“Know Thyself” Is A Lot To Ask

By Neuroskeptic | February 24, 2013 7:21 am

I’ve written before about the limitations of self-report measures in psychiatry.

It’s an issue that’s been recognized for decades but, unfortunately, self-report seems to be more popular than ever. I suspect that this is because it’s far and away the easiest and cheapest way of getting data, and hence publications, in a great many fields of science.

Now a new study has examined patients who’d suffered head injuries, strokes, brain lesions and other neuropsychological issues. It found that people who felt worse rated themselves as suffering from more symptoms as a result of their brain injury, but this perception was only weakly related to their actual cognitive abilities.

Over 2000 cases were included. Everyone was measured in three ways: a set of ‘objective’ neuropsychological tests to measure how well people did on tasks dealing with memory, perception, cognition and so forth, all things that can be impaired by brain injury. There was also a self-report measure of mental impairment – how badly people reported they were suffering from cognitive deficits. Finally, there was a measure of self-reported emotional issues.

The results showed clearly that self-reported functional difficulties were only slightly correlated with the objective tests (r=0.18), but were very strongly linked to emotional problems (r=0.65). In other words, it was how happy people were, rather than how impaired they were, that determined their self-reports of impairment.

But let’s think about this more closely. Can we even trust self-reports of emotional states?

If emotions can color our perceptions of our lives, why can’t they do so for our reports of emotions themselves? As I’ve said before in a more philosophical context

It’s not clear that we have any special insight into our own emotions, beyond that which is available to others. We tend to assume that we do… but feeling an emotion and understanding it are entirely separate… we all interpret our feelings in various ways, and like any act of interpretation, we can be either right or wrong.

Suppose I love you and I think “I love you”. In that case I’m right. But I could love you and think I don’t (maybe I think it’s just lust), or then again I could not love you (it is just lust) but think that I do. Any combination of feelings and thoughts is possible.

The notion that our mind is a single monolithic thing, and that we know everything that’s in our own mind, is a stubborn one, but quite misleading. In fact we know very little about what goes on in our own heads; 100 billion cells are firing all the time, and we’re not aware of any of them. Sometimes we can achieve self-knowledge, but it is never guaranteed.

Until relatively recently, the idea that you could trust self-reports in psychiatry, especially, was rejected out of hand. A basic assumption of psychoanalysis is that one’s conscious self-knowledge is untrustworthy and that only through a difficult process of work can the truth be uncovered. Unfortunately, this sensible idea was generally lost beneath a whole aggregation of dodgy notions about dream interpretation, Oedipus complexes, and symbolic penises.

ResearchBlogging.orgMiller RM, Haws NA, Murphy-Tafiti JL, Hubner CD, Curtis TD, Rupp ZW, Smart TA, & Thompson LM (2013). Are Self-Ratings of Functional Difficulties Objective or Subjective? Applied neuropsychology. Adult PMID: 23383984

CATEGORIZED UNDER: freud, methods, papers, select, Uncategorized
  • http://jayarava.blogspot.com Jayarava

    “It’s not clear that we have any special insight into our own emotions, beyond that which is available to others. We tend to assume that we do… but feeling an emotion and understanding it are entirely separate… we all interpret our feelings in various ways, and like any act of interpretation, we can be either right or wrong.”

    I think this is a very telling statement. We interpret our emotions according to cultural models which are far from systematic or thorough. And given that we rely on sensory feedback for knowledge of our emotional states, and our sensory systems are often skewed by lifestyle choices the situation is quite complex.

    Sometimes a cigar is just a cigar.

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  • John

    One issue I’ve seen is that the empirical tests miss out on variability, and that directly relates to the other two factors being discussed. One of the primary features of diffuse damage is that the patient becomes much more variable. They come into the lab and pass all kinds of cognitive tests but you ask their wife and she won’t let him drive the car. He’s clearly very variable.

    So, the “objective” tests aren’t objective (from that perspective).

