Tuesday, July 1, 2014

Not Sorry I'm Not Sorry



Jessica Glass Kendorski, Ph.D

Pantene's recent commercial depicting women apologizing for being assertive has been getting lots of attention from national media outlets such as Good Morning America and ABC News.  In the ad, several women are seen saying “I’m sorry” in situations that clearly don’t call for it—for example, one woman apologizes for interrupting a business meeting, and another apologizes for handing her husband their child after he comes home from work.

The ad comes at an opportune moment; this week, President Obama is hosting the first-ever White House Summit on Working Families, which will address improving gender equality on the workplace. In light of all of this, I wonder if gender differences in communication account for some of that disparity.

Women make up 47 percent of the work force. Working married women bring home 44 percent of their family’s income, and women make up 59 percent of the recipients of college degrees. Yet women only earn 77 cents for every dollar earned by men.  Could the tendency for women to constantly apologize, and engage in less assertive communication, be a possible contributor to this wage gap?

Expectations are key. Expectations guide communication in the workforce and also guide how adults communicate to impressionable children. Men are expected to ask for what they need and women are expected to apologize for asking. Fostering equal environments in the workforce begins with fostering equal expectations for men and women—starting in early childhood.

Early on, girls are taught to stifle displays of negative emotions such as anger and frustration, and often express the opposite of what they’re feeling, such as smiling even though they’re not happy—and apologizing when they’re not sorry.  On the other hand, it is more acceptable for boys to show evidence of anger and frustration. Because boys can externalize their feelings, they are able to learn to express these behaviors appropriately through assertive communication. If girls continuously suppress their emotions, then they may never learn how to truly be assertive.

Regardless of gender, children experience intense emotions and need to be supported and taught appropriate ways of dealing with these emotions. Adults should be aware of their expectations and the behavior these expectations foster in children.  Boys are expected and taught to grow up strong and assertive, but girls should be taught the same. And as the Pantene commercial shows, women can find strength in the ability to truly express their feelings.



http://workingfamiliessummit.org/
Chaplin, T.A., Aldao, A. (2013). Gender difference in Emotion Expression in Children: A Meta-Analytic Review. Psychological Bulletin, 139, 4, 735-765.

Friday, June 27, 2014

What Colors (are) Your Nation? Nationalism and the World Cup




Petra Kottsieper, Ph.D

A day after a vital soccer game where the US played Germany in the world cup (and thankfully both teams advanced into the next round), I have been thinking about soccer, the construct of pride and national identity.  As a native German who came to this country in 1991, I have been firmly rooting for Germany unless my adopted home team (USA) is playing. However, for yesterday’s game I went red, gold and black all the way. This raises the following question; what is it about the world cup, and soccer specifically, that has suddenly seemed to make it okay to me to paint my nails in the above colors, something I would have not been caught dead doing when younger?

This post is not about the merits of soccer, which I understand can be boring for people not raised on it. This post is about nationalism, pride and identity.  See, if you grew up German and were in my particular high school in the 1970's, your high school history curriculum consisted of pretty much the Third Reich and the Second World War.  We did not just learn “facts” but were asked questions such as “would you have sheltered a Jewish neighbor when they were in danger of being deported?” …… and the answers to these questions never came easy.  And they should have never come easily. Because how do you know for sure what you would do when your own life might be at stake? 

Grappling with my country’s WW2 history, similar to the generation before mine, left a shameful and horrible taste in our collective mouths. Were we guilty as a nation? Were we guilty as individuals?  The question of the condition under which people can commit terrible acts of torture and extermination, and if Germans had a special psychological or constitutional “propensity “ for this were investigated in social psychology research.  The famous Milgram experiments that started in 1961, uncomfortably demonstrated that “average” people administered at times deadly fake (unknown to them) shocks to others in a learning study. These experiments were some of the most famous investigations into the issue of conformity to authority.  Several other studies like this were conducted here in the US and these studies showed that under certain conditions a lot of people might do things that after the fact they themselves might be horrified by.

What does any of this have to do with soccer?  Soccer is one of the few team sports that is played all over the world. And, while of course it is as corporate as anything else these days, it can be played anywhere you can set up a goal and give people a ball. It makes people identify with their team, which really in the end for most people is about identifying with their city or town in league soccer, or their country in the case of the World Cup.  I also learned quickly, and to my utter amazement, that in the US seemingly few people have issues with showing their pride of being American at sporting events.

Just yesterday, an extremely vocal contingent of US fans had decided to watch the game in a German bar, which initially I thought would make watching the game even more fun.  However, it became clear very quickly that these particular fans seemed kind of oddly determined to drown out the Germans present, shouting them down with “USA USA” chants and “We believe we can win” (even when the game had 1 minute left and they were clearly losing). This had the rather odd effect of making the Germans become quiet instead of yelling back, and I observed several Germans in my vicinity shaking their heads at these fans, or just laughing at this very overt display of nationalism. 

