Rationalisation is a defence mechanism (ego defence) in which apparent logical reasons are given to justify behaviour that is motivated by unconscious instinctual impulses.
It is an attempt to find reasons for behaviours, especially ones own. Rationalisations are used to defend against feelings of guilt, maintain self-respect, and protect oneself from criticism.
Rationalisation happens in two steps:
A decision, action, judgement is made for a given reason, or no (known) reason at all.
A rationalisation is performed, constructing a seemingly good or logical reason, as an attempt to justify the act after the fact (for oneself or others).
Rationalisation encourages irrational or unacceptable behaviour, motives, or feelings and often involves ad hoc hypothesizing. This process ranges from fully conscious (e.g. to present an external defence against ridicule from others) to mostly unconscious (e.g. to create a block against internal feelings of guilt or shame). People rationalise for various reasons – sometimes when we think we know ourselves better than we do. Rationalisation may differentiate the original deterministic explanation of the behaviour or feeling in question.
Many conclusions individuals come to do not fall under the definition of rationalisation as the term is denoted above.
Brief History
Quintilian and classical rhetoric used the term colour for the presenting of an action in the most favourable possible perspective. Laurence Sterne in the eighteenth century took up the point, arguing that, were a man to consider his actions, “he will soon find, that such of them, as strong inclination and custom have prompted him to commit, are generally dressed out and painted with all the false beauties [colour] which, a soft and flattering hand can give them”.
DSM Definition
According to the DSM-IV, rationalisation occurs “when the individual deals with emotional conflict or internal or external stressors by concealing the true motivations for their own thoughts, actions, or feelings through the elaboration of reassuring or self serving but incorrect explanations”.
Examples
Individual
Rationalisation can be used to avoid admitting disappointment: “I didn’t get the job that I applied for, but I really didn’t want it in the first place.”
Egregious rationalisations intended to deflect blame can also take the form of ad hominem attacks or DARVO (deny, attack, and reverse victim and offender). Some rationalisations take the form of a comparison. Commonly, this is done to lessen the perception of an action’s negative effects, to justify an action, or to excuse culpability:
“At least [what occurred] is not as bad as [a worse outcome].”
In response to an accusation: “At least I didn’t [worse action than accused action].”
As a form of false choice: “Doing [undesirable action] is a lot better than [a worse action].”
In response to unfair or abusive behaviour: “I must have done something wrong if they treat me like this.”
Based on anecdotal and survey evidence, John Banja states that the medical field features a disproportionate amount of rationalisation invoked in the “covering up” of mistakes. Common excuses made are:
“Why disclose the error? The patient was going to die anyway.”
“Telling the family about the error will only make them feel worse.”
“It was the patient’s fault. If he wasn’t so (sick, etc.), this error wouldn’t have caused so much harm.”
“Well, we did our best. These things happen.”
“If we’re not totally and absolutely certain the error caused the harm, we don’t have to tell.”
“They’re dead anyway, so there’s no point in blaming anyone.”
In 2018 Muel Kaptein and Martien van Helvoort developed a model, called the Amoralisations Alarm Clock, that covers all existing amoralisations in a logical way. Amoralisations, also called neutralisations, or rationalisations, are defined as justifications and excuses for deviant behaviour. Amoralisations are important explanations for the rise and persistence of deviant behaviour. There exist many different and overlapping techniques of amoralisations.
Collective
Collective rationalisations are regularly constructed for acts of aggression, based on exaltation of the in-group and demonisation of the opposite side: as Fritz Perls put it, “Our own soldiers take care of the poor families; the enemy rapes them”.
Celebrity culture can be seen as rationalising the gap between rich and poor, powerful and powerless, by offering participation to both dominant and subaltern views of reality.
Criticism
Some scientists criticise the notion that brains are wired to rationalise irrational decisions, arguing that evolution would select against spending more nutrients at mental processes that do not contribute to the improvement of decisions such as rationalisation of decisions that would have been taken anyway. These scientists argue that learning from mistakes would be decreased rather than increased by rationalisation, and criticise the hypothesis that rationalisation evolved as a means of social manipulation by noting that if rational arguments were deceptive there would be no evolutionary chance for breeding individuals that responded to the arguments and therefore making them ineffective and not capable of being selected for by evolution.
Psychoanalysis
Ernest Jones introduced the term “rationalisation” to psychoanalysis in 1908, defining it as “the inventing of a reason for an attitude or action the motive of which is not recognized” – an explanation which (though false) could seem plausible. The term (Rationalisierung in German) was taken up almost immediately by Sigmund Freud to account for the explanations offered by patients for their own neurotic symptoms.
As psychoanalysts continued to explore the glossed of unconscious motives, Otto Fenichel distinguished different sorts of rationalisation – both the justifying of irrational instinctive actions on the grounds that they were reasonable or normatively validated and the rationalising of defensive structures, whose purpose is unknown on the grounds that they have some quite different but somehow logical meaning.
Later psychoanalysts are divided between a positive view of rationalisation as a stepping-stone on the way to maturity, and a more destructive view of it as splitting feeling from thought, and so undermining the powers of reason.
Cognitive Dissonance
Leon Festinger highlighted in 1957 the discomfort caused to people by awareness of their inconsistent thought. Rationalisation can reduce such discomfort by explaining away the discrepancy in question, as when people who take up smoking after previously quitting decide that the evidence for it being harmful is less than they previously thought.
Physical dependence is a physical condition caused by chronic use of a tolerance-forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms.
Physical dependence can develop from low-dose therapeutic use of certain medications such as benzodiazepines, opioids, antiepileptics and antidepressants, as well as the recreational misuse of drugs such as alcohol, opioids and benzodiazepines. The higher the dose used, the greater the duration of use, and the earlier age use began are predictive of worsened physical dependence and thus more severe withdrawal syndromes.
Acute withdrawal syndromes can last days, weeks or months. Protracted withdrawal syndrome, also known as post-acute-withdrawal syndrome or “PAWS”, is a low-grade continuation of some of the symptoms of acute withdrawal, typically in a remitting-relapsing pattern, often resulting in relapse and prolonged disability of a degree to preclude the possibility of lawful employment. Protracted withdrawal syndrome can last for months, years, or depending on individual factors, indefinitely. Protracted withdrawal syndrome is noted to be most often caused by benzodiazepines. To dispel the popular mis-association with addiction, physical dependence to medications is sometimes compared to dependence on insulin by persons with diabetes.
Symptoms
Physical dependence can manifest itself in the appearance of both physical and psychological symptoms which are caused by physiological adaptions in the central nervous system and the brain due to chronic exposure to a substance. Symptoms which may be experienced during withdrawal or reduction in dosage include increased heart rate and/or blood pressure, sweating, and tremors.[9] More serious withdrawal symptoms such as confusion, seizures, and visual hallucinations indicate a serious emergency and the need for immediate medical care.
Sedative hypnotic drugs such as alcohol, benzodiazepines, and barbiturates are the only commonly available substances that can be fatal in withdrawal due to their propensity to induce withdrawal convulsions. Abrupt withdrawal from other drugs, such as opioids can cause an extremely painful withdrawal that is very rarely fatal in patients of general good health and with medical treatment, but is more often fatal in patients with weakened cardiovascular systems; toxicity is generally caused by the often-extreme increases in heart rate and blood pressure (which can be treated with clonidine), or due to arrhythmia due to electrolyte imbalance caused by the inability to eat, and constant diarrhoea and vomiting (which can be treated with loperamide and ondansetron respectively) associated with acute opioid withdrawal, especially in longer-acting substances where the diarrhoea and emesis can continue unabated for weeks, although life-threatening complications are extremely rare, and nearly non-existent with proper medical management.
Treatment
Treatment for physical dependence depends upon the drug being withdrawn and often includes administration of another drug, especially for substances that can be dangerous when abruptly discontinued or when previous attempts have failed. Physical dependence is usually managed by a slow dose reduction over a period of weeks, months or sometimes longer depending on the drug, dose and the individual. A physical dependence on alcohol is often managed with a cross tolerant drug, such as long acting benzodiazepines to manage the alcohol withdrawal symptoms.
