Contributions of biometrics to psychopathology

Abstract

I have presented a brief review of the contributions of biometrics to psychopathology. Biometrics takes as its starting point the hunches, beliefs, traditions, and untested practices which have arisen from the clinician's confrontation with the immediate needs of the mentally disturbed. From our analysis of the present state of diagnosis, however, it is quite clear, that for research purposes, any comparison of studies of mental patients based on clinical diagnosis alone is of little value. As the diagnoses among clinicians and even for the same clinician from one time to another are not comparable, no homogeneous group is described by a given label. To remedy this situation we have pointed out how these clinically derived conclusions can be subjected to scientific scrutiny by objective measurement with the view of determining their reliability and validity. By subjecting groups of patients possessing similar profiles to certain laboratory tests, we can use an iterative method for relating interview profiles to test results sequentially and improve both the interview and the laboratory test as we move from the one to the other. In order to contain the entire spectrum of psychopathology, we can not depend on treatment cases alone but must investigate an entire population to find those individuals who may exhibit equal amounts of psychopathology as compared to those who come to treatment, but who themselves never seek help. After assessing assets as well as liabilities, a knowledge of why they fail to seek treatment may unearth some of the hidden factors separating the “ill” from the “well”, as well as discover individuals who need treatment but for some reason do not get it. But descriptive psychopathology, no matter how precise, never cured a disorder. For deeper understanding, etiology must be sought. The etiology of mental disorders is so poorly understood that we must use scientific models. To test these models we need adequate tools and examples of such tools were described in the studies reported. One question remains. Has the biometric research program proven its value? If we examine our goals, the unraveling of the causes of the mental disorders through objective approaches, we have made only little progress, but if we look back to where we started, our advances have been considerable. In fact, we may have been too successful! The use of rating scales, systematic structured interviews, and objective instruments and recording forms for evaluating psychiatric status has spread like wild fire because 34 centuries of uncontrolled, subjective observations demanded systematization. This progress, however, has also drawn off the creative energies of many intuitive phenomenologists and turned them in a biometric direction. As a result, we may be running the danger of killing the goose that laid the golden eggs. By siphoning off these creative energies from phenomenology, we may be left with the crystalization of “psychopathology 1970” into a rigid mold and make no further progress. We need the creative, even if unsystematic, curious phenomenologist to examine the psychopathological terrain of his patients so as to provide us with deeper insights and more intuitive understanding which can then be subjected to biometric scrutiny. Examples of the clinical origin of our research are as follows: the study on adolescent friendships in preschizophrenics grew out of our attempt to find an index of type of onset, as insidious onsets had been regarded by clinicians as having a poor prognosis; our measure of the effect of reinforcement on verbal behavior resulted from the clinical observation that flatness of affect led to poor prognosis; our studies of isolation and network communication arose from the clinical observation of the role of family interaction; and our psychomotor, sensory, and perceptual studies arose from clinical observations of psychomotor and perceptual dysfunction in schizophrenia. While the biometrician has his own problems to tackle—reliability, validity, continuity of dimension versus typology—he can not be expected to supply both the universe of discovery as well as the universe of verification. For the universe of discovery, following Reichenbach, there are no rules or regulations, but rather sheer creative moments. If these dry up, neither biometrics nor psychopathology can make further progress.