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A DISCUSSION OF PSYCHODIAGNOSTICS

Posted By Robert DePaolo On April 26, 2010 @ 1:07 pm In Psychotherapy | No Comments

Test Selection and the Neuro-personality

Abstract

This article presents a psycho-diagnostic model based on a neurological concept of personality; specifically involving the effect of integration and discrimination functions on normalcy and pathology.

INTRODUCTION
While neuroscientists have yet to determine exactly how the human brain works, more information is being gathered on this subject that will undoubtedly become important, not only in the fields of education and neuro-motor rehabilitation but also to the practice of clinical psychology. At present there is a fairly clear separation between neurobiological and clinical theory. Certainly medications have become a necessary adjunct (some might say alternative) to counseling and there is ample research pointing to the involvement of biological and neurological factors in various psychiatric disorders (McNeill 2004),(Mathew, Coplan et al 2001) (Marije, Mathew et al 2009 ). Yet most models of clinical diagnosis and treatment still remain primarily within the social and intra-psychic domains. Aside from the early work of Eysenck (1957), few organic theories of personality have been proposed, though Millon’s impressive treatise on evolutionary psychology (1990) and its implications for psychopathology certainly went beyond the conventional theoretical parameters.


In light of that it might be interesting to begin describing the personality in terms of brain functions. After all, all that we do, feel and think (normal or otherwise) is ultimately a function of brain dynamics.
Much is known about brain processes; for example, phenomena such as lateral inhibition, in the form of Mach bands, enable us to think and attend because when neural networks are activated a chaperone-like inhibitory process runs parallel to excitation. That keeps it from dominating the CNS to a point where contemplation becomes an aversive prelude to hyper-arousal (Jacobson 1993). Such an excitation-dampening mechanism also allows us to gain access to varied networks in the brain. That not only provides a capacity for what we call perspective, it also creates a more even distribution of input traces around the brain which serves the dual purposes of information seeking and arousal modulation. That makes thought and cognition per se both possible and tolerable.
It is also known that the human brain operates in ways that favor clustering of networks. For example, noted neurobiologist Donald Hebb demonstrated that when one circuits is activated, proximal circuits will tend to be co-activated as well (Brown,Milner 2003). That process virtually guarantees a kind of peripheral influence, enabling us to round off our perceptions into wholes, thereby perceive and respond effectively to the world in which we live.
Beyond that are mechanisms such as protective inhibition, whereby prolonged excitation of neurons can lead to spreading inhibition as a reaction to overload (Pavlov 1927 ), and reciprocal inhibition, in which the activation of some networks tends to inhibit expression in others (for example norepinephrine pathways fomenting aggressive behavior and cholinergic pathways that accompany states of anxiety (Knox & Berntson 2008).
The neur-behavioral factors of interest here consist of a dual process that affects brain and personality: specifically the tendency to:
A, Discriminate between and among inputs and memories
B. Integrate, or weave together, inputs and memories into conceptual wholes.
Those two functions are probably entrenched in the human brain because of their survival value. With regard to discrimination skills, a creature needs to determine where to go, what to do and what to avoid with regard to predation, the procurement of foods, and other potential dangers and necessities. In so doing it must have a neural preference for, and capacity to singularly activate one memory to the exclusion of others.
Integration is also important, not just for humans but for any animal whose survival depends on categorizing features of his environment in holistic fashion. Lionesses have to see the entire herd before picking out the weakest looking wildebeest. Primates must use stereoscopic vision to see the next branch, as well as any obstacles in the way of the leap. Humans of course have more of this ability than other creatures and we use it in more varied ways. For us, integrative perception and thought are information enhancing processes. If we know that apples, oranges, pears and peaches are “fruit” we merely have to access the word “fruit” as a kind of brain card-catalogue to access all the information we need about that source of nutrition.
Integration and discrimination also have emotional implications, potentially serving as indicators and predictors of normalcy or pathology. Each of the two functions implies a particular set of personality characteristics.

NEURO-PERSONALITY
A person with an over-discriminatory personality style will tend to view experience categorically, which would tend to mitigate against perspective. It could also lead to impulsivity, un-modulated, unrealistic fears and to unchecked arousal levels resulting from narrow neural distribution of inputs in the brain. In addition to incurring less arousal modulation the over-discriminatory personality style will exhibit a proclivity for fragmented ideation and emotion (Hyman & Rudorfer 2000). It is a reciprocal process in which heightened arousal levels create over-discriminatory trends and vice versa. In some instances a tendency to view experience in narrow, exclusionary terms can lead to the onset of psychopathology.
The type of pathology might include paranoia, chronic anxiety, compulsivity and/or depression. Its effect on depression is especially interesting since, in cognitive terms, depression can be likened to an inability to perceive and think beyond immediate experience. In other words one must see beyond present feelings of helplessness, frustration and internally-directed aggression to overcome depression. (Hope has its neural correlate as well). Lack of cognitive breadth and an inability to extenuate experience make that very difficult.
In light of that, the question could be asked as to whether many forms of psychopathology are some manifestation of over-discriminatory thinking.
While Freud alluded to the repetition-compulsion principle as a fulcrum of human behavior few writers have suggested this mechanism as a common thread in psychopathologies. On the other hand, given the presence of psychological rigidity in various syndromes it would seem to be a reasonable assumption.
THE GOLDEN MEAN OF NORMALCY
Based on the above discussion, it might appear that integrative perception and thought are more conducive to normalcy, and to an extent that is probably true. For example the outcomes sought by clinicians using client-centered, psychoanalytic and cognitive therapy methods are typically integrative. On the other hand, integrative thought can be pathogenic as well.
There are times when singular processing is necessary and adaptive. For instance a state of anxiety often entails uncertainty (Masserman 1970) and inhibition (Hirshfeld, Rosenbaum et al 1992). Conjuring up a super focus in the form of a direct, aggressive mindset can be adaptive and serve to ameliorate anxiety. Indeed that is the main premise behind assertive therapy (Bower &Bower 1991).

