Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Thursday, November 06, 2008
The Snake Trail Test
Psychiatrists have a way of assessing judgment during the mental status examination. Typically they'll ask a question like, "If you found an envelope lying on the sidewalk and it was addressed and stamped, what would you do with it?" The typical answer, the one that will get you a 'good' rating on the judgment line, is: "I'd mail it." Duh. There are other possible responses, some of them more interesting or creative than others, but that's the response you get most of the time.
I had a chance to come up with a new "judging judgment" type question this week. I call it the Snake Trail Test. Here's how I came up with it:
As coincidence would have it, one of the best local climbing spots near here also happens to be a repository for copperhead snakes. Since I've taken up climbing I've now seen more copperheads in the wild than I've ever seen in any zoo. Whenever I see a snake, I warn any hikers I happen to see in the area. Many hikers are parents with small children. It's been interesting to see the wide variety of responses.
One parent immediately grabbed the kid and said, "No no honey, don't go down that way. We'll go on this trail instead." Another parent still went down the trail, but cautioned the kids and made sure they stayed on the far side of the path, away from where the snake was spotted. The most interesting reaction came yesterday, from a young tattooed woman hiking with four kids under the age of ten. After I gave her the warning she shrugged, pointed back over her shoulder at the trail she had just come down, and said, "Yeah there's another one back there." Not a word to the kids and they all scrambled on without a care.
The psychiatrist within me thought: "Checkmark for 'poor' judgment." Then I thought again: "Maybe she's an herpetologist. Maybe she comes from a charismatic poisonous snake-handling cult. Maybe she's been hiking here for 20 years, has seen lots of snakes and never had a bad outcome." There were a lot of reasons why someone might not be freaked out by the idea of a poisonous snake in the trail.
My new Snake Trail Test has got me thinking about how we interpret judgment.
Judgment is formed through learning, experience, culture and a multitude of other personal idiosyncratic factors that a psychiatrist might or might not be aware of. The best way to sort out 'normal' and 'impaired' judgment is to ask followup questions. "Why would you do that?" is a good one. "Why not do this?" is another good followup question.
I didn't have a chance to ask the tattooed lady more questions, but I bet if I did she might have given me a good education about snakes.
Note from Dinah: Here's a post from Edwin Leap about what Not to bring to the ER with you, and it includes the snake that bit you.
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Wow, you wrote entire post on Judgment and misspelled it every time. I hope it's okay that I fixed this. I know, I know, I'm not one to talk about typos.
So the other issue is that snakes are not a neutral object, they are something that many people are phobic of, and that skews the issue around simple judgment. Is it great judgment to have young children hanging off those cliffs anyway? The anxiety issues involved change the perspective from one of judgment to one that includes less rationale things. Okay, I suppose the found letter could be greeted with "I wouldn't pick it up because it might be covered in germs" ....
I hope you don't mind that I moved your post time up. Be careful.
Like you, I was originally taught that judgement was spelled without the 'e'. However, current references find both variations acceptable:
American Psychological Association (APA): judgement. (n.d.).
Chicago Manual Style (CMS):
Modern Language Association (MLA):
I won't touch your spelling of 'rational'.
Yeah, the instinctive 'ick' factor regarding snakes was what made that last mother so interesting to me and triggered my post. Since then I've done some literature research on copperhead bites (I knew you'd want to know). Here's what I found:
Apparently one-third of all venomous snakebites in the US annually are from copperheads (hundreds of people). Some of them don't even get admitted to the hospital and few die. The decision about giving antivenom is controversial and depends on the patient's reaction to the bite. If there's evidence of a bleeding or clotting disorder they give antivenom, although in children they haven't established the dosage or safety/efficacy of it. A small number of people have allergic reactions to the antivenom. On average people lose about two weeks of time from work due to a copperhead bite, but may have up to three months of loss of function or disability in the bitten limb. Young copperheads are the most venomous because they haven't learned to control their fangs yet, sort of. (Sounds a lot like my young inmates.)
