrist

was, he said, confirmation of his perception.

Henry described how he had seen two students “flip a coin” over whether he was gay or

straight. Coins, he asserted, could often predict the future. He had once flipped a coin and

“heads” had predicted his mother’s illness. He believed his thoughts often came true.

Henry had transferred to this out-of-town university after an initial year at his local

community college. The transfer was his parents’ idea, he said, and was part of their agenda

to get him to be like everyone else and go to parties and hang out with girls. He said all such

behavior was a waste of time. Although they had tried to push him into moving into the

dorms, he had refused, and instead lived by himself in an off-campus apartment.

With Henry’s permission, his mother was called for collateral information. She said Henry

had been quiet, shy, and reserved since childhood. He had never had close friends, had

never dated, and had denied wanting to have friends. He acknowledged feeling depressed

and anxious at times, but these feelings did not improve when he was around other people.

He was teased by other kids and would come home upset. His mother cried while

explaining that she always felt bad for him because he never really “fit in,” and that she and

her husband had tried to coach him for years without success. She wondered how a person

could function without any social life.

She added that ghosts, telepathy, and witchcraft had fascinated Henry since junior high

school. He had long thought that he could change the outcome of events like earthquakes

and hurricanes by thinking about them. He had consistently denied substance abuse, and

 

 

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two drug screens had been negative in the prior 2 years. She mentioned that her

grandfather had died in an “insane asylum” many years before Henry was born, but she did

not know his diagnosis.

On examination, Henry was tall, thin, and dressed in jeans and a T-shirt. He was alert and

wary and, although nonspontaneous, he answered questions directly. He denied feeling

depressed or confused. Henry denied having any suicidal thoughts, plans, or attempts. He

denied having any auditory or visual hallucinations, panic attacks, obsessions,

compulsions, or phobias. His intellectual skills seemed above average, and his Mini-Mental

State Examination score was 30 out of 30.

Diagnoses

Schizotypal personality disorder

Paranoid personality disorder

Discussion

Henry presents with a pattern of social and interpersonal deficits accompanied by

eccentricities and cognitive distortions. These include delusional-like symptoms (magical

thinking, suspiciousness, ideas of reference, grandiosity), eccentric interests, evidence of

withdrawal (few friends, avoidance of social contact), and restricted affect (emotional

coldness). Therefore, Henry appears to meet criteria for DSM-5 schizotypal personality

disorder.

Henry also suspects that others are undermining him, reads hidden meaning into benign

activities, bears grudges, and is overly sensitive to perceived attacks on his character. In

addition to schizotypal personality disorder, he meets criteria for paranoid personality

disorder. If an individual meets criteria for two personality disorders—as is often the case—

both should be recorded.

Henry, however, is only 19 years old, and a personality disorder diagnosis should be made

only after exploring other diagnoses that could produce similar symptoms. For example,

Henry’s deficits in social communication and interaction could be consistent with a

diagnosis of autism spectrum disorder (ASD) without intellectual impairment. It is possible

that he had unreported symptoms beyond “shyness” in the early developmental period,

 

 

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and, as was reported about Henry, children with ASD commonly undergo schoolyard

teasing. He and his mother do not, however, report the sorts of restricted, repetitive

patterns of behavior, interests, or activities that are also a hallmark of ASD. Without these,

Henry would not be diagnosed on the autism spectrum.

Henry also may have a psychiatric disorder that develops in young adulthood, and he is at

the peak age for the onset of depressive, bipolar, and anxiety disorders. Any of these can

exacerbate baseline personality traits and make them appear to be disorders, but Henry

does not appear to have significant depressive, manic, or anxiety symptoms.

More likely in this case would be a diagnosis on the schizophrenia spectrum. For Henry to

have an actual schizophrenia diagnosis, however, he would need to have two or more of the

following five criteria: delusions, hallucinations, disorganized speech, grossly disorganized

or catatonic behavior, and negative symptoms. Because he denies hallucinations and

appears to be logical and not to have either odd behavior or negative symptoms, he does

not have schizophrenia. Instead, he may have delusions—and it would be useful to clarify

the extent to which he has fixed, false beliefs about predicting and affecting the future—but

his beliefs seem more bizarre than those typically seen in delusional disorder.