More to the point, a hyper-integrative style can lead to stagnation, specifically a confused, global mindset that virtually precludes decisive action.
It would seem that for all the complexity and subtle orchestration within the human brain we tend to have only two options, discrimination and integration. It would appear that extreme versions of either can lead to psychopathologies. In that context, development of a testing/diagnostic format for determining where a client falls on that continuum, and also how fluidly he can shift between integration and discrimination can be a helpful augmentation in both diagnosis and treatment.
PATHOLOGY
Ultimately, both normalcy and psychopathology can be defined in terms of adaptability. After all, nature’s mandate, ie. its fitness-selection criterion, is based not on any given creature’s traits but on whether those traits meet the demands of the environment. The social environment also entails adaptive pressures. Those who interpret, emote and respond in ways proportionate and appropriate to social rules and nuances can be said to have psychological adaptability. There is nothing new in this statement. It was capture more eloquently by Kennair (2003).
With respect to the integration/distinction polarity the adaptation process would entail three psychological or cognitive traits.
First, the ability to think in integrative terms, in which case a person would display a capacity to assimilate experiences, seek and gain perspective, see both figure and ground and establish higher meaning from the nuts and bolts of experience. Having that capacity would also provide the neurological benefit of arousal modulation via a broad input distribution process.
Second; a capacity to perceive and respond to various stimuli and experiences differentially, even at times dogmatically.
Third; a capacity to shift fluidly from one mode to the other. In some ways this model is analogous to Freud’s triadic psychological construct of id- eg- supergo, except that the functions are quite different and this model is more in line with neurological mechanisms in the brain.
An adaptive personality would be said to have adequate capabilities in all three areas. Consequently, normalcy or wellness would be virtually equated with psychic versatility and fluidity.
Although this is a somewhat unorthodox idea it is part and parcel of many theories of personality and psychopathology. For example Freud’s concept of normalcy involved a fluid integration of instinct, judgment and moral probity. By the same token he described psychopathologies as manifestations of imbalance among the three components. Freud’s notion also differed from this one, in that he viewed the psyche in terms of a mechanism by which one component (the id) would provide energy for others through a sublimation process.
The emphasis on integration skills is also considered important in Cognitive, Adlerian, Client-Centered and Existential therapies. It is also an inherent aspect of the Ericksonian and Maslowian models, where the needs for individuation and group affiliation are both woven into overriding clinical/theoretical structures.
Here the contention is simply that the brain pools and distinguishes by virtue of its neural dispersions, and that both the discriminatory and integrative modalities enable persons to utilize one of the other in adaptive fashion (including a facile shift between the two) depending on existing circumstances.
A focus on those three factors narrows down the scope of diagnosis and treatment, and would provide a streamlined approach for therapists to use in short term counseling, particularly with clients amenable to existential treatment methods.
DIAGNOSTIC INSTRUMENTS AND STRATEGIES
Some psychological tests are designed, either directly or indirectly, to measure integrative skills. For example the Bender Gestalt Visual Motor Test can tap into both the organic/neurological and psychic domains through features such as angulation, line intersection (juxtapositions) and figure congruity. In both a perceptual motor and psychic context the Bender can answer certain questions about a client. For example:
A. Can the client assemble visual motor elements without compromising the size, accuracy and quality of the figure?
B. Can the client distinguish between visual motor elements without being swayed by the overall figure concept, so that lines are straight where appropriate, angular where necessary and not “bent” by the overall drift of the figure as a whole?
C. Can the client make efficient alterations between the two without a disruption in performance?
The key element from a clinical perspective is how such skills and test responses pertain to personality functioning per se.
Similar data can be obtained from Rorschach protocols, particularly with regard to the perception of wholes, small detail responses and percept sequencing. Interestingly, the clinical theory underlying the Rorschach is topographically similar to the one offered here. For example, whole percepts are not invariably considered a positive indicator. While correlated with higher intelligence, adaptability and ego strength, a protocol replete with whole percepts might suggest a client who is far too rigid, incapable of appropriate risk taking, and/or perhaps too melancholic to deviate creatively from popular thinking. A highly adaptive client might be inclined to see small details as well as wholes and determinants like color and movement – provided they are tethered to holistic percepts. If they are not, the clinician can look for a piecemeal, fragmented cognitive style susceptible to psychopathology.
In effect the Rorschach technique entails a description of the personality as an entity that can perceive the global and the narrow, the internal as well as the external. In line with the dynamic personality theories from which it derives, it presumes that proportion among the percepts, rather individual percepts themselves are what define normalcy and pathology.
While the Rorschach has been employed as a neurological instrument it is most frequently used in diagnosing personality disorders. Yet when a primarily neurological instrument like the Bender and a primarily psychological instrument like the Rorschach are combined – specifically to look for integrative and discriminatory capacities and fluid shifts between the two – it can comprise, along with other tests, a fairly effective neuro-personality test battery.
A valuable augmentation to this battery would be the Wechsler Intelligence Scales, particularly with regard to certain subtests. The Block Design and Similarities subtests offer a glimpse of one’s integrative abilities, while the Vocabulary, Picture Completion and Symbol Search subtests tap into one’s discriminatory skills. It would be interesting to administer just those subtests in an alternating sequence, not just to determine integrative and discriminatory capacities but also to determine fluid shifts from one mode of processing to the other.
Many neurological tests could provide similar information with respect to this personality concept. The Wisconsin Card Sorting Test offers a direct functional parallel to the shift between integration and discrimination by asking the subject to first develop a categorical focus in which various items are selected based on common category, then asking him to shift that focus in midstream. This test can be very indicative not only of neurological functioning but of cognitive fluidity and personality functioning.
Since it entails the use of themes, so too could the Thematic Apperception Test, albeit less directly than the Rorschach. Indeed a slight modification of instructions for this test might be make it more sensitive to the integration-discrimination-fluidity dynamic. For example on the TAT subjects are typically asked to conjure up a story that includes characters, plot and outcome. The clinician evaluates, among other things, identification processes, themes, press and sequences.
This test could be adapted to a discrimination/integration model by instructing the client as follows: “I want you to make up a story with character, theme and outcome, but there are some rules. First you must assume there is some sort of conflict going on. You can describe that any way you like. Second you must try to resolve the conflict by offering an ending that ties things together. If you cannot do this, it is
Ok, but I’d like you to try.”
A test battery consisting of neuropsychological, cognitive and personality tests could potentially provide a means by which to determine the integrative and discriminatory capacities and overall fluidity of personality, as well as provide a multi-disciplinary diagnostic format in which brain and personality could be merged. In the process such a battery could provide a novel foundational for diagnosis and treatment. And, should this, or some other concept of neuro-personality begin to gain favor among clinicians, more tests could be developed to tap into the integrative, discriminatory and fluidity factors included in the above discussion.

