The New York Times reported today that Albert Ellis has died. Ellis is the founder of what he originally called "rational therapy," then called "rational-emotive therapy," and most recently called "rational-emotive behavior therapy," or REBT. He was a tireless lecturer and writer. He was also a shameless self-promoter and total character. He was known as the Lenny Bruce of psychotherapy.
Ellis started writing and lecturing in the 1950's and continued his work until his death. This year, he was giving seminars from his bed in a nursing home. He founded an institute, currently called the Albert Ellis Institute in New York. In many ways, he has been at least as influential as Freud.
Ellis's great contribution was the recognition that our feelings do not come from what happens to us. Instead, our feelings stem from what we tell ourselves about what happens to us. For example. Imagine you get a B on an exam. First, imagine telling yourself, "Oh, God, I'm such a fool! I only got a B. I'll never get into a good school. I'll never accomplish anything. My parents will be disappointed in me!" You can easily see how upset you'll get.
In contrast, imagine yourself saying in response to the B, "Oh, boy. Only a B. I was hoping for an A. What did I do wrong? What can I learn from this?" Here, you might feel disappointed, but not crashingly depressed.
Finally, imagine yourself saying, "Boy am I proud of myself! This was really hard. I didn't think I could do this well!" Then, you feel good.
Ellis's point is that the B didn't make you feel anything. Your thoughts about the B--what you say to yourself--affect your mood. So, you can't tell your spouse, "You made me angry!" That's an unrealistic--Ellis would say irrational--belief. Your spouse may have done something you don't like, and you have every right to object to it, but you made yourself angry.
I saw Ellis speak several times over the years. He always said the same things. Sometimes he would change names, or refine previous ideas, but he never deviated from this basic message. His lectures were always the same. First, he would talk about his approach, then he would demonstrate therapy with volunteers from the audience. He always peppered his speeches with obscenities.
The last time I saw him, he was in his late 70's, still going strong. I often tell my clients about this, because he managed to explain his approach in two words.
After explaining how thoughts affect mood, Ellis began talking about how to change what you tell yourself. He said,
"There are two words you can tell yourself that will get you through any situation, no matter how bad it is."
You can imagine, this whole room, overflowing with clinicians. We all thought to ourselves, "Oh, boy, we're going to get some wisdom from the Master!" We all leaned forward, and Ellis said,
Broke up the joint.
Ellis's whole life was a tribute to those two words. He started his career at the time that psychoanalysis and humanism were the dominant clinical trends. Everyone thought he was crazy, and the criticism was whithering. Ellis didn't care, basically saying, "They don't like what I'm saying, tough shit. I know I'm right." He outlived all his critics and has been revered as the last of the Grand Old Men of psychology. Today, with variations, an awful lot of us are doing therapy his way.
For about the last 25 years, Ellis was somewhat eclipsed by Aaron Beck's "cognitive therapy." Yet, Beck openly admits that he based his approach on Ellis's ideas. Beck was successful because he was more dignified, if less interesting, than Ellis. He made for a better face for psychotherapy. But, I doubt that cognitive therapy would be where it is today, were it not for Ellis and his willingness to be such a character.
If we live well, we touch the world in some way; we usually don't know how. But Ellis died knowing that the things he believed in were now part of clinical psychology's mainstream. That's an incredible legacy.
Wednesday, July 25, 2007
The New York Times reported today that Albert Ellis has died. Ellis is the founder of what he originally called "rational therapy," then called "rational-emotive therapy," and most recently called "rational-emotive behavior therapy," or REBT. He was a tireless lecturer and writer. He was also a shameless self-promoter and total character. He was known as the Lenny Bruce of psychotherapy.
Wednesday, July 04, 2007
This is the second post in my series on psychotherapy. I know, I've been gone a long time. My stats show it, too.
When Freud published The Interpretation of Dreams, he became a very controversial figure because of his emphasis on sexuality. He went through a brief period where he worked in isolation, but, by 1902. he began to gather a group of physicians around him. By 1908, the group had grown into the Vienna Psychoanalyic Society. Two early members of the Society eventually split from Freud: Alfred Adler and Carl Jung.
Jung and Freud were very close and Freud saw Jung as his successor. This relationship soon fell apart, however, as Jung began to diverge from Freud's views. There are many accounts (some of them scandalous) of their final split, which, fortunately, are irrelevant to my goals for this series.
Jung's theory, like Freud's, is extremely complicated. A good summary of his ideas can be found here. Jung became fascinated with symbols, and began to see a cross-cultural pattern in them. He argued that there are "archetypes" among those symbols which relate to common human heritage, not just the individual's experience. Thus, each of us has a set of common symbols within us, which Jung referred to as the collective unconscious. The collective unconscious coexisted with the personal unconscious.
For Jung, neurosis, or mental illness in general, resulted from attempts to cut off elements of both the collective and personal unconscious from the conscious experience of the individual. Humans have an innate need for "self-realization," which involves understanding and integrating all of the material from the collective and personal unconscious. Proceeding with self-realization results in "individuation," the process of becoming a unique and unified individual.
Psychotherapy for Jung was less structured than psychoanalysis. He did not use free-association the same way Freud did. Rather, he relied on the spontaneous discussion of the individual. Like Freud, he analyzed dreams and verbalized symbols. He was less concerned with uncovering trauma and more concerned with tracing the relationships among symbols. He also understood symbols more in terms of common human experience and less in terms of sexuality. Through therapy, individuals become more centered and more comfortable with their own contradictions.
An early member of Freud's inner circle, Adler was the first to break with Freud. A good summary of his ideas can be found here and here. Adler anticipated much of modern psychology and psychotherapy. He dispensed with Freud's instinctive psychology and focused instead on the goal-oriented nature of human behavior.
Adler saw individuals first and foremost as social creatures, forming goals and striving to meet them. Where Freud talked about the superego managing our behavior, Adler conceived of the role of values. This is an oversimplification, but essentially Adler saw mental health in terms of (a) having healthy values, which affect what goals we try to achieve, and (b) having both the confidence and the ability to achieve those goals.
This means that analysis was very straightforward. The analyst encourages the patient to overcome feelings of insecurity, develop more rewarding and meaningful relationships, and to pursue healthy life goals. Insight and exploration of the patient's past occur early in the relationship, but later on, there is more emphasis on behavior change.
There were two critical differences between Adler and Freud. First, Adler emphasized the role of empathy in the therapeutic relationship. For Freud, the analyst was supposed to be a blank slate. This encouraged the development of transference. The interpretation of transference was critical for psychoanalysis. In contrast, Adler argued that the analyst should develop an empathic relationship with the patient, stimulating hope and commitment to the process. Second, while Freud encouraged the analyst to be quiet and allow the patient to free associate, Adler encouraged the analyst to engage in Socratic dialogs to help the patient achieve insights.
