Essay // A Philosophical Critique of Schopenhauer’s “World as Will and Idea” & a Modern Lucretian View of “l’Art de Vivre”

Mis à jour le Samedi, 8 Avril 2023

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About the life of Arthur Schopenhauer

Arthur Schopenhauer was born on February 22nd of 1788 in Danzig, Germany, he was the son of Henri Floris Schopenhauer aged 38 and Johanna Henriette Trosiener who was then 19 years old. His father was a wealthy merchant and banker who had already planned for his son to become a business man before his birth, and hoped Arthur would follow in his steps. Henri Schopenhauer was also an independent minded man who moved his family from the city of Danzig when it was taken over by Prussia in 1793. The new family home was in Hamburg. Arthur Schopenhauer left to visit England and other countries, on the understanding that when he completed his tour, he would begin work in a business. The latter, then 16 years old, kept his promise but being much more intellectually oriented, he did not have a mercantile mind and had no interest for business and so when his father died, he got consent from his mother to continue his studies.

In 1809, he entered the University of Göttingen to study medicine, but he changed to philosophy in his second year, as he put it “life is a problem and he decided to spend his life contemplating it”. He also studied at Weimar where he lived with his mother until he became estranged from her. Schopenhauer had a moody, irritable temperament and could be violent in his passion.

At the university, Schopenhauer developed an affection for Plato and visited Berlin to hear the lectures of contemporary philosophers Johann Gottlieb Fichte (1762 – 1814) and Friedrich Schleiermacher (1768 – 1834). Fichte was the first transcendentalist idealist and Schleiermacher was a founder of modern Protestant theology. Schopenhauer found Fichte’s comment, “No one could be a true philosopher without being religious” absurd and retorted that no man who was religious turns to philosophy since they have no need for it [a questionable statement when religion (e.g. Christianity) does not cover all the aspects of the experience of life in detail, or study God’s works methodically through the lens of science and rationality, to understand the further implications in the betterment of the human world].

Rodin - Hands (Musee Rodin, Paris)

Image: “Les Mains” par Auguste Rodin

Schopenhauer left Berlin when Prussia rebelled against Napoleon. He never developed strong German patriotic values and sentiments [perhaps never given or found a reason to do so], and always regarded himself more as a cosmopolitan without any strong national affiliation. In that sense we can deduce that Schopenhauer’s vision resonates with the French intellectual heritage because it tends towards universalism; like Montaigne, Descartes and Voltaire, he genuinely had a universal vision of humanity and did not restrict himself to the particular collective frame of mind of a group of organisms conditioned within the limits of a geographical region, which is also similar to the vision of Socrates who said: “I am not an Athenian or a Greek, but a citizen of the world“.

Traduction (EN: “I am not an Athenian or a Greek, but a citizen of the world.” – Socrates

The thinker went into retirement to write his first dissertation called “On the fourfold route of the principle of sufficient reason”, which was published in 1813 and earned him a doctorate at Vienna. The poet Goethe congratulated Schopenhauer, and in return he wrote an essay called “On Vision and Colours” which supported Goethe in his stand against Isaac Newton. But the dissertation, although it won the admiration of Goethe, went practically unnoticed. The author however always considered it the groundwork and essential introduction to his philosophy. Shortly after he published his dissertation, Schopenhauer met an Oriental scholar, Friedrich Majer (1771 – 1818), who introduced him to Indian philosophy and literature. He maintained an interest in Indian philosophy throughout his life, and as an old man, he meditated on the Upanishad, part of the Vedas [the sacred script of the Hindus]. He would later associate his theory of the world of ideas with the Indian doctrine of Maya [to the Indians, Maya is illusion or the world as an illusion]. To Schopenhauer, this meant that the individual subject and object he wrote were “Maya”, all at the end.

For 4 years between 1814 and 1818, Schopenhauer lived in Dresden, which is where he wrote his masterpiece “The World as Will and Idea”. He sent the manuscript to his publishers and left for an art tour of Italy. The book was published the following year in 1819, and although it received attention from some philosophers, it sold very few copies. This was a disappointment to the author who felt sure it contained the secret of the universe.

This failure did not kill his eagerness however, so he returned to Berlin and started lecturing. By now he was 32 years old. He deliberately scheduled his lectures for the hour at which the philosopher Hegel was also accustomed to lecture – planning to compete with the master. But his lecturing career was a failure and Schopenhauer gave it up after only one semester. His ideas seemed at odds with the dominant spirit of the time.

Dolly_the_Sheep

Schopenhauer roamed around a bit and then settled in Frankfurt in 1833, he read European literature and scientific books and journals looking for illustrations or confirmations of his theories. He frequented the theatre and also continued writing, publishing on the Will of nature and winning a Norwegian prize for an essay on freedom. He failed to win a similar prize from the Royal Danish Academy of the Sciences for a separate essay on ethics; they disapproved of his disparaging remarks about other philosophers. These two essays were later published together in 1841, under the title “The two fundamental problems of Ethics”. In 1844, Schopenhauer published a second edition of “The world as Will and Idea”, which contained 50 new chapters. In the Preface, he took the opportunity to make a strong statement of his views about university professors of philosophy, which were of course not admiring.

In 1848 there was an unsuccessful revolution in Germany. A revolution from which Schopenhauer had no sympathy whatsoever. But after the failure of this revolt, people were more willing to consider a philosophy which emphasised the evil in the world which preached the rejection of life for the route of contemplation. Schopenhauer’s popularity was on the rise.

In 1851, he published a collection of essays that dealt with a wide variety of topics, and finally in 1859, he published third edition of the “World as Will and Idea” with more supplements. In the last decade of his life, the author finally became a famous man, all kinds of visitors with all kinds of philosophies came to see him and to enjoy his brilliant conversations. Lectures were given on his system at the University, the very university he has attacked, a sure indication that he had finally achieved success. Schopenhauer has spent a long, lonely life of reflection and only after his works were ignored for many years that he attained fame and reputation. He died in September 1860, at the age of 72.

Schopenhauer by Mitch Francis

Image: Arthur Schopenhauer (1788 – 1860) by Mitch Francis

Schopenhauer, was a realistic philosopher, focused on the raw nature of life: the mental evils and cruelty that lies within man, which he considered inevitable sides of human nature that psychologists view as mental disorders with a negative effect on both the character of the ill mind and the human environment at large exposed to that vile animalistic side of human nature. Schopenhauer’s negative view of man’s behaviour and role in life was a sharp contrast to the other more euphoric and at times unrealistic philosophers who marked the spirits of the generation before him, focussing on a an idealistic and exaggerated side of man’s mind and character.

Although Schopenhauer’s work originally gained little attention at the time it was published [perhaps for being too avant-garde for the atavistic institutions of his time when neither the theory of evolution was known nor evolutionary psychology], he expressed an interpretation of the world that was dragging, and embodied an opposition to the major intellectual figures who had imposed their thought before him: great names in philosophy such as Victor Schelling and Hegel. Schopenhauer opposed their thoughts on important points but did not deny expressions of art such as the romantic movement in its various forms. Schopenhauer who never refrained from publicly criticising people and ideas he disliked was very vocal in his complete contempt for these men, and regarded himself as their great opponent in the ring of the leaders delivering the “Real truth” to mankind and civilisation. Schopenhauer’s work in many ways could be viewed as an extension of another famous German philosopher, namely Immanuel Kant, who preceded him by one generation, delivering his major philosophical work, “a critique of pure reason”.

As a man, Schopenhauer was cultured, broadly educated, eloquent and articulate, witty and conversational, and a very talented writer, but he was also opinionated, egotistical, and often quarrelsome. His remarks about other philosophers were assaulted and his remarks about women in general were so scathing that they had to be deleted from his book by his editor. He was obsessed with the suffering of humanity, but did nothing to alleviate it. He himself made the comment that it is no more necessary for a philosopher to be a saint than it is for a saint to be a philosopher, and he never tried to prove otherwise. But, in the final analysis he was exactly the man he needed to be to write what he wrote.

Arthur Schophenhauer’s pessimistic and grim interpretation of life are not very likely to have come from a man of infallible tolerance or patience, and that interpretation of life played a significant role in the development of human thought and philosophy by keeping the debate open and providing inspiration to viewpoints that forced humanity to re-examine itself yet again.

The “Will to Live”: Schopenhauer’s concept, Human Love, Science & Evolutionary Psychology

The concepts of Arthur Schopenhauer’s major work, “The World as Will and Idea” constitutes the foundations for the future works of major thinkers in both psychology and philosophy. As a modern thinker, it is fundamental to get a good understanding of the core concept that structure the work of Schopenhauer, more precisely his philosophical concept of the “Will To Live“, which is echoed in evolutionary biology [i.e. in Charles Darwin’s theory of evolution, which is widely accepted by the scientific community worldwide]. Schopenhauer was incredibly avant-garde because at the time he composed his philosophical treaty of the “World as Will and Idea”, Darwin had not yet formulated the theory of evolution, which would only be published in 1859 – just one year before the death of Arthur Schopenhauer.

The importance of grasping the concept of Schopenhauer’s “Will To Live” cannot be escaped as that “Will” is also synchronised with our philosophical orientation in regards to desire and motivation for the “Organismic Theory of Psychological Construction“, since it resonates with the fundamental belief of the mind as an active, dynamic and self-generating entity, and this is in the German intellectual tradition of mental life [it was also a founding assumption for Jean Piaget as he developed his Theory of Cognitive Development in Children]. Freud also saw psychoanalysis as a revolution of the mind that had to disturb the consciousness of the world, and viewed the unconscious as a reservoir of impulsive force repressed in the biological depths of the soul – a notion that also relates to Schopenhauer’s “Will To Live”.

When Darwin published his theory of evolution, he was opposed to all the reigning ideas of the times, and faced a lot of criticism from religious scholars as he demonstrated that life appeared on Earth by complete chance and in an absurd manner. Life then developped and became more complex and sophisticated through the process known as natural selection. Darwin radicalised his vision of the world since he would go on to even discard any “Will” and his theory of evolution explains life based on the simplistic mechanic of “natural selection”; for example, natural selection allowed human beings to have organs such as eyes simply because such an organ gave man the ability to escape predators – there is absolutely no “Will” behind this procedure and no finalised plan.

What is genuinely interesting about the philosophical theory of the “Will To Live” in Schopenhauer’s work is that it would eventually come to resonate with the much later works of Charles Darwin. The scientific translation of the “Will to Live” in Schopenhauer’s work is what Darwin called the “struggle for life”. Hence, this connection between Schopenhauer’s thought and Darwin’s theory allows us to understand that for both of them, everything that human beings have inside their bodies is at the service of this “Will to Live” [i.e. survival instinct]. Hence, to acknowledge Schopenhauer’s sharp insight as a truly avant-garde thinker, we have to note that he set the foundations for the field nowadays known as “Evolutionary Psychology at a time when it was inexistent.

What are the principles of evolutionary psychology? Simply to fully extrapolate and firmly apply the logic of the theory of evolution to work out its consequences. The theory of evolution explains that all the organs present in the human body are the simple consequence of the evolutionary process of “natural selection” because those organs allowed the species to survive, i.e. we have eyes, a nose, ears and a mouth because those organs allowed homo sapiens (i.e. humans) to survive. So, evolutionary psychology goes even further to apply that survival and evolutionary logic to develop the school of thought on the foundational argument that, since the brain is also an organ that allowed us to survive, so what mankind has in the mind (i.e. our psychology itself) is also the direct result of the evolutionary process of natural selection. Thus, evolutionary psychology claims that the homo sapien mind (i.e. human psychology) is structured in such a way because it favoured the survival of homo sapiens.

The “Will to Live” what we could also call the “instinct for survival” is a profound force deeply embedded in the biological depths of all homo sapiens. That “Will to Live” impacts behaviour at both an individual level and at the level of the species (i.e. homo sapiens). The will to survive of the species is stronger than the will to survive of the individual – which means that the individual wants to survive but there is an unconscious will which is even stronger in the mind which aims not to ensure the individual’s survival, but to ensure the survival of homo sapiens. If we were to express this phenomena from the perspective of natural selection in Darwin’s theory of evolution, it would explain how nature, over the course of evolution, has selected and favoured individuals who were most apt in showing empathy towards their fellow human beings [e.g. towards their children] because such empathetic behaviour promoted the survival of the group [the species itself].

Schopenhauer pointed out that this “Will to Live” has no specific objective except that of preserving itself; which means that man reproduces life for life itself [i.e. one has children so that those children can have children and their children can also have more children, and so on – an infinite process without any precise objective or end result]. As such, no life has any sense, no life has any precise or known final objective; humans pass down the task of devising sense to the next generation and so on – the question of sense is completely inexistent.

Since, life has no clear final objective and no clear sense, Schopenhauer observed that life is absurd because it is mainly an experience of various kinds of suffering. Hence, his famous formula that life is like a pendulum that oscillates from right to left between suffering and boredom: what does this mean? It means that life is made of desire, and desire is always a lack [e.g. a poor person’s desire to have money results from the lack of money in order to be able to stay alive].

This idea of desire as lack will also be echoed in the works of Jacques Lacan as an explanation to human motivation. Hence, as Schopenhauer explains, lack is a form of frustration and suffering. When a human being desires, that person suffers, and when that desire is satisfied, peace and calmness are obtained and the person is in a state of serenity [for some time], but eventually that state of calmness does not last forever, and boredom soon engulfs the individual because nothing leads to moving forward in that state. It is desire that motivates man, it is desire that allows man to live and move forward, and so man oscillates between suffering [when one desires] and boredom [when a desire is accomplished].

If human psychology [i.e. the mind or psyche] is also direct result of evolution which includes the “Will to Live”, then what purpose do feelings and emotions serve? Much before Darwin and much before evolutionary psychology itself, Arthur Schopenhauer through his meditations asked and answered questions about the purpose of feelings and emotions in the human mind:

– In what way do feelings and emotions help us to survive?

– Is romantic love simply an elaborate illusion at the service of our survival instinct?

All human emotions and feelings are nothing more than illusions at the service of the will to live [or we could say the instinct for survival in evolutionary terms]. What Schopenhauer posits, is that when one understands [i.e. becomes aware] how one is being manipulated by emotions and feelings at the service of the “Will to Live”, it becomes possible to detach oneself from those emotions and feelings. But unfortunately, as Lev Fraenckel points out, detachment also leads the human mind to kneel to the demands of the cold and icy calculations of science in the quest to discard those feelings and emotions manipulating us; that could also compel us to become robotic, mechanical and purely utilitarian in our outlook and behaviour – which nature itself did not design human beings with such a mode of operation. Can we can find a balanced mode of existence to maintain our humanity in a life experienced with emotions while also embracing rationality and reason? This will be elaborated and discussed below in our constructive critique building on Schopenhauer’s foundation while also linking concepts from other disciplines and thinkers.

By the logic of the philosophy of Schopenhauer and evolutionary psychology, human emotions are fake (i.e. a seductive, elaborate and beautiful illusion), because they are simply nature’s manipulation to drive the individual to protect his fellow human beings so as to promote the survival of the species. It is exactly the same for romantic love because we have the impression of following and going after our own individual pleasure and romance when in fact it is also nature’s manipulation (i.e. a trick in the shape of a powerful spectacle of nature inherited through thousands of years of human evolution and natural selection) to push individuals to mate and reproduce – a powerful drive at the service of the will to live (or survival instinct). Lev Fraenckel, the French philosophy professor suggested that as a modern example, we could consider the reason why Jack in James Cameron’s film from 1997, Titanic, went as far as to die for Rose out of love; the reason behind his dramatic sacrifice lies in the fact that he was manipulated by his unconscious at the cost of his own life (i.e. the will to live or survival instinct as nature’s manipulation in the form of emotions that drive man to protect our fellow human beings).

Hence, from Schopenhauer’s perspective and even from the standpoint of evolutionary biology, sexual pleasure is simply a bait used by nature to promote reproduction among human beings [which makes a lot of sense in justifying the presence of sexual drives in human beings and animals alike since without them, a species would be devoid of the desire to procreate and become extinct]. That idea may shed some light on man’s love choices in a fairly interesting manner according to Schopenhauer, since it suggests that a male will fall in love with a female with whom he may hardly care about simply because it serves the interest of our species, i.e. the human race. The male will fall in love scientifically (and in many cases unconsciously, driven by his evolutionary instincts or manipulated by his will to live) with the signs of female fertility, i.e. hips wide enough to procreate and breasts adequate enough to breastfeed.

Image: Des mères allaitant leur bébés / Mothers breasfeeding their babies

In an episode of the French show, Arrêt Sur Image, Sébastien Bohler, the chief editor for the magazine Cerveau & Psycho and doctor in neurology explained how “in general”, men tend to be attracted to females with particularly shaped hips, scientifically caracterised by the waist to hip ratio. It is a value obtained by dividing the waist circumference by the hip circumference, and the ideal waist-to-hip ratio is 0.7 in all cultures apparently (Singh and Singh, 2011). As for females, according to evolutionary logic and Schopenhauer’s perspective, their primary biological instincts tend to make them fall in love with males who bear the apparent signs of virility and who manifest a fairly high level of testosterone in order to ensure the protection and security of the offspring. As such, females are also manipulated by their “Will to Live” towards a particular form of masculinity, which generates the female reproductive instinct.

This allows Schopenhauer to give a strong biological reason to the observation that the rate of infidelity is always higher among men than among women even if it is tending more and more towards equality, but still not the case.

Graphique montrant la démographie de l’infidélité en Amérique / Source: Institute for Family Studies

Logically, going by the physiological limitations of the female body, once a female falls pregnant, it becomes impossible for her to continue reproducing for 9 months; she can only produce an offspring once at a time. As such, it is in her best interest to remain with the same partner. On the other hand, in the male’s case, the dynamic is different, because his physiology does not halt or impose any limitation on his inherited reproductive instinct derived from thousands of years of evolution as a mammal, which allows him the choice to continue reproducing with more female partners. As such, Schopenhauer extracts meaning from this evolutionary logic at every level, and in his line of thought it becomes clear that males are also being manipulated by their survival instinct [i.e. their deeply rooted instinct of sexual selection], which renders them highly reactive and receptive to female signs of fertility, which Schopenhauer points out as the main cause for males’ attraction to young females. The simple and fundamental scientific reason behind such attraction being that the apparent desirable signs of female fertility [i.e. perfect waist-to-hip ratio and adequate breasts for feeding and raising offsprings] are mostly found in young females; although in the modern world, with widespread education about nutrition science, eating patterns, intermittent fasting and fitness, in some societies, for e.g. France, older females are preserving their signs of fertility longer. Fertility after the age of 40 has been rising steadily since 1980 in France.

Graphique: Taux de fécondité par âge à 40 ans ou plus de 1920 à 2020 / Source: INSEE

Le graphique présente les taux d’obésité (IMC>30kg.m-2). La moyenne des pays de l’OCDE est de 19,5% d’obèses. Les Etats-Unis, le Mexique, la Nouvelle Zélande et la Hongrie sont les pays les plus touchés avec respectivement 38,2, 32, 4, 30,7 et 30% d’obèses. Le Japon, la Corée, l’Italie et la Suisse sont les pays les moins touchés avec 3,7, 5,3, 9,8 et 10,3% d’obèses. La France est à 15,3% de taux d’obésité (donnée OCDE basée sur du déclaratif légèrement inférieure aux résultats d’ESTEBAN, basé sur des mesures) / Source: Centre de recherche et d’information nutritionnelles (Cerin)

This inherited “Will to Live” or survival instinct in homo sapiens is also one of the reasons why human beings have an instinctive attraction to beauty, since beauty has a biological basis. Human beings are attracted to the averageness and symmetry of faces, and by the harmony of the body because those signs are linked to good health and internal condition. A study carried out in 1994 by biologist Randy Thornhill supported the hypothesis that human beings prefer averageness and symmetry in faces (Grammer and Thornhill, 1994). Thornhill explained that this attraction and the selective criteria biased towards physical beauty has been observed and is also common among animal species; it is now known that symmetry is linked to better performances in terms of reproduction, survival and resistance to disease – we can now conclude that there is a similar pattern among homo sapiens, i.e. human beings.

As opposed to many common opinions, scientifically we find that beauty is not subjective at all because those criteria for sexual selection are similar across all human cultures., i.e. waist-to-hip ratio, averageness and symmetry of faces, and the harmony of the body.

Hence, Schopenhauer’s argument leads to the position that “love”, on the surface as experienced from the individual perspective of human beings, may seem like a romantic ideal, but this illusion is simply the elaborate spectacle used by the “Will to Live” to manipulate our species towards its survival by favouring mating – in order to replicate the lifeform that contains the will. This comes to echo Spinoza’s thought when he said: “Men are mistaken in thinking themselves free; their opinion is made up of consciousness of their own actions, and ignorance of the causes by which they are determined.”

« Les hommes se trompent quand ils se croient libres ; cette opinion consiste en cela seul qu’ils sont conscients de leurs actions et ignorants des causes par lesquelles ils sont déterminés. » – Spinoza / Traduction (EN): “Men are mistaken in thinking themselves free; their opinion is made up of consciousness of their own actions, and ignorance of the causes by which they are determined” – Spinoza

It is very important to not apply those criteria for sexual selection blindly [as we would for animals], to every single individual because human beings with good reflective self-function [i.e. the ability to reflect on conscious and unconscious psychological states, and conflicting beliefs and desires] have the ability to rise above their basic biological instincts and change their internal working models, and consequently their behaviour. However, it would also not be perceptive or realistic to completely ignore the presence of this powerful biological force in homo sapiens, because no matter how much human beings manage to detach themselves from it (i.e. the biologial will to live, or survival instinct), it is embedded through thousands of years of evolution in the biological depths of the human mind and operates most of the time at an unconscious level.

Sigmund Freud’s founding psychoanalytic concept states that intra-psychic conflict within the human mind is inescapable, which is a fundamental concept in psychoanalysis also taken over by the flamboyant French psychoanalyst Jacques Lacan, who also argued that desire is inextinguishable. Psychoanalysis is also founded on the fundamental concept that human beings are driven by forces beyond their own understanding and are a mystery to themselves, with a reservoir of instinctual “psychic energy” grounded in basic biological processes; the sexual form of this energy is referred to as “libido“. The case of Sigmund Freud’s patient Elisabeth von R. illustrated this well: torn on the one hand between her high morality, which dictated that she preserves the balance of her family, and on the other hand her deep erotic desire for her brother-in-law, of which she had been completely unaware of (unconscious). That unconscious conflict provoked a strong feeling of guilt in her such that she started suffering from violent physical symptoms.

Hence, the concept of the deeply embedded “Will to Live” which is accepted as the “Survival Instinct” of homo sapiens in evolutionary psychology, is also echoed in psychoanalysis. The major motivational constructs of Freud’s theory of personality was derived from instincts, defined as biological forces that release mental energy. Psychoanalysis implies that conflict within the mind’s opposing forces is inevitable:

  • i.e. the wild Unconscious (known as the Id or the “Ça” in French, where the “Will to Live” or survival instinct is located) will get into conflict with the Super-Ego (the preconscious or the “Surmoi” in French, which acts as the person’s conscience and the internalization of society’s rules); and the Ego (which is the conscious part of the mind but also with a partially unconscious side) will have to mediate between those two. The Ego now becomes the servant of three masters: the Id, the Super-Ego and the External Environment [Societal Rules]. It is now not enough to reconcile what is desired with what is possible under the circumstances because now the Ego also needs to take into consideration what is socially prohibited and impermissible. Instinctual drives must still be satisfied; which is a constant, however the Ego now attempts to satisfy them in a way that is flexibly “realistic” – that is, in the person’s best interests under current conditions – but also “socially” permitted. In the case of the majority of people, these prohibitions of various kinds are often very unreasonable and inflexible, rejecting any expression of the drive with an unconditional “NO”, either because the moral structures of a particular “culture” are intrinsically rigid, atavistic or unsophisticated, or because the individual’s internalisation of these structures is simply black-and-white, without any grey area to compromise for an adequate and acceptable form of expression of the drive. Thus, the Super-Ego imposes a pattern of conduct that results in some degree of self-control through an internalised system of rewards and punishments.

Intrapsychic conflict within the human mind is inevitable because the demands of society – or “civilization” – are generally opposed to the natural instincts and drives of homo sapiens. Indeed, intrapsychic conflict is one of the fundamental and defining concepts of psychoanalysis, and conflict within the mind is at the root of personality structure, mental disorder, and most psychological phenomena [e.g. artistic expressions of various forms]. The goal of personality is to reduce the energy drive through some activity acceptable to the constraints of the Super-Ego, which represents the conscience of the individual in line with what is acceptable or what can reasonably be made acceptable to society [This has been explained in detail in the Essay, Psychoanalysis: History, Foundations, Legacy, Impact & Evolution]

A explanatory review of the philosophical concept in “The World as Will and Idea”

Arthur Schopenhauer worked out a system in which reality is known inwardly by a kind of feeling where intellect is only an instrument of the “will to live”: the biological will to live and where process rather than result is ultimate.

Schopenhauer’s pessimism lies in his very strong rejection of life. In fact, this rejection is so strong that he even had to address the question of suicide as a solution to life although he never recommended it. He fortunately rejected this “suicidal solution” to life, which reflected influences rooted in Asian philosophy, particularly Buddhism and Hinduism. That is one of the most significant aspects of his work, being the first thinker produced by Western European intellectual heritage to assimilate Asian spiritual thought and leave a lasting impact on the Western mind. His preoccupation with the evil of the world and the tragedy of life is also reflected in ancient Hindu philosophies, and his writings stimulated an interest in Asian thought and religion in Germany, which can also be seen in the work of many later German philosophers.

In “The World as Will and Idea”, Schopenhauer also considered the important question of the function of art in far more depth than any of his predecessors; he even theorised a hierarchy for the arts, grading music, poetry, architecture [etc], from most important to least important. For that reason, his work had a profound effect not only on future philosophers, but also artists, particularly poets and composers, such as the enigmatic Wagner, who felt indebted to him and sent him a letter of gratitude when he was first introduced to Schopenhauer’s work.

Tristan und Isolde (John Duncan 1912 Symbolism)

Image: Tristan et Isolde (1912) par John Duncan

It is believed that Wagner’s popular opera “Tristan und Isolde” in particular, shows Schopenhauer’s influence as a philosopher who believed that music was the highest form of art, an idea that of course, Wagner found pleasing, and so the composer began to think of himself as a prime example of Schopenhauer’s concept of a genius.

People in other fields of the arts were also influenced by Schopenhauer, including the novelist Thomas Mann. Schopenhauer’s ideas had the unique ability to influence not only philosophy but many other fields of human endeavour and expression. Within philosophy itself, Schopenhauer’s intellectual originality cannot be classified or allocated to a specific school of thoughtper se”, but his influence stimulates other philosophers towards a particular line of thought, which logically varied from one individual to another in terms of their response to Schopenhauer’s writing. The latter’s writing had a major impact on the enigmatic Friedrich Nietzsche, who was also a friend of Schopenhauer’s admirer, Richard Wagner.

Nietzsche shared the belief that life is tragic and terrible but can sometimes be transformed through art. Nietzsche was also the thinker famous, for his concept of the “Overman”. Unfortunately, Nietzsche’s writings and thought was taken out of context by his sister after his death to fit the ideologies of the Third Reich of Adolf Hitler. The “Overman” is in fact universal and not simply nationalistic as the true writings revealed after many scholars rejected the falsified and manipulated versions published by Nietzsche’s sister, Elizabeth [This was portrayed in Hedwig Schmutte’s documentary Nietzsche: Entre Génie et Démence, released in 2016].

Nietzsche’s concept of the Overman states that man is something that must be surpassed. That idea resonates strongly with Schopenhauer’s “Will to Live” (i.e. the wild survival instinct) as something that man must overcome, since those basic animalistic instincts along with other social distractions prevent man from becoming the Overman. Nietzsche’s philosophy sees the elevation to the state of the Overman as the result of one who rises above one’s lowest instincts and habits to reach a higher state of consciousness, in doing so, establishing a distinction from the mass mediocrity of the herd.

Those three names, Schopenhauer, Wagner and Nietzsche are often linked and are associated at times, through no fault of the men themselves with the controversial period of human history that saw the National Socialist regime come to power in Germany with unscientific ideologies and inhuman policies.

“The World is Will and Idea” begins with the famous line, The world is my idea when Schopenhauer says the world is his idea, he is referring to the relationship between an “object” and “the subject” [i.e. The person (subject) who perceives (or senses) the object and extracts meaning from it]. As an example, he did not mean that an apple is identical with your abstract concept of an Apple, he means that the apple as perceived by you exist only in relation to you as a person [the subject] who perceives it; its reality is only in what you perceive, it is what you perceive it to be so.

La Pomme Pourrie (Rotten Apple)- Apparence & Personalité d'purb dpurb site web

So, the world is my idea means that a whole visible world and its sum of total experience is simply “object” for a “subject”, its reality consists in the interpreted perception by a subject.

This theory of the world of idea was taken and developed from Kant’s philosophy, but the second part of Schopenhauer’s philosophy “The World as Will” is completely his own and expresses his very unique interpretation of human life. Briefly, this interpretation says that the will, i.e. “the will to liveis the strongest force in man and everything else is subordinate to it. Schopenhauer’s conception of the supreme wisdom of life lies in the ability of man to reject the irrational force in this “will to live” and escape from the tragic results of it.

The world is my idea. This truth applies to everything that lives and knows, but only man can reflect on it and bring his abstract consciousness to it. It becomes clear to him when he looks at the sun that what he knows is not a sun, but an eye that sees the sun, not a nurse but a hand that feels the earth. This truth is by no means new, it was a fundamental text of the Vedanta philosophy of the Hindus, it was also part of the reflections of the French philosopher René Descartes and finally it was also clarified by the philosopher George Berkeley – although neglected by Kant. But this view of the world as idea is one-sided and must be balanced by another one which is the impressive and awful truth that the world is my “Will”.

The world has necessary hands, the subject and the object. The object and the subject that perceives that object operate together. If one were to disappear, then the whole world would cease to exist. All objects have universal forms and either space, time and causality or the relation of cause and effect as Kant has demonstrated, they may be discovered and known apart from the objects in which they appear, as an expression of reason or the principle of sufficient reason. But what if our whole life is but a dream, or how do we distinguish between dream and reality? Kant tried to answer this question by stating that the connection of ideas, according to the law of causality, constitute the difference between them. But the long life dream in distinction from our short dreams has always had complete connection, according to the principle of sufficient reason. We are such stuff as dreams are made of and our little life is rounded with a sleep.

Life and dreams are leaves of the same book, the book we read through and the one whose leaves we turn idly to read a page here and there. Any system of philosophy that starts with the “object” has to deal with the whole world of perception, the most consistent form of these philosophies is simple materialism; which regards time and space and matter as existing absolutely. It ignores the object’s relationship to the subject (as perceived by it) in whom these ideas exist, then it takes a law of causality as its guiding principle: causality exists by understanding alone. Materialism seeks the most simple states of matter and then tries to develop all other states from it. It ascends from mere mechanism and chemistry: the chemical properties and attractions of objects. It ascends to vegetable and animal life, to sensibility and thought. But, the thoughts and knowledge reached through materialism in a long, laborious process, assumed from its starting point that there was a subject or perceived matter: eyes that side, hands that felt it and understanding that knew it.

The system of philosophy which opposes this materialism is idealism, which instead starts with the subject and then tries to derive or reach the object from the subject, but it overlooked the fact that there can be no subject without an object, like materialism this idealism begins by assuming what it is supposed to prove later.

The method of Schopenhauer’s system is different from both materialism and idealism, for it starts from neither object nor subject, it starts from the idea. The idea is the first form of consciousness and its essential form is the antithesis or opposite of subject and object. For each one of us, it is our own body that is the starting point in our perception of the world, and we consider it like all other real object, simply as an idea.

The understanding which develops ideas could never come into being if there were no simple bodily sensations from which to start. If the thinker were no more than a pure knowing subject without a body like a winged cherub that is all spirit, he would not be able to know the nature of the world. He would be like a man going around a castle getting to its façade and trying in vain to enter it, all reality would be a riddle.

But because the subject of knowledge is also an individual with a body and a bodily nature, the world becomes revealed, it is revealed in the will. Every true act of the will is a movement of the body for the action of the body is nothing but will expressed through an object. The body is the object, my body and my will are one. The double knowledge which each one has of his body out of idea and inner will becomes the key to the nature of the world. Phenomenal existence, the existence we perceive with our senses, is an idea and nothing more. Real existence or the thing in itself is the will.

die welt als wille und vorstellung

Will is a term that applies to both the highest and lowest in man’s nature, it is that which drives us to pursue the light of knowledge and it’s also that which in nature strives blindly and dumbly to survive. Both come under the common name of will, just as the first dim light of dawn in the rays of the full midday are both called sunlight.

If we consider the impulse with which water hurries to the ocean, or the way in which a magnet turns to the North Pole, or the eagerness with which electric poles seek to be united, or the way a Crystal takes form, we can recognise our own nature, for the same will describes the inner nature of everything that is in the world. The world as will is one, it knows nothing of the multiplicity of things in the outer world: the world of perception, the world of time and space. Notions like more or less, don’t exist to it, it knows nothing of quantities or qualities. For this reason, it cannot be said that there is a small part of the will in a stone or a large part of the will in a man. Relations like this between part and whole belong to the idea of space which does not apply to the will.

In reality, the will is present in its entirety and undivided in every object of nature and in every living thing. Yet in terms of its objectification, that is, its external expression, it has different grades in inorganic matter, in vegetation, in animals and in man. The lowest of these appear in the most universal forces of nature, in the form of gravity, rigidity, elasticity, electricity and the like, which are in themselves manifestations of the will, just as much as human actions are. The higher grades are seen in man where the will takes the form of individuality and consciousness. It is here that the will shows its second side. For in the human brain lies the potential of comprehending the will, so that as it is kindled by a spark it brings the whole world as idea into existence. In this manner, knowledge proceeds from the will, knowledge that is either from the senses or is rational and is destined to serve the will in its aim of expressing itself.

In all beasts and in most men, knowledge remains in subjugation to the will, yet in certain individuals, knowledge can free itself from this bondage to the will, so the subject of knowledge exists for itself as a pure mirror of the world. As a rule, knowledge remains subordinate to the will and grows on the will [so to speak] as a head on the body. In the case of the beast, the head is directed towards the Earth where the objects of its will are. But in the case of man, the head is elevated and set freely upon the body as in the Apollo Belvedere where the head of the guard stands so freely on his shoulders that it seems delivered of the body and no longer subject to it.

The Apollo Belvedere (Ancient Sculpture) - Vatican Museum - Roma

Image: Apollo Belvedere (Sculpture Ancienne), Musée du Vatican, Rome /Apollon est le dieu grec des arts, du chant, de la musique, de la beauté masculine, de la poésie et de la lumière. Il est conducteur des neuf muses. Apollon est également le dieu des purifications et de la guérison, mais peut apporter la peste par son arc ; enfin, c’est l’un des principaux dieux capables de divination, consulté, entre autres, à Delphes, où il rendait ses oracles par la Pythie de Delphes. Il a aussi été honoré par les Romains, qui l’ont adopté très rapidement sans changer son nom. Dès le ve siècle av. J.-C., ils l’adoptèrent pour ses pouvoirs guérisseurs et lui élevèrent des temples.

The transition from the individual’s knowledge of particular things to the knowledge of the idea takes place suddenly. It happens when the knowledge of the will changes someone into a pure will-less subject of knowledge, contemplating things as they are in themselves. If raised by the power of the mind, a man leaves the common way of looking at things behind and forgets both his individuality and his will, then he becomes a pure “without will”, timeless and painless subject of knowledge – this appears in the genius; because when Genius appears in a man a far larger amount of the power of knowledge comes to him than is necessary for the service of his will. This extra knowledge is free and purified from will: a clear mirror of the inner nature of the world.

All willing arises from want (desire). The satisfaction of a desire ends it, but for one wish that is satisfied, there remain 10 which are denied. No attained object of desire can give lasting satisfaction, for it is likely alms thrown to a beggar that keep him alive today so that his misery may be prolonged tomorrow. Attending to the demands of the will continually occupies and influences our consciousness. But when we are lifted out of the endless stream of willing, we can comprehend things free from their relation to our will without any personal interest or subjective opinions, and then the peace we have been seeking comes of our own accord. For we are, at least for the moment, set free from the miserable striving of the will – the wheel stands still. There is no more slavery to the will.

It is the function of the fine arts to express this freedom from the will: the different grades along the way. Matter as such cannot be an expression of the idea, but when it is expressed through a form of art like architecture (its characteristics of gravity, cohesion and hardness), the universal qualities of stone appear as a direct but low grade of the objectified or expressed will. In the building, nature reveals itself a conflict between the gravity of the building and the rigidity of the structure of the support, as in the simplest form of a column. The problem of architecture, apart from practical utility, is to make this conflict appear in a distinct way so that the building material instead of a mere heap of matter bound to the earth is raised above it, so that the roof for example is realised only by the means of the columns or arches which support it. The pleasure that comes from looking at a beautiful building lies in the fact that the viewer is set free from the knowledge which serves the will and is raised to the kind of knowledge which comes from contemplation that has no will.

Woman and Man Roman Sculpture

The highest grade of the expression of the will is found in anything that reflects human beauty in a way which reveals the idea of man. No object transports us so quickly into will-less contemplation as the most beautiful human form. We know human beauty when we see it, but true artists can express it so clearly that it surpasses even what we have seen. In the genius of a sculptor, we find a representation of what nature intended to express, so that if you were to present his statue to nature, he would say “This is what you wanted to say!”

danaide-le-baiser-par-auguste-rodin

Image: “Danaide” & “Le Baiser” par Auguste Rodin

In order to detach oneself from the “Will to live” which imposes suffering and meaningless striving, art plays a major role for Schopenhauer; the artist is not locked in a utilitarian relationship with the functional world, i.e. that of the “Will to Live”, but on the contrary, the artist will produce objects that have no functional use but that are simply beautiful. Schopenhauer defined beauty as a biological attraction for good health (i.e. the symmetry of the face, the harmony of the body, etc), and so we are still at the service of the desire imposed by the “Will” for reproduction. However, the artist will gain the ability to detach beauty from its functional goal (i.e. of reproduction): we can find the above sculptures by Auguste Rodin, “Danaide” and “Le Baiser” exquisitely beautiful, but we know that nothing concrete biologically (as desired by the “”Will”) can happen between oneself and those works since they are not living organisms. Hence, Arthur Schopenhauer noted that the artist does not participate in this tragic comedy of existence which consists of reproducing life at any cost, but instead, the artist is uninterested and produces objects of beauty in a completely uninterested frame of mind.

Painting as an art has character as well as beauty and grace for its object, for it attempts to represent the will of the highest grade in the idea of humanity. This, however, can be an abstract form of the concept known as the picture attempt [as it does at times an allegorical painting] to represent something other than what is perceived.

In poetry the relationship is reversed, for here what is given directly in words is the concept that leads readers away to the object of perception, this is done through metaphors, similes, parables, allegories and the like. The aim of all poetry is the representation of man. When it is a representation of the poet himself, we have the lyric. The lyric poet reveals himself in joy or more often grief as the subject of his own will, but along with this as the sight of nature impresses him, there is the awareness of himself as the subject of pure will-less knowing, and his joy now appears as a contrast to the stress of desire: desire imposed on him by his will. Epic poetry portrays man in a more historical context in connection with significant situations in human life. Drama in the form of tragedy is not only the best of poetic art, but the most significant in terms of this system of philosophy because it is the strife of the will represented at its highest grade of objectivity, it becomes visible in human suffering that is brought about by fate or error or wickedness, in which the will lives on while people fight against and destroy one another. The tragic effect in poetry may be produced by means of a character of extraordinary evil such as Iago in Othello or Creon in Antigone or by blind fate as in the Oedipus Rex of Sophocles or by circumstance and the situation in which the character finds himself such as Hamlet. In the tragic character we can observe how the noblest of men – after a long personal conflict and inward suffering – come at last to renounce the pleasures of life and the particular goals once so keenly fought for, instead the character joyfully surrenders to life itself. It is in this sense that Hamlet renounces life for himself but askes Horatio to remain a while and to – in this harsh world – draw his breath in pain to tell Hamlet’s story and clear his name.

Shakespeare's Hamlet Tragedy

Beginning with architecture, in which gravity and rigidity reveal the lowest grade of the conflict of the will with itself and ending with tragedy where this conflict reaches its highest grade, we have considered the arts and how they represent the will and the idea, but music stands quite alone, cut off from all the other arts, since it’s not a mere copy of any idea of existence in the world.

Music is as direct an expression of the whole will as the world itself is. Nature and music are two different expressions of the same thing, and so music speaks a universal language.

Traduction(EN): “What we could not say and what we could not silence, music expresses.” -Victor Hugo (1802 – 1885)

In the deepest tones of harmony in the bass we recognise the lowest grades of the will, for bass is in harmony with the crudest matter on which all things rest and from which they originate. The higher complimental parts of music are parallel with animal life and in the melody of high voice singing we recognise the high grade of the will in the effort and intellectual life of man.

The pleasure we received from beauty, the consolation we get from art and the enthusiasm of the artist, rest on the fact that whereas existence in the world is something sorrowful and terrible, the contemplation of the world as idea is both soothing and significant. But in the case of the artist, the contemplation of beauty doesn’t quiet the will and it doesn’t provide a pathway out of life as does the resignation of the saint. The deliverance from the will only occurs when – tired of the game – one renounces life and gets a grasp on what is real.

When the will – this blind and incessant impulse of nature – becomes conscious in man, it is recognised as the will to live. Man may affirm or deny it. He affirms the will to live when – having seen it as that which has produced nature and his own life – he then adds his own desires to it. The denial of the will to live occurs when the awareness or consciousness of it means the end of desire. The phenomena of the world – what we see and perceive – no longer motivates the will, for the comprehension of the world as idea has freed the will and allowed it to be silent.

It the essential nature of the will: nowhere free and everywhere powerful – to strive endlessly towards satisfaction that it is incapable of getting. Just as in nature, gravitation is the ceaseless striving towards a mathematical centre and this striving will not stop even if the whole universe were rolled into a single ball. In the same way the solid will become a fluid, the fluid will become a gas, and the plant – restless and unsatisfied – will strive through ascending forms until it goes to seed where it finds a new starting point.

All nature is a struggle in which war is waged that is deadly to both sides. All striving is in vain, and yet it cannot be abandoned and all this is identical to what appears in us. In us, the blind striving of nature becomes the will to live, but it is self-conscious will: we are aware of it! The fate of this will is in keeping with its striving nature in the face of constant obstacles and hindrances, and anyone who will consider the character and destiny of the will to live, will be convinced that suffering is essential to all life.

“Sadeness Partie I” par Enigma / Album : MCMXC a.D. (1990)

Ad Augusta Per Angusta

Translation (EN): “Has grandiose results by narrow lanes” / Source: Le Petit Larousse 2018 / Les locutions étrangères gravées dans nos mémoires ont la magie des formules oubliées dont le charme va croissant lorsque l’alchimie des mots nous est plus mystérieuses. Elles ont l’autorité de la chose écrite. / Mot de passe des conjurés au quatrième acte d’Hernani, de Victor Hugo. On n’arrive au triomphe qu’en surmontant maintes épreuves.

From where then did Dante take the materials for his hell? From the world! And when it came to describing the delights of heaven he had an insurmountable task, for the world could offer him no proper material. The fatal assertion of the will to live has produced man’s body and the desire to preserve and perpetuate it. So the assertion of the will is really the assertion of the body. In such assertion, we find the source of all egoism and all wrongdoing, but such selfhood is really an illusion due to a false philosophy in which the individual imagines he lives to himself alone. He is really only a product of the one will to live. Just as a sailor sitting in a boat trusting to his frail barque in a stormy sea, so it is that in the world of sorrows man sits quietly, trusting to the principle of individualisation and separateness, in which he only knows things superficially or as they appear to him, but when he comes to understand that the one will to live exists in all men alike, he realises that the difference between those that inflict suffering and those that bare it is only a perceived difference that is not real.

Eugène_Delacroix La Barque de Dante (1822) d'purb dpurb site web.jpg

“La Barque de Dante” par Eugène Delacroix (1822)

In truth, the evil man is like a wild beast, who frenzied and excited, unintentionally buries its teeth in its own flesh, injuring itself as it tries to injure another. But no matter how veiled and evil man is by illusion, he still feels the sting of conscience, which creates a sense that the gulf which seems to separate him from others isn’t real.

As all hatred and wickedness rely upon egoism and as egoism rest on the assertion of the will to live, so do all goodness and virtue spring from the denial of the will to live. The will turns around and no longer asserts itself but denies its own nature instead. Man then denies his own nature as expressed in his body and no longer desires sensual gratification under any condition.

Voluntary and complete chastity is the first step in the denial of the will to live. But then the human race would die out, and with it the mind in which the world is reflected, and without a subject of knowledge, there would be no object, there would be no world. To those in whom the will to live has turned and denied itself [miserable and utterly dead inside], this world of ours with all its sun and milky ways is nothing.

These are some of the ideas and the basic themes presented in Schopenhauer’s “The world as Will and Idea”, a very lengthy work that of course includes many other ideas and elaborations of the ones we have mentioned. But the essence and main thrust of Schopenhauer’s philosophy can be found in a few basic points.

To begin with, he sees the will of man, and specifically the will to survive as the dominant force in the universe and slavery to this will is the root of all evil. Man and all other creatures are subservient to their will to live. In exercising his will, man inflicts all kinds of cruelties and evil. Schopenhauer first examined these cruelties in the world of nature, spending a lot of time on the way in which animals of one species prey on those of another. Then he moved onto man and says, “the chief source of the most serious evils which afflict man is man himself”. Whoever keeps this last fact clearly in view, sees the world as a hell which surpasses that of Dante through the fact that one man must be the devil of another. Schopenhauer uses war and various other cruelties such as industrial exploitation, bravery and social abuses to back up his claim.

Schopenhauer had no sympathy for the revolution of his time because he felt the state was justified, exactly because of the cruelty of man. It existed to make the world a little more bearable than it would otherwise be. He did not consider the state government divine, but he considered it necessary [a view he may have been willing to revise had he been alive in the 21st century with democracy falling apart and not being properly applied, leading to evil, unethical, unscrupulous and unskilled street politicians getting into positions above their understanding – forgetting that they are the servants of the people and instead believing that they should have power over the people].

Schopenhauer believed that we can take action to alleviate human suffering but that it is pointless to think that we can change the fundamental character of the world or of human life. If war was abolished for instance and if all of men’s material needs were met, they would eventually still resort to conflict – “it is their nature”. He is quick to condemn the optimism or idealism of other philosophers who disregard the ugly side of human nature, or who try to justify it as rational. To Schopenhauer these dark aspects of life were not secondary feature, they were the most significant aspects of human life in history. On this basis, he created his theory of The Blind and Striving Impulse, he called the Will. Then, he looked around and found support for his theory in the inorganic, organic and human phenomena of life.