Drugs That Cause Physical Dependence
All µ-opioids with any (even slight) agonist effect, such as (partial list) morphine, heroin, codeine, oxycodone, buprenorphine, nalbuphine, methadone, and fentanyl, but not agonists specific to non-µ opioid receptors, such as salvinorin A (a k-opioid agonist), nor opioid antagonists or inverse agonists, such as naltrexone (a universal opioid inverse agonist).
All GABA agonists and positive allosteric modulators of both the GABA-A ionotropic receptor and GABA-B metabotropic receptor subunits, including (partial list):
A wide range of drugs whilst not causing a true physical dependence can still cause withdrawal symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal. These can include caffeine, stimulants, steroidal drugs and antiparkinsonian drugs. It is debated whether the entire antipsychotic drug class causes true physical dependency, a subset, or if none do. But, if discontinued too rapidly, it could cause an acute withdrawal syndrome. When talking about illicit drugs rebound withdrawal, especially with stimulants, it is sometimes referred to as “coming down” or “crashing”.
Some drugs, like anticonvulsants and antidepressants, describe the drug category and not the mechanism. The individual agents and drug classes in the anticonvulsant drug category act at many different receptors and it is not possible to generalise their potential for physical dependence or incidence or severity of rebound syndrome as a group so they must be looked at individually. Anticonvulsants as a group however are known to cause tolerance to the anti-seizure effect. SSRI drugs, which have an important use as antidepressants, engender a discontinuation syndrome that manifests with physical side effects; e.g. there have been case reports of a discontinuation syndrome with venlafaxine (Effexor).
Personality psychology is a branch of psychology that examines personality and its variation among individuals. It aims to show how people are individually different due to psychological forces. Its areas of focus include:
Construction of a coherent picture of the individual and their major psychological processes;
Investigation of individual psychological differences; and
Investigation of human nature and psychological similarities between individuals.
“Personality” is a dynamic and organised set of characteristics possessed by an individual that uniquely influences their environment, cognition, emotions, motivations, and behaviours in various situations. The word personality originates from the Latin persona, which means “mask”.
Personality also pertains to the pattern of thoughts, feelings, social adjustments, and behaviours persistently exhibited over time that strongly influences one’s expectations, self-perceptions, values, and attitudes. Personality also predicts human reactions to other people, problems, and stress. Gordon Allport (1937) described two major ways to study personality: the nomothetic and the idiographic. Nomothetic psychology seeks general laws that can be applied to many different people, such as the principle of self-actualisation or the trait of extraversion. Idiographic psychology is an attempt to understand the unique aspects of a particular individual.
The study of personality has a broad and varied history in psychology, with an abundance of theoretical traditions. The major theories include dispositional (trait) perspective, psychodynamic, humanistic, biological, behaviourist, evolutionary, and social learning perspective. Many researchers and psychologists do not explicitly identify themselves with a certain perspective and instead take an eclectic approach. Research in this area is empirically driven – such as dimensional models, based on multivariate statistics such as factor analysis – or emphasizes theory development, such as that of the psychodynamic theory. There is also a substantial emphasis on the applied field of personality testing. In psychological education and training, the study of the nature of personality and its psychological development is usually reviewed as a prerequisite to courses in abnormal psychology or clinical psychology.
Philosophical Assumptions
Many of the ideas conceptualised by historical and modern personality theorists stem from the basic philosophical assumptions they hold. The study of personality is not a purely empirical discipline, as it brings in elements of art, science, and philosophy to draw general conclusions. The following five categories are some of the most fundamental philosophical assumptions on which theorists disagree:
Assumption
Outline
Freedom versus Determinism
This is the question of whether humans have control over their own behaviour and understand the motives behind it, or if their behaviour is causally determined by forces beyond their control. Behaviour is categorised as being either unconscious, environmental or biological by various theories.
Heredity (Nature) versus Environment (Nurture)
Personality is thought to be determined largely either by genetics and biology, or by environment and experiences. Contemporary research suggests that most personality traits are based on the joint influence of genetics and environment. One of the forerunners in this arena is C. Robert Cloninger, who pioneered the Temperament and Character model.
Uniqueness versus Universality
This question discusses the extent of each human’s individuality (uniqueness) or similarity in nature (universality). Gordon Allport, Abraham Maslow, and Carl Rogers were all advocates of the uniqueness of individuals. Behaviourists and cognitive theorists, in contrast, emphasize the importance of universal principles, such as reinforcement and self-efficacy.
Active versus Reactive
This question explores whether humans primarily act through individual initiative (active) or through outside stimuli. Traditional behavioural theorists typically believed that humans are passively shaped by their environments, whereas humanistic and cognitive theorists believe that humans play a more active role. Most modern theorists agree that both are important, with aggregate behaviour being primarily determined by traits and situational factors being the primary predictor of behaviour in the short term.
Optimistic versus Pessimistic
Personality theories differ with regard to whether humans are integral in the changing of their own personalities. Theories that place a great deal of emphasis on learning are often more optimistic than those that do not.
Personality Theories
Type Theories
Personality type refers to the psychological classification of people into different classes. Personality types are distinguished from personality traits, which come in different degrees. There are many theories of personality, but each one contains several and sometimes many sub theories. A “theory of personality” constructed by any given psychologist will contain multiple relating theories or sub theories often expanding as more psychologists explore the theory. For example, according to type theories, there are two types of people, introverts and extroverts. According to trait theories, introversion and extroversion are part of a continuous dimension with many people in the middle. The idea of psychological types originated in the theoretical work of Carl Jung, specifically in his 1921 book Psychologische Typen (Psychological Types) and William Marston.
Building on the writings and observations of Jung during World War II, Isabel Briggs Myers and her mother, Katharine C. Briggs, delineated personality types by constructing the Myers-Briggs Type Indicator. This model was later used by David Keirsey with a different understanding from Jung, Briggs and Myers. In the former Soviet Union, Lithuanian Aušra Augustinavičiūtė independently derived a model of personality type from Jung’s called socionics. Later on many other tests were developed on this model e.g. Golden, PTI-Pro and JTI.
Theories could also be considered an “approach” to personality or psychology and is generally referred to as a model. The model is an older and more theoretical approach to personality, accepting extroversion and introversion as basic psychological orientations in connection with two pairs of psychological functions:
Perceiving functions: sensing and intuition (trust in concrete, sensory-oriented facts vs. trust in abstract concepts and imagined possibilities).
Judging functions: thinking and feeling (basing decisions primarily on logic vs. deciding based on emotion).
Briggs and Myers also added another personality dimension to their type indicator to measure whether a person prefers to use a judging or perceiving function when interacting with the external world. Therefore, they included questions designed to indicate whether someone wishes to come to conclusions (judgement) or to keep options open (perception).
This personality typology has some aspects of a trait theory: it explains people’s behavior in terms of opposite fixed characteristics. In these more traditional models, the sensing/intuition preference is considered the most basic, dividing people into “N” (intuitive) or “S” (sensing) personality types. An “N” is further assumed to be guided either by thinking or feeling and divided into the “NT” (scientist, engineer) or “NF” (author, humanitarian) temperament. An “S”, in contrast, is assumed to be guided more by the judgment/perception axis and thus divided into the “SJ” (guardian, traditionalist) or “SP” (performer, artisan) temperament. These four are considered basic, with the other two factors in each case (including always extraversion/introversion) less important. Critics of this traditional view have observed that the types can be quite strongly stereotyped by professions (although neither Myers nor Keirsey engaged in such stereotyping in their type descriptions), and thus may arise more from the need to categorise people for purposes of guiding their career choice. This among other objections led to the emergence of the five-factor view, which is less concerned with behaviour under work conditions and more concerned with behaviour in personal and emotional circumstances (The MBTI is not designed to measure the “work self”, but rather what Myers and McCaulley called the “shoes-off self.”).
Type A and Type B personality theory: During the 1950s, Meyer Friedman and his co-workers defined what they called Type A and Type B behaviour patterns. They theorised that intense, hard-driving Type A personalities had a higher risk of coronary disease because they are “stress junkies.” Type B people, on the other hand, tended to be relaxed, less competitive, and lower in risk. There was also a Type AB mixed profile.
