APPLYING DAVID
LEVY’S ERRORS IN CRITICAL THINKING TO SUICIDOLOGY
David Lester
Levy (2010) wrote a provocative book
on common errors in psychological research and theorizing. He did not focus on
suicide at all but, as I read his book, I could see how his errors occasionally
creep into our research and theorizing about suicide. Hence this essay in which
I explore Levy’s errors in critical thinking in suicidology.
Conceptualizing
Phenomena
Error 1: Language is Evaluative
Although language may sound
non-judgmental, there is often an evaluative connotation to particular words.
Language, then, can affect our thoughts and attitudes and, vice versa, our
thoughts and attitudes can affect our language. It is important, therefore, to
not present our value judgments as objective reflections of truth.
A good example here is from Robins,
Murphy, Wilkinson, Gassner and Kayes (1959). They looked at the past history of
134 completed suicides and found that only eight were not psychiatrically ill
and, of these eight, five had a terminal illness.[1] Are
the results of this study objective truths? First, as we will see in Error 2,
psychiatric diagnoses are constructs and not real things. Second, a perusal of
other studies on this issue finds that the proportion of suicides judged
retrospectively to be psychiatrically disturbed ranges from about 33% to the
94% reported by Robins, et al. Thus, it seems that the article by Robins is an
opinion. Robins and his team believe that one must be psychiatrically disturbed
in order to die by suicide. Their “scientific” study is merely a subjective
opinion of normality versus abnormality. Their language is a value judgment
that “suicidal individuals are crazy.”
Error 2: The Reification Error
This refers to the error of regarding
abstracts concepts as if they are concrete objects. Levy gives the example of self-esteem. Self-esteem is not a thing
that a person has; it is a concept that psychologists have created to explain
behavior. In suicidology, we typically study a behavior, attempted or completed suicide, but most of our
explanatory concepts are concepts.
Levy draws attention to the often-made distinction between physical and mental
problems. Physical things are concrete things, whereas mental things are
abstract concepts. The unconscious was not discovered; it was invented.
Psychosis is not detected; it is declared.
Levy noted that theories can be
event theories (Type E) or construct theories (Type C). Bullying increases the
risk of suicide is a Type E theory; perceived burdensomeness increases the risk
of suicide is a Type C theory. Type E theories can be proved and refuted. Type
C theories cannot be proved directly. Levy noted that we can neither prove nor
disprove the existence of the unconscious. Type C theories can be evaluated
only on their usefulness. For example, is Einstein’s theory of gravity (a
construct) more useful than Newton’s
theory of gravity. Because Type C theories cannot be disproved, people mistake
them as truths, and the theories survive longer than they should after they
have outlived their usefulness.
Error 3: Physical and Psychological
Events occur Simultaneously
Psychological events include
perceptual, experiential, cognitive and mental variables; physical variables
are biochemical, physiological, anatomical and neurological. What is the
relationship between these two sets of variables. Do physical events cause psychological variables? For
cause-and-effect
(i)
Event
A must occur before event B
(ii)
When
event A changes, event B changes accordingly.
Physical
events can occur without psychological consequences. (For example, physical events
occur after death!) On the other hand, psychological events cannot occur
without physical events. When we observe a patient, the physical and
psychological events occur simultaneously. Therefore, Levy argues, it makes no
sense to say that a patient’s problem is physical or mental. It is always both.
Furthermore, if the physical and mental variables are measured at the same
time, it is not possible to say that one variable caused the other.
In most research on suicide,
researchers identify physiological (and psychological) correlates of suicidal
behavior. Since these are occurring simultaneously, criterion (i) is not met. In
most suicide research, event A is rarely measured before event B (suicidal behavior). Furthermore, when longitudinal
studies are conducted, event A is often a construct. For example, Lester (1991)
studied the gifted children followed up in the Terman study at Stanford
University. Lester found that the parents’ judgment that their child at age 10 had
a strong desire to excel predicted suicide later in life rather than earlier in
life. The parents’ judgment cannot be
said to have caused their child’s
later suicidal behavior. Furthermore, the desire to excel is a construct, and
so we cannot conclude that this desire caused the later suicidal behavior. On
the other hand, loss of the father by death or divorce and a longer pregnancy
predicted suicide at an earlier age. Here were an actual event at time 1 and a
behavior at time 2. This meets criterion (i) and avoids reification (Error 2).
Error 4: The Nominal Fallacy
This fallacy involves naming a
phenomenon and then thinking that we have explained it. Levy gives an example.
