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- Does This Patient Need Psychiatric Referral?
- Giftedness and Psychological Abuse in Borderline Personality Disorder
- NonBlind Placebo Trial
- Personal Intelligence
- Psychiatry at JHU
Currently, there is no reliable instrument that directly assesses cognitive personality features such as intuitive talents or giftedness (Costa & McCrae, 1990; Stemberg & Smith, 1985; Taylor & Cadet, 1989). For this exploratory study, we developed a rough rating scale derived from Gardner's work on the concept of "personal intelligence" (1983, 1985). Gardner has provided detailed evidence that, in humans, there are at least six relatively independent or modular (Gould, 1992) categories of intelligence: linguistic, musical, logical—mathematical, spatial, bodily—kinesthetic, and personal. Personal intelligence consists of two intimately interrelated information-processing capacities involving perception of self and others: intrapersonal intelligence, or "access to one's own feeling life"; and interpersonal, or "the ability to notice and make distinctions among other individuals and, in particular, among their moods, temperaments, motivations, and intentions" (Gardner, 1983. p. 239). Accurate labeling of the latter includes empathy, the ability of a person to "place oneself into the skin of specific other individuals" (1983, p. 250). This sophisticated form of intelligence is unique to and has been central in the evolution of primates, and its expression is markedly vulnerable to cultural and caretaker influences (Byrne, 1991; Cheney and Seyfarth, 1990; Gardner, 1983; Lieberman, 1991; Small, 1990). Gardner provides an argument that, as with other forms of intelligence, personal intelligence has a range of individual variation, including exceptional individuals.
Our scale is based on the proposal that borderline patients are such exceptional individuals. Because of additional assumptions that borderlines are largely blocked from access to this talent due to caretaker assault, but that they retain a strong innate need for such access, we included preoccupation with, as well as access to, feelings and perceptions. The preoccupation must reflect efforts to understand or resolve feelings and perceptions about self and others, rather than simply reflect a burden of symptomatic distress or strong affects.
We estimated the degree of personal intelligence or giftedness by rating patients as clearly showing the following:
- Intense preoccupation with and/or talented access to their feelings.
- Intense preoccupation with and/or sense of the feelings of others.
- At least 3 perceptive intuitions or insights about others expressed during therapy.
- (a) Capability of empathic concern for important others is clearly evident at times; and (b) grandiosity, devaluation, and envy are not pervasive.
Item 4 is added based on the commonsense assumption that perceptual giftedness generally would not be associated with absence of a capacity for genuine concern or caring for others, or with pervasive grandiosity/devaluation. Further, . Perry and Cooper (1986) found that omnipotence and devaluation are characteristically narcissistic but not borderline defenses. Grandiosity, devaluation and envy were judged to be pervasive if they were detected frequently and in many contexts, and were highly resistant to change or insight.
A score of 1 to 4 was given to each patient according to how many of these criteria were met, and we arbitrarily assigned patients with scores of 3 or 4 as gifted.
We examined histories for evidence of caretaker abuse, and for patterns of parental behaviors and attitudes. This information was obtained from review of records and from direct questioning of patients, who were informed this was for research as well as for treatment purposes.
Caretaker abuse was categorized as chronic physical, sexual, and chronic, pervasive verbal/psychological. We realize that physical and sexual abuse are also forms of psychological abuse (Byers, 1987; Wolfe, 1991), but for the purposes of this study they are classified separately. Again, there is no satisfactory standardized rating scale for varieties of psychological abuse, and we devised a simple one for this study based on our clinical experience and review of the literature (Bowlby, 1984, 1988;Cicchetti & Carlson, 1989; Kohut, 1971; Miller, 1981; Shapiro, 1978; Soloff and Millward, 1983). We subcategorized chronic verbal/psychological abusive behaviors as: neglect; constant devaluation; intrusion/invasion; attack on autonomy; and attack on, depreciation of, or total nonrecognition of the child's special access to intuitive Insights. We required clear reports Involving incidents or behaviors that occurred on a repetitive basis. Because psychological abuse cannot be measured clearly, we did not make a rating unless we felt it should be obvious to anyone, and did not classify a patient as psychologically abused unless 2 categories were checked.
In order to investigate in more detail our findings about psychological abuse, we further categorized patients' perceptions of parental behaviors and attitudes as: psychologically dominating, controlling, warm, empathic, and hostile.
RESULTS
Seventeen of the 23 BPD patients (74%) met the definition for giftedness, meeting at least 3 personal intelligence criteria, with 11 (48%) meeting all 4 criteria. A significantly smaller proportion of the controls (34%: 13/38) met at least 3 criteria, with 6(16%) meeting all 4 criteria (x2= 7.52, df = 1, p < .01). The second criterion, intense preoccupation with and/or sense of the feelings of others, was the most discriminating (96% borderlines vs. 45% controls), and the fourth, presumably an indicator of narcissistic tendencies, was the least (65% vs. 66%). (Only 2 borderlines and 4 controls met 4 or more DSM-III-R criteria for NPD.)
We reviewed these scores for gender differences and found that male borderlines received significantly higher scores than female borderlines (3.80 vs. 3.06: t = 1.82, df = 21, p < .05). Because there were only 5 males, this unexpected finding is suspect. However, it is in line with our clinical experience that all the male borderlines could be exquisitely sensitive to subtle cues from others, although this was not evident on casual acquaintance because they all tended to respond with male stereotypical concealment of personal feelings and/or with "antisocial" impulsive, threatening, angry, destructive, or self-destructive behaviors. For the controls, the average score was 2.00 for males and 2.13 for females (t = .33. df = 36, NS).