John L. Holland’s RIASEC vocational model, commonly referred to as the Holland Codes, stipulates that six personality types lead people to choose their career paths. In this circumplex model, the six types are represented as a hexagon, with adjacent types more closely related than those more distant. The model is widely used in vocational counselling.
Eduard Spranger’s personality-model, consisting of six (or, by some revisions, 6 +1) basic types of value attitudes, described in his book Types of Men (Lebensformen; Halle (Saale): Niemeyer, 1914; English translation by P.J.W. Pigors – New York: G. E. Stechert Company, 1928).
The Enneagram of Personality, a model of human personality which is principally used as a typology of nine interconnected personality types. It has been criticised as being subject to interpretation, making it difficult to test or validate scientifically.
Perhaps the most ancient attempt at personality psychology is the personality typology outlined by the Indian Buddhist Abhidharma schools. This typology mostly focuses on negative personal traits (greed, hatred, and delusion) and the corresponding positive meditation practices used to counter those traits.
Psychoanalytical Theories
Psychoanalytic theories explain human behaviour in terms of the interaction of various components of personality. Sigmund Freud was the founder of this school of thought. He drew on the physics of his day (thermodynamics) to coin the term psychodynamics. Based on the idea of converting heat into mechanical energy, Freud proposed psychic energy could be converted into behaviour. His theory places central importance on dynamic, unconscious psychological conflicts.
Freud divides human personality into three significant components: the id, ego and super-ego. The id acts according to the pleasure principle, demanding immediate gratification of its needs regardless of external environment; the ego then must emerge in order to realistically meet the wishes and demands of the id in accordance with the outside world, adhering to the reality principle. Finally, the superego (conscience) inculcates moral judgment and societal rules upon the ego, thus forcing the demands of the id to be met not only realistically but morally. The superego is the last function of the personality to develop, and is the embodiment of parental/social ideals established during childhood. According to Freud, personality is based on the dynamic interactions of these three components.
The channelling and release of sexual (libidal) and aggressive energies, which ensues from the “Eros” (sex; instinctual self-preservation) and “Thanatos” (death; instinctual self-annihilation) drives respectively, are major components of his theory. It is important to note that Freud’s broad understanding of sexuality included all kinds of pleasurable feelings experienced by the human body.
Freud proposed five psychosexual stages of personality development. He believed adult personality is dependent upon early childhood experiences and largely determined by age five. Fixations that develop during the infantile stage contribute to adult personality and behaviour.
One of Sigmund Freud’s earlier associates, Alfred Adler, agreed with Freud that early childhood experiences are important to development, and believed birth order may influence personality development. Adler believed that the oldest child was the individual who would set high achievement goals in order to gain attention lost when the younger siblings were born. He believed the middle children were competitive and ambitious. He reasoned that this behaviour was motivated by the idea of surpassing the firstborn’s achievements. He added, however, that the middle children were often not as concerned about the glory attributed to their behaviour. He also believed the youngest would be more dependent and sociable. Adler finished by surmising that an only child loves being the centre of attention and matures quickly but in the end fails to become independent.
Heinz Kohut thought similarly to Freud’s idea of transference. He used narcissism as a model of how people develop their sense of self. Narcissism is the exaggerated sense of self in which one is believed to exist in order to protect one’s low self-esteem and sense of worthlessness. Kohut had a significant impact on the field by extending Freud’s theory of narcissism and introducing what he called the ‘self-object transferences’ of mirroring and idealisation. In other words, children need to idealize and emotionally “sink into” and identify with the idealised competence of admired figures such as parents or older siblings. They also need to have their self-worth mirrored by these people. Such experiences allow them to thereby learn the self-soothing and other skills that are necessary for the development of a healthy sense of self.
Another important figure in the world of personality theory is Karen Horney. She is credited with the development of “Feminist Psychology”. She disagrees with Freud on some key points, one being that women’s personalities are not just a function of “Penis Envy”, but that girl children have separate and different psychic lives unrelated to how they feel about their fathers or primary male role models. She talks about three basic Neurotic needs “Basic Anxiety”, “Basic Hostility” and “Basic Evil”. She posits that to any anxiety an individual experiences they would have one of three approaches, moving toward people, moving away from people or moving against people. It is these three that give us varying personality types and characteristics. She also places a high premium on concepts like Overvaluation of Love and romantic partners.
Behaviourist Theories
Behaviourists explain personality in terms of the effects external stimuli have on behaviour. The approaches used to evaluate the behavioural aspect of personality are known as behavioural theories or learning-conditioning theories. These approaches were a radical shift away from Freudian philosophy. One of the major tenets of this concentration of personality psychology is a strong emphasis on scientific thinking and experimentation. This school of thought was developed by B.F. Skinner who put forth a model which emphasized the mutual interaction of the person or “the organism” with its environment. Skinner believed children do bad things because the behaviour obtains attention that serves as a reinforcer. For example: a child cries because the child’s crying in the past has led to attention. These are the response, and consequences. The response is the child crying, and the attention that child gets is the reinforcing consequence. According to this theory, people’s behaviour is formed by processes such as operant conditioning. Skinner put forward a “three term contingency model” which helped promote analysis of behaviour based on the “Stimulus – Response – Consequence Model” in which the critical question is: “Under which circumstances or antecedent ‘stimuli’ does the organism engage in a particular behavior or ‘response’, which in turn produces a particular ‘consequence’?”
Richard Herrnstein extended this theory by accounting for attitudes and traits. An attitude develops as the response strength (the tendency to respond) in the presences of a group of stimuli become stable. Rather than describing conditionable traits in non-behavioural language, response strength in a given situation accounts for the environmental portion. Herrstein also saw traits as having a large genetic or biological component, as do most modern behaviourists.
Ivan Pavlov is another notable influence. He is well known for his classical conditioning experiments involving dogs, which led him to discover the foundation of behaviourism.
Social Cognitive Theories
In cognitive theory, behaviour is explained as guided by cognitions (e.g. expectations) about the world, especially those about other people. Cognitive theories are theories of personality that emphasize cognitive processes, such as thinking and judging.
Albert Bandura, a social learning theorist suggested the forces of memory and emotions worked in conjunction with environmental influences. Bandura was known mostly for his “Bobo doll experiment”. During these experiments, Bandura video taped a college student kicking and verbally abusing a bobo doll. He then showed this video to a class of kindergarten children who were getting ready to go out to play. When they entered the play room, they saw bobo dolls, and some hammers. The people observing these children at play saw a group of children beating the doll. He called this study and his findings observational learning, or modelling.
Early examples of approaches to cognitive style are listed by Baron (1982). These include Witkin’s (1965) work on field dependency, Gardner’s (1953) discovering people had consistent preference for the number of categories they used to categorise heterogeneous objects, and Block and Petersen’s (1955) work on confidence in line discrimination judgments. Baron relates early development of cognitive approaches of personality to ego psychology. More central to this field have been:
Attributional style theory dealing with different ways in which people explain events in their lives. This approach builds upon locus of control, but extends it by stating we also need to consider whether people attribute to stable causes or variable causes, and to global causes or specific causes.
Various scales have been developed to assess both attributional style and locus of control. Locus of control scales include those used by Rotter and later by Duttweiler, the Nowicki and Strickland (1973) Locus of Control Scale for Children and various locus of control scales specifically in the health domain, most famously that of Kenneth Wallston and his colleagues, The Multidimensional Health Locus of Control Scale. Attributional style has been assessed by the Attributional Style Questionnaire, the Expanded Attributional Style Questionnaire, the Attributions Questionnaire, the Real Events Attributional Style Questionnaire and the Attributional Style Assessment Test.
Achievement style theory focuses upon identification of an individual’s Locus of Control tendency, such as by Rotter’s evaluations, and was found by Cassandra Bolyard Whyte to provide valuable information for improving academic performance of students. Individuals with internal control tendencies are likely to persist to better academic performance levels, presenting an achievement personality, according to Cassandra B. Whyte.
Recognition that the tendency to believe that hard work and persistence often results in attainment of life and academic goals has influenced formal educational and counselling efforts with students of various ages and in various settings since the 1970s research about achievement. Counselling aimed toward encouraging individuals to design ambitious goals and work toward them, with recognition that there are external factors that may impact, often results in the incorporation of a more positive achievement style by students and employees, whatever the setting, to include higher education, workplace, or justice programming.
