Saturday, September 25, 2004
Accept No Substitutes
By Katherine Tallmadge WP 08-25-2004 Many of us want to include nutrients, the right vitamins and minerals in our diet. But we often don't want to eat all the foods and calories required to get this balance. What we're looking for is a magic supplement that will give us more energy, improve the quality and length of life and prevent the chronic diseases of today such as heart disease, cancer and diabetes. While we know that certain foods have been shown to provide these benefits, can the right supplement do the same? Leading researchers are increasingly convinced that while supplements can serve many positive purposes, they cannot take the place of a well-balanced diet. "The thousands of vitamins, minerals and phytochemicals [beneficial plant compounds] in whole foods act synergistically together to create a more powerful effect than the sum of their parts, producing a result which cannot be recreated by supplements," says Jeff Prince, vice president for education at the American Institute for Cancer Research. Over the past century, nutrition experts gained a fuller appreciation of the need for a plant-based diet. Research began to show in the 1970s that certain patterns of eating, beyond vitamin and mineral intake, were influencing illnesses. By the 1980s, they found that populations that ate more fruits, vegetables and high-fiber foods experienced lower rates of cancer, heart disease and diabetes. Also, by that time, discoveries had been made that newly discovered phytochemicals and certain vitamins and minerals acted as antioxidants and might prevent chronic diseases such as cancer and heart disease. After all, it had been found that people with high blood levels of two antioxidant vitamins (a form of vitamin A called beta carotene and vitamin E) had reduced lung cancer rates. It had also been observed that people who ate more dark-green leafy vegetables (high in beta carotene) experienced less lung cancer, even if they smoked. Sensing a major breakthrough, the National Institutes of Health funded one of the biggest studies ever conducted. Known as the ATBC (Alpha-Tocopherol, Beta Carotene) Cancer Prevention Study, published in the New England Journal of Medicine in 1994, it tested the theory that the antioxidant vitamins beta carotene and alpha-tocopherol (vitamin E) would prevent lung cancer in smokers, the highest-risk population. After following 29,000 male smokers for six years, the stunned researchers found "a higher incidence of lung cancer among the men who received beta carotene supplements than among those who did not. In fact, this trial raises the possibility that these supplements may actually have harmful as well as beneficial effects." Needless to say, these revelations sent shock waves through the scientific community. "This study was a turning point in the nutrition field, especially when multiple studies kept confirming that supplements didn't work at preventing cancers and heart disease," says David Klurfeld, national program leader for human nutrition at the USDA's Agricultural Research Service. "People think that we can pull out the fiber, pull out the antioxidants. But research does not back that up. Study after study says you gain the most benefit from whole foods." That is not to say that supplements are of no use. They can be of great benefit, when taken based on individualized needs. Most nutrition experts recommend a daily multivitamin and mineral tablet for everyone. But supplements simply can't compete with better food choices. Consider recent findings: • When the ATBC Cancer Prevention study data was re-analyzed years later for consumption of fruits and vegetables, researchers found that while supplements did not prevent lung cancer, eating fruits and vegetables high in beta carotene (e.g., carrots, sweet potatoes), lycopene (e.g., tomatoes) and lutein/zeaxanthin (deep-green leafy vegetables such as spinach and kale) reduced lung cancer risk. • A diet high in cereal and vegetable fiber (35 grams versus 15 grams) reduces the risk of colon cancer by 40 percent, according to recent findings in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. But studies of fiber supplements have failed to find any benefits and some have found an adverse effect. • A diet high in fruit reduces lung cancer risk by 40 percent, also according to new EPIC study findings. Another study found subjects with a high fruit intake had a 44 percent lower risk of lung cancer compared with subjects eating the least amount of fruit. But when subjects added beta-carotene supplements, there was no benefit from the fruit. • Men who ate 10 servings of tomato products weekly reduced their risk of prostate cancer by 35 percent compared with men who ate fewer than 1.5 servings, according to a Harvard Health Professional study. While the benefit is largely attributed to the phytochemical lycopene, trials of lycopene so far have found it is less potent