You need to know, if you do not already, that draping yourself in flags and national colors and walking about the street chanting “Germany” is something you would have never seen when I grew up in Germany unless you had some kind of fascist tendencies. Nationalism, or national “pride” was often equated with fascism. And seeing this kind of display yesterday in the US carried out with such ease and apparent thoughtlessness, makes me uncomfortable....

However, as I think back to the World Cup in 2010, I see a change in the outward display of German nationalism.  I, for the first time, noted significant numbers of people carrying German flags (both here and in Germany) and wearing little cute face flag painting etc.  And I painted my nails for the first time. It was and remains odd for me to do, but I have come to realize that identifying with my heritage is not the same as thinking it is better than anyone else’s. I identify with being German, because I was raised on Rainer Fassbinder movies, read Herman Hesse, Boell, and Grass in high school, grew up on the humor of Loriot and Otto, love Broetchen and Nutella for breakfast and knew that when the bus schedule says the bus comes at 10:02 am and I showed up at 10:03 I was sheer out of luck.   


I watch World Cup soccer because I love the game. I wear the colors of the country that shaped me with joy, but also with a sharp awareness that we can and should never forget its victims;  and hope that our re-identification will never be equated with exceptionalism. 

Friday, April 4, 2014

When Enough is Never Enough: The Psychology Behind Animal Hoarding.




Petra Kottsieper, Ph.D

If you have been following the regular Philadelphia evening news you may have come across one of the biggest recent animal hoarding cases in Philadelphia, which also made it into some international newspapers.  On March 26, some 239 cats were removed from a double row house in the Frankford section of Philadelphia, after the same person had previously surrendered about 40 of her cats voluntarily.  The woman who lived with and took care of the cats also officially ran an animal rescue group, a situation that very clearly got out of hand.   Hoarding has become popular in recent years with TV shows such as the now cancelled “Hoarders” on A&E, and “Hoarding: Buried Alive” on TLC.  I assume, and I am assuming because I have never watched them, most people watch these shows with a mixture of curiosity and disgust.  It seems, however, that animal hoarding presents its own unique challenges that, until very recently, have not been explored at all.

Hoarding is finally gaining its own entry as a diagnosis in the Diagnostic and Statistical Manual of the American Psychiatric Association, 5th Edition (DSM-5; 2013).   Hoarding disorder, as it is now called, appears to affect between 2-5% of the population.  It furthermore appears to be a distinct disorder and not just a symptom of Obsessive Compulsive Personality Disorder (OCPD) , or Obsessive Compulsive Disorder (OCD).  Hoarding has been referenced in the literature going back all the way to Dante, and was first discussed by psychoanalysts as one of the determinants of having an "anal personality."  In the 1980’s the anal personality construct (also containing orderliness and obstinacy) developed into Obsessive compulsive Personality Disorder.  To make things more difficult hoarding has also been thought and is still thought to be a part of Obsessive Compulsive Disorder.[i]

So now in essence we have 2 types of hoarding categorization. Hoarding disorder in itself and OCD with hoarding behaviors.  Differences between these two manifestations are that in hoarding disorder the accumulation and refusal to discard things (or animals) is often thought to be “normal” by the person and may even be associated with positive experiences. Whereas individuals with OCD who engage in hoarding are more likely to experience their behavior as distressing and not really part of their self-identity. Individuals who clutter are not necessarily hoarders, but individuals who hoard have excessively  cluttered and largely unusable work and living spaces, often resulting in serious health and safety concerns.

Why do people hoard compulsively? Many reasons have been put forth. One example is the belief that individuals who have grown up in poverty or serious deprivation may grow into someone who engages in hoarding.  This theory has not been substantiated by research. Hoarding has been thought of as a pathological excess of capitalism, and several psychoanalytic theories have conceptualized hoarding as a drive to acquire in one’s self-development for a variety of functions.  More recent research has begun to outline psychological and cognitive processes closely related to or may even causally related to some hoarding behavior.  For example, one recent study used functional magnetic resonance imaging to compare neural activity and self-reports in individuals with HD, OCD and individuals with no mental health diagnosis.   It was found that individuals who compulsively hoard exhibited very distinct neural activity in specific brain regions that mapped onto their self-reported and observable psychological states in response to specific stimuli.   Compared to the other two groups, the individuals with HD reported significantly more difficulty with decision making around personal objects they had brought to the study, especially around the emotional value they assign to the objects in question. In addition these same individuals reported experiencing significantly more sadness and anger when thinking about discarding any of these items.[ii]  

Other emerging theoretical approaches have pointed out the importance of a dysfunctional attachment style in individuals who hoard animals.[iii]   Even “normal” animal rescue behavior probably function as a means of deriving meaning and a sense of self as a “good” person. Additionally, rescuing an animal from a "kill shelter" or the streets, which may otherwise mean “death” for the animal, can afford the person a special feeling of control, a sense that individuals who develop hoarding behaviors may not experience in other areas of their lives. These individuals may have disrupted or dysfunctional attachments to other humans, and their attachment to the animals develops into their primary means to build and maintain a sense of self. The control experienced often becomes so extreme (and some have argued delusional) that these individuals believe that no one else can take care of the animals as well as they do, despite evidence of death , disease and squalor all around them.