Walter Mischel (1999) has also defended a cognitive approach to personality. His work refers to “Cognitive Affective Units”, and considers factors such as encoding of stimuli, affect, goal-setting, and self-regulatory beliefs. The term “Cognitive Affective Units” shows how his approach considers affect as well as cognition.
Cognitive-Experiential Self-Theory (CEST) is another cognitive personality theory. Developed by Seymour Epstein, CEST argues that humans operate by way of two independent information processing systems: experiential system and rational system. The experiential system is fast and emotion-driven. The rational system is slow and logic-driven. These two systems interact to determine our goals, thoughts, and behaviolr.
Personal construct psychology (PCP) is a theory of personality developed by the American psychologist George Kelly in the 1950s. Kelly’s fundamental view of personality was that people are like naïve scientists who see the world through a particular lens, based on their uniquely organised systems of construction, which they use to anticipate events. But because people are naïve scientists, they sometimes employ systems for construing the world that are distorted by idiosyncratic experiences not applicable to their current social situation. A system of construction that chronically fails to characterise and/or predict events, and is not appropriately revised to comprehend and predict one’s changing social world, is considered to underlie psychopathology (or mental illness). From the theory, Kelly derived a psychotherapy approach and also a technique called The Repertory Grid Interview that helped his patients to uncover their own “constructs” with minimal intervention or interpretation by the therapist. The repertory grid was later adapted for various uses within organisations, including decision-making and interpretation of other people’s world-views.
Humanistic Theories
Humanistic psychology emphasizes that people have free will and that this plays an active role in determining how they behave. Accordingly, humanistic psychology focuses on subjective experiences of persons as opposed to forced, definitive factors that determine behaviour. Abraham Maslow and Carl Rogers were proponents of this view, which is based on the “phenomenal field” theory of Combs and Snygg (1949). Rogers and Maslow were among a group of psychologists that worked together for a decade to produce the Journal of Humanistic Psychology. This journal was primarily focused on viewing individuals as a whole, rather than focusing solely on separate traits and processes within the individual.
Robert W. White wrote the book The Abnormal Personality that became a standard text on abnormal psychology. He also investigated the human need to strive for positive goals like competence and influence, to counterbalance the emphasis of Freud on the pathological elements of personality development.
Maslow spent much of his time studying what he called “self-actualizing persons”, those who are “fulfilling themselves and doing the best they are capable of doing”. Maslow believes all who are interested in growth move towards self-actualizing (growth, happiness, satisfaction) views. Many of these people demonstrate a trend in dimensions of their personalities. Characteristics of self-actualisers according to Maslow include the four key dimensions:
Dimension
Outline
Awareness
maintaining constant enjoyment and awe of life. These individuals often experienced a “peak experience”. He defined a peak experience as an “intensification of any experience to the degree there is a loss or transcendence of self”. A peak experience is one in which an individual perceives an expansion of themselves, and detects a unity and meaningfulness in life. Intense concentration on an activity one is involved in, such as running a marathon, may invoke a peak experience.
Reality and Problem Centred
Having a tendency to be concerned with “problems” in surroundings.
Acceptance/Spontaneity
Accepting surroundings and what cannot be changed.
Unhostile Sense of Humour/Democratic
Do not take kindly to joking about others, which can be viewed as offensive. They have friends of all backgrounds and religions and hold very close friendships.
Maslow and Rogers emphasized a view of the person as an active, creative, experiencing human being who lives in the present and subjectively responds to current perceptions, relationships, and encounters. They disagree with the dark, pessimistic outlook of those in the Freudian psychoanalysis ranks, but rather view humanistic theories as positive and optimistic proposals which stress the tendency of the human personality toward growth and self-actualization. This progressing self will remain the centre of its constantly changing world; a world that will help mould the self but not necessarily confine it. Rather, the self has opportunity for maturation based on its encounters with this world. This understanding attempts to reduce the acceptance of hopeless redundancy. Humanistic therapy typically relies on the client for information of the past and its effect on the present, therefore the client dictates the type of guidance the therapist may initiate. This allows for an individualised approach to therapy. Rogers found patients differ in how they respond to other people. Rogers tried to model a particular approach to therapy – he stressed the reflective or empathetic response. This response type takes the client’s viewpoint and reflects back their feeling and the context for it. An example of a reflective response would be, “It seems you are feeling anxious about your upcoming marriage”. This response type seeks to clarify the therapist’s understanding while also encouraging the client to think more deeply and seek to fully understand the feelings they have expressed.
Biopsychological Theories
Biology plays a very important role in the development of personality. The study of the biological level in personality psychology focuses primarily on identifying the role of genetic determinants and how they mould individual personalities. Some of the earliest thinking about possible biological bases of personality grew out of the case of Phineas Gage. In an 1848 accident, a large iron rod was driven through Gage’s head, and his personality apparently changed as a result, although descriptions of these psychological changes are usually exaggerated.
In general, patients with brain damage have been difficult to find and study. In the 1990s, researchers began to use electroencephalography (EEG), positron emission tomography (PET), and more recently functional magnetic resonance imaging (fMRI), which is now the most widely used imaging technique to help localise personality traits in the brain.
Genetic Basis of Personality
Ever since the Human Genome Project allowed for a much more in depth comprehension of genetics, there has been an ongoing controversy involving heritability, personality traits, and environmental vs. genetic influence on personality. The human genome is known to play a role in the development of personality.
Previously, genetic personality studies focused on specific genes correlating to specific personality traits. Today’s view of the gene-personality relationship focuses primarily on the activation and expression of genes related to personality and forms part of what is referred to as behavioural genetics. Genes provide numerous options for varying cells to be expressed; however, the environment determines which of these are activated. Many studies have noted this relationship in varying ways in which our bodies can develop, but the interaction between genes and the shaping of our minds and personality is also relevant to this biological relationship.
DNA-environment interactions are important in the development of personality because this relationship determines what part of the DNA code is actually made into proteins that will become part of an individual. While different choices are made available by the genome, in the end, the environment is the ultimate determinant of what becomes activated. Small changes in DNA in individuals are what leads to the uniqueness of every person as well as differences in looks, abilities, brain functioning, and all the factors that culminate to develop a cohesive personality.
Cattell and Eysenck have proposed that genetics have a powerful influence on personality. A large part of the evidence collected linking genetics and the environment to personality have come from twin studies. This “twin method” compares levels of similarity in personality using genetically identical twins. One of the first of these twin studies measured 800 pairs of twins, studied numerous personality traits, and determined that identical twins are most similar in their general abilities. Personality similarities were found to be less related for self-concepts, goals, and interests.
Twin studies have also been important in the creation of the five factor personality model: neuroticism, extraversion, openness, agreeableness, and conscientiousness. Neuroticism and extraversion are the two most widely studied traits. Individuals scoring high in trait extraversion more often display characteristics such as impulsiveness, sociability, and activeness. Individuals scoring high in trait neuroticism are more likely to be moody, anxious, or irritable. Identical twins, however, have higher correlations in personality traits than fraternal twins. One study measuring genetic influence on twins in five different countries found that the correlations for identical twins were .50, while for fraternal they were about .20. It is suggested that heredity and environment interact to determine one’s personality.
Evolutionary Theory
Charles Darwin is the founder of the theory of the evolution of the species. The evolutionary approach to personality psychology is based on this theory. This theory examines how individual personality differences are based on natural selection. Through natural selection organisms change over time through adaptation and selection. Traits are developed and certain genes come into expression based on an organism’s environment and how these traits aid in an organism’s survival and reproduction.
Polymorphisms, such as gender and blood type, are forms of diversity which evolve to benefit a species as a whole. The theory of evolution has wide-ranging implications on personality psychology. Personality viewed through the lens of evolutionary psychology places a great deal of emphasis on specific traits that are most likely to aid in survival and reproduction, such as conscientiousness, sociability, emotional stability, and dominance. The social aspects of personality can be seen through an evolutionary perspective. Specific character traits develop and are selected for because they play an important and complex role in the social hierarchy of organisms. Such characteristics of this social hierarchy include the sharing of important resources, family and mating interactions, and the harm or help organisms can bestow upon one another.
