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Monday, 22 December 2014
"Conduct Disorder" is Associated with "Deficient Empathy" - You Don't Say!

If brevity is the soul of wit, verbosity is often the veil of ignorance. There was an instance of this in a recent article in the New England Journal of Medicine, with the title “Conduct Disorder and Callous-Unemotional Traits in Youth.” At considerable length and with much polysyllabic vocabulary, it told us much that we already knew (some of it true by definition). It mistook the illusion of progress for progress itself.

The paper starts with a definition:

The term “conduct disorder” refers to a pattern of repetitive rule-breaking behavior, aggression and disregard for others.

It sounds to me like a recipe for success in the modern art world, where “transgressive” is a term of the highest praise. But, says the paper, such problems have received increased attention recently, for two reasons: first, young people with conduct disorder sometimes “perpetrate violent events,” and second, the Diagnostic and Statistical Manual of Mental Disorders has modified its criteria for diagnosis. This latter seems to me an odd reason for increased attention. (Whose attention, by the way, the authors do not specify. The attention is like the pain in the room as described by Mrs Gradgrind. She thought there was a pain somewhere in the room, but couldn’t positively say that she had got it.)

The authors say that those with conduct disorder fall into two main groups. There are those whose aggression is the consequence of anxiety and over-sensitivity to signs of threat, and those whose aggression is the result of a failure to empathize with others. The latter have a worse prognosis than the former; in other words, they are more likely to grow out of it.

The paper made me think that we are back in the age of Molière (or perhaps we never entirely left it): the doctor in the Imaginary Invalid tells his patient that opium causes sleep because of its “dormitive property.” The NEJM tells us, nearly three and a half centuries later, that “Deficient empathy shows a particularly sensitive selective association with conduct disorder accompanied by callous-unemotional traits.”

Of course it does, because callousness means indifference to the suffering of others, as does deficient empathy. One way of testing the meaningfulness of an assertion with supposedly empirical content is to examine whether its opposite is either absurd or conveys no different meaning: and clearly the assertion that deficient empathy had no connection with callous-unemotional traits would be absurd.

We are likewise informed that “deficient brain functioning may be associated with deficient decision making,” which will come as a surprise only to those who believe that the brain has nothing whatever to do with conduct, or who would be surprised to learn that good brain functioning may be associated with good decision making. I suppose that mediocre brain functioning may be associated with mediocre decision making as well.

Again, the mystery of human conduct is reduced to that great duo, that constant tandem, that indissoluble double act, nature and nurture. In other words, some people are born with a propensity to be bad, and that propensity may be reinforced by bad things in the environment, such as drugs, punitive mothers, etc. (Others are born good, but we are not interested in them.) We all fall somewhere on the spectrum of genetic and environmental interaction, but do we really need the NEJM to tell us this?

The authors look forward to the day when we will be able to put people into some kind of scanner and out will come the reasons for their (bad) behavior. I don’t much look forward to that day myself – not that I expect to live to see it – just in case somebody put me in such a device and decided that, in view of the results, preventive detention would be best.

First published in PJ Media.

Posted on 12/22/2014 5:48 AM by Theodore Dalrymple
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