Marc Chagall and the Meaning of Life

Science and art are often pitted against one another.  Science is 'Objective' and 'Rational' and art is the opposite.  'Subjective'.  'Emotional'.

But is this distinction real?  There is an art to rationality, just as there is a science to artistry.  But more importantly, art and science are both slaves to the same fundamental question: ''Why?''.  Oh, it's not that we don't care about who and what, when and where.  But science and art need to know why.

And so, predictably, art has come to be the answer to that most dangerous of questions that plagued me for most of the summer:  Why psychology?


Finally, I have an answer:  Marc Chagall.  Bear with me if my explanation seems cryptic, I'm doing my best here.  Psychology's raison d'être - when there are other fields like neuroscience and philosophy, sociology and economics - is that one day a man decided to be an artist.  He asked why love and family, why health and illness, why religion and country...   Chagall is my favorite artist.  And if I had to make up a reason why, I'd say it is because he asked all the right questions without ever being afraid of the answer.

These are themes that we all have to grapple with at some point in this life, and a science of psychology gives us a language, a framework, for talking about and questioning  these themes - and for keeping our answers at least a little bit honest.

There's more to being a science than the answers.  If anything, it's more about asking questions.  And Chagall's work has something to say about that too.  Perhaps in our determination to make sure it is a respectable-looking Science, psychology loses more than it gains because it cannot ask all its questions.  Part of what contributed to my existential crisis over the summer was my devastation at the futility of the questions being posed in social science.  But maybe we are asking uninspired questions because we are afraid of the answers we might get to any better questions.  (After all, few of us actually really want to be saddled with anything like the political nightmare that are Milgram's results).

Maybe this is where art has something to teach us.  Asking 'why' even when it doesn't look like the answers will be all that much fun.  Far from running from it, psychology can be inspired by art to ask all of its questions.

--
Thanks to ArtisticThings.com and GrandeYeoem.com for images.

Psychology's Raison D’Ëtre, Part 2

Scientific modeling of Psychological Truth is hard.  Standard nomenclature is difficult when most of our constructs are expressed in the modern languages (as opposed to having a periodic table of the emotions, let's say, that is universal).  To make matters worse, we rely on somewhat unreliable statistics to tell us whether or not we are Right.  Correct.  In the general area of Truth.

Is this a Science?

I’m going to say Yes. (Obviously.)  But ours is a developing science.  Somewhere on the continuum between Alchemy and Chemistry, Astrology and Astronomy. 

It has been suggested that Psychology is the Science before Neurology. 

I disagree.  Neurological science is going to massively inform Psychology.  But it is never going to replace it.  The reason for this is that nobody goes around saying ‘Oh my neurons are firing wrong today’.  We say ‘I feel sad!’ or ‘I feel happy!’.  And we say those things in predictable ways.  The existence of a micro-level construct does not preclude the existence of (or the importance of) the macro-level construct. 

Depression is not just a problem in the brain; it is a diseased state of mind and ALSO a problem in the brain. 

That being said, I think Psychology will split off into Science-Parts, and Non-Science Parts.  In the future,I think this is what the Science and the Non-Science of Psychology will look like:

-          Research psychology = Science in its own right.  And with major overlap in the biomedical sciences, mainly neuroscience.

-          Clinical psychology = Both science and alchemy.

-          Philosophical psychology = Philosophy.

-          Lay psychology = Some fun, some practical, some common sense.  And some derived from the above.

In short, I am trying to be clear about the Raison-D’Ëtre of psychology in modern science.  In talking to my colleagues, I think there is a shared and only half-spoken unease about the place of our science in the world today.  Who are we, and what are we good at?

I think the answers are there.  I think there will be changes to how we define ourselves.  But the issues that psychology talks about (e.g., relationships, group dynamics, mental health, how we think and why we do things) are so fundamental to our well being and operation as individuals and as a society that we have to study them scientifically, even if there are also other ways to approach them.

After all, when I think of the reasons I went into this crazy field, I remember them clearly.  I thought that a Scientific Psychology would incorporate all my favourite parts of Mathematics, Philosophy, Medicine, and Theology.  And I still do.

--

See Part 1

In Defense of The Scientific Practice of Speculation, Part 2

These days, speculation seems to be almost a dirty word.  There’s good reason for this.  Scientists, especially social scientists (especially psychologists?) are known for drawing conclusions that go way beyond their data.  We tend to be an idealist lot, and we think we have already intuited all there is to know about human nature and are really just conducting these studies and things to confirm our notions (OK – luckily this is not always true… but let’s be honest… “research is me-search” and we are often a liiiiittle more invested in our hypotheses than we should be. I think this is partly a systems issue. But I digress.)

But that's BAD speculation.  And bad science.

However, speculation before the creation of hypotheses I think is essential.  We are altogether too “in the box” these days.  We need to flatten that box into a topological map of psychic life and get some better ideas flowing!  (Kudos if you get the reference.)

And the only way to do that is by being a little bold, a little outlandish, and by being wrong.  Maybe 10,000 times.

Psychology's Raison D’Être

What are the goals of science?  We have several options:

1)      The goal is to explain the world so that we can predict and control it

2)      Goal 1 becomes Goal 2 of philanthropy

3)      Fun

4)      Exploration of the world as it exists (or doesn’t)

I feel like psychological science is having a bit of an existential crisis.  At least, I am having an existential crisis for it. 

How come all of the really cool research seems to have been done 50 years ago?  How is it that thousands of studies have been published on the relationship between depression and heart disease and we still don’t know what we’re doing? 

Is the field of Psychology really passé? I can’t believe it!  (Seriously.  I can’t.  I’m getting a degree in this here-now field.  How depressing would that be?)

But it seems clear that psychology without solid empirical and methodological anchors is doomed to failure as a science (though it can still make good philosophy, and in some cases, maybe even good therapy).  My only fear is that psychology with solid empirical and methodological anchors is doomed to failure as well.

Let me explain.

One of the most important freedoms of good science is the Right to be Wrong.  I always love it when I read posts about how important it is to allow oneself to be wrong.  There was a blogging trend along these lines on awhile back and I thought it was fabulous.  People were talking about the importance of accepting being wrong during training in medicine – a field where being wrong can be accompanied by disastrous consequences.

