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30 Jan 08 – Just Say No? No! It Just Doesn’t Work.

30 January 2008

 

On this day in 1986, the then president of the American Psychological Association, Robert Perloff, presented the APA Presidential Citation to Nancy Reagan for her efforts in promoting the “Just Say No” campaign against drug abuse.  This is an interesting blip in the history of psychology given that there was no evidence at the time for or against the campaign.  Furthermore, now that evidence has come back, we have discovered that, just as with all other abstinence movements, it just didn’t work.

 

What does this mean that it didn’t work?  The anti-drug curricula developed was developed in the 1980s.  There was a steady drop in drug use from the early 1980s to about 1992.  However, this decline in drug use predated the effective implementation of this anti-drug movement.  By the time that it was fully implement (in the early 1990s), the use of drugs was again on the rise.  In 2002, for example, when the movement should have shown progress, 53% of seniors said they had used illegal drugs.  This is compared to 41% in 1992. 

What accounts for this negative trend?  Why didn’t the anti-drug curricula work?  Certainly, there are a number of potential hypotheses.  However, I would surmise it does not work because the pressure comes from an outside source.  The individuals targeted are not developing an internal motivation to follow through with non-use.   Essentially, the message is “conform to my peer pressure that involves non-use” and “don’t conform to other peer pressure that involves use.”  This is an odd message to begin with and certainly not a useful one to deter someone who has an inclination, however mild, to rebel against mandates from authority figures.

 

In fact, research on controlled behaviors versus autonomous behaviors predicts exactly this sort of behavior.  Controlled behavior, such as imposing perspective such as abstaining from drug use or anything else, involves an external perceived locus of causality (e.g., that something or someone other than the behaving individual determines the behaviors) and is experienced as pressured by demands and contingencies (e.g., to use or not use the drugs).  Autonomous behaviors, on the other hand, have an internal perceived locus of causality (e.g., that the behaving individual determines the presentation of the behaviors) and are experienced as chosen and volitional (e.g., that the individual is agentic).  Perceived autonomous, agentic behavior, as opposed to perceived controlled, determined behavior, is related to enhanced performance and persistence (e.g., continuing to abide by that personal choice).  Based on such findings, the discovery that drug use actually rose after individuals were told to abstain makes sense:  they perceived they were under control of outside forces, both forces toward and away from use, which made it easier for them to “change with the winds” of the forces upon them.  They were, in this sense, much like a sail boat without a captain: at the whim of forces not under their control. 

Alternatively, agency beliefs about effort and ability are the strongest and most critical predictors of actual performance.  In this sense, then, a better tack would have been to engage the individuals in discussion.  This discussion would be non-threatening and non-punitive, perhaps led by a respected peer.  The point of the discussion would be to address myths and misconceptions and provide facts but not provide mandates on behaviors.  The discussion would also involve an open discussion of what the individuals motivations for and against drug use (or other concerning behaviors), in order to address ambivalence regarding it.  Finally, the discussion would conclude with the individuals, themselves, stating their reasons for and against use of drugs and for them to make an honest, confidential assessment of their motivation to use or not use.   

Fuel for thought, I guess… head to my website GivingPsychologyAway.net for more fuel for thought regarding psychology.

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January 30, 2008 Posted by | In Psychology | , , , , , , , , | Leave a comment

20 Jan 08 – Children with Emotional Disturbances and Expulsion from School

20 January 2008

On this day in 1988, the U.S. Supreme Court ruled, in Honig v. Doe, that schools may not expel children with emotional disorders for more than 10 days without parental consent or court order. I would like to offer a dissenting opinion on this case, as I think that it reflects our tendency to “biologize” psychological phenomena (e.g., see them as biologically determined, without any personal or interpersonal choice involved) and sets a poor precedent, starting early in people’s lives, for excusing bad behaviors.

I believe that the underlying thought process behind this is that children with emotional disorders really have no choice in their behaviors. They are, instead, determined by forces (such as “chemical imbalances”) outside of their control. These children are not responsible for their behaviors; nor are they responsible for changing their behaviors. As such, expelling them is unreasonable and requires some checks and balances to prevent undue abuse of these disabled individuals.