Jung and Adler are really polar opposites. Adler was much the realist, while Jung was much more mystical. Together, Jung and Adler moved analysis off the couch and put it across the desk. This changed the dynamic between the patient and the analyst, making it possible to create the modern collaborative relationship.
Both Jung and Adler continue to be influential, and there continue to be institutes (e.g., Alfred Adler Institutes and C. G. Jung Institutes) devoted to their ideas. While Jung is better known, it has been Adler whose influence has been most pervasive in modern psychotherapy. He anticipated the more active approaches we use today and was the first analyst to downplay the emphasis on probing the unconscious. We will come back to him briefly when we discuss cognitive-behavior therapy.
Sunday, May 20, 2007
When I originally conceived of this series, I thought it would be a brief set posts. I can already see that I was overly optimistic. There's an awful lot of material here. So, at this point, I'm not sure of how many posts it will take to complete this project.
Freud, Charcot, and Hysteria
Most people believe that psychotherapy began with Freud. Actually, Freud himself (Himself?) began as a student of the French neurologist, Charcot, who was investigating the phenomenon of hysteria. In this disorder, patients, mostly women, would manifest symptoms of physical disorders (such as paralysis or blindness) with no known physical causes. (Space prevents me from dealing with the feminist issues here.)
Charcot discovered that hypnotizing his patients and encouraging them to talk about their symptoms would result in their remission. Freud was very impressed with this and began trying Charcot's technique on his own patients. He began a brief collaboration with Josef Breuer, and in 1895, they published Studies on Hysteria, probably the first book ever published on psychotherapy.
Freud apparently was either not a very good hypnotist or not a very enthusiastic hypnotist and soon abandoned hypnotic induction. He kept everything else in place; the patient would lie down on a couch in a dimly lit room and begin talking about her symptoms. There is an apocryphal story that Freud initially used to question his patients to clarify what they were talking about. On at at least one occasion, the patient said, "Don't interrupt me when I'm talking," and Freud learned to be quiet and listen during free association. This is the form of classical psychoanalytic practice: a period of free association followed by interpretation of the material by the analyst.
Freud's initial work led to the publication of The Interpretation of Dreams in 1899. (The publisher later dated the book for 1900, probably to identify it with modernity.) This book, along with his later book, An Outline of Psychoanalysis, (published in 1940) contain the best material on Freudian psychoanalysis.
Personality and Behavior
Psychoanalytic theory is highly complex and was constantly evolving under Freud; I cannot do it justice here. Nevertheless, to understand why Freud did what he did, you have to understand some part of his theory of personality.
For Freud, personality reflected the interaction of forces inside the psyche. These intrapsychic forces interacted and opposed each other. The healthy psyche was one where the forces balanced each other out and energy was expended in rational behavior. These forces interacted within and between three major structures in the psyche: The id, or unconscious mind; the ego, the conscious, rational part of our minds; and the superego, essentially our conscience, although Freud thought of it as the internalized parent.
The id is driven by instincts to either create or destroy. The basic physiological instinct associated with creativity is, of course, sexual reproduction. Aggression is the basic physiological instinct associated with destruction. Because the id is the only source of energy, it is always the central player in our behavior.
The ego and the superego obtain energy from the id through symbolization. The id is unable to tell the difference between reality and the symbol; that is the job of the ego. Hence, the ego would direct the individual to engage in behaviors symbolically related to these instincts. Anything, from playing a musical instrument, to telling a joke to a friend, to doodling on a piece of paper would accomplish this.
It is the job of the superego to control the impulsive, reckless, and immoral behavior of the id. In the healthy individual, the ego is the negotiator between them; in the unhealthy individual, the ego is the battlefield between them. When the superego is in control, the individual is rigid, compulsive, and intolerant. In this three-way interplay, the symptoms of mental illness emerge.
It is important to understand that treatment actually evolved before the theory did. Freud thought that his treatment worked. After being analyzed, symptoms of hysteria seemed to go away. Hence, psychoanalysis is really an explanation for why treatment worked.
Treatment, for Freud, was a matter of balancing intrapsychic forces. For doing this, he had three primary tools: Free association, dream interpretation, and analysis of the transference relationship. Free association gives us the classical image of the patient on The Couch.
Free association. Free association, as described above, provided the primary data for analysis. It was assumed that if the patient was talking about it, it was important. The juxtaposition of different ideas gave a clue about unconscious connections between them. Symbolization was manifested both in free association and in dreams, and proper interpretation was crucial to treatment.
Dream interpretation. Freud regarded dreams as the "royal road to the unconscious." He found that patients often discussed dreams during free association and became convinced that dreams represented unconscious processes. By analyzing the dream symbols, the analyst developed insight into the patient's problems.
Transference. Transference refers to the manner in which the patient responds to the analyst. Does the patient idealize the analyst, or does the patient "forget" about appointments? Freud concluded that the patient "transfers" his or her feelings about the parents onto the analyst. This, of course gives clues about early family relationships that are so critical to the development of the individual. To this end, Freud argued that the analyst should be as bland as possible.
Countertransference is the other side of the coin and refers to the feelings of the analyst toward the patient. While this gives insight into the analyst's state of mind, it also helps the analyst understand how the patient affects other people. If, for example, the analyst feels angry at a patient, it may suggest that the patient is behaving in a hostile manner toward the analyst. That provides much data for the analysis.
Analysis. Using these tools, Freud investigated the unconscious life of the individual. By uncovering unconscious conflicts and developing insight, Freud believed that he could strengthen the ego and redirect the emotional energies in a healthier manner. This always involved understanding the internal symbolic world of the individual, and the symptom was always linked symbolically to the underlying trauma. If, for example, a patient complained of hysterical blindness, Freud assumed it was because they had seen something awful. Hence, it was necessary to uncover the traumatic event the patient had seen, to relieve the symptoms. Generally, for Freud, the traumatic event involved childhood trauma.
By developing insight and uncovering repressed trauma, energies attached to inappropriate objects can be released and appropriately redirected by the ego. Freud used the term, catharsis, to refer to re-experiencing the emotions related to the trauma. Release of the tensions associated was called "abreaction."
For those who know something of Freud, you will note that I have said nothing about his theories of development. I have done that deliberately. I am more interested in focusing on psychotherapy than on personality development or psychopathology. I will only say in passing that Freud was very right to observe that a child is not a small adult. His scheme of development was very wrong.
Freud remains a controversial figure today. We continue to argue about his strengths and weaknesses. (A good discussion of the strengths and weaknesses of classical psychoanalytical theory is contained here.) In relation to psychotherapy, I think it is safe to say, he made several significant errors.