But this speaks to the difference between research and the clinic.  In research, and in innovation, it is not only OK to be wrong, it is frankly necessary.

To use a hackneyed example, Edison is reputed to have been “wrong” 10,000 times before he came up with the right model for a light bulb.  How often do students of science allow themselves to be wrong these days?

I noticed this when TAing over the past year.  Graduate students in Medical Psychology, both clinical students and research students, were very uncomfortable being wrong.  Students were very uncomfortable getting a grade under an A, and would often staunchly argue that they were right… even when they weren’t… or when they could have been, but they also could have been wrong.  That’s research.

I think that when I start teaching in earnest I am going to start each class with the following quotation, from my ever-brilliant mom: “The quickest way to be right is to admit it when you’re wrong.”

After all, I like being right too.  You don’t become an over-achieving grad student if you don’t like to be right, and have everybody around you acknowledge it.

But here’s the problem: you don’t become a good scientist unless you are sometimes (often?) wrong.  And know it.   

That’s the whole point of a hypothesis.  Come up with a hypothesis, test it, go forward if it is correct – and change it if it is not!  Follow where the data lead!

Understanding Human Connections, or In Defence of The Scientific Practice of Speculation!

Ramachandran said that mirror neurons are the basis of society.  This might be considered stretching the data.  But let’s!  (It's fun!)

In studying disease, we come to see that disease spreads (Christakis & Fowler, 2007, 2008).  Why?

So, why?  We don’t really know the answer to that question (see review of Christakis & Fowler book - really worth reading).

What if neuroscience showed us a way?  What if mirror neurons – or more accurately, a neurological system that both could identify others’ goals and made us imitate them when we identify with that person whether we are aware of it and whether we like it or not – could explain it? 

The issue with the mirror neuron hypothesis is that as far as I understand it, I would have to see you eat or smoke in order to be able to internalize that goal.  But according to this research, that does not seem to be necessary.

There has got to be a mechanism though.  We just don’t know what it is yet.  And without speculation, we never will!

Oh, To Be a Real Science!!

I am not the only psychologist with Physics Envy, I see.  Check out this delightful post that makes use of the wave-particle idea on PsychCentral.

An exerpt:

"And I think we’re also getting over what the systems theory people did when they discovered that the pathology of adolescents was the function of families. They went in to work solely with families and lost the self. We lost the self in the system. Self is the system, but it’s also a location interacting with a system…

What I’m trying to do in my writing is to highlight that it is neither the self nor the system; it’s the oscillation between the two. That’s the constant; the oscillation. Self changes, the system changes, but the oscillation is constant. Maybe that’s what the self is – the oscillation.

That’s fascinating. So that oscillation between the self and the system, between self and other, and also between thought and feeling,…

And between particle and wave…

…so you’re considering that movement itself as maybe where the self resides…

Well, is there a particle? No. Is there a wave? No. There’s a wave-particle relationship, and interaction, and what’s constant is the oscillation. So that begins to provide you with a process that’s not chaotic – if everything is moving, then that movement becomes the structure."

- From  Getting the Love You Want: Interview with Harville Hendrix (Part 3) 

by Gabrielle Gawne-Kelnar

Methodological Challenges in Psychology, or Why We Shy Away from Measuring Emotion.

I previously wrote regarding the difficulties of measurement in a science with no bad incomplete nomenclature.  Psychology is a scientific discipline that is concerned with the measurement, prediction, and explanation of complicated macro-level phenomena that we often have difficulty identifying and explaining.  Like emotion.

Emotion is a powerful force.  So powerful, in fact, that it can move entire populations to migrate, to fight, and to die.  And yet, in our day to day lives, many of us do not like to acknowledge how we feel.  Emotions can get in the way.  Indeed, certain psychopathologies may have their roots in emotion avoidance (think: depression, anxiety, certain somatic disorders).  In other words, you get anxious to avoid feeling sadness.  You get depressed to avoid feeling anger or pain. 

It all makes sense, really.  If emotion really is such a powerful force, then we know intuitively the devastating effects it can have on our lives, and most of us have stuff to do, and really can’t be bothered.  Some of us also are probably more prone to strong emotion than others, which makes things more difficult for those who have to sort them all out.  (This is part of my two-factor lay-theory of psychopathology:  extremes of sensitivity or intelligence = bad news for your mental health.)

But here’s the point I really want to get to: we do not know how to measure emotion.

Asking people (self-report) often doesn't work, unless they are particularly self-aware and willing to share with you.  ‘Objective’ measures (physiology) are often used, but they can be confounded by anything from hot coffee to a hot research assistant. 

Emotion used to be reviled as a topic of study in psychology because it was thought of as too fluffy: “If we can’t measure it, it doesn’t exist”.  I think this was misguided.  After all, emotion is too powerful a motivator, and I think that having ignored it in science and theory so far is part of the reason we can’t explain or don’t understand a lot of what’s going on in the world today.  We have to stop being afraid of measuring things that we don’t understand.  After all, I don’t understand what light is (a wave AND a particle?  For serious?)  But I could measure it anyway. 

We have to step up to the challenge in psychological research today of addressing the issues that matter:  motivation, beliefs, pain, emotion.  The big ones.  The scary ones. 

Yes, the methodology will be complicated and a pain in the butt.  But big deal!  Check out how complicated it is to measure light. 

Reflection, Validation, and the Most Important Discovery in Neuroscience

Dr. Ramachandran’s TED Talks discussion of mirror neurons, is the awesomest thing.

Not everybody shares Dr. Ramachandran’s opinions about the importance of mirror neurons.  But I do!

The notion of mirroring is so central to human relationships, seeing yourself in others is absolutely crucial to discovering who you are and what you want.  It may be speculation, but there must be biological underpinnings to this process that are widely shared – because they allow society and civilization.  Reflection and social connectedness is a theme in most if not all of the major religions (Prothero, 2011).  This is a process that is so crucial to our humanness it deserves to be studied more fully. 

I have been reading an AMAZING article relating mirror neurons and Theory of Mind (ToM) in humans (Gallese & Goldman, 1998).  If mirror neurons are the basis of a certain kind of empathy, or theory of mind, then we must explore this more fully.