This certainly could have some important implications. One important implication for the children is that their behavior has nothing to do with the choices that they make. That is, as long as these individuals are perceived to not be responsible for their behaviors, it also follows that their behaviors are not a result of the choices and decisions they make.  Instead, it is merely their biology, working at a level over which they do not have control, which is responsible for and governs their actions. Furthermore, it means that they are perceived and perceive themselves as incapable of changing their behaviors on their own, either making it better or worse, because they have no choice in their actions.

An analogy, here, might help to clarify how this perception operates. Based on the deterministic logic that underlies this perspective on such children and their behaviors and that implies that children are controlled by natural (in this case, biological) forces over which they have no control, we could logically analogize these children to any other natural object that was being controlled by other forces (e.g., if children are determined, like any other natural object, by sources over which they have no control, they are no different, in-kind, from these natural objects). Take, for example, a ball being thrown from a pitcher to a catcher, bracketing out, for the moment, the involvement of the pitcher. Much like this ball has no choice about where it will land and what it will do between the pitcher and the catcher, based on the deterministic perspective, neither does the individual diagnosed with an emotional disorder have any choice or control over his or her actions or behaviors. The individual, like the ball, is controlled by hypothetical natural – in this case neurobiological – forces over which he or she has no control. As indicated above, with no control over his or her own behavior, this individual can also not be held responsible for his or her behaviors and is, thus, not perceived to be responsible for these behaviors. There is, in essence, no one – no human, at least – who is perceived to be blamable for the individual’s behaviors.

Substituting neurobiology for the pitcher, it is merely the individual’s neurobiology that is perceived to control how the individual will behave. Certainly, there are other forces that can act upon the ball and this is also true of the individual. Still, all of these forces are considered to be natural – or, similarly, neurobiological – over which the child is perceived to have no control or no choice in changing. The ball is not seen as choosing to curve or be pushed by the air. Similarly, the individual diagnosed with an emotional disorder, if the emotional disorder is perceived to be caused by neurobiology, is not seen as capable of choosing to change his or her behavior.

There is certainly a paradoxical sense in which those in the child’s social environment (such as the school system look toward expulsion) want to hold the child responsible, as if he or she was choosing his or her behaviors. Still, it would make little sense to say, “bad ball,” for not heading in the proper direction as the ball had no choice in its direction. Similarly, following the deterministic perspective, it would make little sense to say, “bad child,” for not behaving appropriately, as the child had no choice in his or her behaviors. As the biologically deterministic logic goes, the children are perceived as not responsible for their behaviors. Still, schools want to hold the children responsible. The Supreme Court, evidently, however, felt that the children were not responsible and a check of attempts to hold them responsible was warranted.

So what? Why should we be concerned about this apparent irresponsibility? The possible implications of such meanings of medication are important considerations in addressing these questions. The most important implication of what such meaning of medication may indicate has to do with society. The past president of the American Psychological Association, George W. Albee, for example, noted that, ” …the conservative view of causation [of the medical model]…perpetuates social injustice.” What does Albee mean by joining forces that “perpetuates social injustice?” Simply put, Albee’s appraisal implies that the medical model and the centrality, in this model, of biological causation is responsible for the experience of medication as indicating lack of personal responsibility. The result of this lack of personal responsibility is what Albee refers to as, “social injustice.”

What, then, might be meant by social injustice? If someone is not considered responsible for his or her behaviors, especially those behaviors considered negative, asocial, or maladaptive, because he or she is biologically determined to act in certain manners, then, as noted above, he or she also cannot be held to blame for those actions. The implication of not being held responsible for negative actions is especially important when those actions are defined as including impulsive and potentially destructive social actions. If, for example, an individual happens to be apprehended committing a crime of an impulsive and potentially destructive nature, and the individual has been diagnosed with an emotional disorder, by virtue of the logic that this individual is a product of his or her biology, this person cannot be held responsible for these actions. He or she could say, following the biologically deterministic perception of his or her emotional disorder-related behaviors, “I am not to blame. My neurobiology made me do it.” He or she might blame the physician for not refilling the medication in a timely manner. Alternatively, the parents might be blamed for not ensuring that the medication was given or taken by the individual.

