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Who is James Dobson?

Published on by Andrew Marshall1 Comment

Introduction

James Clayton Dobson Jr. (commonly known as Jim Dobson, born 21 April 1936) is an American evangelical Christian author, psychologist, and founder of Focus on the Family (FOTF), which he led from 1977 until 2010.

In the 1980s he was ranked as one of the most influential spokesmen for conservative social positions in American public life. Although never an ordained minister, he was called “the nation’s most influential evangelical leader” by The New York Times while Slate portrayed him as a successor to evangelical leaders Jerry Falwell and Pat Robertson.

As part of his former role in the organisation, he produced the daily radio programme Focus on the Family, which the organisation has said was broadcast in more than a dozen languages and on over 7,000 stations worldwide, and reportedly heard daily by more than 220 million people in 164 countries. Focus on the Family was also carried by about sixty US television stations daily. Dobson also founded the Family Research Council in 1981. He is no longer affiliated with Focus on the Family. Dobson founded Family Talk as a non-profit organisation in 2010 and launched a new radio broadcast, Family Talk with Dr. James Dobson, that began on 03 May 2010, on over 300 stations nationwide.

Early Life and Education

James Dobson was born to Myrtle Georgia (née Dillingham) and James C. Dobson, Sr., on 21 April 1936, in Shreveport, Louisiana. From his earliest childhood, religion played a central part in his life. He once told a reporter that he learned to pray before he learned to talk, and says he gave his life to Jesus at the age of three, in response to an altar call by his father. He is the son, grandson, and great-grandson of Church of the Nazarene ministers.

The parents took their young son along to watch his father preach. Like most Nazarenes, they forbade dancing and going to movies. Young “Jimmie Lee” (as he was called) concentrated on his studies.

Dobson studied academic psychology, which most evangelical Christians in the 1950s and 1960s did not look upon favourably. He came to believe that he was being called to become a Christian counsellor or perhaps a Christian psychologist. He attended Pasadena College (now Point Loma Nazarene University) as an undergraduate and served as captain of the school’s tennis team. In 1967, Dobson received his doctorate in psychology from the University of Southern California.

Career

In 1967, he became an Associate Clinical Professor of Paediatrics at the University of Southern California School of Medicine for 14 years. He spent 17 years on the staff of the Children’s Hospital of Los Angeles in the Division of Child Development and Medical Genetics.

For a time, Dobson worked as an assistant to Paul Popenoe at the Institute of Family Relations, a marriage-counselling centre, in Los Angeles.

Dobson arguably first became well-known with the publication of Dare to Discipline (1970), which encouraged parents to use corporal punishment in disciplining their children. Dobson’s social and political opinions are widely read among many evangelical church congregations in the United States.

In 1977 he founded Focus on the Family. Dobson published monthly bulletins, which were dispensed as inserts in some Sunday church-service bulletins.

Dobson interviewed serial killer Ted Bundy on-camera the day before Bundy’s execution on 24 January 1989. The interview became controversial because Bundy was given an opportunity to attempt to explain his actions (the rape and murder of 30 young women). Bundy claimed in the interview (in a reversal of his previous stance) that violent pornography played a significant role in moulding and crystallising his fantasies. In May 1989, during an interview with John Tanner, a Republican Florida prosecutor, Dobson called for Bundy to be forgiven. The Bundy tapes gave Focus on the Family revenues of over $1 million, $600,000 of which it donated to anti-pornography groups and to anti-abortion groups.

Dobson stepped down as President and CEO of Focus on the Family in 2003, and resigned from the position of chairman of the board in February 2009. Dobson explained his departure as twofold: one to allow a smooth transfer of leadership to the next generation, and in this case, to Jim Daly who he directly appointed as his replacement. And secondly, due to some differences in opinion about organisational positions which represented “significant philosophical differences” with successor Jim Daly. He said, “I have believed for many years that one of the biggest mistakes a founder and president can make is to stay too long. By holding the reins of power as the years go by, an executive prevents his organization from developing the leadership to carry on when he dies or suddenly decides to step down. Then a crisis can occur that may even doom the ministry. We have all seen that happen.”

In 2010, Dobson founded the Dr. James Dobson Family Institute, a non-profit organisation that produces his radio programme, Dr. James Dobson’s Family Talk.

Dobson frequently appears as a guest on the Fox News Channel.

Personal Life

Dobson married Shirley Deere on 26 August 1960. The couple have two children, Danae and Ryan. Ryan was adopted by the Dobsons.