Drive Theories
In the 1930s, John Dollard and Neal Elgar Miller met at Yale University, and began an attempt to integrate drives, into a theory of personality, basing themselves on the work of Clark Hull. They began with the premise that personality could be equated with the habitual responses exhibited by an individual – their habits. From there, they determined that these habitual responses were built on secondary, or acquired drives.
Secondary drives are internal needs directing the behaviour of an individual that results from learning. Acquired drives are learned, by and large in the manner described by classical conditioning. When we are in a certain environment and experience a strong response to a stimulus, we internalise cues from the said environment. When we find ourselves in an environment with similar cues, we begin to act in anticipation of a similar stimulus. Thus, we are likely to experience anxiety in an environment with cues similar to one where we have experienced pain or fear – such as the dentist’s office.
Secondary drives are built on primary drives, which are biologically driven, and motivate us to act with no prior learning process – such as hunger, thirst or the need for sexual activity. However, secondary drives are thought to represent more specific elaborations of primary drives, behind which the functions of the original primary drive continue to exist. Thus, the primary drives of fear and pain exist behind the acquired drive of anxiety. Secondary drives can be based on multiple primary drives and even in other secondary drives. This is said to give them strength and persistence. Examples include the need for money, which was conceptualised as arising from multiple primary drives such as the drive for food and warmth, as well as from secondary drives such as imitativeness (the drive to do as others do) and anxiety.
Secondary drives vary based on the social conditions under which they were learned – such as culture. Dollard and Miller used the example of food, stating that the primary drive of hunger manifested itself behind the learned secondary drive of an appetite for a specific type of food, which was dependent on the culture of the individual.
Secondary drives are also explicitly social, representing a manner in which we convey our primary drives to others. Indeed, many primary drives are actively repressed by society (such as the sexual drive). Dollard and Miller believed that the acquisition of secondary drives was essential to childhood development. As children develop, they learn not to act on their primary drives, such as hunger but acquire secondary drives through reinforcement. Friedman and Schustack describe an example of such developmental changes, stating that if an infant engaging in an active orientation towards others brings about the fulfilment of primary drives, such as being fed or having their diaper changed, they will develop a secondary drive to pursue similar interactions with others – perhaps leading to an individual being more gregarious. Dollard and Miller’s belief in the importance of acquired drives led them to reconceive Sigmund Freud’s theory of psychosexual development. They found themselves to be in agreement with the timing Freud used but believed that these periods corresponded to the successful learning of certain secondary drives.
Dollard and Miller gave many examples of how secondary drives impact our habitual responses – and by extension our personalities, including anger, social conformity, imitativeness or anxiety, to name a few. In the case of anxiety, Dollard and Miller note that people who generalise the situation in which they experience the anxiety drive will experience anxiety far more than they should. These people are often anxious all the time, and anxiety becomes part of their personality. This example shows how drive theory can have ties with other theories of personality – many of them look at the trait of neuroticism or emotional stability in people, which is strongly linked to anxiety.
Personality Tests
There are two major types of personality tests, projective and objective.
Projective tests assume personality is primarily unconscious and assess individuals by how they respond to an ambiguous stimulus, such as an ink blot. Projective tests have been in use for about 60 years and continue to be used today. Examples of such tests include the Rorschach test and the Thematic Apperception Test.
The Rorschach Test involves showing an individual a series of note cards with ambiguous ink blots on them. The individual being tested is asked to provide interpretations of the blots on the cards by stating everything that the ink blot may resemble based on their personal interpretation. The therapist then analyses their responses. Rules for scoring the test have been covered in manuals that cover a wide variety of characteristics such as content, originality of response, location of “perceived images” and several other factors. Using these specific scoring methods, the therapist will then attempt to relate test responses to attributes of the individual’s personality and their unique characteristics. The idea is that unconscious needs will come out in the person’s response, e.g. an aggressive person may see images of destruction.
The Thematic Apperception Test (TAT) involves presenting individuals with vague pictures/scenes and asking them to tell a story based on what they see. Common examples of these “scenes” include images that may suggest family relationships or specific situations, such as a father and son or a man and a woman in a bedroom. Responses are analysed for common themes. Responses unique to an individual are theoretically meant to indicate underlying thoughts, processes, and potentially conflicts present within the individual. Responses are believed to be directly linked to unconscious motives. There is very little empirical evidence available to support these methods.
Objective tests assume personality is consciously accessible and that it can be measured by self-report questionnaires. Research on psychological assessment has generally found objective tests to be more valid and reliable than projective tests. Critics have pointed to the Forer effect to suggest some of these appear to be more accurate and discriminating than they really are. Issues with these tests include false reporting because there is no way to tell if an individual is answering a question honestly or accurately.
The Myers-Briggs Type Indicator (also known as the MBTI) is self-reporting questionnaire based on Carl Jung’s Type theory. However, the MBTI modified Jung’s theory into their own by disregarding certain processes held in the unconscious mind and the impact these have on personality.
Personality Theory Assessment Criteria
Verifiability – the theory should be formulated in such a way that the concepts, suggestions and hypotheses involved in it are defined clearly and unambiguously, and logically related to each other.
Heuristic value – to what extent the theory stimulates scientists to conduct further research.
Internal consistency – the theory should be free from internal contradictions.
Economy – the fewer concepts and assumptions required by the theory to explain any phenomenon, the better it is Hjelle, Larry (1992). Personality Theories: Basic Assumptions, Research, and Applications.
Psychology has traditionally defined personality through its behavioural patterns, and more recently with neuroscientific studies of the brain. In recent years, some psychologists have turned to the study of inner experiences for insight into personality as well as individuality. Inner experiences are the thoughts and feelings to an immediate phenomenon. Another term used to define inner experiences is qualia. Being able to understand inner experiences assists in understanding how humans behave, act, and respond. Defining personality using inner experiences has been expanding due to the fact that solely relying on behavioural principles to explain one’s character may seem incomplete. Behavioural methods allow the subject to be observed by an observer, whereas with inner experiences the subject is its own observer.
Methods Measuring Inner Experience
Descriptive Experience Sampling (DES)
Developed by psychologist Russel Hurlburt. This is an idiographic method that is used to help examine inner experiences. This method relies on an introspective technique that allows an individual’s inner experiences and characteristics to be described and measured. A beep notifies the subject to record their experience at that exact moment and 24 hours later an interview is given based on all the experiences recorded. DES has been used in subjects that have been diagnosed with schizophrenia and depression. It has also been crucial to studying the inner experiences of those who have been diagnosed with common psychiatric diseases.
Articulated Thoughts in Stimulated Situations (ATSS)
ATSS is a paradigm which was created as an alternative to the TA (think aloud) method. This method assumes that people have continuous internal dialogues that can be naturally attended to. ATSS also assesses a person’s inner thoughts as they verbalise their cognitions. In this procedure, subjects listen to a scenario via a video or audio player and are asked to imagine that they are in that specific situation. Later, they are asked to articulate their thoughts as they occur in reaction to the playing scenario. This method is useful in studying emotional experience given that the scenarios used can influence specific emotions. Most importantly, the method has contributed to the study of personality. In a study conducted by Rayburn and Davison (2002), subjects’ thoughts and empathy toward anti-gay hate crimes were evaluated. The researchers found that participants showed more aggressive intentions towards the offender in scenarios which mimicked hate crimes.
Experimental Method
This method is an experimental paradigm used to study human experiences involved in the studies of sensation and perception, learning and memory, motivation, and biological psychology. The experimental psychologist usually deals with intact organisms although studies are often conducted with organisms modified by surgery, radiation, drug treatment, or long-standing deprivations of various kinds or with organisms that naturally present organic abnormalities or emotional disorders. Economists and psychologists have developed a variety of experimental methodologies to elicit and assess individual attitudes where each emotion differs for each individual. The results are then gathered and quantified to conclude if specific experiences have any common factors. This method is used to seek clarity of the experience and remove any biases to help understand the meaning behind the experience to see if it can be generalised.
In Freudianpsychoanalysis, the term oral stage or hemiataxia denotes the first psychosexual development stage wherein the mouth of the infant is their primary erogenous zone.
Spanning the life period from birth to the age of 18 months, the oral stage is the first of the five Freudian psychosexual development stages:
The oral;
The anal;
The phallic;
The latent; and
The genital.