A note about the research so far:  Not everybody is equal in terms of empathic capacity or theory of mind.  It is unlikely that anything so finicky as mirror neurons should show the same activation in all people, without regard to their trait levels of such variables.  And in order to measure empathic capacity or theory of mind in adults, researchers have to get creative.  Perhaps an emotion-induction procedure followed by a validation procedure can help us get to where we need to be?

A note on social media:  The process of seeing oneself reflected on a computer screen has not been studied empirically in enough detail.  How important is it to me that blogging reflects a part of my mind I don’t express anywhere else?  How important is it to know that somebody who reads this, gets it? 

Pretty important, I think.

Social media and blogging are likely to be one of the best platforms for studying the processes relating to ToM (self-consciousness and other consciousness) and its potential neural underpinnings, in adults.  This is so exciting!  Has this been done anywhere?  Did I miss it?  When can we get started???

Social Medicine: we need a 300 year plan

The WHO defines health as follows: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

I like this definition for including the phrase "social well-being".


When we talk about “lifestyle” and lifestyle changes that need to happen to prevent chronic disease, we are talking about what is really a social problem.

Social medicine is the field that is concerned with building the infrastructure we need for healthy communities. 

Our default when we think about health is to think of it as a biological phenomenon, lying within one individual.  While I wouldn’t argue that this is not the mechanism through which disease seems to be expressed, I would argue that this does not accurately reflect the whole picture.


Take the following pieces of trivia:

1)   Childhood trauma predicts poor physical and mental health in adults, and chronic pain (Goodwin & Stein, 2004; Van Houdenhove & Luyten, 2006). 

2)   Low SES or social trauma (Benjet, 2010) in childhood also predicts chronic disease in adulthood (Pollitt et al., 2005).

I found this so surprising when I first came across it.  SES matters to the development of chronic disease.  Why should that be?! What does that mean?  Well, my take homes were this:

1)   The psychological and the physiological aspects of health are intertwined in complex ways.  Maybe negative social pressures are the reason motivational interventions in chronic disease often fail: those who had the mental & social resources to implement positive change already have! (And hence did not develop chronic disease in the first place.)

2)   Health and behavior are community (see: family systems) issues.

Public health policy has been most involved in the field of social medicine so far.  Interventions range from sex ed to food regulation.  This work is invaluable, but we need more. We know that we need to eat right, exercise, not be too stressed, not get too fat... We know what we need to do, but still, we don't seem to have the the infrastructure in place to make it easy, or natural, to do those things.  Healthy food is harder to access than unhealthy food.  Pollution is a growing problem.  And a cursory look at the news shows that social strain, conflict, and stress are poorly managed among many of us.  

Part of the problem is just life.  The other part of the problem is just bad (social) planning.  



Social medicine asks what we are doing to promote:

-     Public health policy that benefits both individuals and communities

-     Community & health development

-     Individual care (combining the best of both physical and psychological treatments)

-     A systems approach that takes into account the social value of healthcare (i.e., what, other than direct medical care, does a patient get out of a hospital or clinic visit?  Social support?  Empathy?  If so, how best can we design our health care system and other aspects of social infrastructure to provide its members with support sustainably throughout a lifetime?)   

 
With the problems the world is facing today in terms of sustainability, wars, pollution, etc… we need interventions that not only help us right now, but help us long term.  Forget a 30-year plan, we need a 300-year plan.
  
 ----
 On social medicine and its uses:

- The Canadian Facts  
- WHO Social Determinants of Health 
- Monthly Review 
- Wikipedia (always)

Motivation, Health, and the Type and Timing of Interventions

So I wanted to write a post about motivation.  After all, it occurred to me when I was sick earlier this year, that health, as so many other endeavours in life, requires motivation.  You have to want to be healthy, just like you have to want to be a good person, or a good athlete, or a good writer in order to actually become one.  I was inspired by reading a business blog where I saw this list: 9 things that successful people do (and that you should do too).  And I was shocked because it seems easier to find a “how to” guide for gaining success in ones careers than it is to find a guide to being successful in ones health. (Seriously, how about applying these 9 rules to any health goal? Eating right, exercising?)

Don’t get me wrong.  There is, in fact, plenty of guidance out there.  There is a new “food plate” (goodbye, food pyramid!) telling you what to eat, there are recommendations to get 30 minutes of cardiovascular exercise in 5 times per week (anybody else think that’s funny?), and if I go visit my doctor or dentist I usually get a bunch more good advice for what I should be doing.

But it doesn’t come with a “how to” guide.  And I want one, please.

Because I was thinking that if I, who have no dependents and a lot of freedom, have trouble eating and exercising the way I should and may get submerged by stress more often than my research recommends I do… then my guess is that people with lifelong bad habits, kids, mortgages, and careers are going to have a pretty rough time too.  

So my original thought was: “Why don’t I get more motivational psychology when I go visit my doctor?”

But as I was pondering the feasibility of this (as well as searching for any evidence that it would help), I realised two things:

1)      Even if motivational interventions worked very well for health-related issues (and it seems like they might work more at the “OK” level), they would probably have an effect in disease prevention, rather than in the people already suffering from chronic pain or disease.

2)      Humans are social creatures with certain hard-wired preferences (for example, for fatty foods), and the behaviour of those around us influences us profoundly.  I.e., asking an individual to change their habits alone without taking into account the society they operate in is completely unrealistic. (See this article by Christakis & Fowler, 2007 if you have not. Because it's awesome.)

If we want to get serious about the prevention and treatment of the biggest epidemics in our society at this time (read: heart disease, cancer, depression, obesity), it has to happen at a community or even at a policy level.

Asking people to go it alone flies in the face of everything we know about social psychology and how people operate.  People are willing to lie about perfectly concrete realities in order to fit in with a group of people they barely know (Asch, 1951)… what makes us think they are willing to change bad habits (e.g., exercising instead of watching American Idol, quitting smoking, etc.) if their friends or families do?

Individual motivation, though it seems to underlie many a success story, will never be the whole answer (Gladwell, 2008).  Motivation interventions will probably be successful if they are aimed at a group of people who are in a situation where they can respond to them.  And maybe that’s why you’re more likely to hear a motivational psychologist comment on success in the corporate world than on success fighting coronary artery disease. 

We need to find a way to get communities to be healthy, not just individuals.  We need to think big in terms of “herd immunity” to chronic disease.  We need to influence policy leaders who can make real change come into our environments in terms of what we eat and help improve our communities (first of all, by making sure we have communities!) by better city planning and promoting health and wellness, stress reduction and physical activity.

