The Beck Cognitive Insight Scale (BCIS): A sarcastic and not especially serious commentary

If I weren’t such an assiduous—and perhaps even obsessive—reader of Schizophrenia Bulletin, I probably never would have come across this (relatively) new scale (designed in the cognitivist tradition by Beck and company).  But there it was…sitting in my inbox.  Now, before I drop all attempts at serious critique, let me say that I don’t necessarily disagree with the validity or usefulness of what I take to be the motivating thrust behind Beck et al.’s stated goal of “measur[ing] patients’ capacity for distancing themselves from and re-evaluating anomalous beliefs and misinterpretations” (never mind how problematic their specific language is: “anomalous beliefs” and “misinterpretations”).  Do I think their pleasant little scale measures  (real) “insight,” however…? Rhetorical question.  (It may, however, very efficiently measure the degree of individuals’ “engulfment” in the role of the compliant patient, and even more so, the compliant-patient-of-CBTp.)

For fun (?) I thought I’d just “do” the scale and roughly describe the thought process involved in arriving at my choices (I say ‘I’ but really I want to attempt to play some kind of hybrid between myself and the average (but nevertheless still ‘spirited,’ insightful and intelligent) patient.  If I was strictly sticking to myself I’d answer a little differently primarily because my own therapist is so wonderful (and not at all dismissive) and because I would approach these questions more “philosophically”/technically).

…

Response choices are “do not agree at all,” “agree slightly,” “agree a lot,” and “agree completely”

1. At times, I have misunderstood other people’s attitudes towards me. (Do not agree at all)

Hmmm..  I’m surrounded by a society that clearly precisely misunderstands psychosis (me!), I’ve experienced any number of acts of explicit and implicit discrimination, have been threatened with involuntary hospitalization on dozens of occasions, get stared at on the train because I often talk to myself, was temporarily “banned” from work/school because my boss/advisor thought I was going to ‘blow up a building’…  Am I misinterpreting other people’s attitudes? I don’t think so.

1. My interpretations of my experiences are definitely right. (Agree a lot or Agree completely)

Once again I have been, for years, experiencing things—experiences that feel absolutely real to me—which other people (friends, colleagues, and professionals) generally dismiss outright without even really listening to what I’m saying (or trying to say). I’m frequently told that these—extremely salient and important experiences—are “nothing more than ‘symptoms.’”  So is my interpretation—namely that there is something profoundly and irreducibly “real” about my own experiences—definitely right?  Absolutely.

1. Other people can understand the cause of my unusual experiences better than I can. (Do not agree at all.)

You mean all those other people who haven’t the slightest clue what I’m going through?  This is…a serious question?

1. I have jumped to conclusions too fast. (Do not agree at all)

Whoa.  This is precisely the insulting claim cognitivists are always making.  Do you jump to conclusions too fast when you see an apple on the table and conclude that it’s an apple?  Well, I guess you’d have to experience what I’ve experienced to know that it’s just not all that different…

1. Some of my experiences that have seemed very real may have been due to my imagination. (Do not agree at all.)

My imagination?! Is this scale designed to insult me?  How many times have I told people that I am not just imagining things, that imagined experience and the experiences I’m having are two fundamentally different things?

1. Some of the ideas I was certain were true turned out to be false. (Do not agree at all.)

At this point I’m feeling pretty insulted. Obviously this is exactly what people are telling me all the time—that my ideas are false.  Normally I would admit that some of my ideas turn out to be false…but under the circumstances I don’t think I want to make that concession.

1. If something feels right, it means that it is right.

What exactly could they mean here? Is this some kind of trick? I think I’m just going to skip this one.

1. Even though I feel strongly that I am right, I could be wrong. (Do not agree at all.)

Again, given that people are constantly telling me how wrong I am, and that I have to fight and fight to maintain my own position, I’m not about to simply concede that they may be right.

1. I know better than anyone else what my problems are. (Agree completely.)

And this is, again…a real question?

1. When people disagree with me, they are generally wrong. (Agree completely.)

Given the context here—that we are talking about instances in which other people are dismissing my experiences, almost constantly denying their validity and veracity—do I think they’re generally wrong? Absolutely.

1. I cannot trust other people’s opinion about my experiences. (Agree completely)

It is extremely rare to find someone whose opinion of psychotic experience can be trusted or deserves my trust.

1. If somebody points out that my beliefs are wrong, I am willing to consider it. (Agree a lot.)

You mean to ask whether, after having my ideas and experiences dismissed by people for months or years, I’m willing to consider further imputations along these lines?  Usually, honestly, no.  I’m quite weary of being dismissed or told how wrong or deluded or symptomatic I am…

1. I can trust my own judgment at all times. (Agree a lot.)

Love the little “at all times” modifier…  I’m tempted to be reasonable and say no, but it’s quite clear what these researchers are actually getting at.  How do I know this? Because people are constantly telling me not to trust my own judgment… And do I? Do I trust my own experience? Of course.

1. There is often more than one possible explanation for why people act the way they do. (Disagree completely.)

Well, yes, but given how insulted I am at this point—and suspicious of what the researchers are trying to prove—how am I going to answer?  I mean who are they really talking about? Not people in general, clearly, but me.  They’re really saying that I should “consider other explanations” for my experiences. Again, something I get told all the time, and have come to resent more and more.  So, no, I think I’m not going to concede this one either.

1. My unusual experiences may be due to my being extremely upset or stressed. (Disagree completely.)

Well certainly this is what the establishment is always telling me—glibly extolling their stress-diathesis theory.  Sadly, though, no, there is just no way in hell I’m going to agree that the profound transformations I’ve experienced are simply due to stress or emotional upset…

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