Moreover, because it is the infant’s first human relationship – biological (nutritive) and psychological (emotional) – its duration depends upon the child-rearing mores of the mother’s society. Sociologically speaking, the duration of infantile nursing is determined normatively; in some societies it is common for a child to be nursed by their mother for several years but in others this period is much shorter.
Oral-Stage Fixation
Psychologically, Sigmund Freud proposed that if the nursing child’s appetite were thwarted during any libidinal development stage, the anxiety would persist into adulthood as a neurosis (functional mental disorder). Therefore, an infantile oral fixation (oral craving) would be manifest as an obsession with oral stimulation; yet, if weaned either too early or too late, the infant might fail to resolve the emotional conflicts of the oral, first stage of psychosexual development and they might develop a maladaptive oral fixation.
The infant who is neglected (insufficiently fed) or who is over-protected (over-fed) in the course of being nursed, might become an orally-fixated person. Said oral-stage fixation might have two effects:
The neglected child might become a psychologically dependent adult continually seeking the oral stimulation denied in infancy, thereby becoming a manipulative person in fulfilling their needs, rather than maturing to independence; and
The over-protected child might resist maturation and return to dependence upon others in fulfilling their needs.
Theoretically, oral-stage fixations are manifested as garrulousness (talkativeness), smoking, continual oral stimulus (eating, chewing objects), and alcoholism. Psychologically, the symptoms include a sarcastic, oral sadistic personality, nail biting, oral sexual practices (fellatio, cunnilingus, analingus, irrumatio), et cetera.
Criticism
Since Freud’s presentation of the theory of psychosexual development in 1905, no evidence has confirmed that extended breast-feeding might lead to an oral-stage fixation, nor that it contributes to a person becoming maladjusted or to developing addictions (psychologic, physiologic). The paediatrician Jack Newman proposed that breast feeding a child until they choose to wean (c. 2-4 years of age) generally produces a more psychologically secure, and independent person. Contradicting the Freudian psychosexual development concept of oral-stage fixation, the Duration of Breast-feeding and the Incidence of Smoking (2003) study of 87 participants reported no causal relation between the breast-feeding period and whether or not a child matures into a person who smokes.
National Registry of Evidence-Based Programmes and Practices (NREPP) Logo.
The National Registry of Evidence-based Programmes and Practices (NREPP) was a searchable online database of interventions designed to promote mental health or to prevent or treat substance abuse and mental disorders.
The registry was funded and administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the US Department of Health and Human Services. The goal of the Registry was to encourage wider adoption of evidence-based interventions and to help those interested in implementing an evidence-based intervention to select one that best meets their needs.
The NREPP website was phased out in 2018.
Background
In the behavioural health field, there is an ongoing need for researchers, developers, evaluators, and practitioners to share information about what works to improve outcomes among individuals coping with, or at risk for, mental disorders and substance abuse. Discussing how this need led to the development of NREPP, Brounstein, Gardner, and Backer (2006) write:
It is important to note that not all prevention programs work. Still other programs have no empirically based support regarding their effectiveness. […] Many others have empirical support, but the methods used to generate that support are suspect. This is another reason to highlight the need for and use of scientifically defensible, effective prevention programs. These are programs that clearly demonstrate that the program was well implemented, well evaluated, and produced a consistent pattern of positive results.
The focus of NREPP is on delivering an array of standardised, comparable information on interventions that are evidence based, as opposed to identifying programmes that are “effective” or ranking them in effectiveness. Its peer reviewers use specific criteria to rate the quality of an intervention’s evidence base as well as the intervention’s suitability for broad adoption. In addition, NREPP provides contextual information about the intervention, such as the population served, implementation history, and cost data to encourage a realistic and holistic approach to selecting prevention interventions.
As of 2010, the interventions reviewed by NREPP have been implemented successfully in more than 229,000 sites, in all 50 States and more than 70 countries, and with more than 107 million clients. Versions of ura review process and rating criteria have been adopted by the National Cancer Institute and the Administration on Aging.
The information NREPP provides is subject to certain limitations. It is not an exhaustive repository of all tested mental health interventions; submission is a voluntary process, and limited resources may preclude the review of some interventions even though they meet minimum requirements for acceptance. The NREPP home page prominently states that “inclusion in the registry does not constitute an endorsement.”
Submission Process
NREPP holds an open submission period that runs 01 November through 01 February. For an intervention to be eligible for a review, it must meet four minimum criteria:
The intervention has produced one or more positive behavioural outcomes (p ≤ .05) in mental health, mental disorders, substance abuse, or substance use disorders use among individuals, communities, or populations.
Evidence of these outcomes has been demonstrated in at least one study using an experimental or quasi-experimental design.
The results of these studies have been published in a peer-reviewed journal or other professional publication, or documented in a comprehensive evaluation report.
Implementation materials, training and support resources, and quality assurance procedures have been developed and are ready for use by the public.
Once reviewed and added to the Registry, interventions are invited to undergo a new review four or five years after their initial review.
Review Process
The NREPP review process consists of two parallel and simultaneous review tracks, one that looks at the intervention’s Quality of Research (QOR) and another that looks at the intervention’s Readiness for Dissemination (RFD). The materials used in a QOR review are generally published research articles, although unpublished final evaluation reports can also be included. The materials used in an RFD review include implementation materials and process documentation, such as manuals, curricula, training materials, and written quality assurance procedures.
The reviews are conducted by expert consultants who have received training on NREPP’s review process and rating criteria. Two QOR and two RFD reviewers are assigned to each review. Reviewers work independently, rating the same materials. Their ratings are averaged to generate final scores.
While the review process is ongoing, NREPP staff work with the intervention’s representatives to collect descriptive information about the intervention, such as the program goals, types of populations served, and implementation history.
The QOR ratings, given on a scale of 0.0 to 4.0, indicate the strength of the evidence supporting the outcomes of the intervention. Higher scores indicate stronger, more compelling evidence. Each outcome is rated separately because interventions may target multiple outcomes (e.g. alcohol use, marijuana use, behaviour problems in school), and the evidence supporting the different outcomes may vary. The QOR rating criteria are:
Reliability of measures.
Validity of measures.
Intervention fidelity.
Missing data and attrition.
Potential confounding variables.
Appropriateness of analysis.
The RFD ratings, also given on a scale of 0.0 to 4.0, indicate the amount and quality of the resources available to support the use of the intervention. Higher scores indicate that resources are readily available and of high quality. These ratings apply to the intervention as a whole. The RFD criteria are:
Availability of implementation materials.
Availability of training and support resources.
Availability of quality assurance procedures.
Reviewers
QOR reviewers are required to have a doctoral-level degree and a strong background and understanding of current methods of evaluating prevention and treatment interventions. RFD reviewers are selected from two categories: direct services experts (including both providers and consumers of services), or experts in the field of implementation. Direct services experts must have previous experience evaluating prevention or treatment interventions and knowledge of mental health or substance abuse prevention or treatment content areas.
Products and Publications
NREPP publishes an intervention summary for each intervention it adds to the Registry. The summaries, which are accessed through the Registry’s search engine, contain the following standardised information:
A brief description of the reviewed intervention, including targeted goals and theoretical basis.
Study populations (age, gender, race/ethnicity).
Study settings and geographical locations.
Implementation history.
Funding information.
Comparative evaluation research conducted with the intervention.
Adaptations.
Adverse effects.
List of studies and materials reviewed.
List of outcomes.
Description of measures and key findings for each outcome.
Research design of the studies reviewed.
Quality of Research and Readiness for Dissemination ratings.
Reviewer comments (Strengths and Weaknesses).
Costs.
Replication studies.
Contact information.
NREPP also maintains an online Learning Centre. Offerings include learning modules on implementation and preparing for NREPP submission; a research paper on evidence-based therapy relationships; and links to screening and assessment tools for mental health and substance use.
Predecessor System
The registry originated in 1997 and has gone through several changes since then. The predecessor to today’s NREPP was the National Registry of Effective Prevention Programmes (later renamed the National Registry of Effective Programmes and Practices), which was developed by SAMHSA’s Centre for Substance Abuse Prevention as part of the Model Programmes initiative. Procedures under this earlier registry were developed to review, rate, and designate programmes as Model, Effective, or Promising. Based on extensive input from scientific communities, service providers, expert panels, and the public, the procedures were revised. Reviews using the new NREPP system began in 2006, and the redesigned Web site debuted in March 2007.
