A news item that was displayed prominently on Google News
for a couple of days, which was picked up by hundreds of news outlets,
was an item about
href="http://en.wikipedia.org/wiki/Intermittent_Explosive_Disorder"
rel="tag">Intermittent Explosive Disorder.
One
example is
href="http://www.suntimes.com/output/news/cst-nws-rage06.html">here,
in the Chicago Sun-Times. This generated
a lot of blogging:
href="http://www.blogpulse.com/search?query=intermittent+explosive+disorder&offset=50&operator=and&start_date=&end_date=&sort=date&max_results=10">Blogpulse
indicates 304 blog posts on the subject,
almost all posted on June 6 or 7. Most of the posts express
some version of the
href="http://www.analphilosopher.com/posts/1149628352.shtml">following
sentiment:
I read about href="http://www.psychnet-uk.com/dsm_iv/intermittent_explosive_disorder.htm">this
in today's Dallas Morning News.
At first I thought it was a joke, but then I realized it wasn't. People
with this "disorder" used to be known, vulgarly, as assholes. Are we
now supposed to view them as victims? Do they deserve sympathy rather
than condemnation? Whatever happened to self-control? Notice how moral
concepts are being replaced, ever so subtly, by medical concepts. It's
not a good trend, for it threatens to dissolve us as persons.
I was kind of perplexed by the intensity of the response, at first.
After all the journal article that was the apparent basis for
the
news reports was rather dry -- completely unremarkable, in fact.
So what got everyone so worked up? Continue reading
below
the fold...
The abstract is
href="http://archpsyc.ama-assn.org/cgi/content/abstract/63/6/669">here.
(You need a subscription to view the full article, which is
href="http://archpsyc.ama-assn.org/cgi/content/full/63/6/669">here.)
The Prevalence and Correlates of DSM-IV
Intermittent Explosive Disorder in the National Comorbidity Survey
Replication
Ronald C. Kessler, PhD; Emil F. Coccaro, MD; Maurizio
Fava, MD; Savina Jaeger, PhD; Robert Jin, MS; Ellen Walters, MS
Arch Gen Psychiatry. 2006;63:669-678.
Context Little is known about the
epidemiology of intermittent explosive disorder (IED).
Objective To present nationally
representative data on the prevalence and correlates of DSM-IV IED.
Design The World Health Organization
Composite
International Diagnostic Interview was used to assess DSM-IV anxiety
disorders, mood disorders, substance use disorders, and impulse control
disorders.
Setting The National Comorbidity Survey
Replication, a face-to-face household survey carried out in 2001-2003.
Participants A nationally representative
sample of 9282 people 18 years and older.
Main Outcome Measure Diagnoses of DSM-IV
IED.
Results Lifetime and 12-month prevalence
estimates of
DSM-IV IED were 7.3% and 3.9%, with a mean 43 lifetime attacks
resulting in $1359 in property damage. Intermittent explosive
disorder–related injuries occurred 180 times per 100 lifetime
cases. Mean age at onset was 14 years. Sociodemographic correlates were
uniformly weak. Intermittent explosive disorder was significantly
comorbid with most DSM-IV mood, anxiety, and substance disorders.
Although the majority of people with IED (60.3%) obtained professional
treatment for emotional or substance problems at some time in their
life, only 28.8% ever received treatment for their anger, while only
11.7% of 12-month cases received treatment for their anger in the 12
months before interview.
Conclusions Intermittent explosive
disorder is a much
more common condition than previously recognized. The early age at
onset, significant associations with comorbid mental disorders that
have later ages at onset, and low proportion of cases in treatment all
make IED a promising target for early detection, outreach, and
treatment.
The National Institute of Mental Health (NIMH) put out a press release
href="http://www.nimh.nih.gov/press/iedepi.cfm">here.
Intermittent Explosive Disorder Affects up
to 16 Million Americans
June 5, 2006
Contact: Jules Asher
NIMH Press Office
301-443-4536
NIMHpress@nih.gov
A little-known mental disorder marked by episodes of unwarranted anger
is more common than previously thought, a study funded by the National
Institutes of Health's (NIH) National Institute of Mental Health (NIMH)
has found. Depending upon how broadly it's defined, intermittent
explosive disorder (IED) affects as many as 7.3 percent of adults
— 11.5-16 million Americans — in their lifetimes.
The study
is based on data from the National Comorbidity Survey Replication, a
nationally representative, face-to-face household survey of 9,282 U.S.
adults, conducted in 2001-2003. [...]
Neither the abstract, nor the press release, gives me any clue as to
what the fuss is all about. In fact, reading the entire
original
journal article, I find no mention of "road rage."
In contrast, here is an excerpt from a typical newspaper report:
href="http://www.suntimes.com/output/news/cst-nws-rage06.html">'Explosive
disorder' a reason for the rage?
Chicago Sun-Times
June 6, 2006
BY JIM RITTER Health Reporter
What causes guys like Bobby Knight or Russell Crowe to suddenly erupt
in a titanic rage?
Psychiatrists say they may have "intermittent explosive disorder," or
IED. And according to a study, the condition is more common than
previously thought, affecting as many as 16 million Americans.
Researchers who surveyed more than 9,000 adults found that 7.3 percent
have IED, making it more common than schizophrenia or bipolar disorder.
"It is news to a lot of people, even those who are specialists in
mental health services, that such a large proportion of the population
has these clinically significant anger attacks," said Ronald Kessler of
Harvard Medical School, lead author of the study in the Archives of
General Psychiatry. [...]
The news articles seemed to draw information from other sources.
I suspect there is another press release floating around out
there somewhere, but I was not able to find it. Remember, none
of the original sources contain the phrase "road rage," yet all of the
newspaper reports and most of the blog posts focus on that particular
topic.
