A psychiatric advance directive (PAD), also known as a mental health advance directive, is a written document that describes what a person wants to happen if at some time in the future they are judged to be suffering from a mental disorder in such a way that they are deemed unable to decide for themselves or to communicate effectively.
It can inform others about what treatment they want or do not want from psychiatrists or other mental health professionals, and it can identify a person to whom they have given the authority to make decisions on their behalf. A mental health advance directive is one kind of advance health care directive.
Psychiatric advance directives are legal documents used by persons currently enjoying legal capacity to declare their preferences and instructions for future mental health treatment, or to appoint a surrogate decision maker through Health Care Power of Attorney (HCPA), in advance of being targeted by coercive mental health laws, during which they may be stripped of legal capacity to make decisions.
In the United States, although 25 states have now passed legislation in the past decade establishing authority for PADs, there is relatively little public information available to address growing interest in these legal documents. In addition in states without explicit PAD statutes, very similar mental health advance care planning can and does take place under generic HCPA statutes – expanding the audience for PADs to all 50 states (refer to National Resource Centre on Psychiatric Advance Directives).
In addition, states are beginning to recognise legal obligations under the federal Patient Self-Determination Act of 1991, which includes informing all hospital patients that they have a right to prepare advance directives and – with certain caveats – that clinicians are obliged to follow these directives.
Finally, the Joint Commission on the Accreditation of Healthcare Organisations (JCAHO) requires behavioural health facilities to ask patients if they have PADs. The Centres for Medicare and Medicaid Services announced that patients have the right to formulate advance directives and to have hospital staff and practitioners who provide coercive interventions in the hospital comply with these directives. Hospitals out of compliance risk loss of Medicare and Medicaid revenue.
Proponents of these directives believe thy of followed by treatment providers, crisis planning using PADs will help involuntary detainees retain control over their decision making – especially during times when they are labelled incompetent. Additionally, advocates argue that health care agents will be instrumental in providing inpatient clinicians with information that can be central to patients’ treatment, including history of side effects and relevant medical conditions.
Clinical Benefits
Recent data from a NIH-funded study conducted by researchers at Duke University has shown that creating a PAD with a trained facilitator increases therapeutic alliance with clinicians, enhances involuntary patients’ treatment satisfaction and perceived autonomy, and improves treatment decision-making capacity among people labelled with severe mental illness.
Moreover, PADs provide a transportable document – increasingly accessible through electronic directories – to convey information about a detainee’s treatment history, including medical disorders, emergency contact information, and medication side effects. Clinicians often have limited information about citizens detained and labelled as psychiatric patients who present or are coercively presented and labelled as in crisis. Nonetheless, these are the typical settings in which clinicians are called upon to make critical patient-management and treatment decisions, using whatever limited data may be available. With PADs, clinicians could gain immediate access to relevant information about individual cases and thus improve the quality of clinical decision-making – appropriately managing risk to patients and others’ safety while also enhancing patients’ long-term autonomy.
For these reasons, PADs are seen as an innovative and effective way of enhancing values of autonomy and social welfare for detainees labelled with mental illness. Since PADs are among the first laws that are specifically intended to promote autonomy among people detained under mental health laws, wider use of PADs would empower a traditionally disenfranchised group when targeted for coercive psychiatry.
Barriers
National surveys in the United States indicate that although approximately 70% of people targeted by coercive psychiatry laws would want a PAD if offered assistance in completing one, less than 10% have actually completed a PAD.
Some people detained and forcibly drugged under coercive psychiatry laws report difficulty in understanding advance directives, scepticism about their benefit, and lack of contact with a trusted individual who could serve as proxy decision maker. The sheer complexity of filling out these legal forms, obtaining witnesses, having the documents notarised, and filing the documents in a medical record or registry may pose a formidable barrier.
Recent studies of practitioners of coercive psychiatry’s attitudes about PADs suggest that they are generally supportive of these legal instruments, but have significant concerns about some features of PADs and the feasibility of implementing them in usual coercive intervention settings. Clinicians are concerned about lack of access to PAD documents in a commitment, lack of staff training on PADs, lack of communication between staff across different components of mental health systems, and lack of time to review the advance directive documents.
In a survey conducted of 600 psychiatrists, psychologists, and social workers showed that the vast majority thought advance care planning for crises would help improve patients’ overall mental health care. Further, the more clinicians knew about PAD laws, the more favourable were their attitudes toward these practices. For instance, while most psychiatrists, social workers, and psychologists surveyed believed PADs would be helpful to people detained and targeted for forced drugging and electroshock when labelled with severe mental illnesses, clinicians with more legal knowledge about PAD laws were more likely to endorse PADs as a beneficial part of patients’ treatment planning.
However, many clinicians reported NOT knowing enough about how PADs work and specifically indicated they lacked resources to readily help patients fill out PADs. Thus, if clinicians knew more about advance directives and had ready assistance for creating PADs, they said they would be much more likely to help their clients develop crisis plans.
Resources
It thus has become clear that the potential significance of PADs is becoming widely recognized among those targeted for coercive psychiatry, survivors of coercive psychiatry, influential policy makers, clinicians, family members, and patient advocacy groups but that significantly more concerted efforts at dissemination were needed. The community of stakeholders interested in PADs and the broader concept of self-directed care are in need of online resource and gathering place for exchange of views and information.
As a result, in the United States, a collaboration between the Bazelon Centre for Mental Health Law and Duke University has led to creation of the MacArthur Foundation-funded National Resource Center on Psychiatric Advance Directives, the only web portal exclusively devoted to developing a learning community to help people targeted for coercive psychiatry, their families, and clinicians prepare for, and ultimately prevent, coercive psychiatry interventions. The NRC-PAD includes basic information, frequently asked questions, educational webcasts, web blog, most recent research, legal analyses, and state-by-state information on PADs and patient-centred crisis planning. The NRC-PAD website thus includes easy step-by-step information to help those targeted for forced drugging, family, and clinicians complete PADs that mirror the provisions in the PAD statutes.
Voluntary commitment is the act or practice of choosing to admit oneself to a psychiatric hospital, or other mental health facility.
Overview
Unlike in involuntary commitment, the person is free to leave the hospital against medical advice, though there may be a requirement of a period of notice or that the leaving take place during daylight hours. In some jurisdictions, a distinction is drawn between formal and informal voluntary commitment, and this may have an effect on how much notice the individual must give before leaving the hospital. This period may be used for the hospital to use involuntary commitment procedures against the patient. People with mental illness can write psychiatric advance directives in which they can, in advance, consent to voluntary admission to a hospital and thus avoid involuntary commitment.
In the UK, people who are admitted to hospital voluntarily are referred to either as voluntary patients or informal patients. These people are free to discharge against medical advice, unless it is felt that they are at immediate risk, then a doctor can use mental health law to hold people in the hospital for up to 72 hours. People who are detained by mental health law are referred to as formal patients.
In Europe, the treatment of mental illness became a health policy priority under the impetus of the World Health Organisation (WHO) Mental Health Plan for Europe elaborated in 2005. This plan promoted a more effective balance between inpatient hospital care and outpatient care through the development of community mental healthcare services. Since the 1970s, the majority of European countries have shifted away from institutionalised care in large mental hospitals to the integration of patients in their living environment through the provision of home and community care services. Germany, England, France and Italy deinstitutionalised psychiatric care in the second half of the 20th century, but the speed and methods by which it was implemented varied, notably due to differences in social and political contexts. In Italy, the reform movement took place a little later. Until the 1968 Mariotti Law introducing voluntary internment, admission into a psychiatric hospital was only by compulsory commitment and was entered in an individual’s criminal records.
Involuntary commitment, civil commitment, or involuntary hospitalisation (also known informally as sectioning or being sectioned in some jurisdictions, such as the UK) is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily. This treatment may involve the administration of psychoactive drugs, including involuntary administration. In many jurisdictions, people diagnosed with mental health disorders can also be forced to undergo treatment while in the community; this is sometimes referred to as outpatient commitment and shares legal processes with commitment.
Criteria for civil commitment are established by laws which vary between nations. Commitment proceedings often follow a period of emergency hospitalisation, during which an individual with acute psychiatric symptoms is confined for a relatively short duration (e.g. 72 hours) in a treatment facility for evaluation and stabilisation by mental health professionals who may then determine whether further civil commitment is appropriate or necessary. Civil commitment procedures may take place in a court or only involve physicians. If commitment does not involve a court there is normally an appeal process that does involve the judiciary in some capacity, though potentially through a specialist court.
Historically, until the mid-1960s in most jurisdictions in the US, all committals to public psychiatric facilities and most committals to private ones were involuntary. Since then, there have been alternating trends towards the abolition or substantial reduction of involuntary commitment, a trend known as “deinstitutionalisation”. In many currents, individuals can voluntarily admit themselves to a mental health hospital and may have more rights than those who are involuntarily committed. This practice is referred to as voluntary commitment.
In the United States, an indefinite form of commitment is applied to people convicted of some sexual offences.
Purpose
For most jurisdictions, involuntary commitment is applied to individuals believed to be experiencing a mental illness that impairs their ability to reason to such an extent that the agents of the law, state, or courts determine that decisions will be made for the individual under a legal framework. In some jurisdictions, this is a proceeding distinct from being found incompetent. Involuntary commitment is used in some degree for each of the following although different jurisdictions have different criteria. Some jurisdictions limit involuntary treatment to individuals who meet statutory criteria for presenting a danger to self or others. Other jurisdictions have broader criteria. The legal process by which commitment takes place varies between jurisdictions. Some jurisdictions have a formal court hearing where testimony and other evidence may also be submitted where subject of the hearing is typically entitled to legal counsel and may challenge a commitment order through habeas corpus. Other jurisdictions have delegated these power to physicians, though may provide an appeal process that involves the judiciary but may also involve physicians. For example in the UK a mental health tribunal consists of a judge, a medical member, and a lay representative.
First Aid
Training is gradually becoming available in mental health first aid to equip community members such as teachers, school administrators, police officers, and medical workers with training in recognising, and authority in managing, situations where involuntary evaluations of behaviour are applicable under law. The extension of first aid training to cover mental health problems and crises is a quite recent development. A mental health first aid training course was developed in Australia in 2001 and has been found to improve assistance provided to persons with an alleged mental illness or mental health crisis. This form of training has now spread to a number of other countries (Canada, Finland, Hong Kong, Ireland, Singapore, Scotland, England, Wales, and the United States). Mental health triage may be used in an emergency room to make a determination about potential risk and apply treatment protocols.
Observation
Observation is sometimes used to determine whether a person warrants involuntary commitment. It is not always clear on a relatively brief examination whether a person should be committed.
Austria, Belgium, Germany, Israel, the Netherlands, Northern Ireland, Russia, Taiwan, Ontario (Canada), and the United States have adopted commitment criteria based on the presumed danger of the defendant to self or to others.
People with suicidal thoughts may act on these impulses and harm or kill themselves.
People with psychosis are occasionally driven by their delusions or hallucinations to harm themselves or others. Research has found that those who suffer from schizophrenia are between 3.4 and 7.4 times more likely to engage in violent behaviour than members of the general public. However, because other confounding factors such as childhood adversity and poverty are correlated with both schizophrenia and violence it can be difficult to determine whether this effect is due to schizophrenia or other factors. In an attempt to avoid these confounding factors, researchers have tried comparing the rates of violence amongst people diagnosed with schizophrenia to their siblings in a similar manner to twin studies. In these studies people with schizophrenia are found to be between 1.3 and 1.8 times more likely to engage in violent behaviour.
People with certain types of personality disorders can occasionally present a danger to themselves or others.
This concern has found expression in the standards for involuntary commitment in every US state and in other countries as the danger to self or others standard, sometimes supplemented by the requirement that the danger be imminent. In some jurisdictions, the danger to self or others standard has been broadened in recent years to include need-for-treatment criteria such as “gravely disabled”.