Although Henry currently may best fit the two personality disorder diagnoses listed above,

he may go on to develop a more explicitly psychotic disorder. Psychiatric clinicians and

researchers are particularly interested in distinguishing individuals who present as unusual

as teenagers and are likely to go on to develop a more disabling schizophrenia from those

who present similarly but will not go on to develop a major psychiatric disorder. Although

the current ability to predict schizophrenia is not robust, early intervention could

substantially reduce the psychological suffering and the long-term functional

consequences. To that end, DSM-5 Section III includes attenuated psychosis syndrome as

one of the conditions for further study. Attenuated psychosis syndrome focuses on

subsyndromal symptoms, including impaired insight and functionality, in an effort to

clarify which patients are in the process of a decline into schizophrenia and which patients

are demonstrating the beginnings of a more crystallized personality disorder.

Suggested Readings

Addington J, Cornblatt BA, Cadenhead KS, et al: At clinical high risk for psychosis:

outcome for nonconverters. Am J Psychiatry 168(8):800–805, 2011 PubMed ID:

 

 

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21498462

Ahmed AO, Green BA, Goodrum NM, et al: Does a latent class underlie schizotypal

personality disorder? Implications for schizophrenia. J Abnorm Psychol 122(2):475–491,

2013 PubMed ID: 23713503

Fisher JE, Heller W, Miller GA: Neuropsychological differentiation of adaptive creativity

and schizotypal cognition. Pers Individ Dif 54(1):70–75, 2013 PubMed ID: 23109749

Case 18.4 Unfairness

Charles L. Scott, M.D.

Ike Crocker was a 32-year-old man referred for a mental health evaluation by the human

resources department of a large construction business that had been his employer for 2

weeks. At his initial job interview, Mr. Crocker presented as very motivated and provided

two carpentry school certifications that indicated a high level of skill and training. Since his

employment began, his supervisors had noted frequent arguments, absenteeism, poor

workmanship, and multiple errors that might have been dangerous. When confronted, he

was reportedly dismissive, indicating that the problem was “cheap wood” and “bad

management” and added that if someone got hurt, “it’s because of their own stupidity.”

When the head of human resources met with him to discuss termination, Mr. Crocker

quickly pointed out that he had both attention-deficit/hyperactivity disorder (ADHD) and

bipolar disorder. He said that if not granted an accommodation under the Americans with

Disabilities Act, he would sue. He demanded a psychiatric evaluation.

During the mental health evaluation, Mr. Crocker focused on unfairness at the company

and on how he was “a hell of a better carpenter than anyone there could ever be.” He

claimed that his two marriages had ended because of jealousy. He said that his wives were

“always thinking I was with other women,” which is why “they both lied to judges and got

restraining orders saying I’d hit them.” As “payback for the jail time,” he refused to pay

child support for his two children. He had no interest in seeing either of his two boys

because they were “little liars” like their mothers.

Mr. Crocker said he “must have been smart” because he had been able to make Cs in school

despite showing up only half the time. He spent time in juvenile hall at age 14 for stealing

 

 

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“kid stuff, like tennis shoes and wallets that were practically empty.” He left school at age 15

after being “framed for stealing a car” by his principal. Mr. Crocker pointed out these

historical facts as evidence that he was able to overcome injustice and adversity.

In regard to substance use, Mr. Crocker said he smoked marijuana as a teenager and

started drinking alcohol on a “regular basis” after he first got married at age 22. He denied

that use of either substance was a problem.

Mr. Crocker concluded the interview by demanding a note from the examiner that he had

“bipolar” and “ADHD.” He said that he was “bipolar” because he had “ups and downs” and

got “mad real fast.” Mr. Crocker denied other symptoms of mania. He said he got down

when disappointed, but he had “a short memory” and “could get out of a funk pretty quick.”

Mr. Crocker reported no difficulties in his sleep, mood, or appetite. He learned about

ADHD because “both of my boys got it.” He concluded the interview with a request for

medications, adding that the only ones that worked were stimulants (“any of them”) and a

specific short-acting benzodiazepine.

On mental status examination, Mr. Crocker was a casually dressed white man who made

reasonable eye contact and was without abnormal movements. His speech was coherent,

goal directed, and of normal rate. There was no evidence of any thought disorder or

hallucinations. He was preoccupied with blaming others, but these comments appeared to

represent overvalued ideas rather than delusions. He was cognitively intact. His insight

into his situation was poor.

