Thursday, June 4, 2020

Tendency for Interpersonal Victimhood (an enduring feeling that the self is a victim across different kinds of interpersonal relationships) & the need for recognition, moral elitism, lack of empathy, & rumination

The tendency for interpersonal victimhood: The personality construct and its consequences. Rahav Gabay et al. Personality and Individual Differences, Volume 165, October 15 2020, 110134.

Abstract: In the present research, we introduce a conceptualization of the Tendency for Interpersonal Victimhood (TIV), which we define as an enduring feeling that the self is a victim across different kinds of interpersonal relationships. Then, in a comprehensive set of eight studies, we develop a measure for this novel personality trait, TIV, and examine its correlates, as well as its affective, cognitive, and behavioral consequences. In Part 1 (Studies 1A-1C) we establish the construct of TIV, with its four dimensions; i.e., need for recognition, moral elitism, lack of empathy, and rumination, and then assess TIV's internal consistency, stability over time, and its effect on the interpretation of ambiguous situations. In Part 2 (Studies 2A-2C) we examine TIV's convergent and discriminant validities, using several personality dimensions, and the role of attachment styles as conceptual antecedents. In Part 3 (Studies 3–4) we explore the cognitive and behavioral consequences of TIV. Specifically, we examine the relationships between TIV, negative attribution and recall biases, and the desire for revenge (Study 3), and the effects of TIV on behavioral revenge (Study 4). The findings highlight the importance of understanding, conceptualizing, and empirically testing TIV, and suggest that victimhood is a stable and meaningful personality tendency.

Keywords: VictimhoodInterpersonal relationsPersonalityCognitive biasesAttachment styles

To beer or not to beer: A meta-analysis of the effects of beer consumption on cardiovascular health

To beer or not to beer: A meta-analysis of the effects of beer consumption on cardiovascular health. Giorgia Spaggiari et al. PLoS, June 3, 2020.

Abstract: A moderate alcohol consumption is demonstrated to exert a protective action in terms of cardiovascular risk. Although this property seems not to be beverage-specific, the various composition of alcoholic compounds could mediate peculiar effects in vivo. The aim of this study was to evaluate potential beer-mediated effects on the cardiovascular health in humans, using a meta-analytic approach (trial registration number: CRD42018118387). The literature search, comprising all English articles published until November, 30th 2019 in EMBASE, PubMed and Cochrane database included all controlled clinical trials evaluating the cardiovascular effects of beer assumption compared to alcohol-free beer, water, abstinence or placebo. Both sexes and all beer preparations were considered eligible. Outcome parameters were those entering in the cardiovascular risk charts and those related to endothelial dysfunction. Twenty-six trials were included in the analysis. Total cholesterol was significantly higher in beer drinkers compared to controls (14 studies, 3.52 mg/dL, 1.71–5.32 mg/dL). Similar increased levels were observed in high-density lipoprotein (HDL) cholesterol (18 studies, 3.63 mg/dL, 2.00–5.26 mg/dL) and in apolipoprotein A1 (5 studies, 0.16 mg/dL, 0.11–0.21 mg/dL), while no differences were detected in low density lipoprotein (LDL) cholesterol (12 studies, -2.85 mg/dL, -5.96–0.26 mg/dL) and triglycerides (14 studies, 0.40 mg/dL, -5.00–5.80 mg/dL) levels. Flow mediated dilation (FMD) resulted significantly higher in beer-consumers compared to controls (4 studies, 0.65%, 0.07–1.23%), while blood pressure and other biochemical markers of inflammation did not differ. In conclusion, the specific beer effect on human cardiovascular health was meta-analysed for the first time, highlighting an improvement of the vascular elasticity, detected by the increase of FMD (after acute intake), and of the lipid profile with a significant increase of HDL and apolipoprotein A1 serum levels. Although the long-term effects of beer consumption are not still understood, a beneficial effect of beer on endothelial function should be supposed.

Achilles & Patroklos - from Edward Carpenter's book, Ioläus: An Anthology of Friendship (1902)

Achilles & Patroklos

[The following excerpt, on the lover-warriors Achilles and Patroklos (or Patroclus), is from Edward Carpenter's book, Ioläus: An Anthology of Friendship (1902). Carpenter himself translated the passage from the Iliad.]