Starting in the 1960s, there has been a worldwide trend toward moving psychiatric patients from hospital settings to less restricting settings in the community, a shift known as deinstitutionalisation. Because the shift was typically not accompanied by a commensurate development of community-based services, critics say that deinstitutionalisation has led to large numbers of people who would once have been inpatients as instead being incarcerated or becoming homeless. In some jurisdictions, laws authorising court-ordered outpatient treatment have been passed in an effort to compel individuals with chronic, untreated severe mental illness to take psychiatric medication while living outside the hospital (e.g. Laura’s Law and Kendra’s Law).
Before the 1960s deinstitutionalisation there were earlier efforts to free psychiatric patients. Philippe Pinel (1745-1826) ordered the removal of chains from patients.
In a study of 269 patients from Vermont State Hospital done by Courtenay M. Harding and associates, about two-thirds of the ex-patients did well after deinstitutionalisation.
Around the World
France
In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. Édouard Séguin developed a systematic approach for training individuals with mental deficiencies, and, in 1839, he opened the first school for the intellectually disabled. His method of treatment was based on the idea that the intellectually disabled did not suffer from disease.
United Kingdom
In the United Kingdom, provision for the care of the mentally ill began in the early 19th century with a large state-led effort. Public mental asylums were established in Britain after the passing of the 1808 County Asylums Act. This empowered magistrates to build rate-supported asylums in every county to house the many ‘pauper lunatics’. Nine counties first applied, and the first public asylum opened in 1812 in Nottinghamshire. Parliamentary Committees were established to investigate abuses at private madhouses like Bethlem Hospital – its officers were eventually dismissed and national attention was focused on the routine use of bars, chains and handcuffs and the filthy conditions the inmates lived in. However, it was not until 1828 that the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums.
The Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment. The Act created the Lunacy Commission, headed by Lord Shaftesbury, to focus on lunacy legislation reform. The commission was made up of eleven Metropolitan Commissioners who were required to carry out the provisions of the Act; the compulsory construction of asylums in every county, with regular inspections on behalf of the Home Secretary. All asylums were required to have written regulations and to have a resident qualified physician. A national body for asylum superintendents – the Medico-Psychological Association – was established in 1866 under the Presidency of William A. F. Browne, although the body appeared in an earlier form in 1841.
At the turn of the century, England and France combined had only a few hundred individuals in asylums. By the late 1890s and early 1900s, this number had risen to the hundreds of thousands. However, the idea that mental illness could be ameliorated through institutionalisation was soon disappointed. Psychiatrists were pressured by an ever-increasing patient population. The average number of patients in asylums kept on growing. Asylums were quickly becoming almost indistinguishable from custodial institutions, and the reputation of psychiatry in the medical world had hit an extreme low.
United States
In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The Utica State Hospital was opened approximately in 1850. The creation of this hospital, as of many others, was largely the work of Dorothea Lynde Dix, whose philanthropic efforts extended over many states, and in Europe as far as Constantinople. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect.
In the United States and most other developed societies, severe restrictions have been placed on the circumstances under which a person may be committed or treated against their will as such actions have been ruled by the United States Supreme Court and other national legislative bodies as a violation of civil rights and/or human rights (e.g. O’Connor v. Donaldson). Thus a person is rarely committed against their will and it is illegal for a person to be committed for an indefinite period of time.
United Nations
United Nations General Assembly Resolution 46/119, “Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care“, is a non-binding resolution advocating certain broadly drawn procedures for the carrying out of involuntary commitment. These principles have been used in many countries where local laws have been revised or new ones implemented. The UN runs programmes in some countries to assist in this process.
Criticism
The dangers of institutions were chronicled and criticized by reformers almost since their foundation. Charles Dickens was an outspoken and high-profile early critic, and several of his novels, in particular Oliver Twist and Hard Times demonstrate his insight into the damage that institutions can do to human beings.
Enoch Powell, when Minister for Health in the early 1960s, was a later opponent who was appalled by what he witnessed on his visits to the asylums, and his famous “water tower” speech in 1961 called for the closure of all NHS asylums and their replacement by wards in general hospitals:
“There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside – the asylums which our forefathers built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault. Let me describe some of the defenses which we have to storm.”
Scandal after scandal followed, with many high-profile public inquiries. These involved the exposure of abuses such as unscientific surgical techniques such as lobotomy and the widespread neglect and abuse of vulnerable patients in the US and Europe. The growing anti-psychiatry movement in the 1960s and 1970s led in Italy to the first successful legislative challenge to the authority of the mental institutions, culminating in their closure.
During the 1970s and 1990s the hospital population started to fall rapidly, mainly because of the deaths of long-term inmates. Significant efforts were made to re-house large numbers of former residents in a variety of suitable or otherwise alternative accommodation. The first 1,000+ bed hospital to close was Darenth Park Hospital in Kent, swiftly followed by many more across the UK. The haste of these closures, driven by the Conservative governments led by Margaret Thatcher and John Major, led to considerable criticism in the press, as some individuals slipped through the net into homelessness or were discharged to poor quality private sector mini-institutions.
Wrongful Involuntary Commitment
Mental health professionals have, on occasion, wrongfully deemed individuals to have symptoms of a mental disorder, and thereby commit the individual for treatment in a psychiatric hospital. Claims of wrongful commitment are a common theme in the anti-psychiatry movement.
In 1860, the case of Elizabeth Packard, who was wrongfully committed that year and filed a lawsuit and won thereafter, highlighted the issue of wrongful involuntary commitment. In 1887, investigative journalist Nellie Bly went undercover at an asylum in New York City to expose the terrible conditions that mental patients at the time had to deal with. She published her findings and experiences as articles in New York World, and later made the articles into one book called Ten Days in a Mad-House.
In the first half of the twentieth century there were a few high-profile cases of wrongful commitment based on racism or punishment for political dissenters. In the former Soviet Union, psychiatric hospitals were used as prisons to isolate political prisoners from the rest of society. British playwright Tom Stoppard wrote Every Good Boy Deserves Favour about the relationship between a patient and his doctor in one of these hospitals. Stoppard was inspired by a meeting with a Russian exile. In 1927, after the execution of Sacco and Vanzetti in the United States, demonstrator Aurora D’Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a rally in support of the anarchists. Throughout the 1940s and 1950s in Canada, 20,000 Canadian children, called the Duplessis orphans, were wrongfully certified as being mentally ill and as a result were wrongfully committed to psychiatric institutions where they were forced to take psychiatric medication that they did not need, and were abused. They were named after Maurice Duplessis, the premier of Quebec at the time, who deliberately committed these children to in order to misappropriate additional subsidies from the federal government. Decades later in the 1990s, several of the orphans sued Quebec and the Catholic Church for the abuse and wrongdoing. In 1958, black pastor and activist Clennon Washington King Jr. tried enrolling at the University of Mississippi, which at the time was white, for summer classes; the local police secretly arrested and involuntarily committed him to a mental hospital for 12 days.
Patients are able to sue if they believe that they have been wrongfully committed. In one instance, Junius Wilson, an African American man, was committed to Cherry Hospital in Goldsboro, North Carolina in 1925 for an alleged crime without a trial or conviction. He was castrated. He continued to be held at Cherry Hospital for the next 67 years of his life. It turned out he was deaf rather than mentally ill.
In many American states sex offenders who have completed a period of incarceration can be civilly committed to a mental institution based on a finding of dangerousness due to a mental disorder. Although the United States Supreme Court determined that this practice does not constitute double jeopardy, organisations such as the American Psychiatric Association (APA) strongly oppose the practice. The Task Force on Sexually Dangerous Offenders, a component of APA’s Council on Psychiatry and Law, reported that “in the opinion of the task force, sexual predator commitment laws represent a serious assault on the integrity of psychiatry, particularly with regard to defining mental illness and the clinical conditions for compulsory treatment. Moreover, by bending civil commitment to serve essentially non-medical purposes, statutes threaten to undermine the legitimacy of the medical model of commitment.”
O’Connor v. Donaldson, 422 U.S. 563 (1975), was a landmark decision of the US Supreme Court in mental health law ruling that a state cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing and responsible family members or friends.
Since the trial court jury found, upon ample evidence, that petitioner did so confine respondent, the Supreme Court upheld the trial court’s conclusion that petitioner had violated respondent’s right to liberty.
Kenneth Donaldson (confined patient) had been held for 15 years in Florida State Hospital at Chattahoochee, due to needs of “care, maintenance, and treatment.” He filed a lawsuit against the hospital and staff members claiming they had robbed him of his constitutional rights, by confining him against his will. Donaldson won his case (including monetary damages) in United States District Court, which was affirmed by the United States Court of Appeals for the Fifth Circuit. In 1975, the United States Supreme Court agreed that Donaldson had been improperly confined but vacated the award of damages. On remand, the Fifth Circuit ordered that a new trial on damages be held.
A finding of “mental illness” alone cannot justify a State’s locking a person up against his will and keeping him indefinitely in simple custodial confinement. Assuming that that term can be given a reasonably precise content and that the “mentally ill” can be identified with reasonable accuracy, there is still no constitutional basis for confining such persons involuntarily if they are dangerous to no one and can live safely in freedom.
May the State confine the mentally ill merely to ensure them a living standard superior to that they enjoy in the private community? That the State has a proper interest in providing care and assistance to the unfortunate goes without saying. But the mere presence of mental illness does not disqualify a person from preferring his home to the comforts of an institution. Moreover, while the State may arguably confine a person to save him from harm, incarceration is rarely if ever a necessary condition for raising the living standards of those capable of surviving safely in freedom, on their own or with the help of family or friends. May the State fence in the harmless mentally ill solely to save its citizens from exposure to those whose ways are different? One might as well ask if the State, to avoid public unease, could incarcerate all who are physically unattractive or socially eccentric. Mere public intolerance or animosity cannot constitutionally justify the deprivation of a person’s physical liberty. In short, a State cannot constitutionally confine without more a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.
Kenneth Donaldson
The origins of Donaldson’s institutionalisation began in 1943, at age 34, when he suffered a traumatic episode. He was hospitalized and received treatment, before resuming life with his family.
In 1956 Donaldson travelled to Florida to visit his elderly parents. While there, Donaldson reported that he believed one of his neighbours in Philadelphia might be poisoning his food. His father, worried that his son suffered from paranoid delusions, petitioned the court for a sanity hearing. Donaldson was evaluated, diagnosed with “paranoid schizophrenia,” and civilly committed to the Florida State mental health system. At his commitment trial, Donaldson did not have legal counsel present to represent his case. Once he entered the Florida hospital, Donaldson was placed with dangerous criminals, even though he had never been proved to be dangerous to himself or others. His ward was understaffed, with only one doctor (who happened to be an obstetrician) for over 1,000 male patients. There were no psychiatrists or counsellors, and the only nurse on site worked in the infirmary.
He spent 15 years as a patient; he did not receive any treatment, actively refusing it, and attempting to secure his release. Throughout his stay he denied he was ever mentally ill, and refused to be put into a halfway house.
Donaldson later wrote a book about his experience as a mental patient titled Insanity Inside Out.
The obligatory dangerousness criterion is a principle present in the mental health law of many developed countries. It mandates evidence of dangerousness to oneself or to others before involuntary treatment for mental illness. The term “dangerousness” refers to one’s ability to hurt oneself or others physically or mentally within an imminent time frame, and the harm caused must have a long-term effect on the person(s).
Psychiatric hospitals and involuntary commitment have been around for hundreds and even thousands of years around the world, but the obligatory dangerousness criterion was created in the United States in the 1900s. The criterion is a controversial topic, with opponents claiming that it is unethical and potentially harmful. Supporters claim that the criterion is necessary to protect the mentally ill and those impacted by their involuntary treatment.
Background
If a court determines that a person may cause long-term harm to themselves or others, then the person can be hospitalised or be required to outpatient treatment and treated involuntarily. In order to be released, the court must determine whether the person is no longer dangerous. The length of time that a person is involuntarily hospitalised varies and is determined by the state.
An obligatory dangerousness criterion has two main parts:
First is the Latin phrase parens patriae, which translates to “parent of his or her nation,” which “assigns to the government a responsibility to intervene on behalf of citizens who cannot act in their own best interest”.
The second part “requires a state to protect the interests of its citizens,” meaning that the government must do what it can to care for greater society, which may involve limiting one individual’s rights to avoid harming the greater society.