Unquestionably, Schopenhauer held a one-sided vision of the world, but because of its one-sidedness and exaggeration it served as a counterbalance to philosophers like Hegel who focused attention on the glorious triumph of reason throughout history and he tended to dismiss evil and suffering with elaborate, evasive, phrasing. He did believe that the human mind could develop beyond what was required just to satisfy his physical and material needs; it could develop a surplus of energy over and above what was needed to fulfil its biological function. When that happened, man can use the extra energy to escape the life of desire and striving, of assertion of the ego, of conflict, none of which brings him satisfaction anyway.

Schopenhauer did offer 2 ways of escape from the slavery to the will:

(i) one was the path of contemplation, which is the way of art;

(ii) and the other was the path of asceticism, which involves renouncing the world in one’s personal desires or will (i.e. to completely get rid of the “will to live”). Man must stop willing to live, not only at the level of our species but more importantly at the individual level.

In transcending the Will through art [expressing it with insight], Schopenhauer was very specific about which art forms served what purpose, and in defining which were superior to others. Not surprisingly, the supreme poetic art is tragedy, for tragedy reveals the real character of human life expressed in dramatic form or as he said the unspeakable pain: the wail of humanity, the triumph of evil, the mocking mastery of chance and the irretrievable fall of the just and innocent.

However, art and contemplation, besides reflecting on the evil of life, can also open a door that becomes perhaps the only hopeful point in Schopenhauer’s entire book. This door is opened when man can see through the veil of Maya [illusion]. That is precisely where Schopenhauer finds much inspiration from hinduism and buddhism; in those philosophies of Asia, there is the notion that in order to attain the state of nirvana, one must extinguish the “will to live” and thus one’s irrational desire, which is simply a form of manipulation that is referred to as “Maya”. We find this idea resumed in the four noble truths of Buddhism.

Maya, being the Hindu concept for the illusionary nature of the world and life. It is Maya [i.e. the illusionary manipulation of the will to live] that causes one to see separateness and division where there is none. Schopenhauer observed that man had the intellectual capacity to develop gradually a site that penetrated this illusionary manipulation that is Maya. He raised some very important questions:

– What is the purpose of achieving such virtue?

– What happens afterwards?

To start with, the man who denies the Will treats the world as nothing, for the world is just the appearance of the will, which he denied. So it is true that when we discard our will to live, it is a scenario when the will denies itself, and when this happens our world with all its sun and Milky ways means nothing! But then what happens at death? Schopenhauer is convinced of the finality of death. “Before us”, he says “there is indeed only nothingness”. Death or the withdrawal from the world means the extinction of consciousness. In life, he reduces existence to thin thread, and at death, it is finally destroyed.

The man who denies his will to live reaches the final goal, which is to not live. This is where Schopenhauer finds strong inspiration from Asian spiritual philosophy, more precisely in Buddhism, which is to say that when one renounces the “Will to Live”, life becomes much more enjoyable and serene. This is a powerful remedy since it allows us to put all our suffering into perspective when we are at our worst [for e.g. in deception in love matters when one realises the feelings are simply the manipulation from the will]. However, like all great remedy, extreme abuse can have a negative effect since we can overdose on them, which would lead us to completely shut down our “Will to Live”, and that can lead to suicide because human experience and life itself would lose all meaning and taste: no desire and no motivation. A clinical investigation among community-dwelling older adults in the US found that the will to live decreases with age, and that decrease in the “will to live” predicts depressive symptoms (Carmel, Tovel, Raveis and O’Rourke, 2018). However, those older adults studied were not meditating from a conscious desire to extinguish their will to live, and as such developped depressive symptoms.

Image: Image: Dieu hindou, Seigneur Shiva en méditation [Shiva est le dieu de la destruction, de l’illusion et de l’ignorance. Il représente la destruction mais le but de celle-ci est la création d’un nouveau monde. Voir :History on Western Philosophy, Religious cultures, Science, Medicine & Secularisation]

Individuals who consciously extinguish their will to live after firmly acknowledging the belief that it is the source of their suffering will not feel depressed, but will instead reach a different frame of mind; and with it, a different model of perception. We find that some people sometimes known as “Gurus” in deep meditation in Asia [where Schopenhauer adopted the concepts of Hinduism and Buddhism] are often barely dressed, sitting under the trees and surrounded by nature, in a meditative trance in the posture of the hindu god, Lord Shiva. It appears that their consciousness has been elevated to a point unachievable to the majority of people who are fully under the powerful control of their “Will to Live” and conditioned to the modern civilization of industrialized capitalism, i.e. the majority of Westernized societies all over the planet nowadays. In some regions of Asia (particularly India), those enigmatic figures are treated as living legends as close to gods, where the common people even go to touch their feet and then their own heads, as an act of taking their blessing; which is different from most of the modern societies of our Westernized planet, where the complete opposite to these kinds of individuals are treated as the model of the perfect man, for e.g. billionaires on the covers of magazines.

When extreme meditation allows such spiritual individuals like we find in Asia to detach themselves from the “Will to Live”, the whole world of perception changes within the mind and every single object that structures modern life [that to most people conditioned to the modern materialistic world gained a particular meaning that was passed on to them through their parents, teachers, the media, the government or books] loses meaning to the individual who goes to the extreme and extinguishes his will to live; the way his mind experiences life changes [i.e. perception and interpretation of everything in our world]. Those kinds of people may turn into passive lifeforms as close to plants and the very atoms that constitute every single particle in the universe, completely in harmony with nature and the cosmos, since they would find no meaning in life as defined by the industrialized world; they would have no desire and no motivation unlike most people, since by extinguishing their “Will to Live”, they renounced the suffering that comes with desire, and life is made of desire which is a lack, and lack is a form of frustration and suffering. That path may partially fit the direction of Nietzsche’s “Overman” in the search for nirvana.

Reaching such extreme levels of consciousness by rejecting the “Will to Live”, detaches the mind from all external influence in interpreting the universe and life, it can also lead to seeing everything simply as atoms, which constitute the whole universe, and hence generating the feeling of being one with the cosmic reality of the universe. In the case of organic life, which includes, plants, animals and human beings, those too are simply atoms [i.e. dust from the universe] that have gathered into living cells simply because the atmospheric conditions on Earth allowed such transformation. From such perspective, human consciousness is simply the product of the brain, which is the organic matter resulting from the assimilation of atoms from the universe expressing themselves through the limited senses of the human body.

Schopenhauer does leave one last hope beyond the grim disappearance of consciousness and of the world, admitting that it is possible that ultimate reality, which he called the thing in itself may possess attributes that we do not know about and that we cannot know. That reality would not be a state of knowledge since there would not be a subject and an object [that phenomenal and illusionary relationship that is required for knowledge], but it might resemble some experience that cannot be communicated and to which mystics refer to, but only in obscure vague ways.

In the end, like all great thinkers are expected to, Arthur Schopenhauer admitted that he did not have all the answers, but he thought he had some. Ultimately, it is the questions his answers posed to others that became his most significant contribution, for the role of the philosopher and of philosophy itself is not only to solve our problems, but also to express points of views that stimulate us to further thought and consideration on human nature and the meaning of life, in that, he was incredibly successful.

Schopenhauer sur Le Style

“Style is the physiognomy of the mind. It is a more reliable key to character than the physiognomy of the body.” – Arthur Schopenhauer

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Concluding Thoughts on “The World as Will & Idea”

One of the interesting aspects of Schopenhauer’s philosophy is that it is in a fairly strong resonance with science, i.e. the theory of evolution, which is accepted among the scientific community, and it also set the groundwork for the field of evolutionary psychology. In that aspect, the philosopher was incredibly insightful and avant-garde.

Schopenhauer’s philosophical framework empowers individuals by providing a mode of thinking and perception that acts as a the tool to rise above grief & sadness from the many tribulations of life, especially love matters.

The concept behind the “World as Will and Idea” can become a very strong remedy for people depressed and weakened by love deceptions because Schopenhauer’s foundational framework clearly explains that those emotions and sentiments are simply an illusion (i.e. a manipulation) at the service of one’s survival instinct or “Will to Live”. Schopenhauer strenghens the individual by giving the individual the awareness of this manipulation of nature and hence the ability to rise above, discard and become detached from those feelings and emotions to heal their pain.

This is quite ironic, because while many personal development coaches advise us to reinforce our “Will to Live” to be better in life, the philosophy of Schopenhauer orients us towards the complete opposite, but only after developing the awareness of the consequences of renunciation that such action can lead towards personal empowerment. However, precautions must be taken to not completely extinguish our “Will to Live” since it can lead to suicide if we are not firmly aware of its implications and ready to cope with the life it imposes.

Schopenhauer does not recommend killing oneself even if he does not condemn the act in some texts – he even describes suicide as nonsense. However, he does not hide his admiration for the courage of the Hindus who go as far as to offer themselves as food to the crocodiles, or allow themselves to die of starvation voluntarily, or even throw themselves from the top of the Himalayas – as such the philosopher saw the end of life as a solution to the incessant suffering imposed by the will to live but did not openly promote or propose it as a complete solution the wider human population. It appears that those people who consciously end their lives, have extinguished their will to live after coming to terms with the fact that life is a state of various kinds of suffering and also an endlessly replicating cycle without any clear end result, i.e. living or not living has absolutely no impact on the state of things in the universe. No matter how far human civilization goes [for e.g. colonizing planets in the universe], the same cycle will be repeated endlessly without any clear end objective, i.e. human beings would replicate everything on Earth on those planets and continue to mate, reproduce and pass down the task of finding sense to life to the next generation; we would invest tremendous resources to reach other planets [e.g. developing artificial intelligence, creating sophisticated and articulate androids with human-like capabilities, developing cryogenics or some other technical solution to survive journeys that may last from 50 to 100 years or more], and once there, we would build houses, roads, restaurants, shops, an economic system, create jobs, etc.

In the case of people who become completely aware of the manipulation imposed on human experience by the “Will to Live” and make the conscious choice to extinguish it completely, the continuity of the human race or the survival of his fellow humans have absolutely no importance or meaning since life has no sense to such a being because it simply replicates for the sake of replicating itself – in the cosmic order of the universe we are nothing but atoms, or space dust.

The final and fundamental powerful point to keep is that thanks to Schopenhauer’s philosophy, we can at any moment we choose to detach ourselves from all of the most violent emotions and feelings that inhabit our thoughts simply by reminding ourselves that our “Will to Live” (i.e. survival instinct) is simply manipulating us.

A constructive critique for joie de vivre & progress

A reason to live for the human race

We can base ourself on the observation that if atoms from space dust in the universe collected on a very specific planet known as Earth where the atmospheric conditions are perfect to allow the transformation of those atoms into living cells which over thousands of years became more complex to eventually give rise to human beings, then there must be a hidden force that lead to this creation. In that sense, we can also question this creative atomic force and meditate forever about the reason behind our creation. The explanation from the Christian bible about the creation of man by The Lord God from the dust of the ground comes across as a great metaphor since all life is made from matter.

Some people may link this creative force that sparked life on our planet to the notion of divinity and the process of creating life. So, on that issue if we were to allocate reasons behind every form of creation, we can assume that the cosmic forces of the universe had a reason for creating humans and as such, those forces that may be linked to the divine creation and wanted us to live, and may have planned for us to achieve some form of task in the story of the universe. This, I believe, makes a case for the human race to value surival and continuity, even if we are unaware of any final objective or final result that our continuity will lead to. Perhaps one day, we will understand why we were created and why we are the most sophisticated lifeform on this planet, unmatched in terms of intellectual abilities by no other species known to date.

The Right to Choose a Mode of Existence

Every individual should have the right to choose how to experience life and it would be extremely arrogant to impose a particular model of living or a particular mode of existence as the ultimate way of being. If an individual chooses to restrain his “Will to Live” to the limits of extinction and wishes to experience life through his organic body in a minimalistic and spiritual way as some people in Asia do, then it is a choice as valid as any other, moreover those people are not asking anything from others and are not imposing this mode of existence of humanity; it is a matter of personal perspective and desire in line with a vision to discard what some see as an existence of suffering and desiring endlessly in the industrialised world. Whatever the reasons behind the choice of an individual to live such a minimalistic life by repressing their “Will to Live” [or survival instinct], as long as it is personal, it should be respected. Among those personal reasons, may also be the choice to not replicate life to endure various forms of suffering, and this may be a reasonable and admirable choice for individuals who unfortunately are not in the best conditions due to a range of factors, to bring a new life into this world and provide it with the best chances to prosper and live a fulfilling existence.

According to the epicurean school of thought, pleasure is the absence of suffering, and in order to stop suffering, it is a duty for individuals to question whether it is fair to create life when the conditions awaiting mean struggling through various kinds of hardship.

There is only a limited amount of living space on our planet, and the issue of population growth being mismanaged and unrestrained should be a great topic of concern for humanity to reflect on as the world begins to deal with the question of over-population which will only cause extreme mass suffering when also having to deal with the problems of climate change that will lead to many catastrophic environmental disasters in the future (e.g. limited resources to feed a dangerously growing population). For example in many poor regions on the planet, for e.g. Africa, the population growth has been steadily increasing despite the lack of resources to provide an adequate and respectable standard of living to the new born, who come to the world only to suffer due to the lack of family planning. Hence, this topic should be the concern of all respectable community leaders, and should raise the urgency for providing education about family planning.

A Sense of Concern for the Survival of Homo Sapiens

Complete detachment from our feelings and emotions once an individual extinguishes the “Will to Live” can lead to suicide, which is nonsense. Complete detachment may also lead to a mind that is stale and completely devoid of any form of reaction to any external event that is not connected to the organism that is in such a state, this would also lead to a lack of emotions, for e.g. compassion and empathy (since those are the products of the ability to feel the pain of others and react to the emotions and feelings elicited).

If an individual discarded the “Will to Live” completely, it would also mean discarding the very behaviours linked to the “Will” that are responsible for the survival of homo sapiens, which lead us to protect our fellow human beings [i.e. the evolutionary purpose of emotions and the ability to feel].

The individual who kills the “Will to live” completely would also have no sexual drives, which would also not promote the survival of the human race as there would not be motivation to mate and reproduce. In that sense, if the whole population were to choose to completely extinguish their will to live, it would lead to the extinction of homo sapiens (i.e. the human race).

Engineering our Modern World in Harmony with Nature

The evolution of our species has led to the development of its various intellectual abilities and eventually given rise to the modern world, which took homo sapiens out of the primitive lifestyle from the caves and the jungles and into settlements of the modern world with a range of facilities, for e.g. sophisticated healthcare, education, technological advancement, legal protection, literary and artistic developments, to name a few.

However, with all those developments as advantages, also came disadvantages, since human suffering is still a reality in our modern world, with inequality, greed, lack of concern, badly managed economic systems, laws that are still primitive in terms of promoting human wellbeing.

We also have corrupt governments run by mediocre politicians who lack the philosophical knowledge and values of legendary imperial leaders, but are nothing more than simple minded bureaucrats from mainly financial and legal backgrounds who seem to think of the management of a civilisation as if it was an enterprise to manage. People trained in a particular subject should stay in their field.

A strong economy provides a lot of options and helps to foster development, and hence those trained in finance should be in charge of departments for economic development to ensure that the economy is working to improve and sophisticate human existence and civilisation not the other way round [i.e. education, traning, wellbeing and human development at every level]. As for those trained in legal matters, they should manage the department of justice to ensure that the funds are being used properly and also to protect the rights of individuals at every level of society.

To place people with purely financial and legal perspectives at the head of civilisation is a sure way to a ship wreck; because that is the scenario in store when a civilisation places its destiny in the hands of people who lack the proper knowledge to understand how human beings function [i.e. what leads to wellbeing and harmony, what kind of support individuals need to prosper, what individuals feel and desire, how a human being’s mind works, and what philosophical values to implant and protect in order to defend human dignity, foster creativity, provide freedom at every level, and eradicate suffering].

Logically, living as a recluse in a meditative trance in nature or living as a citizen of the modern world is a personal choice for the individual that both comes with advantages and disadvantages. My perspective on this issue will also come with a frame of mind as an individual who is a pure product of  Western European intellectual heritage, and also someone born and raised in the the modern Westernised world. In that sense, throughout history, all thinkers have had to side with an argument. In the end, as we know from the history of civilisation, we have to take a stance and believe in something, because whether we choose not to have any opinions, or we choose to spectate quietly, we are going to be judged. As educated human beings of the post 20th century, we have to find the balance and extract meaning from the lessons history has taught us. We have to synthesise the advantages of a life in nature and the advantages of a life in the modern technological world.

We need to find a sense of harmony in the modern world with nature and continue to push for the design of a civilisation that respects:

(i) the environment;

(ii) the liberties of the individual;

(iii) the promotion of a greener lifestyle;

(iv) the scientific discoveries about the creative force of the human brain;

(v) the philosophy of individual growth;

(vi) the dignity of working men and women;

(vii) the right to rise in a meritocratic system of values;

(viii) the belief in an economic system that is organized so that everyone has a chance to prosper;

(ix) the right to decent education at every level for everyone at every stage of life;

(x) the free access to high quality health care and guidance for everyone; and

(x) the fact that there is no eternal essence since evolution means that everything is locked in a constant process of change; however, we have the power to steer this change in the direction that leads to a civilisation that embraces those elements for a harmonious human experience for mankind.

Only after engineering our modern world to be in harmony with nature, i.e. both the environment and the psychology of human beings, that life will become a noble and pleasant experience – only the absence of suffering brings pleasure, happiness and prosperity, as the Epicurean school of thought posits.

Thus, Lucretius, the Roman thinker’s main philosophical thrust would definitely be a great doctrine for human beings to read, reflect on and adopt if we are to steer civilisation on the right track and live a harmonious life without suffering while embracing the advantages and possibilities of the multi-dimensional senses that nature has equipped mankind with, i.e. the ability to experience existence through an incredible brain.

Mental Conditioning: Justified Desire & Rational Emotions as Restraints to a Healthy Will to Live

The powerful aspect of Schopenhauer’s concept is that it operates similarly to our very own “Organismic Theory of Psychological Construction” as it does not aim to simplify human life or experience, but it acts as a strong guiding compass that allows individuals to shift their perception at any moment to find clarity, order & stability when they may be faced with a clouded mind due to stress or a lack of mental clarity caused by the many obstacles of human life.

Both concepts provide strong intellectual frameworks or skeletons as foundations to explain human experience, and although those foundations may come across as mechanical, they are also dynamic and provide a precise objective model to understand the way organisms function. Those models also do not claim to be permanent modes of perception that individuals should be locked in all the time, but rather act as a perceptive filter and guiding restraint based on logical reasoning that will be used to shape human consciousness through practice; once firmly embedded in the conscious mind, all human emotions can be released, since they would be synchronized with reason and logic, and simply be a layer superposed over, in order to be able to experience life with human emotions since they motivate us and also allow us to feel.

So, those philosophical frameworks allow all the layers that sophisticate, deepen, add symbolic meaning and bring artistic complexity to be superposed, constructed and developed on them; in that sense they are mechanical, but also dynamic since they do not discard an organic reality.

In the attempt to generate an imagery in the reader’s mind, I will use the metaphor of a tsunami causing a massive displacement of water rushing towards an area. If that area had a well designed barrier to receive the full blow of the torrent of water with a perfectly designed system of tunnels that would cause the force of the torrent to be broken down by evenly splitting the water through an articulate system of canals, there would be no catastrophic damage, and the water could even be used for a range of purposes. The powerful torrent of water is meant to represent the survival instinct, or the “Will to live”; and the well designed system to channel that torrent is meant to represent a trained “consciousness”. Similarly to this metaphor, Freud used a wilful horse to describe the force of the unconscious Id, and explained that the human consciousness [which in his theory is represented by the Ego] should act as a rider in order to channel all of the horse’s force into a desired outcome or direction.

That is exactly what it means to shape one’s consciousness. In order to orient oneself in life and make the right decisions, it is important to calculate and think with a clear mind oriented with reason. Every individual does not have the same objectives in life [i.e. in terms of career goals, philosophical values about a range aspects in life, vision of success, tastes in various personal matters, etc], and as such, every individual should be able to use pure reason to situate themselves in life and know what their objectives are and what they need to do to attain those objectives [e.g. the short-term objectives and the long-term objectives]. Such reflection is best done with a rational mind that is not clouded by irrational emotions; however emotional feelings cannot be permanently discarded because they serve the purpose of motivating human beings in various situations in life and play a significant role in the enjoyment and jouissance of existence itself.

Emotions paint a picture of both our inner world and the external world, telling us where to look, what to remember and what to forget, what to think about, and what our next step should be – this is backed up by science. The choices we make as individuals are influenced by our emotional feelings, for e.g. we watch particular types of films or read particular types of books that elavate us, empower us, enlighten us, make us smile, laugh or cry. In other social situations, we tend to avoid people who elicit a sense of disgust, anger or fear in us. At a physiological level, our bodily feelings indicate us that our stomach is full when we eat. Until this day, the human mind’s depth and complexity has not allowed psychologists to precisely figure out the exact number of the types of emotions that human beings feel.

Scientists have always had problems with emotions and trouble on agreeing what it really means; most of them assume that emotions involve other things than simply feelings [e.g. bodily reactions, like when a person’s heart is racing from a feeling of excitement; or expressive movements such as facial expressions and sounds; or behaviours like yelling at someone when we are angry]. Despite the fact that there are many types of emotions, feelings are usually seen as the most important; as such scientists studying emotions measure them as much as their metholodologies allow by asking participants in their study how they are “feeling”. In an investigation published in 2017, to study the number of emotional feelings human beings experience, 300,000 self-reported emotional responses elicited by 2,185 emotional videos were collected. Mathematical modelling was then used to find out about the different emotions captured in those responses; this lead to the patterns of emotions being found corresponding to at least 25 different categories of emotions where many of them can be mixed together (Cowen and Keltner, 2017). Those 25 categories of emotions are:

  • admiration, adoration, appreciation of beauty, amusement, anger, anxiety, awe, awkwardness, boredom, calmness, confusion, craving, disgust, empathic pain, entrancement, excitement, fear, horror, interest, joy, nostalgia, relief, sadness, satisfaction, and surprise.

     

As such, it was found that the emotions people reported experiencing are much more complex than scientists had theorised. Hence, in order to achieve this state of equilibrium between reason and emotions and embed that particular state into one’s consciousness, every individual may resort to different methods depending on their uniqueness. Some may achieve it instantly, others may need to resort to meditation and practice, and others may use whatever techniques from coaches or psychologists. This is a matter of individual differences that best suits a particular type of person. However, once this stage is perfected, that individual can then shift his/her mode of thought from the focused, disciplined, meditative and reasoned state to a relaxed state of being. It is a scientific fact nowadays, through the field of Neuroscience that new experiences shape the nervous system, a phenomenon known as “neuroplasticity”, and the more we practice a particular task, the better the brain gets at performing it – as the well known saying goes “Practice makes perfect” [See the essay, Biopsychology: How our Neurons work].

This is where we can refer to the act of extinguishing the “Will to live” temporarily to find clarity as the extreme meditators do. When an individual is in this state, the mind is detached from all external influence, emotions, and gains a sense of freedom to interpret everything the external world and life itself. This exercise resonates with Descartess words, when he said: “In order to seek truth, it is necessary once in the course of our life to doubt, as far as possible of all things.”

« Pour examiner la vérité il est besoin, une fois dans sa vie, de mettre toutes choses en doute autant qu’il se peut. » // Traduction[EN]: “In order to seek truth, it is necessary once in the course of our life to doubt, as far as possible, of all things.” – Descartes

This state of serenity can be reached from meditation, and when in that frame of mind, it becomes easier to think and reason rationally and logically, with a clearer perspective of everything in one’s life about topics of concern and solutions required. However, an individual should ensure that the “Will to live” is not extinguished permanently and that a return to a normal state of conciousness is possible. Logically, most normal individuals in the modern world do not remain in a meditative state 24 hours a day and 7 days a week.

Meditation can be likened to a form of temple (metaphorically) that one enters to find clarity and to think rationally and logically about a problem in the search for solutions. Once the solutions are obtained, one can leave the temple and get back to normal life with a new mode of thinking and perceiving obtained from the “temple” when one was in a state of calmness and oriented purely by reason in the search for clarity and solutions. Now that the solution is in hand, or rather in mind and rationally implanted in one’s consciousness, one can relax, allow the brain to return to its natural state, and allow emotions to compliment that state of clarity and knowledge about one’s path towards the desired objective.

The main objective here is to point out that reason should lead but emotions should follow, those two major qualities of the human condition must be synchronized with each other, i.e. the head and the heart must work together, but the mind must lead and the heart must follow.

Most human beings tend to act on emotions and instincts without questioning their behaviour. However, a human who becomes conscious of life and his/her objectives by reaching an elevated sense of awareness gains the ability to synchronise emotions with reason. It is not a stage easily achievable for every single person, and it is also dependent on talent, individual differences in the ability to reflect, and also personal dedication and will power.

However, when this state of higher consciousness is reached and it becomes a skill that is perfectly managed and firmly embedded, it manifests itself as a reflex (almost normally and unconsciously and goes as far as to shape one’s dreams); life becomes much more stable; through the mental clarity achieved, the individual gains the power to experience life with justified desire and rational emotions; and those restrain the force of the “Will to Live” in the direction that is beneficial to the individual and the human race; to use Freud’s metaphor, the rider (consciousness) learns to master the force of the horse (the Will to Live).

Our Conversion: a Lucretian guide to “l’Art de Vivre”

Lucretius, the great Roman thinker, proposes a conversion for a better life, that is, a renunciation of our old life which brought us only mediocrity, stress and pain.

After an enlightened understanding of life brought about by his reflections, Lucretius the Roman philosopher asks us to abandon this old life forever and to start a conversion by motivating ourselves for our new life, built on an enlightened perspective: an initiation based on an existential wisdom, edifying, practical and really practicable – we just need to want it!

In a 2021 conversation with Pierre Coutelle at Mollat Editions about his book, “La conversion: vivre selon Lucrèce”, the French philosopher Michel Onfray explains precisely the major foundations of Lucretius’ thought.

Roman philosophers discuss suffering and old age, wealth and frugality, love and friendship, women and pleasure, life and death concretely and openly to give the ability to truly live one’s life and not merely think about it.

Onfray says that Lucretius saved his life, and he would like to pass on this philosophical knowledge with his book to people, with the thought that it could be useful to people who are in pain; who are suffering ; who are facing friendship or love pains or wounds inflicted by friends who are not friendly; who are anxious about the passing of time, the money they don’t have, the money they don’t have anymore or the money they have in excess; who are questioning themselves about honours or happiness, etc.

With Lucretius we find answers to all these existential questions and with concrete epicurean solutions – we just need to want it!

Philosophy changes your perception, and therefore your mind, and preserves your health

Cohen et al (1998) identified two types of stresses associated with increased health impairment:

(i) Interpersonal problems with family and friends
(ii) Enduring problems associated with work

While many other studies have revealed the dangers of stress, Marucha, Kiecolt-Glaser and Favagehi (1998) found that healing was prolonged in experimental subjects (dental students) in the period leading up to their exams, and conversely, faster healing was observed during holidays (when stress was at a minimum).

Research by Janice Kiecolt and colleagues (1995) also found that wound healing was prolonged in people exposed to continuous stress, but at the same time these people also had lower levels of cytokines, which are essential for maintaining a functioning immune system, and stress is known to cause an increased secretion of cortisol, a hormone that may stop cytokine production (Kiecolt-Glaser et al., 2002). However, cortisol is crucial for increasing access to energy during stressful experiences and is released daily through two well-defined components: the Cortisol Awakening Rise and diurnal levels that gradually decrease throughout the day. It has also been found that high levels of stress can lead to lower cortisol production in the morning (O’Connor et al., 2009b).

An individual going through a series of severely stressful events would have an increased risk of developing an infectious disease, regardless of age, gender, education, allergic status and/or body mass index (Cohen, 2005). The conclusion that experiencing stress is a reaction to stress triggers in the environment has led researchers to study stress triggers in our daily lives in order to work out ways to improve the environment and eliminate them.

Scientific research has shown that subjective apprehension (our reasoning to justify our choices and actions) of a situation in a positive or negative way plays a major role in the detrimental effects of stress on physical health (Lazarus & Folkman, 1984, p.19); we explained this in the essay “Design, Selection & Stress in Occupational & Organisational Psychology” – calm your fears and stay positive!

One can really live by Lucretius’ philosophy, we just have to want it!

This sentence can change life, as philosophy changes life, and Lucretius’ philosophy can change the life of those who read and understand it, because philosophy changes our perception, and therefore our mind, by providing us with a more harmonious and positive perspective for “apprehending” life and the world around us.

An intellectual material available to everyone for everyday life

Lucretius’ thought aims at solving problems quickly and logically in a few arguments, and in this sense it is truly pragmatic and rooted in the Roman intellectual tradition.

Roman philosophers are interesting because it is possible to live a lifetime according to their principles. As Onfray describes it, it’s an eminently concrete, pragmatic and poetic philosophy; if the arguments are useless then they are rejected; as for the arguments that really bring about a concrete change in life, they must serve in a really effective way.

The Romans were inspired by the Greek arts, but were also disinterested in the thinking of many Greek intellectuals. Roman thinkers didn’t see philosophy as a practice of complicating life with big superficial visions and rhetoric and then running away from life and favouring ideas as many Greek thinkers did; all this complicating didn’t lead to anything concrete and so the Romans thought it was a Greek tradition and they weren’t interested.

Lucretius was a great Roman thinker inspired and influenced by Epicurean philosophy. Despite the fact that Epicureanism originated in Greece, Lucretius retains a truly Roman intellectual trait and did not simply restate Epicurus’ thought in verse as many have often claimed.

For every problem there is a solution; for every suffering there is also a jouissance

Only the one who cannot think will be afraid of death, of the future, of lack of money (if he is poor), of losing his money (if he has too much). If man is able to use his mind to think, then it is possible to address all these questions about suffering, pain, death, honours, wealth, and so on. The philosophical thought of the Epicureans, undoes all these fictions, and allows us to understand that for every problem there is a solution; for every suffering there is also a jouissance (a form of joy); whenever there is a reason to be unhappy, there is a reason to be happy.

These are really simple logical schemas, but with extraordinary power and depth! To live serenely, we simply have to be where we are in life, to live in the present moment and not to destroy this present with what no longer exists or does not exist (e.g. sorrows, pains, arguments from the past, transient feelings based on anger, etc.).

Michel Onfray said it clearly when he explained that if the pain is there and it is so terrible that it embarks you, then you have to go. But if the pain doesn’t take you away, it means that the situation is not serious and you just need to learn to breathe and stay calm – simple yet extraordinary philosophical recipes for keeping your composure!

Pleasure is the absence of suffering

Cicero, who was a Stoic, criticized the Epicureans and argued that the only thing they were interested in was pleasure, which for him was enjoyment, which he judged to be a crude goal that gave rise to all sorts of obscenities.

Obviously, Epicureanism is a hedonistic thought where the triumph of pleasure is sought. Julius Caesar was an Epicurean, but the pleasure was far from the crudeness that Cicero described. Pleasure among the followers of Epicurean thought is not an obsession with unbounded and total enjoyment; it would be a grotesque caricature of Epicureanism to imagine grand scenes with stuffed sows, generalized orgies and other coarsenesses, explains Onfray.

The pleasure of the Epicureans is above all the absence of suffering. If you don’t suffer then you are happy: when you are thirsty, you drink to quench your thirst, and when you are hungry, you eat bread to quench your hunger. So these images are far from the scenes with stuffed sow’s teats, which was a crude caricature of Epicureanism by the Stoic opponents.

Simply calm your fears!

« Je sais qui est Lucrèce ! Je vais le mobiliser dans ma vie ! Je vais le mobiliser parce que je suis dans une situation où il me faut régler des problèmes. » said Onfray.

[French for: “I know who Lucretius is! I will mobilise him in my life! I will mobilise him because I am in a situation where I have to solve problems”]

With the thought of Lucretius one can approach and solve all the questions about the problems of every day and of everyone: friendship, death, suffering, pain, honours, wealth, and many other questions of existence and of daily life.

Lucretius’ thought is based on the Epicurean school of thought:
If death is here, you are no longer here, but if you are here, then death is not here!

So, it suggests that in order to live without spoiling your life on a daily basis, you should stop focusing on anxious events that are not yet present!

This is a simple thought, but with a profound effectiveness that can be adopted by all humanity! If we inhabit our present fully, we will not destroy it with nostalgia for the pains of the past, nor with a depressing and negative future when this present is calm and harmonious.

A man who tells himself that it was really good in the past, in his youth when he was handsome and slim, will ruin his life; in the same way if he tells himself that his advanced age means that death is near, while complaining of being tired, carried by the thought that he does not have much time to live.

Epicurean philosophy explains that a person destroys the moment by nostalgia for what was, or by a future that anguishes him: this is the recipe for unhappiness. For the Epicureans, to live harmoniously and not to be depressed and unhappy, one must live in the present moment!

Are you going to die? It’s true, this applies to you, me and every human being. But is death for now? No ? So why talk about it and think about it? Michel Onfray explains it very well: death will come one day, we can wait for it serenely, and when it comes, it will only be a bad quarter of an hour to spend. We simply have to calm our fears!

Onfray asks the question: “What do you want? A legion d’honneur?”

We can deconstruct this desire by thinking that it is simply a piece of cloth, and that many noble people have not received it, which illuminates us with the understanding that it is not proof of a person’s greatness or nobility; especially since nowadays it is the politicians in charge who decide who to give the Legion of Honour to; politicians who rarely have unbiased opinions. There are many noble people who have refused the Legion d’honneur, such as the economist Thomas Piketty who even said: « Je refuse cette nomination, car je ne pense pas que ce soit le rôle d’un gouvernement de décider qui est honorable » [French for: “I refuse this nomination, because I don’t think it is the role of a government to decide who is honourable”].

Image: Les politiciens européens faisant preuve d’agressivité / European politicians in a display of aggression

Do you want to be President perhaps? Again, Onfray notes that there is not only happiness in this pursuit since it means having lots of stress, and trouble and having to make decisions about everything constantly, while knowing that the whole world will be scrutinizing your every move. And by being in charge of the administration, you will be surrounded by liars and hypocrites; you will also lose many of your friends while not being completely free of your emotions and to express yourself, or to indulge in the everyday pleasures of life – you will be forced to wear a social mask and take part in a bureaucratic theatrical sham that the whole world is aware of in the 21st century. Epicurean thinking undoes all these fictions that make you unhappy.

In citing the above examples, the point is not to discourage anyone from desiring a Legion d’honneur or to dissuade from wanting to reach the head of state, but it is simply to argue that if the conditions are against these goals, it should not stunt you since life is layered and there will always be reasons to be happy, to live fully, to have an exciting existence and to remain serene while keeping your inner greatness and your honour intact.

Lucretius thought tells us that wisdom can be achieved, and that it consists of an arithmetic of pleasures with a dietetics of desireswe have to give the body what it desires but we also need to make sure that we stay within a limit so that the body does not become a slave to what we give it.

The idea is truer than reality

Onfray reminds us that the history of philosophy is made up of opposition between idealists and materialists. In the end, it is the idealists who have come to dominate the world of thought since Christianity is a form of idealism – Friedrich Nietzsche said that Christianity is Platonism for the poor.

Idealism is based on the argument that the idea is more true than reality. What we perceive as reality is in fact an illusion. This thought is also supported by Jacques Lacan, who explains that the real is not reality, because reality for the individual is what has a symbolic value.

What we see in the real, in all its banality, is not reality since the ideal world does not need it to exist, nor does the individual since he does not attach any importance to it – it is a part that is almost invisible to the eyes and especially to the mind.

These concepts, in the time of Cicero and Lucretius, made the philosophers did politics in spite of themselves. Politicians were also involved in philosophy, since to be a Stoic or an Epicurean is to have a certain belief in the structural values of a world and of the individual, and therefore, these are political issues. Onfray skilfully and ironically invites us to try to imagine the climate of political mediocrity in the 21st century with presidential candidates who would have been Sartreans, Camusians, Aronians, etc.

Moreover, towards the end of his writings, Lucretius explained the beginning of the end of his era; he could clearly see that the republican Rome in which he lived had nothing of the great imperial Rome of before. Onfray finds the present situation in the 21st century comparable to that precise historical epoch described by Lucretius, who sensed the decomposition of the republican Roman state and saw this as the herald of a new form of civilisation, which is the one of our generation today; he predicted that our civilisation too would disappear in its turn to give birth to something else.

An aesthetic of existence: a dynamic world that allows for self-sculpting

In contrast to Epicurean thought, the philosopher Plato’s vision of a republic was not truly egalitarian and just, because the Platonic republic was based on an almost unmovable hierarchy. In Plato’s republic, we have a social structure that places the philosopher at the top of the pyramid, then at the base we have those who work, and in between these two categories we have the military to enforce the law and act as a barrier to prevent individuals from the working classes from having the desire to be people of power.

A true republic must be the result of a vision of justice, but this Platonic republic is not truly just, since it prevents and discourages a section of its population from risingan idea contrary to the science, psychology and enlightenment heritage of Descartes and Voltaire. In this Platonic republic, we find the aristocrats (who nowadays might represent the very wealthy) who after esoteric classes among themselves get the opportunity to maintain or take power in order to keep this terrible hierarchy going.

But in Epicurean philosophy, we have what is called the garden of Epicurus. And since Epicureans believe that one must live to resemble gods who know ataraxy (the absence of suffering), Onfray extrapolates to point out that this presupposes that in Epicureanism, men live as friends; and observes that if Lucretius had completed his writings, there would most likely be a greater consideration of friendship between men than in the texts that influenced him, i.e. Epicurus himself.

Onfray argues that there is an idea in Epicureanism about friendship that tells us that on earth we can build an ideal communitya kind of republic in Epicurus’ garden that would be truly egalitarian and just, and that would contrast with the injustice in Plato’s republic. Unlike Plato, among the Epicureans there is room for everyone: men, women, young, old, poor and also those who are not poor. In this sense, this human composition is astonishing since it really aims at making a civilisation work while synchronizing in a spirit of fraternity and mutual aid all its members.

The modern society closest to those ideals of the Epicurean garden republic or “république du jardin” (as Onfray phrased it) is the French civilisation. It was the French revolution, which had been heavily influenced by the ideas of the intellectuals of the Enlightenment [i.e. the 18th century intellectual movement of reason], that would secularise a number of concepts inspired by Christianity into the constitution, most notably the famous « Liberté, égalité, fraternité » [Translation / French for: “Liberty, equality, fraternity”], which is inspired from the free will of Christians. Equality [Égalité] is derived from the belief in equality before God, and brotherhood [Fraternité] is derived from the concept of the community of the ecclesia. Liberté [Freedom], of course, most people know what this means, which is the freedom to explore, to choose, to discover, to learn, to express ourself, to speak, to have open debates, to question, to propose, to love, to create, to live life fully within the limits of reason and respect for the mother psychosocial sphere. The new generation of French people secularised and embedded those values with the firm belief that “we have a universal world view; we want everyone to share our values – liberté, égalité, fraternité!“.

In this vision of the Epicurean republic, which could be called a “garden republic”, there is an idea that echoes the organic theory of psychological construction that we have developed; a belief in line with modern psychological science in the capacity of the human organism (the individual) to educate itself, to cultivate and sculpt its mind, to deepen its discourse, and to elevate itself through its own intellectual efforts; and so there is a belief in the nobility of meritocracya meritocratic hierarchy based on effort, talent and merit, and open to all!

In the Epicurean garden, we have this idea that it is never too late or too early to philosophise: you can philosophise if you are young, or if you are very old! If some of you think that at 80 years old it might be too late to philosophise, Epicurean thinking will prove you wrong! The time is always right – better late than never.

The very young, children, as soon as they have the capacity to think, can start philosophising. Of course, it would be unreasonable to impose on a three-year-old the knowledge and full understanding of the logical reasoning of the thoughts of Lacan, Nietzsche, Darwin, Schopenhauer, Voltaire, Kant, Camus, Descartes, Freud and Rousseau. But we can start to implant the ability to reason and question from a very young age; to teach them to think about the world, to think about their place in the world, to question life and the structures of civilisation to develop a critical sense and also a sophisticated reasoning that will allow them to have solid opinions; this is what I call creativity, and this foundation will develop and serve them in all fields for a lifetime and maybe even their children if the transmission is done.

Time is limited: put excellence into every moment and don’t waste the second

In a logic and line of thought similar to ours, Onfray very perceptively suggests that an individual must understand that the moment we live is not eternal. Therefore, to live as if we have an infinite number of moments is not reasonable, since our time on earth among humans is counted. Just as in the womb there is a limited number of eggs and at a certain age the ability to give life stops – for some this is not even possible from birth, for some it stops early, for others late, for some with much pain, for others peacefully.

But Epicureanism opens the eyes of those who encounter it, and asks the individual not to waste the second, not to waste the moment, not to waste the day; if we do not use our time productively to live, we lose it forever since time is counted and will not return.

In the 2021 interview with Pierre Coutelle, Michel Onfray uses everyday scenes from life in the modern world to emphasise the importance of not wasting time, explaining that many people simply think that their lives will magically turn out okay; those ordinary people who are in the industrialised routine of the five-day week (i.e. wake up every morning, look at the time, shower, coffee, get the kids ready for school, train, office, work, anecdotes from the kids who find school unbearable, trouble at the office, coffee breaks for a quick bite to eat, and then the same recipe on Tuesday, Wednesday, Thursday, Friday) As for the weekend, everyone is exhausted, so on Sunday these people stay in slippers or trainers, they don’t shave, they don’t wash, they’re not clean or fresh, they smell bad, they watch TV, they flick from one channel to another, and then, on Monday, it all starts again!

In the face of all this, Onfray’s observations invite civilisation to ask itself the following questions:

« Est-ce que c’est ça la vie ? »

Traduction[EN]: “Is this what life is all about?”

« Est-ce que c’est ça que nous voulons comme vie ? »

Traduction[EN]: “Is this what we want as life?”

« Est-ce que nous pouvons nous s’asseoir paisiblement en pensant qu’a un moment donné tout cela va changer magiquement et le bonheur apparaitra ? »

Traduction[EN]: “Can we sit back and think that at some point all this will magically change and happiness will appear?”

« Ne serait-il pas convenable de prendre les choses en main toute de suite sans perdre de temps pour changer notre existence de tel sorte qu’on ne vive pas cette vie raté et nulle ? »

Traduction[EN]: “Wouldn’t it be nice to take matters into our own hands right now without wasting time to change our existence so that we don’t live this failed and lousy life?”

The Epicurean thought that inspired the writings of Lucretius asks us to put excellence in every moment and not to bear mediocrity, every moment lost is definitely lost! This may not be a great revolution for those who are self-aware, civilised and have cultivated the art of critical thinking, but these questions simply push us towards answers that ask us to live each moment as if we could see it reappear infinitely.

If you are still reading this essay and have felt and understood the arguments, then asking yourself the other three questions would be constructive:

« Est-ce qu’on va encore démarrer sa semaine de la même manière ? »

Traduction[EN]: “Are we going to start our week the same way again?”

Crédits : Philippe Lopez – AFP

That is, for example:
– Going to work knowing that we live with people we don’t love, and who don’t love us?
– Knowing that the relationship with the people you work with or with your children is not serene and healthy?

« Est-ce qu’on a envie que ça continue ainsi et que ça se répète sans cesse ? »

Traduction[EN]: “Do we want it to continue like this and repeat itself over and over again?”

« Pouvez-vous vous mettre à la place d’un autre être humain ? »

Traduction[EN]: “Can you put yourself in the place of another human being?”

« Pensez-vous qu’un autre être humain puisse éprouver des émotions ? »
[Par exemple, des émotions telles que la confusion, le dégoût, la colère, l’horreur, la honte, la tristesse, la faiblesse, l’anxiété, la solitude, l’ennui, la douleur empathique, la nostalgie, le soulagement, la satisfaction, l’admiration, la joie, le calme, l’excitation, etc ?]

Traduction[EN]: “Do you think another human being can experience emotions?”
[For e.g., emotions such as confusion, disgust, anger, horror, shame, sadness, weakness, anxiety, loneliness, boredom, empathic pain, nostalgia, relief, satisfaction, admiration, joy, calmness, excitement, etc ?]

« Puisque l’on serait Dieu si l’on était parfait, et que l’on n’est pas Dieu. Pouvez-vous imaginer la possibilité que votre comportement ou celui d’un autre être humain puisse déclencher certaines des émotions négatives ou positives mentionnées ci-dessus chez un autre être humain ? »

Traduction[EN]: “Since one would be God if one was perfect, and one is not God. Can you imagine the possibility that your behaviour or another human beings’s behaviour could trigger some of the above negative or positive emotions in another human being?”

« Ne devrions-nous pas faire tout ce qui est nécessaire pour arranger les choses, afin que les expériences négatives et horribles n’aient plus lieu et que le reste de notre vie soit différent ? »

Traduction[EN]: “Shouldn’t we do whatever is necessary to make things right, so that negative and horrific experiences do not take place anymore and the rest of our lives are different?”

Carl Jung was incredibly accurate in saying: “Crises, upheavals and illness do not happen by chance, they serve as indicators to rectify a trajectory, explore new directions, experience another way of life.”

CITATION Jung - les crises & bouleversements (un autre chemin de vie)

« Les crises, les bouleversements et la maladie ne surgissent pas par hasard. Ils nous servent d’indicateurs pour rectifier une trajectoire, explorer de nouvelles orientations, expérimenter un autre chemin de vie. » / Traduction[EN]: “Crises, upheavals and illness do not happen by chance, they serve as indicators to rectify a trajectory, explore new directions, experience another way of life.” – Carl Jung

In 1948, from an article entitled “Ni victimes ni bourreaux” and in the chapter entitled “Le siècle de la peur” [French for, “The century of fear”], Albert Camus wrote that man lived in terror; between generalised fear of some kind of war that everyone at that time seemed to be preparing for, and the particular fear of murderous ideologies. Surprisingly, his words seem still fresh for our world today.

Camus saw man living in terror because persuasion seemed impossible, since man had been handed over entirely to history [as if history had stopped and could not be written anymore]. For Camus, man seems unable to turn to that part of himself, which is just as true as history itself, that part of himself which he finds in front of the beauty of the world and of human faces; because man lives in a world of abstraction, which is the world of offices and machines, the world of absolute ideas and messianism without nuance. Camus noted that man suffocates among people who believe that they are absolutely right, whether in their machines or in their ideas; he observed that for all us who can only live in dialogue and human friendship, that silence means the end of the world.

