The Neuropsychology of Diagnosis-Dependent Bias


Canadian researchers found that a brainwave associated with “recognition of incongruent speech” differed according to whether the person listening to such speech was told that the speaker was diagnosed with schizophrenia. The brainwave was absent when the person was told that the speaker had been diagnosed with schizophrenia. “Such responses to abnormal speech in schizophrenia indicate an expectation of abnormality from individuals with schizophrenia,” say the authors, “which has implications for understanding social exclusion of individuals with the disorder.” Results appeared online in Schizophrenia Research.

Abstract →

Best, M., Bowie, C., Neurophysiological responses to schizophrenia-associated communication abnormalities. Schizophrenia Research. Online June 24, 2013.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. The existence of a world full of people who would use the following sentence “has implications for understanding social exclusion of individuals with the disorder.” has implications for understanding the social exclusion of individuals labeled out of order by people who believe labeling people out of order is a worthwhile thing to do. I think every sentence that ends with “individuals with the disorder” is a sentence that ends abnormally.

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    • That’s very orderly of you, to point out the out of order of the disorder of those causing the out of orderliness. I feel a lot safer, and less confused: “A medical orderly (also known as a ward assistant or nurse assistant), is a hospital attendant whose job consists of assisting medical and/or nursing staff with various nursing and/or medical interventions. These duties are classified as routine tasks involving no risk for the patient. Orderlies are typically dressed in all white clothing.”

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  2. This study really doesn’t surprise me. Once a diagnosis is alleged/admitted, all of a person’s actions and speech are seen through that lens. If you’re alleged to be bipolar and you start acting out and resisting assault (perhaps restraints, isolation or both), then you’re even “sicker,” perhaps borderline, perhaps schizoaffective. So it only stands to reason that if you’re a normal who talks nonsense (perhaps religious gobbledygook) then you’re fine. But if you’re mentally ill and do the same thing, then you’re biochemically deformed.

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  3. This is fascinating and disturbing to me. I’m someone who believes I (occasionally) suffer from something that I don’t have a problem calling, at least, a deviation from a state of functioning that I desire to correct, when the state is operative. The “depressions” and “manic episodes” and “psychoses” — and I agree that there should be, but what *would be* better names; they are a thing that need to be referred to using language) I have experienced were at once real, and broken from reality (as I had experienced reality throughout my lifetime). But that’s, of course, a wholly separate question than, does science know how to treat the condition. I am increasingly, highly, skeptical of that, and in particular about the long term use of anti-psychotics. To the extent I agree the ideas of folks on this site regarding the importance of gaining a “consciousness” it is more along the lines of , full recovery requires one ultimately to believe that science is in its infancy, purports to know far more than is known in the area of psychiatry, and is corrupted by pernicious influences that exacerbate psychiatry’s lack of usefulness and proclivity to cause harm. Psychiatrists in some respects, it seems, are not real doctors. I’ve already been taken aback over the years by my observation that I feel like I can do as good (i.e. bad) a job as the psychiatrists I’ve been treated by in making prescription decisions. It’s like rolling the dice and trying again if you don’t get the numbers you want. There is some level of expertise in terms of what kinds of drugs (weighted dice) are supposed to treat what kinds of mood states. I also accept that, *for me* some of these drugs will occasionally have some short term benefits, as measured by reverting the “broken from reality” to the reality I’d previously known. But I feel like I know how to weigh the dice pretty cold, as a layperson. This is a kind of consciousness that doesn’t require disbelief that something biologically wrong is going on. Don’t get me wrong — names and stigma are extremely, extremely problematic. A 60 minutes piece not long ago featured Iraq/Afgan war veterans who had suffered brain trauma in combat. I was disgusted by the fact that it seemed as much or even more important for the soldiers suffering the brain injury to be able to see a cat-scan that showed that the brain was damaged by an external force, and was not organically compromised. The soldiers rejoiced in relief at being able to confidently say that the mood states they were in, depression, anxiety, etc., were not mental illnesses and, therefore “not their fault” and “not an exhibition of weakness.” This study shows that their concerns were rational, as they would be treated differently by others were they diagnosed with an illness or disorder. If am fully cognizant of, and have experienced first hand, the stigma that is associated with being labeled “mentally ill,” depressive, bipolar, and schizo-affective.” Is anyone here comfortable at all with describing these mood states as a deviation, objectively, from a reality that a person requires to occupy in order to function effectively in the (*this*) world? Absent infinite wealth and and zero stress?

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    • ” The soldiers rejoiced in relief at being able to confidently say that the mood states they were in, depression, anxiety, etc., were not”

      I don’t think a CAT scan proves that at all. They are also still veterans. Their ‘combat fatigue’ could just as easily, is probably just environmental like that of their comrades. Especially considering the implausibility of their brain injuries damaging no objective bodily system, they can still walk, talk, eat, etc, but their injury is alleged to ’cause’ identical life problems as that of their non brain injured fellow combatants? Forgive the dysphagia analogy but that is hard to swallow.

      You use the word ‘function’ a lot, the ‘functioning’ of a human being in a mass society is just life, sometimes it is hard sometimes it is easy. Approaching it from a machine-like angle, as if ‘reality’ is some objective stone cold fact, an indicator of health as clear as a beating or dead heart, is IMO not the ideal way of looking at it.

      And it is not that ‘science is in its infancy’. Science isn’t an appropriate tool for for these problems. Looking to false experts on states of mind that the experts haven’t even experienced, is folly IMO.