Brief History
Psychiatric asylums and guardianship over the mentally ill have been present for centuries. In Greece, individuals, such as Hippocrates, believed that those with mental illnesses should be separated from others and maintained within a safe, healthy environment. Ancient Rome allowed guardianship over mentally ill individuals. In the US, psychiatric hospitals were not established until the late 18th and early 19th centuries. Before their establishment, individuals suffering with mental illnesses were imprisoned or kept from society. After their establishment, anyone could be admitted to a psychiatric hospital if a family member brought them and a physician agreed to provide a treatment. Individuals could be at the hospital indefinitely until a court ruled they could be released.
An obligatory dangerousness criterion was officially established in the United States in 1964 by the Ervin Act in Washington DC. It provided a more lenient interpretation of “dangerousness” as well as alternatives to involuntary hospitalisation. It is meant to protect individuals with mental health disorders on the basis of parens patria. In order to be involuntary hospitalised under the obligatory dangerousness criterion, one must have a mental illness, and most states also require that the individual is in need of medical treatment for the illness.
In 1964, Washington D.C. established that an individual may only be involuntarily hospitalised if the individual has a mental illness, may be threat to others or their self in the near future, or is unable to survive on their own. States followed suit and began implementing a dangerousness criteria, as well. In the 1975 Supreme Court case, O’Connor v. Donaldson, the Supreme Court ruled that the individual must have a mental illness, pose a known threat to the safety of their self or others, be unable to care for themselves, or need psychiatric care. States adjusted their rules so that a patient’s involuntary hospitalisation would be re-evaluated over the span of a short period of time, ranging from two days to two weeks before a patient could have a court hearing to potentially be released.
Controversy
The obligatory dangerousness criterion is controversial. Supporters claim that the criterion is necessary in order to ensure that those who are in vital need of psychiatric care will receive it, and to prevent the mentally ill individual from potentially harming themselves or others. They also note that mental health disorders can impair one’s judgement, for example, if an individual with depression does not think that they need help. They argue that psychiatric care often involves some form of hospitalisation or treatment, and as a result, “involuntary hospitalization, or civil commitment, has been a mainstay of psychiatric care” since the field first began. Some individuals who have been involuntarily hospitalised perceived their experience to be beneficial and fair. Lastly, they also note how many states require that the least invasive measures be taken before involuntary hospitalisation is considered.
Its opponents claim that an obligatory dangerousness criterion is unethical. Some believe it denies the individual of consent, is discriminatory based on mental health, and may increase the patient’s risk of suicide, psychotic symptoms, or other harmful behaviours. They worry an obligatory dangerousness criterion might lead individuals without a serious mental illness to be involuntarily hospitalised, or that individuals without a serious mental illness will be involuntarily hospitalised as a “preventative” means. Those who oppose an obligatory dangerousness criterion also argue that there are less restrictive alternatives to involuntary hospitalisation that can help those with a mental illness.
Global mental health is the international perspective on different aspects of mental health. It is ‘the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide’. There is a growing body of criticism of the global mental health movement, and has been widely criticised as a neo-colonial or “missionary” project and as primarily a front for pharmaceutical companies seeking new clients for psychiatric drugs.
In theory, taking into account cultural differences and country-specific conditions, it deals with the epidemiology of mental disorders in different countries, their treatment options, mental health education, political and financial aspects, the structure of mental health care systems, human resources in mental health, and human rights issues among others.
The overall aim of the field of global mental health is to strengthen mental health all over the world by providing information about the mental health situation in all countries, and identifying mental health care needs in order to develop cost-effective interventions to meet those specific needs.
The Global Burden of Disease
Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease (GBD). This is a global measure of so-called disability-adjusted life years (DALY’s) assigned to a certain disease/disorder, which is a sum of the years lived with disability and years of life lost due to this disease within the total population. Neuropsychiatric conditions account for 14% of the global burden of disease. Among non-communicable diseases, they account for 28% of the DALY’s – more than cardiovascular disease or cancer. However, it is estimated that the real contribution of mental disorders to the global burden of disease is even higher, due to the complex interactions and co-morbidity of physical and mental illness.
Around the world, almost one million people die due to suicide every year, and it is the third leading cause of death among young people. The most important causes of disability due to health-related conditions worldwide include unipolar depression, alcoholism, schizophrenia, bipolar depression and dementia. In low- and middle-income countries, these conditions represent a total of 19.1% of all disability related to health conditions.
Mental Health by Country
The following is an outline from selected countries.
Africa
Mental illnesses and mental health disorders are widespread concerns among underdeveloped African countries, yet these issues are largely neglected, as mental health care in Africa is given statistically less attention than it is in other, westernised nations. Rising death tolls due to mental illness demonstrate the imperative need for improved mental health care policies and advances in treatment for Africans suffering from psychological disorders.
Underdeveloped African countries are so visibly troubled by physical illnesses, disease, malnutrition, and contamination that the dilemma of lacking mental health care has not been prioritised, makes it challenging to have a recognised impact on the African population. In 1988 and 1990, two original resolutions were implemented by the World Health Organisation’s (WHO) Member States in Africa. AFR/RC39/R1 and AFR/RC40/R9 attempted to improve the status of mental health care in specific African regions to combat its growing effects on the African people. However, it was found that these new policies had little impact on the status of mental health in Africa, ultimately resulting in an incline in psychological disorders instead of the desired decline, and causing this to seem like an impossible problem to manage.
In Africa, many socio-cultural and biological factors have led to heightened psychological struggles, while also masking their immediate level of importance to the African eye. Increasing rates of unemployment, violence, crime, rape, and disease are often linked to substance abuse, which can cause mental illness rates to inflate. Additionally, physical disease like HIV/AIDS, the Ebola epidemic, and malaria often have lasting psychological effects on victims that go unrecognised in African communities because of their inherent cultural beliefs. Traditional African beliefs have led to the perception of mental illness as being caused by supernatural forces, preventing helpful or rational responses to abnormal behaviour. For example, Ebola received loads of media attention when it became rampant in Africa and eventually spread to the US, however, researchers never really paid attention to its psychological effects on the African brain. Extreme anxiety, struggles with grief, feelings of rejection and incompetence, depression leading to suicide, PTSD, and much more are only some of the noted effects of diseases like Ebola. These epidemics come and go, but their lasting effects on mental health are remaining for years to come, and even ending lives because of the lack of action. There has been some effort to financially fund psychiatric support in countries like Liberia, due to its dramatic mental health crisis after warfare, but not much was benefited. Aside from financial reasons, it is so difficult to enforce mental health interventions and manage mental health in general in underdeveloped countries simply because the individuals living there do not necessarily believe in western psychiatry. It is also important to note that the socio-cultural model of psychology and abnormal behaviour is dependent on factors surrounding cultural differences. This causes mental health abnormalities to remain more hidden due to the culture’s natural behaviour, compared to westernised behaviour and cultural norms.
This relationship between mental and physical illness is an ongoing cycle that has yet to be broken. While many organisations are attempting to solve problems about physical health in Africa, as these problems are clearly visible and recognisable, there is little action taken to confront the underlying mental effects that are left on the victims. It is recognised that many of the mentally ill in Africa search for help from spiritual or religious leaders, however this is widely because many African countries are significantly lacking in mental health professionals in comparison to the rest of the world. In Ethiopia alone, there are “only 10 psychiatrists for the population of 61 million people,” studies have shown. While numbers have definitely changed since this research was done, the lack of psychological professionals throughout African continues with a current average of 1.4 mental health workers per 100,000 people compared to the global statistic of 9.0 professionals per 100,00 people. Additionally, statistics show that the “global annual rate of visits to mental health outpatient facilities is 1,051 per 100,000 population,” while “in Africa the rate is 14 per 100,000” visits. About half of Africa’s countries have some sort of mental health policy, however, these policies are highly disregarded, as Africa’s government spends “less than 1% of the total health budget on mental health”. Specifically in Sierra Leone, about 98.8% of people suffering from mental disorders remain untreated, even after the building of a well below average psychiatric hospital, further demonstrating the need for intervention.
Not only has there been little hands-on action taken to combat mental health issues in Africa, but there has also been little research done on the topic to spread its awareness and prevent deaths. The Lancet Global Health acknowledges that there are well over 1,000 published articles covering physical health in Africa, but there are still less than 50 discussing mental health. And this pressing dilemma of prioritising physical health vs. mental health is only worsening as the continent’s population is substantially growing with research showing that “Between 2000 and 2015 the continent’s population grew by 49%, yet the number of years lost to disability as a result of mental and substance use disorders increased by 52%”. The number of deaths caused by mental instability is truly competing with those caused by physical diseases: “In 2015, 17.9 million years were lost to disability as a consequence of mental health problems. Such disorders were almost as important a cause of years lost to disability as were infectious and parasitic diseases, which accounted for 18.5 million years lost to disability,”. Mental health and physical health care, while they may seem separate, are very much connected, as these two factors determine life or death for humans. As new challenges surface and old challenges still haven’t been prioritised, Africa’s mental health care policies need significant improvement in order to provide its people with the appropriate health care they deserve, hopefully preventing this problem from expanding.
Australia
A survey conducted by Australian Bureau of Statistics in 2008 regarding adults with manageable to severe neurosis reveals almost half of the population had a mental disorder at some point of their life and one in five people had a sustained disorder in the preceding 12 months. In neurotic disorders, 14% of the population experienced anxiety and comorbidity disorders were next to common mental disorder with vulnerability to substance abuse and relapses. There were distinct gender differences in disposition to mental health illness. Women were found to have high rate of mental health disorders, and Men had higher propensity of risk for substance abuse. The SMHWB survey showed families that had low socioeconomic status and high dysfunctional patterns had a greater proportional risk for mental health disorders. A 2010 survey regarding adults with psychosis revealed 5 persons per 1,000 in the population seeks professional mental health services for psychotic disorders and the most common psychotic disorder was schizophrenia.
Bangladesh
Mental health disorder is considered a major public health concern and it constitutes about 13% of the Global Burden of disease and severe mental health disease may reduce each individual’s life expectancy by about 20%. Low and middle-income countries have a higher burden of mental health disorder as it is not considered as a health problem as other chronic diseases. Being a low-income country, in Bangladesh, mental health issues are highly stigmatised.
A community-based study in the rural area of Bangladesh in 2000-2001 estimated that the burden of mental morbidity was 16.5% among rural people and most were suffering from mainly depression and anxiety and which was one-half and one-third of total cases respectively. Furthermore, the prevalence of mental disorders was higher in women in large families aged 45 years.
Care for mental health in Bangladesh
A study conducted in 2008 stated that only 16% of patients came directly to the Mental Health Practitioner with a mean delay of 10.5 months of the onset of mental illness, which made them more vulnerable in many ways. 22% of patients went for the religious or traditional healer and 12% consulted a rural medical practitioner with the least delay of 2-2.5 weeks.
Canada
According to statistics released by the Centre of Addiction and Mental Health one in five people in Canada experience a mental health or addiction problem. Young people of ages 15 to 25 are particularly found to be vulnerable. Major depression is found to affect 8% and anxiety disorder 12% of the population. Women are 1.5 times more likely to suffer from mood and anxiety disorders. WHO points out that there are distinct gender differences in patterns of mental health and illness. The lack of power and control over their socioeconomic status, gender based violence; low social position and responsibility for the care of others render women vulnerable to mental health risks. Since more women than men seek help regarding a mental health problem, this has led to not only gender stereotyping but also reinforcing social stigma. WHO has found that this stereotyping has led doctors to diagnose depression more often in women than in men even when they display identical symptoms. Often communication between health care providers and women is authoritarian leading to either the under-treatment or over-treatment of these women.
Women’s College Hospital has a program called the “Women’s Mental Health Program” where doctors and nurses help treat and educate women regarding mental health collaboratively, individually, and online by answering questions from the public.