First, Peter Kramer, in his book, Freud: Inventor of the Modern Mind, argues that a great error of Freud was his belief that the symptom is a symbol. For Freud, the symptoms were always related to the underlying psychodynamics of the individual. We know now that is not true. Depressed people show similar symptoms regardless of their underlying dynamics. So, for example, if a person experiences panics when out of the house, Freud would have assumed that the person experienced some trauma outside of the house. The goal of treatment would involve uncovering that trauma and unlocking the emotions associated with it.
Freud's second error was that he didn't understand the role of the situation, and saw behavior as a function of the internal dynamics of the individual. Freud did not recognize that individuals acquire maladaptive behavior through experience. A child growing up in an abusive environment learns to be a perfectionist because it helps reduce the abuse. It's not because of a rigid superego.
Third, Freud did not understand the influence of culture. We know that as culture changes, symptoms of mental illness change. Freud saw a lot of hysterical blindness and paralysis. We see almost none of it today. In fact, I have been in practice for over 30 years, and I have yet to see an individual with hysterical blindness. Similarly, Freud saw the role of women as being biologically, not culturally determined. He would be amazed to see women working along side of men, much less fighting in the military.
Finally, Freud hoped that someday psychoanalysis would be subjected to scientific evaluation. But, psychoanalysis is not a scientific theory, especially as science is practiced over 100 years after The Interpretation of Dreams was written. Psychoanalysis is too complex and it makes too many conflicting predictions. There is also a paucity of systematically collected data. But, that does not mean Freud has nothing to offer us.
As I said previously, Freud was a visionary. His ideas are so ingrained in us today, that we cannot conceive of a world without the idea of unconscious motivation. For me, Freud, beginning with almost nothing, made three significant breakthroughs.
First, through his concept of transference, Freud uncovered the therapeutic relationship. Today, we understand that the relationship between the therapist and the patient is the primary vehicle for change. The therapist and the patient must have a relationship of mutual trust and respect if the patient will explore material that is potentially shameful and anxiety-provoking. The modern view of the therapeutic relationship is broader than Freud's, but there is no doubt that he originated the idea.
Second, Freud recognized that something is going on in people's minds that they are unable to talk about. Most modern therapists do not talk about investigating the unconscious, but they do recognize that there are things going on the person's head that are relevant but difficult to identify and change.
Finally, and most importantly, Freud recognized that speech is a very powerful tool. The term, "talking cure" came from one of Freud's patients, and it is a very apt description. Without Freud, there would be no psychotherapy today.
Today, it is safe to say that there are few orthodox Freudians left. In fact, early in the twentieth century, contemporaries of Freud began to elaborate and diverge from his thinking. By the 1950's psychoanalysis had evolved significantly from it's roots. My next post will trace that change.
Sunday, May 13, 2007
I'm going to begin a series of posts on psychotherapy, which are long overdue. When I started blogging, I anticipated writing a lot about the science of psychotherapy, but I haven't followed through with it; I've been having too much fun with other things.
Two events have come together to get me started. First, at Aardvarchaeology (on ScienceBlogs), there was a recent post entitled, Is Psychotherapy Superstition? in which the author, Dr Martin Rundkvist, seemed to be confused about what psychotherapy is. Furthermore, some of the commenters on the blog seemed totally unaware of the evidence for the effectiveness of psychotherapy.
Second, I put off a post on a story in last week's New York Times Magazine by Bruce Stutz, who decided to withdraw himself from Effexor. Stutz initially went on Effexor after becoming depressed during difficult period in his life. He stayed on the drug for several years, and was advised to stay on it the rest of his life. He decided that he didn't want to and weaned himself off, but experienced severe withdrawal symptoms in the process:
Over the next several days they (low doses of Effexor--F.O.) came in handy, especially at night, when I would wake up feeling dizzy, almost seasick, disoriented and in a heavy sweat, the pillow soaked. One night, awake and not eager to go back to lying restlessly in bed, I went online, typed in “Effexor withdrawal” and found bulletin boards full of pained, plaintive and sometimes angry posters who had quit taking their medication and were suffering a broad but surprisingly consistent range of symptoms: dry mouth, muscle twitching, sleeplessness, fatigue, dizziness, stomach cramps, nightmares, blurred vision, tinnitus, anxiety and, weirdest of all, what were referred to as “brain zaps” or “brain shivers.” While there were those who went off with few or no symptoms at all, others reported taking months to feel physically readjusted.Stutz eventually did wean himself off Effexor, and has not had a recurrence of depression. He puts his finger on the issue:
If my psychiatrist had told me, “I think you can do this without taking any drugs,” would I have done just as well? If I had been told how difficult it would be to get off the drug, would I have so readily started on it? Even the doctors and researchers who most believe in the effectiveness of antidepressants acknowledge that the “chemical balance” paradigm, the magic-bullet paradigm, makes things seem simpler than they actually are. For some, these drugs may be a lifesaving treatment. But for most of us troubled or even temporarily anguished by life’s difficulties, does our long-term reliance on these drugs become more of a convenience than a cure, allowing us to simply keep going in the midst of very difficult circumstances? And once we start taking them, how do we find the wherewithal to stop?To make a decision between drugs alone, psychotherapy alone, and both combined, patients need to understand what psychotherapy is. It is not a panacea, as it was once advertised. It's not for all people, or even for all depressed people. Prospective clients of a psychotherapist need to understand what they are getting into. So, there are three topics I want to address in this series.
First, I'll talk about what psychotherapy is and is not. To do that, I have talk about the history of psychotherapy and how we got to where we are today. Next, I'll give a brief description of research in psychotherapy, and finally, I'll talk about how therapy and medication work together in treatment.
I hope this will give readers a better idea of what to expect if they seek psychotherapy and a better ability to understand some of the stories about the effectiveness of therapy that emerge in the press. All treatments for physical and mental illnesses involve decision making. The more you understand the options, the better.
Sunday, May 06, 2007
I was reading the New York Times, as usual, and stumbled across two articles I knew I should blog about. The first was Bruce Stutz's account of his withdrawal from Effexor, an antidepressant drug. Effexor is a very popular drug, especially among primary care physicians, and it can be very hard to get off. His story is, at points, gruesome. But it speaks for itself, and right now I have nothing to add. I will soon, though, so stay tuned.
The second story is much funnier and more enjoyable. It's an article in the Book Review, entitled, Why Not the Worst? In it, the author, Joe Queenan, writes about his love of bad books and compares himself to others who are obsessed with quality:
Most of us are familiar with people who make a fetish out of quality: They read only good books, they see only good movies, they listen only to good music, they discuss politics only with good people, and they’re not shy about letting you know it. They think this makes them smarter and better than everybody else, but it doesn’t. It makes them mean and overly judgmental and miserly, as if taking 15 minutes to flip through “The Da Vinci Code” is a crime so monstrous, an offense in such flagrant violation of the sacred laws of intellectual time-management, that they will be cast out into the darkness by the Keepers of the Cultural Flame.Queenan goes on:
Some people would identify a passion for bad books as a guilty pleasure, but I prefer to think of it as a pleasure I do not feel guilty about, even though I probably should. Bad movies, bad hairdos, bad relationships and bad Supreme Court rulings merely make me chuckle. Bad books make me laugh. And if they ever stop writing books with lines like “Being a leader of the Huns is often a lonely job,” I want to stop breathing on the spot.
