The following post shows that there is a rather significant flaw in the methods which are used to diagnose psychotic conditions. For reference these conditions include psychotic spectrum disorders such as Schizophrenia, depressive illnesses with psychotic features such as bipolar disorder or those forms of psychosis which are comorbid with PTSD (which I apparently do not have). I have interestingly not received any counterargument from any psychiatrist which negates the conclusion reached.
[I have asked for responses from Professor Simon Baron Cohen of Trinity College, Cambridge asking him to point out any flaws in the analysis but he has not done so, despite acknowledging recipt of my email. I have also just asked Dr William Wedin, a clinical psychologist from New York and will await his response.]
As with most psychiatric disorders, a patient is diagnosed with a form of psychosis using a list of criteria provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychosis is a term which amongst other things encompasses delusions. According to the DSM, a delusion is “a false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.”
A diagnosis of psychosis is not however provided according to objective measurements but will be subject to the individual judgment of a psychiatrist who will base his decision upon the criteria which are provided for such a diagnosis in the DSM. Because this involves a personal and subjective judgment rather than a scientific and objective measure, it can thus be said to be unreliable.
In certain cases, an objective method of ascertaining whether someone is or is not experiencing a form of psychosis can be determined through the psychometric measurement of cognitive function.
This can be achieved through the usage of one of the four categories of the Weschler Acquired Intelligence Scale (WAIS), one of the most popular IQ test available on the market. The category is known as Perceptual Reasoning (PR).
In addtion to providing a measurement of certain intellectual capacities, PR measures the ability or otherwise of an individual to notice patterns, details and by extension to form logical conclusions based upon inferences from external reality.
Given that, on the one hand, a delusion is “a false belief based on incorrect inference about external reality” and perceptual reasoning is, amongst other things “the ability to form logical conclusions based upon inferences from external realities”, a high level of perceptual reasoning would appear to negate the possibility of psychosis.
This correlation is confirmed by the available scientific literature which concludes that those with a very high degree of perceptual reasoning do not suffer from psychosis. This phenomenon is known as the cognitive reserve.
Although a mere selection is provided here, other academic documents most notably the analysis carried out by the Australia Schizophrenia Institute will confirm the conclusions which are reached within these documents.
- Perceptual Organization Impairment in Schizophrenia and Associated Brain Mechanisms: Review of Research from 2005 to 2010.
- Cognitive Functioning in Prodromal Psychosis: A Meta-analysis Perceptual Organisation deficits in psychotic patients.
- Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses- meta-analytic study.
The evidence shows that those with a high enough level of PR, which, as mentioned, can be defined as the ability, amongst other things, to think logically based upon inferences from external realities, do not suffer from psychosis.
In fact those with enhanced PR can in fact be said to have the opposite of psychosis. An enhanced level of PR, given that in essence, it shows the ability to think logically, can in fact be said to be the opposite of psychosis. In autistic spectrum conditions for instance, it is common to see individuals with enhanced PR. This has been defined as Enhanced Perceptual Reasoning and the following documents provide an explanation with regard to this particular phenomenon.
- Enhanced Perceptual Functioning in the Development of Autism
- Enhanced Perceptual Functioning in Autism: An Update, and Eight Principles of Autistic Perception
On a personal note, my level of Perceptual Reasoning as measured from the most recent official report is 133 which places me in the top 2%. I mention this not as a boast of my intelligence, but because it just so happens that my level of PR, on the basis of the evidence, would appear to establish that psychosis is not a possibility in my case.
It might be argued that an IQ test is taken at a specific point in time and individuals suffer a deterioration in cognitive functioning as a result of psychosis and would report lower scores as a result. This is indeed possible, but speaking on a personal basis again, I have regularly taken various forms of IQ tests and other similar tests over the course of the past twenty years with consistently high results. Had I been experiencing a form of psychosis, the overall score would have been lower at some point.
One might argue that given the case of John Nash who was an outstanding mathematician with a high IQ who suffered at a particular stage with schizophrenia, that it is possible to have a high IQ and to suffer from schizophrenia. However one might like to take into account the fact that his mathematical abilities, which are also measured by perceptual reasoning, deteriorated as a result of his schizophrenia. By extension this would have indicated that his level of PR deteriorated.