Another Canadian organisation serving mental health needs is the Centre for Addiction and Mental Health (CAMH). CAMH is one of Canada’s largest and most well-known health and addiction facilities, and it has received international recognitions from the Pan American Health Organisation and WHO Collaborating Centre. They do research in areas of addiction and mental health in both men and women. In order to help both men and women, CAMH provides “clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.” CAMH is different from Women’s College Hospital due to its widely known rehab centre for women who have minor addiction issues, to severe ones. This organization provides care for mental health issues by assessments, interventions, residential programs, treatments, and doctor and family support.
Israel
In Israel, a Mental Health Insurance Reform took effect in July 2015, transferring responsibility for the provision of mental health services from the Ministry of Health to the four national health plans. Physical and mental health care were united under one roof; previously they had functioned separately in terms of finance, location, and provider. Under the reform, the health plans developed new services or expanded existing ones to address mental health problems.
United States
According to the WHO in 2004, depression is the leading cause of disability in the United States for individuals ages 15 to 44. Absence from work in the US due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. Each year, roughly 30,000 Americans take their lives, while hundreds of thousands make suicide attempts. In 2004, suicide was the 11th leading cause of death in the United States, third among individuals ages 15-24. Despite the increasingly availability of effectual depression treatment, the level of unmet need for treatment remains high. By way of comparison, a study conducted in Australia during 2006 to 2007 reported that one-third (34.9%) of patients diagnosed with a mental health disorder had presented to medical health services for treatment. The US has a shortage of mental healthcare workers, contributing to the unmet need for treatment. By 2025, the US will need an additional 15,400 psychiatrists and 57,490 psychologists to meet the demand for treatment.
Treatment Gap
It is estimated that one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Although many effective interventions for the treatment of mental disorders are known, and awareness of the need for treatment of people with mental disorders has risen, the proportion of those who need mental health care but who do not receive it remains very high. This so-called “treatment gap” is estimated to reach between 76-85% for low- and middle-income countries, and 35-50% for high-income countries.
Despite the acknowledged need, for the most part there have not been substantial changes in mental health care delivery during the past years. Main reasons for this problem are public health priorities, lack of a mental health policy and legislation in many countries, a lack of resources – financial and human resources – as well as inefficient resource allocation.
In 2011, the WHO estimated a shortage of 1.18 million mental health professionals, including 55,000 psychiatrists, 628,000 nurses in mental health settings, and 493,000 psychosocial care providers needed to treat mental disorders in 144 low- and middle-income countries. The annual wage bill to remove this health workforce shortage was estimated at about US$4.4 billion.
Interventions
Information and evidence about cost-effective interventions to provide better mental health care are available. Although most of the research (80%) has been carried out in high-income countries, there is also strong evidence from low- and middle-income countries that pharmacological and psychosocial interventions are effective ways to treat mental disorders, with the strongest evidence for depression, schizophrenia, bipolar disorder and hazardous alcohol use.
Recommendations to strengthen mental health systems around the world have been first mentioned in the WHO’s World Health Report 2001, which focused on mental health:
Provide treatment in primary care.
Make psychotropic drugs available.
Give care in the community.
Educate the public.
Involve communities, families and consumers.
Establish national policies, programs and legislation.
Develop human resources.
Link with other sectors.
Monitor community mental health.
Support more research.
Based on the data of 12 countries, assessed by the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), the costs of scaling up mental health services by providing a core treatment package for schizophrenia, bipolar affective disorder, depressive episodes and hazardous alcohol use have been estimated. Structural changes in mental health systems according to the WHO recommendations have been taken into account.
For most countries, this model suggests an initial period of investment of US$0.30 – 0.50 per person per year. The total expenditure on mental health would have to rise at least ten-fold in low-income countries. In those countries, additional financial resources will be needed, while in middle- and high-income countries the main challenge will be the reallocation of resources within the health system to provide better mental health service.
Prevention
Prevention is beginning to appear in mental health strategies, including the 2004 WHO report “Prevention of Mental Disorders”, the 2008 EU “Pact for Mental Health” and the 2011 US National Prevention Strategy. NIMH or the National Institute of Mental Health has over 400 grants.
Stakeholders
World Health Organisation (WHO)
Two of WHO’s core programmes for mental health are WHO MIND (Mental health improvements for Nations Development) and Mental Health Gap Action Programme (mhGAP).
WHO MIND focuses on 5 areas of action to ensure concrete changes in people’s daily lives. These are:
Action in and support to countries to improve mental health, such as the WHO Pacific Island Mental Health network (PIMHnet).
Mental health policy, planning and service development.
Mental health human rights and legislation.
Mental health as a core part of human development.
The QualityRights Project which works to unite and empower people to improve the quality of care and promote human rights in mental health facilities and social care homes.
Mental Health Gap Action Programme (mhGAP) is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The aim of mhGAP is to build partnerships for collective action and to reinforce the commitment of governments, international organisations and other stakeholders.
The mhGAP Intervention Guide (mhGAP-IG) was launched in October 2010. It is a technical tool for the management of mental, neurological and substance use disorders in non-specialist health settings. The priority conditions included are: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioural disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints.
This book charts the creeping of psychology and psychiatry across the borders of everyday experience and across geographical borders, as a form of colonialism that comes from within and from outside, swallowed in the form of a pill. It maps an anxious space where socio-economic crises come to be reconfigured as individual crisis – as ‘mental illness’; and how potentially violent interventions come to be seen as ‘essential’ treatment.
Another prominent critic is Ethan Watters, author of Crazy Like Us: The Globalisation of the American Psyche. A more constructive approach is offered by Vincenzo Di Nicola whose article on the Global South as an emergent epistemology creates a bridge between critiques of globalisation and the initial gaps and limitations of the Global Mental Health movement.
Educational psychology is the branch of psychology concerned with the scientific study of human learning.
The study of learning processes, from both cognitive and behavioural perspectives, allows researchers to understand individual differences in intelligence, cognitive development, affect, motivation, self-regulation, and self-concept, as well as their role in learning. The field of educational psychology relies heavily on quantitative methods, including testing and measurement, to enhance educational activities related to instructional design, classroom management, and assessment, which serve to facilitate learning processes in various educational settings across the lifespan.
Educational psychology can in part be understood through its relationship with other disciplines. It is informed primarily by psychology, bearing a relationship to that discipline analogous to the relationship between medicine and biology. It is also informed by neuroscience. Educational psychology in turn informs a wide range of specialities within educational studies, including instructional design, educational technology, curriculum development, organizational learning, special education, classroom management, and student motivation. Educational psychology both draws from and contributes to cognitive science and the learning sciences. In universities, departments of educational psychology are usually housed within faculties of education, possibly accounting for the lack of representation of educational psychology content in introductory psychology textbooks.
The field of educational psychology involves the study of memory, conceptual processes, and individual differences (via cognitive psychology) in conceptualising new strategies for learning processes in humans. Educational psychology has been built upon theories of operant conditioning, functionalism, structuralism, constructivism, humanistic psychology, Gestalt psychology, and information processing.
Educational psychology has seen rapid growth and development as a profession in the last twenty years. School psychology began with the concept of intelligence testing leading to provisions for special education students, who could not follow the regular classroom curriculum in the early part of the 20th century. However, “school psychology” itself has built a fairly new profession based upon the practices and theories of several psychologists among many different fields. Educational psychologists are working side by side with psychiatrists, social workers, teachers, speech and language therapists, and counsellors in an attempt to understand the questions being raised when combining behavioural, cognitive, and social psychology in the classroom setting.
Brief History
Early Years
Educational psychology is a fairly new and growing field of study. Although it can date back as early as the days of Plato and Aristotle, educational psychology was not considered a specific practice. It was unknown that everyday teaching and learning in which individuals had to think about individual differences, assessment, development, the nature of a subject being taught, problem-solving, and transfer of learning was the beginning to the field of educational psychology. These topics are important to education and, as a result, they are important in understanding human cognition, learning, and social perception.
Plato and Aristotle
Educational psychology dates back to the time of Aristotle and Plato. Plato and Aristotle researched individual differences in the field of education, training of the body and the cultivation of psycho-motor skills, the formation of good character, the possibilities and limits of moral education. Some other educational topics they spoke about were the effects of music, poetry, and the other arts on the development of individual, role of teacher, and the relations between teacher and student. Plato saw knowledge acquisition as an innate ability, which evolves through experience and understanding of the world. This conception of human cognition has evolved into a continuing argument of nature vs. nurture in understanding conditioning and learning today. Aristotle observed the phenomenon of “association.” His four laws of association included succession, contiguity, similarity, and contrast. His studies examined recall and facilitated learning processes.
John Locke
John Locke is considered one of the most influential philosophers in post-renaissance Europe, a time period that began around the mid-1600s. Locke is considered the “Father of English Psychology”. One of Locke’s most important works was written in 1690, named An Essay Concerning Human Understanding. In this essay, he introduced the term “tabula rasa” meaning “blank slate.” Locke explained that learning was attained through experience only and that we are all born without knowledge.
He followed by contrasting Plato’s theory of innate learning processes. Locke believed the mind was formed by experiences, not innate ideas. Locke introduced this idea as “empiricism,” or the understanding that knowledge is only built on knowledge and experience.
In the late 1600s, John Locke advanced the hypothesis that people learn primarily from external forces. He believed that the mind was like a blank tablet (tabula rasa), and that successions of simple impressions give rise to complex ideas through association and reflection. Locke is credited with establishing “empiricism” as a criterion for testing the validity of knowledge, thus providing a conceptual framework for later development of experimental methodology in the natural and social sciences.
Before 1890
Philosophers of education such as Juan Vives, Johann Pestalozzi, Friedrich Fröbel, and Johann Herbart had examined, classified and judged the methods of education centuries before the beginnings of psychology in the late 1800s.
Juan Vives
Juan Vives (1493-1540) proposed induction as the method of study and believed in the direct observation and investigation of the study of nature. His studies focused on humanistic learning, which opposed scholasticism and was influenced by a variety of sources including philosophy, psychology, politics, religion, and history. He was one of the first prominent thinkers to emphasize that the location of a school is important to learning. He suggested that a school should be located away from disturbing noises; the air quality should be good and there should be plenty of food for the students and teachers. Vives emphasized the importance of understanding individual differences of the students and suggested practice as an important tool for learning.
Vives introduced his educational ideas in his writing, “De anima et vita” in 1538. In this publication, Vives explores moral philosophy as a setting for his educational ideals; with this, he explains that the different parts of the soul (similar to that of Aristotle’s ideas) are each responsible for different operations, which function distinctively. The first book covers the different “souls”: “The Vegetative Soul;” this is the soul of nutrition, growth, and reproduction, “The Sensitive Soul,” which involves the five external senses; “The Cogitative soul,” which includes internal senses and cognitive facilities. The second book involves functions of the rational soul: mind, will, and memory. Lastly, the third book explains the analysis of emotions.
Johann Pestalozzi
Johann Pestalozzi (1746-1827), a Swiss educational reformer, emphasized the child rather than the content of the school. Pestalozzi fostered an educational reform backed by the idea that early education was crucial for children, and could be manageable for mothers. Eventually, this experience with early education would lead to a “wholesome person characterised by morality.” Pestalozzi has been acknowledged for opening institutions for education, writing books for mother’s teaching home education, and elementary books for students, mostly focusing on the kindergarten level. In his later years, he published teaching manuals and methods of teaching.
During the time of The Enlightenment, Pestalozzi’s ideals introduced “educationalisation”. This created the bridge between social issues and education by introducing the idea of social issues to be solved through education. Horlacher describes the most prominent example of this during The Enlightenment to be “improving agricultural production methods.”
Johann Herbart
Johann Herbart (1776-1841) is considered the father of educational psychology. He believed that learning was influenced by interest in the subject and the teacher. He thought that teachers should consider the students’ existing mental sets – what they already know – when presenting new information or material. Herbart came up with what are now known as the formal steps. The 5 steps that teachers should use are:
Review material that has already been learned by the student.
Prepare the student for new material by giving them an overview of what they are learning next.
Present the new material.
Relate the new material to the old material that has already been learned.
Show how the student can apply the new material and show the material they will learn next.
1890-1920
There were three major figures in educational psychology in this period: William James, G. Stanley Hall, and John Dewey. These three men distinguished themselves in general psychology and educational psychology, which overlapped significantly at the end of the 19th century.