Why does she have difficulty falling asleep? Because she has insomnia. This is
a tautology. An example of this is
one of the earlier explanations for the sex difference in suicide rates. Why do
men die by suicide more than women while women attempt suicide more than men
do? Because men have a stronger suicidal intent. This is a tautology and not an
explanation.
Error 5: Dichotomous versus Continuous
Variables
Variables can be divided into two
mutually exclusive categories or they can be continuous. A person who engages
in a suicidal act may either survive or die - a dichotomy. But normal-abnormal
or conscious-unconscious, for example, are continua. Errors occur in theorizing
when scholars dichotomize variables that are continuous. This arose, for
example, in discussions as to whether suicide bombers are suicides or not. Some
argue that they are not suicides (e.g., Abdel-Khalek, 2004), but the level of
suicidal intent is a continuous variable, not a dichotomous variable. We
should, therefore, talk of degrees of suicidal intent.
Error 6: Not Considering the Opposite
Levy noted that in order to define a
concept, we need to define its opposite. To define mental illness we need to
also define mental health. Levy gave an example of considering the opposite by
contrasting research into changing people’s attitudes that was stimulated by
McGuire and Papageorgis (1961) who considered instead the question of how we can
resist attitude change, leading
researchers into the study of inoculation.
An excellent example in suicidology
is an old paper by Norman Farberow (1970) in which he addressed the problem of
raising a child so as to maximize the probability that the adult would die by
suicide. It provided a stimulating contrast to the typical papers on how to
prevent children from becoming suicidal. More recently, after years of research
on risk factors for suicide, interest has turned to protective factors. In some
instance, a protective factor is simply a low score on a scale measuring a risk
factor, but some constructs, such as reasons for living (Linehan et al., 1983),
are unique.
Error 7: All Things are the Same;
Everything is Unique
Levy noted that, when we contrast
two objects, they can have no overlap, a little overlap, a great deal of
overlap, and complete overlap. When comparing two objects, no matter how much
they have in common, at some point there will be a conceptual fork or
bifurcation in the road after which they differ. Levy called this fork the point of critical distinction (PCD).
Before this point, the two objects are similar; after this point, they are
different. This results in two types of error.
Error 7a: Differences Obscured by
Similarities
Here, we let the similarities
between two phenomena eclipse their differences. At a telephone hotline, the
crisis counselor may decide, “Here we have another typical depressed
middle-aged man (or woman),” and miss the unique features of this particular caller.
The crisis counselor then inappropriately applies the usual “cookie cutter”
approach.
Error 7b: Similarities Obscured by
Difference
Levy gives the example of a black
client telling a white counselor that the counselor could never understand his
(or her) problems. The counselor might respond, “You’re right, I can’t. But I’m
a woman, and I have experienced discrimination because of my sex, and so I have
had similar experiences. We are both similar and different.”
Levy suggests always asking two
questions. How are these two phenomena similar? How are these two phenomena
different? For example, Lester (in press) recently asked how suicide bombing,
protest self-immolation and hunger strikes are alike and how are they
different.
Error 8: Confusing “Is” with “Should”
Levy called this the naturalistic fallacy, and noted four
variants: (i) if something is common, then it is good, (ii) if something is
uncommon, then it is bad, (iii) if something is common, then it is bad, and
(iv) if something is uncommon, then it is good. With respect to (i), Levy noted
once upon a time, slavery, child labor, public torture and burning books,
heretics and witches were all common. Were they good?
Levy noted that evolutionary
psychology labels behaviors that propagate the genes of the individual (or the
genes of his or her family group) as “natural.” It is natural for men to seek
as many young female partners as possible while women prefer monogamous
relationships with rich and powerful men. Does this make the sexual double
standard acceptable? High suicide rates among those unable to pass on their
genes effectively helps the group. Does this make it acceptable? Examples can
be found of all four variants of the naturalistic fallacy.
Error 9: Correlation does not Prove
Causation
I hope we have all learned this
lesson well in our undergraduate statistics and research methods courses!
However, Levy noted a variant of this in which it assumed that, because two
events occurred close to each other in time, one caused the other – the contiguity-causation error. We run the
risk of this by giving too much weight to the “precipitating event” when trying
to understand why an individual chose to die by suicide. This error results in
magical thinking and superstition, as in many athletes who wear their “lucky” clothing
to improve their chances of winning.
Error 10: Failing to consider Bidirectional
Causation
As we know, a correlation between
two variables A and B means that A could have caused B, B could have caused A,
some third variable C could have caused both A and B, or events A and B could
have a bidirectional causal loop. In the 1960s, there was a debate over whether
physical punishment caused misbehaving children or whether naturally
misbehaving children were so difficult to control that their frustrated parents
turned to physical punishment. Rather, there could have been a causal loop (or a vicious cycle) at work. A similar bi-directionality could take
place in the link between, say, drug use and depression.