The head of human resources did a background check during the course of the psychiatric

evaluation. Phone calls revealed that Mr. Crocker had been expelled from two carpentry

training programs and that both his graduation certificates had been falsified. He had been

fired from his job at one local construction company after a fistfight with his supervisor and

from another job after abruptly leaving a job site. A quick review of their records indicated

that he had provided them with the same false documentation.

Diagnosis

Antisocial personality disorder

Discussion

 

 

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Mr. Crocker has a pervasive pattern of disregard for and violation of the rights of others, as

indicated by many different actions. He has been arrested twice for domestic violence—

once each from two separate marriages—and has spent time in jail. Mr. Crocker has

falsified his carpentry credentials and provides ample evidence of repeated fights and

irritability, both at work and within his relationships. He demonstrates little or no regard

for how his actions affect the safety of his coworkers. He refuses to see his young sons or

pay child support, because they are “little liars.” He exhibits no remorse for how his actions

negatively affect his family, coworkers, or employers. He routinely quits jobs and fails to

plan ahead for his next employment. He meets all seven of the symptomatic criteria for

DSM-5 antisocial personality disorder (APD).

The diagnosis of APD cannot be made until age 18, but it does require evidence for conduct

disorder before age 15. Mr. Crocker’s history indicates a history of truancy, adjudication for

theft at age 14, and expulsion from school at age 15 for car theft.

At the end of the evaluation, Mr. Crocker requests two potentially addictive medications.

He smoked marijuana in high school and may have begun to drink alcohol heavily in his

20s. Although it might be difficult to elicit an honest account of his substance use, Mr.

Crocker may indeed have a comorbid substance use disorder. Such a diagnosis would not

affect his diagnosis of APD, however, because his antisocial behavior predates his reported

use of substances. In addition, his antisocial attitudes and behaviors are manifest in

multiple settings and are not simply a result of his substance abuse (e.g., stealing to pay for

his drugs).

Mr. Crocker’s claim that he has ADHD would require evidence that he had some

hyperactive-impulsive or inattentive symptoms that caused impairment before age 12

years. Although ADHD could be a comorbid condition and could account for some of his

impulsivity, it would not account for his wide-ranging antisocial behavior.

The APD diagnosis also requires that the behavior not occur only during the course of

bipolar disorder or schizophrenia. Although Mr. Crocker states that he has bipolar

disorder, he provides no evidence that he has ever been manic (or schizophrenic).

Mr. Crocker’s interpersonal style is marked by callous disregard for the feelings of others

and an arrogant self-appraisal. Such qualities can be found in other personality disorders,

such as narcissistic personality disorder, but they are also common in APD. Although

 

 

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comorbidity is not uncommon, individuals with narcissistic personality disorder do not

exhibit the same levels of impulsivity, aggression, and deceit as are present in APD.

Individuals with histrionic personality disorder or borderline personality disorder may be

manipulative or impulsive, but their behaviors are not characteristically antisocial.

Individuals with paranoid personality disorder may demonstrate antisocial behaviors, but

their actions tend to stem from a paranoid desire for revenge rather than a desire for

personal gain. Finally, people with intermittent explosive disorder also get into fights, but

they lack the many exploitive traits that are a pervasive part of APD.

Suggested Readings

Edwards DW, Scott CL, Yarvis RM, et al: Impulsiveness, impulsive aggression, personality

disorder, and spousal violence. Violence Vict 18(1):3–14, 2003 PubMed ID: 12733616

Wygant DB, Sellbom M: Viewing psychopathy from the perspective of the Personality

Psychopathology Five model: implications for DSM-5. J Pers Disord 26(5):717–726, 2012

PubMed ID: 23013340

Case 18.5 Fragile and Angry

Frank Yeomans, M.D., Ph.D.

Otto Kernberg, M.D.

Juanita Delgado, a single, unemployed Hispanic woman, sought therapy at age 33 for

treatment of depressed mood, chronic suicidal thoughts, social isolation, and poor personal

hygiene. She had spent the prior 6 months isolated in her apartment, lying in bed, eating

junk food, watching television, and doing more online shopping than she could afford.

Multiple treatments had yielded little effect.

