By Gretchen Gibbs

While my health today is excellent, five years ago I was diagnosed with breast cancer, a potentially life-threatening experience that also made me feel like a fool. I had the estrogen-positive variety of the disease, meaning it had been stoked by estrogen, prescribed by my gynecologist. This is a familiar story, how estrogen was regarded by the medical profession as a way to lessen the chances of breast cancer, but when the “best science” study was conducted, it was discovered actually to increase rates of the illness.

For the past few years I have been taking the standard post-treatment for my kind of breast cancer, a drug which counteracts the effects of whatever estrogen the body is still producing, and leads to some nasty side effects including severe arthritis, hot flashes, and depression. In the past weeks I have found new articles in the Times and Wall Street Journal showing how in some conditions estrogen does reduce the likelihood of breast cancer.

What’s a person to do? New directives from medical science are always contradicting the old ones. Don’t eat eggs. It’s OK to eat eggs. Eat margarine, not butter. Eat butter, not margarine. Drink eight glasses of water a day. Don’t bother. Most of these changes are laughable, but the breast cancer example, at least for me, is not.

I was educated to believe in scientific progress. Medicine might make mistakes, but these would be corrected with time, and eventually we would understand almost everything about how the body works, just as we would understand the workings of the atom and the universe. A recent article in the New Yorker by Jonah Lehrer about the scientific method questions this premise. Entitled “The Truth Wears Off,” the article describes the “decline effect,” the phenomenon that, over time, “truths” in science become less able to be proved. Second generation anti-psychotic drugs, for instance, once provided dramatic improvement for patients compared to their functioning under the older class of drugs. Today, studies are concluding that the old drugs are cheaper and just as good. Lehrer describes a number of similar declines in what we have regarded as scientific truths, in the social and physical sciences.

The possible reasons he describes for the “decline effect” are several. Unless the study is a clear double blind, with neither experimenter nor subject aware of which is the experimental and which the control condition, biases from both participants can affect the result. Significant experimental findings are sometimes a consequence of unusual variation in scores, which will diminish on retest, a phenomenon called regression to the mean. Journals are only likely to accept significant findings, so that negative findings languish in the experimenter’s desk drawer. Granting agencies and pharmaceutical companies do not want to submit negative findings to journals. All of these factors contribute to a spate of positive findings in our scientific journals which do not hold up well on retest.

While Lehrer is not attacking the fundamentals of the scientific method themselves, he is implying that science, as it is practiced, is not likely to arrive at enduring truths. He concludes that once the experiments are done, we still have to choose what to believe. This is a troubling notion, since neither Lehrer nor anyone else has come up with criteria to help us choose. The danger is that science will be rejected altogether, with a kind of New Age arbitrariness, leaving us victim to charlatans and quacks. While there may be other avenues to truth, rejection of science seems to me dangerous.

I would like to come up with some criteria to help us choose what to believe. I would like to find some way to reassure myself and others that science is the right path. All I can say is that I think medical science played a role in causing my breast cancer, since I had few risk factors other than taking estrogen. Yet I know that the next time I’m ill, I’ll go to the doctor, not the shaman, and see what’s prescribed. I may not take it though.
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Gretchen Gibbs is a clinical psychologist and Professor Emeritus at Fairleigh Dickinson University. She is currently writing, and working at a domestic violence agency. Reach her at guestwriter@zestoforange.com.

By Gretchen Gibbs

Recently as I wrote down a diagnosis of Narcissistic Personality Disorder, I realized it might be for the last time. In the last couple of weeks The New York Times, The Wall Street Journal, and Psychology Today have featured articles on the diagnostic system of the American Psychiatric Association and how it’s changing to eliminate some of the personality disorders, defined as “maladaptive patterns of living.” Dropping Narcissistic Personality Disorder seems to be garnering the most attention.

So who cares? Some psychologists, including me, think the diagnostic system is an arbitrary group of categories into which we drop people to provide the illusion that we understand them. Still, the system has shorthand communication value, and some of the diagnoses are linked to effective treatments.  

What interests me is the power of the diagnostic system both to reflect societal shifts and to shape those shifts. While I was in graduate school in 1968, the second APA Diagnostic and Statistical Manual (DSM) came out, still including Homosexuality as a sexual deviation, alongside Sadism and Pedophilia. We learned in our classes the role of the overly involved, seductive mother in producing a homosexual son. Even in 1980, the third edition of DSM had a category for “ego-dystonic homosexuality,” which meant if it made you unhappy to be gay you could still be treated. Homosexuality was finally dropped as a disorder in 1987, reflecting the increased tolerance of our society. What an enormous impact dropping the diagnosis had, as mental health workers all over the country suddenly stopped labeling gays and lesbians as deviant. Without that change, we wouldn’t be talking about gays getting married, adopting children, or serving openly in the military.

Other changes in the diagnostic system reflected the feminist movement and shifting attitudes towards women. Can’t you just hear the disapproval of the male psychiatric establishment in the Hysterical Personality label, used to describe “self-dramatizing, attention-getting and seductive” women? That diagnosis bit the dust, along with Passive-Aggressive Disorder, also used more frequently for women than men. When your access to legitimate power is limited, finding some roundabout ways of getting your way becomes understandable.

What does it mean that the APA is dropping the Narcissistic Personality diagnosis? The label was created in 1980, apparently as our culture became more aware of entitlement and self aggrandizement as problems. Thirty or so years later, we seem to be saying, “Not problems, just the norm.”

Narcissistic Personality Disorder “is a pattern of grandiosity, need for admiration and lack of empathy.” According to The Wall Street Journal, quoting a 2007 Pew Research study, 51 percent of young adults said their first or second goal in life was to become famous.

There is narcissism all around us. I see it in politicians and sports figures and entertainers and the number of young people who want to go into the entertainment industry. I see it in young psychologists, who no longer say they want to help people; they want to “follow their passion.” I see it in reality TV and the endless people on cell phones or texting or twittering about their most mundane activities. I see it in the lack of empathy of American culture when it considers universal health care and minimum wages and giving to charity. Can you imagine how Tom Brokaw’s greatest generation would regard the narcissism of today?

Apparently, narcissism is now so general that the pathological level can’t be distinguished from the “normal” level. I believe, however, that dropping the disorder as a diagnosis will lead to further societal acceptance of the behavior. Removing the label of mental illness for homosexuality made it acceptable, no longer a social problem. We are about to do the same thing for narcissism.

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