Andrew Marshall

What is Social Defeat?

Published on 05/08/2024 by Andrew Marshall1 Comment

Introduction

In social psychology, social defeat is the negative experience of being excluded from the majority group. The term is used in the study of the physiological and behavioural effects of hostile interactions among either animals or humans, in either a dyadic or in a group-individual context, potentially greatly affecting control over resources, access to mates, and social positions.

Background

Research on social stress has accumulated a useful body of knowledge, providing perspective on the effects of detrimental social and environmental interaction on the brain. Research and experimentation suffer from many methodological difficulties: usually a lack of ecological validity (similarity with natural conditions and stressors) or are not amenable to scientific investigation (difficult to test and verify).

Social psychology approaches to human aggression have developed a multitude of perspectives, based on observations of human phenomena like bullying, physical and verbal abuse, relational and indirect aggression, etc. Despite the richness of theories developed, the body of knowledge generated has not satisfied scientific requirements of testability and verifiability.

Animal studies of within-species aggression developed in 2 main branches:

Approaches based on laboratory experiments, on controlled conditions, allowing the measurement of behavioural, endocrine and neurological variables, but with the shortcoming of applying unnatural stressors (such as foot-shocks and restraint stress) in unnatural conditions (laboratory cages rarely approximate native habitats); and
Approaches based on observations of animals in naturalistic settings, which avoided artificial environments and unnatural stresses, but usually not allowing the measurement of physiological effects or the manipulation of relevant variables.

In real life situations, animals (including humans) have to cope with stresses generated within their own species, during their interactions with conspecifics, especially due to recurrent struggles over the control of limited resources, mates and social positions (Bjorkqvist, 2001; Rohde, 2001; Allen & Badcock, 2003).

Social defeat is a source of chronic stress in animals and humans, capable of causing significant changes in behaviour, brain functioning, physiology, neurotransmitter and hormone levels, and health (Bjorkqvist, 2001; Rohde, 2001; Allen & Badcock, 2003).

Brief History

The social defeat approach was originated from animal experiments, using the “resident-intruder” paradigm, in which an animal was placed in the cage of another animal or group of animals of the same species, in a manner that allowed a non-lethal conflict. It has been documented to produce anxiety-like and depressive-like behavioural declines in susceptible mice, for instance.

If animals are allowed to fight on a single occasion only, it is usually regarded as a model of acute stress; if they are allowed to fight on several occasions, on different days, consecutive or not, it is regarded as a model of chronic stress. After the defeat or in the interval between fights, the subordinate animal may also be exposed to threats from the dominant one, by having to stay in a cage or compartment beside or nearby the dominant, exposed to its visual or olfactory cues.

Later, the social defeat approach was also applied to observations of animal within-species aggression, in the wild, which suggested that the hypotheses generated on artificial laboratory settings can also be applied in observed in natural settings, confirming the predictions of the model.

In Humans

It has been proposed that animal models of social conflict may be useful for studying a number of mental disorders, including major depression, generalised anxiety disorder, post-traumatic stress disorder, drug abuse, aggressive psychopathologies, eating disorders and schizophrenia (Bjorkqvist, 2001; Selten & Cantor-Graae, 2005; Rohde, 2001).

The social defeat model has been extended to include observations of human aggression, bullying, relational aggression, chronic subordination and humiliation. The social defeat model attempts to extend animal studies to include human behaviour as well, in contrast to the social psychology study of aggression, in which comparisons are drawn exclusively from experiments involving humans (Bjorkqvist, 2001; Rohde, 2001).

Bullying has interesting parallels with animal models of social defeat, the bully being equivalent to the dominant animal and the victim the subordinate one. At stake are possessions of material objects, money, etc., social position in the group, represented by in-group prestige, and the consequent lack of access to mates, including for socio-sexual behaviours like copulation. Human victims typically experience symptoms like low self-esteem (due to low regard by the group), feelings of depression (due to unworthiness of efforts), social withdrawal (reduced investments in the social environment), anxiety (due to a threatening environment), and they can also be shown to experience a plethora of physiological effects, e.g. increased corticosterone levels, and also a shift towards sympathetic balance in the autonomic nervous system (Bjorkqvist, 2001).

Research about human aggression, usually conducted by psychologists or social psychologists, resembles to a great extent the research about social defeat and animal aggression, usually conducted by biologists or physiological psychologists. However, there is the problem of the use of different terminologies for similar concepts, which hinders communication between the two bodies of knowledge (Bjorkqvist, 2001).

Similarly, research on depression has employed similar constructs, such as learned helplessness, although that theory is focused on the perceived inability to escape any sort of negative stimuli rather than on social factors.

Behavioural and Physiological Effects

Social defeat is a very potent stressor and can lead to a variety of behavioural effects, like social withdrawal (reduced interactions with conspecifics), lethargy (reduced locomotor activity), reduced exploratory behaviour (of both open field and novel objects), anhedonia (reduced reward-related behaviours), decreased socio-sexual behaviours (including decreased attempts to mate and copulate after defeat), various motivational deficits, decreased levels of testosterone (due to a decline in the functionality of the Leydig cells of the testes), increased tendencies to stereotyped behaviours and self-administration of drugs and alcohol (Rygula et alli, 2005; Huhman, 2006).

Research also implicates that the referred behavioural effects are moderated by neuroendocrine phenomena involving serotonin, dopamine, epinephrine, norepinephrine, and in the hypothalamic-pituitary-adrenal axis, locus ceruleus and limbic systems (Bjorkqvist, 2001; Rygula et alli, 2005; Selten & Cantor-Graae, 2005; Marinia et alli, 2006; Huhman, 2006).

Both animal and human studies suggest that the social environment has a strong influence on the consequences of stresses. This finding seems to be especially true in the case of social stresses, like social defeat (Bjorkqvist, 2001; Rygula et alli, 2005; de Jong et alli, 2005).

In animal studies, animals housed collectively showed reduced symptoms after defeat, in comparison with those housed alone; and animals that live in more stable groups (with stable hierarchies, less intra-group aggression) exhibit reduced effects after a defeat, in comparison with those housed in a more unstable group (de Jong et alli, 2005). In separate studies, defeat behaviours can be modulated by acetylcholine (Smith et al., 2015).[2]

In human studies, individuals with greater support seem to be protected against excessive neuroendocrine activation, thereby reducing the adverse effects of stresses in general, and especially stresses of social origin.

This apparent confusion, in which social defeat generates behavioural and neuroendocrine effects, both of which depending on social contextual variables, raises the question of how to interpret this data. A useful concept is the concept of “causal chain”, in which recurrent evolutionary events, in this case intra-specific competition, generates selective pressures that last for thousands of generations, influencing a whole species. This way physiological phenomena may evolve, in this case the referred neuro-endocrine phenomena, to facilitate adaptive patterns of action by individuals, in this case the referred behavioural effects. According to this framework, selective pressures generated by intra-specific competition can be considered as the ultimate cause, the neuroendocrine phenomena can be considered to be the proximate causes (sometimes also called mechanisms or moderators) and the observed behavioural alterations are considered the effects (the end events in the causal chain)(Gilbert et alli, 2002; Allen & Badcock, 2003; Rygula et alli, 2005).

Some authors, for example Randolph Nesse, warn us that patterns of behaviour commonly considered inappropriate or even pathological may well have adaptive value. Evolutionary psychology provides several possible explanations for why humans typically respond to social dynamics in the way that they do, including possible functions of self-esteem in relation to dominance hierarchies. In a synchronic perspective behaviours considered abnormal may in fact be part of an adaptive response to stressors in modern or at least in old environments, for example social stressors from chronic subordination or interpersonal conflicts (Gilbert et alli, 2002; Allen & Badcock, 2003). Similarly, from a diachronic perspective various behaviours related to intra-species competition or predator-prey relationships may have played a role in the evolution of human abilities, for example defensive immobilisation is hypothesized to have played a role in the evolution of both human parent-child attachment and theory of mind.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Social_defeat >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Social Stress?

Published on 05/07/202405/08/2024 by Andrew Marshall2 Comments

Introduction

Social stress is stress that stems from one’s relationships with others and from the social environment in general. Based on the appraisal theory of emotion, stress arises when a person evaluates a situation as personally relevant and perceives that they do not have the resources to cope or handle the specific situation.

Refer to Social Defeat.

The activation of social stress does not necessarily have to occur linked to a specific event, the mere idea that the event may occur could trigger it. This means that any element that takes a subject out of their personal and intimate environment could become a stressful experience. This situation makes them socially incompetent individuals.

There are three main categories of social stressors. Life events are defined as abrupt, severe life changes that require an individual to adapt quickly (ex. sexual assault, sudden injury). Chronic strains are defined as persistent events which require an individual to make adaptations over an extended period of time (ex. divorce, unemployment). Daily hassles are defined as minor events that occur, which require adaptation throughout the day (ex. bad traffic, disagreements). When stress becomes chronic, one experiences emotional, behavioural, and physiological changes that can put one under greater risk for developing a mental disorder and physical illness.

Humans are social beings by nature, as they typically have a fundamental need and desire to maintain positive social relationships. Thus, they usually find maintaining positive social ties to be beneficial. Social relationships can offer nurturance, foster feelings of social inclusion, and lead to reproductive success. Anything that disrupts or threatens to disrupt their relationships with others can result in social stress. This can include low social status in society or in particular groups, giving a speech, interviewing with potential employers, caring for a child or spouse with a chronic illness, meeting new people at a party, the threat of or actual death of a loved one, divorce, and discrimination. Social stress can arise from one’s micro-environment (e.g. family ties) and macro-environment (e.g. hierarchical societal structure). Social stress is typically the most frequent type of stressor that people experience in their daily lives and affects people more intensely than other types of stressors.

Definitions

Researchers define social stress and social stressors in various ways. Wadman, Durkin, and Conti-Ramsden (2011) defined social stress as “the feelings of discomfort or anxiety that individuals may experience in social situations, and the associated tendency to avoid potentially stressful social situations”. Ilfield (1977) defined social stressors as “circumstances of daily social roles that are generally considered problematic or undesirable”. Dormann and Zapf (2004) defined social stressors as “a class of characteristics, situations, episodes, or behaviors that are related to psychological or physical strain and that are somehow social in nature”.

Measurement

Social stress is typically measured through self-report questionnaires. In the laboratory, researchers can induce social stress through various methods and protocols.

Self-Reports

There are several questionnaires used to assess environmental and psychosocial stress. Such self-report measures include the Test of Negative Social Exchange, the Marital Adjustment Test, the Risky Families Questionnaire, the Holmes–Rahe Stress Inventory, the Trier Inventory for the Assessment of Chronic Stress, the Daily Stress Inventory, the Job Content Questionnaire, the Perceived Stress Scale, and the Stress and Adversity Inventory.

In addition to self-report questionnaires, researchers can employ structured interview assessments. The Life Events and Difficulties Schedule (LEDS) is one of the most popular instruments used in research. The purpose of this type of measure is to probe the participant to elaborate on their stressful life events, rather than answering singular questions. The UCLA Life Stress Interview (LSI), which is similar to the LEDS, includes questions about romantic partners, closest friendships, other friendships, and family relationships.

Induction

In rodent models, social disruption and social defeat are two common social stress paradigms. In the social disruption paradigm, an aggressive rodent is introduced into a cage housing male rodents that have already naturally established a social hierarchy. The aggressive “intruder” disrupts the social hierarchy, causing the residents social stress. In the social defeat paradigm, an aggressive “intruder” and another non-aggressive male rodent fight.

In human research, the Trier Social Stress Task (TSST) is widely used to induce social stress in the laboratory. In the TSST, participants are told that they have to prepare and give a speech about why they would be a great candidate for their ideal job. The experimenter films the participant while they give the speech and informs the participant that a panel of judges will evaluate that speech. After the public speaking component, the experimenter administers a mathematics task that involves counting backwards by certain increments. If the participant makes a mistake, the experimenter prompts them to start again. The threat of negative evaluation is the social stressor. Researchers can measure the stress response by comparing pre-stress salivary cortisol levels and post-stress salivary cortisol levels. Other common stress measures used in the TSST are self-report measures like the State-Trait Anxiety Inventory and physiological measures like heart rate.

In a laboratory conflict discussion, couples identify several specific areas of conflict in their relationship. The couples then pinpoint a couple topics to discuss later on in the experiment (ex. finances, child-rearing). Couples are told to discuss the conflict(s) for 10 minutes while being videotaped.

Brouwer and Hogervorst (2014) designed the Sing-a-Song Stress Test (SSST) to induce stress in the laboratory setting. After viewing neutral images with subsequent 1-minute rest periods, the participant is instructed to sing a song after the next 1-minute rest period is complete. Researchers found that skin conductance and heart rate are significantly higher during the post-song message interval than the previous 1-minute intervals. The stress levels are comparable to that induced in the Trier Social Stress Task. In 2020, a systematic review about the TSST provided several guidelines to standardise the use of the TSST across studies.

Statistical Indicators of Stress in Large Groups

A statistical indicator of stress, simultaneous increase of variance and correlations, was proposed for diagnosis of stress and successfully used in physiology and finance. Its applicability for early diagnosis of social stress in large groups was demonstrated by the analysis of crises. It was examined in the prolonged stress period preceding the 2014 Ukrainian economic and political crisis. There was a simultaneous increase in the total correlation between the 19 major public fears in the Ukrainian society (by about 64%) and also in their statistical dispersion (by 29%) during the pre-crisis years.