William James (1842-1910)
The period of 1890-1920 is considered the golden era of educational psychology where aspirations of the new discipline rested on the application of the scientific methods of observation and experimentation to educational problems. From 1840 to 1920 37 million people immigrated to the United States. This created an expansion of elementary schools and secondary schools. The increase in immigration also provided educational psychologists the opportunity to use intelligence testing to screen immigrants at Ellis Island. Darwinism influenced the beliefs of the prominent educational psychologists. Even in the earliest years of the discipline, educational psychologists recognized the limitations of this new approach. The pioneering American psychologist William James commented that:
Psychology is a science, and teaching is an art; and sciences never generate arts directly out of themselves. An intermediate inventive mind must make that application, by using its originality”.
James is the father of psychology in America but he also made contributions to educational psychology. In his famous series of lectures Talks to Teachers on Psychology, published in 1899, James defines education as “the organization of acquired habits of conduct and tendencies to behavior”. He states that teachers should “train the pupil to behavior” so that he fits into the social and physical world. Teachers should also realise the importance of habit and instinct. They should present information that is clear and interesting and relate this new information and material to things the student already knows about. He also addresses important issues such as attention, memory, and association of ideas.
Alfred Binet
Alfred Binet published Mental Fatigue in 1898, in which he attempted to apply the experimental method to educational psychology. In this experimental method he advocated for two types of experiments, experiments done in the lab and experiments done in the classroom. In 1904 he was appointed the Minister of Public Education. This is when he began to look for a way to distinguish children with developmental disabilities. Binet strongly supported special education programs because he believed that “abnormality” could be cured. The Binet-Simon test was the first intelligence test and was the first to distinguish between “normal children” and those with developmental disabilities. Binet believed that it was important to study individual differences between age groups and children of the same age. He also believed that it was important for teachers to take into account individual students’ strengths and also the needs of the classroom as a whole when teaching and creating a good learning environment. He also believed that it was important to train teachers in observation so that they would be able to see individual differences among children and adjust the curriculum to the students. Binet also emphasized that practice of material was important. In 1916 Lewis Terman revised the Binet-Simon so that the average score was always 100. The test became known as the Stanford-Binet and was one of the most widely used tests of intelligence. Terman, unlike Binet, was interested in using intelligence test to identify gifted children who had high intelligence. In his longitudinal study of gifted children, who became known as the Termites, Terman found that gifted children become gifted adults.
Edward Thorndike
Edward Thorndike (1874-1949) supported the scientific movement in education. He based teaching practices on empirical evidence and measurement. Thorndike developed the theory of instrumental conditioning or the law of effect. The law of effect states that associations are strengthened when it is followed by something pleasing and associations are weakened when followed by something not pleasing. He also found that learning is done a little at a time or in increments, learning is an automatic process and its principles apply to all mammals. Thorndike’s research with Robert Woodworth on the theory of transfer found that learning one subject will only influence your ability to learn another subject if the subjects are similar. This discovery led to less emphasis on learning the classics because they found that studying the classics does not contribute to overall general intelligence. Thorndike was one of the first to say that individual differences in cognitive tasks were due to how many stimulus-response patterns a person had rather than general intellectual ability. He contributed word dictionaries that were scientifically based to determine the words and definitions used. The dictionaries were the first to take into consideration the users’ maturity level. He also integrated pictures and easier pronunciation guide into each of the definitions. Thorndike contributed arithmetic books based on learning theory. He made all the problems more realistic and relevant to what was being studied, not just to improve the general intelligence. He developed tests that were standardized to measure performance in school-related subjects. His biggest contribution to testing was the CAVD intelligence test which used a multidimensional approach to intelligence and was the first to use a ratio scale. His later work was on programmed instruction, mastery learning, and computer-based learning:
If, by a miracle of mechanical ingenuity, a book could be so arranged that only to him who had done what was directed on page one would page two become visible, and so on, much that now requires personal instruction could be managed by print.
John Dewey
John Dewey (1859-1952) had a major influence on the development of progressive education in the United States. He believed that the classroom should prepare children to be good citizens and facilitate creative intelligence. He pushed for the creation of practical classes that could be applied outside of a school setting. He also thought that education should be student-oriented, not subject-oriented. For Dewey, education was a social experience that helped bring together generations of people. He stated that students learn by doing. He believed in an active mind that was able to be educated through observation, problem-solving, and enquiry. In his 1910 book How We Think, he emphasizes that material should be provided in a way that is stimulating and interesting to the student since it encourages original thought and problem-solving. He also stated that material should be relative to the student’s own experience.
“The material furnished by way of information should be relevant to a question that is vital in the students own experience”.
Jean Piaget
Jean Piaget (1896-1980) was one of the most powerful researchers in the area of developmental psychology during the 20th century. He developed the theory of cognitive development. The theory stated that intelligence developed in four different stages. The stages are the sensorimotor stage from birth to 2 years old, the preoperational state from 2 to 7 years old, the concrete operational stage from 7 to 10 years old, and the formal operational stage from 12 years old and up. He also believed that learning was constrained to the child’s cognitive development. Piaget influenced educational psychology because he was the first to believe that cognitive development was important and something that should be paid attention to in education. Most of the research on Piagetian theory was carried out by American educational psychologists.
1920-Present
The number of people receiving a high school and college education increased dramatically from 1920 to 1960.[8] Because very few jobs were available to teens coming out of eighth grade, there was an increase in high school attendance in the 1930s. The progressive movement in the United States took off at this time and led to the idea of progressive education. John Flanagan, an educational psychologist, developed tests for combat trainees and instructions in combat training. In 1954 the work of Kenneth Clark and his wife on the effects of segregation on black and white children was influential in the Supreme Court case Brown v. Board of Education. From the 1960s to present day, educational psychology has switched from a behaviourist perspective to a more cognitive-based perspective because of the influence and development of cognitive psychology at this time.
Jerome Bruner
Jerome Bruner is notable for integrating Piaget’s cognitive approaches into educational psychology. He advocated for discovery learning where teachers create a problem solving environment that allows the student to question, explore and experiment. In his book ‘The Process of Education’ Bruner stated that the structure of the material and the cognitive abilities of the person are important in learning. He emphasized the importance of the subject matter. He also believed that how the subject was structured was important for the student’s understanding of the subject and that it was the goal of the teacher to structure the subject in a way that was easy for the student to understand. In the early 1960s, Bruner went to Africa to teach math and science to school children, which influenced his view as schooling as a cultural institution. Bruner was also influential in the development of MACOS, Man: a Course of Study, which was an educational program that combined anthropology and science. The programme explored human evolution and social behaviour. He also helped with the development of the head start programme. He was interested in the influence of culture on education and looked at the impact of poverty on educational development.
Benjamin Bloom
Benjamin Bloom (1903-1999) spent over 50 years at the University of Chicago, where he worked in the department of education. He believed that all students can learn. He developed the taxonomy of educational objectives. The objectives were divided into three domains:
Cognitive
1. The cognitive domain deals with how we think. 2. It is divided into categories that are on a continuum from easiest to more complex. 3. The categories are knowledge or recall, comprehension, application, analysis, synthesis, and evaluation.
Affective
1. The affective domain deals with emotions and has 5 categories. 2. The categories are receiving phenomenon, responding to that phenomenon, valuing, organisation, and internalising values.
Psychomotor
1. The psychomotor domain deals with the development of motor skills, movement, and coordination and has 7 categories that also go from simplest to most complex. 2. The 7 categories of the psychomotor domain are perception, set, guided response, mechanism, complex overt response, adaptation, and origination.
The taxonomy provided broad educational objectives that could be used to help expand the curriculum to match the ideas in the taxonomy. The taxonomy is considered to have a greater influence internationally than in the United States. Internationally, the taxonomy is used in every aspect of education from the training of the teachers to the development of testing material. Bloom believed in communicating clear learning goals and promoting an active student. He thought that teachers should provide feedback to the students on their strengths and weaknesses. Bloom also did research on college students and their problem-solving processes. He found that they differ in understanding the basis of the problem and the ideas in the problem. He also found that students differ in process of problem-solving in their approach and attitude toward the problem.
Nathaniel Gage
Nathaniel Gage (1917-2008) is an important figure in educational psychology as his research focused on improving teaching and understanding the processes involved in teaching. He edited the book Handbook of Research on Teaching (1963), which helped develop early research in teaching and educational psychology. Gage founded the Stanford Centre for Research and Development in Teaching, which contributed research on teaching as well as influencing the education of important educational psychologists.
Perspectives
Behavioural
Applied behaviour analysis, a research-based science utilising behavioural principles of operant conditioning, is effective in a range of educational settings. For example, teachers can alter student behaviour by systematically rewarding students who follow classroom rules with praise, stars, or tokens exchangeable for sundry items. Despite the demonstrated efficacy of awards in changing behaviour, their use in education has been criticised by proponents of self-determination theory, who claim that praise and other rewards undermine intrinsic motivation. There is evidence that tangible rewards decrease intrinsic motivation in specific situations, such as when the student already has a high level of intrinsic motivation to perform the goal behaviour. But the results showing detrimental effects are counterbalanced by evidence that, in other situations, such as when rewards are given for attaining a gradually increasing standard of performance, rewards enhance intrinsic motivation. Many effective therapies have been based on the principles of applied behaviour analysis, including pivotal response therapy which is used to treat autism spectrum disorders.
Cognitive
Among current educational psychologists, the cognitive perspective is more widely held than the behavioural perspective, perhaps because it admits causally related mental constructs such as traits, beliefs, memories, motivations, and emotions. Cognitive theories claim that memory structures determine how information is perceived, processed, stored, retrieved and forgotten. Among the memory structures theorised by cognitive psychologists are separate but linked visual and verbal systems described by Allan Paivio’s dual coding theory. Educational psychologists have used dual coding theory and cognitive load theory to explain how people learn from multimedia presentations.
The spaced learning effect, a cognitive phenomenon strongly supported by psychological research, has broad applicability within education. For example, students have been found to perform better on a test of knowledge about a text passage when a second reading of the passage is delayed rather than immediate. Educational psychology research has confirmed the applicability to the education of other findings from cognitive psychology, such as the benefits of using mnemonics for immediate and delayed retention of information.
Problem solving, according to prominent cognitive psychologists, is fundamental to learning. It resides as an important research topic in educational psychology. A student is thought to interpret a problem by assigning it to a schema retrieved from long-term memory. A problem students run into while reading is called “activation.” This is when the student’s representations of the text are present during working memory. This causes the student to read through the material without absorbing the information and being able to retain it. When working memory is absent from the reader’s representations of the working memory they experience something called “deactivation.” When deactivation occurs, the student has an understanding of the material and is able to retain information. If deactivation occurs during the first reading, the reader does not need to undergo deactivation in the second reading. The reader will only need to reread to get a “gist” of the text to spark their memory. When the problem is assigned to the wrong schema, the student’s attention is subsequently directed away from features of the problem that are inconsistent with the assigned schema. The critical step of finding a mapping between the problem and a pre-existing schema is often cited as supporting the centrality of analogical thinking to problem-solving.
Cognitive View of Intelligence
Each person has an individual profile of characteristics, abilities, and challenges that result from predisposition, learning, and development. These manifest as individual differences in intelligence, creativity, cognitive style, motivation, and the capacity to process information, communicate, and relate to others. The most prevalent disabilities found among school age children are attention deficit hyperactivity disorder (ADHD), learning disability, dyslexia, and speech disorder. Less common disabilities include intellectual disability, hearing impairment, cerebral palsy, epilepsy, and blindness.
Although theories of intelligence have been discussed by philosophers since Plato, intelligence testing is an invention of educational psychology, and is coincident with the development of that discipline. Continuing debates about the nature of intelligence revolve on whether it can be characterized by a single factor known as general intelligence, multiple factors (e.g. Gardner’s theory of multiple intelligences), or whether it can be measured at all. In practice, standardised instruments such as the Stanford-Binet IQ test and the WISC are widely used in economically developed countries to identify children in need of individualised educational treatment. Children classified as gifted are often provided with accelerated or enriched programs. Children with identified deficits may be provided with enhanced education in specific skills such as phonological awareness. In addition to basic abilities, the individual’s personality traits are also important, with people higher in conscientiousness and hope attaining superior academic achievements, even after controlling for intelligence and past performance.