Phase out in 2018
According to an email from SAMHSA:
“SAMHSA is committed to advancing the adoption of evidence-based interventions related to mental health and substance use. Consistent with the January 2018 announcement from the Assistant Secretary for Mental Health and Substance Use related to discontinuing the National Registry of Evidence-based Programs and Practices (NREPP), SAMHSA has now phased out the NREPP website, which has been in existence since 1997. In April 2018, SAMHSA launched the Evidence-Based Practices Resource Center (Resource Center) that aims to provide communities, clinicians, policy makers, and others in the field with the information and tools they need to incorporate evidence-based practices into their communities or clinical settings. The Resource Center contains a collection of science-based resources; however, it does not replace NREPP and does not contain all of the resources that were previously available on NREPP.
“The Resource Center is a component of SAMHSA’s new comprehensive approach to identify and disseminate clinically sound and scientifically based policy, practices, and programs. Under this new approach, we are continuing to develop and add additional resources to the Resource Center as they become available. In the meantime, please use our Resource Center as well as the SAMHSA Store to find information on evidence-based practices and other resources related to mental health and substance use. For products and resources not developed by SAMHSA, please contact the developers for more information.”
Further Reading
Hennessy, K., Finkbiner, R., & Hill, G. (2006) The National Registry of Evidence-Based Programs and Practices: A Decision-Support Tool to Advance the Use of Evidence-Based Services. International Journal of Mental Health. 35(2), pp.21-34. doi: 10.2753/IMH0020-7411350202.
Brounstein, P. J., Gardner, S. E., & Backer, T. (2006) Research to Practice: Efforts to Bring Effective Prevention to Every Community. Journal of Primary Prevention. 27(1), pp.91-109. doi: 10.1007/s10935-005-0024-6. PMID 16421654. These criteria and the accompanying rating anchors are unique to NREPP but share common elements with the types of standards used by other Federal agencies to assess evidence-based programmes.
The negative therapeutic reaction in psychoanalysis is the paradoxical phenomenon whereby a plausible interpretation produces, rather than improvement, a worsening of the analysand’s condition.
Freud’s Formulations
Freud first named the negative therapeutic reaction in The Ego and the Id of 1923, seeing its cause, not merely in the analysand’s desire to be superior to their analyst, but (more deeply) in an underlying sense of guilt: “the obstacle of an unconscious sense of guilt….they get worse during the treatment instead of getting better”. The following year he offered the alternative formulation of a need for punishment instead; but in his thirties summation it was again unconscious guilt to which he attributed “the negative therapeutic reaction which is so disagreeable from the prognostic point of view”.
Precursors to the idea can be found in his own article Criminals from a sense of guilt, as well as in Karl Abraham’s 1919 article on envy and narcissism as enemies of the analytic work.
Later Developments
The negative therapeutic reaction is unusual in psychoanalytic history in never being the subject of major controversy, while still be steadily worked on and reformulated in later analytic phases. These have added additional motivations behind the reaction to that singled out by Freud. Joan Riviere pointed to the neurotic’s fear of any change in condition, even from worse to better, while the desire to spite the analyst may also be a motive. Lacan highlighted the role of amour propre in the hatred of being helped by any outside force. Object relations theory has also pointed to the way that underdoing defences means the patient experiencing their underlying conflicts more fully, and reacting negatively to that.
National Institute for Mental Health in England (NIMHE) was an English medical organisation established in 2001 under the leadership of Professor Louis Appleby to “coordinate research, disseminate information, facilitate training and develop services”.
Background
The NIMHE was disbanded and a new body, the National Mental Health Development Unit was launched in 2009. The director of NIMHE, Ian MacPherson, became the director of NMHDU. The NMHDU was also disbanded in March 2011.
One of NIMHE’s first publications, titled Cases for Change, was funded by the Department of Health to review documents published since 1997 about adult mental health, and was undertaken in conjunction with the Department of General Practice.
A mental health consumer (or mental health patient) is a person who is obtaining treatment or support for a mental disorder, also known as psychiatric or mental illness.
The term was coined by people who use mental health services in an attempt to empower those with mental health issues, historically considered a marginalised segment of society. The term suggests that there is a reciprocal contract between those who provide a service and those who use a service and that individuals have a choice in their treatment and that without them there could not exist mental health providers.
Brief History
In the 1970s the term “patient” was most commonly used. Mental Health activists of the civil rights times recognised, as did many other groups seeking self-definition, that such labels are metaphors that reflect how identities are perceived and constructed. In particular, in the mental health field they shape the nature of the relationship between the giver and receiver of psychiatric services, be it one with an emphasis on reciprocity or hierarchy. Users of psychiatric services repulsed the efforts of experts to define them and sought to develop ways to define themselves. In Australia, informal support groups of people who had recovered from episodes of mental ill health were formed during the first wave of moving patients out of psychiatric hospitals into the community in the 1960s. In the USA and other countries, radical movements to change service delivery and legislation began to be driven by consumers during the 1980s. Activists, such as Judi Chamberlain, pressed for alternatives to psychiatrist dominated and controlled systems of mental health provision. Chamberlain’s On Our Own: Patient Controlled Alternatives to the Mental Health System helped guide others intent on a more collaborative form of mental health healing.
In the 1980s with some funding from NIMH, small experimental groups flourished. In 1985 at the First Alternatives Conference attendees agreed upon the term “consumer” reflecting the patients’ choice of services. The term also implied assumptions of rationality and ability to make choices in one’s own best interests rather than be a passive incapacitated recipient of “expert” attention. In the 1990s many consumer groups were formed, such as Self Help Clearing House and the National Empowerment Centre. They continued to press for more peer involvement in alternatives treatments, pointing out that peers support and comfort, which may be in contrast to some therapists who just attempt to change the behaviour and thinking patterns.
Contemporary Usage
Today, the word mental health consumer has expanded in the popular usage of consumers themselves to include anyone who has received mental health services in the past, anyone who has a behavioural health diagnosis, or simply anyone who has experienced a mental or behavioural disorder. Other terms sometimes used by members of this community for empowerment through positive self-identification include “peers,” “people with mental health disabilities,” “psychiatric survivors,” “users,” individuals with “lived experience” and “ex-patients.” The term “service users,” is commonly used in the UK. In the US “consumer” is most frequently used by ex-patients and users of psychiatric and alternative services.
One can view this term, “consumer,” neutrally as a person who receives psychological services, perhaps from a psychologist, a psychiatrist or a social worker. It can be impersonal term relating to the use in the health sector of a large economy. It suggests that the consumer expects to have some influence on service delivery and provides feedback to the provider. Used in its more activist sense, consumer groups aim to correct perceived problems in mental health services and to promote consultation with consumers. Consumer theory was devised to interpret the special relationship between a service provider and service user in the context of mental health. Consumer theory examines the consequences and sociological meaning of the relationship.
Masking is a process by which an individual changes or “masks” their natural personality to conform to social pressures, abuse or harassment.
Masking can be strongly influenced by environmental factors such as authoritarian parents, rejection, and emotional, physical, or sexual abuse. An individual may not even know they are masking because it is a behaviour that can take many forms.
Masking should not be confused with masking behaviour, which is to mentally block feelings of suffering as a survival mechanism (refer to Defence Mechanism).
Brief History
The term masking was first used to describe the act of concealing disgust by Ekman (1972) and Friesen (1969). It was also thought of as a learned behaviour. Developmental studies have shown that this ability begins as early as preschool and improves with age. In recent developmental studies, masking has evolved and is now defined as concealing one’s emotion by portraying another emotion. It is mostly used to conceal a negative emotion (usually sadness, frustration, and anger) with a positive emotion.
Causes
Contextual factors including relationships with one’s conversation partner, status differences, location, and social setting are all reasons as to why an individual would express, suppress, or mask an emotion. Masking is a façade to behave in certain ways that would help one hide their emotions and represses emotions that are not approved by those around them. Because a person wants to receive acceptance from the public, masking helps disguise characteristics like anger, jealousy or rage – emotions that would not be considered socially acceptable.
