Adam Blatner, M.D.

May, 2002


 In the early 1970s, Thomas Harris wrote a book titled I'm OK, You're OK, an explication of the then-fashionable theory of Transactional Analysis, developed first by Eric Berne, M.D., in the early 1960s. These folks noted that people tend to take a position that, given any ambiguity or friction in the interpersonal field, either assumed as a given that the source of the difficulty was either in oneself or the others. I've found this to be generally valid, but the source of this tendency lies in the individual's innate temperament, more than the influences of their family during early childhood.

 The key dynamic is the sense of reality, and the point to note is that this varies among people just as most qualities vary–the ability to sing well, to dance well, to become geographically oriented, etc. Some folks are better at stuff than others. There is of course a goodly factor of training, practice, and experience, but still there are natural differences in all kinds of talent.

 There's an old joke that there are two kinds of people: Those who divide people into two kinds, and those who don't. Well, sometimes making distinctions is useful, so here we will do so. The two kinds derive from the neurophysiological function that lends a sense of reality to one's own thoughts.

 The "I'm okay" type senses its own thoughts and perceptions as solid, real, the way things are. They tend to be confident, leaders, more naturally stubborn, self-righteous, complacent. So-and-so called them "Normotic."

 The "I'm not okay" type enjoys the virtue of intellectual humility–but it's based on a simple temperament of not-so-sure-ness. Thoughts, memories, perceptions are experienced a little more tentatively. This type does well in scientific settings–and this "let's find out if it's really true" is the essence of the scientific spirit. It errs on the side of doubt, though, and thus its people tend to be less decisive, more followers, etc.

 Now, we need to recognize a couple of things: These two types just described represent the two directions of a spectrum, and most folks are near the middle. Both types derive from a natural slight variation of neurophysiologic function, and this function may well be amenable to psycho-pharmacological change.

 The second point is that the more extreme forms of this dichotomy in temperament may be found in a variety of types of psychopathology.  People with more of a tendency toward I'm-not-okayness can slip into anxiety, depression, and obsessive-compulsive disorder of the doubting type. People with more of a tendency to I'm-okay-you're-not-okay-ness slip towards paranoia, narcissism, and sociopathy. Their worldviews come to fit their desires and fears rather than be checked out in reality. (Ironically, some who have been called obsessive-compulsive personalities tend to be more this way–almost the opposite of the doubting type–so the terms are misleading, actually.)


 The clue to my appreciation of this came as our awareness of OCD became more acute, and this happened because it became a more treatable condition. The SRI medications such as Luvox really relieved many people's crippling doubts. So in the early 1990s more psychiatrists were asking probing questions and bringing to the surface symptoms that had been previously overlooked or hidden.

 One informal diagnostic test I used in my practice was to ask if the person ever found him- or herself checking more than once to see if s/he locked the car or house door. I had become intrigued with that experience–that sense of "Did I really do it? I think I did, but I'm not sure."  I started to notice that some folks extended this doubting to a sense of uncertainty about all kinds of ambiguous issues, especially in the interpersonal field–and that others did not, often even when an attitude of carefulness should indicate that they really should check things out a little more.

 What is called confidence in one situation–and it seems like a compliment–may in fact be slight or severe over-confidence, smugness, denial. What seems like deep conviction may be actually a lack of sensitivity to the possibilities that one might be mistaken, mixed with a lack of imagination as to the range of alternatives.

 Confidence in the mid-20th Century for a while seemed to be a virtue, especially when contrasted with those who are "wishy-washy"–note the semantics here, the emotional colorings of the words used. There was a book written by the sociologist David Reisman called the "Organization Man" and it noted the difference between those who were "inner-directed" and those who were "outer-directed." (Or is it "other-directed"?) The implication was that there was a slight moral gradient, that those who were inner-directed were better grounded psychologically, rooted in noble convictions, less needful of approval. Well, maybe this was a factor, but I suspect it was less because of the essential health of the psyche and more a matter of this temperamental divergence.

 Outer-directiveness may not be mere passive pliability to the exhortations of demagogues or to peer pressure. It may be a natural tendency to think, "Hey, if they seem more sure of the way things are, well, probably they're right." This is because within the mind of the more uncertain types, there are also gradients of uncertainty, and times when one feels more sure of oneself than other times. So when this certainty is perceived in others, it tends not to be questioned.

 The problem is that the certain types often come to their conclusions based on a direct intuition of the way things are, and this intuition is frequently more determined by desire than evidence. They see what they want to see. So their sense of direction or meaning may in fact be simply wrong.