THE fact, already mentioned, that the romance of love among the Greeks was chiefly felt towards male friends, naturally led to their poetry being largely inspired by friendship; and Greek literature contains such a great number of poems of this sort, that I have thought it worth while to dedicate the main portion of the following section to quotations from them. No translations of course can do justice to the beauty of the originals, but the few specimens given may help to illustrate the depth and tenderness as well as the temperance and sobriety which on the whole characterized Greek feeling on this subject, at any rate during the best period of Hellenic culture....
    It is not always realized that the Iliad of Homer turns upon the motive of friendship, but the extracts immediately following will perhaps make this clear. E. F. M. Benecke in his Position of Women in Greek Poetry (p. 76) says of the Iliad: —

        It is a story of which the main motive is the love of Achilles for Patroclus. This solution is astoundingly simple, and yet it took me so long to bring myself to accept it that I am quite ready to forgive any one who feels a similar hesitation. But those who do accept it cannot fail to observe, on further consideration, how thoroughly suitable a motive of this kind would be in a national Greek epic. For this is the motive running through the whole of Greek life, till that life was transmuted by the influence of Macedonia. The lover-warriors Achilles and Patroclus are the direct spiritual ancestors of the sacred Band of Thebans, who died to a man on the field of Chæronæa.

    The following two quotations are from The Greek Poets by J. A. Symonds, ch. iii., p. 80 et seq.: —
        The Iliad therefore has for its whole subject the passion of Achilles — that ardent energy or μηνις of the hero which displayed itself first as anger against Agamemnon, and afterwards as love for the lost Patroclus. The truth of this was perceived by one of the greatest poets and profoundest critics of the modern world, Dante. When Dante, in the Inferno, wished to describe Achilles, he wrote, with characteristic brevity:  
                  Che per amore al fine combatteo.”

                  Who at the last was brought to fight by love.”)

        In this pregnant sentence Dante sounded the whole depth of the Iliad. The wrath of Achilles for Agamemnon, which prevented him at first from fighting; the love of Achilles, passing the love of women, for Patroclus, which induced him to forego his anger and to fight at last; these are the two poles on which the Iliad turns.

    After his quarrel with Agamemnon, not even all the losses of the Greeks and the entreaties of Agamemnon himself will induce Achilles to fight — not till Patroclus is slain by Hector — Patroclus, his dear friend “whom above all my comrades I honored, even as myself.” Then he rises up, dons his armor, and driving the Trojans before him revenges himself on the body of Hector. But Patroclus lies yet unburied; and when the fighting is over, to Achilles comes the ghost of his dead friend: —

        The son of Peleus, by the shore of the roaring sea lay, heavily groaning, surrounded by his Myrmidons; on a fair space of sand he lay, where the waves lapped the beach. Then slumber took him, loosing the cares of his heart, and mantling softly around him, for sorely wearied were his radiant limbs with driving Hector on by windy Troy. There to him came the soul of poor Patroclus, in all things like himself, in stature, and in the beauty of his eyes and voice, and on the form was raiment like his own. He stood above the hero's head, and spake to him: —

            Sleepest thou, and me hast thou forgotten, Achilles? Not in my life wert thou neglectful of me, but in death. Bury me soon, that I may pass the gates of Hades. Far off the souls, the shadows of the dead, repel me, nor suffer me to join them on the river bank; but, as it is, thus I roam around the wide-doored house of Hades. But stretch to me thy hand I entreat; for never again shall I return from Hades when once ye shall have given me the meed of funeral fire. Nay, never shall we sit in life apart from our dear comrades and take counsel together. But me hath hateful fate enveloped — fate that was mine at the moment of my birth. And for thyself, divine Achilles, it is doomed to die beneath the noble Trojan's wall. Another thing I say to thee, and bid thee do it if thou wilt obey me: — lay not my bones apart from thine, Achilles, but lay them together; for we were brought up together in your house, when Mencœtius brought me, a child, from Opus to your house, because of woeful bloodshed on the day in which I slew the son of Amphidamas, myself a child, not willing it but in anger at our games. Then did the horseman, Peleus, take me, and rear me in his house, and cause me to be called thy squire. So then let one grave also hide the bones of both of us, the golden urn thy goddess-mother gave to thee.

    Him answered swift-footed Achilles: —

            Why, dearest and most honoured, hast thou hither come, to lay on me this thy behest? All things most certainly will I perform, and bow to what thou biddest. But stand thou near: even for one moment let us throw our arms upon each other's neck, and take our fill of sorrowful wailing.