2022-02-05 Camus (La Peur) D'Purb dpurb site

« Entre la peur très générale d’une guerre que tout le monde prépare et la peur toute particulière des idéologies meurtrières, il est donc bien vrai que nous vivons dans la terreur. Nous vivons dans la terreur parce que la persuasion n’est plus possible, parce que l’homme a été livré tout entier à l’histoire et qu’il ne peut plus se tourner vers cette part de lui-même, aussi vraie que la part historique, et qu’il retrouve devant la beauté du monde et des visages ; parce que nous vivons dans le monde de l’abstraction, celui des bureaux et des machines, des idées absolues et du messianisme sans nuances. Nous étouffons parmi les gens qui croient absolument avoir raison, que ce soit dans leurs machines ou dans leurs idées. Et pour tous ceux qui ne peuvent vivre que dans le dialogue et dans l’amitié des hommes, ce silence est la fin du monde. » / Traduction [EN]: “Between the very general fear of a war that everyone is preparing for and the very particular fear of murderous ideologies, it is therefore true that we live in terror. We live in terror because persuasion is no longer possible, because man has been handed over entirely to history and can no longer turn to that part of himself which is as true as the historical part and which he finds again before the beauty of the world and of faces; because we live in the world of abstraction, the world of offices and machines, of absolute ideas and of messianism without nuance. We suffocate among people who believe they are absolutely right, whether in their machines or in their ideas. And for all those who can only live in dialogue and human friendship, this silence is the end of the world.” – Albert Camus

However, Camus also argued that in order to get out of that terror, one should be able to think, reflect and act on one’s reflection. But if man lives in a world of terror, it is precisely the terror that creates a climate that does not encourage or provide space for reflection. He was of the opinion that instead of blaming that terror, we should work to find a solution to it, and that there was nothing more important because it concerns the fate of a great number of human beings who are fed up of violence and lies, disappointed in their highest hopes, disgusted at the thought of inflicting suffering on their fellow men.

Learning to live a life so that you won’t regret it when death comes

Optimists see the best everywhere, pessimists see the worst everywhere. Tragic people see reality as it is, and this requires a lot of courage because reality in all its rawness is not always easy, even if what it presents is of no value to us and we are almost blind to that empty aspect of life which symbolises nothing. In spite of this, tragics do not tend to make myths or fictions – they see the real, it is not perfect, but it is so.

Lucretius is known to be a vitalist, and this line of thought tends towards the tragic since vitalists are firmly anchored in the fact that everything that is alive will eventually die. In the organic world, there is always a cycle: growth, decay and then extinction. Onfray points out that this also applies to civilisations. This is a very logical observation since the Aztec civilisation, the Egyptian empire with the pharaohs, the Roman empire, the empire of Alexander, to name a few examples, no longer exist – except in the form of fragments preserved in our museums. The conclusion is that nothing and no one can stop the disappearance of what has done its time – of what eventually becomes obsolete.

Tragedy thus reminds us that no one and almost nothing (except atoms) will last forever and that we will all eventually disappear. This notion is exactly the treasure of tragic thinking, because it makes us understand that we really have to learn to live a sublime life in every sense. We must cherish each day and lead a life that will allow us to watch death come with a smile, serenely, telling ourselves that if we had to do it again, we would do it exactly the same way without any regrets.

Image: Socrate
(470-469 av. J.-C. –
399 av. J.-C.) a en train de débattre

Reality, as Onfray reminds us, is made up of many people who, at the moment of death, regret not having done a lot of things that were important to them, not having made the right choices, not having given enough importance to this or that person in their life, not having succeeded in realising their dreams, etc. So we have to learn to live and lead a life in a way that will not leave us in pain and regret the day death decides that our journey among humans has come to an end.

“La mort de Napoléon” (1828) par Charles de Steuben. Musée Napoléon, Palais d’Arenenberg, Suisse.

Will power: do we have power over ourselves?

The Epicurean philosophers’ reflection on life is nothing more than an invitation to will power to counteract suffering.

In contrast to the Epicurean philosophers, the philosophers of fate always have something problematic; they believe that everything is already written. But if there is only fatality, what can we do with free will? Onfray also invites us to ask ourselves this question. If everything is already written, how is it that we have the possibility of choosing?

– For example, to eat a strawberry instead of a potato? To move to a city or a village? To read Balzac or Camus? To study the mind or law? To become a writer or an electrician? To write an academic book or a work of fiction? To engage in debates and learn from the great intellectuals to change the world or to chat with tramps in a bar? To criticize politics, gastronomy, sports, technology, economics, psychology, philosophy, art or business?

The question of the individual having power over his life has long been the question of Nietzsche, Spinoza, and the Stoics. The Epicureans, on the other hand, never asked this question about the power of the will over oneself. But if there really is a fatality of what happens, then what can be done with will power?

– Does will power exist?

– Does man have power over himself?

Lucretius, like us, truly believes that we have power over ourselves, that we can take matters into our own hands to change our destiny and guide it towards healthier and more harmonious horizons. All we have to do is to want it: to live each moment of life as if it were our last, to live each day as if it were our last. But abusing any good remedy can be harmful, and this is where Onfray asks us to impose a certain reasonable limit.

Living each day as if it were your last should not lead an adult to suddenly throw out his children, whom he finds untalented, personality-less, and future-less; to suddenly divorce his annoying spouse without discussion; to take all his money and spend it at the casino or betting on a horse; to suddenly quit his job while savagely insulting his tyrannical boss, whom he has always found to be rude, disrespectful, insensitive, intransigent, and depressing. If Epicurean philosophy makes you think that it is justifiable to act in this way then you have misunderstood, because if this is not your last day on earth, the next day you will find yourself in a truly miserable and possibly suicidal state.


Living each moment of life as if it were the last, and living each day as if it were the last, should inspire you to build your life discreetly, modestly, but powerfully
!

Onfray tells us that it is to willingly accept that your current life is miserable. In that sense, to acknowledge that the elements that define your life are not well organized; and therefore, to say to yourself:

« Je ne vais pas passer ma vie à vivre des choses qui ne me conviennent pas. Je n’aurais pas deux vies. »

Traduction[EN]: “I’m not going to spend my life living things that don’t suit me. I won’t have two lives.”

It’s a way of motivating yourself to build your present so that you can be happy and live in the absence of suffering – it’s a revolutionary healing thought!

Onfray believes that Lucretius’ work was left unfinished, and so there is a clear doctrine on friendship that might be found in the missing pages. There are, however, a few lines, which Onfray believes represent an idea that an individual can have a companion or a being in his life, with whom the capacity to share something serene, calm, without hatred, without war, without contempt, with gentleness and tenderness, develops. There is here the idea of love as a remedy for passion.

An invitation to a sculpture of the self: the psychological construction

Lucretius’ work echoes my own thinking in the sense that it is an encyclopedic elaboration. Lucretius left us an encyclopaedic poem, a knowledge where he painted a dynamic world. Like the logic of the organismic theory of psychological construction that we have developed, Lucretius’ perspective is quite similar since he is a dynamic atomist, not a purely mechanical and reductionist one. He starts with the atom and then explains life; we start with the individual organism and then explain everything by extrapolating a theory derived from established work in various fields, respecting a logic based on scientific observation while valuing clarity in the explanation.

Like the organismic theory of psychological design, Lucretius’ work is also an invitation to sculpt the self, in its psychological depth, in order to re-establish sound philosophical foundations that allow one to structure one’s thinking and thus modify one’s perception for a more harmonious life; it is an aesthetics of existence that aims to decorate and reshape the mind in order to promote mental equilibrium and thus keep the mind harmonious in all the dramatic situations of life.

The Romans proposed a conversion, which was also a consolation quite similar to the initiation ceremony of Freemasonry in the sense that there is the life before which one renounces, and then there is the life after which one adopts for good; it is like a new birth, and so by accepting the conversion, one is reborn – it is a rebirth.

Conversion among Roman thinkers means adopting a new life: rebirth

Among the Romans, when one has accepted one’s conversion, it is no longer the same life; among the followers of Epicurean philosophy there is no initiation ceremony as in Freemasonry, but simply the meeting with, or one could say the adoption of, a “maître” (master); a wise man who initiates us by transmitting his knowledge and reminding us the real is simply made of atoms in free fall in the void; that the real is material and does not constitute reality; that the idea is truer than reality; that this physics of the here below dispenses with a metaphysics of the world beyond; that paradise exists on earth but it must be built with determination!

As Michel Onfray also points out, when we meet this “maître” (master of thought), one fine day he enters our lives, opens the curtains (metaphorically) and everything becomes clear. In Roman antiquity it was like this, with an existential maître of truth who asks us to strip ourselves of all our old clothes (metaphorically – to describe our old life) in order to live another life from now on; a life that will allow us to be sovereign over ourselves, lord of ourselves, and in becoming so we will know truth, freedom and enjoyment.

Onfray emphasises that hedonism is this: be the master of yourself, and you will see what jubilation there is in being so! Lucretius’ Epicurean thought finally seems to wake us up by showing us what an excellent life we have the possibility to live – without pain and without horror.

Rome was founded from a collection of people of different origins, so the Romans genuinely believed in the concept of assimilation and never had any problems imagining that a foreigner could become fully Roman [As explained in detail in the essay, “Psychological Explanations of Prejudice & Discrimination and the Conceptual Philosophy of Assimilation à la Française“]. The Europe of the 21st century – at least in nations with a sophisticated breed of refined thinkers such as those of the French intellectual heritage – is a direct heir to this large-scale assimilation of the Roman tradition.

Matter: everything can be explained from the atom

Lucretius’ philosophy is atomistic and shows us that reality is simply material and consists only of atoms that fall into the void and nothing else. Epicureanism is a very subtle thought, and in Lucretius’s work we find a vitalist materialism. Onfray points out that it is not just the atom that is found in the atom, but much more; there is an arrangement of atoms.

Epicureanism is therefore not a vulgar, simplistic or reductionist mechanism. Obviously, it starts with an atom, but this atom goes on to explain the creation of civilisation, i.e. the whole world; in this sense, Lucretius’ Epicureanism is a profoundly sophisticated proposition.

This idea of the atom was already present in the work of the Greeks and Democritus. The latter had found inspiration in a very ordinary everyday scene. Democritus was in his room with the curtains closed, and through a small opening a ray of light entered, and at that moment Democritus saw a very fine cloud of dust dancing in that ray of lightan event that man does not see with the naked eye, but which is revealed by the light. These dust particles that constitute our whole world and reality as it is, represent the atoms (the term “Atomos” is used in Greek, referring to the hypothetical ultimate particles of matter, a word that meant uncut, since the atom is the smallest indivisible unit of matter).

In Lucretius’ work, everything is explained from the atom: one atom meets another atom and so on to start a chain process and eventually we see the world structured into an infinite number of universes. In this sense, it is a coherent thought, intuitive but also empirical. Onfray points out that even if we visit the works of Lamarck and Darwin, the evolutionary explanations, quantum mechanics, the theory of the multiverse and the multiverse, we can see that Lucretius’ thought cannot be disqualified, since it resonates with the whole scientific philosophy of the modern world.

When we speak of atoms, we are speaking of the making of the whole universe and of all life, and so there is a certain mystical and spiritual aspect where we might well associate the creative process which for many is connected to God, that is, the divine creation of everything from matter. How something as simple and mundane as seeing a few particles of dust in the light through the curtains in a bedroom can reveal to us this idea of the atom giving birth to the world and the universe is truly amazing; moreover, 25 centuries later, the atom and the intellectual debates about creation are still part of our reality.

Anything that has mass and take up a given amount of volume is defined as matter. As such, everything around us is made up of matter, and to go further, everything is made up of atoms. Atoms however are incredibly far from one another since they are more void than they are matter. Every atom has a nucleus  in the centre, surrounded by electrons.

To understand the relative size of the empty space that represents the void in an atom, we can imagine the nucleus [noyau in French] being the size of a peanut, and if that was the case, the entire atom would be about the size of a large football stadium. Around the edges of that stadium the electrons exist, their numbers varying by different elements. Hence, a nucleus is about 100 000 times smaller than the atom in which they are locked in, hence the atom is practically empty space.

If all the empty space was removed from every single atom in every single human being on earth (i.e. around 7.6 billion people), then compressed together, the overall volume of all the particles that make up the whole human population would be smaller than a sugar cube. This may sound ridiculous, however, it makes sense when we consider the weight of that sugar cube of human beings, because it would weight exactly the same as the sum of weight of all human beings on earth. If we assume an average weight of 45 Kg (considering children weight less and adults more) for 7.6 billion people, that small sugar cube would reach a weight of 345 billion Kg, which is the equivalent of around 1000 huge skyscrapers.

Atoms make up 100% of the universe and since 99% of the atom is empty space, we come to the conclusion that a human being is made up of nothingness. Every human being on planet Earth is made up of several millions of atoms [around 7,000,000,000,000,000,000,000,000,000 (7 octillion) per person], and every single atom is 99% empty space.

If everything is made of matter, what are the gods made of? Matter!

Onfray explains it in a simple way accessible to all, this notion in Lucretius that atoms are extremely subtle, and that there is a theory of simulacra. If you and I are on stage and there is an audience that sees us, this theory of simulacra suggests that metaphorically there is a kind of aura, a layer, or a skin that comes off of us that is made of atomic particles and that diffuses into the external environment.

If you hear me, it is because my speech passes through in the form of sound as I speak, and the act of speaking emits atoms according to this theory of simulacra: these atoms of my speech travel all over the world, and they are simulacra which penetrate into the ears and into the minds of those who listen to us; into the eyes as far as vision is concerned; at which point one develops the possibility of the art of communication.

“Tête Raphaélesque Éclatée” par Salvador Dali (1951)

To sum up Lucretius’ theory of simulacra clearly, it is simply to understand that there are simulacra everywhere, all the time! Onfray invites us to imagine that these atoms of simulacra are like waves during the use of a mobile phone; waves which are invisible to the eye but which remain very present. Simulacra operate in the same way; they are extremely tenuous atoms that travel, circulate and offer the possibility of seeing, tasting, hearing, perceiving, among many other capacities.

Since these atoms of simulacra are indeed present in the environment and proceed subtly in the effects they generate while being invisible, then the gods must be made of this kind of subtle matter. Onfray explains that we have one world, two worlds, many worlds, and this multiplicity of worlds implies that there are interworlds. The gods are present in the interworlds and are made of matter, and represent an autonomous power that is satisfied with itself; a power that knows ataraxy (which means the end of suffering).

The gods rejoice in being and enjoy the power of existence; the Epicureans ask man to resemble these gods, to know the absence of trouble – this absence of suffering is enjoyment!

So, we see that this enjoyment is not crude as Cicero’s Stoic thought conceived it.

Based on this theory of atoms, the Epicureans tell us that death is not to be feared because it is simply a disorganisation and reorganisation of matter and not its suppression; all matter that decomposes will eventually recompose itself, it is an eternal cycle and an atomic recycling of the universe.

This idea of the eternal recycling of matter (and thus of atoms) seems to suggest that there might be a kind of resurrection in atomic terms, that a dead being can have fragments of the matter of which it was composed transported into another being generations later; this is perhaps one of the many reasons for the presence of the qualities of great dead men in succeeding generations, whether in terms of personality or physical resemblance; it is something for deep atomic thinkers to ponder: the atom cannot be destroyed and is eternal, there is a limited amount of matter and on earth it follows an eternal cycle of recycling. This observation seems to echo a metaphoric interpretation of reincarnation in Hinduism, where it is believed that a living being begins a new life in a different physical form or body after biological death.

Most of the atoms on Earth have been present since the formation of the planet itself; a small amount came from outer space and through nuclear reactions. As such, human beings are just a composition of atoms that used to part of something else, we are all recycled. The atoms in our living body used to be the food, the water and the air we consume to remain alive; since our conception in the womb, food, water and air (and all tha atoms that consitute them) has been used by our organic body and transformed into what we are.

When a person dies, the atoms that made up its body is quickly recycled. If a human corpse is buried, the bacteria in the intestinal tract are starved from not being given any food, and they start devouring the corpse itself which leads to decomposition. Decomposition is also dependent on temperature, i.e. a corpse in the tropics will be reduced to a skeleton within days or weeks. If a corpse is buried in a wooden coffin, it quickly becomes food for organisms that live in the soil (e.g. worms), and the atoms that were part of that dead body quickly re-enters the food chain – those atoms become part of whatever consumed the corpse and later of whatever consumes that organism. When the bones decay, which is a slower process, the calcium and phosphorous in those bones will be incorporated in plants. Eventually, those plants will be consumed by people or animals, and those living organisms eventually die, and the cycle through the biosphere goes on over and over. If a corpse is buried in a hermetically sealed container or crypt, then the recycling process is interrupted and that body turns into a soup of rotting flesh and bones. If a corpse is embalmed, then the decomposition process is slowed down, but not halted completely. If a person dies in a very cold region, e.g. on a glacier, then the corpse may be found perfectly frozen and intact dozens or hundreds of year later. In the case where a corpse is cremated, the organic body is combusted, the soft tissues are consumed by oxygen and mostly turn into carbon dioxide: the gases are released into the atmosphere and the bones are reduced to ash, which is mostly carbon. The atoms released in the air from combustion are quickly recycled into other things in the biosphere [environment]; if a person’s ashes are spread around, they eventually re-enter the food chain or are converted into minerals. As such, tiny pieces of a person [his atoms] of this generation, may eventually end up in the pork chop, the corn flakes or the potato salad of his or her grand children.

Hence, the atoms that make up our body come from outer space, and have been around for billions of years since the creation of Earth. We get to use them for a very short amount of time, since our average lifetime is incredibly short and meaningless when we speak in planetary terms [consider a very young planet being 25 million years]. We should make the most of our atoms while we can, because our life is short and once we are gone, our atoms are converted into something else.

The law of thermodynamics states that both matter, which is made up of atoms, and energy can neither be created nor destroyed. Thus, all the atoms in our physical dead body eventually get recycled.

Hence, we can ask ourselves this question:

“Are we truly dead if our atoms still exist?”

Philosophy, Poetry, Tragedy & Comedy were Linked for Centuries

12 hommes en colère de Reginald Rose dpurb 2022

Image : “12 hommes en colère” de Reginald Rose, adaptée par Francis Lombrail et mise en scène par Charles Tordjman (Théâtre Hébertot, Paris, 2022) / Photo : Fabienne Rappeneau

Lucretius’ philosophical work is a huge poem that has been poorly translated like all ancient poetry. Aeschylus, Euripides, Sophocles and the Roman comedy (e.g. The Iliad, The Odyssey) were all written in verse; this aspect has been forgotten because all translations were made in prose. 5 or 6 years before Christ, intellectuals had to memorise, and poetry was used because it facilitates memorising: just as a song allows us to memorise the words more easily (e.g. Aragon’s poem, sung by Jean Farrain).

There is a lyrical dimension to Lucretius, it is a poetic and scenic dimension. Onfray finds that Lucretius, in his style, tries to get people on board. This is a tangible deduction when we know the extent of Lucretius’ Epicurean thought, which gives the concrete feeling of a real intellectual journey that transforms us for good.

If we take the example of a passage of Lucretius in “De Rerum Natura” which is in the last section of Canto VI, where he describes the plague in Athens, we can see with what descriptive mastery he makes the scene of the plague present, explaining to us a detailed chronology of the beginning, the development and then the horrors of death on men. Onfray wonders if this is really reality and asks himself:

– Is it metaphorical?

– Is it allegorical?

Anything is possible in Lucretius, Onfray notes that he seeks to reach those who are listening, in a message that tries to make the point that the real plague is the human condition – again a metaphor that seems to describe what might be called mental illness in the 21st century.

Philosophy, poetry, tragedy and comedy were linked for centuries. What Lucretius leaves us is an immense existential treatise synthesized in an encyclopedia of the world. Translated into prose, it is an intellectual material available for everyday life where pleasure, which means the absence of suffering, is what we seek and aim for!

Throughout this essay, we have also seen how so many thinkers across different generations have had their thoughts echo each other’s perspectives and beliefs with many also confirmed by modern science.  Good ideas, or good people, find each other and fit together. This reminds the world that all intellectual work that is built on the solid foundations of reason, logic and rationality will echo in eternity. Voltaire was completely right in his correspondence with M. Thiériot dated June 30, 1760, when he wrote: « Les beaux esprits se rencontrent. » [French for: “Beautiful minds meet.”]

« Les beaux esprits se rencontrent. » // Traduction[EN]: “Beautiful minds meet.” – Voltaire

In Lucretius’ writings, there is a multitude of ethical and moral propositions that give man the ability to liberate himself by elevating his mind, to lead an Epicurean philosophical life in particular, a life that is made for happiness – “l’art de vivre” according to Lucretius!

D.J. d’Purb | dpurb.com

*****

Bibliographie

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Essay // Developmental Psychology: The 3 Major Theories of Childhood Development

Mis à jour le Mercredi, 14 Avril 2021

TheoriesOfDevelopment danny d'purb dpurb

Source: An Introduction to Developmental Psychology by Slater & Bremner (Blackwell:Oxford, 2nd Edn, 2011)

It is fundamental to undertstand that as human beings, whatever stage of our lives we are, in order to be able to function fully in our daily lives and in any other activity we first of all need to have a strong foundation. That foundation is our brain, and hence, if our brain [i.e. the hardware] is not physiologically within the limits of what is deemed fit and healthy, every aspect of our mind will be affected and also of our lives. There is no psyche [mind] without a brain, because this biological hardware given to us by nature throughout the course of the shared evolutionary history of primates on planet Earth, allows us to experience every aspect of our lives, both physical and psychical [i.e. mental].

So, before diving deeper into the depth of children’s development, we are going to explore this link between brain and behaviour in order to get a foundation of the importance or a healthy brain, for a healthy development and a healthy and fulfulling life, by starting with how brain damage can affect our personalities and mental abilities; we are going to look at the Frontal lobe, which is the part of the brain behind our forehead responsible for problem solving, strategic planning, use of environmental instructions to shift procedures, and the inhibition of impulsivity.

FLD

(Photo: Jez C Self / Frontal Lobe Gone)

 

Frontal Lobes (& Frontal Lobe Damage)

The Wisconsin Card Sorting Test (WCST; Grant & Berg, 1948; Heaton, Chelune,Talley, & Curtis, 1993) has long been used in Neuropsychology and is among the most frequently administered neuropsychological instruments (Butler, Retzlaff, & Vanderploeg, 1991).

The test was specifically devised to assess executive functions mediated by the frontal lobes such as problem solving, strategic planning, use of environmental instructions to shift procedures, and the inhibition of impulsivity. Some neuropsychologists however, have questioned whether the test can measure complex cognitive processes believed to be mediated by the Frontal lobes (Bigler, 1988; Costa, 1988).

The WCST test, until this day remains widely used in clinical settings as frontal lobe injuries are common worldwide. Performance on the WCST test is believed to be particular sensitive in reflecting the possibilities of patients having frontal lobe damage (Eling, Derckx, & Maes, 2008). On each Wisconsin card, patterns composed of either one, two, three or four identical symbols are printed. Symbols are either stars, triangle, crosses or circles; and are either red, blue, yellow or green.

At the start of the test, the patient has to deal with four stimulus cards that are different from one another in the colour, form and number of symbols they display. The aim of the participant would be to correctly sort cards from a deck into piles in front of the stimulus cards. However, the participant is not aware whether to sort by form, colour or by number. The participant generally starts guessing and is told after each card has been sorted whether it was correct or incorrect.

Firstly they are generally instructed to sort by colour; however as soon as several correct responses are registered, the sorting rule is changed to either shape or number without any notice, besides the fact that responses based on colour suddenly become incorrect. As the process continues, the sorting principle is changed as the participant learns a new sorting principle.

potbIt has been noted that those with frontal lobe area damage often continue to sort according to only one particular sorting principle for 100 or more trials even after the principle has been deemed as incorrect (Demakis, 2003). The ability to correctly remember new instructions with for effective behaviour is near impossible for those with brain damage: a problem known as ‘perseveration’.

Another widely used test is the ‘Stroop Task’ which sets out to test a patient’s ability to respond to colours of the ink of words displayed with alternating instructions. Frontal patients are known for badly performing to new instructions. As the central executive is part of the frontal lobe, other problems such as catatonia – a condition where patients remain motionless and speechless for hours while unable to initiate – can arise. Distractibility has also been observed, where sufferers are easily distracted by external or internal stimuli. Lhermite (1983) also observed the ‘Utilisation Syndrome’ in some patients with Dysexecutive Syndrome (Normal & Shallice, 1986), who would grab and use random objects available to them pathologically.

 

Incomplete Frontal Lobe Development & Impulsiveness in Children

Image: PsyBlog

The Frontal lobe, responsible for most executive functions and attention, has shown to take years [at least 20] to fully develop. The Frontal lobe [located behind the forehead] is responsible for all thoughts and voluntary behaviour such as motor skills, emotions, problem-solving and speech.

In childhood, as the frontal lobe develops, new functions are constantly added; the brain’s activity in childhood is so intense that it uses nearly half of the calories consumed by the child in its development.

As the Pre-Frontal Lobe/Cortex is believed to take a considerable amount of at least 20 years to reach maturity (Diamond, 2002), children’s impulsiveness seem to be linked to neurological factors with the Pre-Frontal Lobe/Cortex; particularly, their [sometimes] inability to inhibit response(s).

The idea was supported by developmental psychologist and philosopher Jean Piaget‘s  Theory of Cognitive Development of Children [known for his epistemological studies] where he showed the A-not-B error [also known as the “stage 4 error” or “perseverative error”] is mostly made by infants during the substage 4 of their sensorimotor stage.

Researchers used 2 boxes, marked A and B, where the experimenter had repeatedly hid a visually attractive toy under the Box A within the infant’s reach [for the latter to find]. After the infant had been conditioned to look under Box A, the critical trial had the experimenter move the toy under Box B.

Children of 10 months or younger make the “perseveration error” [looked under Box A although fully seeing experimenter move the toy under Box B]; demonstrating a lack of schema of object permanence [unlike adults with fully developed Frontal lobes].

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Frontal lobe development in adults was compared with that in adolescents, e.g. Sowell et al (1999); Giedd et all (1999); who noted differences in Grey matter volume; and differences in White matter connections. Adolescents are likely to have their response inhibition and executive attention performing less intensely than adults’. There has also been a growing & ongoing interest in researching the adolescent brain; where great differences in some areas are being discovered.

The Pre-Frontal Lobe/Cortex [located behind the forehead] is essential for ‘mentalising’ complex social and cognitive tasks. Wang et al (2006) and Blakemore et al (2007) provided more evidence between the difference in Pre-Frontal Lobe activity when ‘mentalising’ between adolescents and adults. Anderson, Damasio et al (1999) also noted that patients with very early damage to their frontal lobes suffered throughout their adult lives.

skull

2 subjects with Frontal Lobe damage were studied:

1) Subject A: Female patient of 20 years old who suffered damages to her Frontal lobe at 15 months old was observed as being disruptive through adult life; also lied, stole, was verbally and physically abusive to others; had no career plans and was unable to remain in employment.

2) Subject B was a male of 23 years of age who had sustained damages to his Frontal lobe at 3 months of age; he turned out to be unmotivated, flat with bursts of anger, slacked in front of the television while comfort eating, and ended up obese in poor hygiene and could not maintain employment. [However…]

Reflections

While research and tests have proven the link between personality traits & mental abilities and frontal brain damage, the physiological defects of the frontal lobe would likely be linked to certain traits deemed negative by a subject willing to be a functional member of society [generally Western societies].

However, personality traits similar to the above Subjects [A & B] may in fact not always be linked to deficiency and/or damage to the frontal lobes; as many other factors are to be considered when assessing the behaviour & personality traits of subjects; where [for example] violence and short temper may [at times] be linked to a range of factors and environmental events during development, or other mental strains such as sustained stress, emotional deficiencies due to abnormal brain neurochemistry, genetics, or other factors that may lead to intense emotional reactivity [such as provocation or certain themes/topics that have high emotional salience to particular subjects, ‘passion‘]

 

THE 3 MAJOR THEORIES OF DEVELOPMENT

In 1984, Nicholas Humphrey described us as “nature’s psychologists’” or homo psychologicus. What he meant was that as intelligent social beings, we tend to use our knowledge of our own thoughts and feelings – “introspection” – as a guide for understanding how others are likely to think, feel and hence, behave. He also argued that we are conscious [i.e. we have self-awareness] precisely because such an attribute is useful in the process of understanding others and having a successful social existence – consciousness is a biological adaptation that enables us to perform introspective psychology. Today, we are confident in the knowledge that the process of understanding others’ thoughts, feelings and behaviour is an ability that develops through childhood and most likely throughout our lives; and according to the greatest child psychologist of all time, Jean Piaget, a crucial phase of this process occurs in middle childhood.

Developmental psychology can be characterised as the field that attempts to understand and explain the changes that happen over time in the thought, behaviour, reasoning and functioning of a person due to biological, individual and environmental influences. Developmental psychologists study children’s development, and the development of human behaviour across the organism’s lifetime from a variety of different perspectives. Hence, if we are studying different areas of development, different theoretical perspectives will be fundamental and may influence the ways psychologists and scholars think about and study development.

Through the systematic collection of knowledge and experiments, we can develop a greater understanding and awareness of ourselves than would otherwise be possible.

 

Focussing on changes with time

The new born infant is a helpless creature, with communications skills that are limited along with few abilities. By 18 – 24 months, the end of the period of infancy – this scenario changes. The child has now formed relationships with others, has gained knowledge about the aspects of the physical world, and is about to undergo a vocabulary explosion as language development leaps ahead. At the time of adolescence, the child has turned into a mature, thinking individual actively striving to come to terms with a fast changing and complex society.

The important contribution to development, is maturation and the changes resulting from experience that intervene between the different ages and stages of childhood: the term maturation refers to those aspects of development that are primarily under genetic control, and which are relatively uninfluenced by the environment. An example would be puberty, and although its onset can be affected by environmental factors such as diet, the changes that occur are genetically determined.

 

Development Observed

The biologist, Charles Darwin, notable for his theory of evolution, made one of the earliest contributions to our understanding of child psychology in his article “A biographical sketch of an infant” (1877), which was based on observations of his own son’s development. By the early 20th century, most of our understanding of psychological development was not based on scientific methodology as much was still based on anecdotes and opinions of qualitative analysis, a method that strict empiricists have never managed to grasp or like. Nevertheless, knowledge was still being organised through both observation and experiment and during the 1920s and 1930s the study of child development started to grow as a movement, particularly in the USA with the founding of Institutes of Child Study or Child Welfare in university centres such as Iowa and Minnesota. Minute observations were made of young children in their developmental phase along with normal and abnormal behaviour and adjustment. In the 1920s Jean Piaget started his long and passionate career in child psychology, blending observation and experiment in his studies of children’s thinking.

The observations carried out in naturalistic settings was soon criticised by the empiricists of the behavioural movement in the 1940s and 1950s [although it continued to be the method of choice in the study of animal behaviour by zoologists]. This led to many psychologist carrying their experiments under laboratory conditions with statistical methods, and such experiments although come with some advantages from the perspective of empirical statistics, they do have limitations and drawbacks [e.g. on measuring qualitative aspects of personality such as emotions, values, etc]. It should be noted that much of the laboratory work on child development from the 1950s and 1960s has been described by Urie Bronfenbrenner (1979) as “the science of the behaviour of children in strange situations with strange adults”.

Schaffer (1996, pp. xiv – xvii) notes other changes in the methods in which psychologists now approach child development, such as the importance in understanding the processes of how children grow and develop rather than simply outcomes, and to integrate findings from a range of sources at different levels of analysis – for example meaningful others, community [geography, socio-linguistics, arts, etc] and culture [religion, nationality(ies), education, class, etc).

In the course of this essay, we will be integrating perspectives to make the most of the findings in distinguishing differences in personality, by reflecting on the links to be made by psychologists between the concept of the child’s “internal working model of relationships” and discoveries about the “theory of mind”.

It is fundamental to acknowledge that psychology itself is mostly based on accurate approximations due to the statistical methods used and the problematic nature of the qualitative variables measured, and not precision. And with this in mind, we should accept the complementary virtues of various different methods of investigation and gain a sense that the child’s process of development and the socio-behavioural context in which they exist are closely intertwined, each having an influence on the other.

 

Defining development according to world views

Intellectuals and researchers who study development also have different views on the topic, that is, the way in which development is defined, and the areas of development that are of interest to individual researchers generally orients them towards specific methodologies and philosophy when studying development.

We are now going to look at the 2 main views in the study of development given by psychologists who hold different views or sometimes combine elements of both, like ourselves, being firmly on the organic perspective of development and construction.

A world view [also known as paradigm, model, or world hypothesis] can be characterised as “a philosophical system of thinking, perceiving and feeling [ideas and more] that serves to organise a set or family of scientific theories and associated scientific methods” (1986, p. 42).

They are beliefs we adopt because it aligns with our values, and these are qualitative and often not open to common reductive empirical tests – that is precisely why we believe them!

Lerner and others note that many developmental theories appear to fall under one or two world views: organismic and mechanistic.

 

Organismic World View

The organismic world view which is the main view that we adopted to be the foundation of the Organic Theory, is one that sees a human being on earth as a biological organism that is inherently active and continually interacting with the environment [all aspects and dimensions], and therefore helping to shape its own development. The organismic worldview emphasises the interaction between maturation and experience that leads to the development of new internal, psychological structures for processing environmental input (e.g. Getsdottir & Lerner, 2008).

As Lerner states: “The Organismic model stresses the integrated structural features of the organism. If the parts making up the whole become reorganised as a consequence of the organism’s active construction of its own functioning, the structure of the organism may take on a new meaning; thus qualitatively distinct principles may be involved in human functioning at different points in life. These distinct, or new, levels of organisation are termed stages…” (p.57). A good analogy would be qualitative changes that take place when the molecules of two gasses hydrogen and oxygen, combine to form a liquid, water. Many other qualitative changes happen to water when it changes from frozen (ice) to liquid (water) to steam (vapour). Depending on the temperature, these qualitative changes in the state of water are easily reversed, BUT in human development the qualitative changes that take place are very rarely, if ever, reversible – that is, each new stage represents an advance on the previous stage, and the organism [human being] does not regress to former stages.

Irreversible

The main argument is that the new stage is not simply reducible to components of the previous stage; it represents new characteristics that were not present in the previous stage.

For example, the organism appears to pass through structural changes during foetal development [See Picture A].

PA Development of the human foetal brain_A_v2.jpg

PICTURE A. Development of the human foetal brain / Source: Adapted from J.H.Martin (2003), Neuroanatomy Text and Atlas (3rd ed., p.51). Stamford, CT:Appleton & Lange.

In the initial stage [Period of the Ovumfirst few weeks after conception] cells multiply and form clusters; in the second stage [Period of the Embryo – 2 – 8 weeks] the major body parts are formed by cell multiplication, specialisation and migration as well as cell death; in the last stage [Period of the Foetus] the body parts mature and begin to operate as an integrated system [e.g. head orientation towards and away from stimulation, arm extensions and grasping, thumb sucking, startles to loud noises, and so on (Fifer, 2010; Hepper, 2007)]. It is important to understand that similar stages of psychological development are postulated to happen after birth also, and the individual from one stage to another is different with new abilities that cannot be reversed.

Jean Piaget is perhaps the greatest and best example of a successful organismic theorist. Piaget suggested that cognitive development occurs in stages and that the reasoning of the child at one stage is qualitatively different from that of the earlier or later stages.

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“Chaque civilisation se forge un mythe destiné à expliquer son apparition et construit sa tradition écrite autour d’un support privilégié” / Découvrez (Liens): (i) l’aventure des écritures et (ii) l’aventure du livre | Source: La Bibliothèque Nationale de France (BNF)

The main job of the developmental psychologist who believes in the organismic worldview [like ourselves] is to determine when [i.e., at what age?] different psychological stages operate and what variables and processes represent the different between stages and determine the transition between them.

 

Mechanistic World View

From the mechanistic world view, it is assumed that a person can be broken down into components and can be represented as being like a machine [such as a computer], which is inherently passive until stimulated by the environment [this view seems to be more in line with the early British thinkers about the brain]. Human behaviour is reducible to the operation of fundamental behavioural units [e.g. habits] that are acquired in a progressive, cumulative manner. The mechanistic view assumes that the frequency of behaviours can increase with age due to various learning processes and they can decrease with age when they no longer have any functional consequence, or lead to negative consequences [such as punishment]. The developmental psychologists job here is to study environmental factors, or principles of learning, which determine the way organisms respond to stimulation, and which results in increases, decreases, and changes in behaviour.

Quite unlike the organismic world view, the mechanistic world view sees development as reflected by a more continuous growth function, rather than occurring in qualitatively different stages, and the child is believed to be passive rather than active in shaping its own development and its environment. This mechanistic view is generally embraced by behaviourists and cognitive-behaviourists who function on a reductionist philosophy based on the limitations of the scientific method when faced with understanding psychology and the mechanism of mind; instead they tend to focus on measurable behaviour and treat the brain as an information processing centre with a highly similar logic to a computer. The mechanistic view while being fairly grotesque due to its reductionist values, has revealed to be very practical in the study of human-machine interaction and along with new cognitive methods, it has helped to enhance the design of technological equipment to improve human experience in a wide range of areas.

As for us, we are mostly on the perspective of the organismic school of thought but refuse to completely dismiss all the mechanistic world view’s elements, because some of it can be embedded as secondary cognitive processes carried out by the conscious or preconscious areas of the mind when appraising stimuli from an organism’s environment. Hence, some elements can be embedded in understanding interaction with basic objects and elements of an organism’s “external” [not internal] environment, but to fully base our thoughts and behaviour on a mechanistic world view would arguably be irrationally reductionist.

 

Theories of Development

 

“Es gibt nichts Praktischeres al seine gute Theorie.”

–Emmanuel Kant (1724 – 1804)

 

“There is nothing so practical as a good theory.”

-Kurt Lewin (1944, p. 195)

 

Human development is complex and it would be irrational to expect a single universal theory of development that could do justice to this complexity, and indeed no theory of development attempts to do so. Each theory attempts to account for only a limited range of development and it is often the case that within each area of development there are competing theoretical views, each attempting to account for the same aspects of development. We shall see below some of this complexity and conflict in our account of different theoretical views.

First of all, it would be helpful to understand what is implied by a “Theory” in the field of developmental psychology. A theory of development is a scheme or system of ideas that is generally based on evidence and attempts to explain, describe and predict behaviour and development. So, from this account, it is quite clear that a theory aims to bring order to what might otherwise be a chaotic mass of information – and hence why there may indeed not be anything more practical than a good theory.

We usually deal with at least 2 kinds of theory in every area of development, we have the minor theories [that are generally concerned with very specific and narrow areas of development such as eye movements, the origins of pointing and so on], and we have the major theories which are the ones we are primarily interested in as they attempt to explain large areas of development.

They have been divided in 3 groups for the purpose of this essay, with cognition, emotion and motivation in focus:

(I) The Theory of Cognitive Development of Jean Piaget


(II) The Theory of Attachment in Emotional Development by John Bowlby


(III) The Genetic/Psychosexual Model of Development by Sigmund Freud

 

__________

 

(I) The Theory of Cognitive Development (Jean Piaget)

The theory of cognitive development we are interested in is that of Jean Piaget who saw children as active agents in shaping their own development,  and not simply blank slates who passively and unthinkingly responds to whatever the environment throws at them or treats them to [an assumption that is insulting to human intelligence, hence why we do not subscribe blindly to the passive school of thought but only consider some elements related to very basic cognitive processes].

This suggests that children’s behaviour and development is motivated largely intrinsically (internally) rather than extrinsically (externally).

For Piaget and intellectuals with a firm belief in the mind as an active entity, children learn to adapt to their environment and as a result of their cognitive adaptations they are now better able to understand their world. Adaptation is an act that all living organisms have evolved to do and as children adapt, they also gradually construct more advanced understanding [internal working models] of their worlds.

These more advanced understanding of the world reflect themselves in the appearance of new stages of development. Piaget’s theory is the best and most accomplished example of the organismic world view, and it portrays children as inherently active, continually interacting with various dimensions of their environments, in such a way as to shape their own development.

With this assumption in mind, Piaget’s theory is also often referred to the Constructivist Theory.

 

Piaget’s Theory of Cognitive Development (0 – 12 yrs)

Jean Piaget’s theory developed out of his early interest in observing animals in their natural environment. Piaget published his first article at the age of 10 about the description of an albino sparrow that he had observed in the park, and before the age of 18, journals had accepted several of his papers about molluscs. During his adolescent years, the young theorist developed a keen interest in philosophy, particularly “epistemology” [the branch of philosophy focused on knowledge and the acquisition of it]. However, his undergraduate studies were in the field of biology and his doctoral dissertation was once again, on molluscs.

For a short while, Piaget then worked at Bleuler’s psychiatric clinic where his interest in psychoanalysis grew. As a results, he moved to France and attended the Sorbonne university, in 1919 to study clinical psychology and also pursued his interest in philosophy. In Paris, he worked in the Binet Laboratory with Theodore Simon on the standardisation of intelligence tests. Piaget’s task was to monitor children’s correct response to test times, but instead, he became much more interested in the mistakes that children made, and developed the idea that the study of children’s errors could provide an insight into their cognitive processes.

Piaget came to realise that through the process and discipline of psychology, he had an opportunity to create links between epistemology and biology. Through the integration of the disciplines of psychology, biology and epistemology, Piaget aimed to develop a scientific approach to the understanding of knowledge – the nature of knowledge and the ways in which an organism acquires knowledge. As a man who valued richness and detail, Piaget was not at all impressed by the reductionist quantitative methods used by the empiricists of the time, however, he was influenced by the work on developmental psychology by Binet, a French psychologist who had pioneered studies of children’s thinking [his method of observing children in their natural setting was one that Piaget followed himself when he left the Binet laboratory].

Piaget later integrated his own experience of psychiatric work in Bleuler’s clinic with the observational and questioning strategies that he had learned from Binet. Out of this fusion of techniques emerged the “Clinical Interview” [an open-ended, conversational technique for eliciting children’s thinking (cognitive) processes]. It was the child’s own subjective judgement and explanation that was of interest to Piaget, as he was not testing a particular hypothesis, but rather looking for an explanation of how the child comes to understand his or her world. The method is not simple, and the team of Piaget’s researchers had to be trained for 1 year before they actually started collecting data. They were trained and educated about the “art” of asking the right questions and testing the truth of what the children said.

Piaget’s career was devoted to the quest for the mechanisms guiding biological adaptation, and also the analysis of logical thought [that derives from these adaptations and interaction with the exterior environment] (Boden, 1979). He wrote more than 50 books and hundreds of articles, correcting many of his earlier ideas in later life. At its core, the theory of Jean Piaget is concerned with the human need to discover and acquire deeper understanding and knowledge.

Piaget’s incredible output of concepts and ideas characterises his attitude towards constant construction and reconstruction of his theoretical system, which was quite consistent with his philosophy of knowledge, and perhaps indirectly to the school of thought of the mind as an “active” entity.

This section will explore the model of cognitive structure developed by Piaget along with the modifications and some of the re-interpretations that subsequent Piagetian researchers have made to the master’s initial ideas. Although many details have been questioned, it is undeniable that Piaget’s contribution to the understanding of thinking processes [cognitive] of both children and adults.

One great argument made by the theorist suggested that if we are to understand how children think we ought to look at the qualitative development of their problem-solving abilities.

Two famous examples from Piaget’s experiments will be considered that explore the thinking processes in children, showing how they develop more sophisticated problem-solving skills.

Example 1 – One of Piaget’s dialogue with a 7-year-old

Adult:    Does the moon move or not?
Child:    When we go, it goes.
Adult:    What makes it move?
Child:    We do.
Adult:    How?
Child:    When we walk. It goes by itself.

(Piaget, 1929, pp. 146-7)

From this example and other observations based on the similar theme, Piaget described a particular period in childhood which is marked by egocentrism. Since the moon appears to move with the child, she concluded that it does indeed do so. But as the child grows and her sense of logic follows, there is a shift from her own egocentric perspective where the child starts to learn to differentiate between what she sees and she “knows”. Gruber and Vonèche (1977) provide a good example of how an older child used her sense of logic to investigate the movement of the moon. This particular child had sent his younger brother for a walk down the garden while he himself remained immobile. The younger child reported that the moon moved with him, but the older boy realised from his observation that the moon did not move and could then disprove this wrong information with his brother.

Example 2 – Estimating the Quantity of a Liquid

FA Piaget Liquid Quantity

FIGURE A. Estimating a quantity of liquid

This example is taken from Piaget’s research into children’s understanding of quantity. Let us assume that John [aged 4] and Mary [aged 7] are given a problem; two glasses, A and B, are of equal capacity [volume] but glass A is short and wide and glass B is tall and narrow [See Figure A]. Glass A is filled to a particular height and the children would then be asked, separately, to pour liquid into glass B [tall and narrow] so that it would contain the same amount as glass A. Despite the striking proportional differences of the 2 containers, John could not grasp that the smaller diameter of glass B requires a higher level of liquid. To Mary, John’s response is incredibly senseless and stupid: of course one would have to add more to glass B. Piaget interestingly saw the depth of the argument that was in the responses of those children. John could not “see” that the liquid in A and the liquid in B are not equal, because his thought processes are using a mechanism that is qualitatively different in terms of reasoning and that is not yet developed [perhaps due to physiological/hardware limitations] and lacks the mental operations that would have allowed him to solve the problem. Mary, the 7 year old girl finds it hard to understand 4 year old John’s stupidity and why he could not perceive his error.

Facing this situation, Piaget brilliantly proposed that the essence of knowledge is “activity” – a line of thought and perspective adopted by many psychologists and intellectuals from the German and French school of Lacan quite opposite to the early British thoughts that assumed the mind to be “passive” and mostly shaped by the effects of the outside environment.  This argument is not only one that embraces human ingenuity and creativity and acknowledges our instinctual drives to thrive and succeed but also characterises the mind as an entity with high creative power instead of simple junction of neurons conditioned to react to stimuli from its environment almost helplessly as the “passive” school assumed it to be. Hence, to Piaget and ourselves, the essence of knowledge is “activity”, he could be referring to the infant directly manipulating objects and in doing so also learning about their properties. It may also refer to a child pouring liquid from one glass to another to find out which has more in it. Or it may refer to the adolescent forming hypotheses to solve a scientific dilemma. In the examples mentioned, it is important to note that the learning process of the child is taking place through “action”, whether physical (e.g. exploring a ball of clay) or mental (e.g. thinking of various outcomes and reflecting on what they mean). Piaget’s emphasis on activity was important in stimulating the child-centred approach to education, because he firmly believed that for lasting learning to occur, children would not only have to manipulate objects but also manipulate and define ideas. The major educational implications of Piaget will be discussed later in this section.