 These folks tend to get together as spouses, because the I'm-okay type finds it congenial to be with someone who is more easy-going, more deferential, while the I'm-not-okay-type finds it comforting to be with someone who seems to know what's going on.

 In the long run, though, the more certain types need to learn how to counter their own tendencies to overconfidence, and to check things out a bit more. They need to practice intellectual humility. The less certain types need to counter their own tendencies to doubt, they need to check things out more, too, but in the direction that lends a bit of weight to the possibility that they were right. What they remember saying was actually said, even if the other person says with great glibness, "You never said that."

 A friend was recounting a trip he and his girl friend took in Europe, and as they drove around–a little lost–the lady, who was naturally more certain of her own intuitions– would insist on the right way being in this or that direction. My friend, being more deferential, tended to go along, but not infrequently he doubted his lady's intuitions, even though he wasn't absolutely sure of his own. In the end, he laughed, his lady friend wasn't as accurate in her sense of direction as she had assumed–only about 50% of the time–i.e., according to chance, just as if they had flipped a coin at each juncture.

 We know this differs between small children and older children–we call it "infantile omnipotence." But even there, I think it is simply more obvious. The truth, I suspect, is that lots of kids are deferential, even timid, and in older years, arrogance becomes more subtle, less obvious.

Symptom Choice

 Work on temperament as a variable in psychology has gone on from the beginning of the development of the field, but it hasn't caught on very well. Freud's theories gave only the most cursory nod to this obvious dynamic, and attributed the variations in why this one became more sociopathic and why that one became more obsessive-compulsive to differences in childhood rearing.

 Carl Jung talked about different psychological types, and even today many people use the Meyers-Briggs test to help in organizations, marriages, and in the workplace. The field of astrology hinted at these differences, too, and there was a flurry of books about "Sun Signs" in the early 1970s, and how knowing these factors could help in relationships. In the 1960s the pioneering work of Thomas, Chess & Birch in the area of temperament and child development was excellent–but still not adequately appreciated in the broader field.

 There is still no great body of research that correlates temperament with symptom choice. Life is complex enough so that it's possible to attribute any behavior to something in childhood–in retrospect. But those who have been parents or worked with children know the obvious–kids have different temperaments. Some are more "hard-headed" while others are more "impressionable."  The pliable, deferential types tend to get along all right in their early years, but being too nice becomes a problem later in life.

 Uncertain types tend to give away their power, and as a result, they begin to feel powerless. They need to be helped to recognize this tendency and re-own their power without edging over into arrogance.

 Over-certain types tend to exercise their personal power without sufficient reflection or reality-testing, and thus to create family and social structures that are a bit too rigid. They experience challenges to their world-view as assaults on themselves, and become angry.

 (I'm reminded of the earliest breakdown of temperament into the Galenical Four Humors–depending on whether one was viewed as having an excess of blood, yellow bile, phlegm, or black bile. Respectively, these folks were called "sanguine, choleric, phlegmatic, or melancholic." In the theory being presented here, though, the sanguine first group could be either type–probably more of the certain type--easy going. But also they could be viewed as easy going as long as the system was stable, good followers of the uncertain type.

 The choleric were chronically dissatisfied, perhaps reflecting more early childhood or life-stress disturbance. The world was a problem–why was everything and everyone so imperfect? It must be because they didn't care. They were grumpy, irritable, inclined to paranoia and anger.

 The phlegmatic had opted out of the problem. They just dampened down, what the heck, whatever, couch potato time. Again, this option might be a way of coping with the instability of either irritation or depression.

 The melancholic had let the weight of the world fall in. Usually the more uncertain type, they mixed their dissatisfaction with self-reproach for not knowing what to think or do about their helplessness. The result was a kind of chronic depressive attitude.)


 If this thesis is valid, it's worth recognizing also other temperamental variables, and I'll be interested in the various combinations that result. This paper thus recognizes that there's lots of room for theory building in psychology even at a fairly basic level. We must not assume that just because so much has been done that everything is covered. For example, there is hardly anything written about the phenomenon of "cute" and its impact on human affairs. I have a friend who has found that the emotion of joy is similarly neglected–more drama and weight being given to the negative emotions.

I hope this essay has been stimulating to you and I'd be interested in any comments, suggestions for additions or revisions, and even direct arguments. I'm just a little on the uncertain side so I would rather learn something than indulge in what I experience as the illusion of "being right." 

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