Error 10: Failing to Consider Multiple Causation
Levy called this the either/or fallacy. What is the cause of
depression and suicide? Is it internalized anger, learned helplessness, or too
little serotonin in the central nervous system? Levy suggested replacing “or”
with “and.” Levy also noted that taking the “and” approach can lead to complex
linear and nonlinear combinations of variables in our theories.
Error 11: Not all Causes are Created
Equal
It is easy to find multiple causes
for a behavior if we think hard enough. Why am I a professor? The four major
reasons (May, June, July and August), overcompensation for the stutter I had as
a child, my exhibitionistic tendencies, etc.? Why did you, who are reading this
essay, decide to study suicide? Levy suggested that each contributing cause
differs in weight, degree or magnitude, and we should not neglect causes with less
weight.
Error 12: Different Causes, Same Effect
A behavior, such as depression, can
be caused by many factors, such as withdrawal from drugs, vitamin deficiencies,
starvation, loss, failure, loneliness, trauma, irrational thought patterns,
etc. The same applies to treatment.
Depression can be ameliorated by antidepressants, cognitive therapy, supportive
interpersonal relationships, etc. The error comes in assuming that similar
outcomes must have similar causes.
Error 13: The Fundamental Attribution
Error
Levy defines this as our bias to
attribute a behavior in an individual to internal factors and minimize external
factors (the situation in which the individual finds himself or herself). If
you hurt me, then you are cruel. If you fail to tip me when I serve you in a
restaurant, then you are stingy. This results in our tendency to blame the
victim (such as the rape victim or the battered spouse). The contrast occurs
when we explain our own behavior, especially if it is behavior of which we are
not proud. Then we typically hold the situation as responsible. If you do well
on an exam, you take the credit for being brilliant. If you fail, you blame the
examiner or some other factor in the situation that was not under your control.
Levy suggested that the fundamental
attribution error comes from our cognitive bias (in a situation, we focus on
the other actors) and from our motivational bias (we endeavor to satisfy our own
personal needs). Levy advises us, “Never underestimate the power of the
situation” (p. 102).
Error 14: The Intervention-Causation
Fallacy
A good example of this is when you
have a headache and take an aspirin. The headache goes. Did you then have an
“aspirin deficiency” disease that caused the headache? Modifying an event does
not, per se, prove what caused the
event – the treatment-etiology fallacy.
The causes of most events are multiple, and so are the ways of reversing the
outcome. Individuals can become suicidal from many causes, and they can be
helped to a non-suicidal state using many techniques. The method we use to help
them does not necessarily indicate
what caused the suicidal state (although, on some occasions, it might).
Error 15: The Consequence-Intentionality
Fallacy
This is more simply phrased as the effect doesn’t prove the intent. It
may in many situations, but not always. Levy gives the example of someone who cuts
their wrists severely. Can we assume that their intent was to get attention –
as in Farberow and Shneidman’s (1961) classic book on attempted suicide which
they called The Cry for Help? Levy
suggests other possible causes, including self-punishment, sensory stimulation,
confirmation of life, reification of emotion, catharsis, revenge against pain,
displacement of anger, psychological control and suicide. Sylvia Plath died by
suicide in 1963 in London, England, using toxic domestic gas. Did she intend to
complete suicide? Alvarez (1972), one of her friend’s thought not. He argued
that her behavior was a cry for help and that she expected a visitor that
morning who would break in and save her. In order to avoid this error, Levy
suggested that we think of other possible causes for the behavior (Error 10
above).
Error 16: Relying on Feelings
Levy calls this the “If I feel it, it must be true” fallacy. Levy
noted four possibilities here.
(i)
Comfortable truths: feeling good and the event is true
(ii)
Comfortable falsehoods: feeling good and the event is false
(iii)
Uncomfortable truths: feeling bad and the event is true
(iv).Uncomfortable
falsehoods: feeling bad and the event is false
One of the best examples of these
types of fallacies is the controversial debate over the validity of repressed
memories of childhood sexual abuse. Those who believe that they have recovered
such a memory or helped someone recover such a memory rely on (iii) above – if
it feels bad, then it must be true. If a client of a psychoanalyst becomes
uncomfortable, and even hostile, as a result of a particular interpretation
made by the psychoanalyst, then this “resistance” and “defensiveness” is often
used to confirm the validity of the interpretation, again an illustration of (iii).