 

Assumptions of Piaget’s Theory of Development: Structure & Organisation

Through his carefully devised techniques, and using observations, dialogues and small-scale experiments, Piaget suggested that children progress through a series of stages in their thinking, each of which synchronises with major changes in the structure or logic of their intelligence. [See Table A]

TA Piaget - Stages of Intellectual Development

TABLE A. The Stages of Intellectual Development in Piaget’s Theory

Piaget named the main stages of development and the order in which the occurred as:

I. The Sensori-Motor Stage [0 – 2 years]
II. The Pre-Operational Stage [2 – 7 years]
III. The Concrete Operational Stage [7 – 12 years]
IV. The Formal Operational Stages [12 years but may vary from one child to the other]

Piaget’s structures are sets of mental operations, which can be applied to objects, beliefs, ideas or anything in the child’s world, and these mental operations are known as “schemas”. The schemas are characterised as being evolving structures, in other words, structures that grow and change from one stage to the next.

The details of each section of the 4 stages will be explored below, however it is fundamental that we first understand Piaget’s concept of the unchanging or “invariant” [to use his own term – this may be related to temperament but here it involves another set of abilities] aspects of thought, which refers to the broad characteristics of intelligent activity that remains constant throughout the human organism’s life.

These are the organisation of schemas and their adaptation through assimilation and accommodation.

Organisation: Piaget used this term to explain the innate ability to coordinate existing cognitive structures, or schemas, and combine them into more complex systems [e.g. a baby of 3 months old has gained the ability to combine looking and grasping, with the earlier reflex of sucking]. The baby is able to perform all three actions together when feeding from her mother’s breast or a feeding bottle, an ability that the new born child did not originally have in his/her repertoire. A further example would be Ben who at the age of 2 had learned to climb downstairs while carrying objects without dropping them, and also to open doors. This means that he could then combine all three operations to deliver newspaper to his grandmother in the basement flat. To note, each separate operation combines into a new action more complex than the sum of the parts.

The complexity of the organisation also grows as the schemas become more elaborate. Piaget described the development of a particular action schema in his son Laurent as he attempted to strike a hanging object. Initially, Laurent only made random movement towards the object, but at the age of 6 months the movements had evolved and were now deliberate, focused and well directed. As Piaget put it in his description, at 6 months old, Laurent possessed the mental structure that guided the action involved in hitting a toy. Laurent had also gained the ability to accommodate his actions to the weight, size and shape of the toy and its distance from him.

The next invariant function, adaptation is characterised by the striving of the organism for balance [or equilibrium] with the environment, and is achieved through the further processes of “assimilation” and “accommodation”. During the process of assimilation, the child’s repertoire of knowledge expands and he/she takes in [learns about] a new experience [and the knowledge acquired with it] and fits it into an existing schema. For example, a child may learn the words “dog” and “car”, and following this enigmatic event, the child may call all animals “dogs” [i.e. different animals taken into a schema related to the child’s understanding of dog], or all vehicles with four wheels are called “cars”. The process of accommodation balances this erroneous process, where the child adjusts an existing schema to fit in with the nature of the environment [i.e. from experience, the child begins to perceive that cats can be distinguished from dogs, and may develop schemas for these 2 different animals – also that cars can be distinguished from other vehicles such as trucks or lorries.

By these two processes, namely assimilation and accommodation, the child achieves a new state of equilibrium which is however not permanent as this balance is generally soon upset as the child assimilates further new experiences or accommodates her existing schemas to another new idea.

Equilibrium only seems to prepare the child for more disequilibrium through further learning and adaptation; these two processes occur together and cannot be thought of separately. Assimilation provides the child with consolidation for mental structures; and accommodation results in growth and change. All adaptations contains the components of both processes and striving for balance between assimilation and accommodation [Remember: Organisation  Adaptation + (Assimilation & Accommodation)] leads to the child’s intrinsic motivation to learn [This is also reminiscent of the psychodynamic school of thought as several processes colliding to find balance in its model of the mental life of the individual mind]. When new experiences are within the child’s response range in terms of abilities, then conditions are said to be at their best for change and growth to occur.


The Stages of Cognitive Development

To adepts of Piaget’s outlook, intellectual development is a continuous process of assimilation and accommodation. We will not describe the four stages identified in the development of cognition from birth to about 12 years old [in normal children]. This order is similar for all children but the age these milestones are achieved may vary from one child to another – with the stages being:

I. The Sensori-Motor Stage [0 – 2 years]
II. The Pre-Operational Stage [2 – 7 years]
III. The Concrete Operational Stage [7 – 12 years]
IV. The Formal Operational Stages [12 years but may vary from one child to the other]


I. The Sensori-Motor Stage (about 0 – 2 years) | Stage 1 of 4

During the sensori-motor stage the child changes from a newborn, who focuses almost entirely on immediate sensory and motor experiences, to a toddler who possesses a rudimentary capacity for thinking. Piaget described in detail the process by which this occurs, by documenting his own children’s behaviour. On the basis of such observations, carried over the first 2 years of life, Piaget divided the sensori-motor stage into 6 sub-stages. [See Table B]

TB Sub-stages of the sensori-motor period

TABLE B. Substages of the sensori-motor period according to Piaget

The first substage, reflex activity, included the reflexive behaviours and spontaneous rhythmic activity with which the infant is born. Piaget called the second substage primary circular reactions. He used the term “circular” to emphasise how children tend to repeat an activity, especially those that are pleasing or satisfying (e.g. thumb sucking). The term “primary” refers to simple behaviours that are derived from the reflexes of the first period [e.g. thumb sucking develops as the thumb is assimilated into a schema based on the innate suckling reflex].

Secondary circular reactions refer to the child’s willingness to repeat actions, but the word “secondary” is used here to point out the behaviours that are the child’s very own. In other words, she is not limited to just repeating actions based on early reflexes, but having initiated new actions, she can now repeat these if they are satisfying. However, at the same time, these actions tend to be directed outside the child (unlike simple actions like thumb sucking) and are aimed at influencing the environment around her.

This is Piaget’s description of his own daughter Jacqueline at 5 months old, kicking her legs (in itself a primary circular reaction) in what gradually ascends to a secondary circular reaction as the leg movement is repeated not just for itself, but is initiated in the presence of a doll.

Jacqueline looks at a doll attached to a string which is stretched from the hood to the handle of the cradle. The doll is approximately the same level as the child’s feet. Jacqueline moves her feet and finally strikes the doll, whose movement she immediately notices… The activity of the feet grows increasingly regular whereas Jacqueline’s eyes are fixed on the doll. Moreover, when I remove the doll Jacqueline occupies herself quite differently; when I replace it, after a moment, she immediately starts to move her legs again.

(Piaget, 1936, p. 182)

In displaying such behaviours, Jacqueline seemed to have established a general relation between her movement and the doll’s, and was also engaged in a secondary circular reaction.

Coordination of Secondary Circular Reactions, being substage 4 of the Sensori-motor period, and as the word “coordination” implies, it is particularly at this substage that children begin to combine different behavioural schema. In the following extracted section, Piaget described how his daughter (aged 8 months) combined several schemas, such as “sucking an object” and “grasping an object” in a series of coordinated actions when playing with a new object:

Jacqueline grasps an unfamiliar cigarette case which I present to her. At first she examines it very attentively, turns it over, then holds it in both hands while making the sound apff (a kind of hiss which she usually makes in the presence of people). After than she rubs it against the wicker of her cradle then draws herself up while looking at it, then swings it above her and finally puts it in her mouth.

(Piaget, 1936, p. 284)

Jacqueline’s behaviour illustrates how a new object is assimilated to various existing schema in the fourth substage. In the following stage, that of tertiary circular reactions children’s behaviours become more flexible and when they repeat actions they may do so with variations, which can lead to new results. By repeating actions with variations, children are, in effect, accommodating established schema to new contexts and needs.

The final sub-stage of the sensori-motor period is known as the substage of Internal Representations and it refers to the child’s achievement of mental representation. The previous substages the child has interacted with the world through her physical motor schema, another way of phrasing it would be that, she has acted directly on the world. In this final substage, she can now act “indirectly” on the world because she has developed the capacity to hold mental representations of the world – that is, she can now think and plan.

As evidence for children attaining the level of mental representation, Piaget pointed out that by this substage children have a full concept of object permanence. Piaget noticed that very young infants ignored even highly attractive objects once they were out of sight [e.g. a child reaching for a toy, but then the toy is suddenly covered with a cloth and it immediately leads to the child losing all interest in it and would not attempt to search for it, and might even just look away]. According to Piaget it was only after the later substages that children demonstrated an awareness [by searching and trying to retrieve the object] that the object was “permanently” present even if it was temporarily out of sight. Searching for an object that cannot be seen directly implies that the child has a memory of the object, i.e. a mental representation of it.

It is only towards the end of the sensori-motor period that children demonstrated novel patterns of behaviour in response to a problem. For example, if a child wants to reach for a toy and comes across an object between herself and the desired toy, younger children might just try and reach for the toy directly and it is possible that the child knocks over the object while reaching for the target toy – this is best described as “Trial and Error” performance. In the later substages, the child might solve the problem by instead first removing the object out of the way before reaching for the desired toy. Such structured behaviour suggests that the child was able to plan ahead, which indicates that he/she had a mental representation of what she was going to do.

An example of planned behaviour by Jacqueline was given where she was trying to solve the problem of opening a door while carrying two blades of grass at the same time:

She stretches out her right hand towards the knob but sees that she is cannot turn it without letting go of the grass. She puts the grass on the floor, opens the door, picks up the grass again and enters. But when she wants to leave the room things become complicated. She put the grass on the floor and grasps the door knob but then she realises that in pulling the door towards her she will simultaneously chase away the grass which she placed between the door and the threshold. She therefore picks it up in order to put it outside of the door’s zone of movement.

(Piaget, 1936, pp. 376-7)

Jacqueline solved the problem of the grass and the door before she opened the door. It is assumed that she would have had a mental representation of the problem, which permitted her to work out the solution, before she acted.

A third line of evidence for mental representations comes from Piaget’s observation of deferred imitation, that is when children carry out a behaviour that is a reflection of copied behaviour that was previously taken in by the developing child. Piaget provides a good example of this:

At 16 months old Jacqueline had a visit from a little boy of 18 months who she used to see from time to time, and who, in the course of the afternoon got into a terrible temper. He screamed and he tried to get out of a playpen and pushed it backward, stamping his feet. Jacqueline stood observing him in amazement, having never witnessed such a scene before. The following day, she herself screamed in her playpen and tried to move it, stamping her foot lightly several times in succession.

(Piaget, 1951, p. 63)

This suggests that if the little boy’s behaviour was repeated by Jacqueline a day later, she would have had to have retained an image of his behaviour, i.e. she had a mental representation of what she had seen from the day before, and that representation provided the basis for her own copy of the temper tantrum.

To conclude, during the sensori-motor period, the child advances from very simple and limited reflex behaviours at birth, to complex behaviours at the end of the period. The more complex behaviours depend on the progressive combination and elaboration of the schema, but are, at the beginning, limited to direct interactions with the world – thus, the name Piaget gave to this period because he thought of the child developing through her sensori-motor interaction with the environment. It is only towards the end of that period that the child is not limited to immediate interaction anymore because she has now developed the ability to mentally represent her world [mental representation], and with this ability the child can manipulate her mental images (or symbols) of her world, in other words, she can now act on her thoughts about the world as well as on the world itself.

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Revisions of the Sensori-motor Stage

Jean Piaget’s observations of babies during this first stage lasting until 2 years of age, have been largely confirmed by subsequent reseachers, however Piaget may have underestimated children’s mental capacity to organize the sensory and motor information they take in. Several investigators have shown that children have abilities and concepts earlier than Piaget thought.

Bower (1982) examined Piaget’s hypothesis that young children did not have an appreciation of objects if they were not in sight. For this experiment, children a few months old were recruited and shown an object, and shortly after a screen was moved across in front of the object [so that it would be hidden/unseen from the child’s visual field], to then finally be moved back to its original position. This scenario was presented with 2 slight changes: in Condition 1 the object was still in place and hence seen again by the child when the screen was moved back to its original location; and in Condition 2, the object was removed so the child would perceive the object to have disappeared when the screen was moved back. After monitoring the children’s heart rate to measure changes [which reflect surprise]. To go back to Piaget’s assumptions from his qualitative observations, it would be assumed that children of a few months old do not retain information about objects that are no longer present, and if this was the case, we would not register any heart rate change because as there should be no element of surprise [i.e. the child would not expect an object to be there once the screen was moved back to its original location], thus in Condition 2, no reaction should be displayed by the children, however it was found that children displayed more surprise in Condition 2 and Bower inferred that the children would have had an expectation of the object to still be in its position or “re-appear” after the screen was moved back – this would be the evidence that young children must retain a mental representation of the object in their mind [could be interpreted as young children having some basic form of object permanence even if not properly developed at an earlier age than the assumptions of Piaget based on the results of his experimental methods].

In a further experiment, Baillargeon and DeVos (1991) showed 3-month-old children objects that moved behind a screen and then re-appeared from the other side of the screen. The upper half of the screen had a window and in one condition the children saw a short object move behind the screen [the object was small and below the level of the window and hence when it passed behind the screen it was completely out of sight / not visible, until it appeared at the other side of the screen].

In a second condition a taller object was passed behind the screen, and it was high enough to be seen through the window as it passed from one side to the other. Furthermore, Baillargeon and DeVos created an “impossible event” by passing the tall object through the screen without it appearing through the window, and it lead to the children displaying more interest by looking longer at the scenario than that with the small object. This lead to the argument that children reacted so, due to their expectation of the taller object to appear through the window, and hence this would suggest that young children early in the sensori-motor stage have an awareness of the continued existence of objects even when they are out of view. These results along with that of Bower (1982) seem to suggest that young children to have “some” understanding of object permanence earlier than assumed.

Another one of Piaget’s conclusion was also investigated further by another group of researchers who wanted to find out if children only developed planned action [which demonstrated their ability to form mental representations] at the end of the sensori-motor stage. Willatts (1989) placed an attractive toy on a cloth, out of the reach of 9-month-old children; the children could pull the cloth to access the attractive toy. However, the children could not reach the cloth directly since it was not accessible as Willatts placed a light barrier between the child and the cloth [the child had to move the barrier to reach the cloth]. The experiment showed that children were able to access the toy by carrying out appropriate the series of actions [i.e. first moving the barrier, then pulling the cloth to bring the toy within reach]. Most importantly, many of the children carried out the correct actions within the first occasion of being presented with the problem without the need of going through a “trial and error” phase. Willatts argued that for such young children to demonstrate novel planned actions, it may be inferred from such behaviour that they are operating on a mental representation of the world which they can make use of to organise their behaviour before carrying it out [This is also earlier than assumed by Piaget’s experiments].

Another point made by Piaget was that deferred imitation was an evidence that children should have a memory representation of what they had seen earlier. Soon after birth however it was found that babies are able to imitate the facial expression of an adult or the head movement (Meltzoff and Moore, 1983, 1989), however such imitation is performed in the presence of the stimulus being imitated. From Piaget’s experiments, it was initially deduced that stored representations are only achieved by children towards the end of the sensori-motor stage, however, Meltzoff and Moore (1994) showed that 6-week old infants could imitate a behaviour a day after they had seen the original behaviour. In Meltzoff and Moore’s study some children saw an adult make a facial gesture [e.g. sticking out her tongue] and others just saw the adult’s face while she maintained a neutral expression. The next day, all the children in the experiment saw the same adult, however this time, she kept a passive face. Compared to the children who had not seen any gesture, the children who had seen the tongue protrusion gesture the day before were more likely to make tongue protrusions to the adult the second time they saw her. Meltzoff and Moore argued that for the children to be able to perform those actions they would have had to have a mental representation of the action at a much earlier age than Piaget’s experiments concluded

 

II. The Pre-operational Stage (about 2 – 7 years) | Stage 2 of 4

This stage will be divided in 2 periods: (a) The Pre-conceptual Period (2 – 4 years) and (b) the Intuitive Period (4 – 7 years)


(a) The Pre-Conceptual Period (2 – 4 years)

The pre-conceptual period builds on the ability for internal, or symbolic thought to develop based on the latest advancements during the final stages of the sensori-motor period. During the pre-conceptual period [2 – 4 years old], we can observe a rapid increase in children’s language which, in Piaget’s view, results from the development of symbolic thought. Piaget unlike other theorists of language [who suggested that thought emerges from linguistic competence] argued that thought arises out of action and this idea is supported by research into cognitive abilities of deaf children who, despite limitations in language, have the abilities for reasoning and problem solving. Piaget argued that thought shapes language far more than language shapes thought [at least during the pre-conceptual period], and symbolic thought is also expressed in imaginative play.

However there are some limitations in the child’s abilities at the pre-conceptual period (2-4 years) of the pre-operational stage. The pre-operational child is still centred in her own perspective and finds it difficult to understand that other people can look at things differently. Piaget called this the “self-centred” view of the world and used the term egocentrism.

Egocentric thinking occurs due to the child’s belief that the universe is centred on herself, and thus finds it hard to “decentre”, that is, to take the perspective of another individual. The dialogue below gives an example of a 3-year-old’s difficulty in taking the perspective of another person:

Adult: Have you any brothers or sisters?
John: Yes, a brother.
Adult: What is his name?
John: Sammy.
Adult: Does Sammy have a brother?
John: No.

It is quite clear here that 3-year old John’s inability to decentre makes it hard for the child to realise that from Sammy’s perspective, he himself is a brother.

The egocentric trait at this particular period of development is apparent in their flawed perspective taking tasks. One of the most famous experiments carried out by Piaget is the three mountains experiment tasks, and it involves exploring children’s ability to see things from the perspective of another. In 1956, Piaget and Inhelder asked children between the ages of four and twelve [4 – 12 years old] to say how a doll would perceive an array of three mountains from different perspectives [i.e. by placing the doll at different locations].

FJ Piaget III Mountain Task.jpg

FIGURE J. Model of the mountain range used by Piaget and Inhelder viewed from 4 different sides

For example in Figure J, a child might be asked to sit at position A, and a doll would be placed at one of the other positions (B, C or D), then the child would be made to choose from a set of different views of the model, the view that the doll could see. When four and five year old children [4 and 5 years old] were asked to do this task, they often chose the view that they themselves could see (rather than the doll’s view) and it was not until 8 or 9 years of age that children could confidently work out the doll’s view. Piaget argued that this should be convincing in asserting that young children were still learning to manage their egocentricity and could not decentre from their own perspective to work out the perspective / view of the doll.

However, several criticisms have been made regarding the 3 mountain tasks, and one researcher, Donaldson (1978) pointed out that the tasks were unusual to use with young children who might not have a good familiarity with model mountains or be used to working out other people’s views of landscapes. Borke (1975) carried out a similar task to Piaget, but instead of using model mountains, he used the layout of toys that young children typically spend time with in play. She also altered the way that children were asked to respond to the question about what a different person’s view would be, and found that children as young as 3 or 4 years of age had some basic understanding of how another person’s perspective would be different from another position. This was much earlier than previously deduced from Piaget’s experiments, and shows that the type of objects and procedures used in a task can have a huge impact on the performance of the children. By using mountains, Piaget may have selected a far too complex content for such young children’s perspective-taking abilities to be demonstrated optimally.


Borke’s Experiment: Piaget’s Mountains Revised & Changes in the Egocentric Landscape

Borke’s main inquisition was about the appropriateness of Piaget’s three mountain tasks for such young children, and was concerned with the aspects of the task that were not related to perspective-taking and whether this might have adversely affected the children’s performance. These aspects were:

(i) the mountain from a different angle or not may not have sparked any interest or motivation in the children
(ii) the pictures of the doll’s views that Piaget had asked the children to select may have been too taxing for their intelligence
(iii) due to the task being unusual in nature, children may have performed poorly because they were unfamiliar with such a task

Borke considered if some initial practice and familiarity with the task would improve the children’s performance, and with those points in mind, Borke repeated the basic design of Piaget and Inhelder’s experiment but changed the content of the task, avoided the use of pictures and gave children some initial practice. She also used 4 three-dimensional  displays: there were a practice display and three experimental displays [see FIGURE B].

FB Borke's 4 three-dimensional displays

FIGURE B. A schematic view of Borke’s four three-dimensional displays viewed from above.

Borke’s participants were 8 three-year-old children and 14 four-year-old children attending a day nursery. Grover, a character from the popular children’s television show, “Sesame Street” was used for the experiment as a substitute for Piaget’s doll. There we 2 identical versions of each display (A and B), and Display A was for Grover and the child to look at, and Display B was on a turntable next to the child.

The children were tested individually and were first shown a practice display which consisted of a large toy fire engine. Borke placed Grover at one of the sides of the practice Display A so that Grover could view the fire engine from a point of view [perspective] that was different from the child’s own view of this display.

A duplicate of the fire engine [practice Display B] appeared on a revolving turntable, and Borke briefed the children, explaining that the table could be turned so that the child could look at the fire engine from ANY side. Children were then prompted to turn the table until their view of the Display B matched the exact perspective that Grover had while looking at Display A. If necessary, Borke even helped the children to move the turntable to the correct position or walked the children round Display A to show them the exact view [perspective] that Grover had in view

Once the practice session was over, the child was ready to take part in the experiment itself. This time, the procedures were similar, except no help was provided by the experimenter. Every single child was shown three dimensional displays, one at a time [see FIGURE B].

Display 1 included a toy house, lake and animals
Display 2 was based in Piaget’s model of three mountains
Display 3 included several scenes with figures and animals
Note: There were 2 identical copies of each display, and of course, children had to rotate the second  copy which was on a turntable to match the perspective [view] that Grover had in sight [as prepared in the practice session].

What Borke found was that most of the children in the experiment were able to work out Grover’s perspective for Display 1 [three and four-year-olds were correct in 80% of trials] and for Display 3 [three-year-olds were correct in 79% of trials and four-year-olds, in 93% of trials. However, for Display 2 [Piaget’s mountains], the three-year-olds were correct in only 42% of trials and four-year-olds in 67% of trials. Borke calculated an analysis of variance, and found that the difference between Displays 1 & 3 and Display 2 was significant at p < 0.001. As for errors, there were no significant differences in the children’s responses for any of the 3 positions – 31% of errors were egocentric [i.e. child rotated Display B to show their OWN view/perspective of Display A, rather than Grover’s view].

Borke successfully demonstrated that the task had a major influence on the perspective-taking performances of young children. When the display included toys that the children were familiar with and hence recognisable, and when the response involved rotating a turntable to work out Grover’s perspective, even the comparatively complex Display 3 task was successfully achieved by the children.

This seems to suggest that the poor performance by the children in Piaget’s original experiment involving three mountains was due in part to the unfamiliar nature of the objects that the children were shown.

Borke concluded that the potential for understanding the viewpoint of another was already present in children as young as 3 and 4 years of age, and this seems to be a reliable addition and revision to Piaget’s original assumption that children of this age are egocentric and incapable to taking the viewpoint of others. It now seems clear that although their perspective taking abilities may not be fully developed, they tend to make egocentric responses when they misunderstood the task, but when given the appropriate conditions, they show that they are capable of working out another’s viewpoint.

However, on a final note, it is important to also consider that Borke’s finding that children as young as three years can perform correctly in perspective-taking tasks stands in firm contrast to other researchers who have found that three-year-olds have difficulty realising another person’s perspective when the child and the other person are both looking at the same picture from different point of view [e.g. at the Louvres museum] (e.g., Masangkay et al, 1974).

 

(a) The Pre-Conceptual Period (2 – 4 years)… continued from above

Piaget use the three mountains task to investigate visual perspective taking and it was on the basis of this task that he concluded that young children were egocentric. There are also a variety of other perspective taking scenarios, and these include the ability to empathise with other people’s emotions, and the ability to know what other people are or may be thinking depending on the scene, setting and scenario (Wimmer and Perner, 1983). In other words, young children are less egocentric than Piaget initially assumed.

 

(b) The Intuitive Period (4 – 7 years)

At about the age of four, there is a further shift in thinking where the child begins to develop the mental operation of ordering, classifying and quantifying in a more systematic way. The term “intuitive” was particularly chosen by Piaget because the child is largely unaware of the principles that underlie the operations she completes and cannot explain why she has done them, nor can she carry them out in a fully satisfactory way, although she is able to carry out such operations involving ordering, classifying and quantifying.

langues-enfants-cartes-orange-d'purb dpurb site web

Difficulties can be observed if a pre-operational child is asked to arrange sticks in a particular order. 10 sticks of different sizes from A (the shortest) to J (the longest), arranged randomly on a table were given to the children. The child was asked to arrange them in ascending order [order of length]. Some pre-operational children could not complete the task at all. Some other children arrange a few sticks correctly, but could not complete the task properly. And some put all the smaller ones in one and all the longer one in another. A more advance response was to arrange the sticks so that tops of the sticks when order even though the bottoms were not [See FIGURE C].

FC Pre-operational ordering different-sized sticks

FIGURE C. The pre-operational child’s ordering of different-sized sticks. An arrangement in which the child has solved the problem of seriation by ignoring the length of the sticks.

To sum up, the pre-operational child is not capable of arranging more than a very few objects in the appropriate order.

It was also discovered that pre-operational children also have difficulty with class inclusion tasks – those that involve part-whole relations. Let us assume that a child is given a box that contains 18 brown beads and 2 white beads; all the beads are wooden. When asked “Are there more brown beads than wooden beads?” [note that the question does not make sense since all the beads are made of wood but some are brown and some are white], the pre-operational child tends to say that there are “more brown beads”. The child at the intuitive-period of the pre-operational stage finds it hard to consider the class of “all beads” [wooden] and at the same time considering the subset of beads, the class of “brown beads”[wooden + brown].

This findings is generally true for all children in the pre-operational stage, irrespective of their cultural background. Investigators further found that Thai and Malaysian children gave responses that were very similar to those of Swiss children at this stage of life [4 – 7 years old] and in the same sequence od development [the intuitive period].

Here, a Thai boy who was shown a bunch of 7 roses and 2 lotus [all are in the class of flowers], states that there are more roses than flowers [problem with class of all flowers] when prompted by the standard Piagetian questions:

Child: More roses.
Experimenter: More than what?
Child: More than flowers.
Experimenter: What are the flowers?
Child: Roses.
Experimenter: Are there any others?
Child: There are.
Experimenter: What?
Child: Lotus
Experimenter: So in this bunch which is more roses or flowers?
Child: More roses.

(Ginsburg and Opper, 1979, pp. 130-1)

One of the most extensively investigated aspects of the pre-operational child’s thinking processes is what Piaget called “conservation”. Conservation refers to the understanding that superficial changes in the appearance of a quantity do not mean that there has been any real change in the quantity. For example, if we had 10 dolls placed in line, and then they were re-arranged in a circle, it would not mean that the quantity has been altered [i.e. if nothing is added or subtracted from a quantity then it remains the same – conservation].

Piaget’s experiments revealed that children in the pre-operational stage generally find it hard to grasp the concept that an object’s qualities remain intact even if it is changed in shape and appearance. A series of conservation tasks were used in the investigations and examples are given in FIGURE D and PLATE A.

FD Piaget - Tests de Conservation

FIGURE D. Some tests of conservation: (a) two tests of conservation of number (rows of sweets and coins; and flowers in vases); (b) conservation of mass (two balls of clay); (c) conservation of quantity (liquid in glasses). In each case illustration A shows the material when the child is first asked if the two items or sets of items are the same and illustration B shows the way that one item or set of items is transformed before the child is asked a second time if they are still similar.

PA Piaget - Conservation of Number

PLATE A. A 4-year-old puzzles over Piaget’s conservation of number experiments; he says that the rows are equal in number in arrangement (a), but not in arrangement (b) “because they’re all bunched together here”.

If 2 perfectly identical balls of clay are given to a child and if questioned about whether the quantity of clay being similar in both balls, the child will generally agree that it is. However, if one of the balls of clay is rolled and shaped into a sausage [see FIGURE D(b)], and the child is questioned again about whether the amount are similar, he/she is more likely to say that one is larger than the other. When asked about the reasons for the answer, they are generally unable to give an explanation, but simply say “because it is larger”.

Piaget suggested that a child has difficulty in a task such as this because she could only focus on one attribute at a time [e.g. if length is being focussed on, then she may think that the sausage shaped clay, being longer, has more clay it it. According to Piaget, for a child to appreciate that the sausage of clay has the same amount of clay as the ball would require an understanding that the greater length of the sausage is compensated for by the smaller cross section of the sausage. Piaget said that pre-operational children cannot apply principles such as compensation.

A further example to demonstrate this weakness in the child’s reasoning about conservation is through the sweets task [see FIGURE D(a)]. In this scenario, a child is shown 2 rows of sweets with a similar number of sweets in each row [presented with one to one layout] and when asked if the numbers match in each row, she will usually agree. Shortly after, one row of sweets is made longer by spreading them out, and the child is once again asked whether the number of sweets in similar in each row; the pre-operational child usually makes a choice between the rows suggesting that one has more sweets in it. He/she may for example think that the longer row means more objects [logic of the pre-operational child]. At this stage, the child does not realise that the greater length of the row of sweets is compensated for by the greater distance between the sweets.

Compensation is only one of several processes that can help children overcome changes in appearance; another process is known as “reversibility”. This is where the children could think of literally “reversing” the change; for example if the children imagine the sausage of clay being rolled back and reshaped into a ball of clay, or the row of sweets being pushed back together, they may realise that once the change has been reversed the quantity of an object or the number of items in the row remains similar to before. Pre-operational children lack the thought processes needed to apply principles like “compensation” and “reversibility”, and therefore they have difficulty in conservation tasks.

In the next stage, which is the third stage of development known as the “Concrete Operational Stage”, children will have achieved the necessary logical thought processes that give them the ability to use the required principles and handle conservation techniques and other problem-solving tasks easily.

 

Revisions of the Pre-Operational Stage

While Piaget claimed that the pre-operational child cannot cope with tasks like part-whole relations or conservations, because they lack the logical thought processes to apply principles like compensation. Other researchers have pointed out that children’s lack of success in some tasks may be due to factors other than ones associated with logical processes.

The pre-operational child seems to lack the ability to grasp the concept of the relationship between the whole and the part in class inclusion tasks, and will happily state that there are more brown beads than wooden beads in a box of brown and white wooden beads “because there are only two white ones”. Some other researchers have focussed their attention on the questions that children are asked during such studies and found them to be unusual [e.g. it is not often in every day conversation that we ask questions such as “Are there more brown beads or more wooden beads?”]

Minor variations in the wording of the questions that enhances and clarifies meaning can have positive effects on the child’s performance. McGarrigle (quoted Donaldson, 1978) showed children 4 toy cows, 3 black and 1 white, all were lying asleep on their sides. If the children were asked “Are there more black cows or more cows?” [as in a standard Piagetian experiment with a meaningless trap wording of the question] they tended not to answer correctly. McGarrigle found that in a group of children aged 6 years old, 25% answered the standard Piagetian question correctly, and when it was rephrased, 48% of the children answered correctly – a significant increase. From such an observation it was deduced that some of the difficulty of the task was in the wording of the question rather than just an inability to understand part-whole relations.

Donaldson (1978) put forward a different reason from Piaget as a cause for children’s poor performance in conservation tasks, he argued that children have a build in model of the world by formulating hypotheses that help them anticipate future events based on their past experiences. Hence, in the case of the child there is an expectation about any situation, and his/her interpretation of the words she hears will be influenced by the expectations she brings to the situation. When in a conservation experiment, for example, the experimenter asks a child if there are the same number of sweets in two rows [FIGURE D(a)]. Then one of the rows is changed by the experimenter while emphasising that it is being altered. Donaldson suggested that it is quite fair to assume that a child may be compelled to deduce that there would be a link between the change that occurred [the display change] and the following question [about the number of sweets in each row]; otherwise why would such a precise question come from an adult if there had not been any change? If the child is of the belief that adults only carry actions when they desire a change, then he/she might assume that a change has occurred.

McGarrigle and Donaldson (1974) explored this idea in an experiment with a character known as “Naughty Teddy”, and it was this character rather than the experimenter who changed the display layout and the modification was explained to the children as an “accident” [in such a context the child might have less expectation that a deliberate treatment had been applied to the objects, and there would be no reason to believe a change had taken place]. This procedure was setup in such a way because McGarrigle and Donaldson found that children were more likely to give the correct answer [that the objects remained the same after being messed up by Naughty Teddy] in this new context than in the classical Piagetian context.

Piaget was correct to point out the problems that pre-operational children face with conservation and other reasoning tasks. However, other researchers since Piaget have found out that, given the appropriate wording and context, young children seem capable of demonstrating at least some of the abilities that Piaget thought only developed later [even if these abilities are not well developed at such a stage].

Piaget also found that pre-operational children had difficulties when faced with tasks requiring “transitive inferences”. In this case, the children were showed 2 rods, A and B. Rod A was longer than Rod B, and then Rod A was taken out of sight of the children, who were then showed only Rod B and Rod C [B was longer than C]. When the children were then asked which rod was longer, Rod A or Rod C? Young children on the pre-operational stage find such questions hard and Piaget provided the explanation that these children cannot make logical inferences such as: if A is longer than B and B is longer than C, then A must be longer than C.

Bryant and Trabasso (1971) also considered transitive inference tasks and wondered whether children’s difficulties had more to do with remembering all the specific information about the objects rather than making an inference [i.e. for children to respond correctly they would not only have to make an inference but also remember the lengths of all the rods they had seen]. Bryant and Trabasso proposed that it was possible that young children [with brains still growing and developing physiologically] who have limited working memory capacity, were unable to retain in memory all the information they needed for the task.

In another scenario, children were faced with the similar task in an investigation of transitive inferences, however this time they were trained to remember the lengths of the rods [they were trained on the comparisons they needed to remember, i.e., that A was longer than B, and B was longer than C]. It is only when Bryant and Trabasson were satisfied that the children could remember all the information were they asked the test question [i.e. which rod was longer? A or C?]. The experimenters found that children could now answer correctly. So, the difficulty that Piaget noted in those tasks was more to do with forgetting some of the information needed to make the necessary comparisons, rather than a failure in making logical inferences.

 

III. The Concrete Operational Stage (about 7 – 12 years) | Stage 3 of 4

Mikail Akar Art Education Jan 2020 dpurb site web

Image: Mikail Akar, the 7-year-old being crowned the “Mini Picasso” (2020)

At the age of about 7 years old, the thinking processes of children change once again as they develop a new set of strategies which Piaget called “concrete operations”. These strategies are considered concrete because children can only apply them to immediately present objects. However, thinking becomes much more flexible during the concrete operational period because children lose their tendency to simply focus on one aspect of the problem, rather now, they are able to consider different aspects of a task at the same time. They now have processes like compensation and reversibility [as explained earlier in understanding volume], and they now succeed on conservation tasks. For example, when a round ball of clay is transformed into a sausage shape, children in the concrete operational stage will say, “It’s longer but it’s thinner” or “If you change it back, it will be the same.”

Conservation of number is achieved first [about 5 or 6 years], then this is followed by the conservation of weight [around 7 or 8], and the conservation of volume is fully understood at about 10 or 11 years old. Operations like addition and subtraction, multiplication and division become easier at this stage. Another major shift comes with the concrete operational child’s ability to classify and order, and to understand the principle of class inclusion. The ability to consider different aspects of a situation at the same time enables a child to perform successfully in perspective taking tasks [e.g. in the three mountains task of Piaget, a child can consider that she has one view of the model and that someone else may have a different view].

However, there are still some limitations on thinking, because children are reliant on the immediate environment and have difficulty with abstract ideas. Take the following question: “Edith is fairer than Susan. Edith is darker than Lily. Who is the darkest and who is the fairest?” Such a problem is quite difficult for concrete operational children who may not be able to answer it correctly. However, if children instead are given a set of dolls representing Susan, Edith and Lily, they are able to answer the question quickly. Hence, when the task is made a “concrete” one, in this case with physical representations, children can deal with the problem, but when it is presented verbally, as an abstract task, children have difficulty. Abstract reasoning is not found within the repertoire of the child’s skills until the latter has reached the stage of formal operations.

 

Revisions of the Concrete Operational Stage

A great amount of Piaget’s observations and conclusions about the concrete operational stage have been broadly confirmed by subsequent research. Tomlinson-Keasey (1978) found that conservation of number, weight and volume are acquired in the order stated by Piaget.

As in the previous stage, the performance of children in the concrete operational period may be influenced by the context of the task. In some context, children in concrete operational period may display more advanced reasoning that would typically be expected of children in that stage. Jahoda (1983) showed that 9-year-olds in Harare, Zimbabwe, had more advanced understanding of economic principles than British 9-year-olds. The Harare children, who were involved in the small business of their parents, had strong motivation to understand the principles of profit and loss. Jahoda set up a mock shop and played a shopping game with the children. The British 9-year-olds could not provide any explanation about the functioning of the shop, did not understand that a shopkeeper buys for less than he sells, and did not know that some of the profit has to be set aside for the purchase of new goods. The Harare children, by contrast, had mastered the concept of profit and could understand trading strategies. These principles had been grasped by the children as a direct outcome of their own active participation in running a business. Jahoda’s experiment, like Donaldson’s studies (1978), indicated the important function of context in the cognitive development of children.

 

IV. The Formal Operational Stage (12 years old) | Stage 4 of 4

During the third period of development, the Concrete operations stage, we have seen that the child is able to reason in terms of objects [e.g., classes of objects, relations between objects) when the objects are present. Piaget argued that only during the period of Formal Operations that young people are able to reason hypothetically, now they no longer depend on the “concrete” existence of objects in the real world, instead they now reason with verbally stated hypotheses to consider logical relations among several possibilities or to deduce conclusions from abstract statements [e.g. consider the syllogistic statement, “all blue birds have two hearts”; “I have a blue bird at home called Adornia”; “How many hearts does Adornia have?” The young person who has now reached formal operational thinking will give the correct answer by abstract logic, which is: “Two hearts!” Children within the previous stage will generally not get past complaining about the absurdity of the scenario.

Young people are now also better at solving problems by considering all possible solutions systematically. If requested to formulate as many combinations of grammatically correct words from the letters A, C, E, N, E, V, A, a young person at the formal operational stage could first consider all combination of letters AC, AE, AN, etc., verifying if such combinations are words, and then going on to consider all three letter combinations, and so on. In the earlier stages, children would attend to such tasks in a disorganised and unsystematic fashion.

Inhelder and Piaget (1958) explained the process of logical reasoning used by young people when presented with a number of natural science experiments. An example of one of their task, “The Pendulum Task” can be seen in Figure E.

FE Piaget - Pendulum Prob

FIGURE E. The pendulum problem. The child is given a pendulum, different lengths of string, and different weights. She is asked to use these to work out what determines the speed of the swing of the pendulum (from Inhelder and Piaget, 1958).

The young person as the participant here is given a string [that can be shortened or lengthened], and a set of weights, and then asked to figure out what determines the speed of the swing of the pendulum. The possible factors are the length of the string, the weight at the end of the string, the height of the release point and the force of the push. In this particular scenario the solutions to the solving the problem are all in front of the participant, however the successful reasoning involves formal operations that would also have to incorporate a systematic consideration of various possibilities, the formulation of hypotheses (e.g., “What could happen if I tried a heavier weight?”) and logical deductions from the results of trials with different combinations of materials.

The other tasks investigated by Inhelder and Piaget (1958) included determining the flexibility of metal rods, balancing different weights around a fulcrum, and predicting chemical reactions. These tasks mimic the steps required for scientific inquiry, and Piaget argued that formal scientific reasoning is one of the most important characteristic of formal operational thinking. From his original work, carried out in schools in Geneva, Piaget claimed that formal operational thinking was a characteristic stage that children or young people reached between the ages of 11 and 15 years – having previously gone through the earlier stages of development.

 

Revision of the Formal Operational Stage

Piaget’s claim has been rectified by recent research, more researchers have found that the achievement of formal operational thinking is more gradual and haphazard than Piaget assumed – it may be dependent on the nature of the task and is often limited to certain domains.

FF Piaget - Proportion of boys at different Piagetian stg

FIGURE F. Proportion of boys at different Piagetian stages as assessed by three tasks (from Shayer and Wylam, 1978).

Shayer et al. (1976; Shayer and Wylam 1978) gave problems such as the pendulum task [FIGURE E] to school children in the UK. Their results [see FIGURE F] showed that by 16 years of age only about 30% of young people had achieved “early formal operations” [Is this shocking compared to French speaking Europe where Piaget implemented his theory? Could this provide a partial explanation to the lack of personality, emotion, creativity, openness, depth and sophistication in some populations? Interesting questions…]. Martorano (1977) gave ten of Piaget’s formal operational tasks to girls and young woman aged 12 – 18 years in the USA. At 18 years of age success on the different tasks varied from 15% to 95%; but only 2 children out of 20 succeeded on all ten tasks. Young people’s success on one or two tasks might indicate some formal operational reasoning, but their failure on other tasks demonstrated that such reasoning might be limited to certain tasks or contexts. It is highly likely that young people only manage to achieve and apply formal reasoning across a range of problem tasks much later during their adolescence.

Formal thinking has been shown by some researchers as an ability that can be achieved through training, FIGURE G shows the results of such a study by Danner and Day (1977), where they mentored students aged 10 years, 13 years and 17 years in 3 formal operational tasks. As expected, training had a limited effect on the 10-year-olds, but it had marked effects at 17 years old. In summary, it seems that the period from 11 – 15 years signals the beginning of the potential for formal operational thought, rather than its achievement. Formal operational thought may only be used some of the time, in the domains we are generally familiar with, are trained in, or which have a great significance to us – in most cases formal thinking is not used. After all, we tend to know areas of life where we should have thought things out logically, but in retrospect realise we did not do so [without any regrets sometimes].

FG Piaget - LvL of availability of formal thought

FIGURE G. Levels of availability of formal thought. Percentage of adolescents showing formal thought, with and without coaching (from Danner and Day, 1977).

The Educational Implications of Jean Piaget’s Theory of Cognitive Development

Piaget’s theory was planned and developed over many decades throughout his long life, and at first, it was slow to make any productive impact in the UK and the USA, but from the 1950s its ambitious, embracing framework for understanding cognitive growth was becoming the accepted and dominant paradigm in cognitive development.

Whatever the shortcomings are with Piaget’s theory, it impossible to deny his ingenious contributions, as his approach provided the most comprehensive description of cognitive growth ever put forward on earth. It has had considerable impact in the domains of education, most notably for child-centred learning methods in nursery and infant schools, for mathematics curricula in the primary school, and for science curricula at the secondary school level.

Piaget argued that young children’s thinking processes are quite different from that of an adult, and they also view he world from a qualitatively different perspective. It goes with the logic that a teacher must make a firm effort to adapt to the child and never assume that what may be appropriate for adults should necessarily be right for the child. The idea of “active learning” is what lies at the heart of this child-centre approach to education. From the Piagetian perspective, children learn better from actions rather than from passive observations [e.g., telling a child about the properties of a particular material is less effective than creating an environment in which the child is free to explore, touch, manipulate and experiment with different materials]. A good teacher should recognise that each child needs to construct knowledge for him or herself, and active learning results in deeper understanding.

JeanPiaget

“Our real problem is: what is the goal of education? Are we forming children who are only capable of learning what is already known? Or should we try to develop creative and innovative minds capable of discovery from the preschool age through life?” – Jean Piaget (1896 – 1980)

So, how can a teacher promote active learning on the part of the pupil? First, it should be the child rather than the teacher who initiates the activity. This should not lead us to allow the child a complete freedom to do anything they want to do, but rather a teacher should set tasks which are finely adjusted to the needs of their pupils and which, as a result, are intrinsically motivating to young learners. For example, nursery school classrooms can provide children with play materials that encourage their learning; set of toys that encourage the practice of sorting, grading and counting; play areas, like the Wendy House, where children can develop role-taking skills through imaginative and explorative play; and materials like water, sand, bricks and crayons that help children make their own constructions and create symbolic representations of the objects and people in their lives. From this range of experiences, the child develops knowledge and understanding for herself, and a good teacher’s role is to create the conditions in which learning may best take place, since the aim of education is to encourage the child to ask questions, try out experiments and speculate, rather than accept information and routine conventions unthinkingly – this also allows the child to learn and be creative about her subjective experience which is unique and different to any other child.

(1919) Jaroslava &amp; Jiri by Alphonse Mucha (1860 - 1939)

(1919) Jaroslava & Jiri, The Artist’s Children by Alphonse Mucha (1860 – 1939)

Secondly, a teacher should be concerned with the process rather that the end-product. This is in line with the belief that a teacher should be interested in the reasoning behind the answer that a child gives to a question rather than just in the correct answer. Conversely, mistakes should not be penalised, but treated as responses that can give a teacher insight into the child’s thinking processes at that time.

The whole idea of active learning resulted in changed attitudes towards education in all its domains. A teacher’s role is not to impart information, because in Piaget’s view, knowledge is not something to be transmitted from an expert master teacher to an inexpert pupil. It should be the child, according to Piaget, who sets the pace, where the teacher’s role is to create situations that challenge the child [creatively] to ask questions, to form hypotheses and to discover new concepts. A teacher is the guide in the child’s process of discovery, and the curriculum should be adapted to each child’s individual needs and intellectual level.

In mathematics and science lessons at primary school, children are helped to make the transition from pre-operational thinking to concrete operations through carefully arranged sequences of experiences which develop an understanding for example of class inclusion, conservation and perspective-taking. At a later period, a teacher can also encourage practical and experimental work before moving on to abstract deductive reasoning. Through this process, a teacher can provide the conditions that are appropriate for the transition from concrete operational thinking to the stage of formal operations.

The post-Piagetian research into formal operational thought also has strong implications for teaching, especially science teaching in secondary schools. The tasks that are used in teaching can be analysed for the logical abilities that are required to fulfil them, and the tasks can then be adjusted to the age and expected abilities of the children who will attempt them.

Considering the wide range of activities and interests that appear in any class of children, learning should be individualised, so that tasks are appropriate to individual children’s level of understanding. Piaget did not ignore the importance of social interaction in the process of learning, he recognised the social value of interaction and viewed it as an important factor in cognitive growth. Piaget pointed out that through interaction with peers, a child can move out of the egocentric viewpoint. This generally occurs through cooperation with others, arguments and discussions. By listening to the opinion of others, having one’s own view challenged and experiencing through others’ reactions the illogicality of certain concepts, a child can learn about perspectives other than her own [egocentric]. Communication of ideas to others also helps a child to sharpen concepts by finding the appropriate words.

SigmundFreudYouthAge

 

“Everyone knows that Piaget was the most important figure the field has ever known… [he] transformed the field of developmental psychology.”

(Flavell, 1996, p.200)

“Once psychologists looked at development through Piaget’s eyes, they never saw children in quite the same way.”

(Miller, 1993, p.81)

“A towering figure internationally.”