According to the implicit deterministic logic, in the end, however, not only would personal responsibility be forfeited when one is considered to not be responsible for his or her behaviors but so would societal responsibility. Why, for example, would an individual have to answer to society for his or her crimes if they were not his or her crimes but crimes caused by something over which he or she did not have control, such as his or her neurobiology? This is, in fact, the logic that underlies some interpretations of the insanity defense, indicating that the perception of irresponsibility due to mental state – equated to physiological state – is a cultural perspective accepted by far more individuals than merely those included in this investigation. This is also what is meant by social injustice here: justice – in the sense of upholding the law and ensuring equitable treatment for breaches of conduct – cannot be served because the individual committing the crime could not, legitimately, be held culpable for the actions if other phenomena (e.g., biochemicals, physicians, parents) could be blamed in the individual’s stead.

Alternatively, the child could be interpreted as someone who does possess responsibility. Conceptualizing the child as someone who does possess responsibility would mean a dramatically different perspective on such children and their behaviors. The concept of personal responsibility is interwoven with the concept of experiential meaning. Experiential meaning, experiencing an individual’s actions as meaningful (e.g., intrinsically important and significant), occurs only when the individual doing the acting is responsible for the actions taken.

An action could certainly be meaningful without the individual perceiving himself or herself as responsible. That is, the individual could be responsible, whether or not the individual perceives himself or herself to be so. However, if the culture perceives them to not be responsible, then the meaning of the behavior is reduced to the biological determinant and does not relate to what the individual values, thinks, or feels about significant aspects of his or her everyday life and actions. Therefore, for an action to be meaningful in terms of what the action means about what the individual values, thinks, or feels about significant aspects of his or her everyday life and actions, the person has to perceive himself or herself as personally responsible – or be responsible – for that action.

Furthermore, for an individual to experience his or her action as important or significant (e.g., “meaningful”) to the extent that he or she owns it as his’ or hers’, the action must be intentional. The individual must intend to perform the action for a specific purpose. An individual, however, does not have to be conscious of his or her intent for him or her to be responsible for it. This intention, however, does include the act on his or her part of selecting among various options, whether consciously or not, and behaving for the sake of the options chosen. Selection from among the various options implies that personal responsibility requires possibility. As Brent Slife and Richard Williams once stated, “Possibility is a category of assumptions with no ‘must’.” In other words, possibility indicates that an event can be interpreted differently than would be expected based on previous events. Possibility, then, involves the assumption that experiences (which are interpretation plus reality) are not determined by previous events. It is the indication that an “otherwise,” a choice, is available.

From this perspective, then, personal responsibility implies a possible alternative perspective to the deterministic perspective accepted by the Supreme Court in this ruling: agency. Agency refers to such factors as choice, free will, or self-generated thoughts and actions. As it relates to the present issue, agency would imply that children with an emotional disorder are able to do otherwise than some causal force (e.g., the neurochemical imbalance or genetics) has dictated. This definition of agency, as requiring responsibility and possibility, then, is synonymous with the idea that such children have the ability to act “other than” the perceived causal forces – such as neurobiology – would seem to determine.

Furthermore, under the alternative perspective of agency, these children would be perceived as responsible for the choices they make. If we were to perceive the treatment for an emotional disorder as involving agency on the part of the individual, then responsibility, both individual and societal, would re-enter the picture. For example, we might say that, much like the ball being thrown from the pitcher to the catcher, there are certain actions occurring that are not under the direct control of the individual (e.g., the actions of the biochemicals, for example, within the individual). However, if we include the complete picture of the scenario, instead of merely the ball, as a representation of the individual diagnosed with an emotional disorder, the phenomenon of interest becomes more complex. In this case, the ball now has an ability to choose among various options and act intentionally for the sake of those things the child chooses. As such, it might be easier to follow the analogy if we think of the child as the pitcher instead of the ball. The complete picture of the scenario, then, might also involve awareness of the pitcher (the child, himself or herself), the pitcher’s abilities (what the child can truly not do and what the child truly can do), both already developed (what the child has learned) and what is expected (both from self and others), and the pitcher’s motivations and desires (what the pitcher is willing to do and wants to do), as well as contextual factors such as those giving the pitcher guidance (such as the catcher giving signs or the catcher’s analogues – the child’s parents, teachers, and physicians) and the environment in which the pitcher is pitching (including the wind velocity and direction or these factor’s analogues – the limits placed on the child by outside forces). If we limit our focus to merely part of the picture – the ball in its trajectory or, analogically, the individual’s biochemicals or the effects of changes in those biochemicals – it is easy to lose sight of responsibility.