REFEERENCES

Bower, S.A. & Bower, G.H. (1991) Asserting Yourself; A Practical Guide for Positive Change. 2nd Edition. Reading, MA, Addison Wesley
Brown, R and Milner, P (2003) The Legacy of Donald Hebb; More than the Hebb Synapse. Nature 4: 1013-1019
Eysenck, H.J. (1957) Sense and Nonsense in Psychology, London, Pelican Books
Hirshfeld, P.R. Rosenbaum, JF, Biederman, J. Bolduc, EA Faraone, S, Snidman, N, Reznick, J.S & Kagan, J (1992) Stable Behavioral Inhibition and its Association with Anxiety Disorders. Journal of American Academy of Child and Adolescent Psychiatry (1) 103-111
Hyman, S.E. & Rudorfin, MV (2000) Anxiety Disorders. In Dale, D & Federman, D (eds) Scientific American vol 13. New York
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Kennair, L (2003) Evolutionary Psychology and Psychopathology. Current Opinions in Psychatry. 16: (6)691-699
Knox, D & Berntson P. (2008) Cortical Modulation by Nucleus Basalis Magnocellularis Cortiopetal Cholinergic Neurons During Anxiety-Like States Are Reflected by Decreases in Delta. Brain Research, 1227: 142-152
Marije, A, Mathew, S & Charney, D (2009) Neurobiological mechanisms in major depressive disorder. Journal of Canadian Medical Association 10 (1503)
Masserman, J (1970) Is Uncertainty a Key to Neurotogenesis? Psychosomatics, 11: 391-402
Mathew, S, Coplan, J. Gorman, JM, (2001) Neurobiological Mechanisms of Social Anxiety Disorder. American Journal of Psychiatry 155: 1558-1567
McNeill, A (2004) Aetiology of Co-Morbid Psychiatric Disorders in Dystonia: A Biopsychosocial Hypothesis. The Internet Journal of Neurology (2) # 2
Millon, Toward A New Personality: An Evolutionary Model, John Wiley & Sons
Pavlov, I.P. (1927) Conditioned Reflexes; An Investigation of the Physiological Activity of the Cerebral Cortex. London, Oxford University Press


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