Queenan is attacking what Karen Horney (pronounced HORN-eye), an early neo-analyst, called "the tyranny of the shoulds." In this, Horney anticipated the cognitive-behavioral therapies of Albert Ellis and Aaron Beck.
Horney recognized that we carry around many beliefs about what should or should not be. Some shoulds are about what happen to us. We believe, "I should be successful," or "My spouse should know what I want without my saying so." Unfortunately, that's just not realistic.
We have every reason and right to want things. But, "should-ing" is based on the unrealistic belief that the world must grant us what we want, just because we think we're right. When the world doesn't cooperate with that belief, we get angry or depressed.
Some shoulds address standards for our own behavior. For example, "I should read only good books." These shoulds make us rigid and rob us of our pleasures. Why not enjoy a bad book occasionally? Queenan's observation, "I prefer to think of it as a pleasure I do not feel guilty about," is a wonderful rejection of those shoulds.
When I hear a client bring up their shoulds, it is my job to attack those beliefs and replace them with more flexible beliefs. Some clinicians use Socratic questioning to attack peoples shoulds. For myself, I've found that far too often, Socratic questioning turns into the Possum Lodge Word Game. Instead, I like to hit people between the eyes with a one-liner.
Needless to say, I'm always on the lookout for a good one-liner. Now, I can't wait to say to a client, "Don't think of it as a guilty pleasure, think of it as a pleasure you don't feel guilty about."
Friday, May 04, 2007
Wednesday, April 18, 2007
I have been trying to write a post on the awful events at Virginia Tech. Every time I try to talk about the psychological issues involved, I sound horribly intellectualized, so I've left that post for another day.
Instead, I will just express my compassion for the victims and their families. I was in college in Ohio when the Ohio National Guard shot several students at Kent State during a demonstration. So, although it was a long time ago, I can imagine how it feels to students to have their security ripped away from them. I can understand why people living and working at other institutions have been affected. The college campus will never again seem like an idyllic place to them.
As a parent, I can barely imagine the families' grief. Losing a child to violence is a parent's worst nightmare. If it were my children who were shot, I would be experiencing overwhelming rage. If my children hadn't been shot, I don't know if I could let them return to school.
One thought keeps going through my head. I think of Mr. Cho's parents. I cannot imagine the guilt, shame, and grief that they must be feeling. I look for news stories about them, and so far, they are absent, thankfully. When they finally get dragged out in front of the cameras and pontificators, it will be awful.
My heart reaches out to all who have been touched by this awful tragedy. I think of Harold Kushner, in his book, When Bad Things Happen to Good People. In it, he grapples with the randomness of tragedy:
Some people will find the hand of God behind everything that happens. I visit a woman in the hospital whose car was run into by a drunken driver running a red light. Her vehicle was totally demolished, but miraculously she escaped with only two cracked ribs and a few superficial cuts from flying glass. She looks up at me from her hospital bed and says, "Now I know there is a God. If I could come out of that alive and in one piece, it must be because He is looking out for me up there." I smile and keep quiet, running the risk of her thinking that I agree with her (what rabbi would be opposed to belief in God?), because it is not the time or place for a theology seminar. But my mind goes back to a funeral I conducted two weeks earlier, for a young husband and father who died in a similar trunk-driver collision; and I remember another case, a child killed by a hit-and-run driver while roller-skating; and all the newspaper accounts of lives cut short in automobile accidents. The woman before me may believe that she is alive because God wanted her to survive, and I'm not inclined to talk her out of it, but what would she or I say to those of the families? That they are less worthy then she, less valuable in God's sight? That God wanted them to die of that particular time and manner, and did not choose to spare them?
Kushner's ultimate answer to this question is that it is the wrong question. The definition of an imperfect world is that bad things happen to people who don't deserve it. So, the more important question is, "What do we do now that bad things have happened?"
For him and for me, it is humanity's job to help all people heal from these terrible wrongs. We need to give up the blaming and finger-pointing and instead give strength to all the survivors. We do that with kindness and understanding.
Sunday, April 01, 2007
A story in the New York Times dated March 26, 2007, entitled, Poor Behavior Is Linked to Time in Daycare sounded pretty scary, so I looked into it in more detail. This is an issue that worries a lot of parents. They apparently turn to the Internet for information; my previous post on the topic is the fifth ranked entry page on my blog.
The New York Times story was pretty weak, as there were some details either missing or garbled, so I found the article on line. It was recently published in the March/April 2007, issue of Child Development. If you don't subscribe to the journal, it's $29.00 to get access. Seems kinda steep to me. Fortunately, ScienceDaily has a good summary of the article on line.
The study is part of a larger multi-site research project led by the National Institute of Child Health and Human Development (NICHD). The lead author was Jay Belsky, a somewhat controversial researcher who has been raising questions about the effects of childcare for years. I think he's gotten a bad rap. As we put more and more children into child care, we are conducting an experiment on our children and Belsky has been looking at the outcome of that experiment. He's asking questions that need to be answered. The problem is that his results are often complicated and get oversimplified in the press, leading to unnecessary huffing and puffing. These data are a classic example.
The study analyzed data on 1,364 children, who NICHD had tracked from birth. This is not a representative sample. They had recruited the families through hospital visits shortly after birth and collected data on academic achievement, intellectual, and social development from birth to the present day. This is a longitudinal study, which means the children were repeatedly evaluated on the same instruments, so they have a picture of how the children have changed over several years.
During the study, researchers measured the quality, quantity and type of child care the children received from birth until they were 54 months old. Child care was defined as care by anyone other than the child's mother that was regularly scheduled for at least 10 hours per week. This included care by fathers, grandparents and other relatives.
The researchers then evaluated the children's academic achievement, cognitive (intellectual) functioning from kindergarten through fifth grade and social development through sixth grade. Other factors, such as parenting quality and the quality of classroom instruction, were also measured. These other factors were taken into account when examining the association between early child care and children's subsequent development. The study tracked children's experience in child care. It was not designed to determine cause and effect and so could not demonstrate conclusively whether or not a given aspect of the child care experience had a particular effect.
The results of the study were pretty complex, but the two big findings that stood out:
An evaluation of the children in fifth grade showed that the children who had higher quality child care continued to show better vocabulary scores, a correlation that was seen previously from kindergarten to third grade. Vocabulary was assessed using the Picture Vocabulary subtest of the Woodcock-Johnson Psycho-Educational Battery -- Revised, which measures children's ability to name objects depicted in a series of pictures.