Public health approaches might be the most direct and effective solution to the current epidemic of chronic “lifestyle” diseases.  Individual responsibility is important, yes.  But integrating healthful eating and physical activity into our daily lives is a change that is going to happen on a community level.  Ignoring the power of the infrastructure we live in to shape our lives is naïve.  And, I might add, unscientific.

Fairy tales, Cultural Narrative, and Quebec’s Secession from Canada

 

"Reality is one of the few words which mean nothing without quotes." ~Vladimir Nabokov

This post is about the power of a good story.

I love fairy tales because I think they say something very important about our human collective unconscious and about the power of a good story.  I have been reading a book of Algerian fairy tales (they’re good – they haven’t been rewritten to be PC yet) and I was struck by one particular manoeuvre in the text that repeated itself in several stories.

The hero of the story is often first introduced to us as a child chased away from home or prince/ princess faced with sudden inexplicable hardship for several years.  The turning point in the narrative comes at some point after these long years of suffering.  At this point, the hero often tells his or her own story.  The recipient of the tale is a new person in the hero’s life.  This person is willing to listen and sees through their rags to the royalty underneath. 

The hero’s recounting of their story, their past and their hardships, marks a turning point in the tale.

I feel like having the hero tell their own story is an ancient storytelling manoeuvre, something that can be seen in the Ilyad and the Odessey.  In the Illyad, there is another remarkable twist, in that the hero makes up his own story.  Odysseus is a clever man, and not one to be hampered by objective reality.  His tales are not necessarily true to the facts of the events; but perhaps they are true to the feelings of the events.  The modern notion of history as a factual and objective narrative of events didn’t exist 10,000 years ago.  And why should it have?  Is it more important – more real or true - to know that X event took place on Y date or to know that it felt like battling a Cyclops?

… But back to the fairy tales. 

It is interesting to note that in this particular collection of fairy tales, there are other characters who undergo years of suffering and never get to tell their stories.  These unfortunate people either get forgotten in the narrative or meet a sad end.  It feels like being able to tell their story to someone who cares saves these heroes.

There is a form of psychotherapy called Narrative Therapy.  In Narrative Therapy, the client tells their story, and then learns to re-tell it.  So if the story has always been depressing, they learn to add elements of light, and they learn to write new chapters that follow a different plot-line.  (Note that the changes to the story really only has to happen on the level of the story. The objective reality might not change.)

I think this approach to psychotherapy is fascinating because it is so simple and so profound.  (I mean come on.  It’s used in fairy tales!!)  After all, don’t we all want to be able to tell the story of who we are and how we got that way to someone who really cares? 

And yet, who’s story do we really know?  Like, really? 

I don’t even really know the story of a couple of my close friends!  (...I hope I’m not a bad friend.)  Of course I know pieces of the stories.  When you know someone over a number of years, if for no other reason you know part of the story because you were in it.  (Still doesn’t mean you know how they would tell their story though.)  But I think it is surprising to think that with a lot of the people we are supposedly closest to, we might not know the stories of (e.g., our parents, our siblings).  Do we know what their full story is as they would tell it?  Do they know ours?  Or is it even worse:  are you close to someone you wish would just stop telling the same old horrible stories?

The idea of having somebody who can hear your story is not terribly different from the notion of having validating relationships (discussed previously).  But it brings another element into the discussion:  culture.

Whatever part of the story you share with a group is your ‘culture’.  Members of that group can’t help but reflect those elements of your story back at you and validate them.  All cultures have their self-narratives.  How deeply you are assimilated to a culture might even be described as how much of the group’s story you consider your own.  And how powerful these stories are! 

Think about a relatively low-octane conflict: language and secession in Canada. 

I got into an argument the other day with a fellow Canadian over Quebec’s position in Canada.  He is from the English part of Canada, I am from the French one.  We are both reasonable people (or at least I am) and – this is important – we both basically agree!  He does not want Quebec to separate from Canada, and I do not want Quebec to separate from Canada.  You’d think we’d be pretty much on the same page.  But you would be wrong.  We get antagonistic emotional reactions to talking about the issue and usually end up arguing and not listening to each others' points of view.  (But at least we try.  I mean seriously, if two people who basically agree on a lower-octane conflict can’t have a civilized conversation, then we really have to give up on peace in some of the stickier conflicts in the world.  And we just can’t afford to do that.)

But back to our argument.  Though I personally do not want secession, I understand why many people do.  Quebec’s culture is distinct from that of the rest of Canada in many ways, and French-Canadian history (or self-narrative) involves a lot of ill-treatment at the hands of the British and English-Canadians.  When I tried to explain this to my friend, he was somewhat surprised.  His narrative of English-Canadians is that they are nice and polite and peaceful and would not mistreat another group.  When I insisted this maltreatment was factual history, he protested that it happened a long time ago and we should all just move on (that may not have been how he said it, but that’s how I heard it).  Note that once again, I basically agree with him.  But we had conflicting cultural narratives that neither of us were sufficiently validating in order to placate the other, and therein lay the problem.  (This is not easy stuff!)

I told my friend to find out more about Quebec’s history from a Francophone perspective.  He replied that it would show a different version of events than the Anglophone one. I said “duh, that’s the point”.  But I meant to say something eloquent and persuasive, along the lines of: “Indeed, it may.  But I know you will enjoy to get to know your cultural neighbours and fellow founders of our great country!  Learn their story as they tell it.” (Yeah, I know.  Apparently I should leave diplomacy to my sister.)

The point is this: how one culture sees themselves may not be how another culture sees them.  How one culture remembers history is not necessarily how another culture remembers the actual events in history.  And how the story morphs over the generations is hard to keep track of.  And yet – despite the fact that we know this about history, our stories are some of the things we hold onto the most strongly.  Even when we know they might be factually wrong or that we can’t prove them.  We need our stories.  After all, it really just isn’t important to know exactly what happened.  It felt like battling a Cyclops.