What does this mean for the woman in our recent local animal hoarding case? Animal hoarding has been described as significantly more difficult to deal with for public health departments as compared to complaints about individuals with non-animal hoarding behaviors.  Individuals who hoard animals are much less willing to cooperate with authorities during the resolution of hoarding complaints leveled against them.  In a very comprehensive overview of animal hoarding, it was noted that animal hoarding largely overlaps with object focused hoarding, but it may constitute even more severe cases , especially as it is often associated with extremely squalid living conditions . 

Individuals who hoard animals often develop the hoarding behavior in middle or older age, as opposed to a younger age as seen in individuals who hoard objects, and they seem to be more often women.  Animal hoarding seems to also be associated with more dysfunctional beliefs and attachments to the animals they hoard as compared to other hoarding situations. Individuals are often unable to bury them or discard the animals even when they are deceased. Furthermore the extreme distress experienced when having to give up the hoarded animal might be greater in individuals who hoard animals as compared to object hoarding. [iv] 

Hoarding in general , but animal hoarding specifically, is in significant need of more research. Very little is known about animal hoarding and the etiology of this possible subtype of hoarding disorder (it is not mentioned as such in the DSM-V).  However, animal hoarding is not an infrequent occurrence, carries not only significant risks to the person and the animals involved but also the nearby community, and can be an expensive and frustrating problem to deal with.  Additionally, animal hoarding has an extremely high relapse rate, reportedly as much as 100% . Historically it has been left to be dealt with by predominantly animal control and law enforcement.  This is clearly an area in dire need of interdisciplinary collaborative efforts and attention from human welfare and mental health agencies. Maybe the inclusion of hoarding disorder as a separate category into the DSM-V will be one important step in this direction.  

In the future I hope to see not only the rescue of the animals from these terribly sad and awful situations, but also envision the provision of (either voluntary or court mandated) help and assistance to the people who very clearly are in need of treatment and relapse prevention.  



[i] Mataix-Cols, D. et al. (2010). Hoarding Disorder: A new disordered for DMS-V?. Depression and Anxiety, 27,  556–572.
[ii] Tolin D.F., Stevens M.C., Villavicencio A.L., et al. (2012). Neural Mechanisms of Decision Making in Hoarding Disorder. Archives of  General  Psychiatry, 69, 832-841.
[iii] Nathanson, J.N. & Patronek, G.J. (2009). A theoretical perspective to inform assessment and treatment strategies for animal hoarders.  Clinical Psychology Review, 29, 274–281.
[iv] Frost, R.O.,  Patronek, G. ,  and Rosenfield, E. (2011). Comparison of object and animal hoarding. Depression and Anxiety, 28, 885–891.




Tuesday, February 18, 2014

Returning to Life After the Olympics: Taking Home More Than the Gold?










Sarah Levin Allen Ph.D, CBIS

Within a minute, the life of Saraka Pancochova, a Czech Olympic snowboarder, went from smiles and High Fives to lying prone on the snow of Sochi. I counted the seconds wondering when the medical staff would arrive. Within minutes, Pancochova got up and was applauded for finishing her run. This was after a fall in which she lost consciousness and cracked her helmet down the back. USA Today[i] quoted Pancochava, “I didn't think I really got any concussion, maybe a tiny bit, but nobody told me…I just got really lucky. It could have been worse. I got knocked out, and that hasn't happened in a while, but I was lucky the snow was soft, and you know, it just happens sometime in snowboarding."

She got lucky? Let’s hope so. I would call it lucky if Pancochova could read this blog and respond to it tomorrow. My guess is that she, and the athletic community in Sochi, mean “lucky” in that she could compete in the next round. What about after that round? What about tomorrow when she attempts to read the articles about her?

“Luck” or “success” is not in finishing the race, but in protecting her brain from future injury and ensuring that she can function on a day-to-day basis. Just ask the students with whom I work. My job is helping students who have sustained brain injuries, desperately trying to succeed in the school setting.

As I reflect on these students, I think about what it takes for me to complete this passage. I am suddenly overwhelmed with understanding for students with concussions and other brain injuries. I’m sitting in front of the television dividing my attention, grasping ahold of all the ideas floating in my head, organizing those ideas, sequencing them, and pulling my attention toward my computer and away from the Olympic games. I’m doing all this while occasionally telling my 3 year old not to clobber her brother and telling my 2 year old to choose an activity other than throwing things down the stairs and sliding on his head to the bottom. 

Then I think about typical students. In high school, students must change classes a minimum of 6 times a day, switch their attention from one topic to another every 40 minutes, selectively attend to the teacher and not the Hottie in the front row; not to mention control their emotions which are triggered repeatedly as hormones reek havoc on their bodies. 

When school ends, they are expected to go to practice or debate team, collect coats for the homeless, and finish their homework preparing for 3 tests before falling asleep in front of the television and doing it all again the next day!  Then there is the socialization that is essential during all of this. Socialization that includes constant texting or group chats in which a significant amount of divided attention, focus, and exposure to stimuli is required, without which, a student would be isolated and lack an identity.