Awards

At the invitation of Presidents and Attorneys General, Dobson has also served on government advisory panels and testified at several government hearings. He was given the “Layman of the Year” award by the National Association of Evangelicals in 1982, “The Children’s Friend” honour by Childhelp USA (an advocate agency against child abuse) in 1987, and the Humanitarian Award by the California Psychological Association in 1988. In 2005, Dobson received an honorary doctorate (his 16th) from Indiana Wesleyan University and was inducted into IWU’s Society of World Changers, while speaking at the university’s Academic Convocation.[6]

In 2008, Dobson’s Focus on the Family program was nominated for induction into the National Radio Hall of Fame. Nominations were made by the 157 members of the Hall of Fame and voting on inductees was handed over to the public using online voting. The nomination drew the ire of gay rights activists, who attempted to have the program removed from the nominee list and to vote for other nominees to prevent it from being approved. However, the programme garnered enough votes and was subsequently inducted into the Radio Hall of Fame

Social Views

Views on Marriage

James Dobson is a strong proponent of marriage defined as “one where husband and wife are lawfully married, are committed to each other for life,” and have a homemaker mother and breadwinner father. According to his view, women are not deemed inferior to men because both are created in God’s image, but each gender has biblically mandated roles. He recommends that married women with children under the age of 18 focus on mothering, rather than work outside the home.

In his 2004 book Marriage Under Fire, Dobson suggests that heterosexual marriage rates in Denmark, Norway, and Sweden have been falling, and that this is due to the recognition of same-sex relationships by those countries during the 1990s. He remarks that the “institution of marriage in those countries is rapidly dying” as a result, with most young people cohabiting or choosing to remain single (living alone) and illegitimacy rates rising in some Norwegian counties up to 80%.

Dobson writes that “every civilization in the world” has been built upon marriage. He also believes that homosexuality is neither a choice nor genetic, but is caused by external factors during early childhood. He anecdotally cites as evidence the life of actress Anne Heche, who was previously in a relationship with Ellen DeGeneres. Criticising “the realities of judicial tyranny,” Dobson has written that “[t]here is no issue today that is more significant to our culture than the defense of the family. Not even the war on terror eclipses it.”

Critics have stated that Dobson’s views on homosexuality do not represent the mainstream views of the mental health community, with Dan Gilgoff referring to the positions of the American Psychiatric Association and the American Psychological Association on homosexuality.

Views on Schooling

Focus on the Family supports private school vouchers and tax credits for religious schools. According to Focus on the Family website, Dobson believes that parents are ultimately responsible for their children’s education, and encourages parents to visit their children’s schools to ask questions and to join the PTA so that they may voice their opinions. Dobson opposes sex education curricula that are not abstinence-only.

According to People for the American Way, Focus on the Family material has been used to challenge a book or curriculum taught in public schools. Critics, such as People for the American Way, allege that Focus on the Family encourages Christian teachers to establish prayer groups in public schools. Dobson supports student-led prayer in public schools, and believes that allowing student-led Christian prayer in schools does not violate the First Amendment to the United States Constitution.

Views on Discipline within the Family

In his book Dare to Discipline, Dobson advocates the spanking of children up to eight years old when they misbehave, but warns that “corporal punishment should not be a frequent occurrence” and that “discipline must not be harsh and destructive to the child’s spirit.”[citation needed] He warns against “harsh spanking” because “It is not necessary to beat the child into submission; a little bit of pain goes a long way for a young child. However, the spanking should be of sufficient magnitude to cause the child to cry genuinely.”

Dobson has called disciplining children to be a necessary but unpleasant part of raising children that should only be carried out by qualified parents:

Anyone who has ever abused a child—or has ever felt himself losing control during a spanking—should not expose the child to that tragedy. Anyone who has a violent temper that at times becomes unmanageable should not use that approach. Anyone who secretly ‘enjoys’ the administration of corporal punishment should not be the one to implement it.

In his book The Strong-Willed Child, Dobson suggests that if authority is portrayed correctly to a child, the child will understand how to interact with other authority figures:

By learning to yield to the loving authority … of his parents, a child learns to submit to other forms of authority which will confront him later in his life—his teachers, school principal, police, neighbors and employers.[51]

In Dobson’s opinion, parents must uphold their authority and do so consistently: “When you are defiantly challenged, win decisively.” In The Strong-Willed Child, Dobson draws an analogy between the defiance of a family pet and that of a small child, and concludes that “just as surely as a dog will occasionally challenge the authority of his leaders, so will a little child—only more so” (emphasis in original).