(Bliss, 2010, p.446)

 

__________

 

(II) The Theory of Attachment in Emotional Development (John Bowlby)

If we pick up a new born baby , he/she will respond without any difference to us or to any other person. However, after 9 months, the same baby will have developed one or more selective attachments and will discriminate familiar faces to unfamiliar ones. So, if we were to pick up the baby again, we may face scenarios where he/she displays anxiety or cries, but if the mother or father picks her/him up, the baby will be reassured and pacified.

This section will explore and give an account of the development of attachment relationships between infants, parents, and other close primary caregivers. The significance of such attachments for development in adult life will also be considered, with its implication for the philosophy of education in sculpting the minds of tomorrow, along with some research on parenting styles analysing some of the factors affecting successful and less successful parenting.

 

The Development of Attachment Relationships: Attachment as an innate drive

The infant’s expression of emotions and the caregiver’s response to these emotions is the fundamental foundation of John Bowlby’s Theory of Attachment. Bowlby’s (1958, 1969 / 1982, 1973, 1980) theory was inspired and influenced by an exciting and creative range of disciplines including psychoanalysis, ethology and the biological sciences. Before Bowlby, the main assumption and view of the infant-mother attachment was that it was a “secondary drive” or a side-product of the infant associating the mother with the provision of physiological needs, such as hunger [Picture B – breast feeding image].

Breastfeeding Mother

PICTURE B. Early theories of infant-mother attachment suggested that it was a secondary drive resulting from the mother satisfying the infant’s primary drives, such as hunger. / Photography:  Jo Frances

Bowlby defied this logic, and argued convincingly that attachment was an innate primary drive in all infants, and while his theory went through many revisions over the years, this argument remained fundamental.

In Bowlby’s first version of his theory of attachment (Bowlby, 1958), the emphasis was on the role of behaviours resulting from our instincts [on how behaviours such as crying, clinging and smiling served the purpose of eliciting a reciprocal attachment response from the caregiver]:

There matures in the early months of life of the human infant a complex and nicely balanced equipment of instinctual responses, the function of which is to ensure that he obtains parental care sufficient for his survival. To this end the equipment includes responses which promote his close proximity to a parent and… evoke parental activity.

(Bowlby, 1958, p. 346)

However, in the 1969 version of his theory (1st volume of his trilogy, Attachment and Loss),  Bowlby focussed on highlighting the dynamics of attachment behaviour, and switched to explaining the infant-mother tie in terms of a goal-corrected system which was triggered by environmental cues rather than innate instinctual behaviours. Whether attachment is instinctual or goal-corrected, we know that it eventually leads to the infant maintaining proximity to the primary caregiver.

Bowlby acknowledged that the development of an attachment relationship was not dependent purely upon the social and emotional interplay between infant and caregiver. Since we can only observe attachment behaviour primarily when the infant is separated from the caregiver, it is logically dependent upon the infant’s level of cognitive development in the ability for object permanence [i.e. the ability to represent an object (living or non-living) that is not physically present within the child’s proximity].

This seems to synchronise partly with Piaget’s outlook and theory of cognitive development, and indeed Bowlby was inspired by Jean Piaget, and based his argument on Piaget’s (1955) contention that this level of object permanence is not attained until the infant is approximately 8 months old. Furthermore, while children would be able to recognise familiar people before such age, they would still not miss the attachment figure and thus display attachment behaviour until they have reached the level of cognitive sophistication that comes with the ability to represent absent objects [and people, who are in the same class].

 

The Phases of Attachment: Development of Attachment Relationships

Let us imagine a classic example of a mother and child [about 1 – 2 year-old] in a park. What we might observe is that the mother is seated on a bench while the infant runs off to explore the area. Periodically, the child may be seen to stop and look back at the mother, and every once in a while may even return close to her, or make physical contact, staying close for a while before venturing off again. In most cases, the infant rarely goes beyond about 60 metres from the mother or primary caregiver, who may however have to go and retrieve the child if the distance gets too great or if the need to leave is imminent.

The scenario here from a developmental psychologist’s perspective is fairly simple; the infant is exploring the environment it is being exposed to inquisitively, and is using the mother as a “secure base” to which to return periodically for reassurance. This is one of the hallmarks of an “attachment relationship”. These observations of children in parks were made by a student of John Bowlby, Anderson (1972) in London, and the development of attachment has been described in detail by John Bowlby (1969).

Bowlby (1969, p. 79) described 4 phases in the development of attachment and subsequently extended it to a 5th.

The phases are:

I. The pre-attachment phase (0 – 2 months) is characterised by the infant showing hardly any differentiation in their responses to familiar or unfamiliar faces.

II. During the second phase (2 – 7 months), the foundations of attachment are being laid. Here infants start to recognise their caregivers, even if they still do not possess the ability to show attachment behaviours upon separation. The infant is also more likely to smile at the mother or important caregivers and to be comforted by them if distressed.

bebe-mange-puree-de-fruits.jpg

III. Clear cut attachment behaviours only start to appear after 7 months. At this phase, infants start to protest at being separated from their caregivers and become very wary of strangers [so called stranger anxiety] – this is often taken as a definition of attachment to caregiver and this onset of attachment happens from 7 – 9 months.

IV. When the attachment relationship has evolved into a goal-corrected partnership (from around 24 months / 2 years of age), [i.e. when the child also begins to accommodate to the mother’s needs, e.g. being prepared to wait alone if requested until the mother returns]. This is an important change because before this phase, the infant only saw the mother as a resource that had to be available when needed. Bowlby saw this as characterising the child at 3 years of age, although as mentioned from 2 years old babies can partly accommodate to verbal requests by mothers to await for her return (Weinraub and Lewis, 1977). From this phase onwards, the child relies on representation or internal working models of attachment relationships to guide their future social interactions.

V. The lessening of attachment is noticed as measured by the child maintaining proximity. The characteristics of a school-age child, and older, is the idea of a relationship based more on abstract considerations such as affection, trust, loyalty and approval, exemplified by an internal working model of the relationship.

Bowlby viewed attachment as a canalized developmental process where both the mainly instinctive repertoire of the new born and certain forms of learning are important in early social interactions. Certain aspects of cognitive sensori-motor development [as supported by Jean Piaget] are also fundamental for attachment. Until the developing infant can master the concept of cause-effect relations, and of the continued existence of objects [incl. persons] when out of sight, he or she cannot protest at separation and attempt to maintain proximity [note the importance of object permanence in emotional development and internal working models]. Hence, sensori-motor development is also a canalised process, and it should not be in opposition to an ethological and a cognitive-learning approach to attachment development.

 

Attachments: Between whom?

Many articles and textbooks have characterised the attachment relationship as mainly focussed on the mother (e.g. Sylvia and Lunt, 1981), and this may not be completely true, since many studies have suggested that early attachments are usually multiple, and although the strongest attachment is often to the mother, this need not always be so.

In a study conducted in Scotland, mothers were interviewed and asked to whom their toddlers showed separation protest (Schaffer and Emerson, 1964), the proportion of babies with more than 1 attachment figure increased from 29% when separation protest first appeared [about 7 – 9 months] to 87% at 18 months [1 and half year old]. It was also found that for about one third of babies, the strongest attachment seemed to be to someone other than the mother, such as father, or other trusted primary caregivers. In most cases, attachment were formed to responsive persons who interacted and played a lot with the infant; basic caregiving such as nappy changing was clearly not in itself such an important factor; and similar results were obtained by Cohen and Campos (1974).

UglyLeeches

Peinture: Sandrine Arbon

Studies in other cultures also support this conclusion, for example in the Israeli kibbutzim, young children spend the majority of their waking hours in small communal nurseries, in the charge of a nurse or metapelet. In a study of 1- and 2- year-olds reared in this way, it was found that the infants were very strongly attached to both the mother, and the metapelet; either could serve as a base for exploration, and provide reassurance when the infant felt insecure (Fox, 1977). In many agricultural societies, mothers tend to work in the fields, and often leave infants in the village, in the care of grandparents, or older siblings, returning periodically to breastfeed. In a survey of 186 non-industrial societies, it was found that the mother was rated as the “almost exclusive” caretaker in infancy in only 5 of them; hence other persons had important caregiving roles in 40% of societies during the infancy period, and in 80% of societies during early childhood (Weisner and Gallimore, 1977).

 

The Security of Attachment

Early infant-caregiver attachment relationships and the internal working models are the main aspects of Bowlby’s theory of attachment and have been given the greatest attention, with researchers developing 2 of the most widely used measuring instruments in developmental psychology to investigate Bowlby’s theoretical claims: the strange situation procedure to assess the goal-corrected system that evolved from the early attachment relationship, and the Adult Attachment Interview to assess internal working models.

Bowlby’s theory was focussed and interested with the making and breaking of attachment ties, probably because his experiences of working as a child psychologist exposed him to the negative consequences for emotional development of severe maternal deprivation [such as long term separation or being orphaned].

Nowadays, researchers and intellectuals are generally less concerned with whether a child has formed an attachment [since any child who experiences any degree of continuous care will become attached to the caregiver], but are rather more interested in the quality or security of the attachment relationship. This important shift in emphasis was due to the empirical work of Mary Ainsworth.

Ainsworth interest in the concept of attachment grew after working with Bowlby in London during the 1950s. Later, she moved to Uganda to live with the Ganda people where she made systematic observations of infant-mother interactions in order to investigate Bowlby’s goal-corrected attachment systems in action.

One factor that struck Mary Ainsworth (1963; 1967), was the lack of uniformity in infant’s attachment behaviour, in terms of its frequency, strength, and degree of organisation. Furthermore, these differences were not specific to Gandan infants, since she replicated these findings in a sample of children in the USA when she moved to Baltimore. These variations in attachment type had not been accounted for by John Bowlby’s Theory and hence, this led Ainsworth to investigate the question of individual differences in attachment.

Mary Ainsworth experience of working with Bowlby, along with her rich collection of data harvested over a period of many years, put her in a unique position in the development of attachment as an empirical field of research. Her contribution led to attachment issues becoming part of mainstream developmental psychology, rather than being simply confined to child psychiatry, and behind this achievement was an investigation of the development of attachment under normal family conditions and by developing a quick and effective way of assessing attachment patterns in the developmental laboratory.

Although the strange situation procedure (Ainsworth & Wittig, 1969) circumvented [found a way around] the need for researchers to conduct lengthy observations in the home, it was not developed simply for research convenience, but because there are problems in trying to evaluate attachment type in the child’s own home environment. For example, if a child becomes extremely distressed upon the mother moving to another room in their own home environment, this may be an indication of a less than optimal attachment achieved, because if a child feels secure then such a separation should not trigger any distress. The extensive experience of Ainsworth in observing infant-mother interactions enabled her to identify the situations that we most crucial in attachment terms, and therefore formed the basis of the strange situation procedure.

 

The Strange Situation Procedure

Ainsworth and her colleagues then developed a method for assessing the attachment strength of an individual infant towards her mother or caregiver (Ainsworth et al., 1978). The method is known as the Strange Situation, and has been widely used with 12 – 24 months old infants in many countries worldwide. To sum up, it is a method for checking in a standardised way, how well the infant uses the caregiver as a secure base for exploration, and is comforted by the caregiver after a lightly stressful experience.

The strange situation assesses infants’ responses to separations from and subsequent reunions with, the caregiver [mother here], and their reactions to an unfamiliar woman [the so-called “stranger”]. In the testing room, there are only 2 chairs [one for the mother and one for the stranger] and a range of toys with which the infant can play.

TA - The Strange Situation Procedure

Table A. The Strange Situation Procedure

As Table A shows, the episodes are ordered so that the infant’s attention should shift from the exploration of the environment to attachment behaviour towards the caregiver as the Strange Situation proceeds. The most crucial points are the infant’s responses to the 2 reunion episodes, and form the basis for assessing an infant’s security of attachment. The coding scheme for security attachment was developed by Ainsworth et al. (1978) and describes infant behaviour according to 4 indices:

1) Proximity-seeking
2) Contact-maintenance
3) Resistance
4) Avoidance

Referring to Table A, in a well-functioning attachment relationship, it would generally assumed that the infant would use the mother as a base to explore [Episodes 2, 3 and the end of Episode 5], but be stressed by the mother’s absence (Episodes 4, 6 and 7;  these episodes are cancelled if the infant is overly distressed or the mother wants to return sooner]. Special attention is also given to the infant’s behaviour in the reunion episodes (5 and 8), to see if her or she is effectively comforted by the mother. Based on those measures, Ainsworth and others distinguished a number of different attachment types.

The 4 primary ones are:

Type A – Insecure Avoidant Attachment

Insecure-Avoidant (Type A) infants display high levels of environment-directed behaviour to the detriment of attachment behaviour towards the caregiver [i.e. Avoidant (A) – avoids caregiver and explores environment]. The Insecure Avoidant Types display little if any proximity-seeking behaviour, and even tend to avoid the caregiver, by averting gaze or turning or moving away, if the caregiver attempts to make contact. Throughout the whole process of the Strange Situation, Insecure Avoidant infants appear completely indifferent toward the caregiver, and treat both the latter and the stranger is very similar ways; hence, these infants may show less avoidance of the stranger than of the caregiver.

Note that conversely, the (Type C) Insecure Resistant / Ambivalent Attached infants show high levels of environmental-directed behaviour to the detriment of the caregiver [the complete opposite to Type A].

Type B – Secure Attachment

When the dynamics of the attachment relationship is a balance between environmental exploration and attachment behaviour directed towards the caregiver [See PICTURE C], then the securely attached infants are considered as having the right balance.

PC Attachment as a balance of behaviour TA

PICTURE C. Attachment as a balance of behaviour directed toward mother and the environment. Source: Adapted from Meins (1997).

The presence of the caregiver in the pre-separation episodes affords them the security to turn their attention to exploration and play, with the confident knowledge that the caregiver will be available for comfort or support should it be required. However, attachment behaviour is triggered in securely-attached infants during the separation episodes, leading to seek contact, comfort, proximity or interaction with the caregiver when they return. Securely attached infants may or may not become distressed upon separation from caregivers, and this makes the infants’ response to separation a relatively unreliable and poor indicator of attachment security. However, regardless of their response to separation, securely attached children are marked by their positive and quick response to the caregiver’s return, displayed generally by their readiness to approach, greet and interact with the caregiver.

It important to note that Type B [Secure] Attachment is the only “secure” attachment in the group, all the rest are insecure attachment types, and in contrast to Type B, they have their balance of infant attachment tipped to either extreme [i.e. Avoidant (A) – avoids caregiver and explores environment / Resistant (C) – avoids environment and exhausts caregiver]

Type C- Insecure Resistance / Ambivalent

Insecure-resistant infants are over-involved with [to the point of exhausting] the caregiver, showing attachment behaviour even during the pre-separation episodes, with little or no interest in exploring the environment. The Insecure Resistant (Type C) infants tend to become extremely distressed upon separation, however, the over-activation of their attachment system hampers their ability to be comforted by the caregiver upon reunion – this leads to angry or petulant behaviour, with the infant resisting contact with and from the caregiver [in extreme cases this manifests itself as tantrum behaviour where the caregiver may sometimes be hit or kicked by the infant].

Type D – Insecure Disorganised

Besides the original 3 categories mentioned above distinguished by Ainsworth et al. (1978), Main and Solomon (1986, 1990) established a fourth category, Type D [Insecure Disorganised Attachment] for infants whose behaviours appeared not to match any of the A [Avoidant], B [Secure] and C [Resistant/Ambivalent] categories. These insecure-disorganised infants look disoriented during the strange situation procedure, and display no clear strategy for coping with separations from and reunion with their caregivers. Infants classified as insecure-disorganised may simultaneously display contradictory behaviour during the reunion episodes, such as seeking proximity while also displaying obvious avoidance [e.g. backing to which the caregiver or approaching with head sharply averted]. Insecure-disorganised infants (Type D) may also react to reunion with fearful, stereotypical or odd behaviours [e.g. rocking themselves, ear pulling, or freezing]. Main and Hesse (1990) argued that, although the classification criteria for insecure-disorganised attachment are diverse, the characteristic disorganised behaviours all include a lack of coherence in the infant’s response to attachment distress and betray the “contradiction or inhibition of action as it is being undertaken” (p.173).

Main and her colleagues (1985) believe the Type D [Insecure-disorganised ] is a useful extension of the original Ainsworth classification.

There are many subtypes of these main types, however most studies do not refer to them, and in older studies, type D babies [who are often difficult to classify as they do not show a clear pattern] were ‘forced’ into 3-way and 4-way classifications.

In most cases, type B babies (secure – considered as most desired, i.e. “normal” / although debated] are compared with types A and C [inscure-avoidant and insecure-resistant/ambivalent], and the type B [secure-attachment] tends to be seen as developmentally normal, or advantageous. Many criticisms have been made of the attachment typing resulting from the Strange Situation procedure (Lamb et al., 1984), particularly of the earlier work that was based on small samples, and of the normative assumption that “B is best”. They also pointed out the procedure only measures the relationship between mother and infant, and not the characteristics of the infant. Since attachment security is the dyadic measure, infant-mother attachment type is not necessarily the same as infant-father attachment type. In fact, many studies have found that the attachment type to father is not related to that with the mother; meta-analyses (Fox et al., 1991; van Ijzendoorn and De Wolff, 1997) found a very modest association between the two.

However, the strange situation procedure is today a commonly and internationally used technique. One of the most important test of utility of attachment types is that it should allow us to predict other aspects of development, and we now have considerable evidence for this (see Bretherton and Waters, 1985 and Waters et al., 1995, for reviews).

Kochanska (2001) followed infants longitudinally from 9 to 33 months and observe their emotions in standard laboratory episodes designed to elicit fear, anger or joy. Over time, type A (Avoidant – towards caregiver) infants became more fearful, type C (Resistant/Ambivalent – exhausts caregiver) infants became less joyful, type D (Disorganised – does not fit in A, B or C behavioural categories) infants became more angry; whereas type B (Secure) infants showed less fear, anger or distress. Using the strange situation procedure, secure attachment to mother at 12 months has been found to predict curiosity and problem solving at age 2, social confidence at nursery school at age 3, and empathy and independence at age 5 (Oppenheim et al., 1988), and a lack of behaviour problems (in boys) at age 6 (Lewis et al., 1984).

Is the Strange Situation valid across populations worldwide?

Van Ijzendoorn and Kroonenberg (1988) provided a cross-cultural comparison of strange situation studies in a variety of different countries. In American studies, some 70% of infants were classified as securely attached to their mothers (type B), some 20% as Type A, and some 10% as Type C. However, German investigators found that some 40-50% of infants were of Type A (Grossman et al., 1981), while a Japanese study found 35% to be of Type C (Miyake et al., 1985). These percentages do raise the question about the nature of “insecure attachment”: is it a less satisfactory mode of development or are these just different styles of interaction?

Takahashi (1990) argued that the Strange Situation must be interpreted carefully when it is applied across cultures. He found that Japanese were excessively distressed by infant alone episode (episode 6 – Table A), because generally in Japanese culture babies are never left alone at 12 months. This is the reason why fewer Japanese babies scored B (Secure). It is also important to note, that there was no chance for them to show avoidance (and score A – insecure avoidant), since the mother seeing the level of distress went straight on without hesitation to pick up the baby. This may also be possible explanation as to why many Japanese babies were C (Insecure Resistant/Ambivalent) at 12 months [still they are not at 24 months, nor are adverse consequences apparent]. This distortion can be avoided by virtually omitting episode 6 (see Table A) for such babies. Rothbaum et al. (2000) do take a more radical stance, in comparing the assessment security in the USA and Japan. They argue that these two cultures put different cultural values on constructs such as independence, autonomy, social competence and sensitivity; such that some fundamental tenets of attachment theory are called into question as cross-cultural universals.

Cole (1998) suggested that we need information of the geographical trends in socio-behavioural patterns [culture, heritage, language, arts, etc] under study if we are to understand the nature of the everyday interactions that shape the development of young children in relation to their caregivers. The strange situation may be a valid indicator but we at least need to redefine the meaning of the categories “avoidant, secure and resistant / ambivalent” according to the geographical socio-behavioural patterns [culture]. He also argued that although it is a standardised test, strange situation is really a different situation in different environmental circumstances. However for successful use of the strange situation in a non-western culture [one that is not of Western European heritage], we can take a look at the Dogon people of Mali.

Infant-mother attachment among the Dogon of Mali

The study we are about to discuss is a very rare one among its kind which took place among the Dogon people of Eastern Mali, a primarily agrarian people living by subsistence farming of millet and other crops, as well as cash economy in towns [see PICTURE D].

PD - Dogon mother spinning cotton with child on her lap

PICTURE D. Dogon mother spinning cotton with child on her lap

The study was carried out in 2 villages with a total population of about 400, and one town population of 9000, with the researchers attempting to get a complete coverage of infants born between mid-July and mid-September 1989. Not all infants could take part, due to relocation or refusal, and the researchers excluded 2 infants who had birth defects, and 8 suffering from severe malnutrition. In addition, after recruitment two infants die before or during the two-month testing period. Finally, 42 mother-infant pairs took part and provide a good quality data. The infants were 10 to 12 months old at the time of testing.

The Dogon are a polyamorous society, and mothers typically live in a compound with an open courtyard, often shared with co-wives. There was some degree of shared care of infants, about one half were cared for primarily or exclusively by the mother, about one third primarily by the maternal grandmother with a mother however being responsible for breastfeeding (see PICTURE E).

PE - Dogon mother breastfeeding her child

PICTURE E. Dogon mother breastfeeding her child.

Breastfeeding is a normative response by the mother to signs of distress in in the Dogon infants. Three related features of infant care in the Dogon – frequent breastfeeding on demand, quick response to infant distress, and constant proximity to the mother or caregiver – are seen as adaptive and there is high infant mortality [as in some other traditional African cultures].

The researchers have several objectives in mind, they wish to see if the strange situation could be used successfully in Dogon culture; one distribution of attachment types was obtained; whether infant security correlated with maternal sensitivity – a test of the Maternal Sensitivity Hypothesis; whether infant attachment type related to patterns of attachment-related communications in mother-infant interaction – the test of what the authors call the Communication Hypothesis; and to see if frightened or frightening behaviour by the mother predicted disorganised infant attachment.

Three situations were used to obtain relevant data, the behaviour being recorded on videotape in each case. One was rather new – the Weigh-In, part of the regular well-infant examination, in which the mother handed over the infant to be weighed on a scale – and mildly stressful separation for the in, especially in Dogon culture. The other two were more standard – the strange situation, carried out in an area of courtyard separated off by hanging mats; and two 15 minute observations in the infant’s home, and the mother was cooking, bathing/caring for the infant.

The following data were obtained:

  • Infant attachment classification (from the strange situation)
  • A rating of infant security on a 9-point scale (from the strange situation)
  • Mother and infant communication related to attachment, coded by 5-point Communications Violations Rating scales (from the Weigh-in)
  • Maternal sensitivity, rated in terms of promptness, appropriateness and completeness of response to infant signals (from the home observations)
  • Frightened or frightening behaviours by the mother, such as aggressive approach, disorientation, trance state, rough handling as if baby is an object, on a 5-point scale (from the home observations and the Weigh-In).

[REMEMBER!!!! [although we are quite sure you know this already] : “r” is known as the correlation coefficient and tells us 2 things: (i) Direction of Relationship + or – & (ii) Strength of Relationship : +or- .1 is a small effect / +or- .3 is a medium effect / +or- .5 is a large effect | and p-value is the critical decider of whether to reject Null Hypothesis( i.e. the scenario we rightly thought would be opposite to our predictions) if p small enough (if p < .05 we say results were statistically significant, if p < .01 we say it is HIGHLY statistically significant) we reject the Null Hypothesis [both cases].

The strange situation was found to be feasible, following quite standard procedures. The distribution of attachment types was 67% B (Secure), 0% A (Avoidant), 8% C (Resistant/Ambivalent), and 25% D (or on a forced 3-way classification, 87% B, 0% A and 13% C). This is quite unusual in having no avoidant (A) classifications; D is high but not significantly greater than Western norms.

The Maternal Sensitivity Hypothesis only received weak support. The correlation between infant security and maternal sensitivity was r = 0.28, and with p < .10; the difference in means between attachment classifications was not statistically significant (B=5.26, C=5.00, D=4.20).

The Communications Hypothesis did get support. Infant security correlated -.54 with Communications Violations (p < .001), and the attachment classifications differed significantly (B=2.66, C = 3.50, D = 3.89; p < .01).

Finally, frightened or frightening behaviour by the mother correlated r = -.40 (p < .01) with infant security, and was particularly high in children with disorganised attachment (B= 1.23, C = 1.33, D = 2.35; p < .01).

Besides demonstrating the general application of the strange situation procedure in a nonwestern group with socio-behavioural patterns very different to our own, the findings provides support for the Communication Hypothesis. The case here would have been stronger if the different kinds of communication patterns for each attachment classification had been described in more detail. For example, that insecure resistant / ambivalent (C) attachment type infants would be inconsistent and often unable to convey their intent, or to terminate their own or another’s arousal, whereas insecure disorganised (D) attachment type infants would “manifest contextually irrational behaviours and dysfluent communication” (p. 1451). As it is, the main findings show that insecure infants show more communications violations, do not describe the detailed typology. Indeed, since some of the Communications Violations rating scales were of “avoidance, resistance and disorganisation” (p. 1456), there is a possible danger of conceptual overlap between this scale and the attachment classifications.

Although support for the Maternal Sensitivity Hypothesis was we, the correlation of r = .28 is in line with the average of r = .24 found in the meta-analysis by De Wolff and Van Ijzendoorn (1997) on mainly Western samples. The researchers used a multiple regression analysis to examine the contributions of both maternal sensitivity and mothers frightened/frightening behaviour, to attachment security. They found that the contribution of maternal sensitivity remain modest, whereas the contribution of mothers frightened/frightening behaviour was substantial and significant; ratings of maternal sensitivity do not normally take account of mothers frightened/frightening behaviour, and the researchers suggest that this might explain the modest effects found for maternal sensitivity to date.

The absence of avoidant (A – avoids caregiver and favours exploration) type infants is interesting and the researchers argue that, given the close contact mothers maintained with the Dogon infants, and the normal use of breastfeeding as a comforting activity, it would be very difficult for it Dogon infant to develop an avoidant strategy [this may have some similarity with the low proportion of A-type in Japanese infants). If avoidant (A) attachment is a rare or absent when infants nursed on demand (which probably characterises much of human evolution), this might suggest that A type attachment was and is a rare except in Western samples in which infants tend to be fed on schedule, and often by bottle rather than breast, so that the attachment and feeding systems are effectively separated.

Most Dogon infants showed secure (B) attachment, but 25% scored as disorganised (D) [though mostly with secure as the forced 3-way classification]. The researchers comment that the frightened or frightening behaviours were mild to moderate, and did not constitute physical abuse. But why should mothers show these sorts of behaviour at all? An intriguing possibility is that it is related to the high level of infant mortality prevalent in the Dogon. About one third of infants died before five years of age, and most mothers will have experience in early bereavement. Unresolved loss experienced by a mother is hypothesised to disorganised (D) attachment; perhaps, frightened behaviours are more rational or expected, when the risk for infants are so much higher.

This study to great efforts to be sensitive to the geographically specific socio-behavioural patterns (culture) of the venue, when using procedures and instruments derive mainly from Western samples. A Malian researcher assisted in developing the maternal sensitivity coding, and Dogon women acted as strangers in the strange situation procedure. The Weigh-In and home observations were natural settings. The authors comment, however, that future work might make more effort to tap the perceptions of mothering and attachment held by the Dogon people themselves, in addition to the constructs coming from Western psychology.

(True, M. M., et al, 2001)

 

Back Home in the West: Why do infants develop certain attachment types?

Enfant en train de lire

Individual differences in the caregiver’s sensitivity to infant’s cues were the earliest reported predictors of attachment security. Ainsworth and colleagues (Ainsworth, Bell & Stayton, 1971, 1974; Ainsworth et al., 1978) found that mothers who responded most sensitively to their infants’ cues during the first year of life tended subsequently to have securely attached infants. The insecure-avoidant (Type A) pattern of attachment was associated with mothers who tended to reject or ignore their infants’ cues, and inconsistent patterns of mothering were related insecure-resistant/ambivalent (Type C) pattern of attachment. Although further research has largely supported this link between early caregiver sensitivity and later attachment security, the strength of the relation between these factors has not been replicated. For example, De Wolff and van Ijzendoorn (1997) conducted a meta-analysis to explore the parental antecedents of attachment security using data from 21 studies involving over 1000 infant-mother says, and reported a moderate effect size for the relation between sensitivity and attachment security (r = 0.24), compared with the large effect (r = 0.85) in Ainsworth et al.’s (1978) study. This led De Wolff and van Ijzendoorn to come to the conclusion that “sensitivity cannot be considered to be the exclusive and most important factor in the development of attachment” (p. 585).

It seemed that the construct of sensitivity might have been responsible for the result, so we return to Ainsworth et al.’s (1971, 1974) original definitions in order to have a better understanding of predictors of attachment security. In this research, we were particularly influenced by Ainsworth’s focus on the caregiver’s ability not merely to respond to the infant, but to respond in a way that was consistent with the infants cue. For example, Ainsworth et al., (1971) describe how mothers of securely attached infants appeared “capable of perceiving things from the child’s point of view” (p. 43), whereas maternal insensitivity involve the mother attempting to “socialise with the baby when he is hungry, play with him when he is tired, and feed him when he is trying to initiate social interaction” (Ainsworth et al., 1974, p. 129). Meins et al. (2001) verse argued that the critical aspect of sensitivity was the caregiver’s ability to “read” the infant’s signals accurately so that the response could be matched to this passive cue from the child.

baby-bebe-d'purb dpurb site web.jpg

In order to test this proposal, Meins et al. (2001) obtain measures of mothers’ ability to read their 6-month-olds’ signals appropriately (so called mind-mindedness), and investigated the comparative strength of mind-mindedness versus general maternal sensitivity in predicting subsequent infant-mother attachment security. Meins et al. reported that maternal mind-mindedness was a better predictor of attachment security 6 months later than was maternal sensitivity, with mind-mindedness accounting for almost twice the variance in attachment security than that accounted for by sensitivity.

This seems like a strong conclusion, since the genetic factors have been accounted for and do not contribute to attachment type as van Ijzendoorn et al. (2000) argued that it has a modest if any influence on attachment type. This can be confirmed from a twin study conducted by O’Connor and Croft (2001) when they assessed 110 twin pairs in the strange situation and found concordance of 70% in monozygotic twins and 64% in dizygotic twins – not significantly different. The model suggested estimates of only 14% of variance in attachment type due to genetics, 32% to shared environment, and 53% in non-shared environment.

A study of attachments formed by babies to foster mothers (Dozier et al., 2001) found as good a concordance between mothers’ attachment state of mind (from the Adult Attachment Interview, see below) and infant attachment type from the strange situation, as for biological mother-infant pairs, once again suggesting little genetic influence on attachment type.

So, it is fairly accepted today that mothers’ mind-mindedness is an important construct and it is defined as the mother treating her infant as an individual with a mind, instead of just an organism or small creature with needs to be satisfied. The emphasis should be on responding to the infant’s inferred state of mind, rather than simply their behaviour. In a longitudinal study of 71 mother-infant pairs, they found that maternal sensitivity (responding to infant cues) and some aspects of mind-mindedness, especially appropriate mind-related comments by the mother, measured at six months, both independently predicted security of attachment at 12 months. True et al., (2001) also found evidence that mothers’ frightened or frightening behaviour may also contribute independently to attachment security (Refer to Dogon Study above – Picture D and Picture E).

We should also take note that a huge amount of variance in attachment type appears to be related non-shared environment, and this cannot be explained by generalised maternal sensitivity. It is highly probable that, mothers are more sensitive and behave differently to some infants than others, depending on birth order, gender and infant characteristics, suggesting the need for family systems on these issues (van Ijzendoorn et al., 2000).

 

Attachment Beyond Infancy & The Internal Working Model

The attachment theory proposes that children use their early experiences with their caregivers to form internal working models (Bowlby, 1969 /1982, 1980) which incorporate representations of themselves, their caregivers, and their relationships with others. These internal working models will then be used by the child as templates for interacting with others. Consequently, because of the sensitive, loving support that securely attached children’s caregivers have supplied, these children are self-confident and have a model of themselves as being worthy; they therefore expect others to behave in a sensitive and supportive fashion. Conversely, given the patterns of interaction typically experienced by avoidant and resistant infants, insecurely attached children expect people to be rejecting, or inconsistent and ambivalent when interacting with them.

The strange situation measures security of attachment in terms of behaviours; especially how the infant behaves at a reunion of the separation. The strange situation procedure is generally used with infants between the ages of 12-24 months old. For 3 – 6 year-olds, variants of the strange situation, such as a reunion episodes after separation, have been used with some success (Main and Cassidy, 1988).

Research during the last 10 years has seen attachment become a life-span construct with corresponding attempts to measure it at different developmental stages (see Melhuish, 1993, for a review). It has been revealed that as infants grow older, in Bowlby’s 4th and 5th stages, attachment relationships become less dependent on physical proximity and overt behaviour, and more dependent on abstract qualities of the relationship such as affection, trust, approval, internalised in the child and also in the adult.

Research has revealed that it is useful to think of internal representations of the relationship in the child’s mind; the child is thought of as having an internal working model of his or her relationship with the mother, and with other attachment figures (Bowlby, 1988; Main et al., 1985). These are characterised as cognitive structures embodying the memories of day-to-day interactions with the attachment figure. They may be ‘schemas’ or ‘event scripts’ that guide the child’s action with the attachment figure, based on their previous interactions and the expectations and affective experiences associated with them.

Different attachment type would be expected to have differing working models of the relationship. Secure (Type B) attachment would be based on models of trust and affection [and a Type B infant would be able to communicate openly and directly about attachment-related circumstances, such as how they felt if left alone for a while]. By contrast, a boy or girl with an Insecure Avoidant (Type A) attachment may have an internal model of his/her mother that leaves the child without any expectancy of secure comforting from the latter when he/she is distressed [the mother may in fact reject his/her approaches]. The child’s action rules then become focused on avoiding her, thus inhibiting approaches to her that could be ineffective and instead lead to further distress; and this can be problematic, as there is less open communication between mother and son, and their respective internal working models of each other are not being accurately updated.

Insecure Resistant / Ambivalent (Type C) infants might not know what to expect from their mother, and they in turn would be inconsistent in their communication with the latter and often unable to convey their intent.

PF - Boy by Land Rover - from Separation Anxiety Test

PICTURE F. Boy by Land Rover: A picture from the Separation Anxiety Test

Over the last 15 years, researchers have attempted to measure attachment quality in older children [as much as the empirical methods allowed them to do in terms of construct validity and internal consistency], by trying to tap in to their internal working models (Stevenson-Hinde and Verschueren, 2002). One of the methods used involved narrative tasks, often using doll-play; children use a doll family and some props and complete a set of standardised attachment related story beginnings. Another method used has been the Separation Anxiety Test, in which children or adolescents respond to photographs showing separation experiences [see Picture G for an example]. The child is questioned about how the child in the photograph would “feel and act”, and then how he/she [the participating child] would feel and act if in that situation (Main et al., 1985). This test was found to have a good rater reliability and consistency for 8 to 12-year-olds. Large differences in responses between children having clinical treatment for behaviour disturbance and a normal control group was found (See Table B)

TB - Two Protocols from the Separation Anxiety Test

TABLE B. Two protocols from the Separation Anxiety Test

Securely attached children generally acknowledge the anxiety due to the separation but come up with feasible coping responses; insecurely attached children generally deny the anxiety, or give inappropriate or bizarre coping responses.

 

The Adult Attachment Interview

The internal working models of relationships can normally be updated or modified as new interactions develop. It is likely possibility that for younger children, these changes must be based on actual physical encounters. However, the Main et al. (1985) suggested that in adolescents or adults who have achieved formal operational thinking [Jean Piaget’s 4th and final stage at around the age of 12 as explained in our essay], it is possible to change / modify their internal working models without the need for such direct interaction. In order to measure attachment in older adolescents and adults, they developed the Adult Attachment Interview. This is a semi-structured interview that proves memories of one’s own early childhood experiences. The transcripts are coded, not on the basis of experiences themselves, so much as on how the person reflects on and evaluate them, and how coherent total account is [Adults’ attachment classifications are not based on the nature of their actual childhood experiences, but on the way they represent these experiences, be they good or bad]. They are also generally asked to describe their childhood relationships with mother and father, and to recall times when they were separated from their parents or felt upset or rejected. There are specific questions that also deal with experiences of loss and abuse. According to their responses during the AAI, Allsopp placed into one of the 4 attachment categories: (i) Autononous, (ii) Dismissing, (iii) Preoccupied [Or Enmeshed] and (iv) Unresolved

 

(i) Autonomous Attachment

Autonomous adults are able to give coherent, well-balanced accounts of their attachment experiences, showing clear valuing of close personal and meaningful relationships [note meaningful subjectively to the individual]. These adults classified as autonomous may have experience problems in childhood, or even had a very difficult or abusive upbringings, but they can generally have an open conversation and talk openly about the negative experiences and most seem to have managed to resolve any early difficulties and conflicts. In contrast to the open and balanced way in which autonomous adults talk about childhood experiences, adults in the remaining three categories have incredible difficulties in talking about attachment relationships.

 

 (ii) Dismissing Attachment

Dismissing adults deny the importance of attachment experiences and insist they cannot recall childhood events and emotions, or provide idealised representations of the attachment relationship that they are unable to corroborate the real-life events. [i.e. dismiss attachment relationship as of little importance, concern or influence

 

(iii) Preoccupied [or Enmeshed] Attachment

Preoccupied adults lack the ability to move on from the childhood experiences, and are still overinvolved with issues relating to the early attachment relationship [generally preoccupied with dependency on their own parents and still struggle to please them].

 

(iv) Unresolved Attachment

The final category is reserved for adults who are unable to resolve feelings relating to the death of a loved one or to abuse they may have suffered [people who have not come to terms with a traumatic experience, or work through the mourning process]

It is to be noted that, people from lower socio-economic groups are slightly more likely to score as Dismissing. However the large difference is in people receiving clinical treat, the great majority of whom do not score as Autonomous on the AAI.

 

Are attachments stable over time? From Infancy to Adult Attachment Type

The main question should be asking ourselves is does the security of attachment change the life, or does infant-parent attachment set the pattern not only for later attachment in childhood, but even for one’s own future parenting? As attachment has become lifespan construct, these questions have generated considerable research and debate.

Many studies have now spanned a period of some 20 years to examine whether strange situation classification in infancy predicts Adult Attachment Interview (AAI) classification as young adults (Lewis et al., 2000; Waters et al., 2000). The outcome is varied, but some of these studies have found significant continuity of the 3 main attachment types; that is, from Secure to Autonomous; Avoidant to Dismissive, and Resistant (Ambivalent) to Enmeshed. Several studies have also found relationships between discontinuities in attachment classification, and negative life events such as the experience of parent divorce.

 

Relationship between Adult Attachment Interview (AAI) and Infant-Parent Attachments

Adult Attachment Interview (AAI) and classifications have been found to relate systematically to the security of the infant-parent attachment relationship. Autonomous parents are more likely to have securely attached infants, and parents in the 3 non-autonomous group. Dismissing, Preoccupied and Unresolved are much more likely to form insecure attachment relationships with their infants. This relationship has been identified for both patterns of infant-mother (e.g. Fonagy et al., 1991; Levine et al., 1991) and infant-father (Steele et al., 1996) attachment. Furthermore, unresolved maternal AAI classification has been identified as a predictor of insecure-disorganised attachment (Main & Hesse, 1990; van Ijzendoorn, 1995). Thus, the way in which a parent represents their own childhood attachment experiences is related to the types of relationship formed with their children.

 

Are attachment stable over generations?

On top of the degree of continuity over time for an individual’s attachment typing, there is also evidence for the transmission of attachment type across generations; specially from the parent’s AAI (Adult Attachment Interview) Coding and their infant’s strange situation coding. Main et al. (1985) had reported some evidence for such a link, and indeed the AAI coding system is based on it; it was argued that Autonomous adults would end up with Secure infants; Dismissing adults with Avoidant infants, Enmeshed adults with Resistant (Ambivalent) infants; and Unresolved adults would have Disorganised infants. [See Table C].

TC - Hypothesized relationships between maternal stage of mind (AAI), maternal behaviour, and child attachment type

TABLE C. Hypothesised relationships between maternal stage of mind (from the AAI – Adult Attachment Interview), maternal behaviour, and child attachment type

Van Ijzendoorn (1995) looked at a large number of available studies in the decade since Main’s work and found considerable linkage between adult AAI (Adult Attachment Interview) and infant Strange Situation coding; Van Ijzendoorn argued that this “intergenerational transmission” of attachment may be via parent responsiveness and sensitivity. We discussed above how this is only a partial explanation, and other aspects of maternal behaviour and of the home environment may also be involved.

We have considerable evidence for some degree of continuity of attachment security through life, and onto the next generation; but considerable evidence that this can be affected by life events. An adult’s attachment security can also be influenced by counselling, clinical treatment, or simply by reflection [self mind-mindedness].

Some insight into this matter comes from a study by Fonagy et al. (1994). In a longitudinal study with 100 mothers and 100 fathers in London, who are given the AAI and other measures shortly before their child was born. The strange situation was used subsequently to measure security of attachment, to mother at 12 months and the father at 18 months. As many other studies have discovered, the parent’s AAI scores predicted the Strange Situation scores of the infants. The researchers also calculated the estimates of the amount of disrupted parenting and deprivation which the parents had experienced themselves, and use the measures to find out if these influenced infant attachment, which they did. However, the amount of disrupted parenting and deprivation the parents had experienced interacted strongly with the way in which the parents had dealt with their own representations of their experiences of being parented. Coding the AAI (Adult Attachment Interview), the researchers developed a Reflective Self-function scale to assess the ability parents had to reflect on conscious and unconscious psychological states, and conflicting beliefs and desires. Of 17 mothers with deprived parenting and low reflecting self-function scores, 16 had insecurely attached infants, as might have been expected. Completely opposite to this scenario 10 mothers who had experienced deprived but had high reflective self-function scores, all had securely infants. It was argued that reflective self-function could have the saliency to change the internal working models of people, and also demonstrate resilience to adversity and a way of breaking the inter-generational transmission of insecure attachment.

Adults who experienced difficult childhoods but have overcome early adversity and insecure attachment by a process of reflection, counselling or clinical help, are known as “earned secures”, and could be distinguished from “continuous secures”, who had a positive upbringing and what most might quality as “normal” childhood. Phelps et al. (1998) made home observations of mothers and their 27-month-old children, and found that earned-secures, like continuous secures, showed positive parenting; under conditions of stress, both these groups showed more positive parenting than insecure mothers.

Another fascinating perspective on this issue of inter-generational transmission of insecure attachments would be the Holocaust study (Bar-On et al., 1998; van Ijzendoorn et al., 1999). The Holocaust refers to the experiences of Jews and other persecuted unwanted & unassimilated minorities [who did not want to be Germans] in the concentration camps of World War II to be securely offloaded/deported when Adolf Hitler’s Germany became the Third Reich and when the policies changed to focus on National Socialism and Imperial Intentions of Expansion and Conquest (1939-45).

LittleJewsToBeSentBack

Jew Children: Here we see Jew school children in 1942. They look like younger children who are just beginning school. Notice that at least 2 teachers are with them. By this time the Jewish children had been forced out of public schools. For a short time however, they we allowed to attend schools set up by the Jewish community. At the time this photograph was taken, the transports to the deportation camps had already begun. Often children under 10-years of age were not required to wear the badges, but some of these children look much younger.

Although many revisionist such as the English historian, David Irving, of this dark part of human history are finding out inaccuracies regarding the true people responsible for those massacres [since no evidence has been found of Hitler giving any extermination order] along with other atrocities as evil if not worse than the deaths in concentration camps [for a section of a population that was causing instability to the proper functioning of a nation during times of revolt and huge global conflicts involving economic treaties, Jewish propaganda and ultra-liberal communist migration agendas fused with policies based on business & banking motives] committed by many of the “supposed good guys of the Allies” that involved the rape and murder of innocent children and women, fuelled by pure hate, Bolshevism and Jewish Communism against the native aryans of Germany [i.e. the German Volk/People].

A documentary extract from the diary of Dr. Joseph Goebbels who decided to take a firm stance against the national destruction of Germany (and Western Europe), Christianity, and whom many Nationally oriented thinkers consider to be among the bravest of the last great Christian Aryan men to have walked the earth. [See Aryan Race et aussi Race Aryenne / Also to be noted perhaps quite surprisingly that there were strong ancient Aryan religious & mythological warrior values embedded in the mind of Heinrich Himmler (the Reichsführer of the SS), the person believed to have taken the decision to exterminate the jews (remember the term itself originated from human sacrifices by Jews to their god, Baal), as he told his personal masseur & physician Felix Kersten that he always carried with him a copy of the ancient Aryan scripture, the Bhagavad Gita because it relieved him of guilt about what he was doing – he felt that like the sacred warrior Arjuna, who was simply doing his duty for his people and their future without attachment to his actions]

But, since the majority on this planet have been made to believe one version where all the Jews and the alien army of the allies are the good guys, and all the Germans [including Adolf Hitler] were the blood-sucking vampires who also turned into cannibals on the week ends, we are going to base our comments on this politically correct version that the history books and mainstream publishers prefer. [Politics too nowadays is in serious need of revision; are people really divided into 3 main categories? Left, Centre and Right? I tend to believe that we are above all this and have elements of all 3 embedded in us as modern human beings of the 21st century]

But getting back to the Bedouin cultured civilisation’s distinguished members, i.e. Jews as an example of victims in those concentration camps [that many people have begun to question the evidence used to claims of gas chambers (with a great amount found on territories occupied by Stalin) with many camp detainees reporting being kept in facilities with swimming pools, orchestras and kitchens, the number of casualties, and the true perpetrator of the crimes]. It is believed by most people of the 21st century who have had no other options but to take in their news from mainstream Jewish-owned media, that besides being treated like despicable rats, degraded and tortured, many of the Jews to be deported kept in those camps were killed [some shot like parasitic animals as they tried to escape], leaving behind them orphaned children in traumatic circumstances.

Our question here however in regards to the focal point of this section, i.e. “insecure attachments”, is whether such traumatic experiences could have an impact on attachment, and could this also have been transmitted inter-generationally to the Jewish children scattered around the globe today like modern gypsies? This issue of inter-generational transmission of insecure attachments is the focus of the Holocaust study (Bar-On et al., 1998; van Ijzendoorn et al., 1999). The study we are looking at encompasses 3 generations of Jews, now grandparents, who went through the Holocaust [note that the name Holocaust itself comes from an event involving human sacrifices to the Jewish god, Baal], typically as children themselves who had lost their parents; their children, now parents; and their grandchildren. These generations are compared here with comparable 3-generation families who had not experienced the Holocaust.

