A measure of intelligenc.., p.6
A Measure of Intelligence, page 6
310 Borderline mental retardation IQ 68–83
311 Mild mental retardation IQ 52–67
312 Moderate mental retardation IQ 36–51
313 Severe mental retardation IQ 20–35
314 Profound mental retardation IQ under 20”
But in the editions of the DSM that followed, the information provided about each diagnosis was less focused on tracing the cause of a condition and increasingly preoccupied with the description and identification of symptoms. In the DSM-5, I read that, “The various levels of severity are defined on the basis of adaptive functioning, not IQ scores, because it is adaptive function that determines the level of support required.” This implies that the conditions of a person’s environment—how inclusive or oppressive it may be—can be considered as part of the diagnosis.
In its fifth edition, the DSM began to refer to intellectual disability instead of mental retardation. The change in label indicates a seismic shift in thought for the American Psychiatric Association, an institution that once pathologized homosexuality. The current definition of intellectual disability de-emphasizes the IQ score, or at least does so relative to the definitions in earlier editions of the DSM. It now considers other factors like adaptive behavior, environment, and health. The evolution in the definition indicates a slow transition from seeing intellectual disability as a condition to be cured to identifying a need to modify a person’s circumstances to better suit her needs. In this way, Baby Boomshalala isn’t a troubling sign of Louisa’s deviation from normal. This conjured companion demonstrates Louisa’s need for the time and space for imaginative play, an opportunity for her to develop her internal sense of self.
But psychologists still consider IQ tests to be one of their most important diagnostic tools, and the diagnosis of intellectual disability still leans heavily on the IQ score. In an article published in the journal Intelligence in 2010, psychologist Douglas Detterman defended how earlier systems of diagnosis linger in twenty-first century definitions of intellectual disability. “Measurement is essential to any good scientific definition,” he writes. Detterman makes an important point here. Diagnosis should rely on objective evidence as much as possible. Otherwise, clinicians are forced to improvise, which opens up diagnosis to errors and bias. But it also seems impossible to fully eliminate the gap between measurement and judgment.
To support his case for the importance of the accurate measurement of intelligence, Detterman mentions Atkins vs. Virginia, the 2002 Supreme Court ruling that executing people with intellectual disabilities violated the Eighth Amendment prohibition against cruel and unusual punishment. “It can literally be a life-or-death issue at least partially based on clinical judgment,” he claims. And thus, he believes, “we should complete the task begun by Galton, Cattell, Binet, and Goddard, and countless others of understanding exactly what general intelligence is.” For these psychologists, the task was to establish a clear system for assessing intelligence. They believed that statistics could determine a person’s fate.
This perspective seems common among psychologists. I once had a psychologist peg me as an “IQ skeptic,” and reply to me in an email, “I find IQ testing ‘skeptics’ often have little understanding of how many things they are not skeptical of depend on intelligence testing—such as not subjecting people with an intellectual disability to the death penalty.” The snappy retort demonstrated to me one of the most disturbing outcomes of the belief in intelligence as something that can be measured and absolute, rather than something shaped by bias and power. Certainly, I do not believe that people with intellectual disabilities should face the death penalty. But more to the point, I do not believe that anyone should.
Psychologists in the early twentieth century used IQ scores as a reason to intervene in the lives and bodies of their patients and segregate them from the rest of society. Using IQ tests as part of the diagnosis of intellectual disability—especially in the circumstance of the death penalty—does the same. Because of its perceived scientific certainty, the IQ score gives governments a false claim over the bodies and lives of people with intellectual disabilities. This claim does not consider whether IQ testing should be used as part of the government’s unjust power to end the lives of its citizens in the first place.
Psychology manuals like the DSM describe a person with an intellectual disability as potentially a threat to self and others. They state that a lack of communication skills in people with intellectual disabilities may lead to aggressive behavior. Gullibility and lack of risk-assessment skills may result in exploitation, victimization, and physical or sexual abuse. It is easier to blame a person than to correct structural injustice in our society. Turning our scrutiny away from the pathology of individuals and toward the systemic reasons why so many people with intellectual disabilities face poverty, segregation, and diminished opportunity would open up the possibility for social change. I hope this will occur within my daughter’s lifetime.
Louisa’s cognitive evaluation came with a substantial plan of care, a list of suggestions to help engage her attention in the classroom. But most of the suggestions seemed so obvious it felt condescending for me to even bring them up when I met again with Louisa’s teachers. Eye contact should always be made when giving Louisa a task. Louisa needs to be seated near the teacher for instruction. She may also benefit from visual learning strategies. These were things that Louisa’s teachers were already doing. I began to see that Louisa wasn’t going to be supported with a list of suggestions. Her challenges were caused by a bad match between the processing speed and attention expected in the classroom and who she fundamentally was. Solving this would take a larger structural shift in education.