Mental Health

Research has consistently demonstrated that social stress increases risk for developing negative mental health outcomes. One prospective study asked over fifteen hundred Finnish employees whether they had “considerable difficulties with [their] coworkers/superiors/inferiors during the last 6 months, 5 years, earlier, or never”. Information on suicides, hospitalisations due to psychosis, suicidal behaviour, alcohol intoxication, depressive symptoms, and medication for chronic psychiatric disorders was then gathered from the national registries of mortality and morbidity. Those who had experienced conflict in the workplace with co-workers or supervisors in the last five years were more likely to be diagnosed with a psychiatric condition.

Research on the LGBT population has suggested that people who identify as LGBT suffer more from mental health disorders, such as substance abuse and mood disorders, compared to those who identify as heterosexual. Researchers deduce that the LGBT people’s higher risk of mental health issues derives from their stressful social environments. Minority groups can face high levels of stigma, prejudice, and discrimination on a regular basis, therefore leading to the development of various mental health disorders.

Depression

Risk for developing clinical depression significantly increases after experiencing social stress; depressed individuals often experience interpersonal loss before becoming depressed. One study found that depressed individuals who had been rejected by others had developed depression about three times more quickly than those who had experienced stress not involving social rejection. Several studies have suggested that unemployment roughly doubles the risk of developing depression. In non-clinically depressed populations, people with friends and family who make too many demands, criticise, and create tension and conflict tend to have more depressive symptoms. Conflict between spouses leads to more psychological distress and depressive symptoms, especially for wives. In particular, unhappy married couples are 10–25 times more at risk for developing clinical depression. Similarly, social stress arising from discrimination is related to greater depressive symptoms. In one study, African-Americans and non-Hispanic whites reported on their daily experiences of discrimination and depressive symptoms. Regardless of race, those who perceived more discrimination had higher depressive symptoms. Posselt and Lipson found, in 2016, that undergraduates had a 37% higher chance of developing developing if they perceived their classroom environments as highly competitive.

Anxiety

The biological basis for anxiety disorders is rooted in the consistent activation of the stress response. Fear, which is the defining emotion of an anxiety disorder, occurs when someone perceives a situation (a stressor) as threatening. This activates the stress response. If a person has difficulty regulating this stress response, it may activate inappropriately. Stress can therefore arise when a real stressor is not present or when something isn’t actually threatening. This can lead to the development of an anxiety disorder (panic attacks, social anxiety, OCD, etc.). Social anxiety disorder is defined as the fear of being judged or evaluated by others, even if no such threat is actually present.

Research shows a connection between social stress, such as traumatic life events and chronic strains, and the development of anxiety disorders. A study that examined a subpopulation of adults, both young and middle-age, found that those who had diagnosed panic disorder in adulthood also experienced sexual abuse during childhood. Children who experience social stressors, such as physical and psychological abuse, as well as parental loss, are also more at risk for developing anxiety disorders during adulthood than children who did not experience such stressors.

In 2016, an analysis of 40,350 undergraduates from 70 institutions by Posselt and Lipson found that they had a 69% higher chance of developing anxiety if they perceived their classroom environments as highly competitive.

Long-Term Effects

Social stress occurring early in life can have psychopathological effects that develop or persist in adulthood. One longitudinal study found that children were more likely to have a psychiatric disorder (e.g. anxiety, depressive, disruptive, personality, and substance use disorders) in late adolescence and early adulthood when their parents showed more maladaptive child-rearing behaviours (e.g. loud arguments between parents, verbal abuse, difficulty controlling anger toward the child, lack of parental support or availability, and harsh punishment). Child temperament and parental psychiatric disorders did not explain this association. Other studies have documented the robust relationships between children’s social stress within the family environment and depression, aggression, antisocial behaviour, anxiety, suicide, and hostile, oppositional, and delinquent behaviour.

Relapse and Recurrence

Social stress can also exacerbate current psychopathological conditions and compromise recovery. For instance, patients recovering from depression or bipolar disorder are two times more likely to relapse if there is familial tension. People with eating disorders are also more likely to relapse if their family members make more critical comments, are more hostile, or are over-involved. Similarly, outpatients with schizophrenia or schizoaffective disorder show greater psychotic symptoms if the most influential person in their life is critical and are more likely to relapse if their familial relationships are marked by tension.

In regard to substance abuse, cocaine-dependent individuals report greater cravings for cocaine following exposure to a social stressor. Traumatic life events and social stressors can also trigger the exacerbation of the symptoms of mental health disorders. Socially phobic children who experience a stressful event can become even more avoidant and socially inactive.

Physical Health

Research has also found a robust relationship between various social stressors and aspects of physical health.

Mortality

Social status, a macro-social stressor, is a robust predictor of death. In a study of over 1700 British civil servants, socioeconomic status (SES) was inversely related to mortality. Those with the lowest SES have worse health outcomes and greater mortality rates than those with the greatest SES. Other studies have replicated this relationship between SES and mortality in a range of diseases, including infectious, digestive, and respiratory diseases. A study examining the link between SES and mortality in the elderly found that education level, household income, and occupational prestige were all related to lower mortality in men. In women, however, only household income was related to lower mortality.

Similarly, social stressors in the micro-environment are also linked to increased mortality. A seminal longitudinal study of nearly 7,000 people found that socially isolated people had greater risk of dying from any cause.

Social support, which is defined as “the comfort, assistance, and/or information one receives through formal or informal contacts with individuals or groups”, has been linked to physical health outcomes. Research shows the three aspects of social support, available attachments, perceived social support, and frequency of social interactions, can predict mortality thirty months after assessment.

Morbidity

Social stress also makes people more sick. People who have fewer social contacts are at greater risk for developing illness, including cardiovascular disease. The lower one’s social status, the more likely he or she is to have a cardiovascular, gastrointestinal, musculoskeletal, neoplastic, pulmonary, renal, or other chronic diseases. These links are not explained by other, more traditional risk factors such as race, health behaviours, age, sex, or access to health care.

In one laboratory study, researchers interviewed participants to determine whether they had been experiencing social conflicts with spouses, close family members and friends. They then exposed the participants to the common cold virus and found that participants with conflict-ridden relationships were two times more likely to develop a cold than those without such social stress. Social support, especially in terms of support for socioeconomic stressors, is inversely related to physical morbidity. A study that investigated social determinants of health in an urban slum in India found that social exclusion, stress, and lack of social support are significantly related to illnesses, such as hypertension, coronary heart disease, and diabetes.

Students who are being bullied may show signs of depression, impaired academic achievement, impaired quality of sleep, and anxiety disorders.

Long-Term Effects

Exposure to social stress in childhood can also have long-term effects, increasing risk for developing diseases later in life. In particular, adults who were maltreated (emotionally, physically, sexually abused or neglected) as children report more disease outcomes, such as stroke, heart attack, diabetes, and hypertension or greater severity of those outcomes. The Adverse Childhood Experiences study (ACE), which includes over seventeen thousand adults, also found that there was a 20% increase in likelihood for experiencing heart disease for each kind of chronic familial social stressor experienced in childhood, and this was not due to typical risk factors for heart disease such as demographics, smoking, exercise, adiposity, diabetes, or hypertension.

Recovery and Other Disease

Social stress has also been tied to worse health outcomes among patients who already have a disease. Patients with end-stage renal disease faced a 46% increased risk for mortality when there was more relationship negativity with their spouse even when controlling for severity of disease and treatment. Similarly, women who had experienced an acute coronary event were three times more likely to experience another coronary event if they experienced moderate to severe marital strain. This finding remained even after controlling for demographics, health behaviours, and disease status.

With regard to HIV/AIDS, stress may affect the progression from the virus to the disease. Research shows the HIV-positive males who have more negative life events, social stress, and lack of social support progress to a clinical AIDS diagnosis more quickly than HIV-positive males who do not have as high levels of social stress. For HIV-positive females, who have also contracted the HSV virus, stress is a risk factor for genital herpes breakouts.

Physiology

Social stress leads to a number of physiological changes that mediate its relationship to physical health. In the short term, the physiological changes outlined below are adaptive, as they enable the stressed organism to cope better. Dysregulation of these systems or repeated activation of them over the long-term can be detrimental to health.

Sympathetic Nervous System

The sympathetic nervous system (SNS) becomes activated in response to stress. Sympathetic arousal stimulates the medulla of the medulla to secrete epinephrine and norepinephrine into the blood stream, which facilitates the fight-or-flight response. Blood pressure, heart rate, and sweating increase, veins constrict to allow the heart to beat with more force, arteries leading to muscles dilate, and blood flow to parts of the body not essential for the fight or flight response decreases. If stress persists in the long run, then blood pressure remains elevated, leading to hypertension and atherosclerosis, both precursors to cardiovascular disease.

A number of animal and human studies have confirmed that social stress increases risk for negative health outcomes by increasing SNS activity. Studies of rodents show that social stress causes hypertension and atherosclerosis. Studies of non-human primates also show that social stress clogs arteries. Although humans cannot be randomized to receive social stress due to ethical concerns, studies have nevertheless shown that negative social interactions characterised by conflict lead to increases in blood pressure and heart rate. Social stress stemming from perceived daily discrimination is also associated with elevated levels of blood pressure during the day and a lack of blood pressure dipping at night.

Hypothalamic-Pituitary Adrenocortical Axis (HPA)

In response to stress, the hypothalamus releases corticotropin-releasing hormone (CRH), stimulating the anterior pituitary to release adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal cortex to secrete glucocorticoids, including cortisol. Social stress can lead to adverse health outcomes by chronically activating the HPA axis or disrupting the HPA system. There are a number of studies that link social stress and indications of a disrupted HPA axis; for instance, monkey infants neglected by their mothers show prolonged cortisol responses following a challenging event.

In humans, abused women exhibit a prolonged elevation in cortisol following a standardised psychosocial laboratory stressor compared to those without an abuse history. Maltreated children show higher morning cortisol values than non-maltreated children. Their HPA systems also fail to recover after a stressful social interaction with their caregiver. Over time, low-SES children show progressively greater output of cortisol. Although these studies point to a disrupted HPA system accounting for the link between social stress and physical health, they did not include disease outcomes. Nevertheless, a dysfunctional HPA response to stress is thought to increase risk for developing or exacerbating diseases such as diabetes, cancer, cardiovascular disease, and hypertension.

Inflammation

Inflammation is an immune response that is critical to fighting infections and repairing injured tissue. Although acute inflammation is adaptive, chronic inflammatory activity can contribute to adverse health outcomes, such as hypertension, atherosclerosis, coronary heart disease, depression, diabetes, and some cancers.

Research has elucidated a relationship between different social stressors and cytokines (the markers of inflammation). Chronic social stressors, such as caring for a spouse with dementia, lead to greater circulating levels of cytokine interleukin-6 (IL-6), whereas acute social stress tasks in the laboratory have been shown to elicit increases in proinflammatory cytokines. Similarly, when faced with another type of social stress, namely social evaluative threat, participants showed increases in IL-6 and a soluble receptor for tumour necrosis factor-α. Increases in inflammation may persist over time, as studies have shown that chronic relationship stress has been tied to greater IL-6 production 6 months later and children reared in a stressful family environment marked by neglect and conflict tend to show elevated levels of C-reactive protein, a marker of IL-6, in adulthood.

Interactions of Physiological Systems

There is extensive evidence that the above physiological systems affect one another’s functioning. For instance, cortisol tends to have a suppressive effect on inflammatory processes, and proinflammatory cytokines can also activate the HPA system. Sympathetic activity can also upregulate inflammatory activity. Given the relationships among these physiological systems, social stress may also influence health indirectly via affecting a particular physiological system that in turn affects a different physiological system.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Social_stress >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Abulia?

Published on 05/06/2024 by Andrew MarshallLeave a comment

Introduction

In neurology, abulia, or aboulia (from Ancient Greek: βουλή, meaning “will”), refers to a lack of will or initiative and can be seen as a disorder of diminished motivation (DDM). Abulia falls in the middle of the spectrum of diminished motivation, with apathy being less extreme and akinetic mutism being more extreme than abulia. The condition was originally considered to be a disorder of the will, and aboulic individuals are unable to act or make decisions independently; and their condition may range in severity from subtle to overwhelming. In the case of akinetic mutism, many patients describe that as soon as they “will” or attempt a movement, a “counter-will” or “resistance” rises up to meet them.

Symptoms and Signs

The clinical condition denoted abulia was first described in 1838; however, since that time, a number of different, some contradictory, definitions have emerged. Abulia has been described as a loss of drive, expression, behaviour and speech output, with slowing and prolonged speech latency, and reduction of spontaneous thought content and initiative, being considered more recently as ‘a reduction in action emotion and cognition’. The clinical features most commonly associated with abulia are:

Difficulty in initiating and sustaining purposeful movements
Lack of spontaneous movement
Reduced spontaneous speech
Increased response-time to queries
Passivity
Reduced emotional responsiveness and spontaneity
Reduced social interactions
Reduced interest in usual pastimes

Especially in patients with progressive dementia, it may affect feeding. Patients may continue to chew or hold food in their mouths for hours without swallowing it. The behaviour may be most evident after these patients have eaten part of their meals and no longer have strong appetites.