The researchers found that the correlation between high quality care and better vocabulary scores continued regardless of the amount of time the child had spent in child care or the type of care. The researchers wrote that this finding was consistent with other evidence indicating that children with greater early exposure to adult language were themselves more likely to score higher on measures of language development. However, child care quality was not associated with improved reading skills after 54 months of age.
The researchers also found that, as in the earlier grades, children with more experience in child care centers continued to show, through sixth grade, a greater frequency of what the researchers termed teacher-reported externalizing problem behavior. These behaviors were listed on The Child Behavior Checklist Teacher Report Form, which consisted of 100 problem behaviors.
So, this data indicates that quality daycare is associated with better language scores and more disruptive behavior. But, these results are very equivocal. First, the differences in language scores disappears after age 4 1/2. That can't be too important in the development of adult language.
Second, the relationship between disruptive behavior and time spent in daycare is very small. As they said in ScienceDaily:
The researchers emphasized that the children's behavior was within the normal range and were not considered clinically disordered.
It would not be possible to go into a classroom and with no additional information, pick out which children had been in center care, Dr. Belsky explained.
Significance versus Importance
So, what happened here? Very simply, there is a difference between statistical significance and importance. When we assess statistical significance, we estimate the likelihood that (in this case) a relationship is due to random chance. If the odds that the relationship is due to chance is less than 5%, we say that the relationship is "statistically significant."
One major factor affecting statistical significance is sample size. Smaller samples are more likely to have random errors affecting the results, so it takes stronger relationships to reach statistical significance. Large samples are less affected by random errors (they tend to cancel each other out), so weak relationships can reach statistical significance. In the NICHD study, they assessed 1,364 children. That's a very big sample. And they came up with very weak relationships. The relationships are not important.
Children in daycare might be slightly more verbal, but being in daycare won't make them grow up to be great orators. Children in daycare might be slightly more aggressive, but spending more time in daycare won't make them grow up to be criminals.
Monday, March 26, 2007
March 26 is the first anniversary of Just Noticeable Differences. I was shocked to see that the year went so fast. Now that I'm approaching 60, time just flies by.
It has been an interesting year. Blogging has been more difficult than I thought. I had forgotten (or repressed) the experience of writer's block from when I was writing my dissertation. Fortunately, unlike my dissertation, I can get up and leave the computer until my brain reconnects.
Blogging has been very rewarding; it's helped me met some interesting people. The attention I've gotten from readers has been gratifying and a bit surprising. One reason I had named myself Free Operant was because I wasn't sure I was going to get any readers. As a result, I thought, most of what I was writing would be free operants. I'm happy to find out that some people have indeed been reading what I write. Thank you all.
One interesting thing I've found in this year. Blogging anonymously has its own set of limitations, some positive and some negative. On the positive side, I realized it isn't fair for me to attack people from behind a shield of anonymity. I've tried to eliminate snarkiness when responding to people who write under their own name. I may disagree with them, but I should do it respectfully. Their reputation is out there and mine isn't. I think that limitation has made me a better writer. It's easier to be snarky than to be respectful and still disagree.
On the negative side, I also decided that I would create a wall between my real person and Free Operant. Free Operant will never comment on what I do under my real name, and I will never comment on Free Operant under my real name. This is proving frustrating because I am working on another project under my real name that I can't reference.
Finally, even with my anonymity, I would love to discuss events that have happened in therapy, but I can't. A recent article addressed that particular pitfall for medical doctors who blog. I think confidentiality is too critical to come even close to breaching it. Before I ever wrote my first post, I decided to put up a "fence around the law," to use a Talmudic phrase, and never write about anything that ever happened in therapy. There was one point where I was going to post a comment on another blog about an event occurring 30 years ago in therapy. I didn't. It killed me because it was hysterically funny, but I didn't post it.
Overall, it's been a good year. I look forward to many more.
Saturday, March 17, 2007
We are coming up on Passover, which is a joyous time of year. I thought it would be fun to break away from the serious stuff and post this story, which I wrote last year.
Passover is a family holiday, where, over a sumptuous meal, we read the story of the exodus from Egypt. It is a very happy time and most Jews have very good memories of family seders.
The text of the story is contained in a book called the Haggadah. Along with the text, the Haggadah also contains commentaries and prayers. It used to be, the only Haggadah you could find was distributed by Maxwell House Coffee. It contained the traditional Hebrew text, along side of a translation written in King James English. Today, there are many different versions available, written with new text and translation into modern English.
The modern Haggadahs written by non-orthodox movements have eliminated a small section from the traditional text. It contains an interplay between three Rabbis, Rabbi Akiva, Rabbi Eleazar, and Rabbi Yose (pronounced, “Yo-say”), in which they recount the number of plagues visited on the Egyptians.
In Exodus we are told there were ten plagues, but through Talmudic logic and deduction, Rabbi Yose concluded there were fifty plagues visited on the Egyptians at the Red Sea. Rabbi Eleazar deduced there were forty plagues visited on the Egyptians in Egypt, and two hundred plagues visited on the Egyptians at the Red Sea. Rabbi Akiva deduced that in Egypt there were fifty plagues, and at the Red Sea there were two hundred and fifty plagues.
For years, I read this as Talmudic pilpul (hairsplitting), and was not sorry to see it go in our current Haggadah. However, I've come to realize that the Haggadah doesn't tell the full story, and I think there's an important message in this commentary.
In the Jewish tradition of the Midrash, I've taken liberties and fleshed out the story. I've interspersed the traditional text in the story below, signified by boldface. The entire text from the traditional Hagaddah is there. But first, we start with some background.
Rabbi Akiva was the dominant thinker of his day. He was not only a great Rabbi, but he was also a leader in the resistance against the Romans. He was later martyred by them in a particularly gruesome manner. So, Rabbi Akiva was not your typical locked-in-the-Yeshiva Rabbi. He was a very smart and very tough guy. Rabbi Eleazar was a contemporary of Akiva's. Not as brilliant, but no slouch, either. Rabbi Yose was one of Rabbi Akiva's students, conceivably one of his best.
In those days, there were no Haggadahs and the recounting of the Exodus was spontaneous. Everybody did it differently. Being invited to a seder with Rabbi Akiva would have been a great honor. The learned, the wealthy, and the powerful would all have been there. His seder would have been a great event, with everyone hanging on Akiva's words as he told the story of the Exodus in his own way.
Rabbi Yose was thrilled to be invited to Akiva's seder, and wanted to impress him with his intellect. He spent weeks thinking about the Exodus, studying the Torah, trying to find something there to impress Akiva. On the night of the seder, he was ready.
There were many people present at Akiva's seder. The table was set, and the master expounded on the Exodus with incredible brilliance. Rabbi Yose was in awe of him and almost forgot what he prepared.