Developmental
Developmental psychology, and especially the psychology of cognitive development, opens a special perspective for educational psychology. This is so because education and the psychology of cognitive development converge on a number of crucial assumptions. First, the psychology of cognitive development defines human cognitive competence at successive phases of development. Education aims to help students acquire knowledge and develop skills that are compatible with their understanding and problem-solving capabilities at different ages. Thus, knowing the students’ level on a developmental sequence provides information on the kind and level of knowledge they can assimilate, which, in turn, can be used as a frame for organising the subject matter to be taught at different school grades. This is the reason why Piaget’s theory of cognitive development was so influential for education, especially mathematics and science education. In the same direction, the neo-Piagetian theories of cognitive development suggest that in addition to the concerns above, sequencing of concepts and skills in teaching must take account of the processing and working memory capacities that characterise successive age levels.
Second, the psychology of cognitive development involves understanding how cognitive change takes place and recognising the factors and processes which enable cognitive competence to develop. Education also capitalises on cognitive change, because the construction of knowledge presupposes effective teaching methods that would move the student from a lower to a higher level of understanding. Mechanisms such as reflection on actual or mental actions vis-à-vis alternative solutions to problems, tagging new concepts or solutions to symbols that help one recall and mentally manipulate them are just a few examples of how mechanisms of cognitive development may be used to facilitate learning.
Finally, the psychology of cognitive development is concerned with individual differences in the organization of cognitive processes and abilities, in their rate of change, and in their mechanisms of change. The principles underlying intra- and inter-individual differences could be educationally useful, because knowing how students differ in regard to the various dimensions of cognitive development, such as processing and representational capacity, self-understanding and self-regulation, and the various domains of understanding, such as mathematical, scientific, or verbal abilities, would enable the teacher to cater for the needs of the different students so that no one is left behind.
Constructivist
Constructivism is a category of learning theory in which emphasis is placed on the agency and prior “knowing” and experience of the learner, and often on the social and cultural determinants of the learning process. Educational psychologists distinguish individual (or psychological) constructivism, identified with Piaget’s theory of cognitive development, from social constructivism. The social constructivist paradigm views the context in which the learning occurs as central to the learning itself. It regards learning as a process of enculturation. People learn by exposure to the culture of practitioners. They observe and practice the behaviour of practitioners and ‘pick up relevant jargon, imitate behaviour, and gradually start to act in accordance with the norms of the practice’. So, a student learns to become a mathematician through exposure to mathematician using tools to solve mathematical problems. So in order to master a particular domain of knowledge it is not enough for students to learn the concepts of the domain. They should be exposed to the use of the concepts in authentic activities by the practitioners of the domain.
A dominant influence on the social constructivist paradigm is Lev Vygotsky’s work on sociocultural learning, describing how interactions with adults, more capable peers, and cognitive tools are internalized to form mental constructs. “Zone of Proximal Development” (ZPD) is a term Vygotsky used to characterize an individual’s mental development. He believed the task individuals can do on their own do not give a complete understanding of their mental development. He originally defined the ZPD as “the distance between the actual developmental level as determined by independent problem solving and the level of potential development as determined through problem solving under adult guidance or in collaboration with more capable peers.” He cited a famous example to make his case. Two children in school who originally can solve problems at an eight-year-old developmental level (that is, typical for children who were age 8), might be at different developmental levels. If each child received assistance from an adult, one was able to perform at a nine-year-old level and one was able to perform at a twelve-year-old level. He said “This difference between twelve and eight, or between nine and eight, is what we call the zone of proximal development.” He further said that the ZPD “defines those functions that have not yet matured but are in the process of maturation, functions that will mature tomorrow but are currently in an embryonic state.” The zone is bracketed by the learner’s current ability and the ability they can achieve with the aid of an instructor of some capacity.
Vygotsky viewed the ZPD as a better way to explain the relation between children’s learning and cognitive development. Prior to the ZPD, the relation between learning and development could be boiled down to the following three major positions:
Development always precedes learning (e.g. constructivism): children first need to meet a particular maturation level before learning can occur;
Learning and development cannot be separated, but instead occur simultaneously (e.g. behaviourism): essentially, learning is development; and
Learning and development are separate, but interactive processes (e.g. gestaltism): one process always prepares the other process, and vice versa.
Vygotsky rejected these three major theories because he believed that learning should always precede development in the ZPD. According to Vygotsky, through the assistance of a more knowledgeable other, a child is able to learn skills or aspects of a skill that go beyond the child’s actual developmental or maturational level. The lower limit of ZPD is the level of skill reached by the child working independently (also referred to as the child’s developmental level). The upper limit is the level of potential skill that the child is able to reach with the assistance of a more capable instructor. In this sense, the ZPD provides a prospective view of cognitive development, as opposed to a retrospective view that characterises development in terms of a child’s independent capabilities. The advancement through and attainment of the upper limit of the ZPD is limited by the instructional and scaffolding-related capabilities of the more knowledgeable other (MKO). The MKO is typically assumed to be an older, more experienced teacher or parent, but often can be a learner’s peer or someone their junior. The MKO need not even be a person, it can be a machine or book, or other source of visual and/or audio input.
Elaborating on Vygotsky’s theory, Jerome Bruner and other educational psychologists developed the important concept of instructional scaffolding, in which the social or information environment offers supports for learning that are gradually withdrawn as they become internalised.
Jean Piaget’s Cognitive Development
Jean Piaget was interested in how an organism adapts to its environment. Piaget hypothesized that infants are born with a schema operating at birth that he called “reflexes”. Piaget identified four stages in cognitive development. The four stages are:
Sensorimotor stage;
Pre-operational stage;
Concrete operational stage; and
Formal operational stage.
Conditioning and learning
To understand the characteristics of learners in childhood, adolescence, adulthood, and old age, educational psychology develops and applies theories of human development. Often represented as stages through which people pass as they mature, developmental theories describe changes in mental abilities (cognition), social roles, moral reasoning, and beliefs about the nature of knowledge.
For example, educational psychologists have conducted research on the instructional applicability of Jean Piaget’s theory of development, according to which children mature through four stages of cognitive capability. Piaget hypothesized that children are not capable of abstract logical thought until they are older than about 11 years, and therefore younger children need to be taught using concrete objects and examples. Researchers have found that transitions, such as from concrete to abstract logical thought, do not occur at the same time in all domains. A child may be able to think abstractly about mathematics, but remain limited to concrete thought when reasoning about human relationships. Perhaps Piaget’s most enduring contribution is his insight that people actively construct their understanding through a self-regulatory process.
Piaget proposed a developmental theory of moral reasoning in which children progress from a naïve understanding of morality based on behaviour and outcomes to a more advanced understanding based on intentions. Piaget’s views of moral development were elaborated by Lawrence Kohlberg into a stage theory of moral development. There is evidence that the moral reasoning described in stage theories is not sufficient to account for moral behaviour. For example, other factors such as modelling (as described by the social cognitive theory of morality) are required to explain bullying.
Rudolf Steiner’s model of child development interrelates physical, emotional, cognitive, and moral development in developmental stages similar to those later described by Piaget.
Developmental theories are sometimes presented not as shifts between qualitatively different stages, but as gradual increments on separate dimensions. Development of epistemological beliefs (beliefs about knowledge) have been described in terms of gradual changes in people’s belief in: certainty and permanence of knowledge, fixedness of ability, and credibility of authorities such as teachers and experts. People develop more sophisticated beliefs about knowledge as they gain in education and maturity.
Motivation
Motivation is an internal state that activates, guides and sustains behaviour. Motivation can have several impacting effects on how students learn and how they behave towards subject matter:
Provide direction towards goals.
Enhance cognitive processing abilities and performance.
Direct behaviour toward particular goals.
Lead to increased effort and energy.
Increase initiation of and persistence in activities.
Educational psychology research on motivation is concerned with the volition or will that students bring to a task, their level of interest and intrinsic motivation, the personally held goals that guide their behaviour, and their belief about the causes of their success or failure. As intrinsic motivation deals with activities that act as their own rewards, extrinsic motivation deals with motivations that are brought on by consequences or punishments. A form of attribution theory developed by Bernard Weiner describes how students’ beliefs about the causes of academic success or failure affect their emotions and motivations. For example, when students attribute failure to lack of ability, and ability is perceived as uncontrollable, they experience the emotions of shame and embarrassment and consequently decrease effort and show poorer performance. In contrast, when students attribute failure to lack of effort, and effort is perceived as controllable, they experience the emotion of guilt and consequently increase effort and show improved performance.
The self-determination theory (SDT) was developed by psychologists Edward Deci and Richard Ryan. SDT focuses on the importance of intrinsic and extrinsic motivation in driving human behaviour and posits inherent growth and development tendencies. It emphasizes the degree to which an individual’s behaviour is self-motivated and self-determined. When applied to the realm of education, the self-determination theory is concerned primarily with promoting in students an interest in learning, a value of education, and a confidence in their own capacities and attributes.
Motivational theories also explain how learners’ goals affect the way they engage with academic tasks. Those who have mastery goals strive to increase their ability and knowledge. Those who have performance approach goals strive for high grades and seek opportunities to demonstrate their abilities. Those who have performance avoidance goals are driven by fear of failure and avoid situations where their abilities are exposed. Research has found that mastery goals are associated with many positive outcomes such as persistence in the face of failure, preference for challenging tasks, creativity, and intrinsic motivation. Performance avoidance goals are associated with negative outcomes such as poor concentration while studying, disorganised studying, less self-regulation, shallow information processing, and test anxiety. Performance approach goals are associated with positive outcomes, and some negative outcomes such as an unwillingness to seek help and shallow information processing.
Locus of control is a salient factor in the successful academic performance of students. During the 1970s and ’80s, Cassandra B. Whyte did significant educational research studying locus of control as related to the academic achievement of students pursuing higher education coursework. Much of her educational research and publications focused upon the theories of Julian B. Rotter in regard to the importance of internal control and successful academic performance. Whyte reported that individuals who perceive and believe that their hard work may lead to more successful academic outcomes, instead of depending on luck or fate, persist and achieve academically at a higher level. Therefore, it is important to provide education and counselling in this regard.
Technology
Instructional design, the systematic design of materials, activities, and interactive environments for learning, is broadly informed by educational psychology theories and research. For example, in defining learning goals or objectives, instructional designers often use a taxonomy of educational objectives created by Benjamin Bloom and colleagues. Bloom also researched mastery learning, an instructional strategy in which learners only advance to a new learning objective after they have mastered its prerequisite objectives. Bloom discovered that a combination of mastery learning with one-to-one tutoring is highly effective, producing learning outcomes far exceeding those normally achieved in classroom instruction. Gagné, another psychologist, had earlier developed an influential method of task analysis in which a terminal learning goal is expanded into a hierarchy of learning objectives connected by prerequisite relationships. The following list of technological resources incorporate computer-aided instruction and intelligence for educational psychologists and their students:
Intelligent tutoring system.
Cognitive tutor.
Cooperative learning.
Collaborative learning.
Problem-based learning.
Computer-supported collaborative learning.
Constructive alignment.
Technology is essential to the field of educational psychology, not only for the psychologist themselves as far as testing, organisation, and resources, but also for students. Educational Psychologists who reside in the K-12 setting focus the majority of their time on Special Education students. It has been found that students with disabilities learning through technology such as iPad applications and videos are more engaged and motivated to learn in the classroom setting. Liu et al. explain that learning-based technology allows for students to be more focused, and learning is more efficient with learning technologies. The authors explain that learning technology also allows for students with social-emotional disabilities to participate in distance learning.
Applications
Teaching
Research on classroom management and pedagogy is conducted to guide teaching practice and form a foundation for teacher education programmes. The goals of classroom management are to create an environment conducive to learning and to develop students’ self-management skills. More specifically, classroom management strives to create positive teacher-student and peer relationships, manage student groups to sustain on-task behaviour, and use counselling and other psychological methods to aid students who present persistent psycho-social problems.