Differentiation from other Disorders

Both neurologists and psychiatrists recognise abulia to be a distinct clinical entity, but its status as a syndrome is unclear. Although abulia has been known to clinicians since 1838, it has been subjected to different interpretations – from ‘a pure lack of will’, in the absence of motor paralysis to, more recently, being considered ‘a reduction in action emotion and cognition’. As a result of the changing definition of abulia, there is currently a debate on whether or not abulia is a sign or a symptom of another disease, or its own disease that seems to appear in the presence of other more well-researched diseases, such as Alzheimer’s disease.

A 2002 survey of two movement disorder experts, two neuropsychiatrists, and two rehabilitation experts, did not seem to shed any light on the matter of differentiating abulia from other DDMs. The experts used the terms “apathy” and “abulia” interchangeably and debated whether or not abulia was a discrete entity, or just a hazy gray area on a spectrum of more defined disorders. Four of the experts said abulia was a sign and a symptom, and the group was split on whether or not it was a syndrome. Another survey, which consisted of true and false questions about what abulia is distinct from, whether it is a sign, symptom, or syndrome, where lesions are present in cases of abulia, what diseases are commonly associated with abulia, and what current treatments are used for abulia, was sent to 15 neurologists and 10 psychiatrists. Most experts agreed that abulia is clinically distinct from depression, akinetic mutism, and alexithymia. However, only 32% believed abulia was different from apathy, while 44% said they were not different, and 24% were unsure. Yet again, there was disagreement about whether or not abulia is a sign, symptom, or syndrome.

The study of motivation has been mostly about how stimuli come to acquire significance for animals. Only recently has the study of motivational processes been extended to integrate biological drives and emotional states in the explanation of purposeful behaviour in human beings. Considering the number of disorders attributed to a lack of will and motivation, it is essential that abulia and apathy be defined more precisely to avoid confusion.

Causes

Many different causes of abulia have been suggested. While there is some debate about the validity of abulia as a separate disease, experts mostly agree that abulia is the result of frontal lesions and not with cerebellar or brainstem lesions. As a result of more and more evidence showing that the mesolimbic and the mesocortical dopamine system are key to motivation and responsiveness to reward, abulia may be a dopamine-related dysfunction. Abulia may also result from a variety of brain injuries which cause personality change, such as dementing illnesses, trauma, or intracerebral haemorrhage (stroke), especially stroke causing diffuse injury to the right hemisphere.

Damage to the Basal Ganglia

Injuries to the frontal lobe and/or the basal ganglia can interfere with an individual’s ability to initiate speech, movement, and social interaction. Studies have shown that 5-67% of all patients with traumatic brain injuries and 13% of patients with lesions on their basal ganglia experience some form of diminished motivation.

It may complicate rehabilitation when a stroke patient is uninterested in performing tasks like walking despite being capable of doing so. It should be differentiated from apraxia, when a brain injured patient has impairment in comprehending the movements necessary to perform a motor task despite not having any paralysis that prevents performing the task; that condition can also result in lack of initiation of activity.

Damage to the Capsular Genu

A case study involving two patients with acute confusional state and abulia was conducted to see if these symptoms were the result of an infarct in the capsular genu. Using clinical neuropsychological and MRI evaluations at baseline and one year later showed that the cognitive impairment was still there one year after the stroke. Cognitive and behavioural alterations due to a genu infarct are most likely because the thalamo-cortical projection fibres that originate from the ventral-anterior and medial-dorsal nuclei traverse the internal capsule genu. These tracts are part of a complex system of cortical and subcortical frontal circuits through which the flow of information from the entire cortex takes place before reaching the basal ganglia. Cognitive deterioration could have occurred through the genu infarcts affecting the inferior and anterior thalamic peduncles. In this case study the patients did not show any functional deficits at the follow-up one year after the stroke and were not depressed but did show diminished motivations. This result supports the idea that abulia may exist independently of depression as its own syndrome.

Damage to Anterior Cingulate Circuit

The anterior cingulate circuit consists of the anterior cingulate cortex, also referred to as Brodmann area 24, and its projections to the ventral striatum which includes the ventromedial caudate. The loop continues to connect to the ventral pallidum, which connects to the ventral anterior nucleus of the thalamus. This circuit is essential for the initiation of behaviour, motivation and goal orientation, which are the very things missing from a patient with a disorder of diminished motivation. Unilateral injury or injury along any point in the circuit leads to abulia regardless of the side of the injury, but if there is bilateral damage, the patient will exhibit a more extreme case of diminished motivation, akinetic mutism.

Acute Caudate Vascular Lesions

It s well documented that the caudate nucleus is involved in degenerative diseases of the central nervous system such as Huntington disease. In a case study of 32 acute caudate stroke patients, 48% were found to be experiencing abulia. Most of the cases where abulia was present were when the patients had a left caudate infarct that extended into the putamen as seen through a CT or MRI scan.

Diagnosis

Diagnosis for abulia can be quite difficult because it falls between two other disorders of diminished motivation, and one could easily see an extreme case of abulia as akinetic mutism or a lesser case of abulia as apathy and therefore, not treat the patient appropriately. If it were to be confused with apathy, it might lead to attempts to involve the patient with physical rehabilitation or other interventions where a source of strong motivation would be necessary to succeed but would still be absent. The best way to diagnose abulia is through clinical observation of the patient as well as questioning of close relatives and loved ones to give the doctor a frame of reference with which they can compare the patient’s new behaviour to see if there is in fact a case of diminished motivation. In recent years, imaging studies using a CT or MRI scan have been shown to be quite helpful in localising brain lesions which have been shown to be one of the main causes of abulia.

Conditions where Abulia may be Present

Normal pressure hydrocephalus
Major depressive disorder
Persistent depressive disorder
Attention deficit hyperactivity disorder
Schizophrenia
Frontotemporal dementia
Parkinson’s disease
Huntington’s disease
Pick’s disease
Progressive supranuclear palsy
Traumatic brain injury
Stroke

Alzheimer’s Disease

A lack of motivation has been reported in 25–50% of patients with Alzheimer’s disease. While depression is also common in patients with this disease, abulia is not a mere symptom of depressions because more than half of the patients with Alzheimer’s disease with abulia do not have depression. Several studies have shown that abulia is most prevalent in cases of severe dementia which may result from reduced metabolic activity in the prefrontal regions of the brain. Patients with Alzheimer’s disease and abulia are significantly older than patients with Alzheimer’s who do not lack motivation. Going along with that, the prevalence of abulia increased from 14% in patients with a mild case Alzheimer’s disease to 61% in patients with a severe case of Alzheimer’s disease, which most likely developed over time as the patient got older.

Treatment

Most current treatments for abulia are pharmacological, including the use of antidepressants. However, antidepressant treatment is not always successful and this has opened the door to alternative methods of treatment. The first step to successful treatment of abulia, or any other DDM, is a preliminary evaluation of the patient’s general medical condition and fixing the problems that can be fixed easily. This may mean controlling seizures or headaches, arranging physical or cognitive rehabilitation for cognitive and sensorimotor loss, or ensuring optimal hearing, vision, and speech. These elementary steps also increase motivation because improved physical status may enhance functional capacity, drive, and energy and thereby increase the patient’s expectation that initiative and effort will be successful.

There are 5 steps to pharmacological treatment:

Optimize medical status.
Diagnose and treat other conditions more specifically associated with diminished motivation (e.g. apathetic hyperthyroidism, Parkinson’s disease).
Eliminate or reduce doses of psychotropics and other agents that aggravate motivational loss (e.g. SSRIs, dopamine antagonists).
Treat depression efficaciously when both DDM and depression are present.
Increase motivation through use of stimulants, dopamine agonists, or other agents such as cholinesterase inhibitors.

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What is the Pseudobulbar Affect?

Published on 05/03/2024 by Andrew MarshallLeave a comment

Introduction

Pseudobulbar affect (PBA), or emotional incontinence, is a type of neurological disorder characterised by uncontrollable episodes of crying or laughing. PBA occurs secondary to a neurologic disorder or brain injury. Patients may find themselves crying uncontrollably at something that is only slightly sad, being unable to stop themselves for several minutes. Episodes may also be mood-incongruent: a patient may laugh uncontrollably when angry or frustrated, for example. Sometimes, the episodes may switch between emotional states, resulting in the patient crying uncontrollably before dissolving into fits of laughter.

The pseudobulbar affect, also referred to as emotional lability, should not be confused with depression that stem from emotional instability – affective dysregulation – commonly seen in mental illnesses and certain personality disorders.

Signs and Symptoms

The cardinal feature of the disorder is a pathologically lowered threshold for exhibiting the behavioural response of laughter, crying, anger or all of the above. An affected individual exhibits episodes of laughter, crying, anger or a combination of these without an apparent motivating stimulus or in response to stimuli that would not have elicited such an emotional response before the onset of their underlying neurologic disorder. In some patients, the emotional response is exaggerated in intensity but is provoked by a stimulus with an emotional valence congruent with the character of the emotional display. For example, a sad stimulus provokes a pathologically exaggerated weeping response instead of a sigh, which the patient normally would have exhibited in that particular instance.

However, in some other patients, the character of the emotional display can be incongruent with, and even contradictory to, the emotional valence of the provoking stimulus or may be incited by a stimulus with no clear valence. For example, a patient may laugh in response to sad news or cry in response to stimuli with no emotional undertone, or, once provoked, the episodes may switch from laughing to crying or vice versa.

The symptoms of PBA can be severe, with persistent and unremitting episodes. Characteristics include:

The onset can be sudden and unpredictable, and has been described by some patients as coming on like a seizure;
The outbursts have a typical duration of a few seconds to several minutes; and,
The outbursts may happen several times a day.

Many people with neurologic disorders exhibit uncontrollable episodes of laughing, crying, or anger that are either exaggerated or contradictory to the context in which they occur. Where patients have significant cognitive deficits (e.g. Alzheimer’s) it can be unclear whether it is true PBA as opposed to a grosser form of emotional dysregulation, but patients with intact cognition often report the symptom as disturbing. Patients report that their episodes are at best only partially amenable to voluntary control, and unless they experience a severe change of mental status, as in traumatic brain injury they often have insight into their problem and judge their emotional displays as inappropriate and out of character. The clinical effect of PBA can be severe, with unremitting and persistent symptoms that can be disabling to patients, and may significantly affect quality of life for caregivers

Social Impact

While not as profoundly disabling as the physical symptoms of the most common diseases that cause it (such as ALS), PBA may significantly influence individuals’ social functioning and their relationships with others. Such sudden, frequent, extreme, uncontrollable emotional outbursts may lead to social withdrawal and interfere with activities of daily living, social and professional pursuits, and reduce overall healthcare. For example, patients with ALS and MS are often cognitively normal. However, the appearance of uncontrollable emotions is commonly associated with many additional neurological disorders such as attention deficit hyperactivity disorder, Parkinson’s disease, cerebral palsy, autism, epilepsy, and migraines. This may lead to avoidance of social interactions for the patient, which in turn impairs their coping mechanisms and their careers.

Depression

PBA may often be misdiagnosed as clinical depression or bipolar disorder; however, many clear distinctions exist.

In depressive and bipolar disorders, crying, anger or laughter are typically indicative of mood, whereas the pathological displays of crying which occur in PBA are often in contrast to the underlying mood, or greatly in excess of the mood or eliciting stimulus. In addition, a key to differentiating depression from PBA is duration: PBA episodes are sudden, occurring in an episodic manner, while crying in depression is a more sustained presentation and closely relates to the underlying mood state. The level of control that one has over the crying, anger or other emotional displays in PBA is minimal or non-existent, whereas for those with depression, the emotional expression (typically crying) can be modulated by the situation. Similarly, the trigger for episodes of crying in patients with PBA may be nonspecific, minimal or inappropriate to the situation, but in depression the stimulus is specific to the mood-related condition. These differences are outlined in the adjacent Table.

In some cases, depressed mood and PBA may co-exist. Since depression is one of the most common emotional changes in patients with neurodegenerative disease or post-stroke sequelae, it is often comorbid with PBA. Comorbidity implies that depression is distinct from PBA and is not necessary for, nor does it exclude, a diagnosis of PBA.

Causes

The specific pathophysiology involved in this frequently debilitating condition is still under investigation; the primary pathogenic mechanisms of PBA remain controversial. One hypothesis, established by early researchers such as Wilson and Oppenheim, placed emphasis on the role of the corticobulbar pathways in modulating emotional expression in a top-down model, and theorised that PBA occurs when bilateral lesions in the descending corticobulbar tract cause failure of voluntary control of emotion, which leads to the disinhibition, or release, of laughing/crying centres in the brainstem. Other theories implicate the prefrontal cortex.

Secondary Condition

PBA is a condition that occurs secondary to neurological disease or brain injury, and is thought to result from disruptions of neural networks that control the generation and regulation of motor output of emotions. PBA is most commonly observed in people with neurologic injuries such as traumatic brain injury (TBI) and stroke, and neurologic diseases such as dementias including Alzheimer’s disease, attention deficit hyperactivity disorder (ADHD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and Parkinson’s disease (PD). It has been reported as a symptom of hyperthyroidism, Graves’ disease, or hypothyroidism in combination with depression.