        So spake he, and with his outstretched hands he clasped, but could not seize. The spirit, earthward, like smoke, vanished with a shriek. Then all astonished arose Achilles, and beat his palms together, and spake a piteous word: —

            Heavens! is there then, among the dead, soul and the shade of life, but thought is theirs no more at all? For through the night the soul of poor Patroclus stood above my head, wailing and sorrowing loud, and bade me do his will ; it was the very semblance of himself.

        So spake he, and in the hearts of all of them he raised desire of lamentation; and while they were yet mourning, to them appeared rose-fingered dawn about the piteous corpse. Iliad, xxiii. 59 et seq.

PLATO in the Symposium dwells tenderly on this relation between Achilles and Patroclus: —

        [And great] was the reward of the true love of Achilles towards his lover Patroclus - his lover and not his love (the notion that Patroclus was the beloved one is a foolish error into which Æschylus has fallen, for Achilles was surely the fairer of the two, fairer also than all the other heroes; and, as Homer informs us, he was still beardless, and younger far). And greatly as the gods honor the virtue of love, still the return of love on the part of the beloved to the lover is more admired and valued and rewarded by them, for the lover has a nature more divine and worthy of worship. Now Achilles was quite aware, for he had been told by his mother, that he might avoid death and return home, and live to a good old age, if he abstained from slaying Hector. Nevertheless he gave his life to revenge his friend, and dared to die, not only on his behalf, but after his death. Wherefore the gods honored him even above Alcestis, and sent him to the Islands of the Blest. Symposiumspeech of Phædrus, trans. by B. Jowett.

And on this passage Symonds has the following note: —

        Plato, discussing the Myrmidones of Æschylus, remarks in the Symposium that the tragic poet was wrong to make Achilles the lover of Patroclus, seeing that Patroclus was the elder of the two, and that Achilles was the youngest and most beautiful of all the Greeks. The fact however is that Homer raises no question in our minds about the relation of lover and beloved. Achilles and Patroclus are comrades. Their friendship is equal. It was only the reflective activity of the Greek mind, working upon the Homeric legend by the light of subsequent custom, which introduced these distinctions. The Greek Poets, ch. iii. p. 103.

Assessment of Psychopathology: Is Asking Questions Good Enough?

Assessment of Psychopathology: Is Asking Questions Good Enough? Barbara Pavlova. JAMA Psychiatry. 2020;77(6):557-558. March 11 2020, doi:10.1001/jamapsychiatry.2020.0108

The evaluation and success of our efforts to prevent, detect, and treat mental illness depend on the assessment of psychopathology. Almost all psychiatric assessments consist of asking questions, through questionnaires or interviews, about behaviors and experiences. We either ask the person being assessed or someone who knows them well. Based on the answers, we diagnose, recommend treatment, and monitor outcome. Regardless of who is reporting, overreporting and underreporting are common. People may overreport or underreport on purpose when they are hoping for benefits associated with a diagnosis (eg, educational support, time off work, or access to medication), or fearing the consequences of diagnosis, including stigma or adverse effects of medication. Beliefs about mental illness not being real, concerns about privacy, health insurance cost, and implications for custody of children are also reasons for underreporting.

Unintentional overreporting and underreporting are even more common. Many diagnoses rely on recalling duration and frequency of multiple symptoms, which is prone to memory bias. Recent events are more salient, and people are more likely to remember times when their mood was similar to the mood at the time of reporting. Mood-dependent memory impedes the assessment of bipolar disorder, where individuals typically present in the depressive phase, and correct diagnosis depends on their recall of manic episodes. What is being reported about others is also influenced by reporters’ mental state. For example, mothers experiencing depression and anxiety report more severe symptoms in their children than the children themselves.1 These biases have been demonstrated in children thanks to routine use of multiple informants. It is likely that biases of self-report in adults remain hidden, because report by others is underused in adult psychiatric practice and research. Other reporting inaccuracies may stem from reporters’ implicit and explicit biases related to age, sex, race/ethnicity, appearance, or disability of the person whose behavior they are describing.

The comparison group that the reporter uses also has an effect and is the most likely explanation for why younger children within the classroom are more often diagnosed as having attention-deficit/hyperactivity disorder than their older classmates.2 Similarly, clinicians who are likely to see those who are severely ill may underestimate problems of the relatively less affected. It is likely that the comparison group also affects self-report in adults and may contribute to apparent strong effects of income inequality and urban environment on psychopathology. Self-report and report by others may have complementary strengths depending on the problem that is being evaluated. While observable problems, such as attention-deficit/hyperactivity disorder, may be suited to report by others, the less visible difficulties, including anxiety, may be more accurately captured by self-report.