The result, then, of pathologizing and biologizing of behavior, as noted, has some serious implications. Read and Harré, for example, found that people who attributed mental disorder to biogenetic causes tended to hold more negative attitudes toward it. Similarly, Mehta and Farina showed that confederates who disclosed a psychiatric problem were blamed less but treated more harshly when the problem was described as being of biological rather than psychosocial origin. Furthermore, Walker and Read found that a biomedical explanation of a psychotic man’s condition increased perceptions of his dangerousness and unpredictability. Some investigators have argued that biologizing behaviors such as emotional disorder-related behaviors trigger paternalistic responses linked to mandating of treatment, such as medication, and encouraging a view of the disordered as deeply and categorically different. The view of children with emotional disorders as categorically different and requiring the provision of different standards is certainly evidenced by the Supreme Court’s ruling in this case. Furthermore, Read & Harré have asserted that attributing the disorder to causes outside the control of the individual, such as the neurobiological determinants evidenced in this study, produces a perception that the disordered are unaccountable, irresponsible, and unpredictable and may produce a sense of vulnerability among the unaffected. Again, the Supreme Court’s ruling in this case support this assertion.

Finally, the empirical literature indicates that a biologized self-understanding handicaps sufferers, engendering a belief that they are incapable of ever functioning normally, a belief that may elicit pessimism and disengagement if also held by the lay public. This negative view of self can involve a belief that they are deficient and different from others. Such a view is also likely to be held by those in their social network. The empirical literature, according to this perspective, does demonstrate that children with emotional disorders have worse self-esteem than those in control groups. Why wouldn’t they? After all, they perceive themselves and others as less than, or at least different from, others in their social context. Furthermore, research indicates that children diagnosed with emotional disorders show a tendency toward attributing both good and bad behaviors to external forces. In other words, the negative view of self, deficiency, and difference, fostered by a biologized and materialistic perspective on their behaviors, appears to generalize to feelings of incompetence, incapability, and, ultimately, feelings that they are controlled by external forces.

The research on controlled behaviors versus autonomous behaviors predicts exactly this phenomenal experience. Externally controlled behavior, with the implicit assumption of personal irresponsibility, involves an external perceived locus of causality (e.g., that something or someone other than the behaving individual determines the behaviors) and is experienced as pressured by demands and contingencies (e.g., taking or not taking the medication). Autonomous behaviors, on the other hand, have an internal perceived locus of causality (e.g., that the behaving individual determines the presentation of the behaviors) and are experienced as chosen and volitional (e.g., that the individual is agentic). Perceived autonomous, agentic behavior, as opposed to perceived controlled, determined behavior, is related to enhanced performance, persistence, and creativity, heightened vitality, self-esteem, and a general sense of well-being.

Agency beliefs about effort and ability in achieving academic success are also the strongest and most critical predictors of actual school performance. Similarly, when children who attribute failure to a lack of ability rather than to the difficulty of the task or insufficient effort are taught to practice lack-of-effort explanations (e.g., “Maybe I didn’t give it my best effort”) rather than lack-of-ability explanations, both their responses to failure and their school performance are improved. In sum, conceptualizing children as possessing agency empowers them and improves their potential for success.

My dissenting opinion, then, involves a simple counterargument/counterperspective: let’s hold people accountable for their behaviors, even children with emotional disorders. I believe this, ultimately, empowers them, whereas not doing so (as implied in the Supreme Court’s decision) subjects them to an ultimately debilitating state wherein both others and themselves perceive such children as incapable, deficient, and, simply, inhuman.

Fuel for thought, I guess… head to my website GivingPsychologyAway.net for more fuel for thought regarding psychology.

January 19, 2008 Posted by | In Psychology | , , , , , , , , , , , , , , | Leave a comment

15 Jan 08 – Breuer, Freud – Deterministic?

15 January 2008

On this day in 1842, Josef Breuer was born.  Breuer was a protege of Freud’s and, together, the two of them wrote up the case study of Anna O.  In this case study, Breuer was the treating physician, using hypnosis to “cure” Anna O. of her neurotic condition.  From this case study, the two (Breuer and Freud) developed the techniques of abreaction (mental reliving of a situation from the past) and catharsis (the physical expression of emotion).  However, the two did have some fundamental differences in their theoretical conceptualization of Anna O. (and all mental health “patients”).