It is traditional at the seder to drink four cups of wine, which always adds to the merriment. Akiva seemed bent on blurring the distinction between a cup and a barrel. As the seder wore on, Akiva began to nod off. There was a lull, and Yose realized that this was the best chance he was going to have. He hoped he could wake up Akiva by speaking loudly. Raising his voice, he asked,
“How can we say that the Egyptians were smitten with ten plagues in Egypt, and in the Red Sea, fifty plagues?” The room was silent. He hoped Akiva was listening. He continued,
“Of Egypt, it is said the magicians told Pharaoh, 'This is the finger of God.' But of the sea, it is said, 'And Israel saw the mighty hand with which God smote the Egyptians, and believed in God and believed in Moses, God's servant.' If one finger smote the Egyptians with ten plagues in Egypt, it may be deduced that in the Red Sea they were smitten with fifty plagues.”
The others at the seder were awestruck. They applauded and cheered. They congratulated Rabbi Yose for his insight.
Except for Rabbi Akiva, who was snoring quietly.
Except for Rabbi Eleazar, who was thinking, “Pretty clever, Junior, but not clever enough. Time to put you in your place.” Rabbi Eleazar thought for a moment more. Then he said,
“How can we say that every plague, which The Most Holy, blessed be the One, brought upon the Egyptians actually consisted of four different plagues? Because it is said God was angry at the Egyptians, sending them wrath, indignation, trouble, and a band of evil angels. Wrath is one; indignation is two, trouble is three, and a band of evil angels is four. Hence, we can deduce that while in Egypt they were smitten with forty plagues, and in the Red Sea, two hundred plagues.”
The onlookers at the seder applauded more. They knew they were watching a rabbinical smackdown in progress and wanted to hear how Rabbi Yose would respond. Unfortunately, Rabbi Yose's mind had gone blank and he was thinking that discretion was the better part of valor. He was about to concede gracefully, happy that Rabbi Akiva was asleep. Then came a snuffle and a snort from the head of the table.
Rabbi Akiva opened his eyes and said, “How can we say that each plague which The Most Holy, blessed be the One, brought upon the Egyptians in Egypt consisted of five plagues? Because, it is said, “God sent against the Egyptians the fierceness of God's anger, wrath, indignation, trouble, and a band of evil angels. The fierceness of God's anger is one, wrath is two, indignation is three, trouble is four, and a band of evil angels is five. Hence, we deduce that while in Egypt, the Egyptians were smitten with fifty plagues, and in the Red Sea, two hundred fifty plagues.
All of the onlookers exploded into cheers and applause. Rabbi Eleazar and Rabbi Yose looked at each other, shrugged their shoulders, raised their glasses to Rabbi Akiva, and both took a long drink of wine. Rabbi Akiva took another drink of wine and slowly slid under the table.
The Haggadah says that all who recount the story of the Exodus are worthy of praise. This story teaches that no recounting is complete without joy, humor, and some friendly competition.
Saturday, March 03, 2007
I have recently been corresponding with a reader concerning paternal age and schizophrenia. Schizophrenia is a serious mental illness where the individual suffers from delusions and hallucinations. Thought processes are often disturbed. (It is not a "split personality.") Schizophrenia is widely considered to be a neurobiological disorder, caused by a combination of genetics, the prenatal environment, and environmental stressors.
Surprisingly, the New York Times, which is becoming my favorite psychological journal, also devoted an article to the issue, entitled, It Seems the Fertility Clock Ticks for Men, Too. The article summarizes research on the relationship between the father's age and the risk of birth defects:
Geneticists have been aware for decades that the risk of certain rare birth defects increases with the father’s age. One of the most studied of these conditions is a form of dwarfism called achondroplasia, but the list also includes neurofibromatosis, the connective-tissues disorder Marfan syndrome, skull and facial abnormalities like Apert syndrome, and many other diseases and abnormalities.Both autism and schizophrenia have been tied to paternal age, dating back to research published in 2001. In an interview with Medscape, Dr. Dolores Malaspina described her research, also cited in the New Y0rk Times article. (Also check here, here, and here.) Malaspina and her colleagues performed several large-scale studies of demographic data collected in Israel both through the public health system and the Israeli Army. She stated:
“We have counseled for quite a long time that as paternal age increases, there is an increased frequency in new mutations,” said Dr. Joe Leigh Simpson, president-elect of the American College of Medical Genetics.
We found that paternal age explained over a quarter of the risk for schizophrenia in the population. At the time, people were skeptical. But the findings have been replicated many times now, and not a single study has failed to find this strong relationship between father's age and the risk for schizophrenia. And at this point, other explanations for the relationship have been ruled out, including social factors in the family, prenatal care, and parental psychiatric ailments. There simply seems to be a relationship between paternal age and schizophrenia risk.Malaspina described the proposed mechanism for this risk:
When Penrose found that paternal age predicted new human genetic diseases, he proposed the Copy Error Theory. He said that each time the spermatozoa are copied there's an opportunity for a new mutation. Sperm cells divide every 16 days after puberty, so the DNA in the sperm of a 20-year-old father has been copied 100 times, but sperm DNA from a 50-year-old father has been copied more than 800 times.Think of sperm replication as a copy machine. Each time the a copier makes a copy, slight imperfections are created. If you copy the original each time, you never notice a change. But, if you make a copy of a copy, of a copy, of a copy, ad nauseum, you get the familiar spots, streaks, and fading. Human sperm is created from copies of previous generations of sperm, not from copies of an original template in the individual. The DNA in the sperm of a 20 year old has been copied 100 times, while the sperm DNA from a 50 year old has been copied more than 800 times.
Evolutionarily, this is advantageous because it provides for more variation in the offspring. But, with increased variation, comes the risk of negative, as well as positive, traits being transmitted. These include mental retardation and mental illnesses, notably schizophrenia and autism.
The Times cites critics of this research who argue the truism that correlation does not prove causality. That argument is certainly true, but there is more to the research than just correlation:
First, it is also a truism that, to show a cause and effect relationship, the cause must precede the effect. In the case of paternal age that is certainly the case. Paternal age obviously precedes conception.
Second, other explanations must be ruled out. Malaspina and her colleagues controlled for a number of environmental variables, including an adverse fetal environment, maternal age, and psychosocial stressors. Of course, we can never rule out all possible explanations, so we can only rely on a preponderance of evidence. But overall, the evidence favors paternal age.
Third, to argue causality, there must be a plausible mechanism moving from cause to effect. Copy error theory is certainly plausible. It is consistent with known biological processes.
Finally, to argue for causality, there has to be a convergence of data which is consistent with the explanation. Malaspina presents the following data:
- The risk of schizophrenia rises with age, from .007% for fathers under 25; to 1% for fathers 30 -35, and 2-3 % for fathers 50 and older;
- The risk factors are consistent across world cultures;
- It's consistent with the data on other genetic diseases, as I mentioned above; and
- Inbred mice show increasing behavioral disturbances with increasing paternal age.
