Second on is that while I thing Malcolm Gladwell is a good writer, I think he's only about, let's say, 35 percent as deep as he thinks he is.
That said, though, he makes a good point on his blog this morning.
In other words, what makes Pit Bulls over-represented in dog bite statistics is not just a product of the dark side of their character (their ferocity and status as fighting dogs) [which causes some people to encourage them to be fighters --- StY] but the good side of their character (their evenness of temperament.)
This is a paradox that is not confined to dogs. For instance, for years people in the pharmaceutical business have been aware of the fact that a large number of reported adverse reactions to a particular drug can mean one of two things. The obvious meaning is that a drug is dangerous. The other meaning is that a drug is SO much better and safer and more effective than any other drug in its class that it tends to be given to the sickest and most troubled patients.
You might recall that there has been a lot of talk in recent months about antidepressants "causing" or, more properly, being associated with aggression and suicide, especially in teenagers. The way this is played on TV, especially on (spit) the O'Reilly Factor and Geraldo, is that the antidepressants cause the aggression, with the perfect post hoc argument that the aggression came after the antidepressants.
Anyone who suffers from depression or treats depression can tell you, however, that the time people are most at risk for suicide in acute depression is as the depression begins to break up. In the deepest depths of depression, a lot of people may think suicidal thoughts, but they can't muster the energy to actually do it until, perversely, they're feeling a little better.
7 comments:
Gale owns a pit bull and he is nice. The dog I mean.
I have been depressed [a long time ago] and when you are really deep in it, there are no alternatives...even suicide. I do agree that sometimes it seems that thoughts of suicide come when people have enough wits about them to know how sick they are.
I know older people on these drugs who do develop some weird side effects but these people are often having other problems as well and that can complicate things.
You are absolutely right about people completing suicide when they are on (the lower end of) the upswing, prompted by the good effect of their antidepressant.
The hype about antidepressants "causing" suicidal behavior is just that. In nearly thirty years of the practice of psychiatry, in academic, community, private practice and HMO settings, I have never seen a clear-cut case of such a thing. An alert psychiatrist with a good realtionship with his (her) patients should worry very little about such an outcome.
Jamie Irons
I understand and respect the clinical lore concerning suicidality. There certainly is something to that and many individuals who attempt suicide, feel slightly less depressed beforehand, having made a decision and resolved their "uncertainties."
However, considering that we are dealing with cognitive biases and base rates, it's helpful to think about how much that piece of information alone helps us in assessing suicide risk. The following is from a chapter on Inference and Attribution errors in psychological testing.Inference and Attribution Errors in Test Interpretation
Terence J. Tracey and James Rounds
University of Illinois at Urbana-Champaign. In R. K. Goodyear & J. W. Lichtenberg, (Eds.), (1999)
Test interpretation: Integrating science and practice. Boston: Allyn & Bacon
A final aspect of representativeness is the confusion regarding reverse conditional probabilities, wherein the probability of one behavior (behavior A) given another (behavior B) is viewed as equal to the probability of behavior B given behavior A. Clinicians seem especially prone to this bias. A common piece of clinical lore is that clients who attempt suicide tend to do so after coming out of a depression, so that clinicians should be alert to elevations in mood of depressed clients. The justification for this pattern is that the client has made a decision to kill him or herself and is thus less in turmoil. The elevation of mood may indeed have occurred in each and every client who has attempted suicide, but this in no way implies that we should attend to mood changes as cues to suicide. The probability of a mood elevation given a suicide attempt may indeed be extremely high, but this does not equal the probability of a suicide attempt given a mood elevation. A conservative estimate of the base-rate of the later (suicide attempt given a mood elevation) is in the ball park of .00001 if not lower. The probability of mood elevations being unrelated to suicide attempts is very high, so the value of attending to mood elevations as a cue for suicide is not justified. Another common example of confusion over reverse conditional probability is the usage of past incidents as diagnostic cues. Just because current clients who report certain interpersonal difficulties have also reported past abuse, does not mean that current abuse is related to having these specific interpersonal difficulties in the future. Another example is clients with eating disorders. Many clinicians have noted the perfectionistic tendencies in clients who have eating disorders and have suggested that perfectionistic tendencies should be used as a diagnostic sign. However, the number of individuals who have perfectionistic tendencies who do not manifest eating disorders far exceeds the number that do.
"Conquer fear, play with a pitbull."
D dnt w rk t w ll. Th y
d nt th nk th f ng rs c n b
r tt ch d.
Th y d nt th nk th f ng rs c n b r tt ch d.
Amazingly intelligent dogs. It's wonderful how your playful friend picked out the a,e,i, and o fingers while leaving the rest attached.
Hunt and peck - I'm down by 40%. Just luck that he got the vowel finger. I'll cope.
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