---

Thanks to @miriam_leia for some edits and tips :)

Good, Evil, and Etymology in Health Research

I have been reading some books on religion that have me fascinated.  God is Not One and Religious Illiteracy, by Stephen Prothero.  I have always found the topic of religion interesting and important, especially as regards health.  Indeed, it seems to me like many religious rules resemble guidelines for healthful living that we have ‘discovered’ though research.  For example, many religions emphasize both psychical and physical purity; modern medicine emphasizes hygiene.  Some emphasize certain moral or ethical aspects, like being nice to others; we in behavioral research are continually floored over how much good social support does.  The principle of being generally satisfied with what you have seems to come up a lot in religion; and we keep telling people to reduce the stress in their lives.

You might argue that this is just a matter of interpretation, and maybe it is, but consider the following. 

Let’s look at some etymology. (Thanks to Online Etymology Dictionary.)

Evil (adj.) 

O.E. yfel (Kentish evel) "bad, vicious, ill, wicked," from P.Gmc. *ubilaz (cf. O.Saxon ubil, O.Fris., M.Du. evel, Du. euvel, O.H.G. ubil, Ger. übel, Goth. ubils), from PIE *upelo-, from base *wap- (cf. Hittite huwapp- "evil"). The noun is O.E. yfel. "In OE., as in all the other early Teut. langs., exc. Scandinavian, this word is the most comprehensive adjectival expression of disapproval, dislike or disparagement" [OED]. Evil was the word the Anglo-Saxons used where we would use bad, cruel, unskillful, defective (adj.), or harm, crime, misfortune, disease. The meaning "extreme moral wickedness" was in O.E., but did not become the main sense until 18c.

Isn’t this interesting?

One of the things I like about what I study is that it has such a spiritual dimension.  The words for good and evil or health and illness, show that.  In French, the word for evil is ‘mal’ and the word for illness is ‘maladie’.  As the link above shows, in English the words illness, ill, and evil are all related.

Now what if we look up the etymology of the word health?

Health

O.E. hælþ "wholeness, a being whole, sound or well," from P.Gmc. *hailitho, from PIE *kailo- "whole, uninjured, of good omen" (cf. O.E. hal "hale, whole;" O.N. heill "healthy;" O.E. halig, O.N. helge "holy, sacred;" O.E. hælan "to heal"). Of physical health in M.E., but also "prosperity, happiness, welfare; preservation, safety."

So there’s a suggestion that health = holy.  In French the connection exists too.  Health, or ‘santé’ is related to the word ‘sain’, which means holy .

But the importance of spirituality in life tends to be ignored in modern science and research.  In general, I don’t think this is a bad thing.  After all, we don’t all agree on the sticky topic that is spirituality and religion, so if we can stay with the ‘facts’ that we CAN all agree on (or mostly all agree on) then we can have meaningful dialogue and progress.  And I like dialogue and progress.  (Seriously.  Just in case you were worried, I don't mean to proselytize.  Except that I believe people should be able to think/ believe whatever they want, so I can do the same.)

But the importance of the spiritual in health can’t be ignored.  Lifestyles, so often informed if not governed by culture and religion, are the basis of a lot of healthful and unhealthy practices.  The presence or absence of a community we can rely on makes a huge difference both in terms of the development and progression of mental and physical health disorders.  When we talk about behavioral health, we are talking about what people do to stay healthy.  And why.  That is, what are the motivations to good health? 

What if by overlooking spirituality and religion in health research and its important effects on motivation and behaviors in health research we are in some ways missing the point?

But then if that's true then how do we develop the language to talk about these things in a health setting?  How can a therapist talk to a client of a different faith (or of no faith) about spirituality in a way that doesn’t make somebody feel left out or misunderstood or pressured?  How can a researcher study spirituality in a country of population that doesn't have a homogeneous set of beliefs or that doesn't want to talk about them? 

It may be too big a challenge.  But it is worth thinking about.

Psychology, Language, Science and Nomenclature

I have spent the past few weeks in the (infinitely long) process of making edits to my thesis.  And I have come to the following conclusion:

Research is annoying.

And, might I add, research in psychology is especially annoying.  Don’t get me wrong.  I love what I do, and don’t think I would find another field more fascinating.  But research in psychology has one big (very very big) shortcoming: our nomenclature stinks.

The types of models we work with in medical psychology are complicated.  They demand a combination of psychological and physiological constructs, the validity of which is often fuzzy.

Take depression, for example.  Depression is a construct that we spend a lot of time on in medical psychology, because, well 1) it is widespread, and 2) it happens a lot when people get sick.  In studies, it is typically assessed using self-reported symptom checklists that essentially ask people if they are feeling sad and hopeless, and if they have a variety of other symptoms of depression.

But are these symptom checklists really reflective of what we are looking for?  Or maybe that’s the wrong question.  Maybe the question should be, what do we mean by “depression”? 

To get a clinical diagnosis of major depression you can be either 1) sad, and 2) have no appetite, not be able to sleep, be restless, and cry all the time OR 1) have lost interest in things, and 2) have excessive appetite, sleep all the time, be lethargic, and never cry. (Or at least this was the case in DSM-IV...)  But that raises a question: are those two depressions the same issue?

Even worse, you can have depressive symptoms secondary to a negative event in your life (e.g., loss of job) or secondary to unresolved childhood abuse and PTSD.  Now those two things are definitely NOT the same thing.  The first is generally self-resolving as long as the individual has the personal and social resources necessary, and may or may not have startling health consequences.  The second implies changes in the CNS from a young age (Shea et al., 2005), as well as a different constellation of personal and social resources throughout the lifecourse, and is almost certain to have long-term mental and physical health consequences (Dong et al., 2004; Dube et al., 2009; Ramiro et al., 2010).

To make matters worse, we know that there are neural correlates to constructs such as depression.  There is no clean split between the physiological and the psychological constructs in medical psychological research.  Human psychology may be an epiphenomenon of biochemistry (but that gets us into a whole ‘nother philosophical debate).

So depression is complicated and comes in many forms.  But we often don’t make these distinctions in research.

The problem is that they all look like what you and I, and everybody and their brother calls “depression”.  Psychology does not have a periodic table of the elements to organise itself.  We rely on human languages.  And the problem with language is that it means whatever the people using it decide it means at any given point in time.

(Fun fact: Many languages do not have a word for “depression”.  What implications does this have for the study of such constructs cross-culturally?  Or again, maybe the better question is: Do these constructs exist cross-culturally? For an interesting discussion see Urban Semiotic.)