Malaspina argues against warning older men away from having children:
I would personally not discourage anyone from having a child at any age. People weigh their own risks. For the offspring of older fathers, the risk of schizophrenia is about 3%. That means that 97% of the offspring do not have schizophrenia. Other cognitive diseases linked to paternal age include mental retardation of unknown etiology and Alzheimer's disease, and there is a strong relationship between paternal age and autism.I'm not sure I would completely agree with her. Given this data, I would urge an older man to think twice about parenthood, as I would urge an older woman to think twice. Having a family member with schizophrenia, autism, mental retardation, or other disorder can be a terrible burden for both parents and siblings.
According to one study, about a third of patients with schizophrenia make a full recovery. About one third make a partial recovery, where medication works effectively to manage their symptoms. The remaining one third remain very seriously ill. So, the risks of having an impaired child are small, but the cost can be tremendous, and should not be taken lightly.
Friday, February 09, 2007
The bizarre story of NASA astronaut Captain Lisa Nowak has everyone talking. It's raised some predictable and reasonable questions about psychological assessment of astronauts. In a storm of comments at a New York Times blog, The Lede, several commenters correctly observed that this incident is the first incident, and that's a pretty good record. (Of course, that's assuming that it is the first incident. Others may have been covered up.) After an incident like this, however, we should still ask if the assessments are good enough.
I did a search for astronaut selection, and I couldn't find a current list of psychological tests NASA uses. Santy (1994) has an intriguing history (available on Questia), but the book is 12 years old, and given publication lag, the information is even older. In a Google search, I found a recent reference to the Astronaut Personal Characteristics Inventory (ASTROPCI), but little other information. The primary tests they use are predictable, including IQ tests, tests of perceptual-motor functioning, personality inventories, and projectives. It appears that NASA is maintaining an active program of research on personality assessment in astronauts. Nevertheless, several news stories indicate that NASA only assesses astronaut candidates once and never repeats the assessment.
However, here is an intriguing quote from Santy:
The Working Group's position was that personality assessment is underutilized as a resource in astronaut selection, but the empirical record in aviation psychological research of using personality traits as predictors of performance is appalling. This dismal record extends back to World War I and the selection of opponents for the Red Baron. (p. 108-109)
In other parts of the book, Santy correctly points out that psychological assessment is often directed toward identifying psychopathology, but psychopathology isn't a good predictor of success on a job. (Yes, I know there are a host of Dilbert-type jokes here.) This is especially true where the occupation is one in which there are only a small number of people who are employed in the field.
Assessment of personality traits is another way to predict success on various jobs. For example, according to Santy, the 16PF, a personality inventory measuring 16 different personality traits, has been used by NASA in astronaut selection. Logically, different jobs require different traits, so assessing for the right combination of traits would make for a good astronaut right?
No. Personality traits do correlate with behavior, but the correlations tend to be somewhat low. The 16pf is a useful instrument--I've used it myself--but by itself, it's inadequate. No personality inventory is adequate by itself. Generally, we compensate for this weakness by using multiple tests and multiple types of assessment.
That's what NASA does. Each test has a certain likelihood of miscategorization. By using multiple tests, the likelihood of miscategorization declines. NASA takes it farther by also using different types of instruments: Psychiatric interviews are included, as are samples of behavior. Behavioral sampling is done by putting candidates into trainers and assessing their performance under roleplay conditions.
Although NASA doesn't do formal, repeat assessments, there is certainly ongoing monitoring of astronauts. It's the same monitoring that goes on at every job. Both peers and superiors are looking at each astronaut's functioning in training and in everyday performance. I can't prove it, but I suspect that such performance evaluations have washed out people who psychological testing has missed. This brings us back to Captain Nowak.
Why didn't she wash out? From all the reports I've seen, Captain Nowak was a competent astronaut. How could she melt down over a marital separation and a perceived love triangle outside her marriage?
The answer lies in an old argument in psychology: Is behavior controlled by person or situation variables? On the one hand, personality theorists argue that internal variables, such as personality traits, conflicts, and dynamics, control behavior. Behaviorists, on the other hand, argued that the external variables, such as the environment and behavioral consequences, control behavior.
For example, what controls the tendency to cheat on tests? Is it a person's honesty (a trait), or is it the opportunity to cheat (the environment)? The resolution to the argument was predictable. Both person and situation variables are needed together to predict behavior. In many cases, the situation exerts more control than the person. To return to the above example, as the risk of getting caught for cheating drops, the number of students who cheat rises. But cheating never reaches 100%, because honesty is important, too.
The Milgram obedience experiment is another example of the power of the situation, as is the Zimbardo prison experiment. The situation has powerful control over the individual. Change the situation and you change individual behavior.
So, Captain Nowak was able to function in the setting of the astronaut corps. She could work in an environment where death was always looming. She just couldn't deal with the environment where rejection had occurred. You're not going to get rejection on the space shuttle. For reasons that I am not privy to, abandonment and rejection were more threatening than death to her. I don't think any amount of psychological testing would have prevented this awful situation.
Santy, P. A. (1994). Choosing the Right Stuff: The Psychological Selection of Astronauts and Cosmonauts. Praeger.
Sunday, February 04, 2007
Today, being Superbowl Sunday, is a good day for a sports rant. Not too long ago, I was a pretty avid sports fan. Over time, I became disillusioned. Professional sports cause too much damage.
I first learned about the damage athletics can cause when I evaluated a soccer player who had been deafened while playing indoor soccer. (I can talk about this because his evaluation is a matter of public record.) The poor guy had no job skills at all. He'd spent his life preparing for major league sport (he was British) and he never made it. What was he going to do now that he's completely deaf?
I also learned while working on this case, that most professional soccer players suffer headaches and memory loss consistent with head injuries. They use their heads as a tool, but wear no head protection. At least football players wear helmets. Which do a fat lot of good.
Recently, there have been a series of articles about the health of retired football players. Many of them are dealing with depression, memory loss, sleep apnea, and arthritis. According to a recent New York Times article, head injuries, caused by repeated concussions, can lead to depression and suicide:
Since the former National Football League player Andre Waters killed himself in November, an explanation for his suicide has remained a mystery. But after examining remains of Mr. Waters's brain, a neuropathologist in Pittsburgh is claiming that Mr. Waters had sustained brain damage from playing football and he says that led to his depression and ultimate death.Waters case is similar to that of Mike Webster, who played for the Pittsburgh Steelers. Here is part of his obituary from the Sports E-Cyclopedia:
The neuropathologist, Dr. Bennet Omalu of the University of Pittsburgh, a leading expert in forensic pathology, determined that Mr. Waters's brain tissue had degenerated into that of an 85-year-old man with similar characteristics as those of early-stage Alzheimer's victims. Dr. Omalu said he believed that the damage was either caused or drastically expedited by successive concussions Mr. Waters, 44, had sustained playing football.