Situations
Personal space: Varies with individuals could be masking emotions to those close to them or strangers.
Setting.
Gender Differences
Masking negative emotions differ for each gender. Females tend to have an advanced ability when hiding their negative emotions towards something they dislike as compared to males. One of the possible reasons as to why females are able to mask their negative emotions better is society’s pressure that a girl must act nice.
Ethnicity
Masking also differs between cultures. Some studies state that certain cultures tend to moderate their expressions of emotion while others show a greater amount of positive emotions and expressions.
Autistic Masking
Some autistic people have been described as being able to “mask” or “camouflage” their signs of autism in order to meet social expectations. This may involve behaviour such as suppressing self-calming repetitive movements, faking a smile in an environment that they find uncomfortable or distressing, consciously evaluating their own behaviour and mirroring others, or choosing not to talk about their interests. As masking is often a conscious effort, it can be exhausting for autistic people to do this for an extended period of time (socially, but also in work contexts). In addition to making the person appear non-autistic or neurotypical, masking may conceal the person’s need for support. Such autistic people have cited social acceptance, the need to get a job, avoiding ostracism, or avoiding verbal or physical abuse as reasons for masking.
Research has found that autistic masking is correlated with depression and suicide. Many autistic adults in one survey described profound exhaustion from trying to pretend to be non-autistic. Therapies that teach autistic people to mask, such as some forms of applied behaviour analysis, are controversial.
Signs and Symptoms
Each person masks their emotions differently. During one’s childhood, an individual learns to behave a certain way when they receive approval from those around them and thus develops a mask. The individual is “not conscious of the role they’ve adopted and is projecting outwards to people they meet”. In some cases where the individual is highly conscious, they may not know that they are wearing a mask. Wearing a mask takes away energy from a person’s consciousness and, in the long run, wears out their energy.
Masking tendencies can be more obvious when a person is sick or weak, since they may no longer have the energy to maintain the mask.
Consequences
Little is known about the effects of masking one’s negative emotions. In the workplace, masking leads to feelings of dissonance, insincerity, job dissatisfaction, emotional and physical exhaustion, and self-reported health problems. Some have also reported experiencing somatic symptoms and harmful physiological and cognitive effects as a consequence
Masked Emotions
Emotions that are usually concealed:
Anger.
Anxiety.
Disgust.
Disinterest.
Embarrassment.
Fear.
Frustration.
Sadness.
Emotions that are expressed in place of the concealed emotions:
The Maudsley is the largest mental health training institution in the UK. It is part of South London and Maudsley NHS Foundation Trust, and works in partnership with the Institute of Psychiatry, King’s College London. The hospital was one of the originating institutions in producing the Maudsley Prescribing Guidelines. It is part of the King’s Health Partners academic health science centre and the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health.
Brief History
Early History
The Maudsley story dates from 1907, when once leading Victorian psychiatrist Henry Maudsley offered London County Council £30,000 (apparently earned from lucrative private practice in the West End) to help found a new mental hospital that would be exclusively for early and acute cases rather than chronic cases, have an out-patients’ clinic and provide for teaching and research. Maudsley’s associate Frederick Walker Mott had proposed the original idea and he conducted the negotiations, with Maudsley remaining anonymous until the offer was accepted. Mott, a neuropathologist, had been influenced by a visit to Emil Kraepelin‘s psychiatric clinic with attached postgraduate teaching facilities in Munich, Germany. The Council agreed to contribute half the building costs – eventually rising to £70,000 – and then covered the running costs which were almost twice as high per bed as the large asylums. The hospital also incorporated the Central Pathological Laboratory, transferred from Claybury Hospital, run by Mott. Construction of the hospital was completed in 1915. An Act of Parliament had to be obtained, that year, to allow the institution to accept voluntary patients without needing to certify them as insane.
However, before it could open, the building was requisitioned to treat war veterans. After the war it was returned to the control of London County Council and it finally opened as the Maudsley Hospital in February 1923. The first superintendent was psychiatrist Edward Mapother, while Frederick Golla took over the running of the pathology lab from Mott. Both were more sceptical of the Kraepelinian categories of diagnosis, and took a more pragmatic and eclectic view on causation and treatment. Psychiatrist Mary Barkas worked here between 1923 and 1927 in the children’s department established by William Dawson.
In the interwar period the Maudsley Hospital engaged in widespread experimentation with animal hormones, both in small doses to rectify supposed deficits and in overdoses as a shock therapy. Numerous psychoactive drugs and procedures were tried out, in what has been described as ‘unconstrained experimentation’. One of those involved, as a trainee and then junior doctor, was the controversial William Sargant. The hospital’s nursing staff comprised a matron, assistant matron, six sisters and 19 staff nurses with at least three years general hospital training, supported by 23 probationers and 12 male nurses. It had a good reputation for training nurses and some applicants even travelled overseas to train there. A report (held at Bethlem’s Archives & Museum) from a nurse who trained at the Maudsley shows some of the work of a new trainee: “Apart from observation and simple treatment, nurses are trained in special investigations and therapy. They carry out many of the routine psychometric tests, help as technicians in the ward laboratories, and are instructors in occupational therapy”.
The Maudsley Hospital Medical School was established in 1924 and eventually became a well-respected teaching centre. In 1932, Mapother described it as “the main postgraduate school of mental medicine in England.” The Maudsley Hospital had initially struggled to secure funding from the Medical Research Council, and, to undertake further research and develop the Medical School, but a substantial grant was obtained in 1938 from American charity the Rockefeller Foundation. Originally, there was no provision for the treatment of children and the rapid growth in this patient population was unforeseen. A child guidance clinic was set up under the directorship of Dr William Moodie, the deputy medical superintendent, in 1928. The late 1920s and 1930s saw a rapid growth in the number of patients treated: this growth led to an ongoing building programme including a secure unit, completed in 1931, and an out-patients department, completed in 1933.
Links with Eugenic Research
Both Mapother and then deputy Aubrey Lewis supported involuntary eugenic sterilisation, unequivocally recommending it to the Brock Committee in 1932. Lewis was a member of the Eugenics Society and a 1934 chapter he authored is “remarkable for its total admiration for the German work and workers”. With the spread of National Socialist (Nazi) laws in Germany from 1933, however, they decried the Nazi conflation of therapy and punishment, a move partly attributed to political and funding expediency. The Maudsley maintained its links with Germany, taking on both pro-Nazis and Jewish emigres through fellowships provided by the Commonwealth Fund and, after 1935, large scale funds from the American Rockefeller Foundation. Eliot Slater continued to visit Munich through the 1930s and contributed to academic festivities honouring Nazi eugenicist Ernst Rudin. During this time, Maudsley psychiatry developed a distinctive combination of practical experimentation and intellectual scepticism. Influential psychiatrist Aubrey Lewis became clinical director of the Maudsley in 1936.
At the outbreak of the Second World War, and with the threat of air-raids, the Maudsley Hospital closed and staff dispersed to two locations: a temporary hospital at Mill Hill School in north London and Belmont Hospital in Sutton, Surrey. Staff returned to the Maudsley site in 1945 and three years later the Maudsley joined up with the Bethlem Royal Hospital to become partners in the newly established National Health Service (NHS).
Post-War
In the 1960s a group from the Maudsley Hospital attacked the use of lithium for mood disorders. The head, Aubrey Lewis, called it “dangerous nonsense”, and colleagues published that it was therapeutically ineffective. Their objections have recently been described as ‘poorly grounded’ and having steered practitioners away from a beneficial agent. In 1999, the Maudsley Hospital became part of the South London and Maudsley NHS Foundation Trust (“SLaM”), along with the Bethlem Royal Hospital.
Services
The trust manages one of the UK’s few biomedical research centres specialising in mental health. The centre, managed in partnership with the Institute of Psychiatry, King’s College London, is based on the Maudsley Hospital campus and funded by the NIHR.
Media
In 2013 South London and Maudsley NHS Foundation Trust (‘SLaM’) took part in a Channel 4 observational documentary entitled Bedlam. The final programme, “Breakdown”, focused on older adults, including those admitted to the Older Adults Ward at Maudsley Hospital.
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