PBA has also been observed in association with a variety of other brain disorders, including brain tumours, Wilson’s disease, syphilitic pseudobulbar palsy, and various encephalitides. Rarer conditions associated with PBA include gelastic epilepsy, dacrystic epilepsy, central pontine myelinolysis, olivopontinocerebellar atrophy, lipid storage diseases, chemical exposure (e.g. nitrous oxide and insecticides), fou rire prodromique, and Angelman syndrome.

It is hypothesized that these primary neurologic injuries and diseases affect chemical signalling in the brain, which in turn disrupts the neurologic pathways that control emotional expression.

Stroke

PBA is one of the most frequently reported post-stroke behavioural disorders, with a range of reported prevalence rates from 28% to 52%. The higher prevalence rates tend to be reported in stroke patients who are older or who have a history of prior stroke. The relationship between post-stroke depression and PBA is complicated, because the depressive syndrome also occurs with high frequency in stroke survivors. Post-stroke patients with PBA are more depressed than post-stroke patients without PBA, and the presence of a depressive syndrome may exacerbate the weeping side of PBA symptoms.

Multiple Sclerosis

Recent studies suggest that approximately 10% of patients with multiple sclerosis (MS) will experience at least one episode of emotional lability. PBA is generally associated with later stages of the disease (chronic progressive phase). PBA in MS patients is associated with more severe intellectual deterioration, physical disability, and neurological disability.

Amyotrophic Lateral Sclerosis

A study designed specifically to survey for prevalence found that 49% of patients with amyotrophic lateral sclerosis (ALS) also had PBA. PBA does not appear to be associated with duration of ALS. It is a symptom of ALS that many patients are unaware of and do not receive information about from their physician.

Traumatic Brain Injury

One study of 301 consecutive cases in a clinic setting reported a 5% prevalence. PBA occurred in patients with more severe head injury, and coincided with other neurological features suggestive of pseudobulbar palsy.

The Brain Injury Association of America (BIAA) indicates that approximately 80% of survey respondents experience symptoms of PBA. Results from a recent investigation estimate the prevalence of PBA associated with traumatic brain injury to exceed more than 55% of survivors.

Treatment

Education of patients, families, and caregivers is an important component of the appropriate treatment of PBA. Crying associated with PBA may be incorrectly interpreted as depression; laughter may be embarrassing, anger can be debilitating. It is therefore critical for families and caregivers to recognize the pathological nature of PBA and the reassurance that this is an involuntary syndrome that is manageable. Traditionally, antidepressants such as sertraline, fluoxetine, citalopram, nortriptyline, and amitriptyline have been prescribed with some efficacy.

Medication

Dextromethorphan hydrobromide affects the signals in the brain that trigger the cough reflex. It is used as a cough suppressant, although it can sometimes be used, medicinally, as a pain reliever, and is also used as a recreational drug.

Quinidine sulfate affects the way the heart beats, and is generally used in people with certain heart rhythm disorders. It is also used to treat malaria. Quinidine sulfate, as a metabolic inhibitor, “increases plasma levels of dextromethorphan by competitively inhibiting cytochrome P450 2D6, which catalyses a major biotransformation pathway for dextromethorphan,” enabling therapeutic dextromethorphan concentrations.

Dextromethorphan/quinidine is a combination of these two generic drugs, and is the first Food and Drug Administration (FDA)-approved drug for the treatment of PBA, approved on 29 October 2010.

In the pivotal multicentre study that led to its approval, the “Objectives…[were] to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 [Dextromethorphan/quinidine combination]…when compared to placebo.” The conditions and results of that study are as follows:

At one study site, a total of 326 participants received one of three dose options. “METHODS: In a 12-week randomized, double-blind trial, ALS and MS patients with clinically significant PBA” were given a twice-daily dose of one of the following:

Placebo (N=109)
Dextromethorphan hydrobromide 30 mg/quinidine sulfate 10 mg (N=110)
Nuedexta – dextromethorphan hydrobromide 20 mg/quinidine sulfate 10 mg (N=107)

283 patients (86.8%) completed the study. The number of PBA episodes (laughing, crying or aggressive outbursts) were 47% and 49% lower (based on the trial’s outcome measures), respectively, for the drug-combination options than for the placebo. The “mean CNS-LS scores” decreased by 8.2 points for both drug-combination options, vs a decrease of 5.7 points for the placebo.

Overall, the trial showed a statistically significant benefit from taking a combination of dextromethorphan and quinidine, with both dosages being safe and well tolerated. For a secondary objective measuring a participant’s “perceived health status…measuring eight health concepts: vitality, physical functioning, bodily pain, general health perceptions, physical role-, emotional role-, social role functioning, and mental health,” the higher dosage showed improvement, especially on measures of social functioning and mental health.

Epidemiology

Prevalence estimates place the number of people with PBA between 1.5 and 2 million in the United States alone, which would be less than 1% of the US population even at the high end of the estimate. Some argue that the number is probably higher and that clinicians underdiagnose PBA. However, the prevalence estimate of 2 million is based on an online survey. Self-selected computer-savvy patients in at-risk groups evaluated their own symptoms and submitted their self-diagnoses. No doctor or clinic confirmed the data. Motivation to participate could have been influenced by the presence of symptoms, which would have skewed the results. The actual prevalence could very well be quite a bit lower than estimated.

Brief History

The Expression of the Emotions in Man and Animals by Charles Darwin was published in 1872. In Chapter VI, “Special Expressions of Man: Suffering and Weeping”, Darwin discusses cultural variations in the acceptability of weeping and the wide differences in individual responses to suffering. The chapter contains the following sentence:

We must not, however, lay too much stress on the copious shedding of tears by the insane, as being due to the lack of all restraint; for certain brain-diseases, as hemiplegia, brain-wasting, and senile decay, have a special tendency to induce weeping.

Terminology

Historically, there have been a variety of terms used for the disorder, including pseudobulbar affect, pathological laughter and crying, emotional lability, emotionalism, emotional dysregulation, or more recently, involuntary emotional expression disorder. The term pseudobulbar (pseudo- + bulbar) came from the idea that the symptoms seemed similar to those caused by a bulbar lesion (that is, a lesion in the medulla oblongata).

Terms such as forced crying, involuntary crying, pathological emotionality, and emotional incontinence have also been used, although less frequently.

In Popular Culture

Arthur Fleck, the central character of the 2019 film Joker, displays signs of pseudobulbar affect, which are said to be what Joaquin Phoenix used as inspiration for his character’s signature laugh.

In the 2019 movie Parasite, the character Ki-woo sustains head trauma, and although it is not clearly mentioned that he’s affected by pseudobulbar affect, he mentions not being able to stop laughing when thinking about all the events that occur in the movie.

In the 2020 movie Naan Sirithal, the character Gandhi (Hiphop Tamizha Adhi) suffers from pseudobulbar affect due to all the stress he suffers from various parts of his life gets accumulated and starts to laugh uncontrollably.

In the medical television show House, season 7, episode 8 (“Small Sacrifices”), the character Ramon Silva, played by Kuno Becker displays pseudobulbar affect, with uncontrollable incongruent laughter, while having the Marburg variety of multiple sclerosis.

In season 3, episode 9 of The Good Fight, the character Brenda DeCarlo, an external auditor, displays pseudobulbar affect, with uncontrollable incongruent laughter.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Pseudobulbar_affect >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Amygdala Hijack?

Published on 05/02/2024 by Andrew MarshallLeave a comment

Introduction

An amygdala hijack is an emotional response that is immediate, overwhelming, and out of measure with the actual stimulus because it has triggered a much more significant emotional threat.

The term, coined by Daniel Goleman in his 1996 book Emotional Intelligence: Why It Can Matter More Than IQ, is used by affective neuroscientists and is considered a formal academic term. The amygdala is made up of two small, round structures located closer to the forehead than (anterior to) the hippocampi, near the temporal lobes. The amygdalae are involved in detecting and learning which parts of our surroundings are important and have emotional significance. They are critical for the production of emotion. They are known to be very important for negative emotions, especially fear. Amygdala activation often happens when we see a potential threat. The amygdala uses our past, related memories to help us make decisions about what is currently happening.

Definition

The output of sense organs is first received by the thalamus. Part of the thalamus’ stimuli goes directly to the amygdala or “emotional/irrational brain”, while other parts are sent to the neocortex or “thinking/rational brain”. If the amygdala perceives a match to the stimulus, i.e. if the record of experiences in the hippocampus tells the amygdala that it is a fight, flight or freeze situation, then the amygdala triggers the HPA (hypothalmic–pituitary–adrenal) axis and “hijacks” or overtakes rational brain function.

This emotional brain activity processes information milliseconds earlier than the rational brain, so in case of a match, the amygdala acts before any possible direction from the neocortex can be received. If, however, the amygdala does not find any match to the stimulus received with its recorded threatening situations, then it acts according to the directions received from the neocortex. When the amygdala perceives a threat, it can lead that person to react irrationally and destructively.

Goleman states that emotions “make us pay attention right now—this is urgent—and gives us an immediate action plan without having to think twice. The emotional component evolved very early: Do I eat it, or does it eat me?” The emotional response “can take over the rest of the brain in a millisecond if threatened”. An amygdala hijack exhibits three signs: strong emotional reaction, sudden onset, and post-episode realization if the reaction was inappropriate.

Goleman later emphasized that “self-control is crucial … when facing someone who is in the throes of an amygdala hijack” so as to avoid a complementary hijacking—whether in work situations, or in private life. Thus for example “one key marital competence is for partners to learn to soothe their own distressed feelings … nothing gets resolved positively when husband or wife is in the midst of an emotional hijacking”. The danger is that:

“when our partner becomes, in effect, our enemy, we are in the grip of an ‘amygdala hijack’ in which our emotional memory, lodged in the limbic center of our brain, rules our reactions without the benefit of logic or reason … which causes our bodies to go into a ‘fight or flight’ response.”

Non-Distressing Hijack

Goleman points out that:

“not all limbic hijackings are distressing. When a joke strikes someone as so uproarious that their laughter is almost explosive, that, too, is a limbic response. It is at work also in moments of intense joy.”

He also cites the case of a man strolling by a canal when he saw a girl staring petrified at the water.

“[B]efore he knew quite why, he had jumped into the water—in his coat and tie. Only once he was in the water did he realize that the girl was staring in shock at a toddler who had fallen in—whom he was able to rescue.”

Emotional Relearning

Joseph E. LeDoux was positive about the possibility of learning to control the amygdala’s hair-trigger role in emotional outbursts.

“Once your emotional system learns something, it seems you never let it go. What therapy does is teach you how to control it—it teaches your neocortex how to inhibit your amygdala. The propensity to act is suppressed, while your basic emotion about it remains in a subdued form.”

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Amygdala_hijack >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Social Alienation?

Published on 04/30/2024 by Andrew Marshall1 Comment

Introduction

Social alienation is a person’s feeling of disconnection from a group – whether friends, family, or wider society – with which the individual has an affiliation. Such alienation has been described as “a condition in social relationships reflected by (1) a low degree of integration or common values and (2) a high degree of distance or isolation (3a) between individuals, or (3b) between an individual and a group of people in a community or work environment [enumeration added]”. It is a sociological concept developed by several classical and contemporary theorists. The concept has many discipline-specific uses and can refer both to a personal psychological state (subjectively) and to a type of social relationship (objectively).

Brief History

The term alienation has been used over the ages with varied and sometimes contradictory meanings. In ancient history it could mean a metaphysical sense of achieving a higher state of contemplation, ecstasy or union—becoming alienated from a limited existence in the world, in a positive sense. Examples of this usage have been traced to neoplatonic philosophers such as Plotinus (in the Greek alloiosis). There have also long been religious concepts of being separated or cut off from God and the faithful, alienated in a negative sense. The New Testament mentions the term apallotrioomai in Greek—”being alienated from”. Ideas of estrangement from a Golden Age, or due to a fall of man, or approximate equivalents in differing cultures or religions, have also been described as concepts of alienation. A double positive and negative sense of alienation is broadly shown in the spiritual beliefs referred to as Gnosticism.

Alienation also had a particular legal-political meaning since as early as Ancient Roman times, where to alienate property (alienato) is to transfer ownership of it to someone else. The term alienation itself comes from the Latin alienus which meant ‘of another place or person’, which in turn came from alius, meaning “other” or “another”. Another usage of the term in Ancient Greco-Roman times was by physicians referring to disturbed, difficult or abnormal states of mind, generally attributed to imbalanced physiology. In Latin alienatio mentis (mental alienation), this usage has been dated to Asclepiades. Once translations of such works had resurfaced in the West in the 17th century, physicians again began using the term, which is typically attributed to Felix Platter.

In medieval times, a relationship between alienation and social order has been described, mediated in part by mysticism and monasticism. The Crusades and witch-hunts have been described as forms of mass alienation.

17th Century

In the 17th century, Hugo Grotius put forward the concept that everyone has ‘sovereign authority’ over themselves but that they could alienate that natural right to the common good, an early social contract theory. In the 18th century, Hutcheson introduced a distinction between alienable and unalienable rights in the legal sense of the term. Rousseau published influential works on the same theme, and is also seen as having popularised a more psychological-social concept relating to alienation from a state of nature due to the expansion of civil society or the nation state.