It was found that the effects of the Holocaust were evident in the grandparent generations, who showed distinctive patterns on the AAI (Adult Attachment Interview), scoring high on Unresolved, as would have been predicted, and high on unusual beliefs – another predicted effect of trauma and unresolved attachment issues. They also displayed avoidance of the Holocaust topic; a very common finding was that the experiences had been so horrific and disgusting that they were unable to talk about their experiences with their own offspring.

However, inter-generational transmission of attachment type was quite low for this group of Jews. The Holocaust parents (‘children of the Holocaust’) showed rather small differences from controls, scoring just slightly higher on Unresolved on the AAI. This normalization process continued to the next generation (‘grandchildren of the Holocaust’), for whom no significant differences in attachment were found from controls. This seems to suggest a minor trend of  “Unresolved” attachment among these Jews [note that this is linked to Disorganised attachment in infants and today some question whether Type-B Securely attached infants are really the “Best” way to be, and whether other personality characteristics also help shape the individual’s uniqueness throughout life, such as their reflective abilities and internal working models (reshaped by other meaningful events/relationships) – however it is also important to note that attachment types are known to remain and be transmitted over generations for the majority of people with low self-reflective skills and intelligence].

 

Disorganised Attachment and Unresolved Attachment Representation

The pattern of infant attachment classed as “Disorganised” from the Strange Situation procedure, was only acknowledged much later than the other well known attachment types [Secure, Inscure Avoidant & Insecure Resistant/Ambivalent], and appears to have rather distinctive correlates.

It has been noted that Disorganised infants may show stereotypic behaviours such as freezing, or hair-pulling; contradictory behaviour such as avoiding the caregiver [e.g. mother] despite experiencing severe distress on separation; and also misdirected behaviour such as seeking proximity to the stranger instead of the caregiver. These characteristic behaviours are known as signs of Unresolved stress and anxiety, and for these types of infants the caregiver is a source of fright rather than a symbol of safety (See Table C) – (see Vondra and Barnett, 1999, for a collection of recent research).

Van Ijzendoorn, Schuengel and Bakermans-Kranenburg (1999) reviewed a series of studies on Disorganized attachment, and argued that it was mainly caused by environmental factors [i.e. exposure]; although there is also some evidence for genetic factors in Disorganised infant attachment, and it is known to be higher in infants with severe neurological abnormalities [e.g. cerebral palsy, autism, Down’s syndrome] – around 35%, compared with around 15% in normal samples. However, Type-D (Disorganised Attachment) is also especially for mothers with alcohol or drug abuse problems (43%) or who have maltreated or abused their infants (48%). Type-D attachment is not higher in infants with physical disabilities; and it is not strongly related to maternal sensitivity as such, however there is evidence relating it to maternal unresolved loss or trauma [like the Jews of the Holocaust generation as mentioned above].

While the Maternal Sensitivity Hypothesis suggests that maternal (in)sensitivity predicts secure (B) or insecure (A,C) attachment, a different hypothesis has been proposed to explain Disorganised Type-D attachment (See Table C), which is that it is would be the result from frightened or frightening behaviour by the caregiver (generally the mother) to the infant, resulting from the mother’s own unresolved mental state related to attachment issues [e.g. abuse by her own parent; violent death of a parent/or close one; sudden loss of a child].

A study in London by Hughes et al. (2001) compared the Unresolved scores on the AAI (Adult Attachment Interview) for 53 mothers who had infants born next after still birth, with 53 controls [normal mothers], and found out that among the mothers who had previously stillborn infants, 58% scored as Unresolved, compared to 8% of Controls; furthermore, 36% had Disorganised (Type D) infants, compared with 13% of controls. A statistical path analysis [looking at the relationships among all the variables showed that the stillbirth experience predicted Unresolved maternal state of mind, and that it was this variable [i.e. Unresolved state of mind] then predicted infant disorganisation.

The hypothesised behavioural aspects of maternal unresolved state of mind [and Disorganisation in infants] were supported by the study in Mali reported above. A study in Germany by Jacobsen et al. (2000) provided further support in which 33 children were examined along with their mothers at 6 years of age. Disorganised attachment (assessed from a reunion episode) was significantly related to high levels of maternal expressed emotion, defined as speech to the child that was severely critical of them or over-involved with them.

Van Ijzendoorn et al., (1999), in a review, also found that insecure Disorganised (Type D) attachment in infants predicted later aggressive behaviour, and child psychopathology. Carlson (1998) found significant prediction from attachment disorganisation at 24 and 42 months, to child behaviour problems in preschool, elementary school and high school. Taking into consideration the prior links to parental maltreatment and abuse, it is highly likely that the Disorganised (Type D) attachment type will be found to be the most relevant aspect of attachment in understanding severely maladaptative or antisocial behaviour in later life.

 

Origins of the Insecure Disorganised State of Mind

The origins of insecure-disorganised (Type D) attachment is becoming an increasingly researched topic, and this may be due to the fact that early disorganisation (Type D) has been identified as a risk factor for later psychopathology (Fearon et al., 2010; van Ijzendoorn et al., 1999), with studies identifying a link between insecure-disorganised attachment in infancy and behavioural problems in later childhood (Lyons-Ruth et al., 1993; Munson et al., 2001; Shaw et al., 1996).

In Main and Hesse’s (1990; Hesse & Main, 2000) their seminal work led to the argument that these insecure-disorganised (Type D) infants have not been able to establish an organised pattern of attachment because they have been frightened by the caregivers or have experienced their caregivers themselves showing fearful behaviour. This is supported by findings that have linked insecure-disorganised attachment to infant maltreatment or hostile caregiving (Carlson, Cicchetti, Brnett & Braunwald, 1989; Lyons-Ruth et al., 1991), maternal depression (Radke-Yarrow et al., 1995), and maternal histories of loss through separation, divorce and death (Lyons-Ruth et al., 1991).

In a meta-analytic review however, van Ijzendoorn et al. (1999) reported that 15% of infants in non-clinical middle class American samples are classified as insecure-disorganised (Type D), suggesting that pathological parenting practices cannot fully account for disorganised attachment in infants. As highlighted by Bernier and Mains (2008), the origins of attachment disorganisation are very complex, involving factors ranging from infants’ genetic make up to parents’ experiences of loss or abuse, and much remains to be learned about why some infants are unable to form and organised attachment relationship with the caregiver.

 

Links between Attachment & Emotional Development

It is fundamental to understand and grasp the importance of the early stages of life, as the brain’s cognitive patterns are shaped by these early experiences that tend to have a lasting effect on personality. The infant’s earliest mode of exploring and engaging with the world revolves around conveying emotions: fear, discomfort, pain, contentment, happiness.

As we have already explained above in the section exploring the reasons why infants develop particular attachment types, the caregiver’s responses [not sensitivity, but mind-mindedness, i.e. the ability to respond “appropriately” to the cues] to such emotional cues and their representations of their own childhood emotional experiences [generally measured with the AAI for Autonomous, Dismissing, Preoccupied or Unresolved] are accepted as strong predictors of attachment security [i.e. Autonomous – Secure, Dismissing –Avoidant, Preoccupied- Resistant and Unresolved – Disorganised].

With this in mind, it is quite surprising that so little research has been conducted on the relation between security and children’s emotional development.

There are 2 main ways in which links between attachment and emotional development have been addressed:

(i) The research has investigated whether infants’ early emotional experiences predict attachment security

(ii) The researchers have explored whether the security of the infant-caregiver attachment relationship predicts children’s subsequent emotional development.

 

Emotional Regulation and Attachment Security

This section is focussed mainly on how caregivers’ ways of responding to the infants’ emotional cues predict later attachment security.

Mothers of insecure-avoidant infants have been found to withdraw when their infants express negative emotions (Escher-Graeub & Grossmann, 1983). Conversely, mothers of insecure-resistant infants typically find it difficult to comfort their infants effectively, meaning that their responses result in prolonging their infants’ feelings of distress (Ainsworth et al., 1978).

Cassidy (1994) argued that caregivers may enable their children to develop good emotional coping and regulation strategies through their willingness to acknowledge and respond to their children’s emotions. She also argued that secure attachment is characterised by the openness with which the caregiver [mother, father, etc] recognises and discusses the full spectrum of emotions [which leads to the child’s understanding that emotions should not be supressed and can be dealt with effectively]. Insecure-avoidant attachment is generally associated with caregivers failing to respond to their infants’ negative emotions because of their tendency to bias interactions in favour of positive emotional expressions. On the opposite, insecure-resistant attachment is associated with the caregiver amplifying the infant’s negative affect. Cassidy maintained that mothers of insecure-resistant children fail to emphasise the importance of attachment relationships, and therefore adopt strategies that fail to help the child regulate negative emotion, hence, prolonging the need for contact with the mother [or caregiver].

 

Affect Attunement

Cassidy’s views are in synchronisation with other theoretical positions, such as Stern’s (1985) characterisation of sensitive parenting in terms of effect attunement, with the sensitive mother being the type of human being who is attuned to all of her infant’s emotions, is also accepting and sharing in their affective content.

Insensitive mothers on the other hand, undermatch or overmatch their infants’ emotional signals because of their own perceptual biases.

In support of these approaches, Pauli-Pott and Mertesacker’s (2009) investigation revealed that mismatches between maternal and infant affect at 4 months [e.g. mother shows positive affect while her infant demonstrates neutral or negative affect] predicted insecure mother-infant attachment at 18 months. Mind-mindedness is also operationalised in terms of the caregiver’s tendency to accurately interpret the infant’s cognitions and emotions, and has been found to predict later attachment security (Meins er al., 2001). Thus, observations by a mother of her infant displaying surprise in response to a jack-in-the-box, followed by enigmatic comments such as “my infant is surprised” are associated with subsequent secure attachment. In contrast, insecure attachment is related to mothers misreading their infants’ internal stress by, for example, commenting that the infant is scared when no cue to suggest such an emotion is present in the infant’s overt behaviour. In more recent work it has been found that these inappropriate mind-related comments are particularly common in mothers of insecure-resistant infants, with mothers in this group being more likely to comment inappropriately on their infants’ thoughts and feelings than their counterparts in the secure, insecure-avoidant and insecure-disorganised groups.

Evidence suggests that mothers in the insecure-avoidant and insecure-resistant groups are aware of over-controlling and under controlling strategies respectively in coping with their children’s negative emotions. Berlin and Cassidy (2003) followed up a sample of infants who had been assessed in the strange situation in infancy, and questioned the mothers when the children were aged 3 about how they dealt with their child’s emotional expressive, and found that insecure-Avoidant (Type A) group mothers reported the greatest control of their 3-year-olds’ negative emotional expressiveness [e.g. expression anger or fear], whereas mothers in the insecure-Resistant(Ambivalent – Type C) reported the least control of children of their children’s expressing negative emotions.

These findings suggest that maternal behaviours associated with avoidant and resistant attachment that have been observed in infancy are stable and persist into the preschool years.

Security-related differences in the way in which children regulate their emotions are also in line with Cassidy’s (1994) approach. Spangler and Grossman (1993) took physiological measures of infant distress during the strange situation procedure and compared these measures with infants’ outward shows of upset and negative affect. The physiological measures showed that insecure-Avoidant (Type A) group infants were as distressed or more distressed than their secured group conterparts (Type B), despite the absence of overt behavioural distress observed in the insecure-avoidant (Type A) groups infants. It was therefore concluded by Spangler and Grossman that insecure-Avoidant infants mask or dampen their expression of negative emotions as a way of coping with the facts that caregivers are likely to ignore or reject their bids for contact and comfort when they are distressed.

Belsky, Spritz, and Crnic (1996) reported that 3-year-olds who had been securely attached in infancy were more likely to recall and memorise the positive emotional events that had witnessed on a puppet show, whereas insecurely attached children tended to attend and remember only the negative events. On the same note, Kirsch and Cassidy (1997) found that both secure and insecure-resistant attachment in infancy were associated at 3 years of age with better remembering and recall for a story in which a mother responded sensitively to her child than to a story where the child was rejected.

In contrast to the scenario above, insecure-Avoidant infants showed no difference in their recall of the responsive versus rejecting stories. Kirsch and Cassidy also found that 3-year-olds classified as insecure in infancy were more likely than those in secure groups to look away from drawings depicting “mother” – child engagement.

These findings suggest that the positive experiences of secure infants with their caregivers may result in these children attending more to positive emotional events because they are consistent with their attachment security.

 

__________

 

(III) The Genetic/Psychosexual Model of Development (Sigmund Freud)

“For generations almost every branch of human knowledge will be enriched and illuminated by the imagination of Freud” (Jane Harrison, 1850- 1928)

The Genetic Model of Psychosexual Stages

The genetic model that we are now going to explore may not have much to do with genes, and relates more to the “development” of the child. Sigmund Freud proposed that childhood development proceeds through a series of distinct stages to adulthood, each of them with their own themes and preoccupations.

The stages are based on the life-drive present in all organisms, as Freud proposed, and it seems logical from a physician who carried empirical work on the sexual organs of eels, to assume that all organisms have the embedded urge for “life” [i.e the life drive to keep itself and its species alive, which involves sexual selection and the fertilisation achieved through sex] that is primarily sexual but some also argued that it can be interpreted (unconsciously or consciously) in other forms [as flamboyant French psychoanalyst, Jacques Lacan proposed in his Theory with the Symbolic, the Imaginary and the Real] to suit a sophisticated society [e.g. France] with all its dimensions. Freud proposed that the psychosexual stages are understood to be organised around the child’s emerging sexuality.

It is important however to not exaggerate or misinterpret Freud’s assumption and also to remember the logic and vital purpose behind the sexual (life) drive in organisms in its own existence and continuity [breeding]. This is also a very good discussion point for the 21st century as it seems to imply that all healthy organisms should have healthy sexual drives, but whether these should “always” find expression through genital sexual acts with another organism is debatable and questionable from an ethical and moral perspective [especially for those not in a healthy and stable relationship]; hence many psychologists recommend “masturbation” as a healthy and safe alternative in managing excessive sexual desires in both young people and adults.

In the process of the child’s emerging “sexuality”, the term “sexual drive” itself meant more than simply adult genital sexuality, and from a psychological perspective, was broadly referring to a physiological/biological sense of “pleasure in the body” and more to “sensuality”. As many psychologists who based their foundations on some aspects of Freudian perspectives, it is assumed that adult sexuality is nothing more than the simple culmination of an orderly set of steps in which the child’s “psychosexual” focus shifted from one part of the body to another, with these body parts or “erotogenic zones” all having something in common with the generation of pleasure; which are orifices lined with sensitive mucous membranes.

Hence, Sigmund Freud may have adequately proposed in a statement regarding mental health that, “the only unnatural sexual behaviour is none at all.”, taking note once again that the term “sexual” from a psychologist exploring the developmental stages of a child generally tends to refer more to “sensuality”. The erotogenic body parts with orifices and sensitive mucous membranes leads to the infant sensuality being initially centred on the mouth (oral cavity), followed by the anus and then the genitals in early childhood. After some characteristic drama at about the age of 5, the child’s sexuality goes nearly completely dormant for a few years, before re-emerging with a vengeance [a rush of hardly managed sexual feelings] when puberty hits.

As the tradition on the debate of the development of the mind itself as an entity [that reflects in linguistic form the desires, both conscious and unconscious of the human organism] goes on among psychologists in the quest for these answers, we are also familiar with critics [mostly from the reductionist schools of thoughts (e.g. Pavlovian) such as the cognitive-behavioural enthusiasts and the medical department with its accolade, the pharmaceutical industry] who have not been entirely positive about Freud’s contribution to knowledge and are still unconvinced [perhaps due to their philosophy on a kind of methodological epistemology that is lacking to cope with matters of the mind] about the unconscious part of the mind that plays a huge role in our conscious behaviour. This may not be completely negative to intellectuals who subscribe to a version of reality that is embedded in language since critics in many cases have led to systematic investigations [scientific methodology] and until now there is an increasing body of evidence that points to the existence of an unconscious drift/urge/motive that exists in all organisms [e.g. as we noted in the essay about Biological Constraints in Learning by Operant Conditioning and also other studies carried out on priming along with observations of the symptomatic manifestations of certain mental disorders such as OCD and Panic Attacks].

The psychoanalytic theory has been modified by some of the best minds of the psychoanalytic tradition [e.g. Jung, Lacan, and some components adopted by ourselves in the conception of the model of mental life within the Organic Theory] since Freud left the questions open with the freedom of dialogue over the concepts and their expansions and applications throughout various dimensions [e.g. analysing qualitative subjective experiences of the expression of love and passion, or the obsoleteness of politics in modern society, or the impact of animal studies in designing a human world]. However, between all the versions of Freud’s theories, there are 3 components that have never been denied by any great psychoanalyst, which are the 3 structures first mentioned in the early Topographic Model, that is, the Unconscious, the Subconscious and the Conscious. These were later replaced with the Structural Model, which is the popular version that remapped and renamed the concepts, and which includes the (unconscious) id [present in all new born infants which consists of impulses, emotions & desires – id demands instant gratification of all wishes and needs], the (conscious, me) ego [which acts a mediator between reality and the desires of the id] and the (subconscious) superego [the conscience: the sense of duty & responsibility], that adepts such as Jacques Lacan and Carl Jung rejected over the earlier Topographic model [being one that is more flexible for the development of further refined models that also have the option to define the life force in other ways than the questionable specificity of the Structural Model’s id, ego & superego.

 

The 5 Psychosexual Stages

Stage I: The Oral Stage (from birth to 1 year old approximately)

From Freudian assumptions, it is believed that the voracious sucking of infants is not pure nutritional, although the infant clearly has a basic need to feed, it also takes a “pleasure” in the act of feeding, a feeling that Freud did not hesitate to quality as sexual and perhaps more “sensual” at this stage as babies appear to enjoy the stimulation of the lips [in play] and the oral cavity, and will often happily engage in “non-nutritive sucking” when they are no longer hungry and the milk supply is withdrawn. Beyond being an intense source of bodily pleasure – an early expression of later sexuality – sucking also represents the infant’s way of expressing love for and dependency on its feeder [normally it is the mother, but it can also be a primary caregiver that the child is attached to, hence Lacan proposed that the Oedipal & Electra complexes may not only not be true for ALL cases, but the child’s early sexual feelings may be projected on other primary caregivers and not necessarily the direct parents]. The sucking behaviour also serves to a general stance that the infant takes towards the world, one of “incorporation” or the taking in of new experiences.

 

Stage II: The Anal Stage (1 to 3 years old approximately)

At the second stage, the Anal stage, the focus shifts from one end of the digestive tract to the other at it happens at around the age of 2, when the child is developing an increasing degree of autonomous control over its muscles, including the sphincters that control excretion. After the incorporative passivity and dependency of the oral stage, the child begins to take a more active approach to life [note the term active also in line with Jean Piaget’s views on the development of the human child]. Sigmund Freud proposed that these themes of activity, autonomy and control, play out most crucially around the anus as the child learns to control defecation, and learns that it can control its direct external environment, in particular its caregivers attention, by expelling or withholding faeces. Moreover, the child takes a sort of sadistic pleasure in this control, a form of pleasure described as “Anal erotism”. An important conflict for the child during this stage involves toilet training, with struggles/disapproval taking place over the parents/caregivers demand that the child control its defecation according to particular rules. However, the anal stage represents a set of themes, struggles, pleasures, and preoccupations that cannot be reduced in any simple way to toilet-training, as many common psychology students from the wrong linguistic vein are in caricatures of Freud maybe in a defensive act for their lack of linguistic subtlety to understand the mental life and the models that govern it.

 

Stage III: The Phallic Stage (3 to 6 years old approximately)

Gradually, although still in the early childhood years, the primary location of sexual pleasure and interest shifts from the anus to the genitals, where the little boy starts to become fascinated with his penis while his counterpart, the little girl on other side of the gender register, develops a fascination with her clitoris. However, this stage is known as “phallic” and not “genital” because Freud maintained that both sexes were focused on the male organ; “phallus” referring not to the actual physical organ, the anatomical penis, but to its “symbolic value”. Briefly explained, the phallic stage is set as the little boy understanding that he has the penis [which has a symbolic value] which the little girl lacks, and develops the belief that he could possibly lose it. In contrast, the little girl does not have a penis and wishes to have one.

This is the very first time that the difference between the sexes comes into play in childhood development, and the contrast between masculinity and feminity, really becomes an issue for the child. It is also the 1st stage at which Freud’s psychosexual theory recognises sexual differences, and marks the crucial point at which, children become gendered beings [between the ages of 3 – 6].

The little boy’s and the girl’s differing relation to the phallus [remember: the “symbolic value” of it not the actual organ] plays a vital role in unfolding drama that takes place within the family during this stage, somewhere around the age of 3 to 5. It has been dubbed the “Oedipus complex”, after the Greek legend in which Oedipus unwittingly murders his father and marries his mother, his original love-object [remember the attachment period in Bowlby’s along with breastfeeding] after all, as is consequently envious of his father, who seems to have his mother to himself. The boy’s fearful recognition that he could lose his penis [symbolically: “masculinity”] – “castration anxiety” – becomes focussed on the idea that the competing male for the love of the mother[the father], could inflict this punishment on him if the boy’s sexual feelings and desire for the female figure of the caregiving mother is recognised. So, faced with fear, he renounces and represses the sexual feelings and desire, to instead identity with the father, becoming his imitator rather than his rival. In this process, the boy learns about masculinity and internalises the societal rules and norms [e.g. about relationships] that the father represents [the development of the Super-Ego, a sense of duty and responsibility, i.e. “conscience” takes place as the Structural Model suggests].

In the case of the little girl, matters are slightly different, and the developing child soon feels her lack of a penis keenly (“penis envy”) and blames the mother for leaving her so grievously unequipped, and then the father soon turns into her primary love-object [the “Electra Complex” appears as the opposite of the “Oedipus” Complex], and the mother her rival.

A similar process to the little boy now takes place in the little girl’s realm, resulting in the repression of her sexual feeling, desires and love, to shift to an identification with her mother, and hence with feminity. However, given that the girl is not under any “castration” threat, this process occurs under much less emotional pressure than in the little boy’s case. Consequently, perhaps due to this difference in emotional pressure, Freud proposed that the Electra complex was resolved less conclusively and with much less complete repression in girls than in boys, but also that girls tend to internalise a conscience [preconscious, or superego] that is in some ways weaker and less prohibitive and punitive than boys. It is not surprising that such a controversial claim about girls has been highly criticised specially with no scientific evidence to back it up; and is perhaps also one reason why Freud’s account of Oedipal [Electra complex] conflict in women has been the subject of much revision [e.g. by Jacques Lacan].

 

Stage IV: Latency (6 years old to puberty)

After the upheavals of the Oedipus and Electra complexes, the sexual drives go into a prolonged “semi-hibernation”. During the pre-pubertal school years, children engage in much less sexual activity and their relationships with others are also desexualised. Instead of desiring the primary caregivers and original love-objects, their parents, children now begin to identify with them – having structured their understanding of the world. However, this sudden interruption of childhood sexuality is largely a result of the massive repression of sexual feelings that concluded the phallic stage. One of the main consequence of this repression is that children come to completely forget their earlier sexual feelings, a major source [Freud claimed] of our general amnesia for early childhood experiences. Other institutional settings with their own social models such as formal schooling, reinforce the repression of sexuality during latency, leading children to focus their energies instead on mastering “culturally valued” knowledge and skills. Freud observed that the desexualisation of latency-age children was less complete among so-called “primitive” peoples.

 

Stage V: The Genital Stage (from the onset of puberty to death)

The latency period of forced or socially imposed sexual repression ends with the biologically-driven surge of sexual energy that accompanies puberty. This marks the final stage of psychosexual development where it all the previous stages were successfully completed, leaves the person with the ability for mature love with sexual feelings. It is important to note that the focus on sexual pleasure is once more shifted to the genitals as it was before the stage of latency [during the phallic stage (3 – 6 years old)] however, now it is fused with the ability for sensible and true affection for the object of desire [and not simply immature sexual feelings trying to find expression from an inadequately developed brain being projected at the easiest accessible caregiver].

In addition, both sexes are now invested in their own genitals rather than sharing a focus on the “symbolic value” of the penis as it occurred during the “Phallic stage”. The Genital Stage therefore marks the end of the “polymorphous perversity” of childhood sexuality. However, these erotic moments have not completely vanished but are instead subordinated to genital sexuality, often finding expression in other subtle ways [e.g. sexual foreplay].

According to the genetic model of psychosexual stages, we pass through each of the psychosexual stages on the way to maturity. However, we do not pass through them unscathed, and there are many ways in which people have problematic difficulties in particular stages [unable to progress successfully] and when such incidents happen a “fixation” develops. A fixation is simply an unresolved difficulty involving the characteristic issues of the particular stage, and leads to a fault-line in our personality, according to Freudian developmental perspectives.

If the individual failed to receive proper and reliable nurturance and gratification during the oral stage – or alternatively if they were over-indulged – a fixation on that stage may develop. It is believed that when a person is confronted with some forms of stresses, they may revert to the typical immature ways of dealing with the world of that period [at the particular point in time of that stage], this process was referred to as “regression” by Freud.

In some cases, fixations may lead to full-fledged mental disorders: Oral fixations are linked to depression and addictions, anal fixations to obsessive-compulsive disorder, and phallic fixations to hysteria [in severe cases]. Fixations [generally later countered by Reaction Formation] do not simply represent forms of behaviour and thinking that people regress to when faced with difficulties but the whole personality [thought structure] or “character” – the term Freud preferred – may be organised around the themes of the stage at which the person is most strongly fixated. As a result, Freud proposed a set of distinct stage-based character types:

(i) Oral Characters

This category of characters tend to be marked by passivity and dependency [think of the sheep metaphor], and are liable to use relatively immature ego defences such as denial.

(ii) Anal Characters

Anal people tend to be inflexible, stingy, obstinate and orderly, with a preference for defence mechanisms such as the isolation of affect [hide their feelings] and reaction formation.

(iii) Phallic Characters

Phallic characters are generally impulsive, vain and headstrong [think alpha-male prototype] with a preference for a defensive style that favours repression.

It is important to note that this 3-part typology is the closest that the psychoanalytic theory of personality comes to bringing forward an explanation for individual differences in personality from early childhood experiences. A phase of development pivotal to the other 2 mentioned theories which also attribute the foundations of fundamental structures to the period of infancy and childhood, although they all also acknowledge the individual’s ability to shape their own minds and correct their own problematic traits through reflection, and indeed as mentioned in the section on John Bowlby’s theory of attachment mothers with high reflective abilities were able to reshape the internal working models of their children’s attachment style and subsequent emotional development. It is to also be noted how all these 3 theorists although different in their perspectives, have been inspired by each other’s works, the idea of attachment itself was inspired by Freud’s pre-oedipal claims, and Jean Piaget like Sigmund Freud came from the school of thought that viewed the mind as an “active” entity in its development and creation, and not a “passive” entity generated by a ball of soft matter acting like a junction box with scripts for stimuli.

 

Psychoanalysis, then and now

One of the main claims of Freudian theory is that much of what motivates us to move forward in life is determined by the unconscious, and since by the reductionist mind state of the common researcher who sadly only had empiricism to dream of a better life for himself, these unconscious processes cannot be measured [such as moles, weight, fingers, teeth, sheep, cattle, etc], and hence it is often claimed [without much understanding or linguistic abilities or skills in discourse and philosophy] that belief in Freudian ideas is precisely that – beliefs rather than mechanical models based on empirical evidence [e.g. medicine, physics, surgery, chemistry, biology, etc – all the disciplines of the hard sciences].

However, while Freud’s views are almost impossible to test with reductionist quantitative methods, his theories and claims have influenced many psychologists who work with different methodologies and the unconscious processes of the brain are also being backed up by emerging fields that focus on the physiology of the brain [e.g. cognitive-neuroscience].

To illustrate one of those views that are hard to test empirically, consider the Freudian notion of “Reaction Formation”. It is assumed for example that if an individual is harshly [by strict parents] toilet trained as a child then the Freudian prediction would be that the person becomes “anally retentive” [i.e. excessively neat and tidy]. However, if in some ways we do recognise such tendencies in ourselves [once again prompting to the existence of a well developed with reflective and perspective taking abilities fully developed by Piaget’s standards], maybe even unconsciously, then we may react against it [Reaction Formation occurs] and we actively become very untidy.

This suggests that we are in control of ourselves and we have the ability to reverse the effects of our upbringing and early childhood experiences, which means in turn that it is impossible to predict a child’s development despite the fact that the first 6 years from birth are supposedly critical in determining later personality formation [self-reflective people save themselves from the mediocrity of the masses].

Freudian Theory has been of immense importance in pointing out 2 possibilities. One is that early childhood can be immensely important in affecting and determining later development [a position also adopted by other major theorists as we have seen such as Bowlby], and the other is that we can be driven by unconscious needs and desires which we are not aware of [until exposed to the right environmental stimuli that release them from their hidden depths]. Thus, it is assumed that if we not complete one of the childhood psychosexual stages very well, it could reflect itself later in adult disorders such as neurotic symptoms, but we would not be aware of the source or cause of the problem. The only way to come to terms with these deeply embedded problems in the depth of the individual’s psyche that has more saliency than the minor cognitive schemas for basic environmental interactions [e.g. making a cup of tea or a sandwich], is through close intensive sessions of psychoanalysis (see Picture G) in which the analyst peers into the unconscious to try and unravel [discover] the problems that occurred during the patient’s childhood development that is causing the current problems.

PG Psychoanalyst tries to discover what went wrong in your childhood that is causing your current problems

PICTURE G. The psychoanalyst tries to uncover the childhood unresolved issues to find the causes of the current problems.

Whatever its weaknesses are, the psychoanalytic theory remains the most complete theory in terms of depth and detail in capturing the essence of the human mind [soul as metaphor, or psyche], and today there are still many who believe that psychoanalytic theories are fundamental in understanding human development with many theoreticians who have brought forward variations and alternatives to Freud’s proposals on some controversial issues [e.g. Jacques Lacan, John Bowlby and Carl Jung] while many of his proposals have also lead to the scientific discovery of unconscious mental processes.

_____________________________________

 

*****

 

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Essay // Clinical Psychology: Learning Disabilities, Anxiety, Depression & Schizophrenia and the Effectiveness of Psychotherapy

Mis à jour le Jeudi, 13 Février 2020

Part 1 of 5 | Children and Adolescents’ Mental Health Services (CAMHS) & Learning and Intellectual Disabilities

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CAMHS deal with the psychological issues of people under the age of 18. They are a non-specialist service and often refer to other more specialised departments following the initial assessment of patients. The most common cases tend to be adolescents with depression and anxiety whose manifestations are not different to those of adults and so are treated fairly similarly.

Inclusivism in Learning Disabilities

In 1969, Bengt Nirje adopted and developed the concept of normalisation in Sweden and beautifully described it as…

“making available to all mentally retarded people patterns of life and conditions of everyday living which are as close as possible to the regular circumstances and ways of life of society.”

– Nirje, 1980

Learning Disability is not just an impairment in Cognition

The social impairment of Learning Disabilities – US Statute 111 – 256: Rosa’s Law defines the factual impairment, the imposed or acquired disability and the awareness of being different.

The Normalisation Theory

This theory focuses on the mainstream trends of social devaluation or deviancy making. Some categories of people tend to be valued negatively due to their behaviours, appearances and characteristics, and this places them at the risk of being devalued [according to the Normalisation Theory of Nirje on the societal processes he assumed] – people fulfil various social roles and stereotypes.

learning disabilities co ltd ii

As part of the deviancy making or social devaluation, the unsophisticated minds of the masses generally do not mean to stereotype, however they seem to do it unconsciously [the unconscious is a concept Sigmund Freud and Jacques Lacan acknowledged in their psychoanalytic theories of mental/psychological activity and mental health problems linked to psychopathic tendencies in people towards others], i.e. deviant groups with social symbols or images that are at a higher risk of being devalued are the focus of the normalisation theory, which is believed to be done with the aim of providing them with the skills they need and eventually change the status of these deviant groups to functional members of society.

Lutte contre l’illettrisme En 6ème, je ne savais pas écrire mon nom ! (2016)

Society tends to distance itself from deviant groups without any purpose or belonging, however psychologists provide support for the social integration and valued social participation of people with learning disabilities through exercises that involve learning through imitation. This challenges stereotypes within wider society through direct experiences of spending time with people who are affected by learning disabilities.

While psychology evolves and sophisticated and modern theories about intelligence and communication such as our “Organic Theory” take shape, we hope that observations such as this one may be digested and understood by the masses, that is:

“While the communicative patterns [language] in human primates vary with socio-behavioural and geographical patterns; creativity and IQ remain constant and do not change. Intelligence and creativity cannot be stopped because of linguistic differences, since talented and gifted humans do not choose the location of their birth nor their linguistic heritage but still contribute to the enhancement of our civilisation.”

Which concludes that that the intelligence of an invidual when assessed on a range of variables [e.g. perception, fluid intelligence, artistic creativity, reasoning, emotional intelligence, courage, values, etc] cannot be deduced by simply assessing their academic abilities, since human life has various sides to itself. Hence, the true worth and value of an individual may always remain a problem and a mystery to fully assess [since most only assess people on the variables they are interested in, for e.g. a company looking for a secretary will assess the applicant on her ability to handle office politics, and not other abilities essential to exist as a human within civilisation], and this seems to go in line with Jean Piaget’s deduction about the uniqueness of the human organism and mind.

Michel-Ange-Toujours-A-Apprendre-Always-Learning

“I am still learning” – Michael-Angelo at the age of 87 / Image: La Création d’Adam (1508 – 1512)

Neurodevelopmental Disorders & Intellectual Disabilities

Neurodevelopmental disorders are disorders occurring due to the biological dysfunction of the brain that in turn lead to developmental deficits that come in a range that can be very specific to global impairment. These groups however often co-occur together, i.e. one could be affected with Intellectual Disability (ID) and also Autistic Spectrum Disorders. Psychologists are expected to show great care when assessing this group of disorder as they vary in severity. Severity has 4 Specifiers and 3 Domains [Intellectual].

Specifiers: [1] Mild – [2] Moderate – [3] Severe – [4] Profound

Domains [Intellectual]: [1] Conceptual – [2] Social – [3] Practical


Intellectual Domains

The first domain, which is the Conceptual Domain refers to all things learnt at school and required for employment and adequate independent functioning within the community. Secondly, the Social Domain refers to social, developmental and emotional factors associated to age. This manifests in them as being victims of manipulation and abuse by others. Finally, the Practical Domain refers to all skills required to live healthily [also this is subject to interpretation depending on contexts, socio-linguistic and cultural settings].

Intellectual Disability

For one to be qualified as intellectually disabled, we would have to meet all the 3 criteria below:

  • Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgement, learning [also from experience].
  • Deficits in adaptive functioning that means failure to meet developmental milestones within the socio-cultural standards. Limited function in daily life, participation, communication, independence in multiple environments (i.e. Global).
  • Onset is during developmental period [childhood – another link to the Psychoanalytic theory of Sigmund Freud & Jacques Lacan]


Assessment and Judgement

Careful distinction must be made when assessing patients suspected of suffering from Intellectual Disabilities (ID) between the low end of normal function and ID itself. The most widely used method clinically are IQ assessments and typically suggest any score that is 2 Standard Deviations below the mean [IQ scores of 75 +/-5] and whether the patient has had any clinical experience. Assessment based on the patient’s reasoning in real-life situations are also made. Global Developmental Delay is a term reserved for children under 5 who cannot adequately be assessed, but have missed all their developmental milestones.


Associated Features with Intellectual Disabilities (ID) to look for when diagnosing patients are:

  • Social judgment
  • Assessment of risk
  • Self-management of behaviour – interpersonal relationships and emotions
  • Motivation in school, university or work
  • Lack of communication skills and functional problem behaviours
  • Gullibility [Diagnosis is based on how people and society mistreat them – quite shocking or controversial?]
  • People with Intellectual Disabilities (ID) are also at high risk of suicide


Prevalence of Intellectual Disabilities

In the UK, 1% of people suffer from intellectual disabilities and 0.006% of the population have severe disabilities requiring supported living [that is about 360, 000 people in the UK] – a slight bias with a ratio of 1.6:1 towards males; this is due to the vulnerability of the male brain.


Autism Spectrum Disorders

As psychology evolves more consideration are being given to a dimensional aspect of abnormal behaviour rather than the usual dimensional [i.e. inflexible and sometimes exaggerated in terms of descriptive precisions disregarding individual fluctuations in symptomatic manifestations] constructs of mental disorders. Autistic Spectrum Disorders (ASD) was the first mental disorder to initiate such a shift from categories to dimensions.

  • Autistic Spectrum Disorders (ASD) with Intellectual Disability (ID) = Autism
  • Autistic Spectrum Disorders (ASD) without Intellectual Disability (ID) = Asperger’s Syndrome


Characteristics of Autism Spectrum Disorders

ASD is characterised mainly by deficits in social communication and restricted patterns of behaviour. For a diagnosis of ASD the deficits must appear early in the developmental period [however they cannot be diagnosed until the demands of a particular task exceeds the child’s capabilities] – so more severe it is the earlier it is diagnosed [e.g. Rett syndrome].


[A] Communication in ASD

In ASD, it is common to find persistent deficits in social communication and social interaction across multiple contexts illustrated by:

  • Deficits in social-emotional reciprocity, ranging from abnormal social approach. Failure to initiate or respond to social communications. Reduction in sharing interests, affect and emotions.
  • Deficits in non-verbal communicative behaviours used in normal social interactions. Abnormal or no eye contact, body language or deficits in reading [understanding] gestures. A total lack of facial expression and non-verbal communication.
  • Deficits in developing, maintaining and understanding relationships [e.g. from difficulties in adjusting behaviour to suit context]. Difficulties in sharing imaginative play or in making positive social acquaintances or friends. Hardly any interest in any form or peers.


[B] Behaviour in ASD

It is also fairly normal to notice restricted, repetitive patterns of behaviour, interests, or activities manifested by at least two of the following:

  • Stereotyped or repetitive motor movements, use of objects, or speech
  • Insistence on sameness, inflexible adherence to routines, or ritualised patterns of behaviour. Shows extreme distress at small changes, difficulty in transition, rigidity, insistence on same route taken or foods
  • Hyper or hypo-reactive to sensory inputs or unusual interest in sensory aspects of the environment (indifference or hyper-responsive to pain, temperature, sound, textures, excessive smelling to touching of objects, visual fascination with movements or lights.

ASD may also manifest itself with or without intellectual disability, with a similar scenario for language impairment, and can be associated with medical or genetic conditions or environmental factors [exposure]. ASD can also be associated with another neurodevelopmental, mental or behavioural disorder and can also comprise catatonia.
Features to look out for

  • People with ASD often have uneven profiles or abilities – even the high functioning variants, and this can lead to substantive stress for them
  • They also often have odd motor idiosyncrasies – such as an odd gait, clumsiness and abnormal ambulatory movements.
  • Disruptive, challenging behaviour and injuries are also very common
  • As sufferers of ASD age, they are also more prone to developing anxiety and depression and are likely to end up in a catatonic state


Prevalence

Autistic Spectrum Disorders (ASD) seem to be a genetic disorder, however it involves a variety of genes. 15% of ASD is due to a known mutation in over 90% of concordance studies with twins. Most researchers nowadays suggest that it is inherited and polygenic [lots of genes from genetic ancestry with each adding their weight to the likelihood of the disorder manifesting]. Males are 4 times more likely to suffer from ASD than females, and even high functioning adults with ASD have poor functioning, such as low rates of independent living and employment – older adults tend to become isolated and do not engage in help-seeking behaviours [note that this is different to individuals who may have a solitary personality by conscious choice or a highly selective social circle in personal relationships based on values, in ASD the patients are generally not conscious of the causes of their debilitating condition]

Specific Learning Disorders

Specific Learning Disorders are characterised by the following:

[A] Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that has persisted for longer than 6 months:

(1) Inaccurate or slow reading
(2) Difficulty understanding meaning in what was read
(3) Difficulties with spelling
(4) Difficulties with written expression
(5) Difficulties mastering number sense, number facts and calculation
(6) Difficulties in mathematical reasoning

[B] The affected academic skills are substantially and quantifiably below the expected level for the chronological age causing interference with academic, occupational or daily living

[C] Learning difficulties begin during school-age years, but will only manifest itself and be diagnosed when the affected person’s capabilities are stretched by demands

[D] It is also independent and not caused by another health or psychological disorder


Specifications of Specific Learning Disorder

SLD generally involves impairment in reading, writing and mathematics. If it is mild in intensity, the person can generally compensate. Moderately affected people however cannot compensate, but will respond to specialist teaching. Finally, severe conditions require specialist teaching in a specialist school as learning will not occur without such arrangements.


Features to look out for in confirming SLD

  • SLD can occur in any individual, even those classed as gifted (IQ 130+)
  • It is usually diagnosed in the early years, but in higher ability individuals it may manifest in odd ways especially when their compensatory methods are undermined
  • Patient generally have difficulties with motor co-ordination
  • It is a life-long condition and does not improve with therapy, but has to be compensated for
  • Patients also tend to have working memory deficits and keep messy environments
  • Early signs include mispronouncing words, struggling to break down words into syllables


Prevalence of Specific Learning Disorders (SLD)

SLD tend to occur in premature children or among societies with a very low birth rate. It is also more common in children with parents that smoke cigarettes [nicotine?] and is 8 to 10 times higher in families with a heritability index of 0.6 and 3 times higher in males [the vulnerability of the male brain once again]. The problems it causes with attention are likely to predict problems with the mathematical and reading components of the brain. SLD usually ends with unemployment, under-employment depression, poorer mental health and suicidal behaviour – support of any kind alters all of these outcomes.

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Part 2 of 5 | Anxiety Disorders

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Anxiety disorders are linked to the development of irrational fears of situations that are not life-threatening (Antony & Stein, 2009a). The avoidance of feared situations or experiences also lead to non-adaptive behavioural patterns. People suffering from anxiety disorders generally have fears accompanied by intense physiological arousal displayed by some or all of the following features: accelerated heartbeat, sweating, trembling, sensations of shortness of breath or smothering feelings of choking, chest pain, nausea, numbness or tingling, and chills or hot flushes. Other experiences of dizziness, derealisation (feelings of unreality) or depersonalization (feelings of being detached from the self) are also present in some cases.

In contemporary psychology there are a number of distinctions made between a variety of anxiety disorders based on the developmental timing of their emergence, the classes of stimuli that elicit the anxiety, the pervasiveness and topography of the anxiety response, and the role of clearly identifiable factors in the aetiology [the cause, set of causes, or manner of causation] of the anxiety.

The six main anxiety disorders are described below.


[1] Separation Anxiety

This condition most occurs in children and is generally manifested by a recurrent and persistent fear that is aroused when separation from the parents or caregivers is anticipated or imminent (American Psychiatric Association, 2000; Furr et al., 2009; Pine & Klein, 2008; World Health Organization, 1992). The persistent, excessive worry about losing, or about possible harm befalling a parent is the main characteristic of Separation Anxiety Disorder with nightmares on the similar themes also present in some cases along with recurrent head-aches, stomach-aches, nausea and vomiting. Separation anxiety is also one of the most common causes of school refusal, and sufferers may also display a refusal to sleep without being in close proximity with the parents.


[2] Phobias

Phobic anxiety is the irrational and intense fear aroused when one is faced with an object, event or situation from a clearly defined class of stimuli which is exaggerated in terms of danger posed (American Psychiatric Association, 2000; Blackmore et al., 2009; Hofmann et al., 2009; World Health Organization, 1992). When the person affected is exposed to the phobic stimulus, or anticipates its exposure, panic attacks may arise in adults whereas is children this may lead to excessive crying, tantrums, freezing or clinging. The persistent avoidance of phobic stimuli in phobias is endured with intense distress and this affects an individual’s personal functioning.

In the DSM, specific phobias are subdivided into those associated with animals, injury (including injections), features of the natural environment (such as heights or thunder), in particular situations (such as elevators or flying). These specific phobias are different from social phobias and agoraphobia.

In those affected with social phobias, anxiety is generally mainly aroused by social situations [e.g. public speaking, eating in public where there is the possibility of scrutiny by others and humiliation or embarrassment as a result of acting inappropriately]. In those with agoraphobia, the condition is known to manifest itself with panic attacks in public places, such as being in a queue, or on public transport – hence, these situations tend to be compulsively avoided to prevent the reoccurrence of the panic attacks.


[3] Generalized Anxiety Disorder

One of the main characteristics in general anxiety disorder is the constant feeling that misfortunes of various sorts will occur (American Psychiatric Association, 2000; Bitran et al., 2009; Hazlett-Stevens et al., 2009; World Health Organization, 1992) and the anxiety is not focused on one particular object or situation along with difficulties controlling the worrying process and a belief that worrying is uncontrollable.

General anxiety disorder is mainly composed of nervousness, restlessness, difficulty relaxing, feeling on edge, being easily fatigued, difficulties in concentration, irritability, tearfulness, sleep disturbance and signs of autonomic over-reactivity such as trembling, sweating, dehydrated mouth, light-headedness, palpitations, dizziness and stomach discomfort. [DSM requires some or more of those symptoms to be present]

Case Example of Generalised Anxiety Disorder

Margie, a 10 year old girl was referred to the psychologist after displaying excessive tearfulness in school, the condition which had been gradually amplifying over a number of months and the bouts were unpredictable. Margie would often end up in tears while playing with her friends during break time or when spoken to by the teacher. In the family doctor’s referral letter she was described as a worrier like her mother.

Presentation

in the assessment interview Margie explained that her worries were mainly about a routine daily activities and responsibilities, she would also worry about doing poorly at school and that she had made mistakes which would later be discovered, that her school friend would not like her, that she would disappoint her parents with the way she did her household chores, that she would either be too late or too early for the school bus, that there would not be any space for on the bus and that she would forget her school books. Her worries also extended to health with frequent stomach aches.

The safety of a family also troubled her, she would worry that her house would be struck by lightning, that the river would break its banks and flood the low-lying fens where she lived, washing away her whole house. The future was also a major concern of hers as she worried about failing her exams and being unable to find a satisfactory job, and being unable to find a marital partner or marrying an inadequate person. A continuous feeling of restlessness with the inability to relax was also reported by her.

Family History

The family was very close and Margie was the eldest of four children and the only girl. It was observed during the intake interview that the mother and the father displayed symptoms of anxiety, while the former had been treated with benzodiazepines for anxiety over a number of years. The family also admitted to regularly discuss their problems about their own health and safety and their own worries about the uncertainty of the future.

The father, Oliver was employed by the insurance company and regularly have conversations at the dinner table about the accidents and the burglaries that had befallen his client, and Margie regularly participated in these conversation, being the eldest among her siblings. However the main concern of the parents was about Margie’s tearfulness which they believed was unusual along with her worries and fears which they thought as legitimate. Margie spent a lot of time with her parents’ company but also had a couple of close friends with whom she played at the weekends.