      It isn’t the tranquilizer drugging on its own that ‘changes reality back to’ your previously preferred way of making your way in the world, there are many other factors you may be forgetting, the passing of time, the place of asylum and the concern of others, the persuasion society’s response to your state of mind engendered in you concurrent with the period of drugging, yet you attribute it all to the drugging. Don’t discount your own role in stepping back from the abyss. This was your reality for a while, this was a part of your life, I know some people get very, very, fearful of it, my position is that the more you see yourself as the ‘passive victim of an active disease’ (Rufus May), the more fearful people are, and the less self mastery and acknowledgement of the degree of their own control over their lives over their entire lifespan they will take responsibility for. Some weeks less control than others, but always, some control.

      How many generations have lived and died waiting for ‘psychiatric science’ breakthroughs that never come? I refuse to be a helpless victim waiting for the technics and ‘expertise’ of others to master my own mind for me. I mastered my mind. I achieved a solidity to my way of making my way in the world and I will retain it. Everything past has made my mind stronger.

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  4. This is fascinating (and, as above, disturbing). It beautifully demonstrates that the flow of ‘biological abnormality’ to signs and symptoms just isn’t so. All sorts of confounding and mitigating factors get in the way, not least of all the person’s expectation of how he should respond as a ‘schizophrenic’.

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  5. Personally, I think so-called “schizophrenia” is mostly a language problem in itself anyway.

    I also think “schizophrenia” itself is a junk term.

    And, it is an omnipotent *negative* term. Detrimental and destructive in itself. It’s like the boogy-man or WORSE. It’s like, satan in the Garden of Eden and God is the *disembodied* voice. Schizophrenia is a BAD word.

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  6. At first, I thought this was an attempt at humor regarding the “diagnosers,” suggesting that they were “dependent on diagnoses” and that such dependence had a neurological underpinning. Might yet make a great article for The Onion or some such farcical publication.

    I’ve seen this phenomenon too many times to catalog. My favorite is a kid in residential treatment who was said to be “sexually acting out.” His crime? He drew pictures with large penises on them, and he engaged in “sexualized talk with his peers.” His age? He was 12 years old! Ever know a 12-year-old boy who wasn’t fascinated with penises, or didn’t have sexualized talk with his peers? But because he was in a “mental health facility,” this normal behavior was labeled as aberrant.

    Glad someone is reporting on this, but it’s kind of obvious that it happens, which is why an objective measure of health/illness is critical before we “diagnose” people. Otherwise, any prejudice we entertain can become a “disorder.” Which is pretty much what the DSM is all about.

    — Steve

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    • This is slightly off topic but I was reminded of it by your response. In 2003, I worked for one month in a psychiatric facility for sexually offending adolescents, although it should have been called a facility for sexually offending boys since there were no girls at all in the 100 people locked up there. As a new staff person (read guard in place of staff person) I was constantly reminded of how important it was to document all “sexually acting out” behavior on the part of the boys; I was to document each and every incident that I witnessed.

      The definition for “sexually acting out” behavior was so broad as to be totally ridiculous. A boy who came out of his room into the hall in bare feet was labeled as sexually acting out. Absently adjusting your shirt so that your stomach was briefly displayed was “sexually acting out.” Let me tell you, these boys couldn’t win for losing and were constantly punished for “sexually acting out.” We psych techs, that was my wonderful title, were constantly kept busy documenting in the charts about “sexually acting out” behavior, these entries dominated all other things in the charts. I once commented that by the very fact that the boys existed they were obviously “sexually acting out” since almost everything that they did was labeled as such.

      Here’s the kicker. Many of the female staff often wore tight, hip hugging jeans that were low cut, low cut blouses and blouses that exposed the navel, and flip flops or sandals. I went to the psychiatrist who was the so-called medical director of this place and asked why women staff were allowed to dress this way around teenage boys. I asked whether the women’s choice of dress was a form of “sexually acting out” behavior. His response was that I obviously didn’t understand how the facility was trying to help the boys.

      Essentially, the boys were being punished. I saw very little of anything that amounted to actual “help” I witnessed constant take downs and shots given because 100 boys were crammed together in a tiny space with nowhere for them to get away from one another. Trying to be by yourself was labeled as “sexually acting out.” Four boys were assigned to each tiny room and they each got five minutes in the bathroom alone in the morning. If they went over the time limit they were obviously “sexually acting out” in the bathroom. The boys were constantly watched, even when they slept at night. At night every four bedrooms had two staff sitting in the hall back to back. Each staff watched eight boys in two rooms, documenting every fifteen minutes what each boy was doing. They were not allowed to sleep with their backs to the doors because you obviously know what they might be trying to do! You got it, “sexually acting out.”

      After one month I realized that the staff and the facility were “sick” in many ways and that the boys were at the mercy of these people who got off on controlling each and every moment of these boys’ lives. I walked in one night and threw my badge and keys on the charge nurse’s desk and walked out. This is a liscensed psychiatric facility. Oh yes, the toxic drugs were dispensed with a very free hand to each and every boy there. I suspect it was to keep them from “sexually acting out!” It should be closed.

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      • This was before my time in the state hospital as a patient and before my “enlightenment” as to how psychiatry and the system are not in the business of truly helping people.

        With my own experience in the system looking back on my month there I now realize just how horrible those boys had it who were sent there to be “helped” so that they would no longer “sexually act out.” What a devastatingly sick system it all truly is.

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