  • Zachary Stansfield

    At a minimum self-report about emotional state can be used as a proxy for perceived distress. Now we can make the argument that any self judgment is inaccurate (and particularly if this judgment is retrospective), but there may be cases where the need for accurate judgments is not as great. I suspect that of we actually wanted to know about the emotional state of people, introspective accuracy would be very poor, but a simple marker of dissatisfaction or distress should require much less introspection and so might be a more reliable marker.

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      It’s a proxy for perceived distress, but some people are emotionally troubled and don’t perceive that they are. Self-report is probably a good way to detect the presence of distress but it can’t verify its absence.

  • http://twitter.com/angelbird72 Tash

    Wouldn’t this result just as easily fit the theory that the ‘objective’ tests are not particularly accurate, and the severity of symptoms is causing more severe emotional disturbance?

    • Jim Benz

      Thank you

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      I suppose so, but these objective neuropsych tests are pretty well validated.

  • http://www.facebook.com/phil.campbell.142 Phil Campbell

    As with all science, the more sources of information you have, the more accurate a picture you can paint. Self report is only one source. We need to look also at observed behaviours, observable physiological responses (skin tone, muscular-skeletal tension, facial expressions etc.), measurable physical responses (galvanic skin response, brain response as documented by fmri, immune system responses, CNS responses etc.). Because self report data is the easiest and cheapest data to collect, it is much more available than the other kinds of data. It is valuable as long as its limitations are understood and there is not exclusive dependence on self report data.

  • http://twitter.com/jdottan Joseph Tan

    I think I mostly agree with the spirit of what you are saying, but I think self-report does have some utility if it is used and interpreted precisely. I think there are situations in which we might be very interested in the perceptions themselves that are given by self-report measures. However, as you have pointed previously, interpreting self-reports on their own as an objective representation of reality rather than the individual’s perception is problematic.

  • http://twitter.com/infinidiv infinidiv

    I couldn’t agree more. It is not that all this data is useless, it is that much of the interpretation of the data is, well… not very useful ;) What I find most interesting is that often a solution has been in use for decades, but due to an inability (lack of common nomenclature) or unwillingness (time-constrained or otherwise) to interact with completely divergent fields, these solutions have to be reinvented time and time again. This is one of my favorite examples, because not only have methods for analyzing the underlying behavior of self-reports been in place and tested for decades in economics (Discrete Choice and Utility Maximization), it actually originated in psychology (Luce Choice Theorem). But only a more limited form has been widely used in psychology (Signal Detection Theory) and, therefore, the models and statistical packages available do not provide the data that psychologists need (generally applied to market prediction as opposed to inference and hypothesis testing). And at the same time, of course, these data have to be supplemented with those cognitive and other tests that do not rely on traditional self-reports, as mentioned by neuroskeptic. The only way to come to an understanding of the dichotomy between these types of tests, however, is to use both techniques to analyze the data we have.

  • http://www.facebook.com/profile.php?id=512400090 Robert Morley

    This is a great point, but let’s not forget the view from the other side as well: many mental health professionals become convinced that they know what you’re thinking/feeling better than you do. Often, I believe that this can be true, but I would venture to say that just as often, it’s not.

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  • https://delicious.com/robertford Robert Ford

    Fibromyalgia. Anyway, I’d bet if you simply asked “What’s Bill like?,” that Bill’s friends will be able to describe his personality as well or better than Bill can. People are not objective about their own behavior.

  • http://skadhitheravernerblog.wordpress.com/ Skadhi_the_Raverner

    Self-report is unreliable. But so is the judgement of professionals, which is likewise demonstrated to be subjective.

    Truly objective measures such as brain scans are rarely available to be used in diagnosis. So its easier to rely on self-report operationalisations or shoehorn everyone into silly ultra-typological categories according to a questionable diagnostic manual.

    Hands up, who really thinks psychiatric practice is science?

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No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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