To be clear, I am not advocating reducing psychology to its neurological bases.  I am not a person who believes that you cannot scientifically examine subjective phenomenon.  After all, I am studying pain – it’s hard to get more subjective than that. (Although I expect there is a word for pain in most languages, which might make it slightly superior a construct to depression… Must look into that.)  But I think the question of how we in the human sciences create our constructs deserves more attention than it receives. 

If we are not going to invent new words to describe our constructs, then we need to know their limitations.  Perhaps depression as we know it in the West does not exist in all cultures.  Perhaps depression is a social construct that exists here that does not exist everywhere.  Alternatively, maybe depression as we understand it in the medical sense exists everywhere in different forms, and we have just decided to label it this way and need to be creative when studying it cross-culturally.  (Kind of like carbon atoms exist everywhere regardless of whether or not there is a term for them.)

We need to be less reliant on our languages.  Those types of depression described above may be qualitatively different as regards their physiological correlates, and if so, they may be responsive to different types of treatments.  Just because they all look like what the English language calls “depression” does not mean they are clinically identical or on the same continuum.

These are challenges in our field that many in the “hard” sciences hold against us.  And for good reason.  Until we can be quite clear about what we mean by a given construct and what we intend to pick up on when we measure it, we cannot pretend to understand its health implications either on the level of the individual, the group, or society.

Reflection, Validation, and The Power of the Blog

It may often be said that psychology is soft science at best, and maybe not science at all.  I beg to differ.  Through empirical tests (the same kind of tests that brought you dynamite and banana-flavor that doesn’t come from bananas) psychologists happened upon two of the most important discoveries ever.  We call them ‘reflection’ and ‘validation’.

If you do not know what these things are, let me tell you, because they will change your life forever.  Reflection is a person-centered therapy technique (Ackerman & Hilsenroth, 2003).  It refers to how to respond to a statement made by a client in therapy (or by anybody else trying to tell you about themselves and their life).  Let’s start by what reflection is not.  If my statement is “My boyfriend isn’t returning my calls and it’s making me go crazy” and my therapist responds with “It’ll be alright, he’s a douchebag (sic, technical term) and you’re awsome” that is NOT reflection.  Sounds nice, but note how it doesn’t mirror what I said.  If my therapist says “So you feel bad because you feel like he let you down”, that is reflection.  It is a nice repackaging of what I said that makes me feel like I was listened to and heard.  So I walk away happier. 

Validation is a similarly mind-blowing technique (Internet Encyclopedia of Personal Construct Psychology).  Again, let’s start with what validation is not.  If my statement is the same “My boyfriend isn’t returning my calls and it’s making me go crazy” and my therapist says that part about him being a douche and me being awesome and follows it up with “This is probably a blessing in disguise! You should be happy” that is not very validating.  It may be true, but it is totally not meeting me where I am emotionally at that moment.  And I walk away feeling like I’m stupid for being upset.  Not helpful.  A more validating comment is something along the lines of “I see why you would feel that way, it feels awful to be left hanging like that.”  Validation makes me feel like I’m not crazy for feeling the way I do. (To be fair, therapists have to be careful not to overdo this one.  Some people are crazy.)

You might say that these are not scientific discoveries because they occur naturally in good human relationships.  But then explosions and banana-flavor also occur naturally (just not in human relationships), and nobody’s saying they are not scientific. 

These are techniques that can be developed and applied to produce results in the world.  And the results are startling.  With reflection we feel seen, our existence matters (there are other words to describe this as we will discuss below). With validation we feel understood, we are not alone in the way we see the world.  These techniques are part of the way we are made to feel human.  

Though not always framed in the language of psychodynamic therapy, reflection and validation have been used in research.  I was at conference this week where one of the speakers was discussing work on emotionally expressive writing and how it helps patients diagnosed with cancer reduce physical symptoms and cancer-related doctor visits (Low et al., 2006).  When she discussed the mechanisms that might be underlying this association, she talked about ‘self-affirmation’ (Creswell et al., 2007) but what is self-affirmation if not reflection - the ability to feel more human by seeing yourself reflected on a page? Furthermore, they are now doing this by having cancer patients blog about their feelings and experiences related to their diagnosis and get feedback from their friends and family – which amounts to a sort of validation, doesn’t it? (I think blogging is validating :D).

I would like to end there, because I have presented only arguments in favor of my thesis.  But I won’t.  Because emotionally expressive writing doesn’t work for everybody all the time.  This form of coping has been shown to be beneficial in women first diagnosed with breast cancer, but not women in the later metastatic stages (Low et al., 2010).  Could it be that the experience was no longer providing the reflection and validation necessary?  Or is reflection and validation not what people want at that point?

Reflection and validation are not always the best option, even in a psychotherapy context.  For example, if a client says ‘I failed a class, I’m never going to amount to anything’ it’s probably unwise of the therapist to spend too much time reflecting and validating – it’s going to sound like agreeing!  At some point in the emotional process, you need to argue with that statement and instill hope (the technical term is ‘Confrontation’. Seriously, this time.)  

Maybe with patients in the later stages of serious disease, there is an analogous situation in that too much reflection of how bad things are is the last thing someone would want.    

I remember talking to a family-doctor friend at one point and trying to teach him the concepts of reflection and validation.  I was surprised that these concepts weren't taught in medicine.  But he said something interesting, that those of us at the intersection of medicine and psychology should know.  Doctors are taught to ‘support’ and ‘normalize’, not 'validate' and 'relflect'.  I was surprised at the time, because those are just two completely different things! And my bias was that reflection and validation are better. 

But being around very ill people changes the game.  If a person is in a lot of pain and feeling hopeless, maybe you want to be careful about reflecting.  Maybe you want to instill hope – not validate hopelessness. Supporting and normalizing might be much more helpful in those cases.

That being said, reflection and validation are often used by medical doctors as well (just maybe not formally taught as in clinical psychology).  For example, I was very sick with a respiratory infection for 3 or 4 weeks in January.  (It sucked.)  And one thing I noticed was how not only the doctor I consulted, but also many of my doctor friends made sure to say to me ‘I’m sorry that you feel so bad’ – which is a very reflecting AND validating comment!  Of course, a flu is not such a big deal you'd need to be careful about reflecting or validating my hopelessness, it's just nice.  They knew what to say. 