With all these daily requirements, my head is spinning. Yet, despite these demands in the setting in which these athletes are required to return, there hasn’t been much discussion about how to help these “typical” students return to full functioning.

There has been a significant amount of conversation about sports concussion. The NFL and NCAA have been in litigation accused of failing to educate athletes on concussions[ii]. Brain injury advocacy groups as well as the NFL have helped to increase awareness around the issue of brain injuries, specifically concussions. In 2011 and 2012, PA[iii] and NJ[iv] respectively passed a youth sports act that required schools to develop “return to play” rules for athletes who have sustained concussions. Once these laws were passed, identification of concussions increased along with the need to support these students once they return to school.

And it’s returning to school that becomes the most difficult. The supports that are typically in place to support students (i.e. 504 plans or IEPs) don’t happen fast enough or are too taxing on an already bleeding system. What do we do when a student shows up to school the next day or the next week and needs help? How do we tell all 6 teachers, physical education instructors, specials instructors, administrators, counselors, and nurses how to support this student? Who is responsible for identifying learning issues, monitoring the rehabilitation that is happening in the classroom, and helping the student gain some self-knowledge into their injury and recovery?

How do we avoid spending 2-4 weeks (up to ½ of a semester) allowing a student to flounder in a typical environment with no supports, before we put things in place to help him/her succeed? These are the questions that have now become the focus of school administrators as the awareness and identification of students with concussions increase.

So, where does that leave those like Pancochova or my high school students? Well, the majority of those with concussions will get better. They’ll need minimal supports for 2-3 weeks, and then they’ll begin to get back to their normal routine. Those with 2 or 3 concussions will struggle more, and those with more significant brain injuries will need even more assistance.  The minimal deficits I experience as a sleep deprived, working mother pales in comparison to the uphill battle these young athletes and students go through as they attempt to get their brains back to normal.

I’ll continue to think about them, and tighten the helmet I have decided to wear around 24 hours a day, as I finalize this blog, change the laundry, break up the wrestling match on the floor of my office, turn off the television, and start dinner. All the while, I’ll be hoping that I never get an injury that could make all these “other jobs” virtually impossible.

For more information on return to school programming for students with concussions see Dr. Allen’s webinar for the BIANJ at http://bianj.org/2013-concussion-in-the-classroom




[i]http://www.usatoday.com/story/sports/olympics/sochi/2014/02/12/snowboarder-cracked-helmet-slopestyle-halfpipe/5414539/
[ii] http://www.usatoday.com/story/sports/college/2014/01/02/concussion-lawsuits-ncaa-consolidated-adrian-arrington/4293867/
[iii] http://www.epysa.org/assets/947/15/PA_Act_101.pdf

Hale, J.B., Metro, N., Kendorski, J.G., Hain, L.A., Whitaker, J., & Moldovan, J. (2009). Facilitating school reintegration for children with Traumatic Brain Injury. In A. Dvis (ed.), Handbook for Pediatric neuropsychology. Hoboken, NJ: John Wiley & Sons.


"Celebrity" Guest Blogger:
Sarah Levin Allen, Ph.D., CBIS is an Assistant Professor at the Philadelphia College of Osteopathic Medicine. She is a licensed pediatric neuropsychologist, certified school psychologist, and certified brain injury specialist, who specializes in the area of evidence based interventions for schools. Her passion is in promoting and integrating brain based learning approaches in the classroom. Dr. Allen consults with school districts on return to school programming for students with brain injuries and works closely with advocacy groups to promote awareness of concussions in the classroom.



Thursday, October 31, 2013

Psychological Treats for Halloween Tricks












Jessica Kendorski, Ph.D  & Stephen R. Poteau, Ph.D.

If someone breaks out the Ouija board at the Halloween party you’re attending in attempts to contact and converse with their late Uncle Bernie, do them a favor, and tell them any movements they make on the board can be explained by the theory of ideomotor action (I’m sure it’ll make you the life of the party). The gist of ideomotor action is that people are prepared to initiate movements they think about performing even if they are not going to actually enact the movement, and most importantly, that there is a tendency to enact the movement the more vividly it is imagined. [1]

Ideomotor action has been used as far back as the 1800s to explain various psychic phenomena such as water witching (using a diving rod to find water underground, a debunked practice which is still very much in practice today), magic pendulums (used to ascertain the sex of an unborn baby; also debunked), and yes, those seemingly involuntary movements made on Ouija boards.[2] There is support for a particular type of ideomotor action that is called intentional induction, which entails the greater likelihood of instigating a movement if it results in something we would like to see happen.[3] One could liken intentional induction to a confirmation bias or self-fulfilling prophecy. Applied to the Ouija board, if your friend expects Uncle Bernie’s psychic powers to move their hands, the intentional induction facet of ideomotor action theory suggests their hands will be more likely to move across the board and spell out what they think is Bernie’s message. It turns out Bernie’s message is merely what you would like to hear from Bernie. 