Levy emphasizes that one’s feelings
are not an accurate or trustworthy guide to the truth.
Error 17: The Spectacular Fallacy
This fallacy involves thinking that
an extraordinary event requires an extraordinary cause. Of particular relevance
to suicidal behavior, Levy notes that extraordinary human behavior (such as
catatonia, hallucinations, bestiality or cannibalistic serial murder) pushes us
to search for spectacular causes and to propose extraordinary theories to
account for it. Levy argues that this is not a valid assumption. Extraordinary
events occur sometimes by chance, as any gambler knows, or as a result of
ordinary events. Psychoanalysis is based on the proposition that abnormal
behavior is governed by the same principles as normal behavior. There is no
qualitative difference between the two categories of behavior.
Error 18: The Pitfalls of Inductive and
Deductive Reasoning
Errors in deductive reasoning come
from starting with erroneous premises and from using flawed logic. Inductive
reasoning is based on data, generalizing from observations to broader
principles, looking for patterns in the observations. This can lead to
erroneous conclusions in several ways: (i) drawing primarily on our memory of
only vivid or salient observations, (ii) ignoring statistical principles such
as sample size and probability, and (iii) selectively seeking observations that
are consistent with our theory and ignoring those that are inconsistent.
Error 19: Disturbing the Phenomenon by
Observing It
It is often the case that observing
a phenomenon changes the phenomenon. For example, the phrasing of questions in
an inventory can affect people’s responses. It has been argued that
interviewing attempted suicides in the emergency room produces invalid answers to
the clinician’s questions because the attempters, in all likelihood, do not
wanted to be admitted to a psychiatric unit and so present themselves as
hypernormal.
When
interviewing survivors of those who died by suicide, the survivors may answer
questions in an effort to disguise their true thoughts and feelings in order to
promulgate a particular interpretation, such as avoiding admitting their own
responsibility in their loved ones suicide. Lester (2013) gave a good example
of this from an account by Meng (2002) of a wife, Fang, who died by suicide in
China. The precipitating events for this suicide were quarrels with her in-laws
and domestic violence as a victim of her husband. Her in-laws viewed Fang’s
suicide as a foolish act for it cost the family a great deal in terms of cost
and reputation. Fang’s parents saw Fang’s suicide as a forced decision. They
blamed Fang’s in-laws, destroyed furniture in the in-laws’ house and demanded a
very expensive funeral and headstone for Fang in her in-laws burial plot. The
villagers gave Fang’s suicide a mystical interpretation, believing that she was
taken by a ghost, which served two functions: (1) to avoid blaming Fang or her
in-laws, and (2) to escape from a sense of responsibility themselves for Fang’s
suicide by not intervening. The asking of questions by the investigator most
likely led the interviewees to think about what the result would be for
different answers that they might give and which result they preferred.
In laboratory experiments, the
researcher can sometimes use unobtrusive measures such as hidden cameras and
one-way mirrors. For the study of suicide, perhaps only the study of documents,
such as suicide notes and diaries, are unobtrusive ways of studying the
behavior.
Error 20: Self-Fulfilling Prophecies
Levy notes that the attitudes we
have toward others can affect their behavior and certainly our judgments about
those others. In victim-precipitated homicide, an individual consciously or
unconsciously provokes another into killing him. In psychic homicide, an
individual consciously or unconsciously encourages another to die by suicide.
Some psychological research involves judges, often clinicians, making judgments
about others. This is so when psychiatrists make diagnoses, but it also occurs
when using judges to rate interviews or written material. Often researchers and
judges are not blind to the theory and hypotheses behind the study, and this
can bias the results.
Error 21: The Assimilation Bias
Psychologists frequently categorize
phenomena and behaviors, and we use schemas to do this. Our schemas are general
expectations, preconceptions or theories about the phenomena we are studying.
What happens when we encounter a phenomenon? If it fits into our schemas, we assimilate it. If it does fit into our schemas, we have to accommodate, that is, shift our schemas
so that now the new phenomenon fits in.
This leads to several possible
errors including, (i) noticing only that information which is consistent with
our theory, (ii) selectively searching for information consistent with our
theory, and (iii) distorting the information so that it fits our theory.
Rosenhan’s (1973) classic study of sending normal individuals to a psychiatric
inpatient unit complaining of hearing voices illustrates this bias. The eight
individuals were admitted and eventually released with schizophrenia in
remission after an average of 19 days (with a range of seven to fifty-two days).