Schizophrenia in Developing Countries, or How the Self-Esteem Researchers Screwed Us All.

Fun facts:  Prognosis for schizophrenia is better in the developing world than it is in the West. (We will come back to this).

First, I want to make a point.  We in psychology are idealists.  When we get an idea, and it seems semi-supported by research, we like to tell people we have found the cure to life’s struggles and implement broad social changes to improve things.  A few decades ago, somebody noted that people with higher self-esteem seemed happier and more successful.  So they decided that if EVERYBODY had high self-esteem, they would be happier and more successful.  Note the mistaken assumption of causality here.  (And we wonder why the physicists won’t look at us!)

Here’s the reality, in case the self-esteem researchers got to you too: we are not all awesome at doing everything all the time.  And having people lie to us and tell us we are, though it might make us feel better on the spot, interferes with our reality testing in the long run. 

Here’s why.  In order to make sense of the ambiguous realities of everyday life, we need some kind of social consensus (Asch, 1951; Sherif, 1931).  Some researchers go so far as to argue that we have a need to compare ourselves to others (Festinger, 1954) because we are looking to make sense of reality (Sherif, 1931). 

The world is complicated.  People’s behaviour doesn’t always make sense.  If someone is brusque to you, you have to make a decision.  Are they being rude, are they in a bad mood, did you do something wrong, or is it a culture or personality disconnect?  On a day to day basis, these are the kinds of questions that we need answered.  And sometimes we just don’t know so we ask other people.  We use social consensus to decide whether someone was rude, whether an outfit is fashionable, whether we are rich or poor, and for just about any other question, big or small, that does not have an observable physical reality - and even then (see Asch, 1951, where 30% of people said an obviously longer line was shorter because everybody else in the room said it was. If you don't believe me, here's a link). 

That’s how important it is to know that the people around you - who you depend on for these answers - are being honest.

A child who wants to know if he is good at baseball or a teenager who wants to know if she is a good driver are looking primarily for the right answer.  The truthful answer.  Not the nicest answer.  We need to know that we perceive as right or wrong, everybody else perceives as right or wrong.  There’s something calming about that - and that's very nice.

Here’s the problem with telling a kid who doesn’t have an athletic bone in his body that he’s good at baseball:

HE’S GOING TO BELIEVE YOU!!!

Now back to the schizophrenics.

Schizophrenia is one of those scary mental disorders that baffles the medical community.  Oh we have a few ideas, but really, prognosis is pretty bad.  But somehow, in less developed parts of the world, it’s better (Isaac, Chand, & Murthy, 2007)

This should blow everybody’s mind. Quality of life is higher here. Medical care is better. People are nicer. There’s less war, disease, death. There doesn’t seem to be any reason diseased individuals should do better elsewhere. (To be fair, some have argued schizophrenics do not always do better in the developing world. Cohen et al 2008).

Unless the problem is that these people are hypersensitive to things that we do not do well here.  Like maintaining relationships with our families and reality testing.  We North Americans are good at many things, but we are not good at telling people when they are making us angry, when they are being rude, or when they suck at baseball.  We are also a highly individualistic culture that allows people to live most of their adult lives separated from their families (maybe not always a bad thing, but very isolating). 

Developing countries don’t have time for that nonsense.  Half of my family is of Algerian heritage (so I feel like I have the right to generalize my experience to the entire developing world).  And my experience is this: people are not concerned with your self-esteem, and families stick together just because.  (I actually think families stick together there because there is very little other form of social infrastructure - but that’s beside the point.) Families are more direct and, though not necessarily less dysfunctional, less afraid of their dysfunctionality.  And I think there is enormous therapeutic value there.

I think that in daily life we underestimate the therapeutic value of looking life’s ugly in the face and knowing we are not alone.  I think that a lack of acknowledgment of certain undesirable realities, even if it’s because we want to make people we love feel better, ultimately leads to problems in our basic understanding of the world and of our place in it.  And I think these problems can have graver consequences than just producing the occasional obnoxious individual with an inflated sense of self.  

Grief, Pain, Freud, and Melzack (Don't worry... this post is way more fun than it sounds)

I’m currently doing a masters thesis on the topic of pain. It’s interesting (to me). I’m examining the multiple determinants of pain in a sample of cardiac patients. So I’m studying the relationships among psychological and biological factors in predicting angina, a particular type of pain brought on by CAD. The reason I got interested in this area is that the heart has for so long been considered an organ tightly related to emotions (see this awesome website http://www.heartsymbol.com/) and because I have had chest pain since I was a child (Research is Me-search…)

The most interesting thing I have found about the topic of pain (read: emotional distress) is the combination of 2 theories: 1) the Neuromatrix Theory of pain (Melzack, 1993, 1999), and 2) Freud’s psychosexual theory of development.

Yes.

Here’s how.

Freud, as we know, was a neurologist (Galbis-Reig, 2004).  His theory, which many these days shorten to “aggression and sex”, was actually intended to indicate that the neural loops (he didn't use those words) laid down as children would dramatically influence personality later in life. He took his theory further in the discussion of “trauma”: the traumas of childhood were repeated in experiences in adulthood. (He was not the first to have this thought: http://en.wikipedia.org/wiki/Eternal_return#Friedrich_Nietzsche.)

But let's translate this into psychological distress speak: The emotional distress established in childhood would be repeated in adulthood.

Crazy talk? Maybe. (Of course not.) But then let’s fast-forward 100 years (give or take.) and get to Melzack’s new and improved theory of pain.  This theory is designed to explain physical pain, and grew out of observations of phantom limb pain, where in fact a limb that has been amputated seems to cause intense physical pain.

Melzack’s theory is a complicated piece of psychological thought, but boils down to this: 1) we have the capacity to feel pain, 2) this capacity is both innate (i.e., we are genetically predisposed to knowing what ‘burn’, ‘itch’, ‘peirce’ feels like) and learned (i.e., if we have been burned before, now we REALLY know what that feels like). According to this theory, there is no need for the peripheral body’s existence in order for humans to feel pain because the experience of pain only becomes translated in neural loops that ‘code for’ certain types of pain. That is to say that if you didn’t have a body, and were nothing but your brain, I could make you feel any type of bodily pain just by activating the right neurons. (I wouldn’t though.)