Formulation

Margie was diagnosed with generalised anxiety disorder. The precipitating factor for the condition was not apparent as it had gradually evolved over the course of Margie’s development. The referral however, was precipitated by episodes of tearfulness at school. The predisposing factors in her case comprised of a highly likely possibility of genetic vulnerability to anxiety and exposure to family culture characterised by an excessive concern with safety and oversensitivity to dangerous situations. The ongoing parental conversations about potential threats to the family’s well-being likely maintained the condition along with inadvertent reinforcement of Margie’s tearfulness at school, where her tears were responded to with considerable concern.

The protective factors in the case included good premorbid adjustment, the parents’ and the school’s commitment to solving the problem and the availability of peer group support. [This formulation is diagrammed below]

General Anxiety Disorder Formulation

Treatment

In this particular case, treatment involved family work focused on helping Margie parents reduce the amount of time they spent discussing themes related to danger and threats to their health and safety, and increase the amount engaged in activities and discussions focused on Margie’s strengths and capabilities. The parents were also assisted in coaching Margie into learning relaxation skills and mastery oriented coping self- statements. Eventually Margie showed improvement in her adjustment in school with some reduction in anxiety and tearfulness.

[4] Panic Disorder

In panic disorders, there are recurrent unexpected panic attacks; an ongoing primary fear of further attacks; secondary fear of losing control, going insane, having a heart attack or dying (American Psychiatric Association, 2000; Ballenger, 2009; Hofmann et al., 2009; World Health Organization, 1992). Acute episodes of intense anxiety our experienced in panic attacks, and these reach a peak within 10 minutes. They are characterised by autonomy hyper arousal shown by some of the following symptoms:

– Palpitations

– Sweating

– Trembling or shaking

– Shortness of breath

– Feelings of choking or smothering

– Chest pain or discomfort

– Nausea or abdominal distress

– Dizziness

– Chills or hot flushes

– Parasthesias (Numbness or tingling sensations)

– Derealisation (Feelings of unreality)

– Depersonalisation (Feelings of being detached from oneself)

In panic disorder, patients tend perceive normal fluctuations in autonomic arousal as a stimulus that provokes anxiety, with the belief that these may signal the onset of a panic attack. During a panic attack, patients typically tend to report an irresistible urge to escape the location where the attack occurred and to avoid such situations in the future. Public settings are usually the most common location where panic attacks take place [e.g. queues, public transport, shopping mall, etc] and acute autonomic arousal is only alleviated upon escape from these places or situations – hence secondary agoraphobia often develops when the patient fears leaving the safety of their homes in case of panic attacks occurring in public settings.

[5] Posttraumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) tends to occur after a catastrophic trauma such as a terrorist attack, an armed combat/robbery, a natural or man-made disaster, a serious accident that was perceived to be potentially life-threatening for oneself or others, torture, child abuse or rape.

PTSD is mainly composed of:

– Recurrent intrusive traumatic memories

– Intense anxiety in response to these memories and ongoing hyper arousal in anticipation of their recurrence

– attempts to regulate anxiety and hyper arousal by avoiding cues that trigger traumatic memories and attempts to suppress these memories when they intrude into consciousness (American Psychiatric Association, 2000; Ehlers, 2009; Friedman, 2009; World Health Organization, 1992).

Recurrent, traumatic memories include flashbacks, nightmares, or repetitive trauma themed play in the case of children, and these occur in response to internal (psychological) or external (environmental) cues that symbolise the traumatic event or aspects of it. Since patients with PTSD tend to anticipate the recurrence of traumatic memories, they experience chronic hyper-arousal which may in turn lead to difficulties in concentration, sleep difficulties, hyper-vigilance and irritability. In PTSD, the attempts to suppress traumatic memories and the avoidance of trauma-related situations may turn out to be unsuccessful, when such a scenario occurs, the PTSD person generally experiences an increase in the frequency and intensity of past traumatic memories. Emotional numbing is also quite common in chronic cases due to the frequent attempts to keep the trauma-related memory out of consciousness – this eventually leads to the inability to recall the traumatic memories. To some this may seem like a solution but the cost is excessive since emotional numbing does not only result in the exclusion of trauma-related emotions such as anxiety and anger out of consciousness, but also tender feelings such as love and joy – which cease to be experienced by the patient.

PTSD may also lead to a subjective sense of foreshortened future to the patient and this may also be accompanied by limited involvement in his/her usual activities.

[6] Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is generally characterised by distressing obsessions and compulsive rituals that reduce the anxiety associated with those obsessions [like 2 opposing forces] (American Psychiatric Association, 2000; Matthews, 2009; World Health Organization, 1992; Zohar et al., 2009). Obsessions are stereotyped thoughts, impulses or images that are recurrent and persistent. These cause serious anxiety to the patient since they are experience as senseless, uncontrollable and involuntary, and are linked to issues such as obscenity [this does not mean that healthy people with normal sexual feelings in healthy relationships have OCD], violence and danger [for e.g. some people suffer from irrational fears of the possibility of a catastrophe occurring unless symmetry or order is maintained, or there may be fears of losing control and violently raping or assaulting others, or fears of contamination [hygienic].

These compulsions are ritualistic and repetitive accompanied by stereotyped behaviours such as hand washing, ordering and checking or mental acts such as repeating words silently [which some patients feel compelled to do to regulate the anxiety caused by the obsessions], counting or praying [this should not lead to the belief that all people with faith in God suffer from OCD]. Compulsions are generally excessive attempts or unrealistic ways to avert imagined dangers entailed by these recurrent obsessions that are debilitating and are usually recognized as pointless while repeated attempts are made to resist them [once again this seems to be linked to the unconscious yet active component of mental activity and yet again leads us to Sigmund Freud and Jacques Lacan].


Clinical Features of Anxiety Disorders

The 6 anxiety disorders listed above are classified into the domains of Perception, Cognition, Affect, Arousal, Behaviour and Interpersonal Adjustment. In regards to perception, the disorders vary in the classes of stimuli that elicit the anxiety in the patient.

i)Perception

In cases of Separation Anxiety, the separation itself is the stimulus. Where phobias are the condition present, it is specific creatures [e.g. animals], events [e.g. injury], or situations [e.g. meeting new people] that trigger the anxiety. With Generalized Anxiety Disorder [GAD], the interpretation of multiple aspects of the environment end up being interpreted as potentially threatening. Panic disorder is characterised by somatic sensations of arousal such as tachycardia being perceived as threatening since they are treated as the signals that lead to full-blown panic attacks. In people with PTSD external and internal cues that bring back memories of the trauma that led to the condition elicit anxiety. In Obsessive Compulsive Disorders (OCD) stimuli that evoke obsessional thoughts elicit anxiety [e.g. potentially dirty environments or situations may give rise to obsessional ideas about hygiene and cleanliness, and anxiety about contamination.

ii)Cognition

It is important to note that in all 6 of those listed anxiety disorders, that the central organizing theme around cognition is “detection and/or avoidance of danger”. In children with Separation Anxiety there is the irrational belief that the caregivers or parents will be harmed if the separation occurs. In people affected by Phobias there is a constant fear of being harmed by either the feared object or creature, or being in the feared situation [e.g. being bitten by a god – in the case of Dog Phobia OR being negatively judged by meaningless strangers that have no connection or impact on the life of the patient in the case of Social Phobia]. As for Generalized Anxiety Disorder (GAD), patients tend to catastrophize about any features of their environment [e.g. fears of their house being burnt down, or that they will be the victim of a car crash, or punishment for some wrongdoing, they will be forsaken by those they consider as friends, and so forth – they also believe that their worries are uncontrollable. In Panic Disorder, there is the belief that more panic attacks are imminent and that they might be fatal to the patient. In many cases secondary agoraphobia also develops as they individual develops the belief that remaining in the safety of their homes might lower the probabilities of suffering from a panic attack. As for PTSD, there is the belief that as long as the intrusive memories of the trauma are forced out of consciousness, the danger of re-experiencing the intense fear, distress and horror associated with the traumatic event that led to the condition of PTSD can be avoided. Obsessive Compulsive Disorder (OCD) generally leads to obsessions mainly concerned with dirt and contamination; catastrophes such as fires, illness or death; symmetry, exactness and order; religious scrupulosity; disgust with secretions and bodily wastes [e.g. urine, saliva or stools]; lucky or unlucky numbers and extreme, wild, violent and even dangerous sexual thoughts [risk-taking] – the neutralisation of the threat posed by specific obsession-related stimuli is believed to be achieved through being engaged in specific rituals.

iii)Affect

In all 6 of the mentioned anxiety disorders affective states generally follow the beliefs about threat and danger, and these are characterized by feelings of uneasiness, restlessness and tension. In the case of OCD, outbursts of anger may occur if the patient is restricted from executing his/her compulsive rituals or if compelled to approach the feared stimuli; and in children with Separation Anxiety Disorder (SAD) may display aggressive tantrums if compelled to stay in school without their caregivers or parents. In Post-Traumatic Stress Disorder (PTSD), on top of the affective experiences of tension and uneasiness, emotional numbing arises from repeated attempts to exclude all affective material from consciousness.

iv)Arousal

The pattern of physiological arousal varies depending on the frequency of contact with the feared stimuli. In Separation Anxiety Disorders (SAD), hyper-arousal only occurs when separation is anticipated or imminent. In the case of Specific Phobias hyper-arousal only manifests in the present of the feared object or animal. In General Anxiety Disorder (GAD), a pattern of ongoing hyper-arousal can be observed, while in Panic Disorder and PTSD it is moderate followed by brief episodes of extreme hyper-arousal – these occur during attacks in Panic Disorder and when memories of the traumatic event intrude into consciousness in PTSD. In the case of OCD, specific cues related to the obsessions evoke acute and intense episodes of arousal.

In somatic symptoms the extent to which physiological arousal finds expression varies, for e.g. recurrent abdominal pain and headaches are quite common in Separation Anxiety. Sleep problems also occur in most Anxiety Disorders. In Panic Attacks it is also common to notice full blown attacks with sweating, feelings of choking or smothering, shortness of breath, trembling, nausea, dizziness, chest pains, hot flushes or chills, parasthesias, depersonalization or derealisation.

v)Behaviour

All Anxiety Disorders are characterized by avoidance behaviours, and in Specific Phobia, avoidance may even lead to a constriction in lifestyle [using an Injury Phobia as example, the patient may refuse to take part in any form of physical activity [e.g. sports] or ride a bicycle]. In other cases, the patient sometimes become house bound due to his compulsive avoidance, and this generally occurs in Separation Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder and PTSD. In those with PTSD, the use of alcohol or drugs to alleviate negative affect and suppress traumatic memories is quite common; and in OCD the patients generally engage in compulsive rituals in a desperate effort to regulate their anxiety associated with obsessional thoughts [it may be fair to note the relation between the Anxiety [as the Signifier] and the Obsessional Thoughts [as the Signified] in a Lacanian perspective here to point out the logic behind the flamboyant Frenchman’s model of Mental Activity based on Freud’s initial Topological Model – the Unconscious, the Preconscious and the Conscious]. These compulsions in OCD genereally include washing, repeating a particular action, checking, removing contaminants, touching, ordering and collecting.

vi)Interpersonal Adjustment

All 6 Anxiety Disorders affect interpersonal adjustment in a precise manner. In cases of Simple Phobia, interpersonal difficulties arise only in those situations where the individual does not conform or co-operate with normal activities [deemed social] so as to avoid the feared stimuli [e.g. a brief episode of marital conflict may occur if a husband refuses to enter an elevator at a shopping mall because of his claustrophobia]. Separation Anxiety Disorder (SAD), Panic Disorder (PD), Generalized Anxiety Disorder (GAD) and Post-Traumatic Stress Disorder (PTSD) sometimes prevent young people from attending school or adults from attending work, and in all those situations friends or family relationships may be seriously compromised. In the case of OCD peers or relatives may sometimes attempt to reduce the sufferer’s anxiety in participative actions in the compulsive rituals or in other cases, they may also exacerbate the anxiety by punishing the patient for his or her compulsive behaviour. In extreme cases, these compulsions can become so extreme that the affected person becomes constricted.


Epidemiology, Risk Factors and Course of Anxiety Disorders

Anxiety Disorders are the most common types of psychological disorders, and the lifetime prevalence rate in adults in the US National Comorbidity Survey Replication was 28.8% (Kessler et al., 2005). There is a consensus that Phobias are the most prevalent anxiety disorders and OCD is the least prevalent across a wide range of epidemiological studies (Kessler et al., 2009; Furr et al., 2009). For Phobias, lifetime prevalence estimates range from 6% to 12%, whereas those with OCD fall below 3%. Generalized Anxiety Disorder (GAD) has a lifetime prevalence of 1% to 6 %, whereas Panic Disorder in adults and Separation Anxiety in children range from 2% to 5%. In National representative samples, the prevalence of PTSD ranges from less than 1% or 2% in Western Europe to almost 8% in the US. The great variability is believed to be due to the fact that PTSD rates depend on the prevalence and traumatic exposure within specific locations geographically and the vulnerability of the populations within these countries to developing PTSD – in populations exposed to terrorism the prevalence is 12% – 16% (DiMaggio & Galea, 2006).

In people suffering from Anxiety Disorders, there is also a high risk of comorbidity [i.e. other anxiety disorders may also be present], and up to 1/3 of those suffering from Anxiety Disorders also suffer from another (Kessler et al., 2009) – they may also occur comorbidly with mood disorders in adults as well as children, substance use disorder in adults and adolescents and disruptive behaviour in young people/children (Furr et al., 2009; Huppert, 2009; Zahradnik & Stewart, 2009).  In cases where substance misuse is also present, the use of drugs or alcohol is quite common in managing anxiety.

OCD is also present in a significant proportion of people with eating disorders such as anorexia nervosa. (Halmi, 2010).

We can observe a clear age and gender difference in the prevalence of Anxiety Disorders (Antony & Stein, 2009a; Furr et al., 2009; Kessler et al., 2009) and across most studies that are available, the modal age of the onset in Separation Anxiety Disorder and Specific Phobias is during the developmental phase in childhood [a stage pointed out by both great Western psychotherapists, Freud and Lacan, and also John Bowlby in his observational research on the development of attachment types in children at this critical stage of development], whereas that of anxiety disorders generally happens during adolescence or adulthood. In both adults and children, there is a tendency for more females to suffer from Anxiety Disorders than males, with the exception to this balance being for OCD which has a similar number men and women suffering from the condition although it is the rarest of anxiety disorders.

Anxiety Disorders tend to show a recurring episodic course with a gradual reduction in prevalence over the course of the life cycle (Kessler et al., 2009). It is also worthy to note that most children with anxiety disorders do not grow up to be adults with anxiety disorders or depression, however most anxious adults do have a history of childhood anxiety disorders. There are a number of risk factors associated with Anxiety Disorders and these include anxiety disorders or psychological disorders in the direct genetic network, an inhibited temperament of behaviour, neuroticism as a trait of personality, a personal experience of psychological problems, a history of over-controlling or critical parents, a history of conflict and violence and a history of stressful life events (Antony & Stein, 2009b; Pine & Klein, 2008). In the scenario of Anxiety Disorders, a behaviourally inhibited temperament is generally the tendency from birth – to become nervous and withdrawn from unfamiliar situations and stimuli. Neuroticism is a trait of personality that gradually develops over the life-span, and it is characterized by the tendency to escape negative affect and includes hostility, anxiety and depression in its manifestations.

In those suffering from Post-Traumatic Stress Disorder (PTSD) the additional factors that increases the risk for development include the severity of the trauma, high-life stress following the trauma, low socio-economic status, low support [from friends or those considered as friends], low intelligence and low educational level (Ehlers, 2009; Ozer et al., 2003). In PTSD, dissociative experiences tends to refer to abnormalities of perception, memory or identity such as derealisation [seeing the world as dream-like], depersonalization [seeing oneself from an external perspective or inability to recall important information]. In the case of parents with PTSD, their children are also at a higher risk of developing the disorder (Pine & Klein, 2008).

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Part 3 of 5 | Depression

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The states of being happy or sad are adaptive feelings, and many behaviours that lead to happiness among human beings, such as socializing [with the people that matter to the subject], becoming completely absorbed in productive work and developing longstanding friendships that are meaningful around values and loyalty, are important not only for the emancipation of the individual but also for a harmonious and functional society that embraces the “humane” qualities of mankind in all its creative aspects.

Sadness on the other hand is a psychological state commonly preceded by loss [of various kinds, which may range from material objects to valued relationships or abilities/skills and status related to them through accident or disease or other situations], and it is a negative feeling which may also be adaptive, in a sense that it is a reminder to most people [at least for those who are NOT philosophically oriented / cultured or have an understanding of values and loyalty in interpersonal relationships], that valued things or people need to be taken care of if they do not want to lose them in the future, especially the common volatile brain [i.e. the basic Darwinian instinct-guided average brain that lacks reflective abilities, reasoning skills, intuition and insight, while also failing to realises or understand the motivation behind its behaviour until matters have taken a disastrous course]. Sadness is also a way of signalling to others that we as human beings also need care and elicits [to most psychologically healthy human beings with a theory of mind] support that soothes our emotional pain – this is what makes us a superior breed of primates, i.e. our ability to reason and evolve with emotions as a propulsive form of energy for both individual and group, like Alexandre Dumas put it, “Un pour tous et tous pour un!” [French for “One for all and all for one!”].

Some extreme states of mood such as depression and mania are less adaptive than happiness and sadness; and it is now commonly known that during periods of hypomania or mania some patients suffering from Bipolar Disorder [which is characterized by episodes of mania and depression] produce highly creative artistic work (Silvia & Kaufman, 2010). This should not lead us to the conclusion that ALL creative people with extreme ways of exploring and expression their emotions through art suffer from Bipolar Disorder. But for those who do suffer from Bipolar Disorder and produce creative work, this highly valued asset comes at a price, since these individuals generally involve themselves in high-risk behaviours that come with the possibility of severe dehydration and exhaustion during manic episodes.

Seasonal Affective Disorder [or Winter Depression, its colloquial name] is a condition that is believed to be linked genetically to our cave-dwelling ancestors from the prehistoric era, who may have hibernated – an adaptive behaviour for the ancestors. However, in the world of today, depression does not seem to serve any adaptive function, and despite this, it remains a highly prevalent condition that affects up to 25% of the population (Kessler & Wang, 2009); because of this prevalence the main focus of this section will be on Major Depressive Disorder.

Share of population with chronic depression

Share of the population reporting that they had chronic depression / Source: EuroStat

It is quite fundamental to grasp that depression is not simply “feeling sad”, as Major Depressive Disorder is an ongoing condition characterized by episodes of low mood and loss of interest in pleasurable activities along with other symptoms such as poor concentration, fatigue, pessimism, suicidal thoughts, and sleep and appetite disturbance. Depression is a serious public health concern because it radically decreases the quality of life of those affected, is a huge economic burden in terms of reduced productivity [and lack of creativity] among the national work force, and it also has adverse effects on the mental health and adjustment of the children of the depressed people (Garber, 2010; Kessler & Wang, 2009). This section will focus on the clinical features, epidemiology, risk factors and course of depression [suicidal risks will also be discussed].


Clinical Features of Depression

Severity

Depression can be classified as mild, moderate to severe, depending on the degree of impairment

Melancholia

In regards to somatic or melancholic features, in severe depression where there is a loss of pleasure in all activities [known as anhedonia] and a lack of reactivity to pleasant stimuli along with diurnal variation in mood and sleep and appetite disturbance, we tend to qualify such episodes as having melancholic features. Historically [please take note that this is not the case anymore], there was an ongoing view that these symptoms reflected “endogenous”, a genetically determined and biologically based form of depression, as different to a “reactive” depression arising from exposure to stressful life events and environmental adversity (Monroe et al., 2009).

However, the difference between these 2 forms of depression was not supported by empirical research, which instead shows that ALL episodes of depression are preceded by stressful life events, and that in any given scenario, we tend to have a combination of genetic vulnerability and environmental adversity that contribute to the development of depression (Parker, 2009).

Psychotic Depression

When mood disrupting delusions and hallucinations are present, depressive episodes are described as having psychotic features. Mood-congruent delusions are generally firmly held beliefs that are extremely pessimistic in nature and that have no basis in reality [illogical and cannot be explained and justified; for e.g. that a completely innocent individual is guilty of many wrongdoings and deserve to die. Mood-disrupting hallucinations in depression are generally auditory and sometimes involve the hearing of voices in a complete absence of any form of external stimuli [uncontrolled and unimagined and ongoing for months], which has negative advices to the sufferer [e.g. You are a failure, you are guilty of wrongdoing, or evil].

Among children, adolescents and adults, there has been a range of clinical features identified through both clinical observation and empirical research (e.g. Bech, 2009; Brent & Weersing, 2008; Gotlib & Hammen, 2009; Nolen-Hoeksema & Hilt, 2009a). Common clinical features of depression tend to affect the domains of cognition, perception, mood, somatic state, behaviour and relationships. Loss is once again a main thematic feature in depression as pointed out by Psychoanalytic Theories [loss of any kind, e.g. material, emotional, relationship, valued attribute due to sickness/accident, health, etc], and clinical features may be linked to those different domains of mental life.

Perception

In regards to perception, depressed individuals who have suffered some form of loss [internal or external] tend to perceive reality and the world as one where further losses are possible, and individuals who suffer from depression also selectively attend to negative stimuli and features in the environment. This leads them to engage in further depressive cognitive patterns in their thoughts processes and unrewarding behavioural patterns which amplify their depression’s severity – in cases of severe depression, mood-congruent auditory hallucinations are often reported. Hence, depressed people or people with depressive personality traits tend to come across as repulsive and despicable because of their obsessive disposition to only perceive the negative side of everything and every situation that life has to offer [note: this is different to constructive criticism which is normally for a purpose and comes with systematic reasons for enhancement]. Psychologists tend to go with the assumption that such severe perceptual abnormality is present only when patients report hearing harsh critical voices or containing depressive contents [as mentioned above]. These auditory hallucinations are also present in schizophrenia, however they are not always mood-congruent like in depression.

Cognition

Depressed patients tend to describe the world and the fabric of reality of their subjective experience in negative terms, this also include descriptions of themselves and their abilities [e.g. occupational and social accomplishments] – this negative evaluation is often portrayed as guilt for not living up to the standards [they set themselves based on their ‘perceived’ abilities] or for letting others down. They sometimes perceive their direct environments [peers, network, family, work colleagues or school/university] as hostile, apathetic, critical and unrewarding. The future is also described in very bleak terms by those suffering from depression, and they also report little if any hope that matters will improve. When extreme hopelessness is reported is it usually accompanied with excessive guilt for which the patients believe they should be punished – suicidal ideas and intentions may also be declared. In depressive delusional systems, extremely negative thoughts about the self are generally reported with the world and their future entangled in them.

Besides the content and thoughts being incredibly negative and bleak, depressed patients also tend to display concentration problems and logical errors in their thinking. These mistakes in reasoning are also characterized by a tendency to maximise the significance of negative events and minimize the significance of positive ones. Depressed patients also suffer from memory problems and struggle to remember happy events but instead have global over-general autobiographical memories about both positive and negative events. In addition to these, this category of patients also suffer from concentration, attention and decision-making problems that in turn give rise to difficulties managing leisure activities requiring sustained attention and academic or occupational responsibilities.

Affect

The impact on the patient’s affect tends to lead to low mood, and diurnal variations in mood and anhedonia. The depressed mood is usually reported as a feeling of sadness, loneliness, emptiness and despair. Diurnal variations in mood is usually quite common in severe cases of depression, with the patient’s mood generally being worse in the morning or after waking up. In cases of major depression, as a person moves from mild to moderate to severe depression, the increasing number of symptoms along with the intensity can also lead to intense anxiety. Generally, fears are experienced in the form of “Will this get worse? Am I stuck in this living hell forever? Will I ever be myself again? Will I be able to prevent myself from committing suicide to escape? Irritability is also a characteristics of depression, with the patient sometimes expressing their anger at the source of their loss [e.g. anger at a deceased one for abandoning the grieving person or sometimes at the health professional for not being able to alleviate their depressive symptoms].

Somatic State

The changes in the patient’s somatic state associated with depression include the disturbances of sleep and appetite, the loss of energy, failure to make age-appropriate physiological growth, weight loss, pain symptoms and a loss of interest in sexual activities. Commonly, depressed people struggle to find sleep and eat insufficiently due to their poor appetite; these symptoms are known as vegetative features. The sleep disturbances in depressed people generally involve problems trying to sleep, wakefulness at night or early-morning sleep disruption. Other symptoms such as racing thoughts and engaging in depressive rumination while unable to sleep is also quite common. In atypical cases of depression, patients may sometimes oversleep due to a constant feeling of exhaustion and consume excessive food due to an increased appetite or due to the feeling that eating may temporarily reduce their distress.

Medically unexplained chest, abdominal and back pain along with headaches are some of the additional features of depression. In some cases the pain symptoms are some of the first signs that would be reported to the doctor and it is only when the medical investigations of these symptoms turn out to be negative that depression is suspected to be the cause. All the somatic symptoms mentioned are consistent with research: dysregulation of neurobiological, endocrine and immune functions is associated with depression and the sleep is also affected.

Behaviour

Depressed patients are characterized behaviourally by the reduced and slow activity levels [psychomotor retardation] that they display, and are often helpless [without any control over their abilities] about their inability in getting involved in activities that could have helped their condition by bringing a sense of achievement or connectedness to meaningful [those chosen by the individual as a person with significance to him/her – note that it is a choice] people in their life. In rare cases some individual become house bound and immobile; such a condition is known as depressive stupor.

One of the major risks of depression is self-harm [a clear distinction is made between non-suicidal deliberate self-harm and suicidal behaviour]. In non-suicidal tendencies, patients may cut or burn themselves to distract themselves from the depressive feelings. In some cases, some have taken non-lethal overdoses to elicit attention and care from their close ones or to simply gain admission to hospital and remove them from the stressful situations that may have been amplifying their depressive symptoms.

Relationships

Depressed patients generally report a deterioration in their relationships with a range of significant figures in their lives from a wide range of environments [from professional to personal], and describe themselves as lonely, unable or unworthy to take steps to try and engage in some form of contact with others. Surprisingly, when the depressed attempt to overcome their loneliness by talking to others, they tend to come across as repulsive, unpleasant and draining through their depressive behaviour, pessimistic belief and sometimes arrogant narcissistic talks, this drives away those they interact with.

Video: Comment faire avec les gens frustrés ? – Benoit Zwick (2019)


Epidemiology, Risk Factors and Course of Depression

The most common mood disorder is Major Depression, and it has a lifetime prevalence rate of 6 – 25% in international community studies (Kessler & Wang, 2009). In the US National Co-morbidity Survey Replication the lifetime prevalence of DSM-IV Major Depression was 16.6% (Kessler et al., 2005). It is good to note that Depression is less common among pre-pubertal children than adolescents and adults (Brent & Weersing, 2008). Among children the number of boys to girl with depression is equal, however this changes in adolescence and by adulthood; compared with men, about twice as many women have depression (Nolen-Hoeksema & Hilt, 2009b).

In most cases of depression, there are many comorbid disorders also present. In the US, National Comorbidity Replication Survey, 59% of depressed patients suffered from comorbid anxiety disorders and 24% had comorbid substance use disorders (Kessler & Wang, 2009). Depression also tends to follow a chronic relapsing course, with up to 80% of people suffering from recurrent episodes, and it has been found that the median duration of episodes in community samples typically lasts for about 5-6 weeks. In clinical samples depressive episodes tend to last for about 5 to 6 months; the majority of cases however recover within 1 year and about half of patients continue to suffer from fluctuating residual symptoms between those depressive episodes; and for less than 10% of patients, recovery does not occur and chronic depressive symptoms persist and most cases relapse within 5 years (Angst, 2009; Boland & Keller, 2009).

During treatment, as more depressive episodes occur, we tend to notice a decrease in inter-episode intervals and a reduction in the amount of stress required to trigger the onset of further depressive episodes, an issue related to Stress Theories (Boland & Keller, 2009).

NOTE: Stress theories propose that individuals develop depression following exposure to stress. The diathesis- stress theories propose that depression only follows after exposure to stress in people who have specific biological or psychological attributes that render them more vulnerable to stressful life events, and the most vulnerable require the least stress to trigger depression (e,g., Joiner & Timmons, 2009: Joormann, 2009; Levinson, 2009). On the other hand, Stress-generation theory proposes that people with certain personal attributes inadvertently generate excessive stress, which in turn leads to depression (Liu & Alloy, 2010)

The risk factors for depression include a family history of mood disorders, female gender, low socio-economic status involving educational and economic disadvantage, and adverse early family or institutional environment, the depressive temperament, a negative cognitive style, deficits and self-regulation, high levels of life stress, and low levels of support from meaningful others (Garber, 2010; Hammen et al., 2010).

Risk factors for recurrent major depressive episodes identified in the US collaborative depression study of 500 patients, include a history of three or more prior episodes, comorbid dysthymia (often known as Double Depression), comorbid anxiety and substance use disorders, long duration of individual episodes, poor control of symptoms by antidepressant medication, onset after 60 years of age, the family history of mood disorder, and being a single female (Boland & Keller, 2009).

Four small category of people who suffer from depression, deficits the visual processing of light and the season of the year are risk factors for depression (Rosenthal, 2009). These people, who experience regularly recurring depressive episodes in the autumn and winter, with remission in the spring and summer, are generally considered as suffering from Seasonal Affective Disorder. These patients develop symptoms in the absence of adequate light and respond positively to enhanced environmental lighting, often referred to as “Light Therapy or Treatment” (Golden et al., 2005).

In community samples about 3.4% of people with major depressive disorder commit suicide; the rate in clinical samples about 15%; about 60% of completed suicides (studied by psychological autopsy) had suffered from depression (Berman, 2009).

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Part 4 of 5 | Schizophrenia

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Before covering the topic of schizophrenia, it is important to take note that the condition is commonly confused to refer to another condition that involves split-personalities, and this is mostly a trend that lives in the world of pop culture and Hollywood. About 40% in the UK equated split or multiple-personality with schizophrenia in a National Survey (Luty et al., 2006). However, after covering this section, we hope that the confusion will be cleared since schizophrenia does not refer to conditions that involve split-personalities [the closest scientific equivalent to this state of being, is a condition known as Multiple Personality Disorder or Dissociative Identity Disorder and are both not as debilitating as schizophrenia with treatment being much more effective].

Schizophrenia refers to a collection of seriously debilitating conditions characterised by positive and negative symptoms in this organisation (Mueser & Jeste, 2008).

Delusions and hallucinations are the principal positive symptoms of schizophrenia. Delusions are strongly held, unfounded, culturally alien beliefs. For example with persecutory delusions, individuals may believe that a group of people conspiring to harm them [this should not lead us to believe that a healthy person with a suspicion caused by the critical analysis of a person or group of people is deluded and is schizophrenic – remember that human beings have individual personalities too]. Hallucinations on the other hand involve experiencing sensations in the absence of external stimuli [e.g. with auditory hallucinations – which are the most common type in schizophrenia – people reported hearing voices that others cannot hear].

The negative symptoms of schizophrenia include flattened affect, alogia and avolition. In the case of flattened affect, the emotional expression of the patient is limited, and with alogia there is an impoverished thought that is inferred from the patient’s speech. Short brief and concrete replies are given to question [this is referred to as poverty of speech], or in some cases speech production is normal but it conveys little meaning and information due to repetition, or being overly abstract [referred to as poverty of content], or being too concrete. When patients suffer from avolition, a lack of goal directed behaviour can be observed. The negative symptoms generally give rise to a restricted lifestyle involving little activity, little social interaction with others and little emotional expression – disorganisation may also affect both speech and behaviour [disorganised, illogical, incoherent, speak are the signs of an underlying formal thought disorder]. Disorganised catatonic behaviour is usually characterised by the complete absence of spontaneous activity or excessive purposeless activity.

Schizophrenia is a debilitating and re-occurring condition that comprises the capacity to carry out normal activities, and also consists of incomplete remission between episodes.  (Hafner & der Heiden, 2008). Symptoms of schizophrenia typically appear in late adolescence or early adulthood, wax and wane over the life course, and have a profound long-term effect on patients and sometimes their families.

Schizophrenia is considered to be the most debilitating of all psychological disorders, since it affects the patient’s capacity to live independently, make and maintain satisfying and enduring relationships, engage in family life, parent children effectively, work productively and enjoy leisure activities. Rates of unemployment, homelessness and imprisonment are very high among people with schizophrenia, although just under 1% of people suffer from schizophrenia, the World Health Organization has rented as second only to cardiovascular disease in terms of overall disease burden internationally (Murray & Lopez, 1996).

Despite these unattractive facts, the scientific advances in our understanding of schizophrenia, along with advances in both psychological and pharmacological approaches to treatment, making it increasingly realistic for people who suffer from schizophrenia to live far more productive lives than were previously possible (Mueser & Jeste, 2008).


Case Example of Schizophrenia

A young man, named Julian was referred for assessment and advice by his doctor. Since returning to his rural home after studying in London for one year, his parents started to worry about his state because of his strange behaviour. After failing as exams, the patient said that he had to ”sort his head out”. Since his return, the parents had noticed a lack of concentration along with incoherent speech during his conversations which happen most of the time – his behaviour was also erratic and unpredictable.

The parents concern grew when Julian suddenly went missing a few weeks prior to the referral. After hours of searching, he was found about 55 Km from their home, dehydrated, exhausted and dressed only in sport shorts, singlet and running shoe. After enquiry, the latter developed the belief that a secret mission in the East had to be undertaken by him; and as he started jogging in the morning, he headed eastwards towards the rising Sun. He even planned to jump onto the car ferry when he reached the coast, across the sea over to Holland, and continue east towards India in his secret mission [reminiscent of a James Bond episode].

Since the episode, Julian has spent much of the time in his room muttering to himself, often becoming quite distressed, and when his parents spoke to him they found it hard to make any sense out of his words.


Family History

Julian was the 19-year-old son of a prominent farmer in a rural English village where the whole family lived in a large amount on an extensive estate. The farm was managed by the patient’s father; who had a traditional authoritarian manner and a positive, if distant, relationship with Julian. While he was incredibly worried about Julian and to the search for him, once the latter was found, the father returned to work unless the care of his son to his wife.

The mother was an artist who dressed flamboyantly, behaved in a theatrical manner and held century, unconventional beliefs [e.g. Conspiracy theories about many issues, was interested in eastern mysticism and believe that faith healing and alternative medicine were preferable to traditional Western medicine]. These characteristics of a personality along with her beliefs affected her treatment of Julian after the ”Running East” episode, where she engaged the latter in intense conversations about mystical meaning of the psychotic experiences that led to him trying to make his way to India on foot. Rather than taking Julian to the accident and emergency department of the local hospital for assessment, she brought him to a feeler and then than homeopathist. It was only of these interventions failed to our view the distress that she took Julian to the doctor, who made the referral to the community mental health team. In the preliminary assessment that was conducted with Julian and both of his parents, the mother responded to the son with intense emotional over involvement (an index of high expressed emotion associated with a relapse in schizophrenia; Hooley, 2007).

With regard to the extended family, according to parents there has never been a family history of psychological disorder. However some members of the mother’s well-to-do family were fairly eccentric and odd, especially her brother, Sedric, and her uncle, William Jr. Williams eccentricities led him into serious conflict with his father, and Sedrick’s odd behaviour underpin his highly conflictual, childless marriage.


Developmental history

Julian on a family farm and went to the local school, his development was what most people would call normal. His Academy former school was above average and he had many friends in his local village, and was a popular child and adolescent who also excelled at cricket. At 18 years old before going to university London, he had no psychological problems.

His first term at college was successful academically and socially, however, the occasional experimental cannabis use that had begun the summer before going to college turn to a regular use once Julian moved to London. During his time at university, the patient also experimented with LSD on a few occasions. In the final term of his first year at college, Julian developed intense fear of exam failure. Other symptoms quickly followed such as difficulty studying effectively and sleeping problems. Julian stopped attending classes regularly and spend more time alone, and was relieved to return home after sitting as exams. Once home he was described as quiet and thought during most of the time prior to the “running East” episode.


Presentation

Julian presented with symptoms such as delusions, hallucinations, disorganised speech and anxiety. At the very start the patient was very reluctant to be interviewed because he believed he had urgent business to attend to in Holland and further afield in India. He also showed signs of being anxiously distressed throughout the interview, explaining that his path was to the east and believed he was being called there by an unknown source. He firmly believes this because of a sign he had seen while out jogging on the morning of the enigmatic “running East” episode. The way in our God will record the sunlight and cast a shadow on the red barn against which it was leaned made a distinctive pattern, which to him meant a special sign indicating that he should go East, first to Holland and then all the way to India. Upon questioning this idea, a clear authoritative voice said that he should leave at once.

At this point in his narrative, stopped mid-sentence and displayed thought blocking, and will strive the topic he was talking about. Upon being asked to continue his story, he began to giggle, and when questioned about the reason behind his amusement, Julian declared to have heard someone say something funny. Julian then spoke about a number of unrelated topics in an incoherent way before experiencing thought blocking again.

Later he expressed the desire to leave soon because people will try to prevent him, as he had heard them plotting about this the day before, and also declare that they had tried to put bad ideas into his head [which he described as frightening]. He was also frightened by periodic sensations that everything was too loud or too bright and coming at him, declaring “it was like doing acid [LSD] all the time… a really bad trip.”


Formulation

In Julian’s case he presented with auditory hallucinations, delusions, thought disorder, anxiety and a significant deterioration in social and occupational functioning which had been present for more than 1 month [symptoms consistent at the time of this essay with a diagnosis of Schizophrenia]. The patient also showed a complete lack of insight and was unable to understand that the voices being heard were hallucinations and that the delusional beliefs were unfounded. Among the major precipitating factors were the experience of recent exam pressure and his transition from living at home to living in London at attending college. The principal predisposing factors were possible genetic vulnerability to psychosis and a history of hallucinogenic drug use.

His psychological condition was maintained by what was likely to be an excessive level of maternal expressed emotion characterised mainly by emotional over-involvement. His delusions were also reinforced by the mother since the latter engaged Julian in long and draining conversations about them. The protective factors in this case were godo premorbid adjustment and a strong family support for the boy.


Treatment

The treatment plan included antipsychotic medication and family will to reduce parental expressed emotion, with an initial brief period of hospitalisation. Julian did recover from his first psychotic episode, and his hallucinations and delusions decrease considerably with medication. Through family Psycho-education, parents develop understanding of this condition and of the requirement of a “low-key” approach to interacting with the boy as he recovered.

However some obstacles were encountered in Julian’s recovery, since he disliked the side effects of the medication, especially the weight gain and reduced sexual drive/function, and so had poor medication adherence – depression also manifested during the remission, when Julian came to realise about the many losses that followed his condition. He was unable to pursue his university studies and thus, could not continue the law career he had dreamed of. He also experienced difficulties in maintaining friendships or to commit to engaging on a regular basis in physical exercises or sports. When his mood was low, Julian would smoke some cannabis to lift his spirits.

The mother found it very difficult to accept the diagnosis of Schizophrenia and continued to hold the belief that his psychotic symptoms were linked to some spiritual or mystical explanation. She even sometimes declared that she thought of her son not as an ill young man, but a gifted seer or a “chosen one” [based on no rational explanation or series of events], and often engaged Julian in intense, distressing conversations about these issues. In the years that followed his initial assessment, poor medication adherence, ongoing cannabis use [which the patient could not tolerate unlike some other users] and exposure to high levels of intrusive parental emotions led Julian to relapse more often than might otherwise have been the case.


Clinical Features of Schizophrenia

A range of clinical features have been identified and associated with Schizophrenia though research and clinical observations (Mueser & Jeste, 2008). The generally concern the domains of perception, cognition, emotion, behaviour, social adjustment and somatic state.


Perception

At the perceptual level, patients suffering with schizophrenia generally describe a breakdown in perceptual selectivity, with difficulties focusing on essential information or stimuli to the exclusion of accidental details or background noise. Most aspects of the environment seem to be salient, however, the inability to distinguish between figure and ground is a serious problem to the sufferer. During an acute psychotic state, internal stimuli such as verbal thoughts are experienced as auditory hallucinations that have the same sensory quality of the spoken word.

Auditory hallucinations can sometimes be experience as extremely loud thoughts, or as thoughts being repeated by another person aloud (thought echo), as voices speaking inside the head or as voices coming from somewhere in the outer environment. The auditory hallucination may occur as third person making comments on the patient’s action, as a voice speaking in the second person directly to the person, or as two or more people talking or arguing – the effect did may also perceive voices to vary along the number of dementia [may be construed as benign or malevolent, controlling or impotent, or knowing or knowing little about the patient, who may sometimes feel compelled to the demands of the voice or not.

When hallucinations are perceived to be malevolent, controlling, all-knowing, where the individual affected feels compelled to obey the demands of the voice, the situation is deemed to be far more distressing than those who do not have these attributes. While auditory hallucinations are the most common features in schizophrenia, hallucinations may okay other sensory modalities too. Somatic hallucinations also often occur in schizophrenia, with many cases including reports of electricity in the body or the feeling of something crawling underneath the skin [these may be qualified as delusional interpretations. For example, a patient reported that the television was activating a transmitter in her pelvis and she could feel the electricity from this closing insects to grow and move around under the skin. Visual hallucinations [seeing visions] are relatively rare in schizophrenia very common in temporal lobe epilepsy.


Cognition

At the cognitive level, delusions are the most common cognitive clinical feature of schizophrenia, and are false, idiosyncratic, illogical and stubbornly maintained erroneous inferences drawn to explain unusual experiences, such as hallucination. [e.g. patient with auditory hallucinations where an authoritative voice commanding the latter to gather the children, was interpreted by the patient that she had been chosen by God to prepare all the children for the second coming of Christ]

Delusions may also arise from unusual feelings associated with psychosis. Persecutory delusions may develop from feelings of being watched. Delusions of thought insertion or thought withdrawal may develop as explanations for feelings that thoughts are not one’s own, or that one’s thoughts have suddenly disappeared. Factor analyses show that delusions fall into 3 broad categories:

Delusions of influence [including thought withdrawal or insertion, and beliefs about being controlled]; delusions of self-significance [including delusions of grandeur or guilt]; and delusions of persecution (Vahia & Cohen, 2008). Delusions may vary in the degree of conviction with which they are held [great certainty to little servant, the degree to which the person is preoccupied with them [the amount of time spent thinking about the belief], the amount of distress they cause.

Particular sets of the may comprise of a confused sense of self, particularly paranoid delusions with the patient holds the belief that they are being persecuted or punished for misdeeds, or delusions of control where there is a belief that their actions controlled by others [e.g. an unknown source or entity].

A lack of insight along with an impaired judgement is quite common during a psychotic episode. This happens when the patient believes that the contents of their hallucinations and delusions are real, and are incapable of coming to terms with the fact that their experiences and beliefs arise from a clinical condition. However in between psychotic episodes, the patient’s insight may improve and in some cases they may acknowledge that their hallucinations and delusions are symptoms of schizophrenia.

Speech in schizophrenic patients is also fairly hard to understand due to the abnormalities in the underlying thought pattern. This formal thought disorder is characterised by

  1. Tangentiality [answers given to questions are off the point]
  2. Derailment [sentences makes sense but hardly any meaning is conveyed by the sequences of sentences because there is a constant jumping from one topic to another, with very loose association between topics and little logic to what is said]
  3. Incoherence [sentences are incorrectly formed so little sense can be made out of them]
  4. Thought blocking [the patient abruptly stop’s in mid-sentence and is unable to complete the train of thought]
  5. Loss of goal [the difficulty in following a logical train of thought from A to B]
  6. Neologisms [inexistent new words are made up that only have idiosyncratic meaning for the patient]

Cognitive impairment or deterioration occurs in schizophrenia and this may either be general or specific. In cases with general cognitive deterioration, we can observe a reduction in overall IQ with many cognitive function also negatively affected. With specific cognitive impairment one or more of the following functions may be impaired: attention, memory, cognitive flexibility, social cognition and executive function, and most commonly the ability and dedication to follow through on a planned course of action. Cognitive impairment remains a better predictor of disability and vocational functioning than positive symptoms.


Emotions

At the emotional level, especially during the prodromal phase, before an acute psychotic episode, anxiety or depression may occur in response to changes in perceptual selectivity and cognitive inefficiency. One of the main functions of relapse prevention is for patients to learn [and eventually master] the ability to identify and manage prodromal changes in affect.

During psychotic episodes that are intense, anxiety or depression may occur in response to hallucinations, delusions, formal thought disorder and other debilitating symptoms. Inappropriate affect may also be present in hebephrenic schizophrenia, where the patient responds to the internal stimuli such as auditory hallucinations [e.g. laughing wildly] and not the external social context. In chronic cases, blunted or flattened affect can also be observed, and in remission [following an episode of psychosis], the sense of loss [e.g. of valued personal relationships, material, career, etc] that comes with increased insight into the reality of the condition may give rise to post-psychotic depression in some cases.

Behaviour

In terms of behaviour, prodromal excitation may occur prior to an acute psychotic episode, characterised by sleep disturbance, impulsive behaviour, and over-reactivity [may include compulsive behaviour]. Avolition also occurs during psychotic episodes with an observable impairment in goal-directed behaviour.

In some chronic cases, it is common to also find catatonic behaviour along with an impairment in the ability to initiate and organise voluntary movement and posture. Catatonia may be either retarded or excited. Excessive purposeless motor activity is the hallmark of excited catatonia and may include stereotypies [repetitive actions], echolalia [repeating the words said by others] or echopraxia [imitating the actions of others] – these tend to occur without the patient being consciously aware of it [not a conscious choice]. In cases where retarded catatonic behaviour is present there is an observable reduction in purposeful activity; patients may display signs of immobility, mutism, adopt odd postures for extended amounts of time, and display waxy flexibility or negativism.

Social Adjustment

A marked deterioration in social adjustment is also common in schizophrenia, and the ability for self-care, appropriate dressing, grooming and personal hygiene deteriorates – patients with schizophrenia often look dishevelled and unkempt. A decline in also commonly present in the domains of education and work with a withdrawal from regular patterns of socialisation and difficulty making and maintaining significant relationships. A deterioration with others also occurs and schizophrenia tends to have a negative impact on parent-child, marital and sibling relationships.

Somatic State

Approximately 50% of people with Schizophrenia also have comorbid substance use disorders and almost 75% have significant health problems, with the most common one being Chronic Obstructive Pulmonary Disease (COPD) [usually due to heavy smoking]; heart disease and diabetes due to obesity; HIV/AIDS and hepatitis B and C caused by unsafe sex and intravenous drug use [e.g. heroin]. These drug and medical problems in schizophrenia are lifestyle problems. However, one the positive side, schizophrenia is associated with reduced rates of cancer and rheumatoid arthritis (Tandon et al., 2008a).

