perm filename CHAP7[4,KMC]13 blob sn#067179 filedate 1973-10-15 generic text, type T, neo UTF8
00100	EVALUATION 
00200	
00300		The primary aim in constructing this model  was  to  explore,
00400	clarify, develop, test and improve -all with a model- a theory having
00500	explanatory value. To satisfy this aim, the model must meet norms  of
00600	internal    consistency   (systemicity)   and   norms   of   external
00700	correspondence with observation (testability). A secondary aim  would
00800	involve pragmatic norms of application.  These aims are not unrelated
00900	but the primary one is more  fundamental  since  useful  applications
01000	require some degree of consistency and correspondence to observation.
01100		As emphasized in Chapter  2,  a  model  in  the  form  of  an
01200	algorithm  consists  of  a structure of functions or procedures whose
01300	inner workings are  sufficient  to  reproduce  the  outward  symbolic
01400	behavior  under  consideration.   The theory embodied in the model is
01500	revealed  in  the  set of statements which illuminate the connections
01600	betweeen input and output, i.e.  which  describe  how  the  structure
01700	reacts under various circumstances.
01800		What constitutes a satisfactory explanation has been  treated
01900	in  2.1.     The "fit" or correspondence with facts of observation as
02000	indicated by measurements and empirical tests indicating  the  degree
02100	of  faithfulness  of  the  reproduction  were described in Chapter 6.
02200	Given that the model has met the above criteria, what does it  as  an
02300	artefact tell us about naturally-occurring paranoid processes?
02400		First, the model attempts to revisualize  or  reconceptualize
02500	the  phenomena  of  paranoid  disorders. They are not to be viewed as
02600	first-order "diseases" but as a mode of processing symbols  secondary
02700	to  a  primary  disturbance.  The  patterns  of  linguistic  paranoid
02800	behavior observed in an  interview  are  produced  by  an  underlying
02900	organized  structure  and  not by a variety of random and unconnected
03000	mechanical failures. Second, the underlying structure consists of  an
03100	algorithm,   an   organization  of  symbol-processing  strategies  or
03200	procedures. Third, the model as an analogy indicates that  to  change
03300	this structure, its procedures must be accessible to reprogramming in
03400	the higher-level language of the algorithm. Finally, as a  conceptual
03500	reform,  the  model  suggests  that  other types of psychopathologies
03600	might be viewed from a symbol-processing standpoint.
03700		Decision procedures for   consensus acceptability of a  model
03800	sometimes  depend  not  so  much  on  truth,  an elusive state, as on
03900	whether a majority of the  relevant  expert  community  believes  the
04000	theory  or  model to approximate truth to some unknown and unknowable
04100	degree and  to  be  better  than  available  plausible  alternatives.
04200	Validation  is  ultimately  a  private  experience of the individual.
04300	Empirical truth or falsity cannot be proven with certainty, but their
04400	presence  can  be  assayed  by  some  sort  of critical assesment and
04500	deliberation. We can forgive models for being only  nearly  true.   A
04600	theory or model may bring cognitive or pragmatic comfort, not because
04700	it is  TRUE  but  because  it  represents  an  improvement  over  its
04800	contending rivals.
04900		Cognitive comfort is a  type  of  intellectual  satisfaction.
05000	Pragmatic  comfort  accrues from applications to problems in order to
05100	make things work the way humans want  them  to  work  efficiently  in
05200	practical  contexts  of  technological  action. For the pragmatist, a
05300	model is a means to an end;  for  the  theoretician,  an  explanatory
05400	model  is  an end in itself. It is hoped that this paranoid model can
05500	contribute to understanding one of the mysteries  of  human  conduct,
05600	the  paranoid mode. There remains the enigma of the paranoid "streak"
05700	which renders whole nations  susceptible  to  idelogical  convictions
05800	in which Elsewhereans are believed to be malevolent oppressors.
05900		It  is  a  truism  of  methodology  texbooks that an infinite
06000	number of theories or  models  can  account  for  the  same  data  of
06100	observation.      Without   questioning   whether   "infinite"  means
06200	indefinitely large or just more than one, we  must  allow  for  rival
06300	explanations.  For a rival to be a live and tenable option, it should
06400	be truly alternative (i.e., not just a family version saying the same
06500	thing in a different way), and be confirmable or infirmable by tests.
06600		Although I  hold  that  faithful  reproduction,  fidelity  as
06700	measured  by  indistinguishability  along  specific  dimensions, is a
06800	proper and major test for the adequacy of simulation models, it would
06900	be a bonus if our model could satisfy the function of making possible
07000	new knowledge  through  prediction.   The  term  "prediction"  has  a
07100	spectrum   of   meanings  ranging  from  forecasts  to  prognoses  to
07200	prophecies to precise point-predictions in time.  To predict (and  to
07300	postdict)  from  a  theory  or model is to derive and announce a fact
07400	prior to  knowledge  of  its  actual  occurence.  However  one  needs
07500	knowledge  of the kind of fact expected, the conditions which produce
07600	it and the circumstances under which it will occur. The  interest  in
07700	prediction  may  stem from a desire (1) to confirm or infirm a theory
07800	or model or (2) to obtain useful information about the future, as  in
07900	weather  forecasting.  Celestial  mechanics  provides  the  ideal  of
08000	accurate long-range  predictions.  But  even  astronomers,  with  the
08100	advantage  of  studying  isolated  and repetitive systems, have their
08200	troubles.  In 1759  Halley's  comet  arrived  four  days  later  than
08300	predicted.   In spite of our advanced 20th century knowledge, in 1962
08400	this pesky comet arrived eight days later than predicted, making  the
08500	prediction twice as bad. (In fairness we must make allowances for the
08600	fact that great masses, distances and velocities are involved).