Interestingly, there is some knowledge to be gleaned from Ouija boards. In a study involving a memory task that specifically examined implicit sematic memory, which is not accessible to conscious recall, participants providing volitional responses to questions they had to guess the answers to were accurate at chance levels (about 50%).[4]  However, participants who used a Ouija board to respond to questions they were guessing the answers to were accurate 65% of the time, a significant difference from the volitional response group. It turns out ideomotor actions can tap into knowledge we have but don’t know we have. Ouija boards can be a useful tool to communicate information about ourselves to ourselves, but falls short of tapping the communication lines of ancestral ghosts. In short, belief in the traditional powers of Ouija boards is plain, old superstitious.
     
Superstitions. What are they? Why do so many of us believe in them? And how is it that people will do seemingly irrational things in order to continue their good fortune and not invite misfortune? Superstition is defined as an irrational belief that an object, action, or circumstance not logically related to a course of event influences its outcome. It’s October, and it seems the month of October is bombarded with superstitions like “playoff beards” in baseball and the ominous sign of black cats on Halloween night. What these things have in common are people engaging in behaviors to support the belief that they are somehow in control of the outcome.

Fifty years ago, one of the greats in Experimental Psychology, B.F. Skinner shaped superstitious behavior in pigeons. In his paper published in 1948, titled "Superstition in the Pigeon," Skinner explained how reinforcing pigeons on an interval schedule (delivering a treat after a certain amount of time has passed) produced superstitious behavior in the pigeon. For example, Skinner would deliver a food pellet to the pigeon after a certain amount of time. He found that the pigeon would then continue to perform any behavior that occurred immediately before the food pellet was delivered. The pigeon's behavior did not control the delivery of the food pellet, but the pigeons began to walk in counter-clockwise circles, bob their heads, or toss their heads as if the pigeon was lifting an "imaginary lever."[5] Although the pigeon's behavior had no control over the outcome, the pigeons continued to engage in the behavior that may have resulted in their fortune. The pigeon’s behaviors sound a lot like lucky socks before a game, a lucky tie before a job interview, never again wearing the shoes that resulted in a particularly bad day. Want to make someone engage in irrational behaviors in their attempt to control the outcome of an event they actually have no control over? Just deliver treats on a time schedule and see what types of behaviors you begin to see. 

And if you want to get a gruesome image stuck in someone’s head while they are performing these irrational behaviors, just tell them not to think of flesh-eating zombies of The Walking Dead ilk. In a study of thought suppression,[6] where participants were instructed not to think of a white bear, what do you think happened?  You guessed it, they reporting having intrusive thoughts of a white polar bear. This is explained by ironic process theory, which states that there is a dual process of cognition: one is automatic and effortless and is responsible for looking for a failure of control, while the other is the conscious operating process.[7] In the polar bear experiment, participants tried to consciously think of something else, but the automatic, effortless process of looking for a failure of control (thinking of a white bear) often kicked in and this restarted the cycle of consciously attempting not to think of the bear yet again…until the automatic, effortless process looking for failure of control forced the white bear back into consciousness (hence the name ironic effects of mental control). It is important to note that these effects are most pronounced under high cognitive load where resources are taxed thereby making those automatic, effortless processes much more influential. This doesn’t take away from the effects of ironic processing theory because in everyday life, we are typically cognitively taxed with the billions of bits of information flooding our senses. In point of fact, the ironic effect of mental control has been demonstrated in several facets of life such as depression, sleep disorders, and even sexual deviancy,[8] which makes this theory one of clinical relevance.

So there you have it, the psychology behind Halloween-related phenomena. Hopefully, a black cat will not cross your path this Halloween night as you are stepping on a crack on the sidewalk, fingers crossed! -just in case. Boo!




[1] http://www.percepp.com/idmoimac.htm
[2] Pfister, R., Janczyk, M., Kunde, W. (2013), Action Effects in Perception and Action: The Ideomotor Approach. Frontiers in Cognition.
[3] Knuf, L., Aschersleben, G., Prinz, W. (2001), An Analysis of Ideomotor Action. Journal of Experimental Psychology General, 130(4): 779-98 
[4] Gauchou, H.L., Rensink, R.A., Fels, S. Expression of Non-conscious Knowledge via Ideomotor Actions,Consciousness and Cognition: An International Journal, Vol 21(2), Jun, 2012. pp. 976-982
[6]   Wegner, D. M. (1989), White bears and other unwanted thoughts: Suppression, obsession, and the psychology of mental control, New York: Viking/Penguin
[7]  Wegner, D. M. (1994), Ironic Processes of Mental Control, Psychological Review 101 (1): 34–52
[8] Johnston, L., Ward, T., Hudson, S. (1997). Deviant Sexual Thoughts: Mental Control and the Treatment of Sexual Offenders, 34(2).