than the tomato. • A diet high in fruits and vegetables reduced stroke risk by 28 percent, and fruit alone reduced the risk by 40 percent, according to a study published in the American Journal of Clinical Nutrition in 2003. No dietary supplements have been found that significantly reduce stroke risk. • People who ate collard greens or spinach two to four times per week had a 46 percent decrease in risk for age-related macular degeneration (the leading cause of blindness) compared with those who ate these vegetables less than once per month, according to a study published in the Journal of the American Medical Association this year. No studies have found supplements prevent or improve macular degeneration. • People who eat more soy have a decreased risk for coronary heart disease, breast cancer and prostate cancer. But when various components of soy foods have been isolated and studied, these finding have not been replicated, and some have found adverse effects. • A diet high in antioxidant-rich foods helps prevent cardiovascular disease, but the studies of individual antioxidant supplements have been so inconclusive that the American Heart Association recently issued an advisory against taking them to reduce cardiovascular disease "Researchers are working as fast as we can to find the most effective components in foods," says Janet Novotny, research physiologist at USDA's Human Nutrition Research Center in Beltsville. "But so far, studies have shown that while fruits and vegetables are associated with decreased risk of chronic disease, studies of the isolated compounds in fruits and vegetables haven't shown an effect." Food and dietary patterns are complicated and expensive to study, and can defy the brightest minds and best intentions. In the meantime, the best advice is to eat a plant-based diet with at least five to nine servings of fruits and vegetables (you'll get the most benefit with the higher amount), at least three to four servings of whole grains and regularly eat legumes as a side dish or occasionally as your protein source. *** Katherine Tallmadge is a Washington nutritionist and author of "Diet Simple" (Lifeline Press, 2004). Send e-mails to her at food@washpost.com.
Friday, September 24, 2004
Against types
Personality tests are everywhere -- from the workplace to the courtroom. But critics say the tests themselves don't pass the test. By Drake Bennett, Globe Staff September 12, 2004 DO YOU PREFER a bath to a shower? Are you fascinated by fire? At parties, do you sometimes get bored, or always have fun? Do you sometimes feel like smashing things? Do you think Lincoln was greater than Washington? Do you feel uneasy indoors? Do you think questions like these tell us anything meaningful about ourselves, or do you think they're nothing more than parlor game fodder? Regardless of how you answer that last one, the fact is that personality tests featuring questions like those are everywhere these days. The Minnesota Multiphasic Personality Inventory, or MMPI, is taken by as many as 15 million people a year and used to screen applicants for jobs from police officer to nuclear technician to priest. Eighty-nine companies in the Fortune 100 use the Myers-Briggs Type Indicator to determine how and with whom their employees work best. The Rorschach test, the granddaddy of them all, is used diagnostically by eight out of 10 psychologists and routinely submitted as evidence in child custody cases, criminal sentencing, and emotional damage lawsuits. Online dating sites even use personality tests to help match prospective couples. Clearly, there's something about the elusive notion of personality, and the possibility of capturing it, that draws us to these tests. But an increasingly vocal group of critics is fighting this testing tsunami, arguing that many of the tests themselves have not been tested and that their unscientific conclusions may do far more harm than good. Last year, in "What's Wrong with the Rorschach? Science Confronts the Controversial Inkblot Test" (California), four psychologists dismissed the Rorschach test as having no more validity than "tea-leaf reading and tarot cards." In "The Cult of Personality: How Personality Tests Are Leading Us to Miseducate Our Children, Mismanage Our Companies, and Misunderstand Ourselves" (Free Press), due out later this month, Annie Murphy Paul, a former senior editor of Psychology Today, charges that personality tests "are often invalid, unreliable, and unfair" and that their prevalence has grave consequences, not least the distortion of the very idea of human nature to fit their arbitrary dictates. Each of the major personality tests has its impassioned defenders. But the dispute hasn't reached the clamorous level of, say, the argument over intelligence testing or the SAT. It may only be a matter of time, though. After all, the debate places two of our most powerful, and perhaps irreconcilable, impulses -- our desire to define ourselves in