The
original study was purely an epidemiological report. The
authors
analyzed data collected in the
href="http://www.hcp.med.harvard.edu/ncs/index.php">National
Comorbidity Survey Replication (NCS-R), and presented the
results in a painstaking, clinical, and nonjudgmental
fashion.
Most of the objections raised in response to the news articles have
nothing to do with the original article. Rather, people are
objecting to the notion that there is some sort of excuse for rageful
behavior. Bur as far as I can determine, the authors do not
actually say that such behavior should be excused, at least in the
academic literature.
To clarify: the authors of the study classified and described the
behaviors. They employed standard epidemiological methods to
estimate the prevalence of behaviors that meet certain criteria.
The criteria used are based upon
href="http://en.wikipedia.org/wiki/DSM-IV" rel="tag">DSM-IV
criteria, which are specified
href="http://www.behavenet.com/capsules/disorders/explosivedis.htm">here.
(In fact, they did not use the exact DSM criteria, for
methodological reasons, but the DSM criteria are close enough for the
purposes of this discussion.)
I suspect that after the NIMH press release, various reporters
contacted the study authors and conducted interviews. They
did
not make it clear, however, that the sensational aspects of the news
articles were not really based on the scientific literature.
I
suspect that reporters, skilled at conjuring up news where none exists,
managed to elicit certain quotes from the authors, and spun a story out
of that.
The treatment of science in the popular press is a big topic, something
I will comment on from time to time in this space. For now,
I'll let it suffice to say that it is hard to draw any meaningful
conclusions from press reports, unless you have access to the original
source material.
What is more interesting to me at the moment, though, is the real point
of this whole post. At the start of this post, I included
this quote :
Notice how moral
concepts are being replaced, ever so subtly, by medical concepts. It's
not a good trend, for it threatens to dissolve us as persons.
This is really the same argument that gets leveled against evolutionary
theory. Scientists go out in to the world, and painstakingly describe
what they see. There is no implied value judgment.
In the case of evolution, naturalists (and others) see
evidence for evolution, and report the evidence. If certain
conclusions are warranted, then hypotheses are formed and tested.
Nothing about that implies any sort of value judgment.
Yet, somehow, some people take that and come up with the
concept of
href="http://en.wikipedia.org/wiki/Social_Darwinism" rel="tag">Social
Darwinism. Some people then use that concept to
justify certain behaviors: behaviors which have no other conceivable
ethical foundation. Other people do the opposite:
they infer that the scientific description of evolution
implies an endorsement, and use the fallacy of that perceived
endorsement to criticize the science.
In the context of Intermittent Explosive Disorder, psychiatrists are
still in the process of figuring out how to define the condition.
Underlying that, is the realization that it might not really
be a valid diagnostic category (the diagnostic system is in a state of
constant revision). At the same time, they are trying to
figure out if there is one cause, or many; simultaneously, they are
trying to figure out if anything can be done to help. Notice
that describing the condition does not imply an endorsement of the
behavior. Likewise, attempting to treat the condition does
not imply that the behaviors should be excused. If anything,
treatment implies a recognition that the behaviors are undesirable.
There is more to say about that, of course, but I'll stop here.
I want to be sure to get something up in
time for the launch of the second wave of ScienceBloggers...
- Log in to post comments
You raise some interesting questions. I have come to see journalism as interpreting events through the lens of the meta-narrative of the publication.
The NYT, CNN, MSNBC, Wash Times, NPR, Fox, etc. each have a particular narrative that subscribers pay to have affirmed. That's what people pay for IMO, not for the news, which is available all over the internet the moment it happens.
During the first few weeks of the Iraq war my wife's relatives had Fox news on 24/7. The few times I was there it was easy to see how they reacted to the dominant Fox network memes - that we (the US) were all-good and all-powerful and were out to rid the world of evil under the leadership of our Godly president. You could almost see their hearts swell. (Although, not to be out neo-conned, most other networks were following this same narrative.)
I'm sure that journalists understand that this is their job. It's why they were hired. The better they present the world through the window of their readers' worldviews and make everything appear to fit that worldview - the more money they will make over they careers. Looking at some of their work, some don't even have the ability to write consistently clear sentences - yet they can sure push those buttons.
PS - This looks like a good place to visit. You affirm my bias that science should be objective.
Welcome Corpus! Happy to have a fellow Michigander and brain-person aboard. PS-You still have my old (non-SB) url on your blogroll.
Pelican's Point: I like your analysis, because it does explain some of the bias that we see, that is difficult to understand otherwise.
Shelly: Welcome to you, also. It's a good point, I do need to update my blogroll -- and do a fair amount of tweaking. I think I will pare the blogroll down, and catagorize it, and add some little badges and do-dads, but this weekend I have to zip over to University of Chicago: my son just finished his first year there.
An iffy dx, and always has been.
Are people looking for an all-purpose frame for their outbursts of rage, one wonders?
Love the new page and your posts (as always) are thought provoking. Best of luck.
Thank you, Susan. I still like your photographs, too.
The fact is this story was probably worked into the news by a PR firm, which came up with the catchy, topical name (IED) and road rage angle. What, you think it's a coincidence that they used words starting with "I", "E", and "D", when those are in the news every day?
I think people are sensing that this is part of a marketing campaign, and some company is going to come out with a heavily-advertised reformulation of an almost-out-of-patent drug, specifically to combat this horrible scourge that supposedly afflicts millions of Americans.
I'm sure they'll come out soon with another story saying that IED is especially prevalent among the elderly, so that said drug company can get lots of that sweet, sweet taxpayer money.