Friday, October 11, 2013

The Stigmatization of Mental Illness

Petra Kottsieper Ph.D


This week, October 6-13 is mental health awareness week.  The first full week of October was designated for this purpose by Congress to further the National Alliance on Mental Illness’ (NAMI) efforts to educate the public about mental illnesses. 1

Over the past several decades NAMI’s agenda included raising awareness that mental illnesses are biological brain disorders due to chemical imbalances, in an attempt to get these problems classified alongside medical disorders such as diabetes. This in turn, would hopefully achieve their second goal to reduce the stigmatization of mental health problems.  This largely overlapped with the declaration by H. W. Bush that 1990-1999 was to be the  “Decade of the Brain."  Consequently, mental health disorders became increasingly labeled as disorders of the “brain” with research focused on neurobiological etiologies, and the development of a large cadre of psychiatric medications to treat these disorders.
In 2010, Bernice A. Pescosolido, Ph.D. and her colleagues published a study on Americans’ attitudes on the attributions/causation of mental illnesses and alcohol dependence. They also looked at attitudes towards psychiatric treatment  and what stigma beliefs respondents held.   The surveys conducted compared the years 1996 and 2006.  It was found that in the 2006, following the "decade of the brain," significantly more respondents stated that they believed the causes of mental illnesses to be rooted in neurobiological problems, and that these problems should be treated by a psychiatrist.  This was good news for those who working towards demystifying  and/or developing a reductionist etiology of  mental illnesses.  According to the beliefs of NAMI and many other advocates, these changes in attitudes should have also translated in a reduction in stigma and negative beliefs often held with regard to this population, but this was not found. 

In a survey conducted in 2006, there was a slight increase in respondents stating that they would not want to work or live next to an individual with schizophrenia or alcohol dependence.   It is obvious that these beliefs have real and significant consequences for individuals with mental illnesses.   Following the de-institutionalization movement , most people with mental illnesses reside in the community , and the main goal for mental health policy makers, providers, advocates and individuals with psychiatric disabilities has been to have people reside in the community and utilize acute care hospital on an as needed basis.  However, as the Pescosolido and other studies have shown , living in the community has not necessary translated into being part of the community.

At this point it might be helpful to talk about what mental illnesses really are and what I mean when I talk about serious mental illnesses (SMI).  First of all they are NOT intellectual disabilities (formerly called mental retardation). Intellectual disabilities, communication disorders, Autism Disorders (including the formerly known Asperger’s disorder) , Attention-Deficit/Hyperactivity Disorders, and some other disorders make up what is called the neurodevelopmental disorders.     Second, mental illnesses and substance use disorders are incredibly heterogeneous.  There are people with what are called personality disorders, where symptoms are thought to be more stable and consistent (which does not mean they cannot be very serious and impairing someone’s functioning), and then there are individuals with what are usually thought to be more “acute” or waxing and waning mental health problems such as depression, anxiety, bipoloar disorder, eating disorders, delusional disorders, somatic disorders and so on.  There is a federal definition for SMI, which does not list specific diagnosis, but addressed that the problems must result in significant functional impairments for the person.   Loosely defined, when practitioners and policy makers discuss SMI’s they are talking about schizophrenia spectrum disorders, bipolar disorder, and major depressive disorder.

It is true that people regard most things, such as novel or different experiences that they are not familiar with or that are clearly out of the norm with some hesitation.  These experiences are hard to classify, and that is something we like to do as human beings.  We are not sure how these experiences are going to turn out and hence the unpredictability makes many people uncomfortable. This means that when it comes to people with mental illnesses we base our perceptions of folks with these problems on several factors that all mutually reinforce each other. 

Individual with serious mental illness often struggle with housing, indeed about 1/3 of the homeless population is estimated to have some form of serious mental illness. Employment opportunities for individuals with SMIs are limited, even more so for individuals with residual symptoms that may require adaptations to their work environments such as quiet spaces, more frequent shorter breaks etc.   This means that we often do not have contact with a person with SMI.  They are not working alongside us, are not living next to us and are not going to the same gym.  The media representations of folks SMI are invariably negative and are often related to violent incidents that have been committed by these individuals.  When we do recognize individuals with this otherwise often invisible disability in the street, or in our local corner store, we are often put off or scared because something in the person’s appearance and behavior seems “off."  This activates previously formed attitudes and beliefs; our stereotypes are activated and we keep our distance. 
It is true, that some people do not seek services for their problems and indeed deny that they have mental health problems, even with strong and overwhelming evidence to the contrary.  The problem of “insight," or rather the lack of insight into illness,  is far from being accepted as simply one of the symptoms of a mental illness (and personality disorder).  If mental illnesses would be less stigmatized would more people seeks services?  If services provided choices in the type of care that people wanted and needed would more people seek them?  These are questions that research can and has started to address.

We also need to understand that the vast majority of people with serious mental illnesses do not choose to be homeless.  They also do not choose to have few prospects to achieve a meaningful present and future.  The choices you make are contingent on your past experiences, your dreams and hopes, and opportunities.   We need to give folks more opportunities which would also allow people to having real meaningful goals again.  Meaningful goals often lead to a stronger commitment to these goals and an acceptance of responsibility for one’s life and choices.  Individuals need to be given more hope and need to learn how to become hopeful again.   Positive life experiences need to replace past negative experiences .
We also need to acknowledge that there are already many folks working alongside us with well managed serious mental illnesses, including such serious problems as bipolar illness and schizophrenia.  These folks may not feel comfortable telling us about their diagnosis due to fear of being stigmatized or discriminated against at their jobs, even in spite of theoretically having the protection of the Americans with Disabilities Act. These individuals need to be welcomed into our workplaces, school boards etc., and encouraged to talk about their experiences.  We all need more role models of individuals who have either overcome significant challenges or are doing mostly well despite ongoing challenges,  as we have enough coverage of people who are not.