simple, concrete terms and our need to carve out a personal identity uniquely our own -- in stark opposition. . . . No personality test is more iconic than the one created by the Swiss psychiatrist Herman Rorschach [see sidebar]. In 1917 he hit upon the idea of showing subjects a series of 10 abstract, bisymmetrical inkblots (the same ones used today) and asking them what they saw. The blots' very ambiguity, he believed, created a sort of perceptual vacuum into which his subjects' inner tendencies flowed. Not only what they saw (morbid or unusual imagery, for example) but how they saw -- whether they picked out movement or tended to privilege color over form -- revealed their modes of understanding and, in turn, who they were. Rorschach believed the test could not only diagnose mental illness, but provide a detailed map of all "the numberless nuances of personality." The test achieved wide currency in the United States, but came under attack in the 1960s for its lack of statistical support. Today, the Rorschach might be only a historical footnote if not for a psychologist named John Exner, then a professor at Bowling Green State University, who in 1974 introduced a complex scoring matrix for the test called the Comprehensive System. It involved more than 140 components, including a Depression Index, an Egocentricity Index, and an Aspirational Ratio. Today, all Rorschachers swear by it. David Medoff, a psychologist and codirector of Massachusetts General Hospital's Children and the Law Program, is a staunch supporter of the test. He has used it to provide expert testimony in child custody disputes, sex offender evaluations, civil suits, juvenile delinquency cases, and other proceedings. "The Rorschach is routinely relied upon in the forensic realm," he said in a recent interview. "It's alive and well, and it's adding to the information base that judges and juries are using to make decisions." While Medoff is quick to add that the Rorschach is only used by psychologists and the courts as "one test among many," that disclaimer does little to mollify the test's critics. In legal and clinical settings alike, they argue, Rorschach evidence still carries plenty of weight, and as a result, decisions that can ruin lives or cost millions are being swayed by pernicious pseudoscience. A recent survey of forensic psychologists in the journal Professional Psychologist rated the Rorschach "unacceptable" for most courtroom uses. Howard Garb, one of the coauthors of "What's Wrong with the Rorschach?" and the head of psychological testing for the United States Air Force, believes that "only 10 percent" of Exner's Comprehensive System meets even the most basic scientific standards. Examination of the data in over 30 Rorschach studies, he argues, shows that the tests have a marked tendency to label healthy people mentally ill. In one 2000 study, for example, 100 mentally sound schoolchildren were given the Rorschach and the majority received scores indicating that they were borderline psychotic. As Scott Lilienfeld, an associate professor of psychology at Emory University and another "What's Wrong with the Rorschach?" coauthor, puts it, "People have looked and looked and looked at whether these scores relate to the kinds of psychological traits and behaviors that they're supposed to, and most of the studies show no effects or no relationships. And even when some positive findings pop up here and there they often are not repeated." Those few positive findings, he says, are usually from researchers affiliated with Rorschach Workshops, an organization Exner heads in Asheville, N.C. Exner acknowledges that some parts of the Comprehensive System aren't as solidly supported as others and cautioned that the test should be used as much as a "descriptive" as a "diagnostic" tool. He also concedes that his Depression Index doesn't really measure depression -- what it does measure, he says, is "emotional disarray" -- and admits that he has considered changing its name. But the other charges against the test are "nonsense," he says, and points to a sheaf of peer-reviewed studies -- some from Rorschach Workshops, some not -- backing up the claims of the Comprehensive System. Mass. General's Medoff, for his part, sees Rorschach opponents as scandal-mongers. "They've created this illusion of a controversy," he says. "They've singled out the Rorschach to the degree that few other psychological tests have been scrutinized. No psychological test is perfect." What's striking, though, is that not even Exner pretends to have any understanding of why the test works -- why, for example, a tendency to see in terms of color rather than form or to see pairs of images (which would appear normal in a symmetrical inkblot) might, as he claims, consistently predict depression or narcissism or even psychosis. Indeed, despite the purported statistical grounding of the test, it retains a sense of mystery -- and that's what seems to so infuriate its critics.