Ms. Delgado was the middle of three children in an upper-middle-class immigrant family in

which the father reportedly valued professional achievement over all else. She felt isolated

throughout her school years and experienced recurrent periods of depressed mood. Within

her family, she was known for angry outbursts. She had done well academically in high

school but dropped out of college because of frustrations with a roommate and a professor.

She attempted a series of internships and entry-level jobs with the expectation that she

would return to college, but she kept quitting because “bosses are idiots. They come across

 

 

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as great and they all turn out to be twisted.” These “traumas” always left her feeling terrible

about herself (“I can’t even succeed as a clerk?”) and angry at her bosses (“I could run the

place and probably will”). She had dated men when she was younger but never let them get

close physically because she become too anxious when any intimacy began to develop.

Ms. Delgado’s history included cutting herself superficially on a number of occasions, along

with persistent thoughts that she would be better off dead. She said that she was generally

“down and depressed” but that she had had dozens of 1- to 2-day “manias” in which she

was energized and edgy and pulled all-nighters. She tended to “crash” the next day and

sleep for 12 hours.

She had been in psychiatric treatment since age 17 and had been psychiatrically

hospitalized three times after overdoses. Treatments had consisted primarily of

medication: mood stabilizers, low-dose neuroleptics, and antidepressants that had been

prescribed in various combinations in the context of supportive psychotherapy.

During the interview, she was a casually groomed and somewhat unkempt woman who was

cooperative, coherent, and goal directed. She was generally dysphoric with a constricted

affect but did smile appropriately several times. She described shame at her poor

performance but also believed she was “on Earth to do something great.” She described her

father as a spectacular success, but he was also a “Machiavellian loser who was always

trying to manipulate people.” She described quitting jobs because people were

disrespectful. For example, she said that when she worked as a clerk at a department store,

people would often be rude or unappreciative (“and I was there only in preparation to

become a buyer; it was ridiculous”). Toward the end of the initial session, she became angry

with the interviewer after he glanced at the clock (“Are you bored already?”). She said she

knew people in the neighborhood, but most of them had “become frauds or losers.” There

were a few people from school who were “Facebook friends,” doing amazing things all over

the world. Although she had not seen them in years, she intended to “meet up with them if

they ever come back to town.”

Diagnosis

Borderline personality disorder

Discussion

 

 

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Ms. Delgado presents with affective instability, difficulty controlling her anger, unstable

interpersonal relationships, an identity disturbance, self-mutilating behavior, feelings of

emptiness, and transient, stress-related paranoia. She meets criteria, therefore, for DSM-5

borderline personality disorder (BPD).

Individuals with BPD often present with depressive and/or bipolar symptoms, and Ms.

Delgado is no exception. Her presenting symptoms include a predominantly depressed

mood, diminished interests, overeating, anergia, and chronic suicidal ideation. Disabling,

persistent for 6 months, and occurring in the absence of substance use or a medical

disorder, Ms. Delgado’s symptoms also meet criteria for a DSM-5 major depression. Such

comorbidity between BPD and depression is common. It is interesting to note that Ms.

Delgado’s preoccupations are accusatory, whereas the typical preoccupation of a depressed

person without a personality disorder is guilty and self-accusatory. It would be worth

exploring the possibility that Ms. Delgado’s depressive symptoms are more episodic and

reactive than she initially reports. It also seems possible that she qualifies for lifelong

depression, which would indicate dysthymic disorder but would also point toward a

personality disorder.

Ms. Delgado reports “manias” that are not typical of someone with bipolar disorder. For

example, she describes having had dozens of 1- to 2-day episodes in which she is energized

and edgy, followed by a “crash” and 12 hours of sleep. These do not conform to the criteria

for bipolar I or bipolar II disorder, in regard to either symptoms or duration. The

emotional instability and affect storms of BPD can look very much like a manic or

hypomanic episode, which can lead to underdiagnosis of BPD. Even in the presence of a

significant manic episode, the clinician should explore such historical variables as affective

stability, maturity of interpersonal relationships, and stability of work, relationships, and

self-assessment. If problems are found, a BPD diagnosis is likely.