It seems that the problem of stigma needs to be address on multiple fronts in multiple ways, and many of these efforts are under way.   But we are all responsible in this endeavor.
To me, one such inspiring act occurred when Kjell Magne Bondevik, the former prime minister of Norway (1997-2000 and 2001-2005), told his country in 1998 that he needed to take some time off from work due to an episode of serious depression seemingly related to work burnout and stress.  Interestingly, he received overwhelming support from the Norwegian people and his fitness for his position was only questioned by a few other politicians, who in turn were criticized for their requests.

Of course most people with mental health problems are not prime ministers, but this at least proves the point that mental health problems can affect anyone.   In 2009, he noted “We must create an environment…where it becomes as easy to talk about mental health as it is to talk about a physical illness or condition…It must be as easy to return to your workplace after a mental breakdown as it is to return after a physical illness.  And we must take more seriously all kinds of harassment… in schools and in the workplace.”
We all need to do more to combat stigma.  Talk to your friend or family member when you think something is going on with them.  No seriously, at least ask the person if they are okay, they can always tell you that they do not want to talk about it, or that everything is alright.   Do not discriminate against qualified applicants with mental health conditions.  When you see someone standing at a bus stop with 20 shopping bags, inappropriately dressed with weird make up and muttering to themselves, think about how this person was once someone who went to school and wanted to be a hairdresser, a chef or an accountant.  How this person may have played an instrument, had a pet, and hated to get up early in the mornings for school.  Also think about that if you are mental health professional; professionals hold similar attitudes towards individuals with SMI as in the general population. If you are a teacher, see if you can include information on mental illnesses it into your curriculum. Speak up if you hear other people talk about people with depression as "weak" or "whiny."  

Educate yourself. Learn that the overwhelming majority of individuals with an SMI are neither violent or dangerous, in other words that  “the absolute number of assaults committed by psychiatric outpatients is low." Read one of the many excellent first person books out there.  If you are a person with a psychiatric disability or a family member get involved in some advocacy that works for you and is important for you. 

And you know, when someone paces up and down on the subway platform, clearly not muttering into a Bluetooth headset, and then of course sits right next to you on the subway, it might just be okay.  Because even though the person may keep fiddling in a strange and obsessive  manner with one of his ears, and then turns to you and asks you if you have a jar of Vaseline on you for his ear, that was it really.  He wanted to borrow a jar of Vaseline. Some people need a tissue, he needed something else.  I just politely said “Nope, I don’t, sorry."  And he politely said, “thanks."  

Monday, September 9, 2013

Framing Syria: The Psychology of Pro vs. Anti U.S. Intervention

Stephen R. Poteau, Ph.D.

 
This is not meant to be another well-worn politicized psychology piece highlighting the differences between Democrats and Republicans, but instead, a reminder of how psychology affects the attitudes of citizens, both Democrat and Republican alike, regarding foreign policy. The big news these last few weeks has focused on Syria and how the U.S. is poised for action. There is no doubt that Bashar al-Assad has used chemical weapons on his own people, and that is a tragedy, but there are many atrocities committed on foreign soils that we, as a nation, were/are comfortable ignoring (e.g., genocides in Cambodia,[1] Rwanda,[2], and Bosnia,[3] to list only a few examples). What underlying psychological processes are responsible for our neutral, supportive, or opposing stances when it comes to U.S. foreign policy?

The psychological research on framing isn’t new, but in areas like attitudes toward politically charged issues, it has a much more recent history. Simply put, the psychology of framing is the examination of how the presentation of something (e.g., emphasizing losses or gains) biases choices/behaviors and attitudes. Since comparisons have been made between the situation in Syria and the missteps we took in going to war in Iraq,[4] a look at the framing of the issues surrounding the Iraq wars may shed light on why nearly 60% of Americans oppose a U.S. intervention in Syria, according to a Reuters poll[5] (only 9% are supportive and 30.2% are supportive if chemical weapons had been used by the Syrian government).