. . . Largely because of its complexity, the Rorschach hasn't spread beyond psychology (and even there it's under assault from HMOs and insurance companies reluctant to fund a time-onsuming test whose validity has come into question). Today, the testing boom is being fueled by user-friendly pencil-and-paper tests better suited to the business world. Like the Rorschach, the Minnesota Multiphasic Personality Inventory, or MMPI, was designed to spot the mentally ill. Introduced to the world in 1942 by Starke Hathaway, a psychologist, and J. Charnley McKinley, a neuropsychiatrist, both of the University of Minnesota, the MMPI contained 504 statements -- such as "Several times a week I feel as if something dreadful is going to happen," "I wake up fresh and rested most mornings," "There is something wrong with my sex organs," and "Often I feel as if there were a tight band around my head" -- to which the subject was instructed to respond "True," "False," or "Cannot say." At the time the test was unique in proposing to determine pathology not by looking at the substance of the responses, but simply by comparing them to those of a control group of 724 presumably sane Minnesotans (the relatives and friends of the patients at the university's hospital) who had also taken the test. The MMPI is by far the most popular psychological test currently used, and almost all psychologists, and even most test skeptics, place some stock in it. Historically the big battles over the MMPI have been waged less over its accuracy than its invasiveness. Within a decade after its creation, the MMPI had escaped the mental ward and, as Annie Murphy Paul writes in "The Cult of Personality," by the 1960s it was being given as often to people in job settings and court cases as to psychiatric patients. As a result, the MMPI and its imitators came under assault from sociologists like William H. Whyte, who saw the tests as helping to create and perpetuate the oppressive group-think of the mid-century "organization man." In 1966, Senator Sam J. Ervin Jr. of North Carolina introduced a bill to sharply curtail the government's use of the MMPI and similar tests, decrying it as a wanton invasion of privacy comparable to McCarthyism. Ervin's bill didn't pass, though, and the MMPI only grew in popularity. In 1989 the test was "re-normed" with a new control group and some of the more bizarre questions were excised. But the breadth of the MMPI's use still stirs controversy. The past decade has seen a series of lawsuits over the role of the test and its knock-offs in the job interviewing process (or, in one case, as a condition of welfare benefits), where its inventors never intended for it to be used. According to Brad Seligman, a lawyer who brought three such cases under the California state constitution's protection of privacy and fairness in employment, some of the questions -- about one's sex life, political views, religious beliefs, and even bowel movements -- are "highly intrusive." Furthermore, he notes, there is no research linking the test results to job performance, especially in the strict pass/fail way it was used by employers. In all three cases, the courts agreed.
. . . While the MMPI is more widely given, and the Rorschach better known, perhaps the most beloved personality test is the Myers-Briggs Type Indicator. Based on Jungian psychoanalytic theory, it was developed in the 1940s and `50s by a bored, bright Philadelphia housewife named Isabel Myers, with some input from her mother, Katharine Briggs. Unlike the Rorschach and the MMPI, it was expressly designed not to diagnose psychopathology but to describe normal personalities. Today, the four Myers-Briggs axes -- Extraversion-Introversion, Sensing-Intuition, Thinking-Feeling, and Judgment-Perception -- are a reflexive lingo to a whole generation of corporate managers, consultants, and headhunters. The test's popularity stems from the basic belief that "personality influences how you interact with other people, so having a detailed understanding of personality allows you to adjust for individual differences," says David Thomas, a Harvard Business School professor who has studied its use in corporate America. The questions the test asks are straightforward: "Do you usually: A) share your feelings freely, or B) keep your feelings to yourself?" or "Do you: A) rather prefer to do things at the last minute, or B) find that hard on the nerves?" None of its 16 personality types are considered more healthy or normal than the others. Because it's free of the language of mental illness, the Myers-Briggs manages to classify without stigmatizing. But for all its ubiquity in the boardroom and as an online quiz, the test is generally ignored