Breuer and Freud were both student of Brucke.  Brucke put great faith in what was referred to as the “constancy principle,” which was first introduced by the physician Robert Mayer in 1842 and furthered by Hermann von Helmholtz as a style of explanation in physics.  The principle, as espoused by Helmholtz (and Mayer before him), held that there is a tendency for energies in a closed system to redistribute themselves (conservation of energy).  The force of this redistribution could account in a linearly deterministic fashion (with one thing causing another thing, like a billiard ball hitting another billiard ball, making it move) for the observed behavior of natural objects.  Breuer’s version of this principle showed up in some of his own published lectures and demonstrated how he applied this concept to humans:

Organisms…are all phenomena of the physical world: systems of atoms,
moved by forces, according to the principle of the conservation of
energy discovered by Robert Mayer in 1842…and then popularized
by Helmholtz…The sum of forces remains constant in every isolated
system.  The real causes are symbolized in science by the word “force.”
The less we know about them, the more kinds of forces do we have to
distinguish: mechanical, electrical, magnetic forces, light, heat. 
Progress in knowledge reduces them to two – attraction and repulsion. 
All this applies as well to the organism man.

Here, then, we have Brucke’s perspective that humans are, like any other natural object, the result of forces of attraction and repulsion; they are determined by forces outside their control.  As a good student of Brucke, Breuer likewise favored the constancy principle.  In fact, this principle was to be the basis of Breuer’s contribution toward explaining the hysterical neurosis: strangulated affect (affect and emotion are often used interchangably in psychology).  According to Breuer, this was a kind of bound energy that required working though in order for it to dissipate.  For Breuer, the way to work through and unbound this energy was to regress (take back in time) the patient to reconstruct the unhealthy circumstance that led to the emtion being strangulated in the first place. 

Freud seemed to accept the formulation of the strangulated affect, in general, but not in specifics.  That is, Freud disagreed with Breuer regarding the cause of such strangulations of affect.  While Breuer felt that the strangulated affect was an inherited condition, Freud felt that it was an act of will on the part of the patient.  In most, if not all cases, all that was needed was some exploration to discover this.  In fact, he met no such hysterical neurotics, “who did not exhibit an effort of while whose motive [could] be specified.”  Breuer’s etiology (belief about what caused the strangulated affect) was phrased “hypnoid hysteria” and Freud’s was phrased “defense hysteria.”

This struggle between deterministic and free will conceptualizations was to follow Freud for some time.  In fact, his close relationship with Wilhelm Fleiss was punctuated with failed attempts for Freud to establish a biologically deterministic perspective not unlike that of Breuer’s on neurosis.  In fact, Freud attempted to write a materialistic document describing neurosis but ultimately gave up on it because it did not fit what he saw in his practice or in his self-examination.  The one consolation Freud gave to the deterministic perspective offered by the constancy principle was his libido theory that certainly appears to be a mere “add-on” to appease his more deterministic minded associates (and to gain the respectability he so desired from the medical community).

Freud, then, was largely a “free will” theorist even though he is frequently painted as deterministic.  In fact, the one overtly deterministic portion of his theory was one he, himself, said depended on more of an analogy to biology than any direct evidence from psychoanalysis itself.  It was, in fact, superfluous to the theory that Freud formulated and did not appear to fit comfortably with Freud’s obviously final causal elements (e.g., wish fulfillment, that “for the sake of which” we act). 

SIDE NOTE: Free will (or, as it is more properly called today, “agency”) should not be confused with “non-deterministic” or “indeterministic.”  The latter terms imply a form of chaos, where anyhing goes and there is no direction to behavior.  The former implies an agent acting for the sake of final causes, who possesses possibilities (choices), which he or she can choose to act on.  This agent is constrained by context and ability but otherwise “free” to act on the choices available to him or her.  Some also add that freedom is associated with the actor making a choose that is “authentic.”  That is, the choice is one that is one is true to the proclivities of that individual, not accepted by someone else’s mandate or acted upon based on a belief that he or she must forfeit his or her choice in the matter (as Rush, the rock band said, “If you choose not to decide you still have made a choice”).

In the end, Freud was not deterministic; yet, due to his add-on of the Libido, he was not entirely a free will theorist, either. 

Fuel for thought, I guess… head to my website GivingPsychologyAway.net for more fuel for thought regarding psychology.

January 15, 2008 Posted by | In Psychology | , , , , , , , , , , , | 1 Comment