In the same century a law of alienation of affection was introduced for men to seek compensation from other men accused of taking away ‘their’ woman.

In the history of literature, the German Romantics appear to be the first group of writers and poets in whose work the concept of alienation is regularly found. Around the start of the 19th century, Hegel popularized a Christian (Lutheran) and Idealist philosophy of alienation. He used German terms in partially different senses, referring to a psychological state and an objective process, and in general posited that the self was a historical and social creation, which becomes alienated from itself via a perceived objective world, but can become de-alienated again when that world is seen as just another aspect of the self-consciousness, which may be achieved by self-sacrifice to the common good.

Around the same time, Pinel was popularising a new understanding of mental alienation, particularly through his ‘medical-philosophical treatise’. He argued that people could be disturbed (alienated) by emotional states and social conditions, without necessarily having lost (become alienated from) their reason, as had generally been assumed. Hegel praised Pinel for his ‘moral treatment’ approach, and developed related theories. Nevertheless, as Foucault would later write, “… in an obscure, shared origin, the ‘alienation’ of physicians and the ‘alienation’ of philosophers started to take shape—two configurations in which man in any case corrupts his truth, but between which, after Hegel, the nineteenth century stopped seeing any trace of resemblance.”

Marx

Marx was initially in the Young Hegelian camp and, like Feuerbach, rejected the spiritual basis, and adapted Hegel’s dialectic model to a theory of (historical) materialism. Marx’s theory of alienation is articulated most clearly in the Economic and Philosophic Manuscripts of 1844 and The German Ideology (1846). The ‘young’ Marx wrote more often and directly of alienation than the ‘mature’ Marx, which some regard as an ideological break while others maintain that the concept remained central. Structuralists generally hold that there was a transition from a philosophical-anthropological (Marxist humanism) concept (e.g. internal alienation from the self) to a structural-historical interpretation (e.g. external alienation by appropriation of labour), accompanied by a change in terminology from alienation to exploitation to commodity fetishism and reification. Marx’s concepts of alienation have been classed into four types by Kostas Axelos: economic and social alienation, political alienation, human alienation, and ideological alienation.

In the concept’s most prominent use, it refers to the economic and social alienation aspect in which workers are disconnected from what they produce and why they produce. Marx believed that alienation is a systematic result of capitalism. Essentially, there is an “exploitation of men by men” where the division of labour creates an economic hierarchy. His theory of alienation was based upon his observation that in emerging industrial production under capitalism, workers inevitably lose control of their lives and selves by not having any control of their work. Workers never become autonomous, self-realised human beings in any significant sense, except in the way the bourgeoisie wants the worker to be realised. His theory relies on Feuerbach’s The Essence of Christianity (1841), which argues that the idea of God has alienated the characteristics of the human being. Stirner would take the analysis further in The Ego and Its Own (1844), declaring that even ‘humanity’ is an alienating ideal for the individual, to which Marx and Engels responded in The German Ideology (1845). Alienation in capitalist societies occurs because in work each contributes to the common wealth but they can only express this fundamentally social aspect of individuality through a production system that is not publicly social but privately owned, for which each individual functions as an instrument, not as a social being. Kostas Axelos summarizes that for Marx, in capitalism “work renders man an alien to himself and to his own products.” “The malaise of this alienation from the self means that the worker does not affirm himself but denies himself, does not feel content but unhappy….The worker only feels himself outside his work, and in his work he feels outside himself….Its alien character emerges clearly in the fact as soon as no physical or other compulsion exists, it is avoided like the plague.”. Marx also wrote, in a curtailed manner, that capitalist owners also experience alienation, through benefiting from the economic machine by endlessly competing, exploiting others and maintaining mass alienation in society.

Political Alienation refers specifically to the idea that “politics is the form that organizes the productive forces of the economy” in a way that is alienating because it “distorts the logic of economic development”.

Through Human Alienation, individuals become estranged to themselves in the quest to stay alive, where “they lose their true existence in the struggle for subsistence”. Marx focuses on two aspects of human nature which he calls “historical conditions.” The first aspect refers to the necessity of food, clothes, shelter, and more. Secondly, Marx believes that after satisfying these basic needs people have the tendency to develop more “needs” or desires that they will work towards satisfying, hence, humans become stuck in a cycle of never ending wants which makes them strangers to each other.

When referring to ideological alienation, Axelos proposes that Marx believes that all religions divert people away from “their true happiness” and instead turn them towards “illusory happiness”.

There is a commonly noted problem of translation in grappling with ideas of alienation derived from German-language philosophical texts: the word alienation, and similar words such as estrangement, are often used interchangeably to translate two distinct German words, Entfremdung and Entäußerung. The former means specifically interpersonal estrangement, while the latter can have a broader and more active meaning that might refer also to externalisation, relinquishment, or sale (alienation) of property. In general, and contrary to his predecessors, Marx may have used the terms interchangeably, though he also wrote “Entfremdung… constitutes the real interest of this Entäußerung.”

Late 1800s to 1900s

Many sociologists of the late 19th and early 20th centuries were concerned about alienating effects of modernisation. German sociologists Georg Simmel and Ferdinand Tönnies wrote critical works on individualisation and urbanisation. Simmel’s The Philosophy of Money describes how relationships become more and more mediated by money. Tönnies’ Gemeinschaft and Gesellschaft (Community and Society) is about the loss of primary relationships such as familial bonds in favour of goal-oriented, secondary relationships. This idea of alienation can be observed in some other contexts, although the term may not be as frequently used. In the context of an individual’s relationships within society, alienation can mean the unresponsiveness of society as a whole to the individuality of each member of the society. When collective decisions are made, it is usually impossible for the unique needs of each person to be taken into account.

The American sociologist C. Wright Mills conducted a major study of alienation in modern society with White Collar in 1951, describing how modern consumption-capitalism has shaped a society where you have to sell your personality in addition to your work. Melvin Seeman was part of a surge in alienation research during the mid-20th century when he published his paper, “On the Meaning of Alienation”, in 1959. Seeman used the insights of Marx, Emile Durkheim and others to construct what is often considered a model to recognize the five prominent features of alienation: powerlessness, meaninglessness, normlessness, isolation and self-estrangement. Seeman later added a sixth element (cultural estrangement), although this element does not feature prominently in later discussions of his work.

In a broader philosophical context, especially in existentialism and phenomenology, alienation describes the inadequacy of the human being (or the mind) in relation to the world. The human mind (as the subject who perceives) sees the world as an object of perception, and is distanced from the world, rather than living within it. This line of thought is generally traced to the works of Søren Kierkegaard in the 19th century, who, from a Christian viewpoint, saw alienation as separation from God, and also examined the emotions and feelings of individuals when faced with life choices. Many 20th-century philosophers (both theistic and atheistic) and theologians were influenced by Kierkegaard’s notions of angst, despair and the importance of the individual. Martin Heidegger’s concepts of anxiety (angst) and mortality drew from Kierkegaard; he is indebted to the way Kierkegaard lays out the importance of our subjective relation to truth, our existence in the face of death, the temporality of existence and the importance of passionately affirming one’s being-in-the-world. Jean-Paul Sartre described the “thing-in-itself” which is infinite and overflowing, and claimed that any attempt to describe or understand the thing-in-itself is “reflective consciousness”. Since there is no way for the reflective consciousness to subsume the pre-reflective, Sartre argued that all reflection is fated to a form of anxiety (i.e. the human condition). As well, Sartre argued that when a person tries to gain knowledge of the “Other” (meaning beings or objects that are not the self), their self-consciousness has a “masochistic desire” to be limited. This is expressed metaphorically in the line from the play No Exit, “Hell is other people”.

In the theory of psychoanalysis developed around the start of the 20th century, Sigmund Freud did not explicitly address the concept of alienation, but other analysts subsequently have. It is a theory of divisions and conflicts between the conscious and unconscious mind, between different parts of a hypothetical psychic apparatus, and between the self and civilisation. It postulates defence mechanisms, including splitting, in both normal and disturbed functioning. The concept of repression has been described as having functionally equivalent effects as the idea of false consciousness associated with Marxist theory.

A form of Western Marxism developed during the century, which included influential analyses of false consciousness by György Lukács. Critics of bureaucracy and the Protestant Ethic also drew on the works of Max Weber.

Figures associated with critical theory, in particular with the Frankfurt School, such as Theodor Adorno and Erich Fromm, also developed theories of alienation, drawing on neo-Marxist ideas as well as other influences including neo-Freudian and sociological theories. One approach applies Marxist theories of commodification to the cultural, educational and party-political spheres. Links are drawn between socioeconomic structures, psychological states of alienation, and personal human relationships. In the 1960s the revolutionary group Situationist International came to some prominence, staging ‘situations’ intended to highlight an alternative way of life to advanced capitalism, the latter conceptualised as a diffuse ‘spectacle’, a fake reality masking a degradation of human life. The Theory of Communicative Action associated with Jürgen Habermas emphasizes the essential role of language in public life, suggesting that alienation stems from the distortion of reasoned moral debate by the strategic dominance of market forces and state power.

This critical programme can be contrasted with traditions that attempt to extract problems of alienation from the broader socioeconomic context, or which at least accept the broader context on its own terms, and which often attribute problems to individual abnormality or failures to adjust.

After the boom in alienation research that characterised the 1950s and 1960s, interest in alienation research subsided, although in sociology it was maintained by the Research Committee on Alienation of the International Sociological Association (ISA).

In the 1990s, there was again an upsurge of interest in alienation prompted by the fall of the Soviet Union, globalization, the information explosion, increasing awareness of ethnic conflicts, and post-modernism. Felix Geyer believes the growing complexity of the contemporary world and post-modernism prompted a reinterpretation of alienation that suits the contemporary living environment. In late 20th and early 21st century sociology, it has been particularly the works of Lauren Langman and Devorah Kalekin-Fishman that address the issue of alienation in the contemporary western world.

Modalities

Powerlessness

Alienation in the sense of a lack of power has been technically defined by Seeman as “the expectancy or probability held by the individual that his own behaviour cannot determine the occurrence of the outcomes, or reinforcements, he seeks.” Seeman argues that this is “the notion of alienation as it originated in the Marxian view of the worker’s condition in capitalist society: the worker is alienated to the extent that the prerogative and means of decision are expropriated by the ruling entrepreneurs”. More succinctly, Kalekin-Fishman says, “A person suffers from alienation in the form of ‘powerlessness’ when she is conscious of the gap between what she would like to do and what she feels capable of doing”.

In discussing powerlessness, Seeman also incorporated the insights of the psychologist Julian Rotter. Rotter distinguishes between internal control and external locus of control, which means “differences (among persons or situations) in the degree to which success or failure is attributable to external factors (e.g. luck, chance, or powerful others), as against success or failure that is seen as the outcome of one’s personal skills or characteristics”. Powerlessness, therefore, is the perception that the individual does not have the means to achieve his goals.

Ultimately breaking with the Marxist tradition, Geyer remarks that “a new type of powerlessness has emerged, where the core problem is no longer being unfree but rather being unable to select from among an overchoice of alternatives for action, whose consequences one often cannot even fathom”. Geyer adapts cybernetics to alienation theory, and writes that powerlessness is the result of delayed feedback: “The more complex one’s environment, the later one is confronted with the latent, and often unintended, consequences of one’s actions. Consequently, in view of this causality-obscuring time lag, both the ‘rewards’ and ‘punishments’ for one’s actions increasingly tend to be viewed as random, often with apathy and alienation as a result”.

Meaninglessness

A sense of meaning has been defined by Seeman as “the individual’s sense of understanding events in which he is engaged”. Seeman writes that meaninglessness “is characterized by a low expectancy that satisfactory predictions about the future outcomes of behaviour can be made.” Whereas powerlessness refers to the sensed ability to control outcomes, this refers to the sensed ability to predict outcomes. In this respect, meaninglessness is closely tied to powerlessness; Seeman argues, “the view that one lives in an intelligible world might be a prerequisite to expectancies for control; and the unintelligibility of complex affairs is presumably conducive to the development of high expectancies for external control (that is, high powerlessness)”.

Geyer believes meaninglessness should be reinterpreted for postmodern times: “With the accelerating throughput of information … meaningless is not a matter anymore of whether one can assign meaning to incoming information, but of whether one can develop adequate new scanning mechanisms to gather the goal-relevant information one needs, as well as more efficient selection procedures to prevent being overburdened by the information one does not need, but is bombarded with on a regular basis.” Information overload or the so-called “data tsunami” are well-known information problems confronting contemporary man, and Geyer thus argues that meaninglessness is turned on its head.

Normlessness

Normlessness (or what Durkheim referred to as anomie) “denotes the situation in which the social norms regulating individual conduct have broken down or are no longer effective as rules for behaviour”. This aspect refers to the inability to identify with the dominant values of society or rather, with values that are perceived to be dominant. Seeman adds that this aspect can manifest in a particularly negative manner, “The anomic situation … may be defined as one in which there is a high expectancy that socially unapproved behaviours are required to achieve given goals”.

Neal and Collas write that “[n]ormlessness derives partly from conditions of complexity and conflict in which individuals become unclear about the composition and enforcement of social norms. Sudden and abrupt changes occur in life conditions, and the norms that usually operate may no longer seem adequate as guidelines for conduct”. This is a particular issue after the fall of the Soviet Union, mass migrations from developing to developed countries, and the general sense of disillusionment that characterised the 1990s.