Mike Webster's durability and toughness made him a 4-time Super Bowl champion and one of the NFL's best linemen ever. However, those very qualities also might have led to a brain injury that sent him spiraling into drug use and homelessness. The bare-armed strongman nicknamed "Iron Mike'' died September 24th he was only 50. He was remembered as a great center whose sturdiness personified the Pittsburgh Steelers' championship teams and whose off-field health and drug problems saddened them.Notice that the Steelers initially lied about Webster's illness. I guess we wouldn't want young children asking if sports are a bad idea for them. They should, but we spend too much time telling them how wonderful athletics are.
The Steelers initially said Webster died of a heart attack but later declined to comment. Webster was diagnosed with brain damage in 1999, an injury caused by all the years of taking shots to the head. "He was one of the main reasons why we won four Super Bowls,'' Hall of Fame running back Franco Harris said. "Unfortunately, he had some turmoil and misfortune after his football career. He is now at peace.''
As bad as professional athletics are for adults, what is happening to young children is even worse. The Times also has a story on a high school football player, a friend of Joseph Addai (who will play in the Superbowl today), who was paralysed in a high school game.
Less clear is the social toll that professional athletics take on us, but I still concerned about it. The American love affair with professional sports has corrupted our values. In school, athletes are often revered. Why? Athletics are entertainment and nothing more. what's so important about them? Shouldn't we teach our children to revere scholars instead?
Nah, I didn't think so.
Children grow up thinking that athletic abilities make them special. They see how much the high school quarterback is revered. Some become so obsessed with it, that they give up their childhood, practicing and playing every chance they get. As they rise up in the ranks of school and professional athletics, their sense of entitlement grows, fed by coaches who use it to motivate them. This is why so many athletes have been arrested for drug abuse and violent crime. They're taught that their athletic skills make them exempt from social rules.
Today, to be "the best" means more than practicing a lot. It means playing when hurt. This is why Andre Waters and Mike Webster suffered brain damage. It also means taking performance-enhancing drugs, and we all know what's being said about Barry Bonds and Mark McGwire. Here is a good resource on the effects of steroid abuse. They are far from trivial.
This attitude has leaked down from the professional ranks, to the college ranks, to the high school ranks, and even lower. I've seen it at every level, including an 11 year old boy. Our love of sports is corrosive and it needs to stop. But, it won't until fans turn away.
Sometimes, the fans sorta get it, but then they back away. A few years ago, the Pittsburgh Steelers and the Pittsburgh Pirates decided they both needed new stadiums. For a while, the fans put up a fuss, but the opposition was all talk and both teams got what they wanted. They spent millions of dollars on PNC Park and Heinz Field. In the meantime, the city of Pittsburgh is fading away. It's downtown is empty. The surge in home prices of the last few years never hit Pittsburgh; there's no reason to live there. That money could have been much better spent on other things.
So, I've lost interest in sports. I'll watch the Superbowl tonight, so I don't sound like a weirdo tomorrow, but I really don't care who wins. I know a lot of people will lose.
Wednesday, January 17, 2007
I have been plowing through a monograph on adolescent decision-making by Valerie Reyna and Frank Farley, and I found a discussion related to my previous post on decision-making. In the article, they discuss the normative analysis of decision-making:
More formally, the normative analysis of a choice identifies the options in the decision makers’ best interests, given their goals and the information available to them, all integrated by the application of a rational decision rule. Customarily, that is an expected utility rule, which multiplies the utility (or attractiveness) of each outcome by the probability of its being obtained for each option. In these terms, rationality is a matter of consistency with a set of rules, such as transitivity (e.g., individuals who prefer A to B and B to C should also prefer A to C), because following such rules can be shown to result in reaching the decision makers’ goals (i.e., maximizing the attractiveness, to that decision maker, of the chosen option; von Neumann & Morgenstern, 1944; Yates, 1990). Whether people actually adhere to such rules or pursue their own best interests is a detail left to descriptive research as opposed to normative analysis.A normative analysis of decision making recognizes that a "good decision" is one that is well-made. The decision-maker considers the alternatives and estimates the probability of achieving different outcomes. The decision-maker then selects the outcome by weighting the attractiveness of the outcome and the probability of achieving the outcome.
Reyna and Farley go on to say:
Normative analyses also recognize that people may rationally pursue goals that others dislike (e.g., adolescents who care more about good times and social approval than adults think is appropriate). Normative analyses recognize that people may make choices with unhappy outcomes because no better options were feasible (e.g., when dealing with bullying or sexual coercion). Normative analyses recognize that bad outcomes may follow good decisions, when chance intervenes, just as good luck may reward poor choices. Indeed, there is a term in decision analysis, outcome bias, for confusing the quality of decision processes and the consequences of decisions (Ritov & Baron, 1995). (p. 10).This is exactly the point I was making when I described how decisions put us on unpredictable paths. The quality of our decision-making processes affects the likelihood of pleasant consequences, but it cannot guarantee it. Outcome bias confuses the quality of the decision with the path on which the decision takes us.
Outcome bias is so attractive because it is comforting. If I make the "right" decisions, my life will be perfect. If I'm unhappy with where my decisions are taking me, it's because I made the "wrong" decision. It is possible for me to predict the future and make only good things happen to me.
Giving up these unrealistic beliefs and accepting the true nature of decision-making is anxiety-provoking:
- It is anxiety-provoking to believe that you can make decisions well, but have them take you to bad places.
- It is anxiety-provoking to believe that you can be in a situation where there are no "good" choices; only least-worst choices.
Some people embrace this belief through a toxic spirituality, which I've discussed before: If I am a good person, God will keep bad things away from me. If bad things happen to me, it must be because God is angry at me. This thinking can be almost magical: If I'm good to my family, God will reward me at work.
So, these beliefs give us an illusion of control over our lives and fend off the anxiety that the unpredictability of life engenders. Ultimately, to live happily, we must give up these illusions. We have to recognize:
- If we make decisions carefully, we have an improved likelihood of taking an enjoyable path, but nothing is guaranteed.
- If our decisions take us down an unpleasant path, it is always possible that, around the next bend, better things will happen.
- If we are unhappy with the path we are on and are convinced that it won't improve, we can make more decisions and take new paths.
- It is rare that a well-made decision will take us down a catastrophic path. It can happen, as in the person who decides to stay late at work and is then hit by a drunk driver on the way home. The probability of such an event is so low that it is not worth worrying about.
Ritov, I., & Baron, J. (1995). Outcome knowledge, regret, and omission bias. Organizational Behavior and Human Decision Processes, 64, 119-127.
von Neumann, J., & Morgensern, O. (1944). Theory of games and economic behavior. Princeton, NJ: Princeton University Press.
Yates, J. F. (1990). Judgment and decision making. Old Tappan, NJ: Prentice Hall.