The studies that evaluated the relative predictive value of information from multiple reporters suggest that while everyone comes with their own biases, each reporter also contributes to the assessment/prediction in a meaningful way. Self-rated depression questionnaire and clinician-rated interview differ, but each contributes uniquely to the prediction of antidepressant treatment outcome.3 Similarly, parents’ ratings of their offspring’s depressive symptoms as well as those self-reported by the offspring prospectively predict a new-onset mood disorder.4

Problems with self-report and recall bias have been known for decades, but alternative methods have not been adopted in practice. The impracticability of accessing multiple informants and lack of objective unbiased standards may be why we continue to use suboptimal but convenient assessment methods. To improve assessment and prediction accuracy, we need methods that are more objective and less biased.

First, observation of behavior by a person who has no stakes in the assessment result improves assessment and prediction of functional outcomes. Independent observation of classroom behavior predicts future attention-deficit/hyperactivity disorder–associated impairment with greater accuracy than the parent and teacher reports.5 Independent raters unaware of parent diagnosis observed more inattention, language/thought problems, and oppositional behavior in offspring of parents with mood and psychotic disorders than in offspring of parents without these disorders.6 Ratings of behavior by independent assessors may also contribute to predicting and evaluating treatment outcome.

Second, ecological momentary assessment (ie, repeated assessment of respondents’ experiences in their natural environment in real time) minimizes memory bias. For example, it may help identify early signs of mood and energy deterioration, which could enable clinicians to intervene early to prevent a major mood episode.

Third, automated analysis of behavior has a potential to avoid biases associated with human reporters. As with human observers, automated analysis of behavior uses the discernible signs of mental state, including speech content and prosody, body movement, and facial expressions. Automated analysis of speech could contribute to diagnosis and prediction of response to treatment. For example, features of speech, including speed, articulation, or repetitiveness, may aid the diagnosis of depression. Corcoran et al7 showed that automated speech analysis can predict psychosis onset among individuals at clinical high risk with high accuracy. In addition, increased pupillary reactivity to sad words distinguished children and young people with depression from their nondepressed peers.8 Automated analysis of speech and pupillary reactivity may also identify individuals at risk for depression. Finally, actigraphy can contribute to the assessment of mental illness through identifying changes in activity and sleep that precede a relapse of psychosis or depression.9 While automated analysis of speech, pupillary reactivity, and actigraphy contribute predictive information that complements self-report, none of these has been developed and validated as a comprehensive stand-alone assessment method that could replace questionnaires and interviews.10

The limits and biases of self-report have been known for decades, and the calls for integrating more objective measurement into psychiatric assessment are not new.11 Yet little has changed in psychiatric assessment to date. The last decade has brought evidence that multisource assessment actually improves the prediction of meaningful outcomes.3,4,7 At the same time, the feasibility of objective measurement is rapidly improving with the availability of wearable technology.9 The next steps in implementing objective assessment should include prospective evaluation of predictive value of objective tests used alone or alongside established interview and questionnaire methods.10 Clinical applicability will be enhanced if these steps are informed by what is known about report biases and multisource assessment. Because each reporter contributes unique predictive information,3-5 new methods should be evaluated against multireporter assessment rather than relying on a single reporter for a standard. New technology often uses artificial intelligence to learn from existing data that include the biases reviewed here. When calibrating new methods, care must be taken to ensure fairness and avoid perpetuation of biases pertaining to race/ethnicity, sex, and education.

While objective measurement of psychopathology is desirable, the presently available methods are far from being universally applicable.10 Although reports by self and others come with various biases and inaccuracies, they will likely remain the most informative way of assessment in psychiatry in the foreseeable future. Yet these traditional methods can and should also be improved. Unbiased objective measures of mental state, with methods such as speech analysis, pupillary reactivity, and actigraphy, may help to design and calibrate self-report and clinical interview measures so that they are less prone to bias.

Combination of multireporter assessment with objective analysis of behavior offers an opportunity to improve diagnosis and prediction of mental illness to better target treatment and preventative efforts. The key to implementing this knowledge may lie in practical solutions that allow incorporating objective and unbiased assessment in the work flow of research and clinical practice.