Introductory educational psychology is a commonly required area of study in most North American teacher education programmes. When taught in that context, its content varies, but it typically emphasizes learning theories (especially cognitively oriented ones), issues about motivation, assessment of students’ learning, and classroom management. A developing Wikibook about educational psychology gives more detail about the educational psychology topics that are typically presented in preservice teacher education.
Special education.
Secondary Education.
Lesson plan.
Counselling
Training
In order to become an educational psychologist, students can complete an undergraduate degree in their choice. They then must go to graduate school to study education psychology, counselling psychology, and/ or school counselling. Most students today are also receiving their doctorate degrees in order to hold the “psychologist” title. Educational psychologists work in a variety of settings. Some work in university settings where they carry out research on the cognitive and social processes of human development, learning and education. Educational psychologists may also work as consultants in designing and creating educational materials, classroom programmes and online courses. Educational psychologists who work in k–12 school settings (closely related are school psychologists in the US and Canada) are trained at the master’s and doctoral levels. In addition to conducting assessments, school psychologists provide services such as academic and behavioural intervention, counselling, teacher consultation, and crisis intervention. However, school psychologists are generally more individual-oriented towards students.
Many high schools and colleges are increasingly offering educational psychology courses, with some colleges offering it as a general education requirement. Similarly, colleges offer students opportunities to obtain a PhD. in Educational Psychology.
Within the UK, students must hold a degree that is accredited by the British Psychological Society (either undergraduate or at Masters level) before applying for a three-year doctoral course that involves further education, placement, and a research thesis.
Employment Outlook
Anticipated to grow by 18-26%, employment for psychologists in the United States is expected to grow faster than most occupations in 2014. One in four psychologists is employed in educational settings. In the United States, the median salary for psychologists in primary and secondary schools is US$58,360 as of May 2004.
In recent decades, the participation of women as professional researchers in North American educational psychology has risen dramatically.
Methods of Research
Educational psychology, as much as any other field of psychology heavily relies on a balance of pure observation and quantitative methods in psychology. The study of education generally combines the studies of history, sociology, and ethics with theoretical approaches. Smeyers and Depaepe explain that historically, the study of education and child-rearing have been associated with the interests of policymakers and practitioners within the educational field, however, the recent shift to sociology and psychology has opened the door for new findings in education as a social science. Now being its own academic discipline, educational psychology has proven to be helpful for social science researchers.
Quantitative research is the backing to most observable phenomena in psychology. This involves observing, creating, and understanding distribution of data based upon the study’s subject matter. Researchers use particular variables to interpret their data distributions from their research and employ statistics as a way of creating data tables and analysing their data. Psychology has moved from the “common sense” reputations initially posed by Thomas Reid to the methodology approach comparing independent and dependent variables through natural observation, experiments, or combinations of the two. Though results are still, with statistical methods, objectively true based upon significance variables or p- values.
Reduced affect display, sometimes referred to as emotional blunting, is a condition of reduced emotional reactivity in an individual.
It manifests as a failure to express feelings (affect display) either verbally or nonverbally, especially when talking about issues that would normally be expected to engage the emotions. Expressive gestures are rare and there is little animation in facial expression or vocal inflection. Reduced affect can be symptomatic of autism, schizophrenia, depression, posttraumatic stress disorder, depersonalisation disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications (e.g. antipsychotics and antidepressants).
Reduced affect should be distinguished from apathy and anhedonia, which explicitly refer to a lack of emotion, whereas reduced affect is a lack of emotional expression (affect display) regardless of whether emotion (underlying affect) is actually reduced or not.
A restricted or constricted affect is a reduction in an individual’s expressive range and the intensity of emotional responses.
Blunted and Flat Affect
Blunted affect is a lack of affect more severe than restricted or constricted affect, but less severe than flat or flattened affect. “The difference between flat and blunted affect is in degree. A person with flat affect has no or nearly no emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others. A person with blunted affect, on the other hand, has a significantly reduced intensity in emotional expression”.
Shallow Affect
Shallow affect has equivalent meaning to blunted affect. Factor 1 of the Psychopathy Checklist identifies shallow affect as a common attribute of psychopathy.
Brain Structures
Individuals with schizophrenia with blunted affect show different regional brain activity in fMRI scans when presented with emotional stimuli compared to individuals with schizophrenia without blunted affect. Individuals with schizophrenia without blunted affect show activation in the following brain areas when shown emotionally negative pictures: midbrain, pons, anterior cingulate cortex, insula, ventrolateral orbitofrontal cortex, anterior temporal pole, amygdala, medial prefrontal cortex, and extrastriate visual cortex. Individuals with schizophrenia with blunted affect show activation in the following brain regions when shown emotionally negative pictures: midbrain, pons, anterior temporal pole, and extrastriate visual cortex.
Limbic Structures
Individuals with schizophrenia with flat affect show decreased activation in the limbic system when viewing emotional stimuli. In individuals with schizophrenia with blunted affect neural processes begin in the occipitotemporal region of the brain and go through the ventral visual pathway and the limbic structures until they reach the inferior frontal areas. Damage to the amygdala of adult rhesus macaques early in life can permanently alter affective processing. Lesioning the amygdala causes blunted affect responses to both positive and negative stimuli. This effect is irreversible in the rhesus macaques; neonatal damage produces the same effect as damage that occurs later in life. The macaques’ brain cannot compensate for early amygdala damage even though significant neuronal growth may occur. There is some evidence that blunted affect symptoms in schizophrenia patients are not a result of just amygdala responsiveness, but a result of the amygdala not being integrated with other areas of the brain associated with emotional processing, particularly in amygdala-prefrontal cortex coupling. Damage in the limbic region prevents the amygdala from correctly interpreting emotional stimuli in individuals with schizophrenia by compromising the link between the amygdala and other brain regions associated with emotion.
Brainstem
Parts of the brainstem are responsible for passive emotional coping strategies that are characterized by disengagement or withdrawal from the external environment (quiescence, immobility, hyporeactivity), similar to what is seen in blunted affect. Individuals with schizophrenia with blunted affect show activation of the brainstem during fMRI scans, particularly the right medulla and the left pons, when shown “sad” film excerpts. The bilateral midbrain is also activated in individuals with schizophrenia diagnosed with blunted affect. Activation of the midbrain is thought to be related to autonomic responses associated with perceptual processing of emotional stimuli. This region usually becomes activated in diverse emotional states. When the connectivity between the midbrain and the medial prefrontal cortex is compromised in individuals with schizophrenia with blunted affect an absence of emotional reaction to external stimuli results.
Prefrontal Cortex
Individuals with schizophrenia, as well as patients being successfully reconditioned with quetiapine for blunted affect, show activation of the prefrontal cortex (PFC). Failure to activate the PFC is possibly involved in impaired emotional processing in individuals with schizophrenia with blunted affect. The mesial PFC is activated in aver individuals in response to external emotional stimuli. This structure possibly receives information from the limbic structures to regulate emotional experiences and behaviour. Individuals being reconditioned with quetiapine, who show reduced symptoms, show activation in other areas of the PFC as well, including the right medial prefrontal gyrus and the left orbitofrontal gyrus.
Anterior Cingulate Cortex
A positive correlation has been found between activation of the anterior cingulate cortex and the reported magnitude of sad feelings evoked by viewing sad film excerpts. The rostral subdivision of this region is possibly involved in detecting emotional signals. This region is different in individuals with schizophrenia with blunted affect.
Diagnoses
Schizophrenia
Patients with schizophrenia have long been recognized as showing “flat or inappropriate affect, with splitting of feelings from events … feelings seem flat instead of being in contact with what is going on”. One study of flat affect in schizophrenia found that “flat affect was more common in men, and was associated with worse current quality of life” as well as having “an adverse effect on course of illness”.
The study also reported a “dissociation between reported experience of emotion and its display” – supporting the suggestion made elsewhere that “blunted affect, including flattened facial expressiveness and lack of vocal inflection … often disguises an individual’s true feelings.” Thus, feelings may merely be unexpressed, rather than totally lacking. On the other hand, “a lack of emotions which is due not to mere repression but to a real loss of contact with the objective world gives the observer a specific impression of ‘queerness’ … the remainders of emotions or the substitutes for emotions usually refer to rage and aggressiveness”. In the most extreme cases, there is a complete “dissociation from affective states”.
Another study found that when speaking, individuals with schizophrenia with flat affect demonstrate less inflection than normal controls and appear to be less fluent. Normal subjects appear to express themselves using more complex syntax, whereas flat affect subjects speak with fewer words, and fewer words per sentence. Flat affect individuals’ use of context-appropriate words in both sad and happy narratives are similar to that of controls. It is very likely that flat affect is a result of deficits in motor expression as opposed to emotional processing. The moods of display are compromised, but subjective, autonomic, and contextual aspects of emotion are left intact.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) was previously known to cause negative feelings, such as depressed mood, re-experiencing and hyperarousal. However, recently, psychologists have started to focus their attention on the blunted affects and also the decrease in feeling and expressing positive emotions in PTSD patients. Blunted affect, or emotional numbness, is considered one of the consequences of PTSD because it causes a diminished interest in activities that produce pleasure (anhedonia) and produces feelings of detachment from others, restricted emotional expression and a reduced tendency to express emotions behaviourally. Blunted affect is often seen in veterans as a consequence of the psychological stressful experiences that caused PTSD. Blunted affect is a response to PTSD, it is considered one of the central symptoms in post-traumatic stress disorders and it is often seen in veterans who served in combat zones. In PTSD, blunted affect can be considered a psychological response to PTSD as a way to combat overwhelming anxiety that the patients feel. In blunted affect, there are abnormalities in circuits that also include the prefrontal cortex.
Assessment
In making assessments of mood and affect the clinician is cautioned that “it is important to keep in mind that demonstrative expression can be influenced by cultural differences, medication, or situational factors”; while the layperson is warned to beware of applying the criterion lightly to “friends, otherwise [he or she] is likely to make false judgments, in view of the prevalence of schizoid and cyclothymic personalities in our ‘normal’ population, and our [US] tendency to psychological hypochondriasis”.
R.D. Laing in particular stressed that “such ‘clinical’ categories as schizoid, autistic, ‘impoverished’ affect … all presuppose that there are reliable, valid impersonal criteria for making attributions about the other person’s relation to [his or her] actions. There are no such reliable or valid criteria”.
Differential Diagnosis
Blunted affect is very similar to anhedonia, which is the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). In the case of anhedonia, emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. There are some other negative symptoms of schizophrenia which include avolition, alogia and catatonic behaviour.
Closely related is alexithymia – a condition describing people who “lack words for their feelings. They seem to lack feelings altogether, although this may actually be because of their inability to express emotion rather than from an absence of emotion altogether”. Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal.
“If the amygdala is severed from the rest of the brain, the result is a striking inability to gauge the emotional significance of events; this condition is sometimes called ‘affective blindness'”. In some cases, blunted affect can fade, but there is no conclusive evidence of why this can occur.
Affect displays are the verbal and non-verbal displays of affect (emotion).
These displays can be through facial expressions, gestures and body language, volume and tone of voice, laughing, crying, etc. Affect displays can be altered or faked so one may appear one way, when they feel another (i.e. smiling when sad). Affect can be conscious or non-conscious and can be discreet or obvious. The display of positive emotions, such as smiling, laughing, etc., is termed “positive affect”, while the displays of more negative emotions, such as crying and tense gestures, is respectively termed “negative affect”.
Affect is important in psychology as well as in communication, mostly when it comes to interpersonal communication and non-verbal communication. In both psychology and communication, there are a multitude of theories that explain affect and its impact on humans and quality of life.
Affect can be taken to indicate an instinctual reaction to stimulation occurring before the typical cognitive processes considered necessary for the formation of a more complex emotion. Robert B. Zajonc asserts that this reaction to stimuli is primary for human beings and is the dominant reaction for lower organisms. Zajonc suggests affective reactions can occur without extensive perceptual and cognitive encoding, and can be made sooner and with greater confidence than cognitive judgments.