Criteria for DSM-5 personality disorders remain unchanged from the previous

classification system. However, the alternative model for personality disorders, presented

in DSM-5 Section III, suggests a more dimensional approach, one in which the interviewer

would explicitly consider personality functioning. The appendix outlines five different trait

domains that exist on a continuum. “Emotional stability” is contrasted with “negative

affectivity,” for example, whereas “antagonism” is at the other end of the spectrum from

“agreeableness” (see Table 18- in the introduction to this chapter).

 

 

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This dimensional view of personality is compatible with Kernberg’s long-standing model of

borderline personality organization (BPO). In addition to meeting the DSM-5 criteria for

BPD, Ms. Delgado fits the criteria for BPO —a psychological structure conceived as being

characterized by 1) lack of a clear and coherent sense of self and others (identity diffusion),

2) frequent use of primitive defense mechanisms based on splitting, and 3) intact but

fragile reality testing. The more integrated and realistically complex the individual’s

representations of self and others are, the more the individual is able to modulate and

control his or her emotional states and successfully interact with others.

Ms. Delgado demonstrates identity diffusion in her contradictory views of herself (as both

superior and inadequate) and others (her father as both spectacular and a “Machiavellian

loser”). Her defensive style is characterized by consistent projection of her hostile feelings

and perceiving the hostility as coming from others. The fragility of her reality testing, seen

in the slights she felt at work, has led to chronic occupational dysfunction.

Because people with personality disorders often do not present an interpersonal narrative

that conforms to the story that would be told by others, it is important to attend to the

patient’s behavior in relation to the therapist. With Ms. Delgado, evidence of her fragility is

seen in her sense that the therapist’s glancing at the clock meant he did not like her and

wanted to get rid of her.

Suicidal tendencies are part of both depression and BPD. In general, acute or chronic

parasuicidal behavior is typical of severe personality disorders. Furthermore, suicidality

can develop abruptly during crises among a variety of patients, but it is especially prevalent

in people—like Ms. Delgado—with a fragile sense of both the world and themselves.

Suggested Readings

Clarkin JF, Yeomans FE, Kernberg OF: Psychotherapy for Borderline Personality:

Focusing on Object Relations. Washington, DC, American Psychiatric Publishing, 2006

Kernberg OF, Yeomans FE: Borderline personality disorder, bipolar disorder, depression,

attention deficit/hyperactivity disorder, and narcissistic personality disorder: practical

differential diagnosis. Bull Menninger Clin 77(1):1–22, 2013 PubMed ID: 23428169

Oldham JM, Skodol AE, Bender DS (eds): American Psychiatric Publishing Textbook of

Personality Disorders, 2nd Edition. Washington, DC, American Psychiatric Publishing (in

 

 

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press).

Tusiani B, Tusiani PA, Tusiani-Eng P: Remnants of a Life on Paper. New York, Baroque

Press, 2013

Case 18.6 Painful Suicidality

Elizabeth L. Auchincloss, M.D.

Karmen Fuentes was a 50-year-old married Hispanic woman who presented to the

psychiatric emergency room (ER) at the urging of her outpatient psychiatrist after telling

him that she had been thinking about overdosing on Advil.

In the ER, Ms. Fuentes explained that her back had been “killing” her since she fell several

days earlier at the family-owned grocery store where she had worked for many years. The

fall had left her downcast and depressed, although she denied other depressive symptoms

aside from a poor mood. She spoke at length about the fall and about how it reminded her

of a fall that she had sustained a few years earlier. At that time, she had gone to see a

neurosurgeon, who told her to rest and take nonsteroidal anti-inflammatory drugs. She

described feeling “abandoned and not cared about” by him. The pain had diminished her

ability to exercise, and she was upset that she had gained weight. While relating the events

surrounding the fall, Ms. Fuentes began to cry.

When asked about her suicidal comments, she said they were “no big deal.” She reported

that they were “just a threat” aimed at her husband to “teach him a lesson” because “he has

no compassion for me” and had not been supportive since the fall. She insisted her

comments about overdosing did not have other meaning. When her ER interviewer

expressed concern about the possibility that she would kill herself, she exclaimed with a

smile, “Oh wow, I didn’t realize it’s so serious. I guess I shouldn’t do that again.” She then

shrugged and laughed. She went on to talk about how “nice and sweet” it was that so many

doctors and social workers wanted to hear her story, calling many of them by their first

names. She was also somewhat flirtatious with her male resident interviewer, who had

mentioned that she was the “best-dressed woman in the ER.”