or ridiculed by psychologists. Robert Hogan, a former psychology professor at the University of Tulsa who now runs his own testing company, Hogan Assessments, says, "I used to use [Myers-Briggs] as an icebreaker. People like taking it, and when you get the results back you feel good. But it has the intellectual content of a fortune cookie." "There's no evidence," Hogan concludes, "that it predicts job performance or any meaningful non-test outcomes." Defenders of the Myers-Briggs say these criticisms are unfair. Steven Reiss, a professor of psychiatry and psychology at Ohio State University (and inventor of a similar test, the Reiss Profile) admits that the test is marred by scoring problems and outdated theoretical baggage. But, he says, it's still much more accurate than the more respectable MMPI. "Academic people have not looked at it because it's based on Jung," he says. "So it's based on bad science, but it actually works." Ultimately, the biggest value -- and danger -- of the Myers-Briggs may be the way it lubricates social interactions. Harvard's David Thomas concedes that in its current corporate usage, the value of the test can stem as much from getting everyone in a room "speaking a common language" as from any real insights about personality. In other words, it's an exercise in conflict resolution and group therapy, a way to get substantive disputes to dissolve in a warm bath of psychologically tinged language about different types, perspectives, and styles. For Annie Murphy Paul, this isn't necessarily a good thing. In an interview, she pointed out that Myers-Briggs is distinctive in that it's not only driven by institutional needs, but sought out by individuals. "People really, really like it -- they latch on to the results," she says. For her, the problem with the test, and with all personality tests, is that it "limits and stereotypes the ways institutions think about individuals and the way individuals think about themselves." Personality types, she says, are "one-dimensional labels." But the tests -- and the controversy over them -- aren't likely to go away anytime soon. For most of us, there is something tantalizing about the prospect of easily digestible self-knowledge -- just as there's something galling about a test that claims to tell us exactly who we are.
*** Drake Bennett is the staff writer for Ideas.
The infamous inkblot
By Drake Bennett, Globe Staff September 12, 2004 HERMANN RORSCHACH didn't invent the inkblot. In the new book "The Cult of Personality," Annie Murphy Paul notes that "inkblots -- accidental forms created by folding a piece of paper on which drops of ink have been placed -- had occupied an odd corner of European culture for almost a hundred years," a favored prop for fortune-tellers and entertainers. Perhaps because of this, the Swiss psychiatrist's test -- designed to reveal personality and diagnose mental illness based on a subject's reaction to a series of inkblots -- had a hard time making it to press. When it was finally published in 1921 (with the number of cards reduced to 10 from the original 15 in order to cut costs and the blots themselves blurred by printing errors), it was either ignored or dismissed by most psychologists. It found a haven in the United States, though, which had already proven so welcoming to the theories of Freud and Jung. Warring schools of Rorschach interpretation sprung up, each with its own charismatic leader. Paul quotes one enthusiast on the "feverish activity, unbridled enthusiasm and optimism" of the American Rorschachers in the 1930s. Another exulted that a "foolproof X-ray of a personality" had been found. One of the more remarkable documents of Rorschach analysis is "22 Cells in Nuremberg," an account by the psychiatrist Douglas Kelley of his administration of the test to the Nazi leaders awaiting trial at Nuremberg in 1946. Looking at one blot, Rudolf Hess saw "two men talking about a crime, blood is on their minds." Robert Ley, formerly head of the German Labor Front, saw a bear. "You can see the head and teeth with terrific legs," he said. "It has shadows and peculiar arms. It is alive and represents Bolshevism overrunning Europe." Since its conception, the test has been battered by charges of mysticism and pseudoscience. But its status as a cultural touchstone was ensured in 1984 when Andy Warhol did his famous series of Rorschach paintings. It was a perfect match for an artist who himself had always cultivated a sort of beguiling blankness. He claimed that he had originally meant to test himself with his paintings, then thought it might be more interesting "to hire somebody to read into them, to pretend that it was me." He never got around to doing either.
