How many times have you reviewed symptoms of psychological disorder on the internet and thought, "I have that!" You're not alone, and there's a reason for it. It's also why psychic readings and the DSM can be very much alike.
Rainbow Statements and the Forer Effect
In 1948, Bertram Forer walked into the room of the psychology class that he taught and handed out pieces of paper. Each of his students was getting an analysis of their personality. They would look through it, and give their evaluation of Forer's work. On a scale of one to five, did the test resemble their personality traits? The students believed that Forer's reviews scored a 4.26 on their accuracy in analysing their personal traits. It was then that Forer revealed that every last one of the analyses were the same, and all the statements were drawn from a horoscope.
After a quick look at the questions, it's clear that astrology hasn't changed much since 1948. The statements included, "You have a great need for others to like and admire you," and "Some of your aspirations tend to be pretty unrealistic." Nearly everyone on Earth will admit that the statements apply to them. Forer's analysis also includes statements that become more general while seeming to be getting more specific. These statements include, "While you have some personality weaknesses, you are generally able to compensate for them," and "At times you are extroverted, affable, sociable, while at other times you are introverted, wary, reserved." These statements are called rainbow statements because they include every possible "colour". Those two alone cover someone who is extroverted and introverted, and cover someone who is able to compensate for their weakness as well as someone who is not able to compensate for their weakness.
The Forer Effect remains reliable. Through the years, psychologists have presented people with vague or all-inclusive statements, and people have judged those statements to be an accurate portrait of their personality. As, indeed, they are. The problem isn't that the statements aren't accurate. The problem is, because they apply to everyone, they're not meaningful. They don't tell us anything about a person that doesn't apply equally well to the person sitting next to them.
The Forer Effect and Psychology
The most interesting test of the Forer Effect came just seven years after it was discovered. In 1955, Norman Sundberg rounded up 44 people had gave them extensive personality tests. Taking the results of those personality tests, he had a group of psychologists do an actual analysis of each of the study participants. He also put together an analysis made of rainbow statements and Forer statements. Fifty-nine per cent of the subjects believed the generalised Forer analysis was a closer match to their personality than the actual analysis. Thinking that those being analysed were blind to their own personality, Sundberg asked them to bring in a friend who knew them well. The friends were also unable to pick the correct analysis.
It's a shame that Sundberg missed out on the real test suggested by his experiment. The ignorance of the friends, and by the subjects themselves, is interesting, but it's not surprising that laypeople aren't able to distinguish a good psychological work-up from a poor one. The question is, if each subject were to go to a new psychologist, and the two were given time to get to know each other, could trained psychologists pick the right psychological analysis? If they couldn't, there would have been no practical difference between a Forer analysis and a real psychological analysis.
The Internet and the Age of Self-Diagnosis
For those of use who aren't extensively trained in psychology, the line between the Forer effect and actual psychology gets thinner by the day, which is one of the reasons why so many people are self-diagnosing. Provided we believe there's a difference between psychology, psychiatry and astrology, some of this self-diagnosis is due to ignorance. A layperson can read the signs of a disorder, but has no frame of reference for those signs. A thousand people can go online and feel like they have extraordinary trouble picking up on social cues, but only a few of them are as socially inept as they believe they are. The rest just lack confidence, or experience, and while it might be helpful to talk to a psychologist about that, it's not a psychological disorder.
People, when looking at a list of characteristics, also tend to focus on the ones that they have, and disregard the ones that they don't have. If a psychological disorder has eight major symptoms, and you have seven, a lot hinges on whether the "true case" always features all eight symptoms, or whether it always features the one symptom you don't have. Lastly, there's a reason why people tend to cluster around "trendy" diagnoses. They know about them. Some people will even mistake physical problems with psychological conditions. Sporadic feelings of panic can be a sign of an anxiety disorder. They can also be a symptom of a heart problem. A psychologist or psychiatrist, with an understanding of the lay of the land, will know better than to automatically attribute symptoms to the most famous disorder.
Not all of the blame can be put on the layperson. There are several aspects of the overall mental health profession that can start looking like the Forer Effect. For one thing, once a psychological disorder gets studied and interpreted enough, it becomes defined by a de facto rainbow statement. The DSM-IV defines schizoid personality disorder using seven main criteria, including "almost always chooses solitary activities" and "appears indifferent to the praise or criticism of others". Go to the Mayo Clinic site, and the criticism condition disappears, but the site states that people with the disorder have eight different symptoms, one of which is that they "feel confused about how to respond to normal social cues and generally have little to say". Meanwhile, another analysis of the disorder asserts that people with the disorder display overt and covert behaviours that are exactly opposite, so someone scanning the behaviours might consider themselves schizoid if they are sometimes indifferent to people's opinions but at other times "exquisitely sensitive", sometimes feel inferior but at other times feel grandiose. Put together enough ideas about a theory, and anyone could have it.
The controversial diagnostic tool, the DSM-V, has drawn criticism for Forer-like problems. Allen Frances, a professor at Duke University who worked on the DSM-IV, noted that "Autism Spectrum Disorder" has three criteria, all of which are vague. According to the criteria, someone with Autism Spectrum Disorder has deficits in "social-emotional reciprocity", in "nonverbal communicative behaviours used for social interaction" and in "developing, maintaining, and understanding relationships". Presumably an experienced psychologist could make the distinction between someone who is awkward with nonverbal communication, and someone who has a "deficit". What's more important, according to Frances, is that there is no explanation as to whether all three criteria need to be present, or some but not others, or only one. That makes the definition incredibly vague, encompassing nearly everyone.
There's also a problem with multiplying and reclassifying diagnoses. Mental health needs to cast a wide net, encompassing all the kinds of problems that people can have. The exact reach of that net is a matter of debate, even among health professionals. In the DSM-V, there is a category for schizophrenia. Signs of schizophrenia involve delusions, hallucinations, incoherent speech, "disorganized" or catatonic behaviour and other signs of great distress. The delusions and hallucinations are key, and are necessary for the diagnosis of schizophrenia. There is also now something called "unspecified schizophrenia spectrum disorder", a category formed for people who don't meet all the criteria for schizophrenia. This is for people who specifically don't have the delusions or hallucinations. If they had either, they would be diagnosed with schizophrenia. This means that, if you specifically have hallucinations, you could be schizophrenic, and if you specifically don't have hallucinations, you could be schizophrenic. Confident or insecure, inferior or grandiose, introverted or extroverted. Either way, you fit the diagnosis.
This isn't to say that mental health professionals are no different than psychics. Debate over a scientific distinction does not render the distinction meaningless. The only way to acquire knowledge is to posit different ideas about what a thing - in this case a mental health disorder - is, and see what ideas work out in the long run. This just shows that the self-diagnoses that spring up from everyone with an internet connection isn't just a sign of rampant narcissism, hunger for attention or faux intellectualism. The diagnostic criteria that people read, and that they apply to themselves, really does apply to them. It just takes a professional to figure out if the fact that it applies to them is meaningful - whether it distinguishes them from the rest of humanity. And even the professionals can't always agree on that.
[Via The Fallacy of Personal Validation, The Acceptability of Fake Versus Bona Fide Personality Test Interpretations, Debunking Myths of the Mind, Two Fatal Flaws in the DSM-V Definition of Autism, Unspecified Mental Disorder?]