I spent 2 months one summer doing geology fieldwork in Whitmore Wash which is part of the Grand Canyon, but outside the park. On a private ranch we walked trails that had not been walked by anyone in many years, so we encountered rattlesnakes many times an hour. An initial fear gave way to relaxed confidence and comfort, but not without rapidly scanning the path as we walked to prevent an encounter. Shortly after, on my honeymoon, my husband and I visited Toroweap Overlook on the north rim of the Grand Canyon where one can view a mile straight down to the Colorado river.
I was excited to point out a rattlesnake to my new husband who had said he'd never seen one before. He was so "rattled" he hopped back in the car and refused to look at the snake OR straight down at the river (no guard rail at that time, 1978). Meanwhile I skipped about the rocks taking photos of the view.
It was all an issue of habituation to the snakes, plus learning their habits. Rattlesnakes (contrary to copperheads) are retiring and dislike humans so will ALWAYS escape if possible. If cornered they give warning of sufficient length that a person of rapid reflex can jump back. An observant person will generally spot the snake first, so on all three counts I felt safe.
In Mexico last December, I saw a yellow anaconda on a little traveled walking trail to some petroglyphs. The enormous head scared me, and though the snake had moved away when it saw me, I was nervous because I know nothing of the anaconda's habits. While I was debating abandoning my hike, a man with a family of children ranging from about age 4 to age 15 came along. I expected them to be afraid when I described the snake but they were nonplussed and invited me to join them. I felt comfortable once again knowing that this man did not seem worried about his 4 year old which I assumed to be the result of his experience in the area (he was a local).
I think this sort of habituation is normal and the lack of fear is rational.
Hi from India!
Incidentally we were told about a snake being around at a place where we were bursting crackers, here few days back on Diwali.
We just joked snake would be scared of sound of crackers and continued our activity with out hitch!!!!
Maybe the tattoed woman was sexually liberated. :)
Hmm. The first thing I thought was, "Hey. Snakes move."
Even a very slow snake can move a mile an hour, I should think. So you see a snake and ten minutes later he could be 500 to 1000 feet away, in any direction.
So, warning people that there are copperheads around, that's okay. But the parents who warned their kids to stay on the other side of the path from where the snake was seen? Sheesh.
Now grizzles ... that's a different matter. We have grizzly warnings up in the mountains quite often, and people take them very seriously.
"Hmm. The first thing I thought was, "Hey. Snakes move."
That was my first thought, too. I grew up in a state with a large poisonous snake population, but only saw them on occasion. Even the more aggressive ones prefer to be left alone, and won't actually chase people down.
I'd go down the trail, but keep my eyes open and carry a long stick for protection. OTOH, if I had small kids with me, I'd probably avoid the trail, since kids are less predictable than snakes.
How does that judgment/judgement rate?
I'd be the person clearing the trail in record-breaking time but then I'm snake-phobic and not really interested in exposure therapy to address it! :)
I'm one of those people who'd score "poor" on the social judgment continuum. However, it goes beyond my affinity for snakes. During my first marriage, I let my dog, Bailey, out in the back of our apartment, at about 3:00 A.M. I noticed her do something she'd never done; jump straight up off of the pine straw. I looked closely and spotted a 33 inch southern Copperhead (gorgeous coloration and markings). Anyway, I pinned it with a stick, and proudly brought it into the apartment, woke up my wife, and waited to be commended for saving our "daughter." She, of course, screamed (this was followed by the question, "Is that thing dead?" When I answered, "No, and I really did save her, it's poisonous, too", I ended up sleeping on the couch for a week. Bad social judgment X2.
P.S. I have a great picture of the snake, if you want to see it.
I say "Duh!" to the whole post. But then I'm not somebody who calls questionnaires "instruments." Give me a multiple-choice question and I'll give you back an essay.
Sounds to me like Mom and Kids were actively looking for snakes.
I usually try to avoid snakes but I think Moms who take their kids out for hikes and then make a point to seek out the icky stuff are cool. Kids like that turn out to be scientists.
The world is full of threats. A kid who learns to move through the world keeping an eye out for problems, surrounded by family is in a good place.
You may need to spend more time outside.
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