Epidemiology, Course, Outcome and Risk Factors of Schizophrenia

International epidemiological studies that have been reviewed have allowed for a number of conclusions to be deduced regarding schizophrenia. We know that [luckily] under 1% of the population suffer from schizophrenia, and the lifetime risk of the condition is about 0.7% (Saha et al., 2005). More men than women suffer from schizophrenia: the male-female ratio is about 1.4:1 (McGrath et al., 2004). Schizophrenia has an earlier onset in males (20-28 years) than in females (28-32 years) (Murray & Van Os, 1998). The rates for schizophrenia have also been found to be similar across countries and cultures when diagnostic criteria are used (Mueser & Duva, 2011).

Schizophrenia tends to follow a distinctive course although a considerable variability exists across cases (Jablensky, 2009; Jobe & Harrow, 2010; Mueser & Duva, 2011, Tandon et al., 2009). The onset of schizophrenia generally occurs in late adolescence or early adulthood and may be acute or insidious [onset generally takes place over 5 years, starting with negative and depressive symptoms, followed by cognitive and social impairment and finally positive symptoms]. Longitudinal studies suggest that there is an early deterioration phase that extends over 5-10 years, a stabilisation phase and a final gradual improvement phase. In over 50 – 70% of cases, the condition follows a chronic relapsing course, typically with incomplete remission between episodes. However, up to 40% of patients show one or more periods of complete recovery with good adjustment for at least 1 year, and  4 – 20% of cases show complete remission.

Psychotic episodes may last from 1 – 6 months, although some cases extend up to 1 year. They are usually preceded by a prodromal period of a number of weeks. Psychotic episodes may be lessened and the severity of the symptoms ameliorated through early detection and the use of pharmacological and psychological treatment. Inter-episode functioning may differ greatly and better inter-episode functioning is associated with a better prognosis. The duration of remission between episodes may be lengthened through the use of maintenance medication and psychosocial interventions to reduce stress and improve coping and illness management.

With treatment, usually positive symptoms (hallucinations and delusions) abate between episodes but negative symptoms (blunted affect, alogia and avolition) can be enduring and are more likely to persist during remission. In the stabilisation phase of schizophrenia, positive symptoms become less prominent, while negative symptoms and cognitive deficits become more prominent. The lifespan of people with schizophrenia is also 9 years less than that of the general population, and this is partly accounted for by the high rate of suicide during the first 10 years of the disorder and the high rate of comorbid medical disorders that also tend to occur along with schizophrenia. About 50% of schizophrenics attempt suicide or self-harm, and about 10% commit suicide (Heisel, 2008; Schennach-Wolff et al., 2011).

One of the greatest risk factors for schizophrenia is a family history of psychosis. Other risk factors make a small contribution to the overall risk within the context of associated with genetic vulnerability. However until now, it is important to note that we still do not have any clear consensus or evidence on how these risk factors operate and whether environmental factors remain a stronger prediction of the onset of schizophrenia than genetic factors that only set a predisposition [risk] of possibly developing the condition. Prenatal and perinatal risk factors, such as maternal flu infection and obstetric complications, are likely to have a negative effect or indirect effect on the development of the nervous system in line with the neurodevelopmental hypothesis that states how those affected by such issues while also being genetically predisposed to schizophrenia are even more neurologically vulnerable to psychosis (Murray & Lewis, 1987). Trauma exposure and most demographic risk factors (being unmarried, low-SES urban migrant) are associated with higher levels of stress and lower levels of social support [which increases the risk of psychosis in the genetically vulnerable] according to the Diathesis-Stress Conceptualisation of Schizophrenia (Zubin & Spring, 1977).

In the short term, relapse is more likely in cases where these is heavy cannabis use [along with poor personal/subjective tolerance of the effects on consciousness], poor treatment adherence, frequent contact with insignificant extended family members who may display excessive negative emotional expressions towards the patient [e.g. criticism, hostility and emotional over-involvement] and exposure to acute stress life events (Jablensky, 2009).

A poor outcome is associated with substance use and a longer period of untreated psychosis in people who have poor premorbid adjustment and an early insidious onset with no clear stressful life event preceding their first treated episode. One of the main traits associated with a poor outcome is “Anxiety”, and people with this stress profile are generally more sensitive to and reactive to life’s stressful events, along with populations living in a developing economy, and family-based stress associated with excessive negative expressions of emotion. The symptom profile predictive of a poor outcome is also marked by severe negative symptoms, cognitive impairment and lack of depressive symptoms.

A favourable outcome in schizophrenia is associated with a range of factors (Bota et al., 2011). These include good premorbid adjustment, and a brief duration of untreated psychosis characterised by an acute onset in response to precipitating stressful life events. A family history of affective problems/disorders [rather than schizophrenia] or little psychopathology and a personal symptom profile in which there are affective as well as psychotic features are also predictive of a good prognosis. A better outcome tends to follow those who have a favourable life situation to return to following discharge from hospital.

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Part 5 of 5 | The Effectiveness of Psychotherapy

ClinP_Descr_Header_05

The main help that a psychotherapist provides is psychotherapy, a contractual process where professionals with expert knowledge interact with clients to guide and help them in the resolution of their psychological conflicts, emotional imbalance, psychological problems and address mental health and behavioural difficulties [if any]. Psychotherapy can be offered to both adults and children on an individual, couple, family or group basis.

Often psychotherapists offer therapy as one element of a multimodal programme provided by a multidisciplinary team [e.g. a multidisciplinary adult mental health team may routinely offer a multimodal programme of psychotherapy combined with some mild anti-depressant for depression]. This final section will focus on the evidence base for the overall effectiveness of psychotherapy.


Evidence-based Practice

In today’s trend of mainstream clinical psychology where the mechanical model of early behaviourists has been combined with cognitive psychology to become Cognitive-Behavioural Psychology, there has been a gradual shift from practice guided by descriptions of clinical cases [qualitative, detailed and individual] to “evidence-based” practice guided by the results of empirical studies using the statistical methods of science to make inferences about behaviour [that can be measured at least] on the effectiveness of psychological interventions. This movement has started in part due to the influence of policies derived from the medical field which bases itself on evidence-based medicine [i.e. tested with laboratory-rigour and statistical methodology] (Sackett et al., 1996, 2000).

Evidence practice in medicine as it has been applied to psychology [or should we say behavioural science] involves the judicious and compassionate use of the best available evidence to make decisions about patient or client care. In clinical psychology, this involves considering available scientific evidence about “what works” on one side, and the client’s unique problems, needs, rights and preferences on the other; while also making balanced, compassionate judgements (APA Presidential Task Force on Evidence Based Practice, 2006; Norcross et al., 2006).


Meta-analyses

The most persuasive form of evidence as far as the effectiveness of psychotherapy and other psychological interventions are concerned in regards to empirical measurements and statistical methodology, comes from meta-analyses on controlled trials.

Meta-analysis is a systematic, quantitative approach to reviewing evidence from multiple trials while also reducing the impact of reviewer bias since the data from many trials are synthesised using statistical methods.

In a meta-analysis, effect sizes are calculated for each trial and then averaged across all trials to provide a quantitative index of the effectiveness of a particular form of treatment with a specified population. The effect sizes calculated in meta-analyses express quantitatively the degree to which treated groups improve over untreated control groups [A graphic explanation of the calculation of an effect size in given in FIGURE A.

FIGURE A - EFFECT SIZES

FIGURE A. A Graphic Representation of an Effect Size of 1

Table A shows a system for interpreting effect sizes, and using it, it may be seen that .9 is a large effect size, and if such an effect size was obtained in a meta-analysis it would mean that the average treated case fared better than 82% of the cases in the control group. It would also indicate that 71% of cases in the treatment group had a successful outcome compared with 29% of control group cases. Finally, a large effect of .9 would indicate that 17% of the variance in outcome would validly be attributed to the effects of the treatment rather than other factors.

Table A - Interpretation of Effect Size

TABLE A / Note: Adapted from Wampold (2001, p. 53). 1. From Cohen (1988), 2. From Glass (1976). 3. From Rosenthal and Rubin (1982). Binomial effect size display, assuming overall success rate of .5, success rate for treated cases is .5+ correlation with outcome/2, and success rate for untreated cases is .5-correlation with outcome/2. 4. From Rosenthal (1994, p. 239), percentage of variance = d²/(d² +4).

Is Psychotherapy effective? If so, how effective?

Mary Smith and Gene Glass published the first major meta-analysis of psychotherapy result studies in American Psychologist in 1977. They included 375 controlled trials of psychotherapy in their analysis and found an average effect size of .68. They concluded that a typical therapy client was better off that 75% of untreated individuals.

Since that seminal study many meta-analyses have been conducted, and in a synthesis of 68 separate meta-analyses of psychotherapy with children, adolescents and adults with a wide range of different psychological problems, Grissom (1996) found an aggregate effect of .75, indicating that the average treated case fared better than 77% of untreated controls.


Effects of Psychotherapy with Adults

The mentioned meta-analysis conducted by Smith and Glass (1977) also included many studies of therapy with children and young people. In the quest to determining the effects of psychotherapy for adults with psychological problems, Shapiro and Shapiro (1982) conducted a meta-analysis of 143 studies of psychotherapy exclusively involving adult populations. This revealed an effect size of 1.03, meaning that after treatment the average adult who participated in psychotherapy fared better than 84% of untreated control group cases.


Effectiveness of Psychotherapy with Children and Adolescents

The results of 4 broad meta-analyses of studies involving children and adolescents under 18 years with a diverse range of psychological problems receiving a variety of forms of psychotherapy provide evidence for the overall effectiveness of psychotherapy with children (Casey & Berman, 1985; Kazdin et al., 1990; Weisz et al., 1987, 1995). These meta-analyses included more than 350 treatment outcome studies. Effect sizes ranged from .71 to .88, with a mean effect size of .77. This indicates that the average treated case fared better than 78% of control group cases.


Psychodynamic Psychotherapy

Within the psychodynamic tradition, a distinction is made between short-term psychodynamic psychotherapy and intensive long-term psychoanalysis. Short-term psychodynamic psychotherapy involve weekly sessions for periods of 6 – 12 months, while Long-term psychoanalysis involves two or more sessions per week, usually lasting for periods longer than 1 year [Jacques Lacan, one of the main psychoanalytic figures in France, broke from other associations to create his own school where he advocated short psychoanalytic sessions that varied ranging from 10 minutes to more, as he argued that the point of therapy is to shape the patient’s consciousness and depending on the person, this can be achieved by a range of ways, e.g. metaphors or word plays that allows the patient to peer into his own psyche and understand himself]

Two important broad meta-analyses have been conducted to evaluate the effectiveness of psychodynamic psychotherapy with adult mental health problems (Leichsenring et al., 2004; Leichsenring & Rabung, 2011). In a meta-analysis of 17 studies, Leichsenring et al. (2004) found that short-term psychodynamic psychotherapy yielded an effect size of .7 for psychiatric symptoms in patients mainly diagnosed with anxiety and mood disorders when therapy was compared with waiting list or minimal intervention control groups. This indicates that after treatment the average treated case fared better than 76% of controls. In this meta-analysis, the outcome for psychodynamic psychotherapy did not differ from that of other forms of psychotherapy in the 14 studies where such comparisons were made.

In a further meta-analysis of 10 studies, Leichsenring and Rabung (2011) found that Long-term psychodynamic psychotherapy involving more than 50 sessions over periods longer than a year yielded an effect size of .54 for overall effectiveness for complex cases with severe symptomatology, comorbid diagnoses, or personality disorders, when long-term psychodynamic psychotherapy was compared with a range of other therapies including Cognitive-Behavioural Therapy (CBT), dialectical behaviour therapy, family therapy and short-term psychodynamic psychotherapy. This indicates that after treatment the average case fared better than 70% of cases treated with other therapies. The gains made during treatment were sustained at 1 to 8 years after follow up.

The results of these two meta-analyses show that short-term psychodynamic psychotherapy is an effective as other widely used forms of psychotherapy, including Cognitive-Behavioural Therapy (CBT), for common psychological problems such as anxiety and depression in adults; and that long-term psychodynamic psychotherapy is more effective that some other forms of therapy for adults with complex mental health difficulties.


Client-centred Humanistic Psychotherapy

Elliot et al., (2004) conducted a meta-analysis of trials of psychotherapy that fall broadly within the client-centred humanistic psychotherapy tradition [over 90 trials of client-centred, experiential, gestalt and emotionally-focussed therapy were included in the analysis]. Clients in these studies had a wide variety of psychological problems including anxiety, mood, eating and relationship distress. The average duration of treatment was 22 sessions, reflecting about 6 months of therapy. An effect size of .78 was obtained, indicating that the average treated case fared better than 78% of cases in control groups. These results indicate that client-centred humanistic psychotherapy is an effective form of treatment for a range of common psychological problems in adulthood.


Overall Effects of Psychotherapy

FIGURE B summarises the results of meta-analyses, described above, of the effectiveness of psychotherapy from a range of different traditions with adults and children. In this figure, where appropriate, effect sizes from multiple meta-analyses have been averaged, and graphed as success rates based on the system given in TABLE A.

From FIGURE B it can be deduced that meta-analyses of psychotherapy trials yield moderate to large effect sizes that range from .65 to 1.02. When expressed as success rates, the results of meta-analyses indicate that 65 – 72% of people with psychological problems benefit from psychotherapy. Thus approximately two-thirds to three-quarters of people who engage in psychotherapy find that it leads to improvements in their mental health.

FIGURE B - SUCCESS RATES W ADULTS &amp; CHILDREN

FIGURE B. Success Rates of Psychotherapy with adults and children, and Therapy from other schools of thought [traditions] based on Effect Sizes from Meta-analyses

Comparison of the effects of Psychotherapy and Medical Procedures

In order to make sense of the overall effectiveness of psychotherapy, it may be useful to ask ourselves: Are the moderate to large effect sizes associated with psychotherapy very different from those associated with the medical and surgical treatment of physical illnesses, diseases and medical symptoms?

In a synthesis of 91 meta-analyses of various medical and surgical treatments for a range of medical conditions, Caspi (2004) found an average effect size of .5. This falls in the moderate range of effect sizes (.5 – .8) and not very dissimilar to the effect size of .75 from Grissom’s (1996) synthesis of 68 meta-analyses of psychotherapy trials mentioned at the beginning of this section. Hence, it may be concluded with some certainty that the moderate effect sizes associated with psychotherapy are similar to those associated with the treatment of medical conditions.


Deterioration and Drop-Out

A consistent finding within psychotherapy research literature is that up to 10% of clients deteriorate following treatment (Lambert and Ogles, 2004; Lilienfeld, 2007). In a review of 46 studies on negative outcome in adult psychotherapy, Mohr (1995) found that deterioration was associated with particular client and therapist characteristics and particular features of psychotherapy. Deterioration was much more common among clients with obsessive compulsive disorder or severe interpersonal difficulties. Lack of motivation and the expectation of benefiting from psychotherapy without personal effort were also associated with deterioration. Deterioration was more common when unskilled therapists lacked the empathy and did not collaborate with clients in pursuing their agreed goals. Failure to manage counter transference appropriately and frequent transference interpretations were also associated with deterioration.

Dropping out of psychotherapy is a relatively common event. In a meta-analysis of 125 studies, Wierzbicki and Pekarik (1993) found a mean dropout rate of 47%. Dropout rates were higher for minority ethnic groups, less educated clients, and those with lower incomes. Thus, we can conclude that about 1 in 10 clients deteriorate following therapy and that marginalised clients with particularly troublesome disorders and negative attitudes to psychotherapy are vulnerable to dropping out of psychotherapy and deterioration.


Medical Cost Offset

So, all the evidence that has been reviewed shows that psychotherapy is effective for a range of problems and populations. However, an important factor regarding the delivery of psychological treatment is the financial implication of it [i.e. the cost to the economy and health services]: How much does it cost to provide such a psychotherapy service? From this financial perspective, two questions would be of interest:

First: Do clients who received psychotherapy use fewer medical services and so incur reduced medical costs? This saving would be referred to as the Medical Cost Offset.

Second: Is the Medical Cost Offset associated with psychotherapy greater than the cost of providing psychotherapy? If so, we would be able to conclude that psychotherapy has a total cost offset.

Findings from meta-analyses and narrative reviews of the cost-offset literature provide explanations on these questions. In a meta-analysis of 91 studies conducted between 1967 and 1997, Chiles et al. (1999) found that psychotherapy and psychological interventions led to significant medical cost offsets. Participants in reviewed studies included surgery inpatients, high health-service users, and people with psychological and substance use disorders who received psychotherapy or psychological interventions alone or as part of a multimodal programme. Chiles and his team found that medical cost offsets occurred in 90% of studies and ranged from 20% to 30%. In 93% of studies where data were provided, cost offsets exceeded the cost of providing psychotherapy. Greater costs offsets occurred for older inpatient who required surgery, oncology, and cardiac rehabilitation than for outpatients who required care for minor injuries and illnesses. Structured psychological interventions, tailored to patient needs associated with their medical conditions, led to greater medical cost offsets than traditional psychotherapy.

In a set of meta-analyses from earlier studies involving Blue Cross and Blue Shield US Federal Employees Plan claim files and 58 controlled studies, Mumford et al. (1984) found that 85% of studies medical cost offset for psychotherapy occurred, and this was due to shorter periods of hospitalisation for surgery, cancer, heart disease and diabetes – particularly in patients over the age of 55. In a review of psychological interventions for people with a variety of health-related difficulties, Groth-Marnat and Edkins (1996) found that medical cost offsets occurred when such interventions targeted patients preparing for surgery and patients with difficulty adhering to medical regimens. Medical offset also occurred for smoking cessation programmes, rehabilitation programmes, and programmes for patients with chronic pain disorders, cardiovascular disorders and psychosomatic complaints.

Three other important reviews of medical cost-offset literature, which focussed largely on mental health problems in adults rather than adjustment to physical illness, deserve mention. In a review of 30 studies of psychotherapy for psychological disorders and drug and alcohol abuse, Jones and Vischi (1979) found that medical cost offsets occurred in most cases. In a review of eight cost-effective studies for substance abuse, Morgan and Crane (2010) concluded that family-based treatments can be cost-effective. In a review of 18 studies of psychotherapy for psychological disorders, Gabbard et al. (1997) found that in more than in 80% of studies, medical cost offsets exceeded the cost of providing psychological therapies. Significant cost-offsets occurred for complex problems and in studies of psychoeducational family therapy for schizophrenia and dialectical behaviour therapy for personality disorders this was achieved by reducing the need for inpatient care and improving occupational adjustment.

Estimated direct and indirect costs related to mental health problems across Europe

Besides the impact on people’s well-being, the report estimates the total costs of mental ill-health at over EUR 600 billion – or more than 4% of GDP – across Europe / Source: OECD Library

Prevalence by mental and substance use disorder 2017 - our world in data

Prevalence by Mental and Substance use disorder / Source: OurWorldinData

The table below provides a brief summary of the data which follows on mental health and substance use disorders

The table provides a brief summary of the data which follows on mental health and substance use disorders / Source: OurWorldinData

Therefore, to conclude with all the evidence reviewed here, it is widely accepted today that psychotherapeutic interventions have a significant medical cost offset. Those who participate in psychotherapy use fewer extra medical services at primary, secondary and tertiary levels and are hospitalised less than those who do not receive psychotherapy.

_____________________________________

*****

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Essay // Clinical Psychology: Controversies that surround modern day mental health practice

Mis à jour le Jeudi, 9 Mars 2023

Mental Health Santé Mentale d'purb dpurb

Modern day mental health practice could be defined as the application of the four main schools of thoughts that dominate the field of psychology in the clinical setting, by abiding to strict criteria set out by packaged behavioural sets, diagnostically defined by names and categorised depending on the core nature of their specific characteristics in terms of behaviour, aetiology and epidemiology. While these four [biological, psychodynamic, cognitive-behavioural & systemic] main schools of thought have contributed to the development and ongoing evolution of the field of psychology, they also have downsides when applied to different types of psychological cases, with some being more efficient in treating particular disorders while others being hardly efficient and questionable. Applying and integrating these four schools of thoughts with new intuitive fact-based theories to explain psychological constructs and disorders are leading to major innovations in psychology; however with each field’s limitations controversies over the validity of their interpretations and the efficiency of their applied doctrines remain a constant topic of debate among scholars and clinicians.

One of the main controversies that surround modern day mental health practice is the medicalisation of psychological disorders, a tradition influenced by the field of medicine which contradicts an important founding philosophy of psychology, which was originally initiated to study the “mind”, not the physical characteristics of the brain as an organ. Furthermore, evidence suggests that psychological problems are not caused exclusively by organic factors. In anxiety, depression and/or schizophrenia, people with genetic vulnerability to the development of those psychological disorders only do so when exposed to particular stresses in their environment (Hankin & Abele, 2005). However, on the other side of the argument, evidence has also shown that deficiencies in genetics and neurobiological anatomy are linked to psychological difficulties and disorders, and hence nowadays, integrated approaches are used in a variety of assessments when treating patients affected by psychological disorders.

On the theme of medicalization, the debate over eating disorders has led to one of the major controversies within the field between advocates of the biomedical conceptualisation of eating disorders and the feminist position (Maine & Bunnell, 2010). The former sees an individual woman as a patient with a debilitating disease, in need of a cure to her illness; while the feminist position views eating disorders as a condition that is gender specific with the woman as a victim of socio-cultural pressures generated by a male-dominated society governed by a hedonistic economic reality focused on the pursuit of the thin ideal. There is an important distinction that should be made here for the benefit of patients since the feminist view may not fully comprehend that in the case of obesity and emaciation related to eating-disorders, the patients are at severe risk of medical complications such as growth retardation, osteoporosis, gastrointestinal bleeding, dehydration, electrolyte abnormalities and cardiac arrest [in chronic cases]. The social feminist constructivist perspective may be interpreting eating disorder as an image debate of “Fat” versus “Thin”. This may lead to the normalisation of obesity and destructive eating habits which in turn may result in further medical complications that involve surgical interventions. As for the feminists, it may be ethical to acknowledge that obesity & emaciation associated with eating disorders are major health issues that precede further complications such as diabetes, cancer and high blood pressure; and should not be confused with social stigma regarding image, but seen as a sign of poor-health and lifestyle that require attention and effort in providing patients with the medical and psychological help they need to adjust their patterns of life to a healthy one by adopting a culture synchronised with dietary & nutritional education. In an episode of the French show, Arrêt Sur Image, Sébastien Bohler, the chief editor for the magazine Cerveau & Psycho and doctor in neurology explained how in general, men tend to be attracted to females with particularly shaped hips, scientifically caracterised by the waist to hip ratio. It is a value obtained by dividing the wait circumference by the hip circumference, and the ideal waist-to-hip ratio is 0.7 in all cultures apparently (Singh and Singh, 2011) [this is not to be taken as ultimately applying to every single male because individuals with good reflective self-function, i.e. the ability to reflect on conscious and unconscious psychological states, and conflicting beliefs and desires, have the ability to rise above their basic biological instincts and change their internal working models, and consequently their behaviour].

Secondly, the medicalization of anxiety disorders as distinct medical & psychological conditions may seem less favourable to the biological model previously mentioned. A mass market of pharmacological products used in treatment has been favoured for being more convenient and less time consuming. This may lead to patients feeling disempowered and hopeless when being treated as victims of an uncontrollable illnesses requiring pharmacological treatment, while already being in a state of distress, shock, disbelief and/or confusion.

Number of people who take antidepressants

Diazepam (Valium) or other benzodiazepines that are highly addictive have also been prescribed for years to treat anxiety disorders. The long term side effects have been trivialised along with the arrogant act of medicalizing fear and courage (Breggin, 1991). Critics of the medicalization of experiences argue that if patients are helped in understanding that panic attacks develop from the misrepresentation of bodily sensations and hyperventilation, this knowledge along with their own courage may strengthen them to take control of their fear. Research has also shown how patients who are educated in cognitive-behaviour techniques learn to use problem-solving and develop other skills (e.g. social – help them build meaningful lasting relationships while letting go of psychosocial burdens) that they lack to reappraise situations that may formerly have brought distress.

TheDownfallOfTheWildAnimals.jpg

The tragic death of one of the most talented vocalists on the planet, Chris Cornell, has sent a shock throughout the arts world and reports have revealed that the gifted artist was on Lorazepam [a benzodiazepine medication sold under the name Ativan used in the treatment of anxiety disorders], the substance is known to heighten the risk of suicide in those suffering from depression, while a recent investigation (Bushnell et al., 2017) has also shown no meaningful clinical benefit from the addition of benzodiazepines during treatment initiation.

Global Suicide rate per 100 000 population

Suicide Rates Around the World per 100 000 (2016)

Estimated rate of suicide per 100,000 population in selected countries in 2016. / Source: Statista

To prevent such tragedies from affecting the human race, more emphasis could be placed on “the mind” with clear guidance on the “thinking styles” (cognitive scripts) to adopt in the protection of the individual organism’s own psyche (mind). Simple foundations based on psychological logic should be propagated educationally to help people understand their uniqueness as organisms while protecting their psyche [mind] from the influence/control of external environmental factors that are beyond their control [e.g. biased negativity, uninformed prejudicial comments of meaningless acquaintances, etc]; acknowledging the fact that as long as an individual organism is within the boundaries of the law, he is allowed to live the life of his choice, and external factors would only affect one’s psyche if attention is given to them; and selectively ignoring parts of the environment  is also an acquired skill vital in maintaining sanity, stability and psychological health, along with the ability to select experiences that are positive & progressive to the organism [while discarding negative ones] in the context and theme of their chosen individual lifestyles.

PrinciplesOfPsychology

This would also shift the focus to the individual’s mind, courage & abilities to handle the world while maintaining a stable sense of self and resilience; and not turn them into biological organisms that are having their neurochemistry savagely altered by powerful chemical substances that are known to affect individuals differently with dangerous & sometimes fatal outcomes.

Chris Cornell dpurb d'purb

Traduction[EN]: Click for Original Message / An artist many might consider to be the Fréderic Chopin & the Edouard Manet of Rock, composing with his heart and painting with his voice, enigmatic vocalist Chris Cornell, known for timeless titles such as « The Last Remaining Light », «What You Are » , « Like A Stone » , « Getaway Car », « Be Yourself », « Exploder » & « Dandelion » left a hole in the hearts of millions touched by his work. His tragic death is a reminder that further research is required in understanding the thought structure of artistic individuals whose psychological subjective reality would likely be deeper and more complex compared to the average psyche. An approach focusing on the « mind » rather than the « behaviour or brain » in the tradition of Sigmund Freud would likely reveal and explain the granularity of their psyche; and whether their suicidal decisions are rooted in full awareness and motivated by a reality they consider to be inadequate for their state of consciousness and IQ. Appropriate interventions involving the restructuration of their psychosocial patterns/exposure [to prevent the burden of stress] may be more individualistic & appropriate to prevent suicide.

« Les meilleurs meurent souvent de leur propre main juste pour s’échapper, et ceux qui restent ne peuvent jamais vraiment comprendre pourquoi quelqu’un voudrait s’éloigner d’eux. »

– Charles Bukowski

Traduction(EN):

« The best often die by their own hand just to get away, and those left behind can never quite understand why anybody would ever want to get away from them. »

-Charles Bukowski

As mentioned above, similar therapies oriented towards changing the “thinking styles” of patients to build a resilient psyche, could also be provided to sufferers of post-traumatic stress disorder who would benefit of a non-pharmacological and empowering intervention to manage and take control of recurrent intrusive and distressing memories – it may be useful to study fear, distress and courage as normal psychological processes happening on a dimensional scale on a normal continuum from one individual to another where those on the extreme ends of the scales may be considered for psychological interventions.

Similarly, antidepressant medication used to treat depression remains controversial due to its questionable efficacy and side-effects. The high level of effectiveness of SSRIs reported in academic journals was greatly due to only trials with positive results of antidepressants being published while those where antidepressants were found to be no more effective than placebos being rejected. The effects of TCAs and SSRIs have also been found to be negligible in mild to moderate depression but effective in severe depression in meta-analyses (Fournier et al., 2010). The negative side-effects of antidepressants are known to be risky and dangerous where symptoms such as loss of sexual desire and impotence, weight gain, nausea, sedation or activation, and dizziness are known to be some of the more disturbing ones, with effects varying with types of antidepressants – for depressed pregnant women, health risks may affect their offspring. Dangerous antidepressants such as MAOIs are only prescribed to patients who can follow strict dietary patterns that exclude foods with thyramine (e.g. cheese) to prevent risks of high blood pressure and hypertensive crises. Although meta-analyses suggest benefits may outweigh the risks, an increased risk of suicide has also been noted among patients under 25 (Bridge et al., 2007).

Edouard Manet - Le Suicide

Edouard Manet (1832 – 1883), “Le Suicidé

Electroconvulsive therapy has also sparked a major controversy as a primitive, dangerous and non-scientific practice for the brevity of its effect and negative side-effects on memory (Read & Bentall, 2010). A thorough review of studies on the effectiveness of ECT and its side-effects [retrograde and anterograde amnesia] revealed it to be effective for a brief duration in treating severe depression [in cases that are unresponsive to psychological treatment] and questionably only supported by psychiatrists with a vested interest in proving ECT’s effectiveness. ECT has also been associated with a slight but significant risk of death, and a qualitative study of patients’ negative experiences concluded that for some ECT leads to fear, shame and humiliation, and reinforces experiences of worthlessness and helplessness associated with depression.

brainbuilding

Medicalization has also led to controversy over the diagnosis of schizophrenia, a condition classified as a disease by the World Health Organization and ranked second only to cardiovascular diseases in terms of overall disease burden internationally (Murray & Lopez, 1996). Diagnosis is believed to be part of best practice in the patient’s “best” interest, however a strongly presented viewpoint by Thomas Szasz (2010) qualified diagnosis as an act of oppression as it may pave way for involuntary hospitalisation; where a deviant, maladjusted or poorly educated person may be subjected to “control” processes that they are not fully aware of – this has been proposed as a “possible” explanation for the greater rates of schizophrenia among ethnic minorities (particularly Africans in the US & those of low-SES groups). This view has also been supported by many who argue that schizophrenia as a distinct category may not be a fully valid diagnostic, but a fabrication constructed that may stigmatise disadvantaged or poorly educated people – while this may be positive in shaping “unacceptable behaviour” and protect citizens & society, some people with moderate symptoms may also be forcefully hospitalised. Thus, nowadays, schizophrenia is not a single definite disorder anymore, but one among others, as it has been revised and turned into a spectrum, known as the schizoid spectrum [with other related disorders]. In the treatment of schizophrenia, medicalisation has also led to the evaluation of psychotherapy as a possibly ineffective treatment (Lehman & Steinwachs, 1998). Freud & others in his discipline acknowledged the treatment of psychosis as problematic with psychotherapy as psychotic individuals tend not to develop transference [interpretation of their hidden feelings, defences & anxiety] to the analyst – unlike neurotic patients. For personality disorders, addictions and other severe mental health problems medicalisation has led to the development of alternative methods of treatment that unlike the traditional authoritarian & hierarchically organised inpatient mental health settings, are run in a more democratic line where service users are encouraged to take an active role in their rehabilitation rather than simply being passive recipients of treatment.

clinicalpsychology

Therapeutic communities have turned out to be effective in the long-term treatment of difficult patients with severe personality disorders with the outcome being more positive with longer treatments. These therapeutic communities are believed to lead to improvements in mental health and interpersonal functioning. For drug misuse issues, the assumption that clinicians make over users attempt to quit being due to conscious guidance & coherent plans should be revised as no evidence suggests so, and more evidence argue that unconscious processes, classical and operant conditioning, erratic impulses, and highly specific environmental cues affect the development and cessation of drug use (West, 2006). According to West, interventions should not stimulate adolescents to think of what ‘stage’ they are in or be matched to a stage, but maximum tolerable pressure should be put on the young person to cease drug use – which contradicts the stages of change model (DiClemente, 2003; Prochaska et al., 1992) where 30 days are allocated to stages [pre-contemplation, contemplation, action & maintenance] based on no evidence. While concepts such as harm reduction programmes with needle exchange, safe injection sites, and the provisions of free tests of quality of MDMA sold at raves remain controversial, some believe they prevent mortality and morbidity (Marlatt & Witkiewitz, 2010), while others argue they send the message that hard drug use [such as heroin] may be acceptable.

The second major controversy in modern day mental health practice remains the “Person or Context” debate where many in the field still question the validity of focusing on context as it shifts attention from the individualistic characteristics of the patient, and whether the focus should shift depending on the disorder and the patient’s age. For example in the treatment of childhood disorders, if difficulties are assumed to be individual ‘psychiatric’ illnesses the risk of focus being solely on the child and not on broader social environment may lead to medical treatments and individual therapy without addressing important risk factors for those of such young age who are influenced by their social environment, e.g. teacher, school and wider social context. This may not be the case for some adults who value a sense of autonomy more than being influenced by wider social contexts that they have no connection to, interest in or affinity for. In contrast, to the autonomic adult, treatment cases of other childhood behaviour disorders such as oppositional defiant disorder and conduct disorders may be particularly problematic, since the major risk factors that should be addressed are social: through interventions such as parent training, family therapy, multisystemic therapy and treatment foster care. For ADHD, the bold emphasis on medication is dangerous as the effects are limited to only 3 years (Swanson & Volkow, 2009), while growth and cardiovascular functioning may be affected that may lead to somatic complaints such as loss of appetite, headaches, insomnia and tics, which are present in 5-12% of cases (Breggin, 2001; Paykina et al., 2007; Rapport & Moffitt, 2002).

Another interesting argument comes from the Scottish psychiatrist and psychoanalyst R. D. Laing (2009) in the 1960s and 1970s who opposed the view that schizophrenia was a genetically based medical condition requiring treatment with antipsychotic medication. His dimensional approach led him to view schizophrenia as a ‘sane reaction to an insane situation’ where the contents of psychotic symptoms were simply viewed as psychological responses to complex, confusing, conflicting and powerful parental injunctions that left no scope for more rational and adaptive modes of expression. Thus, Laing proposed that the treatment involved creating a context where insight into the complex family process [e.g. poor housing, low SES, deviant parents with drug problems, over-involved family members who maintain the patient’s stress, alcohol problems, sexual deviance, incest, lack of financial stability, poor educational motivation, poor emotional education, lack of problem solving skills, lack of sophistication, poor nutrition, restricted finances, etc] of patients with schizophrenia and psychotic response to these could be facilitated. The context here seems partially important in the case where the patient’s delusions and hallucinations are linked, where their interpretation would be the client’s response to conflicting parental injunctions. The experience of psychosis and recovery was a process where the individual could emerge stronger with new and valuable insights regarding the solutions to their problems. However, this has not been supported by any evidence or subsequent research. In contrast, strong scientific evidence points to the importance of a more client-centred individual approach focussed solely on the patient with defective inherited neurobiological factors as major focus for the role they play in schizophrenia, and antipsychotic medication for the reduction of symptoms in two-thirds of psychotic patients affected (Ritsner & Gottesman, 2011; Tandon et al., 2010). Research has supported the hypothesis that suggests the family does affect the psychotic process and that psychotherapy has a place in the management of psychosis, for example personal trauma, including child abuse increases the risk of psychosis, and stressful life events including those within the family can precipitate an episode of psychosis, and high levels of family criticism, hostility and emotional over-involvement increase the risk of relapse (Bebbington & Kuipers, 2008; Hooley, 2007; Shelvin et al., 2008). So for those with a strong sense of family, and heavily involved peers, family therapy delays relapse in troubled families characterized by “extreme” levels of expressed emotion; and cognitive behaviour therapy which stresses the idea that psychotic symptoms are understandable and on a continuum with normal experience can help patients control these psychotic symptoms (Tandon et al., 2010), with solutions to rebuild their lives, their own identity and manage their social circle intelligently by differentiating types of relationship and expectations.

personality

The third and last controversy to be addressed is the ongoing debate in clinical psychology over the categorisation of psychological disorders where many have been arguing over a dimensional outlook on psychological conditions that offers more precision in diagnosis along with a more scientific approach. In the case of childhood behaviour disorders with regard to scientific approaches, there is an ongoing debate over whether they should be viewed and classified in categorical or dimensional terms. While DSM are based on rigid categories, most empirical studies support the view of a dimensional outlook. Furthermore, factor analytic studies consistently show that common childhood difficulties belong to two dimensions of internalizing and externalizing behaviour, which are normally distributed within the population (Achenbach, 2009). Young children diagnosed with oppositional defiant disorder (ODD), conduct disorder and ADHD are part of a subgroup of cases with extreme externalizing behavioural problems, while those with anxiety or depressive disorders have extreme internalizing behaviour problems (Carr, 2006a). By the same dimensional approach, children diagnosed with intellectual disability fall at the lower end of the continuum of intelligence, a trait also normally distributed within the population (Carr et al., 2007). The dimensional approach is not only more scientific, but also has a less stigmatizing and rational approach to human uniqueness. The dimensional approach has also enhanced the movement critical of qualifying psychological deficiencies as ‘real psychiatric illnesses’, conditions such as ADHD, conduct disorder and other DSM diagnoses. Questions have been raised over whether they are invalid fabrications or spurious social constructions (Kutchins & Kirk, 1999). Those who trust the evidence of the dimensionality of childhood disorders argue that they may simply be traits distributed normally among the population where some cases fall on the extreme ends of certain traits, while those who point to the interests of pharmaceutical industries’ financial motives argue that they are spurious social constructions. The latter seems unethical but is a part of the decadent and immoral economic reality that we have allowed to exist. As parents, health and educational professionals, it is clear that the pharmaceutical industry and governments may all gain from conceptualising children’s psychological difficulties as ‘real psychiatric illnesses’. Some schools or uncaring parents may prefer children to receive a diagnosis of ADHD with stimulant therapy as they may have difficulty meeting their needs for intellectual stimulation, nurturance and clear limit-setting; thus these children in their care become more aggressive and disruptive.

In the case of schizophrenia, a dimensional approach has also led to the schizotypy construct as a dimensional alternative to the prevailing categorical conceptualization of schizophrenia (Lenzenweger, 2010). In contrast to the categorical view based on Kraepelin’s (1899) work and used in the DSM which sees schizophrenia as a discrete diagnostic category, this one proposes that anomalous sensory experiences, odd beliefs and disorganized thinking exist in extreme forms of schizophrenia as hallucinations, delusions and thought disorder, but these are simply on continuum with normal experience [i.e. it is present in all ‘normal’ people but peaks in abnormal ones] – a position originally advocated by Bleuler (1911). Research measures have provided support for the dimensional construct of schizotypy (Lenzenweger, 2010) where the continuum may be composed of sub-dimensions; from normal to psychotic experiences. Schizotypy is heritable; and patients with high schizotypy scores but who are not psychotic show attentional, eye-movement and other neuropsychological abnormalities associated with schizophrenia. Further, the dimensional approach has also led to the distinction between schizophrenia and split personality where 40% in the UK equated split or multiple personality with schizophrenia – as popular culture often does. It is clear that schizophrenia does not refer to such characteristics.

dr_jekyll_and_mr_hyde_poster_d'purb

The closest equivalent to split personality is a condition known as dissociative identity disorder (DID), where the central feature is the apparent existence of two or more distinct personalities within the same individual, with only one being evident at a time. Each personality (or alter) is distinct with its own memories, behaviour and interpersonal style. In most cases, the host personality is unaware of the existence of alters and these vary in knowledge of each other. Evidence suggests that the capacity to dissociate is normally distributed within the population and an attribute many use to manage their own lives and network. Those with high degree of this trait may cope by dissociating their consciousness from the experience of trauma (such as child abuse, extreme graphic violence, etc) in early childhood by entering a trance-like state. This dissociative habit is negatively reinforced (strengthened) as an effective distress-reducing coping strategy over repeated traumas in early childhood as it brings relief from distress during trauma exposure. Eventually a sufficient number of experiences become dissociated to constitute a separate personality that may be activated in later life at times of stress or trauma through suggestion in hypnotic psychotherapeutic situations. Treatment often simply involves helping clients integrate the multiple personalities into a single personality and develop non-dissociative strategies for dealing with stress [e.g. argument with work colleagues, new manager, divorce, adolescents leaving home for studies, partner with alcohol problems, over-involved family members, etc] – this helps them deal with tough situations by facing them with problem-solving abilities and skills to come out with a firm resolution and have their views understood. Core symptoms of multiple personality disorder are not treated with psychotropic medication unlike schizophrenia but involves psychological education for patients to learn the skill of mentalizing [understand their own state of mind and that of others].

whoareyou

Finally, with personality disorders, the dimensional approach has led to the trait theory in conceptualizing important aspects of behaviour and experience from a limited number of dimensions. Any given trait is believed to be normally distributed in the population, for example, introversion – extraversion, most people show a moderate level of the trait, however those who exhibit extremely low or high levels [extremes] would have the sort of difficulties attributed in the DSM. Thus, by that logic, normal people only differ from the abnormal in the degree to which they show particular traits. The trait theory has become dominated by the five-factor theory (McCrae & Costa, 2008) in recent years. This model includes the dimensions: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. There is evidence for the heritability of all of factors within the Five Factor Model except agreeableness which seems to be predominantly determined by one’s environment (Costa & Widiger, 1994).

Thomas Widiger has proposed that the five-factor model may be used as an alternative system for describing personality disorders (Widiger & Mullins-Sweatt, 2010). Widiger also argues that trait theory offers a more scientifically useful approach to assessment with good psychometric properties embraced by its questionnaires (De Raad & Perugini, 2002) – they are reliable and valid, and have population norms. Compared to rigid categorical classification systems, trait models may offer a more parsimonious way of describing patients with rigid dysfunctional behavioural patterns which in turn offers a more parsimonious way to conceptualize the development of effective treatments. However, it is important to remember that while this approach may work on some patients, it will not work on the whole human population. Furthermore, the 5 dimensions of the Five Factor Model is far too simplistic to fully understand the sophisticated and highly complex constructions of the human psyche – it would be arrogant to try and prove the contrary. Hence, this justifies the vital importance of having different schools of thoughts in psychological philosophy along with different models in psychology to fit the individual characteristics of patients.

LondonCity

Photo: The Promise of Dawn (J.Hawkes)

One of the major controversies in modern day mental health practice revolve around the precision and the validity of constructs as psychological illnesses, and since they may stigmatise those who suffer from them, the constant research into better and more modern interpretations and explanations of their characteristics and treatment seem bound to revolutionize the field of psychology as the movement takes a more dimensional  and individualistic approach.

If the method of inquiry is respectful of the scientific methods, then it would simply be realistic to acknowledge the fact that its also comprises of shortcomings when applied to the field of psychology – specially in trying to capture the depth of the human psyche. By truthfully acknowledging the depth and individuality of human psychology, therapies must be individually-oriented to suit the uniqueness of each patient. It is a well-known and undeniable fact that the type of therapy that works for one patient will not work with all patients – in matters of the mind it is clearly not a scenario of “one-size fits all” as we would when dealing with socks.

Nowadays, we can see the failed promises of biopsychiatry, along with the hidden failure of the Improving Access to Psychological Therapies initiative, the UK’s government-funded basic Cognitive-Behavioural Therapy (CBT) programme, which by some investigations has had a ridiculously low success rate of 9.2 % (Scott, 2018). Although this failure needs to be addressed, we still see the stubborn emergence of supposedly “precision psychiatry”, CBT chat bots, and psychotherapy based on texts [instructions to be read and applied by the patient]. All those only contribute to the trivializing of human beings with humane problems, and besides being unhelpful, that also increases the psychological and emotional suffering of everyone who can sense a lack of concern and care.

A mentally healthy society & culture is the founding stone towards excellence at every level; and to achieve this in the future, quality psychological therapies will undeniably play a huge part. Therefore, we could gain a lot of insight towards improving therapies by asking the following question: “Can a healthy and trustworthy relationship be built between a psychologist and a patient based solely on objective data, or through a form with a series of check-boxes filled within a few minutes?” [See the Essay, Psychoanalysis: History, Foundations, Legacy, Impact & Evolution]. Norcross stated that therapy research has savagely neglected the important question of studying the therapy relationship. Instead, the focus has been more on the application and mastery of a technique (not a relationship) (Norcross 2002a). It is important to also consider that one’s training in how to conduct psychoanalytic or psychodynamic psychotherapy is focused on how therapists present themselves and how patients respond to this. Such a focus automatically puts the therapeutic alliance at the heart of the matter, something that has taken on more interest over the years (Fairbairn, 1952; Greenberg, 1986, 2001a; Pine, 1998; Stolorow, Atwood & Brandchaft, 1994; Wallerstein, 2002).

The importance of individually-oriented therapies to fit the uniqueness of the patient’s characteristics cannot be escaped. It is a well known fact among psychotherapists that one of the most important factors in successful therapies is the relationship between the patient and the therapist; Wampold (2001) concluded in a meta-analysis of psychotherapy studies that the qualities of the therapist play a much stronger role in the outcome of treatment than does the treatment itself. For example, if an individual is highly educated, artistically cultured, and linguistically rich with a natural ability for expression, he would have a different type of personality; that individual aspect will bring about a feeling of being trivialized if treated with common Cognitive-Behavioural Therapy (CBT) offered by mainstream psychologists. CBT treatment would come across as far too simplistic and basic to study, understand, analyse and unlock the hidden meanings and unconscious feelings within the constructed psyche of such a deep and intellectually rich individualCBT practitioners would not be able to connect linguistically with such a patient or build any sense of trust, and the therapy would fail. Norcross also brought forward that perspective on why the Empirically supported therapy realationships (EST) literature has been so controversial; small attention has been given to the patient characteristics that affect outcome, such as comorbid conditions, capacity for insight, and a history of interpersonal relatedness (Norcross, 2002a). Therefore, with the example of the patient with the characteristics mentioned above, psychoanalytical psychotherapy would be best suited to capture the depth of his psyche [for example, Freudian, Jungian or Lacanian psychoanalytical psychotherapy].

Psychotherapy, being a medical field in constant evolution with different approaches and models, can only hope to impose itself as a respectable universal discipline with a new generation of psychologists willing to apply the rules creatively, i.e. with an open mind and a flexible outlook on different perspectives and methods customized to the individual characteristics and personality of the patient; only then can we hope to realistically transform the field of psychotherapy into a trustworthy discipline. Carl Sagan famously said: “Science is a way of thinking much more than it is a body of knowledge.”, and this can be a guiding force in keeping psychotherapy on a positively progressive course.

UneNation

“A great aggregation of men sane in mind & warm in the heart, creates a moral conscience that is known as a nation” – Ernest Renan / Source: Université Paris 1 Panthéon-Sorbonne

Arthur Hughes - A Music Party 1864

Arthur Hughes (1832 – 1915), “A Music Party

*****

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D.J. d’Purb | dpurb.com

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