Doesn’t this sound to you a lot like the physiological version of Freud’s trauma theory? Especially when you think of chronic pains like back pain, joint pain, and oh recurrent chest pain. Some pattern for these pains gets laid down early on in life, and 20 years later, people are still complaining about it because it got worse. (And just in case you were wondering, there is a terribly poor relationship between how bad it hurts and how bad it's broken. That means, it doesn't always hurt more because it's more broken. Sometimes it is, sometimes it isn't.)

So what about a psychological neuromatrix? Old pains, laid down in childhood (rejection, abandonment, grief), would have formed their own neural loops, and the more those pains were felt, experienced, reminded, … the more practiced the neural loops became. The more practiced those loops become, the easier it is to activate them, until they would come to dominate. Until you couldn’t feel anything else. That's why childhood trauma is so bad. The neural loops for happy would be rusty, the neural loop for love may have atrophied…You need to practice those too, you know.

As an aside. Have you ever noticed how some people refuse to feel bad? (Those people annoy me.) You have a bad day and they say something along the lines of 'it'll be better tomorrow', as if anybody cares. But maybe those people are on to something. Maybe it's related to this fear of losing the ability to feel good if you spend too much time feeling bad that prompts some people to say “don’t be sad” when you’re sad. (Or just be sad for three days. THREE DAYS? See Paulo Coelho’s blog http://paulocoelhoblog.com/2011/02/18/past-and-present/ Some religions suggest to keep mourning down to a minimum too… I’m thinking Islam and Hinduism and I think there are others too http://en.wikipedia.org/wiki/Mourning). And maybe there's sound scientific logic behind this. Maybe we want to make sure we keep the neural loops for pain unpracticed. I think there’s something to that. You always need to remember that it is possible to feel good, and you should practice feeling good so that your mind (and brain) gets used to it.  

BUT – here’s the twist. Ignoring negative emotions doesn’t work. Psychology is all about not allowing people to repress negative emotion. Therapy is all about feeling those emotions, and realizing that that’s the only way through them. That was Freud's big discovery. (And yes I know that therapy has a bad track record when it comes to oh working and all... But more on that later. I'm still on this whole feeling-the-burn kick.)

As long as I'm bringing religion into this, “turn the other cheek” is a Biblical quote often used to encourage forgiveness over revenge. But I think it makes more sense to think of “turning the other cheek” as a response to something or someone causing you pain. For example, if someone hurts you, let’s say through rejection, and you get mad. Then the whole concept of an eye for an eye kind of breaks down doesn’t it? What are you going to take revenge on? And I think this happens a lot in romantic relationships: someone screws you over, and you go screw somebody else over to feel better about things (because often it’s impossible to take revenge off the original person). Does it work? Uhh. Don’t think so. (An other interesting site : http://www.healmybrokenheart.com/)

 

But turn the other cheek? That makes sense. It says “fine, go ahead and hurt me, hurt me again because I am going to deal with these emotions”. You know what that sounds like? Systematic desensitization (Wolpe, 1961)! The process of exposure through which people are taught to get over all sorts of things from snake phobias to motor vehicle accidents. Exposure seems to be the best form of therapy for dealing with trauma or post-traumatic stress disorder. In my opinion (and I’m sure I could find some references to back me up), the main ingredient operating in ANY form of therapy is exposure: therapists encourage patients to try new things, to form new relationships, to expose themselves to their fears – and then offer them the support they need to talk about those experiences, to experience them, to see how they are similar and different from the previous experiences that left a hurtful and sensitive neural trace.

The process of therapy is probably related to the process of creating new neural loops that are not painful, but that contain some elements from the painful neural loops. Some ingredients that seem to make therapy particularly useful (and likely to work...) are reflection and validation. These are fun ways that let the person know you connect with them, and your best friend is probably pretty good at this (though your parents may not have been...) 

But yes, reflection and validation... Possibly the way around the whole painful neural loops thing. how? I don't know, I'm just speculating here and this post is getting way too long. But it wouldn't surprise me if this activated mirror neurons that were instrumental in the process of building new neural loops... Hmmm. More to come.

Aggression, Social Psychology, Threat, and Communication

A couple of weeks ago, I was TAing a Social Psychology lecture on the topic of "Aggression".  A big topic, a great topic... Something you can really sink your teeth into... Metaphor that works on many levels.

At some point in the class, an interesting question came up (posed by me! yey TA!): "Why do people aggress towards others?"

Two answers really grabbed my attention: Threat (survival) and communication.

Threat, I had expected (it was in the readings). Communication, I had not.

But I loved these answers. Both answers really got me thinking (this is the point in the class where I lost everybody though.) Here's the thing about the "communication" answer though. I, too, have often found that there's nothing like a good fight to really connect with somebody. You bond on a deep level when you're willing to just go to the depths of your soul and pull out all that is most intense (ugly? maybe beautiful?) and show it to somebody else. That's really something. (Granted not all aggression gets this epic, but I think we can all agree that it can. "300" anybody?)

Here's the thing though. I wanted to get the students thinking about how these two motivations to aggress could come together and could grow apart.  Here's the reading in a nutshell: "People aggress towards others if they are under threat, because looking down on others makes us feel better about ourselves" (not verbatim, Wills, 1981). But, there's more: "Unless EVERYBODY is under threat. In that case, we just make friends." (also not verbatim, called "shared-fate" in Wills, 1981).

What does that tell you? (Well, who knows what it tells you, this is psychology, ok?) But I think you could make the argument that aggression is communication.  Does it stem from the need to communicate or does it EQUAL communication, that is another question. But I think you could pose the same one with threat, couldn't you? Is aggression a response to threat, or is it an expression of threat?

Hm. I don't know that that's known. Would probably depend on how we define aggression and threat and everything else. We could draw lines in the sand to make them distinct but they probably overlap.

I'm getting bogged down in the weeds. The point is, threat can lead to aggression, but it can also lead to affiliation (read: communication). That would put the two on par (aggression = communication).

But you could go deeper. You could say, we have a need to connect with other human beings. And you could say that aggression is one of the ways to do this. There are other ways: conversation, sex, writing, ... But how often have you gotten angry at somebody and lashed out because they just didn't get what you were saying or how you were feeling and you didn't know how else to tell them - but you really needed them to know you?