Relationships

One concept used in regard to specific relationships is that of parental alienation, where a separated child expresses a general dislike for one of their parents (who may have divorced or separated). The term is not applied where there is child abuse. The parental alienation might be due to specific influences from either parent or could result from the social dynamics of the family as a whole. It can also be understood in terms of attachment, the social and emotional process of bonding between child and caregiver. Adoptees can feel alienated from both adoptive parents and birth parents.

Familial estrangement between parents and adult children “is attributed to a number of biological, psychological, social, and structural factors affecting the family, including attachment disorders, incompatible values and beliefs, unfulfilled expectations, critical life events and transitions, parental alienation, and ineffective communication patterns.” The degree of alienation has been positively correlated with decreased emotional functioning in the parent who feels a loss of identity and stigma.

Attachment relationships in adults can also involve feelings of alienation. Indeed, emotional alienation is said to be a common way of life for many, whether it is experienced as overwhelming, unacknowledged in the midst of a socioeconomic race, or contributes to seemingly unrelated problems.

Social Isolation

Social isolation refers to “The feeling of being segregated from one’s community”. Neal and Collas emphasize the centrality of social isolation in the modern world: “While social isolation is typically experienced as a form of personal stress, its sources are deeply embedded in the social organization of the modern world. With increased isolation and atomization, much of our daily interactions are with those who are strangers to us and with whom we lack any ongoing social relationships.”

Since the fall of the Soviet Union and the end of the Cold War, migrants from Eastern Europe and developing countries have flocked to developed countries in search of a better living standard. This has led to entire communities becoming uprooted: no longer fully part of their homelands, but neither integrated into their adopted communities. Diaspora literature depicts the plights of these migrants, such as Hafid Bouazza in Paravion.

Political Alienation

One manifestation of the above dimensions of alienation can be a feeling of estrangement from the political system and a lack of engagement therein. Such political alienation could result from not identifying with any particular political party or message, and could result in revolution, reforming behaviour, or abstention from the political process, possibly due to voter apathy.

A similar concept is policy alienation, where workers experience a state of psychological disconnection from a policy programme being implemented.

Self-Estrangement

Self-estrangement is an elusive concept in sociology, as recognized by Seeman, although he included it as an aspect in his model of alienation. Some, with Marx, consider self-estrangement to be the result and thus the heart of social alienation. Self-estrangement can be defined as “the psychological state of denying one’s own interests – of seeking out extrinsically rather than intrinsically satisfying, activities…”. It could be characterised as a feeling of having become a stranger to oneself, or to some parts of oneself, or alternatively as a problem of self-knowledge, or authenticity.

Seeman recognised the problems inherent in defining the “self”, while post-modernism in particular has questioned the very possibility of pin-pointing what precisely “self” constitutes. Further in that way, if the self is relationally constituted, does it make sense to speak of “self-estrangement” rather than “social isolation”? Costas and Fleming suggest that although the concept of self-estrangement “has not weathered postmodern criticisms of essentialism and economic determinism well”, the concept still has value if a Lacanian reading of the self is adopted. This can be seen as part of a wider debate on the concept of self between humanism and antihumanism, structuralism and post-structuralism, or nature and nurture.

Mental Disturbance

Until early in the 20th century, psychological problems were referred to in psychiatry as states of mental alienation, implying that a person had become separated from themselves, their reason or the world. From the 1960s alienation was again considered in regard to clinical states of disturbance, typically using a broad concept of a ‘schizoid’ (‘splitting’) process taken from psychoanalytic theory. The splitting was said to occur within regular child development and in everyday life, as well as in more extreme or dysfunctional form in conditions such as schizoid personality and schizophrenia.

Varied concepts of alienation and self-estrangement were used to link internal schizoid states with observable symptoms and with external socioeconomic divisions, without necessarily explaining or evidencing underlying causation. R.D. Laing was particularly influential in arguing that dysfunctional families and socioeconomic oppression caused states of alienation and ontological insecurity in people, which could be considered adaptations but which were diagnosed as disorders by mainstream psychiatry and society. The specific theories associated with Laing and others at that time are not widely accepted, but work from other theoretical perspectives sometimes addresses the same theme.

In a related vein, for Ian Parker, psychology normalizes conditions of social alienation. While it could help groups of individuals emancipate themselves, it serves the role of reproducing existing conditions. This view can be seen as part of a broader tradition sometimes referred to as critical psychology or liberation psychology, which emphasizes that an individual is enmeshed within a social-political framework, and so therefore are psychological problems. Likewise, some psychoanalysts suggest that while psychoanalysis emphasizes environmental causes and reactions, it also attributes the problems of individuals to internal conflicts stemming from early psychosocial development, effectively divorcing them from the wider ongoing context. Slavoj Zizek (drawing on Herbert Marcuse, Michel Foucault, and Jacques Lacan’s psychoanalysis) argues that in today’s capitalist society, the individual is estranged from their self through the repressive injunction to “enjoy!” Such an injunction does not allow room for the recognition of alienation and, indeed, could itself be seen as an expression of alienation.

More to the political right, however, psychotherapy and associated notions have long been considered anywhere from ineffectual due to their inherent bias against the reality of inborn such as group-specific (genetic) traits to actively destructive much rather than emancipatory. On the other hand, they are not alone in this sentiment either as Marcuse, among others, goes on to speak of repressive desublimation.

Disability

Differences between persons with disabilities and individuals in relative abilities, or perceived abilities, can be a cause of alienation. One study, “Social Alienation and Peer Identification: A Study of the Social Construction of Deafness”, found that among deaf adults one theme emerged consistently across all categories of life experience: social rejection by, and alienation from, the larger hearing community. Only when the respondents described interactions with deaf people did the theme of isolation give way to comments about participation and meaningful interaction. This appeared to be related to specific needs, for example for real conversation, for information, the opportunity to develop close friendships and a sense of family. It was suggested that the social meaning of deafness is established by interaction between deaf and hearing people, sometimes resulting in marginalisation of the deaf, which is sometimes challenged. It has also led to the creation of alternatives and the deaf community is described as one such alternative.

Physicians and nurses often deal with people who are temporarily or permanently alienated from communities, which could be a result or a cause of medical conditions and suffering, and it has been suggested that therefore attention should be paid to learning from experiences of the special pain that alienation can bring.

Criticisms

Eric Voegelin with whom also originates the related phrase “to Immanentise the eschaton”, may be read as rather accepting of alienation:

The human condition has radical limits, and humans do not feel perfectly comfortable (to say the least). But it is not “ideological” to feel dissatisfaction or to desire something more perfect than what we have. Indeed such feelings as disquiet, anxiety, frustration and even alienation are, according Voegelin, normal. “Man is in deadly anguish,” writes Voegelin, “because he takes life seriously and cannot bear existence without meaning.” For reflection on the limits of the human condition to give rise to ideology, a certain “mood” must be present. What is this mood? It is the mood not only of alienation but of revolt. Ideology involves the active revolt against existential truth and the effort to construct a different world. Voegelin designates this mood as “pneumopathological,” a term he found in Schelling. It is the feeling of “estrangement from the spirit” so intense that it entails a willful closing of the soul to the transcendent.

Philosophers Heidegger, Peter Sloterdijk and more recently Alexander Grau argue for a similar fact of alienation.

In Art and Popular Culture

Alienation is most often represented in literature as the psychological isolation of an individual from society or community. In a volume of Bloom’s Literary Themes, Shakespeare’s Hamlet is described as the ‘supreme literary portrait’ of alienation, while noting that some may argue for Achilles in the Iliad. In addition, Bartleby, the Scrivener is introduced as a perfect example because so many senses of alienation are present. Other literary works described as dealing with the theme of alienation are: The Bell Jar, Black Boy, Brave New World, The Catcher in the Rye, The Chosen, Dubliners, Othello, Fahrenheit 451, Invisible Man, Mrs Dalloway, Notes from Underground, One Flew Over the Cuckoo’s Nest, The Strange Case of Dr Jekyll and Mr Hyde, The Stranger and The Myth of Sisyphus, The Trial, The Castle, Waiting for Godot, The Waste Land, and Young Goodman Brown. Contemporary British works noted for their perspective on alienation include The Child in Time, London Fields, Trainspotting, and Regeneration.

Sociologist Harry Dahms has analysed The Matrix Trilogy of films in the context of theories of alienation in modern society. He suggests that the central theme of The Matrix is the “all-pervasive yet increasingly invisible prevalence of alienation in the world today, and difficulties that accompany attempts to overcome it”.

British progressive rock band Pink Floyd’s concept album The Wall (1979) and British alternative rock band Radiohead’s album OK Computer (1997), both deal with the subject of alienation in their lyrics.

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What is Mirroring?

Published on 04/17/2024 by Andrew MarshallLeave a comment

Introduction

Mirroring is the behaviour in which one person subconsciously imitates the gesture, speech pattern, or attitude of another. Mirroring often occurs in social situations, particularly in the company of close friends or family, often going unnoticed by both parties. The concept often affects other individuals’ notions about the individual that is exhibiting mirroring behaviours, which can lead to the individual building rapport with others.

Mirroring is distinct from conscious imitation under the premise that while the latter is a conscious, typically overt effort to copy another person, mirroring is unconsciously done during the act and often goes unnoticed. It has also been described as the chameleon effect.

The display of mirroring often begins as early as infancy, as babies begin to mimic individuals around them and establish connections with particular body movements. The ability to mimic another person’s actions allows the infant to establish a sense of empathy and thus begin to understand another person’s emotions. The infant continues to establish connections with other individual’s emotions and subsequently mirror their movements.

Mirroring can establish rapport with the individual who is being mirrored, as the similarities in nonverbal gestures allow the individual to feel more connected with the person exhibiting the mirrored behaviour. As the two individuals in the situation display similar nonverbal gestures, they may believe that they share similar attitudes and ideas as well. Mirror neurons react to and cause these movements, allowing the individuals to feel a greater sense of engagement and belonging within the situation.

Occurrence

Mirroring generally takes place unconsciously as individuals react with the situation. Mirroring is common in conversation, as the listeners will typically smile or frown along with the speaker, as well as imitate body posture or attitude about the topic. Individuals may be more willing to empathize with and accept people whom they believe hold similar interests and beliefs, and thus mirroring the person with whom one is speaking may establish connections between the individuals involved.

Interviews

Additionally, mirroring may play a role in how well an individual fares in a job interview. Within a study conducted by Word, Zanna and Cooper, interviewers were instructed to follow specific types of body language in different experimental conditions. In one condition, interviewers were instructed to demonstrate distant and uninterested body language (such as leaning away or avoiding eye contact), and in another condition, they were asked to demonstrate more welcoming body language (such as smiling and making eye contact). As a result, the individuals being interviewed began to mirror the actions of the interviewer, and thus the individuals in the condition with less friendly body language fared worse within the interview than did individuals in the friendly condition. The study demonstrates that the initial attitudes that an interviewer may have of the individual being interviewed may affect the performance of the interviewee due to mirroring.

Effects of Lacking

Individuals with autism or other social difficulties may be less likely to exhibit mirroring, as they may be less unconsciously and consciously aware of the actions of others. This factor may cause additional difficulties for the individuals, as without mirroring, establishing connections with other people may be more difficult. Additionally, other individuals may be less likely to build rapport with the person, as without mirroring the person may seem more dissimilar and less friendly. Individuals who are not unconsciously aware of the gesture may have difficulties in social situations, as they may be less able to understand another person’s perspective without it being explicitly stated, and thus may not understand covert cues that are often used in the social world. It is possible for autistic individuals to deliberately learn and become aware of these cues.

Examinations in Humans

The use of non-invasive fMRI studies have shown that there is evidence of mirroring in humans similar to that found in monkeys in the inferior parietal lobe and part of the inferior frontal gyrus. Humans show additional signs of mirroring in parts of the brain not observed to show mirroring properties in primates, such as the cerebellum. Mirroring has also been shown to allow neurotypical children to understand what the intentions of an action are before seeing the entire sequence. Because of this, a child can see someone pick up food with the intention to eat and fire all necessary motor chains needed for them to pick up their own food and go through the motions of eating it as well. It has been shown that children with autism lack this motor chain reaction and are thought to use other senses, such as visual or somatosensory, to accomplish similar tasks.

Development

In infant-parent interactions, mirroring consists of the parent imitating the infant’s expressions while vocalizing the emotion implied by the expression. This imitation helps the infant to associate the emotion with their expression, as well as feel validated in their own emotions as the parent shows approval through imitation. Studies have demonstrated that mirroring is an important part of child and infant development. According to Kohut’s theories of self-psychology, individuals need a sense of validation and belonging in order to establish their concepts of self. When parents mirror their infants, the action may help the child develop a greater sense of self-awareness and self-control, as they can see their emotions within their parent’s faces. Additionally, infants may learn and experience new emotions, facial expressions, and gestures by mirroring expressions that their parents utilise. The process of mirroring may help infants establish connections of expressions to emotions and thus promote social communication later in life. Infants also learn to feel secure and valid in their own emotions through mirroring, as the parent’s imitation of their emotions may help the child recognise their own thoughts and feelings more readily.