A framing study in 2008 examined a multitude of factors that influenced attitudes regarding the Iraq wars (Borrelli & Lockerbie), and found, for example, that when asking Americans whether or not they support the Iraq war, merely mentioning U.N. or international support for U.S. involvement in Iraq lends American citizens to be much more likely to support the war. However, when the same question is posed with a mention of a lack of international support, American citizens are not supportive of the U.S. engaging in the Iraq war (Borrelli & Lockerbie).  Applying these framing effects to the Syria question, not only is there a lack of international support for our proposed intervention,[6] but there is also a lack of interest among U.S. politicians (across both parties) to wait for the U.N. to inspect chemical weapon sites,[7] which may ring eerily reminiscent of WMDs in the days George W. Bush was in office (as I write this my phone buzzed with the CNN headline, ‘Clothing and soil samples collected after Syria gas attack tested positive for sarin, UK PM’s office says’[8]).
Questions regarding support also skewed in favor of the Iraq wars if they were framed in such a manner that Hussein’s threats to Saudi Arabia, WMDs, or terrorism were mentioned (Borrelli & Lockerbie, 2008). Similarly, as noted, there is an increase in support for a U.S. intervention in Syria from 9% to 30.2% when sarin is mentioned. There is talk of terrorism in the form of a response from Hezbollah directed at Israel should the U.S. intervene in Syria, but the majority of media outlets have dubbed the repercussions (largely emanating from Syria, Russia, Iran, and China) to a U.S. intervention as exaggerated and unlikely to transpire.[9] In fact, in an article inaptly titled,‘5 Possible Repercussions of a U.S. Military Strike on Syria,’ ABC news addresses only 4 repercussions (the 5th repercussion is that there is no repercussion!). The other 4 repercussions noted are softened or muted by policy wonks.  Obama’s appeal to action in Syria hasn’t gained traction in the psychology of Americans possibly because his claim that there is a direct threat to our own national security[10] isn’t as convincing as WMDs and terrorism after 9/11. The semantic framing of the Iraq war as the ‘War on Terror’ by the Bush administration appealed to American psychology as the confrontation of an evil and irrational adversary that is lacking in the media coverage of the Syrian conflict (Harmon & Muenchen, 2009).

One very interesting finding in the study of the framing of the Iraq war was the effect of the names of the political actors in the forefront of the conflict (Borrelli & Lockerbie, 2008). An explicit mention of George H. W. Bush or George W. Bush led to an oppositional stance on the Iraq war, while explicit mention of Saddam Hussein led to increased support for the Iraq war (Borrelli & Lockerbie). The authors suggest further study into why the American psyche is affected in such a curious manner, but there appear to be parallels with the current Syria situation. Though there is a good amount of coverage of Assad, the dominant theme of the U.S. news cycle revolves around Obama (e.g., Obama pressing/almost ignoring Congress to push forward with a U.S. intervention, Obama versus Putin at the G-20 summit over Syria, etc.). Perhaps this framing with Obama as the dominant focus of the U.S. media coverage of Syria has dampened support for a U.S. intervention just as it did when George H. W. Bush or George W. Bush was mentioned in the context of the Iraq war.  
Framing effects are much more pronounced when attitudes are not strongly held, but maybe after 9/11 and the Iraq and Afghan wars, attitudes regarding foreign policy have calcified into a non-interventionist mindset among the American public. To think we are no longer susceptible to framing effects, however, would be naïve and dangerous. There is a wealth of research on attitude change suggesting that a more elaborate type of thinking can elicit lasting attitude change less resistant to persuasion, while focusing on superficial things like the characteristics of the speaker will lead to only temporary attitude change (Petty & Cacioppo, 1986). Maybe we, as the American public, should consciously engage in a more elaborate processing of issues that are central to the well-being of our country. Maybe we should dare to eliminate or at least blunt framing effects when it comes to such pertinent issues like whether or not we should go to war in Iraq or whether or not we should intervene in Syria.

Borrelli, S. A., & Lockerbie, B. (2008). Framing Effects on Public Opinion During Prewar and Major Combat Phases of the U.S. Wars with Iraq. Social Science Quarterly (Wiley-Blackwell), 89(2), 502-522.
Harmon, M., & Muenchen, R. (2009). Semantic Framing in the Build-Up to the Iraq War: Fox versus CNN and other U. S. broadcast news programs. ETC: A Review Of General Semantics, 66(1), 12-26.

Petty, R.E.,& Cacioppo,J.T. (1986). The elaboration likelihood model of persuasion. Advances in Experimental Social Psychology, 19, 123-162.


[1]http://www.enotes.com/united-states-foreign-policies-toward-genocide-reference/united-states-foreign-policies-toward-genocide
[2]http://www.theguardian.com/world/2004/mar/31/usa.rwanda
[3]http://news.google.com/newspapers?nid=1314&dat=19940204&id=al1WAAAAIBAJ&sjid=9_ADAAAAIBAJ&pg=6657,1941148
[5]http://news.yahoo.com/syria-war-escalates-americans-cool-u-intervention-reuters-003146054.html
[7]http://www.washingtonpost.com/world/national-security/us-dismisses-un-inspections-in-syria-of-alleged-chemical-weapons-sites/2013/09/04/2b1cf3c4-14e3-11e3-880b-7503237cc69d_story.html
[8]http://www.cnn.com/2013/09/05/world/meast/syria-civil-war/index.html?hpt=hp_t1
[9]http://abcnews.go.com/US/repercussions-us-military-strike-syria/story?id=20093229&singlePage=true
[10]http://www.nytimes.com/2013/08/29/world/middleeast/us-facing-test-on-data-to-back-action-on-syria.html?_r=0