I began to see the IQ test and the understanding of intelligence it generated as something made up, or at least no more or less legitimate than other narratives. Argentinian writer Jorge Luis Borges once remarked, “I wonder why a dream or an idea should be less real than this table, for example, or why Macbeth should be less real than today’s newspaper. I cannot quite understand this.” I first read Borges’s short stories in college, and I kept thinking about them when trying to make sense of the DSM. One of my favorites, “Tlön, Uqbar, Orbis Tertius,” is about a country whose actual existence is unclear. If the country is only described in an encyclopedia, does that make it real? How can we really know something if it is not archived, classified, and described through official channels? I found it telling that literature did more to clarify the authority of the DSM to me than the psychologists who use it. Borges’s stories demonstrate how a great deal of what we can know and experience is determined by forces we might not even recognize. More than most, he understood literature’s power as a tool to rethink what we know.
I am determined to provide a life for my daughter that is not ruled by the DSM and shaped by the narrative of its anticipated outcomes. My daughter’s interaction with the world will be shaped by her assessment, diagnosis, and classification. But other stories, other narratives, including how I see my daughter and how my daughter sees herself, can be just as valid and powerful. Baby Boomshalala is real, and she is welcome to stay with us as long as she likes.
Mind Games
I was starting to believe that IQ tests had little purpose for Louisa besides reinforcing low expectations. But at the same time, I knew that they were required for school and helped secure essential educational support. The truth is, I had no idea what it was like to take an IQ test. Was it like a medical exam, seeing a therapist, or taking the SAT? In order to understand their power, I needed to be more familiar with the mechanics of IQ tests, not just their historical emergence but how they work pragmatically in the here and now.
So, on a morning in late summer just as the semester began, I walked across campus to the Psychology Clinic. Sitting in the lobby felt like waiting at a doctor’s office. There were coffee tables with magazines and pamphlets about mental health. A reception desk was tucked behind a sliding glass partition. Harris, a grad student in his mid-twenties, wore neatly pressed khakis and a red button-down shirt and greeted me a few minutes after I checked in. “Nice to meet you, Professor Stetler,” he said as he shook my hand. I insisted that he call me by my first name, but I appreciated his manners. Harris led me down a small hallway into a closet-sized conference room. We sat on opposite sides of a table as he explained that he would give me an IQ test over two, two-hour sessions and that he would write up a report that would be a way for him to practice writing up reports. He wanted to make sure I knew that this was not an official IQ test. Harris was practicing, gaining experience responding to the different scenarios that could occur when giving a test for real. For this reason, my test results were technically not valid. I did not learn my IQ, which was fine by me.
Psychology privileges certain ways of knowing that can only be accessed if you are a psychologist. But how we know determines what we know. How we know—what our expertise is—even shapes what we decide is knowledge. I wanted to learn what can be known about the IQ test—and about oneself—from the perspective of the test-taker. I also hoped that taking a test would be a way to stand in solidarity with Louisa. While my social, professional, and financial opportunities are not linked directly to an IQ test, Louisa’s life potential could be determined by her performance. Taking this high-stakes test that would determine so much of Louisa’s future would, perhaps, help me advocate for her. Neither of our test-taking experiences would have to stand completely without the other.
We started with a clinical interview that helped Harris decide how to modify the various subtests that followed. He asked me how I described my gender and what pronouns I used. “Can you tell me about your family history?” “What are the values that are most important to you?” “What has brought you to the psychology clinic today?” He seemed open to whatever I chose to share. He also explained that he would be writing behavioral observations while I took the various subtests. Whether I got frustrated or flustered or demonstrated complete apathy was part of the assessment, along with whether I got the questions right. In a clinical context like the one being rehearsed by Harris, an IQ score is one part of a larger context of observations and more qualitative assessments.
There are a number of different intelligence tests, and psychologists select the most appropriate one based on what they want to know. Harris prepared to give me the Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV), which is one of the most widely used intelligence tests for adults. It consists of fifteen subtests and provides information about specific cognitive abilities in addition to a general intelligence score. Pearson Assessment, the company that now publishes the exam, claims that it is the “most advanced adult measure of cognitive ability.”
David Wechsler was a Romanian American psychologist who published the first edition of his intelligence test in 1939, known as the Wechsler–Bellevue Intelligence Scale. Wechsler believed that other versions of IQ tests focused too much on skills acquired through formal education and not enough on how well a person functions within his social and economic environment. For example, he knew one “native, white Oklahoman,” who supported a family as an oil driller and earned $60 to $75 a week, a decent living at the time, but scored with the mental age of an eight-year-old on the Stanford-Binet exam. Wechsler’s approach to intelligence testing, removed from the motivations to ground the practice in the social statistics of the early twentieth century, seemed more practical and human to me. According to Wechsler, intelligence tests measure “the capacity of an individual to understand the world about him and his resourcefulness to cope with its challenges.” For Wechsler, intelligence wasn’t just a measure of how well the mind works, but a way of describing the relationship between a person and the environment. An outlook like this makes me think it is possible to have a system where the IQ could be a force for good. It could help Louisa receive more personalized, specific care and support.
In 1932, he was appointed chief psychologist of New York’s massive Bellevue Hospital, where he supervised the testing of thousands of patients. His intelligence test was the first tailored specifically to adults rather than children. Psychologists found that mental age scores did not increase after adolescence and therefore Binet’s IQ formula (mental age divided by chronological age) was not sufficient for adults. As an alternative, Wechsler used the point-scale method that normed all IQ scores at 100 and converted IQ distributions for all age groups to have a standard deviation of 15. This way of expressing a person’s IQ and comparing it to others proved so efficient, it was eventually adapted for IQ tests for children, too, although age equivalents for children are still provided.