Self-Concept

Mirroring has been shown to play a critical role in the development of an infant’s notion of self. The importance of mirroring suggests that infants primarily gather their social skills from their parents, and thus a household that lacks mirroring may inhibit the child’s social development. Without mirroring, it may be difficult for the child to relate their emotions to socially learned expressions and thus have a difficult experience in expressing their own emotions.

Empathy

The inability to properly mirror other individuals may strain the child’s social relationships later in life. This strain may exist because others may feel more distant from the child due to a lack of rapport, or because the child may have a difficult time feeling empathy for others without mirroring. Mirroring helps to facilitate empathy, as individuals more readily experience other people’s emotions through mimicking posture and gestures. Mirroring also allows individuals to subjectively feel the pain of others when viewing injuries. This empathy may help individuals create lasting relationships and thus excel in social situations. The action of mirroring allows individuals to believe they are more similar to another person, and perceived similarity can be the basis for creating a relationship.

Rapport

Rapport may be an important part of social life, as establishing rapport with an individual is generally the initial route to becoming friends or acquaintances with another person. Mirroring can help establish rapport, as exhibiting similar actions, attitudes, and speech patterns as another person may lead them to believe that one is more similar to them and thus more likely to be a friend. Individuals may believe that because one replicates the individual’s gestures, that one may hold similar beliefs and attitudes as the individual. Mirroring may be more pervasive in close friendships or romantic relationships, as the individuals regard each other highly and thus wish to emulate or appease them. Additionally, individuals who are friends may have more similarities than two strangers, and thus may be more likely to exhibit similar body language regardless of mirroring.

The activation of mirror neurons takes place within the individual who begins to mirror another’s movements and allows them a greater connection and understanding with the individual who they are mirroring, as well as allowing the individual who is being mirrored to feel a stronger connection with the other individual.

Power Dynamics

Additionally, individuals are likely to mirror the person of higher status or power within the situation or when they feel physical attraction to the other person. Mirroring individuals of higher power may create an illusion of higher status, or create rapport with the individual in power, thus allowing the person to gain favour with the individual in power. This mechanism may be helpful for individuals in situations where they are in a position of bargaining with an individual who possesses more power, as the rapport that mirroring creates may help to persuade the higher status individual to help the person of lower status. These situations include job interviews, other work situations such as requesting promotions, parent-child interactions and asking professors for favours. Each of these situations involves one party who is in a less powerful position for bargaining and another party who has the ability to fulfil the person of lower status’s needs but may not necessarily wish to. Thus, mirroring can be a useful tool for individuals of lower status in order to persuade the other party to provide goods or privileges for the lower status party.

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Who was Ole Ivar Lovaas (1927-2010)?

Published on 04/16/2024 by Andrew MarshallLeave a comment

Introduction

Ole Ivar Løvaas (08 May 1927 to 02 August 2010) was a Norwegian-American clinical psychologist and professor at the University of California, Los Angeles. He is most well known for his research on what is now called applied behaviour analysis (ABA) to teach autistic children through prompts, modeling, and positive reinforcement. The therapy is also noted for its use of aversives (punishment) to reduce undesired behavior, however these are now used less commonly than in the past.

Løvaas founded the Lovaas Institute and co-founded the Autism Society of America. He is also considered a pioneer of ABA due to his development of discrete trial training and early intensive behavioural intervention for autistic children.

His work influenced how autism is treated, and Løvaas received widespread acclaim and several awards during his lifetime.

Personal Life

Løvaas was born in Lier, Norway on 8 May 1927 to Hildur and Ernst Albert Løvaas. He had two siblings: an older sister named Nora and a younger brother named Hans Erik. Løvaas attended Hegg Elementary School in Lier from 1934 to 1941. He attended junior high school at Drammen Realskole until 1944, and then moved on to Drammen Latin School for high school, graduating in 1947.

Following World War II, Løvaas moved to the United States. There he married Beryl Scoles in 1955, and together they had four children. Lovaas later divorced his wife and remarried Nina Watthen in 1986.

Career

After graduating from high school, Løvaas served in the Norwegian Air Force for 18 months. He was a forced farm worker during the 1940s Nazi occupation of Norway, and often said that observing the Nazis had sparked his interest in human behaviour.

He attended Luther College in Decorah, Iowa, graduating in 1951 after just one year with his B.A. in sociology. Løvaas received his Masters of Science in clinical psychology from the University of Washington in 1955, and his PhD in learning and clinical psychology from the same school 3 years later.

Early in his career, Løvaas worked at the Pinel foundation, which focused on Freudian psychoanalysis. After earning his PhD, he took a position at the University of Washington’s Child Development Institute, where he first learned of behaviour analysis. Løvaas began teaching at UCLA in 1961 in the Department of Psychology, where he performed research on children with autism spectrum disorder at the school’s Neuropsychiatric Institute. He started an early intervention clinic at UCLA called the UCLA Young Autism Project, which provided intensive intervention inside the children’s homes. He was named professor emeritus in 1994. Løvaas also established the Lovaas Institute for Early Intervention (LIFE) that provides interventions based on his research.

Løvaas taught now prominent behaviorists, such as Robert Koegel, Laura Schreibman, Tristram Smith, Doreen Granpeesheh, John McEachin, Ron Leaf, Jacquie Wynn, and thousands of UCLA students who took his “Behaviour Modification” course during his 50 years of teaching. He also co-founded what is today the Autism Society of America (ASA), published hundreds of research articles and several books, and received many accolades for his research. Due to this research, a number of school districts have adopted his programmes. His work influenced how autism is treated.

Research

Autism Intervention

Early Research

Løvaas established the Young Autism Project clinic at UCLA in 1962, where he began his research, authored training manuals, and recorded tapes of him and his graduate students implementing errorless learning—based on operant conditioning and what was then referred to as behaviour modification—to instruct autistic children. He later coined the term “discrete trial training” to describe the procedure, which was used to teach listener responding, eye contact, fine and gross motor imitation, receptive and expressive language, academic, and a variety of other skills. In an errorless discrete trial, the child sits at a table across from the therapist who provides an instruction (i.e. “do this”, “look at me”, “point to”, etc.), followed by a prompt, then the child’s response, and a stimulus reinforcer. The prompts are later discontinued once the child demonstrates proficiency. During this time, Løvaas and colleagues also employed physical aversives (punishment), such as electric shocks and slaps, to decrease aggressive and self-injurious behaviour, as well as verbal reprimands if the child answered incorrectly or engaged in self-stimulatory behaviour.

1987 Study

In 1987, Løvaas published a study which demonstrated that, following forty hours a week of treatment, 9 of the 19 autistic children developed typical spoken language, increased IQs by 30 points on average, and were placed in regular classrooms. A 1993 follow-up study found that 8 maintained their gains and were “indistinguishable from their typically developing peers”, scoring in the normal range of social and emotional functioning. His studies were limited because Løvaas did not randomise the participants or treatment groups. This produced a quasi-experiment in which he was able to control the assignment of children to treatment groups. His manipulation of the study in this way may have been responsible for the observed effects. The true efficacy of his method cannot be determined since his studies cannot be repeated for ethical reasons. A 1998 study subsequently recommended that EIBI programs be regarded with scepticism. In 1999, the United States Surgeon General’s office wrote, “Thirty years of research has demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior”, and he also endorsed the 1987 study.

Literature Reviews

According to a 2007 review study in Paediatrics:

“The effectiveness of [EIBI] in [autism spectrum disorder] has been well-documented through 5 decades of research by using single-subject methodology and in controlled studies… in university and community settings.”

It further stated:

“Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.”

However, the study also recommended to later generalise the child’s skills with more naturalistic ABA-based procedures, such as incidental teaching and pivotal response treatment, so their progress is maintained.

Another review in 2008 described DTT as a “‘well-established’ psychosocial intervention for improving the intellectual performance of young children with autism spectrum disorders…” In 2011, it was found that the intervention is effective for some, but “the literature is limited by methodological concerns” due to there being small sample sizes and very few studies that used random assignment, and a 2018 Cochrane review subsequently indicated low-quality evidence to support this method. Nonetheless, a meta-analysis in the same journal database concludes how some recent research is beginning to suggest that because of the heterology of ASD, there is a wide range of different learning styles and that it is the children with lower receptive language skills who acquire spoken language from Løvaas’ treatment. In 2023, a randomised control trial study of 164 participants indicated similar findings.

UCLA Feminine Boy Project

Løvaas co-authored a study with George Rekers in 1974 where they attempted to modify the behaviour of feminine male children through the use of rewards and punishment with the goal of preventing them from becoming adult transsexuals. The subject of the first of these studies, a young boy at the age of 4 at the inception of the experiment, died by suicide as an adult in 2003; his family attribute the suicide to this treatment. Despite the follow-up study (which Løvaas was not involved in) writing that the therapy successfully converted his homosexuality, his sister expressed concerns that it was overly biased as “he was conditioned to say that”, and she read his journal, which described how he feared disclosing his sexual orientation due to his father spanking him as a child as punishment for engaging in feminine behaviour, such as playing with dolls.

In October 2020, the Journal of Applied Behaviour Analysis officially issued an Expression of Concern about the Rekers and Løvaas study.[30] In the editorial accompanying the Expression of Concern, the journal discusses the damage done by the study. It emphasizes that the study inflicted personal harm upon the study’s subject and his family, as well as to the gay community, for inappropriately promoting the study as evidence that conversion therapy is effective. It also argues that the field of behaviour analysis was harmed by the false portrayal that the study and the use of conversion therapy are currently representative of the field.

Awards and Accolades

Løvaas received praise from several organizations during his lifetime. In 2001, he was given the Society of Clinical Child and Adolescent Psychology Distinguished Career Award. He received the Edgar Doll Award from the 33rd Division of the American Psychological Association, the Lifetime Research Achievement Award from the 55th Division of the American Psychological Association, and the Award for Effective Presentation of Behaviour Analysis in the Mass Media by the Association for Behaviour Analysis International. Løvaas also earned a Guggenheim fellowship and the California Senate Award, which is an honorary doctorate. He was named a Fellow by Division 7 of the American Psychological Association and was given the Champion of Mental Health Award by Psychology Today.

Criticism

The goal of making autistic people indistinguishable from their peers has attracted significant backlash from autistic advocates. Julia Bascom of the Autistic Self Advocacy Network (ASAN) has said “ASAN’s objection is fundamentally an ethical one. The stated end goal of ABA is an autistic child who is ‘indistinguishable from their peers’—an autistic child who can pass as neurotypical. We don’t think that’s an acceptable goal. The end goal of all services, supports, interventions, and therapies an autistic child receives should be to support them in growing up into an autistic adult who is happy, healthy, and living a self-determined life.”

Løvaas has also been criticised for his view of autistic people in relation to other people, as he said in a statement during an interview, “You start pretty much from scratch when you work with an autistic person. You have a person in the physical sense – they have hair, a nose, a mouth – but they are not people in the psychological sense.”

Aversives

Løvaas is credited with popularizing the use of aversives in behaviour modification, as shown in a Life magazine photo spread in 1965.

He later admitted that they were only temporarily effective and punishments became less effective over time. Eventually, Løvaas abandoned these tactics, telling CBS in a 1994 interview, “These people are so used to pain that they can adapt to almost any kind of aversive you give them.”

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What is Discrete Trial Training?

Published on 04/15/2024 by Andrew Marshall1 Comment

Introduction

Discrete trial training (DTT) is a technique used by practitioners of applied behaviour analysis (ABA) that was developed by Ivar Lovaas at the University of California, Los Angeles (UCLA). DTT uses mass instruction and reinforcers that create clear contingencies to shape new skills. Often employed as an early intensive behavioural intervention (EIBI) for up to 25–40 hours per week for children with autism, the technique relies on the use of prompts, modelling, and positive reinforcement strategies to facilitate the child’s learning. It previously used aversives to punish unwanted behaviours. DTT has also been referred to as the “Lovaas/UCLA model”, “rapid motor imitation antecedent”, “listener responding”, errorless learning”, and “mass trials”.

Brief History

Discrete trial training is rooted in the hypothesis of Charles Ferster that autism was caused in part by a person’s inability to react appropriately to “social reinforcers”, such as praise or criticism. Lovaas’s early work concentrated on showing that it was possible to strengthen autistic people’s responses to these social reinforcers, but he found these improvements were not associated with any general improvement in overall behaviour.

In a 1987 paper, psychologists Frank Gresham and Donald MacMillan described a number of weaknesses in Lovass’s research and judged that it would be better to call the evidence for his interventions “promising” rather than “compelling”.

Lovaas’s original technique used aversives such as striking, shouting, and electrical shocks to punish undesired behaviours. By 1979, Lovaas had abandoned the use of aversives, and in 2012 the use of electric shocks was described as being inconsistent with contemporary practice.

Technique

Discrete trial training (DTT) is a process whereby an activity is divided into smaller distinct sub-tasks and each of these is repeated continuously until a person is proficient. The trainer rewards successful completion and uses errorless correction procedures if there is unsuccessful completion by the subject to condition them into mastering the process. When proficiency is gained in each sub-task, they are re-combined into the whole activity: in this way proficiency at complex activities can be taught.