Lazarus on the other hand considers affect to be post-cognitive. That is, affect is elicited only after a certain amount of cognitive processing of information has been accomplished. In this view, an affective reaction, such as liking, disliking, evaluation, or the experience of pleasure or displeasure, is based on a prior cognitive process in which a variety of content discriminations are made and features are identified, examined for their value, and weighted for their contributions.
A divergence from a narrow reinforcement model for emotion allows for other perspectives on how affect influences emotional development. Thus, temperament, cognitive development, socialization patterns, and the idiosyncrasies of one’s family or subculture are mutually interactive in non-linear ways. As an example, the temperament of a highly reactive, low self-soothing infant may “disproportionately” affect the process of emotion regulation in the early months of life.
Non-Conscious Affect and Perception
In relation to perception, a type of non-conscious affect may be separate from the cognitive processing of environmental stimuli. A monohierarchy of perception, affect and cognition considers the roles of arousal, attentional tendencies, affective primacy, evolutionary constraints, and covert perception within the sensing and processing of preferences and discrimination. Emotions are complex chains of events triggered by certain stimuli. There is no way to completely describe an emotion by knowing only some of its components. Verbal reports of feelings are often inaccurate because people may not know exactly what they feel, or they may feel several different emotions at the same time. There are also situations that arise in which individuals attempt to hide their feelings, and there are some who believe that public and private events seldom coincide exactly, and that words for feelings are generally more ambiguous than are words for objects or events.
Affective responses, on the other hand, are more basic and may be less problematic in terms of assessment. Brewin has proposed two experiential processes that frame non-cognitive relations between various affective experiences: those that are prewired dispositions (i.e., non-conscious processes), able to “select from the total stimulus array those stimuli that are casually relevant, using such criteria as perceptual salience, spatiotemporal cues, and predictive value in relation to data stored in memory”, and those that are automatic (i.e. subconscious processes), characterized as “rapid, relatively inflexible and difficult to modify… (requiring) minimal attention to occur and… (capable of being) activated without intention or awareness”.
Arousal
Arousal is a basic physiological response to the presentation of stimuli. When this occurs, a non-conscious affective process takes the form of two control mechanisms; one mobilisation, and the other immobilisation. Within the human brain, the amygdala regulates an instinctual reaction initiating this arousal process, either freezing the individual or accelerating mobilisation.
The arousal response is illustrated in studies focused on reward systems that control food-seeking behaviour. Researchers focused on learning processes and modulatory processes that are present while encoding and retrieving goal values. When an organism seeks food, the anticipation of reward based on environmental events becomes another influence on food seeking that is separate from the reward of food itself. Therefore, earning the reward and anticipating the reward are separate processes and both create an excitatory influence of reward-related cues. Both processes are dissociated at the level of the amygdala and are functionally integrated within larger neural systems.
Affect and Mood
Mood, like emotion, is an affective state. However, an emotion tends to have a clear focus (i.e., a self-evident cause), while mood tends to be more unfocused and diffused. Mood, according to Batson, Shaw, and Oleson (1992), involves tone and intensity and a structured set of beliefs about general expectations of a future experience of pleasure or pain, or of positive or negative affect in the future. Unlike instant reactions that produce affect or emotion, and that change with expectations of future pleasure or pain, moods, being diffused and unfocused, and thus harder to cope with, can last for days, weeks, months, or even years. Moods are hypothetical constructs depicting an individual’s emotional state. Researchers typically infer the existence of moods from a variety of behavioural referents.
Positive affect and negative affect represent independent domains of emotion in the general population, and positive affect is strongly linked to social interaction. Positive and negative daily events show independent relationships to subjective well-being, and positive affect is strongly linked to social activity. Recent research suggests that “high functional support is related to higher levels of positive affect”. The exact process through which social support is linked to positive affect remains unclear. The process could derive from predictable, regularized social interaction, from leisure activities where the focus is on relaxation and positive mood, or from the enjoyment of shared activities.
Gender
Research has indicated many differences in affective displays due to gender. Gender, as opposed to sex, is one’s self-perception of being masculine or feminine (i.e. a male can perceive himself to be more feminine or a female can perceive herself to be more masculine). It can also be argued, however, that hormones (typically determined by sex) greatly affect affective displays and mood.
Affect and Child Development
According to studies done in the late ’80s and early ’90s, infants within their first year of life are not only able to begin recognising affect displays but can begin mimicking the displays and also begin developing empathy. A study in 2011 followed up on these earlier studies by testing fifteen 6-12 month old infants’ arousal, via pupil dilation, when looking at both positive and negative displays. Results showed that when presented with negative affect, an infant’s pupil will dilate and stay dilated for a longer period of time when compared to neutral affect. When presented with positive affect however, the pupil dilation is much larger, but stays dilated for shorter amount of time. While this study does not prove an infant’s ability to empathise with others, it does show that infants do recognise and acknowledge both positive and negative displays of emotion.
In the early 2000s over the period of about seven years, a study was done on about 200 children whose mother had “a history of juvenile-onset unipolar depressive disorder” or simply, depression as children themselves. In the cases of unipolar depression, a person generally displays more negative affect and less positive affect than a person without depression. Or, they are more likely to show when they are sad or upset, than when they are excited or happy. This study that was published in 2010 discovered that the children of mothers that suffer from unipolar depression, had lower levels of positive affect when compared to the control group. Even as the children grew older, while the negative affect began to stay the same, the children still showed consistently lower positive affect. This study suggests that “Reduced PA [positive affect] may be one source of developmental vulnerability to familial depression…” meaning that while having family with depression, increases the risk of children developing depression, reduced positive affect increases the risk of this development. But knowing this aspect of depression, might also be able to help prevent the onset of depression in young children well into their adulthood.
Disorders and Physical Disabilities
Refer to Reduced Affect Display.
There are some diseases, physical disabilities and mental health disorders that can change the way a person’s affect displays are conveyed. Reduced affect is when a person’s emotions cannot be properly conveyed or displayed physically. There is no actual change in how intensely they truly feel emotions, there is simply a disparity between emotions felt and how intensely they are conveyed. These disorders can greatly affect a person’s quality of life, depending on how intense the disability is.
Flat, Blunted and Restricted Affect
These are symptoms in which an affected person feels an emotion, but does not or cannot display it. Flat being the most severe in where there is very little to absolutely no show of emotions. Restricted and blunted are, respectively, less severe. Disorders involving these reduced affect displays most commonly include schizophrenia, post traumatic stress disorder, depression, autism and persons with traumatic brain injuries. One study has shown that people with schizophrenia that experience flat affect, can also experience difficulty perceiving the emotions of a healthy individual.
Facial Paralysis and Surgery
People who suffer from deformities and facial paralysis are also physically incapable of displaying emotions. This is beginning to be corrected though, through “Facial Reanimation Surgery” which is proving not only to successfully improve a patient’s affect displays, but also bettering their psychological health. There are multiple types of surgeries that can help fix facial paralysis. Some more popular types include fixing the actual nerve damage, specifically any damage to the hypoglossal nerve; facial grafts where nerves taken from a donor’s leg are transplanted into the patient’s face; or if the damage is more muscular versus actual nerves, muscle may be transferred into the patient’s face.
Strategic Display
Refer to Psychological Manipulation.
Emotions can be displayed in order to elicit desired behaviours from others.
People have been known to display positive emotions in various settings. Service workers often engage in emotional labour, a strive to maintain positive emotional expressions despite difficulties in working conditions or rude customers, in order to conform to organisational rules. Such strategic displays are not always effective, since if they are detected, lower customer satisfaction results.
Perhaps the most notable attempt to feign negative emotion could be seen with Nixon’s madman theory. Nixon’s administration attempted to make the leaders of other countries think Nixon was mad, and that his behaviour was irrational and volatile. Fearing an unpredictable American response, leaders of hostile Communist Bloc nations would avoid provoking the United States. This diplomatic strategy was not ultimately successful.
The effectiveness of the strategic display depends on the ability of the expresser to remain undetected. It may be a risky strategy since if detected, the person’s original intent could be discovered, undermining the future relationship with the target.
According to the appraisal theory of emotions, the experience of emotions is preceded by an evaluation of an object of significance to that individual. When individuals are seen to display emotions, it serves as a signal to others of an event important to that individual. Thus, deliberately altering the emotion display toward an object could be used make the targets of the strategic emotion think and behave in ways that benefit the original expresser. For example, people attempt to hide their expressions during a poker game in order to avoid giving away information to the other players, i.e. keep a poker face.
Affective science is the scientific study of emotion or affect.
his includes the study of emotion elicitation, emotional experience and the recognition of emotions in others. Of particular relevance are the nature of feeling, mood, emotionally-driven behaviour, decision-making, attention and self-regulation, as well as the underlying physiology and neuroscience of the emotions.
Discussion
An increasing interest in emotion can be seen in the behavioural, biological and social sciences. Research over the last two decades suggests that many phenomena, ranging from individual cognitive processing to social and collective behaviour, cannot be understood without taking into account affective determinants (i.e. motives, attitudes, moods, and emotions). Just as the cognitive revolution of the 1960s spawned the cognitive sciences and linked the disciplines studying cognitive functioning from different vantage points, the emerging field of affective science seeks to bring together the disciplines which study the biological, psychological, and social dimensions of affect. In particular affective science includes psychology, affective neuroscience, sociology, psychiatry, anthropology, ethology, archaeology, economics, criminology, law, political science, history, geography, education and linguistics. Research is also informed by contemporary philosophical analysis and artistic explorations of emotions. Emotions developed in human history make organisms to react to environmental stimuli and challenges.
The major challenge for this interdisciplinary domain is to integrate research focusing on the same phenomenon, emotion and similar affective processes, starting from different perspectives, theoretical backgrounds, and levels of analysis. As a result, one of the first challenges of affective science is to reach consensus on the definition of emotions. Discussion is ongoing as to whether emotions are primarily bodily responses or whether cognitive processing is central. Controversy also concerns the most effective ways to measure emotions and conceptualise how one emotion differs from another. Examples of this include the dimensional models of Russell and others, Plutchik’s wheel of emotions, and the general distinction between basic and complex emotions.
Measuring Emotions
Whether scientific method is at all suited for the study of the subjective aspect of emotion, feelings, is a question for philosophy of science and epistemology. In practice, the use of self-report (i.e. questionnaires) has been widely adopted by researchers. Additionally, web-based research is being used to conduct large-scale studies on the components of happiness for example. (www.authentichappiness.com is a website run by the University of Pennsylvania, where questionnaires are routinely taken by thousands of people all over the world based on a well-being criteria devised in the book ‘Flourish.’ by Martin Seligman). Nevertheless, Seligman mentions in the book the poor reliability of using this method as it is often entirely subjective to how the individual is feeling at the time, as opposed to questionnaires which test for more long standing personal features that contribute to well-being such as meaning in life. Alongside this researchers also use functional magnetic resonance imaging, Electroencephalography and physiological measures of skin conductance, muscle tension and hormone secretion. This hybrid approach should allow researchers to gradually pinpoint the affective phenomenon. There are also a few commercial systems available that claim to measure emotions, for instance using automated video analysis or skin conductance (affectiva).
A common way to measure the emotions of others is via their emotional expressions. These include facial expression, vocal expression and bodily posture. Much work has also gone into coding expressive behaviour computer programmes that can be used to read the subject’s emotion more reliably. The model used for facial expression is the Facial Action Coding System or ‘FACS’. An influential figure in the development of this system was Paul Ekman (For criticism, refer to the conceptual-act model of emotion).
These behavioural sources can be contrasted with language descriptive of emotions. In both respects one may observe the way that affective display differs from culture to culture.
Stanford
The Stanford University Psychology Department has an Affective Science area. It emphasizes basic research on emotion, culture, and psychopathology using a broad range of experimental, psychophysiological, neural, and genetic methods to test theory about psychological mechanisms underlying human behaviour. Topics include longevity, culture and emotion, reward processing, depression, social anxiety, risk for psychopathology, and emotion expression, suppression, and dysregulation.
Mental Health Matters 
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