Unlike the Stanford-Binet, Wechsler’s test introduced a combination of verbal and performance-based tests. In this way, he intended to shape an understanding of intelligence based on a person’s “ability to do things, as well as by the way he can talk about them.” Later he admitted that other factors affect a person’s ability to navigate his environment effectively, including drive, persistence, and curiosity. But Wechsler never developed a test to measure those qualities.
To test my ability to do things, Harris took several sets of blocks and spiral notebooks out of a sturdy black briefcase and arranged them on the table. Then he placed a spiral notebook in front of me and handed me a set of six blocks. The design of each block face varied. Some were solid red or yellow, others were divided diagonally with red or yellow triangles on either side. Harris demonstrated how the blocks could be arranged to reproduce pictures illustrated in the notebook. He handed me three more blocks and asked me to practice. “Are you ready to begin?” Harris asked. Then the test began for real, or at least fake real. “Ready . . . set . . . go.” Harris started his timer and I began arranging my blocks to look like the pictures in the notebook. He pressed stop and flipped the page. I worked through a few more block arrangements until Harris said it was time to move on.
Given Wechsler’s approach to intelligence as behavior rather than a quality of the mind, it was surprising to me how isolating it felt to take the WAIS-IV. Sitting in a windowless room with someone I barely knew hardly seemed conducive to accurately studying a person’s “ability to do things.” I took Wechsler’s phrase to mean the ability to manage one’s life—to make plans and keep them, to meet responsibilities, to adjust when routines change. How could forming pictures out of blocks possibly assess these skills?
I was growing more self-conscious of my behavior and how it was read by Harris. In the next section, he asked me to describe how two words are alike. “Bud and baby,” he said. “They are early stages of life,” I replied. “Music and tides.” “They both consist of patterns and cycles,” I answered. Cycles? Was that right? I wondered. How could such an idiosyncratic association be judged or quantified? The relationship between words became gradually harder to describe. “Allow and restrict.” “They are both actions of authority,” I said. “Tell me more,” Harris replied. Was I making this too complicated? Did I sound like I was trying too hard? “They refer to the control of another person’s actions,” I suggested. Perhaps my association reflected my strong suspicion of authority, and the authority of this test in particular. Harris looked closely at his manual, possibly searching for a way to evaluate what I just said, but I couldn’t really know for sure. He slowly nodded his head and said, “Okay,” and we moved on to the next pair of words.
This was an unusual testing experience for both of us. So often the test administrator controls the pacing and direction of a test. The test-taker is subjected to the administrator’s time frame and questions. But Harris and I politely battled for time control. I waited for Harris to write my answers down and follow the scoring guidelines in the manual. (I assumed he was doing this, but I couldn’t actually see the manual. Asking to see it seemed like a breach of boundaries, and I didn’t want to make him have to tell me no.) But I was taking notes, too, scribbling in a notebook to document the experience, which wouldn’t have been allowed if this were a real test. Harris patiently waited for me to finish writing before moving on to the next question, but the silence as he waited and I wrote was heavy. I was disrupting the flow and rhythm of his work.
Harris recited an increasingly long series of numbers and asked me to repeat the numbers backward. The test gauged working memory, my ability to hold information in my head while using it to complete a task. It was as if I were carrying too many glasses, stumbling to fit them all in my arms before they crashed to the floor, while Harris observed and did nothing. “Would you correct me if I got it wrong?” I asked. “I like how hard you are trying,” he replied. After I recited about ten sequences, he said, “Let’s try something else.”
Cognitive tests ask us to stand alone and deny our instinct to connect to one another through affirmation and support. In a classroom, thinking happens through connection and positive feedback. But in this room the size of a large closet, none of these were offered. As Harris waited for my answers, I began to think about how the circumstances of testing were at odds with Louisa’s social nature. There was no opportunity to feel excited about an idea or to connect to others, which were things that motivated her to think and answer questions in the first place.
I wanted Harris to validate me when I gave an answer, which is embarrassing to admit. It was important to me, I realized, that Harris thought I was smart. Intelligence holds so much power, but it needs to be demonstrated socially, outside of the mind. When I was a kid, I proved my intelligence through report cards, test scores, and incessantly raising my hand first in class to answer a question. Like many kids, I wanted to feel normal, but I also felt as if I had to be the best and most intelligent version of normal possible. The experience of taking an IQ test with Harris seemed surprisingly familiar in this way. It was as if I were back in high school, solving math problems and answering questions in class. My eagerness to perform intelligence—in high school and now with Harris—was also motivated by an urgency to demonstrate that I belonged, in calculus class, at a university, and in the broader middle-class world. The social anxieties I felt around intelligence made sense given Wechsler’s way of defining intelligence. “Intelligence is an aspect of behavior,” he wrote. “It has to do primarily with the appropriateness, effectiveness, and worthwhileness of what human beings do or want to do.”