Friday, September 10, 2004
Men as aesthetes
by H. L. Mencken
published in Poor Mojo's Almanac(k)
Men show no such sagacious apprehension of the relatively feebleloveliness of the human frame. The most effective lure that awoman can hold out to a man is the lure of what he fatuouslyconceives to be her beauty. This so-called beauty, of course, isalmost always a pure illusion. The female body, even at its best isvery defective in form; it has harsh curves and very clumsilydistributed masses; compared to it the average milk-jug, or evencuspidor, is a thing of intelligent and gratifying design--in brief, anobjet d'art. The fact was curiously (and humorously) display duringthe late war, when great numbers of women in all the belligerentcountries began putting on uniforms. Instantly they appeared inpublic in their grotesque burlesques of the official garb of aviators,elevator boys, bus conductors, train guards, and so on, theirdeplorable deficiency in design was unescapably revealed. A man,save he be fat, i.e., of womanish contours, usually looks better inuniform than in mufti; the tight lines set off his figure. But awoman is at once given away: she look like a dumbbell run over byan express train. Below the neck by the bow and below the waistastern there are two masses that simply refuse to fit into a balancedcomposition. Viewed from the side, she presents an exaggerated Sbisected by an imperfect straight line, and so she inevitably suggestsa drunken dollar-mark. Her ordinary clothing cunningly concealsthis fundamental imperfection. It swathes those impossible massesin draperies soothingly uncertain of outline. But putting her intouniform is like stripping her. Instantly all her alleged beautyvanishes. Moreover, it is extremely rare to find a woman who shows even themodest sightliness that her sex is theoretically capable of; it is onlythe rare beauty who is even tolerable. The average woman, until artcomes to her aid, is ungraceful, misshapen, badly calved andcrudely articulated, even for a woman. If she has a good torso, sheis almost sure to be bow-legged. If she has good legs, she is almostsure to have bad teeth. If she has good teeth, she is almost sure tohave scrawny hands, or muddy eyes, or hair like oakum, or no chin.A woman who meets fair tests all 'round is so uncommon that shebecomes a sort of marvel, and usually gains a livelihood byexhibiting herself as such, either on the stage, in the half-world, oras the private jewel of some wealthy connoisseur.
But this lack of genuine beauty in women lays on them no practicaldisadvantage in the primary business of their sex, for its effects aremore than overborne by the emotional suggestibility, the herculeancapacity for illusion, the almost total absence of critical sense ofmen. Men do not demand genuine beauty, even in the mostmodest doses; they are quite content with the mere appearance ofbeauty. That is to say, they show no talent whatever fordifferentiating between the artificial and the real. A film of facepowder, skilfully applied, is as satisfying to them as an epidermis ofdamask. The hair of a dead Chinaman, artfully dressed and dyed,gives them as much delight as the authentic tresses of Venus. Afalse hip intrigues them as effectively as the soundest one of livingfascia. A pretty frock fetches them quite as surely and securely aslovely legs, shoulders, hands or eyes. In brief, they estimatewomen, and hence acquire their wives, by reckoning up purelysuperficial aspects, which is just as intelligent as estimating an eggby purely superficial aspects. They never go behind the returns; itnever occurs to them to analyze the impressions they receive. Theresult is that many a man, deceived by such paltry sophistications,never really sees his wife--that if, as God is supposed to see, her,and as the embalmer will see her--until they have been married foryears. All the tricks may be infantile and obvious, but in the face ofso naive a spectator the temptation to continue practising themis irresistible. A trained nurse tells me that even when undergoingthe extreme discomforts of parturition the great majority of womencontinue to modify their complexions with pulverized talcs, and togive thought to the arrangement of their hair. Such transparentdevices, to be sure, reduce the psychologist to a sour sort of mirth,and yet it must be plain that they suffice to entrap and make fools of men, even the most discreet. I know of no man, indeed, who iswholly resistant to female beauty, and I know of no man, evenamong those engaged professionally by aesthetic problems, whohabitually and automatically distinguishes the genuine, from theimitation. He may doit now and then; he may even preen himselfupon is on unusual discrimination; but given the right woman andthe right stage setting, and he will be deceived almost as readily as ayokel fresh from the cabbage-field.