One of the reasons that psychiatrists misdiagnose individuals with autism and a high level of PR with psychosis sometimes is because:
- Psychiatrists, who would not be especially renowned for possessing an especially high level of PR, would sometimes be unable to spot or see or understand the significance of the patterns and details and logical conclusions which are reached by those with high level of PR. Given that it is generally the case that they would have a lower level of PR, they would sometimes be unable to understand the line of reasoning made by those with EPR and might, as a consequence, conclude that such reasoning is illogical and indicative of psychosis.
- Psychiatrists rely primarily upon the Diagnostic and Statistical Manual in order to diagnose illnesses such as psychosis. The diagnosis is made according to criteria which are observed in a subjective fashion by the psychiatrist rather than the more objective and scientific measures which can determine an illness and which are provided by IQ tests.
- It is the case that upon seeing individuals with EPR but who might have have communication difficulties, that any intellectual capacity may be disregarded.
- Psychiatrists quite often do not have the time or resources within state-run facilties to make such determination.
This conclusion would appear to have been confirmed by comprehensive research which has been undertaken by the Schizophrenia Research Institute (SRI) of Australia. That conclusion does however pose an interesting problem which affects not only psychiatry but other domains in addition. The problem is best explained through a set of examples.
Let us state that an entity known as A finds it convenient, according to a generally policy, for individual B to be diagnosed with a form of psychosis, even though his EPR, which is publicly known, invalidates such a diagnosis.
An obvious concern would be that the research studies performed by the SRI make access to scientific data of an objective, precise and verifiable kind in relation to PR and psychosis, publicly available. In addition, through the usage of modern technology and big data, knowledge of the correlation will become increasingly available. As such, it would be difficult to sustain the view that such a diagnosis could be credible in the eye of the public.
One might also ask whether such a policy is to the advantage of entity A, given the following very probable situations:
- A rival of entity A, which we shall call Entity C does not have a policy to define such individuals as psychotic. Their policy is instead to take advantage of the abilities and intelligence of such individuals. The difference between their approaches to those with EPR means they are stronger than Entity A.
- Entity C wishes to seek advantage and to damage entity A by enticing individual B to work for them through a recognition of their abilities and through informing them that they are not experiencing psychosis.
- Furthermore, in order to damage the reputation of entity A, entity C makes it publicly known that individual B is being deliberately harmed by entity A.
One might argue that entity A could attempt to suppress knowledge of the fact that EPR negates the possibility of psychosis. It is however difficult to forsee how this could be achieved given that:
- It is doubtful whether entity A could persuade entity C or other entities to suppress knowledge of this correlation when it would be to their advantage not to do so. It is also doubtful whether entity C would suppress knowledge of that correlation as they would be able to cause reputation damage to entity A and to attract others like individual B.
- Through the increasingly availability of modern communications, it is difficult to see how the available data and knowledge of the correlation will not at some stage, become public knowledge. The policy of entity A will be become apparent to the public which would damage it in their eyes. As a consequence, there is a probability that others with EPR would look towards other entities.
- Each country wishes to gain competitive advantage through the scientific discoveries which are made by intelligent people. It remains difficult to see how each one of the 196 countries in the world can all agree to cooperate for the first time on concealing such a discovery especially given that countries like Russia do not employ such a system. In a competitive international environment, it is logical to expect that at least one country will choose not to deny but instead to take advantage of those who are highly intelligent but have witnessed/been subject to a system of surveillance and who as a consequence are labeled by the authorities as psychotic in order to discredit them and to conceal this system of surveillance.
As a consequence of the fact that the correlation is and will increasingly become public knowledge, one might like to ask the following questions:
- In cases where it is deemed advantageous for entity A to state that an individual with EPR is psychotic, how can they be aware of their level of EPR beforehand given that such data is not always currently available? In disregarding such measures, how can they avoid the possibility of encouraging that person to go toward entity C?
- How does one avoid a situation where those with EPR through such abilities notice that those with a low level of PR are being subject to incorrect treatment and encourage them to work for entity C?
- What would happen when an individual with EPR who is misdiagnosed with psychosis, realises the correlation and decides to take revenge by for example leaking information.
The conclusion which must be drawn is that it would be disadvantageous for entity A to have a general policy that for the sake of convenience, certain individuals should be diagnosed with psychosis.
So one might pose the question as to how it is rational for a government for convenience’s sake diagnose someone highly intelligent as psychotic.