DTT is carried out in a one-on-one therapist to student ratio at the table. Intervention can start when a child is as young as two years old and can last from two to six years. Progression through goals of the program are determined individually and are not determined by which year the client has been in the program. The first year seeks to reduce self-stimulating (“stimming”) behaviour, teach listener responding, eye contact, and rapid fine and gross motor imitation, as well as to establish playing with toys in their intended manner, and integrate the family into the treatment protocol. The second year teaches early expressive language and abstract linguistic skills. The third year strives to include the individual’s community in the treatment to optimize “mainstreaming” by focusing on peer interaction, basic socializing skills, emotional expression and variation, in addition to observational learning and pre-academic skills, such as reading, writing, and arithmetic. Rarely is the technique implemented for the first time with adults.

DTT is typically performed five to seven days a week with each session lasting from five to eight hours, totalling an average of 30–40 hours per week. Sessions are divided into trials with intermittent breaks, and the therapist is positioned directly across the table from the student receiving treatment. Each trial is composed of the therapist giving an instruction (i.e. “Look at me”, “Do this”, “Point to”, etc.), in reference to an object, colour, simple imitative gesture, etc., which is followed by a prompt (verbal, gestural, physical, etc.). The concept is centred on shaping the child to respond correctly to the instructions throughout the trials. Should the child fail to respond to an instruction, the therapist uses either a “partial prompt” (a simple nudge or touch on the hand or arm) or a “full prompt” to facilitate the child to successfully complete the task. Correct responses are reinforced with a reward, and the prompts are discontinued as the child begins to master each skill.

The intervention is often used in conjunction with the Picture Exchange Communication System (PECS) as it primes the child for an easy transition between treatment types. The PECS programme serves as another common intervention technique used to conform individuals with autism. As many as 25% of autistic individuals have no functional speech. The programme teaches spontaneous social communication through symbols or pictures by relying on ABA techniques. PECS operates on a similar premise to DTT in that it uses systematic chaining to teach the individual to pair the concept of expressive speech with an object. It is structured in a similar fashion to DTT, in that each session begins with a preferred reinforcer survey to ascertain what would most motivate the child and effectively facilitate learning.

Effectiveness

Limited research shows DTT to be effective in enhancing spoken language, academic and adaptive skills, as many studies are of low quality research design and there needs to be more larger sample sizes.

Society and Culture

In Media

A 1965 article in Life magazine entitled Screams, Slaps and Love has a lasting impact on public attitudes towards Lovaas’s therapy. Giving little thought to how their work might be portrayed, Lovaas and parent advocate Bernie Rimland, M.D., were surprised when the magazine article appeared, since it focussed on text and selected images showing the use of aversives, including a close up of a child being slapped. Even after the use of aversives had been largely discontinued, the article continued to have an effect, galvanising public concerns about behaviour modification techniques.

United States Cost

In April 2002, treatment cost in the US was about US$4,200 per month ($50,000 annually) per child. The 20–40 hours per week intensity of the program, often conducted at home, may place additional stress on already challenged families.

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What is Amotivational Syndrome?

Published on 04/11/2024 by Andrew MarshallLeave a comment

Introduction

Amotivational syndrome is a chronic psychiatric disorder characterised by signs that are linked to cognitive and emotional states such as detachment, blunted emotion and drives, executive functions like memory and attention, disinterest, passivity, apathy, and a general lack of motivation. This syndrome can be branched into two subtypes – marijuana amotivational syndrome, interchangeably known as cannabis induced amotivational syndrome which is caused by usage and/or dependency of the substance and is primarily associated with long-term effects of cannabis use, and SSRI-induced amotivational syndrome or SSRI-induced apathy caused by the intake of SSRI medication dosage. According to the Handbook of Clinical Psychopharmacology for Therapists, amotivational syndrome is listed as a possible side effect of SSRIs in the treatment of clinical depression.

Refer to Avolition.

Signs and Symptoms

Amotivational syndrome has been suspected to affect the frontal cortex or frontal lobe of the brain by the impairment of that region which monitors cognitive functions and skills that revolve around emotional expression, decision making, prioritisation, and internal, purposeful mental action. It is most often detected through signs that are linked to apathy such as disinhibited presentations, short and long term memory deficit or amnesia, a lack of emotional display also known as emotional blunting, relative disinterest, passivity, and reluctance to participate in prolonged activities that require attention or tenacity. Common symptoms that may also be experienced include incoherence, an inability to concentrate on tasks, emotional distress, a diminished level of consciousness, selective attention or attentional control, and being withdrawn and asocial. These symptoms are also generally linked to cannabis consumption and abuse, as well as SSRI medication that are often used as forms of antidepressant medication.

Subtypes

Cannabis Amotivational Syndrome

The term amotivational syndrome was first devised to understand and explain the diminished drive and desire to work or compete among the population of youth who are frequent consumers of cannabis and has since been researched through various methodological studies with this focus on cannabis, or marijuana. Cannabis amotivational syndrome is often used interchangeably with marijuana amotivational syndrome and marijuana or cannabis induced or related amotivational syndrome. Cannabis related amotivational syndrome is closely tied with cannabis use disorder which is recognised in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and has similar conditions such as withdrawing and giving up from daily activities and neglecting major roles and responsibilities. It is one of the major complications of chronic exposure to cannabis as it includes the effects and elements of cognitive deficit or cognitive impairment that are similar to what appears in schizophrenia and depression. It is characterised by a gradual detachment and disconnect from the outer world due to a loss of emotional reactivity, drives, and aims. Responsiveness to any stimuli is limited, and those affected are unable to experience or anticipate any pleasure except through the use of cannabis. Marijuana amotivational syndrome has been looked at within the context of how motivation-related constructs influence the young adult in the context of the school or workplace as those affected have poor levels of school-related functioning, are unable to focus on schoolwork due to their lack of motivation, are less satisfied with participating in educational activities, and easily enter into conflict with scholastic authorities. Additionally, marijuana amotivational syndrome is closely linked to self-efficacy, a psychological concept which encapsulates how one values their capabilities and the amount of confidence they hold in their capabilities to persevere – this is related to motivation as people who hold a high amount of self-efficacy are more likely to make efforts to complete a task and persist longer in those efforts compared to those with lower self-efficacy.

SSRI-Induced Amotivational Syndrome

Amotivational syndrome caused or related to SSRI dosage is also commonly known as apathy syndrome, SSRI-induced apathy syndrome, SSRI-induced apathy, and antidepressant apathy syndrome. “Apathy is defined as the presence of diminished motivation in an individual – a development that is not attributable to a reduced level of consciousness, cognitive impairment (e.g. dementia), or emotional distress (i.e. depression)”. This syndrome is linked to the consumption and dosage of selective serotonin reuptake inhibitors (SSRIs), which are typically used as antidepressants, and has been reported in patients undergoing SSRI treatment as SSRIs may modulate and alter the activity occurring in the frontal lobe of the brain, one of the four major lobes in the brain that contains most of the dopaminergic pathways that are associated with reward, attention, short-term memory tasks, planning, and motivation. This syndrome may be related to serotonergic effects on the frontal lobes and/or serotonergic modulation of mid-brain dopaminergic systems which project to the prefrontal cortex, both suggesting the possibility of frontal lobe dysfunction due to the alteration of serotonin levels. This brings on a number of similar symptoms that lead to dose dependency and apathy, however, it has often been unrecognized and undiagnosed due to the lack of prevalent data and its subtle and delayed onset.

When looking at SSRI-induced amotivational syndrome as a clinical side effect, it can be looked at through a behavioural perspective as well as an emotional perspective. When looked at as a behavioural syndrome the association between apathy or low motivation and SSRI prescription has been recognised as a potential side effect, for example, behavioural apathy has been noted in several case reports. Aside from a behavioural perspective, an emotional perspective emphasizes the emotional aspects of indifference such as a lack of emotional responsiveness, a reduction in emotional sensitivity such as numbing or blunting emotion, affected patients often describe having a restricted range of emotions including those emotions that are a part of everyday life, and distinct emotional themes in affected patience that include a general reduction in the intensity or experience of all emotions, both positive and negative, and feeling emotionally detached and “just not caring”, diminishing emotionality in both personal and professional interpersonal relationships.

Treatment and Evaluation

Cannabis Amotivational Syndrome

Treatment of cannabis amotivational syndrome is like the treatment for cannabis dependence in which there should be careful evaluation for any signs of depression that predate the development of the amotivational syndrome and may be the basis for cannabis dependence and usage. The user is slowly weaned off usage through urine monitoring, self-help groups, education, and therapy in different treatment settings such as group, family, and individual therapy in order to separate themselves from cannabis consumption and any cannabis-related environment as both contribute to the cognitive aspects of amotivational syndrome.

SSRI-Induced Amotivational Syndrome

Treatments include gradually reducing or discontinuing the SSRI, changing the SSRI to another antidepressant class, or co-prescribing with the SSRI a medication that boosts dopamine, such as the antidepressant bupropion.

Current Research and Discourse

Cannabis Amotivational Syndrome

Though there is a prevalent relationship between cannabis consumption and amotivational syndrome, there is still some considerable debate that exists around cannabis consumption causing amotivational syndrome meaning that it may not be a single entity but rather a collection of behaviours that form the result of a combination of effects of an already existent or reactive depression that occurs alongside cannabis’s ability to facilitate a unique attention state. Trait absorption is often mentioned within discourses surrounding cannabis-induced amotivational syndrome and it states that the traits associated with a large majority of marijuana users, which are similar to traits found in those who have amotivational syndrome, such as boredom and a general feeling of disconnect, are absorbed and taken up by the cannabis user. It is used as a common argument against cannabis potentially being able to cause amotivational syndrome, instead, many cannabis users have stated that users often absorb what is often thought of as the typical set of traits marijuana consumers possess, which overlap with some of the traits found in amotivational syndrome. As a result, many have proposed that rather than cannabis being thought of as a psychologically harmful substance, it is instead thought of as an active placebo in which its effects on the mind are placebo effects in response to minimal physiological action rather than being a direct cause of the psychological changes seen in users.

Additionally, though research has been conducted, it is recognized that there is not enough substantial empirical research to conclude that the use of cannabis leads to amotivational syndrome. Anecdotal information such as statements taken from cannabis users includes feeling listless and lethargic. Amotivational syndrome still ranks high among the key problems associated with the drug, with researchers having adopted the phrase “amotivational” to describe lethargic cannabis users. The US Department of Health and Human Services also warns that usage in youth may result in amotivational symptoms such as an apathetic approach to life, fatigue, and poor academic and work performance. However, empirical research on the effects of cannabis on users’ motivation implies that there is no strong correlation and that there are numerous alternative explanations of these negative outcomes as a review of laboratory performance research, education data, and employment statistics fail to offer consistent evidence that directly link cannabis to any symptoms associated with amotivational syndrome. Though several studies contain data in which heavy cannabis users have reported feeling a lack of motivation, it has also been acknowledged that other variables such as comorbid drug use and baselines for low motivation may not be examined.

SSRI-Induced Amotivational Syndrome

Most research in psychological fields regarding amotivational syndrome caused by SSRI treatment has revolved around case studies and anecdotal reports to understand how SSRI medication influences levels of motivation and apathy in patients. There is considerable overlap in the clinical presentations of apathy and motivation and depression. Many patients with amotivational or apathy syndrome reported that they felt a lack of motivation that was unlike what they had sometimes experienced during previous episodes or depression, or that their feelings of apathy had no link to depression. Apathy syndrome has also been reported in a number of patients that have received or are receiving SSRI treatment over the last decade, which has also been linked to a deficit in the performance and activities of daily living, signalling a functional decline. It is a common behavioural problem that often goes undiagnosed and untreated, which is why it is considered to be clinical significant. Neuropsychological research has shown that a common feature of amotivational syndrome involves the presence of lesions and other abnormalities in the circulation of the frontal lobe. Neuroimaging studies of clinical populations have also reported correlations between apathy and structural and functional changes in the frontal lobe in the anterior cingulate gyrus and subregions of the basal ganglia. Recent case-control studies have also reported that apathy has appeared to be greater in patients who were treated with SSRI medication compared to patients who were not. Current findings are consistent with other findings supporting the correlation of SSRI and apathy due to the occurrence of abnormalities found within various regions of the frontal lobe. Though amotivational syndrome has been an emerging concern for pharmacotherapeutic industries to consider, there is still a growing body of empirical investigations that need to continue in order for the development of novel therapeutic interventions to improve, as well as treatment. Currently, empirical studies are limited and there is not a substantial enough amount of research to fully understand the link between frontal lobe abnormalities caused by SSRIs and thus resulting in amotivational syndrome. There is a lack of large-scale clinical studies that focus on the prevalence of SSRI-induced amotivational syndrome with regards to emotional blunting and apathy in both psychiatric or primary care populations, despite the high prescription rates for SSRI medication. There are also no current clinically popular scales to measure and assess SSRI-induced apathy. The Oxford Questionnaire of Emotional Side Effects of Antidepressants (OQESA) is a scale under development and presents a 26-item, Likert-style, self-report scale that aims to understand respondents’ emotional experiences such as a general reduction in emotions, a reduction in positive emotions, emotional detachment and blunting, and feelings of not caring. Respondents are also asked to what extent they believe their antidepressant is responsible for these emotional symptoms.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Amotivational_syndrome >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.