Everything the patients did was construed by the staff as signs of abnormality,
such as taking notes and waiting for the cafeteria to open. None of the mental
health personnel thought that the patients were part of a study, whereas a
quarter of the patients confronted the pseudo patients and asked them why they
were really in the ward.
Levy provides a psychoanalytic joke
to illustrate the assimilation bias. If a patient arrives late for a session,
he is hostile; if arrives early he is anxious; and if he arrives on time, he is
compulsive!!!!! Levy points out an interesting problem here. Many clinicians
adopt (and perhaps believe in) a particular perspective – biomedical,
psychodynamics, cognitive, behaviorist, etc. They then assimilate all
information and observations into their perspective – the clinician orientation assimilation bias. Can suicidologists avoid
this orientation bias?
Error 22: Confirmation Bias
If we have a theory or a hypothesis,
it may be that, when we design our research, we selectively gather information
that will confirm our theory or hypothesis and we do not search for
disconfirming evidence. This is called confirmation
bias. Researchers show this when they select one statistical test over
another because the former confirms their hypothesis better than the latter.
Readers, of course, do not know how much data analysis has been tried and
discarded when they read the published paper. Another form of this bias is to
conduct research that only tests one’s preferred theory rather conducting
research that pits your preferred theory against a rival theory.
Error 23: The Belief Perseverance Effect
In the belief perseverance effect, researchers cling to their theory even
when disconfirming evidence comes along. They discount, deny or ignore such
evidence. An individual deviant can be eliminated by declaring the data from
that individual to be an outlier, and
sometimes the whole study can be discounted because of methodological flaws.
Error 24: The Hindsight Bias
In a good example of this, in my
early days as a research while still at graduate school, I submitted an article
in which I made a clear prediction and found the opposite result. The editor, a
famous psychologist, but whose name I’ll protect, rejected the paper, but gave
me advice. He first suggested which journal would accept the paper, and then he
told me not to predict one result and find the opposite. Predict what you
found.
How many of you, after you finished
graduate school, actually choose the significance level that you will use before you run the study? How many of
you had a data set, conducted a slew of analyses on the data set, and then
decided what the paper would be about and what hypotheses you would test? I
rest my case!
Error 25: The Insight Fallacy
The insight fallacy is thinking that, when we understand a phenomenon,
we now know how to change it. We know a great deal about the causes of suicide,
but the suicide rate in the United States is steadily rising, and many suicidal
individuals are in treatment but yet still die by suicide. This fallacy is also
found in some therapy clients who gain insight into the causes of their
problems but find it difficult to change.
Discussion
Levy’s
book on critical thinking and the errors we make is a stimulating book and
merits study by all researchers and theorists. I hope this essay intrigues you
to read it and consider whether you have made these errors yourself.
References
Abdel-Khalek,
A. M. (2004). Neither altruistic suicide, nor terrorism but martyrdom. Archives of Suicide Research, 8, 99-113.
Alvarez,
A. (1972). The savage God. New York:
Random House.
Farberow, N. L. (1970). Self-destruction and
identity. Humanitas, 6, 45–68.
Farberow, N. L., & Shneidman, E. S.
(1961). The cry for help. New York:
McGraw-Hill.
Lester,
D. (1991). Childhood predictors of later suicide. Stress Medicine, 7, 129-131.
Lester,
D. (in press). Suicidal protests. Behavioral
& Brain Sciences.
Levy, D. A.
(2010). Tools for critical thinking:
Metathoughts for psychology. Long Grove, IL: Waveland.
Linehan, M. M.,
Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for
staying alive when you ar ethinking of killing yourself. Journal of Consulting & Clinical Psychology, 51, 276-286.
McGuire, W. J.,
& Papageorgis, D. (1961). The relative efficacy of various types of prior
belief defense in producing immunity against persuasion. Journal of Abnormal & Social Psychology, 62, 327-337.
Meng, L. (2002).
Rebellion and revenge: The meaning of suicide on women in rural China. International
Journal of Social Welfare, 11,
300-309.
Robins, E.,
Murphy, G. E., Wilkinson, R. H., Gassner, S., & Kayes, J. (1959). Some
clinical considerations in the prevention of suicide based on a study of 134
successful suicides. American Journal of
Public Health, 49, 888-899.
Rosenhan, D. L. (1973).
On being sane in insane places. Science, 179,
250-258.
[1] I might note in passing that I
have to see a psychological autopsy study of completed suicides with an
appropriate control groups of people who died of natural causes, with a
standard interview protocol, and judges reading those protocols blind as to which
group each individual is in (and, even better, unaware of the nature of the
study and which groups are being compared).