08700		Predictions of individual human behavior are severely limited
08800	by  our  restrictions  of  knowledge.    For  example, (1) sufficient
08900	knowledge of initial conditions may require that we  know  the  whole
09000	past  history of an individual (something not yet achieved for even a
09100	single person), (2) individuals do not remain isolated over the  time
09200	stretch of the prediction; they interact with other individuals of an
09300	unknown nature, (3)  since  life  is  a  fortuitous  flux  of  chance
09400	intersections of independent causal chains, one would also have to be
09500	able to forsee events of the physical environment  and  its  changes,
09600	(4)  the  process  of  observation  needed  to obtain information for
09700	predictions may have non-negligible and unforseeable effects  on  the
09800	observed.
09900		In  one  sense  our  paranoid  model  makes  moment-to-moment
10000	predictions and asserts  new  counterfactuals  about  behavior  in  a
10100	psychiatric  interview.  That  is,  if  an  interviewer  says X under
10200	conditions Y, then the model's  response  will  be  characterized  by
10300	z1...zn,   and   the   same   holds   true   for  paranoid  patients.
10400	Counterfactual  prediction  means  that  on  the  basis  of  observed
10500	behavior  we  are  willing,with  an  inductive  risk,  to  assume the
10600	presence of unobserved behavior potentials in a model's or  patient's
10700	repertoire of capabilities.
10800		Predicting  new  kinds  of  events  or properties, instead of
10900	kinds we are already familiar with, would represent a genuine  bonus,
11000	indicating  the  model is more than ad hoc and has excess content. It
11100	would give both clinicians and investigators something to  look  for.
11200	This  novelty  could  arise  in  two  ways.    First, the model might
11300	demonstrate a property  of  the  paranoid  mode  hitherto  unobserved
11400	clinically.      In  principle  this could come about because the I-O
11500	behavior of  the  model  is  a  consequence  of  a  large  number  of
11600	interacting  hypotheses  and  assumptions chosen initially to explain
11700	frequently observed phenomena.    When the elements of such a complex
11800	conjunction  interact  with  highly  variable  inputs  they  generate
11900	consequences in addition to those  they  were  designed  to  explain.
12000	Whether  any  of these consequences are significant or characteristic
12100	of the paranoid mode remains a subject for future study.
12200		It  is  also  possible that a new property of paranoia may be
12300	discovered in the clinical  interview,  although  perhaps  everything
12400	that  can  be  said about paranoid dialogues has been said.  If a new
12500	property were found, a search  for  it  might  be  conducted  in  the
12600	model's  behavior. If successful, this again would add to the model's
12700	acceptability.
12800		A second novelty might arise in the behavior of the model  in
12900	some  new situation.   Since it is designed to simulate communicative
13000	behavior in an interview situation, the `new' circumstance would have
13100	to involve some new type of linguistic interaction to which the model
13200	is capable of responding. From its behavior one  might  then  predict
13300	how paranoid patients would behave under similar circumstances.   The
13400	requisite empirical tests and  measures  would  show  the  degree  of
13500	correspondence between patient and model behaviors.
13600		This possibility is of importance in considering emancipatory
13700	therapies for patients  entangled  in  the quandaries of the paranoid
13800	mode.    Since the model operates at a symbol processing level  using
13900	natural  language,  it  is      this  level  at  which linguistic and
14000	conceptual skills of clinicians can be  applied.   Language-based  or
14100	semantic  techniques  do not seem very effective in the psychoses but
14200	they are useful in states of lesser severity. A  wide  range  of  new
14300	semantic  techniques, including extremes, could be tried first on the
14400	model without subjecting patients to blind experimentation.
14500		While we have used the model principally to explore a  theory
14600	and  to study psychiatric judgements, its potential use as a training
14700	device has  not  escaped  our  reflections.    Medical  students  and
14800	psychiatric  residents  need  "disposable  patients"  to  practice on
14900	without jeopardy (to either). A version of  the  paranoid  model  can
15000	display  the  changes  in  its  inner  states  during  an  interview.
15100	Whether  the  optimal  goal  of  interviewing   (gathering   relevant
15200	information  without  upsetting  the patient), has been achieved, can
15300	thus be estimated.     A  beginning  interviewer  could  practice  in
15400	private or with a supervisor present. Many interviewers have reported
15500	that the model has a definite effect on them.    The student can  get
15600	the  feel  of  the  paranoid mode long before he interviews an actual
15700	patient.     The effect  of  various  interviewing  styles  might  be
15800	studied and compared.
15900	
16000		Although this simulation of  paranoia  covers  a  variety  of
16100	facts,  it  is  circumscribed  in  what  it  attempts to explain. The
16200	proffered explanation is local and restricted in that it accounts for
16300	only  one  type  of  symbol-processing mode.  Past attempts at grand-
16400	scale explanations of all  mental  processes  in  all  contexts  have
16500	failed.  A  preferable  strategy, successful in other sciences, is to
16600	build one circumscribed and tested theory or model at a time so  that
16700	the  field  can  gradually  move  forward a step at a time, each step
16800	gaining consensus before attempting the next.