When asked “How long do you think a child should be allowed to cry after being punished? Is there a limit?” Dobson responded:

Yes, I believe there should be a limit. As long as the tears represent a genuine release of emotion, they should be permitted to fall. But crying quickly changes from inner sobbing to an expression of protest … Real crying usually lasts two minutes or less but may continue for five. After that point, the child is merely complaining, and the change can be recognized in the tone and intensity of his voice. I would require him to stop the protest crying, usually by offering him a little more of whatever caused the original tears. In younger children, crying can easily be stopped by getting them interested in something else.

Sociologists John Bartkowski and Christopher Ellison have stated that Dobson’s views “diverge sharply from those recommended by contemporary mainstream experts” and are not based on any sort of empirical testing, but rather are nothing more than expressions of his religious doctrines of “biblical literalism and ‘authority-mindedness.'”

Views on Tolerance and Diversity

In the winter of 2004-2005, the We Are Family Foundation sent American elementary schools approximately 60,000 copies of a free DVD using popular cartoon characters (especially SpongeBob SquarePants) to “promote tolerance and diversity.” Dobson contended that “tolerance” and “diversity” are “buzzwords” that the We Are Family Foundation misused as part of a “hidden agenda” to promote homosexuality. Kate Zernik noted Dobson asserting: “tolerance and its first cousin, diversity, ‘are almost always buzzwords for homosexual advocacy.'” He stated on the Focus on the Family website that “childhood symbols are apparently being hijacked to promote an agenda that involves teaching homosexual propaganda to children.” He offered as evidence the association of many leading LGBT rights organisations, including GLAAD, GLSEN, HRC, and PFLAG, with the We Are Family Foundation as shown by links which he claims once existed on their website.

The We Are Family Foundation countered that Dobson had mistaken their organisation with “an unrelated Web site belonging to another group called ‘We Are Family,’ which supports gay youth.” Dobson countered:

I want to be clear: the We Are Family Foundation—the organization that sponsored the video featuring SpongeBob and the other characters was, until this flap occurred, making available a variety of explicitly pro-homosexual materials on its Web site. It has since endeavored to hide that fact, but my concerns are as legitimate today as they were when I first expressed them in January.

In September 2005, Tolerance.org published a follow-up message advertising the DVD’s continued availability, including We Are Family Foundation president Nancy Hunt’s speculation that many of the DVDs may be “still sitting in boxes, unused, because of Dobson’s vitriolic attack.”

Views on Homosexuality

Dobson believes that God defines marriage as between one man and one woman only and describes this as the central stabilising institution of society. Dobson believes that any sexual activity outside of such a union – including homosexuality – cannot be approved by God.[citation needed] In Dobson’s view, homosexuality results from influences in a child’s environment rather than an inborn trait. He states that homosexual behaviour, specifically “unwanted same-sex attraction”, has been and can be “overcome” through understanding developmental models for homosexuality and choosing to heal the complex developmental issues which led to same-sex attraction.

Focus on the Family ministry sponsors the monthly conference Love Won Out, where participants hear “powerful stories of ex-gay men and women.” Parents, Families and Friends of Lesbians and Gays (P-FLAG) has protested against the conference in Orlando, questioning both its methodology and supposed success. In regards to the conference, Dobson has stated that “Gay activists come with preconceived notions about who we are and what we believe and about the hate that boils from within, which is simply not true. Regardless of what the media might say, Focus on the Family has no interest in promoting hatred toward homosexuals or anyone else. We also don’t wish to deprive them of their basic constitutional rights … The Constitution applies to all of us.” Dobson strongly opposes the movement to legitimise same-sex relationships. In his book Bringing Up Boys, Dobson states, “[T]he disorder is not typically ‘chosen.’ Homosexuals deeply resent being told that they selected this same-sex inclination in pursuit of sexual excitement or some other motive. It is unfair, and I don’t blame them for being irritated by that assumption. Who among us would knowingly choose a path that would result in alienation from family, rejection by friends, disdain from the heterosexual world, exposure to sexually transmitted diseases such as AIDS and tuberculosis, and even a shorter lifespan?”

Sociologist Judith Stacey criticised Dobson for claiming that sociological studies show that gay couples do not make good parents. She stated that Dobson’s claim “is a direct misrepresentation of my research.” In response to Dobson’s claim that “there have been more than ten thousand studies that have showed that children do best when they are raised with a mother and a father who are committed to each other,” Stacey replied that “[a]ll of those studies that Dobson is referring to are studies that did not include gay or lesbian parents as part of the research base.”

Dobson objected to a bill expanding the prohibition of sexual orientation-based discrimination in the areas of “public accommodation, housing practices, family planning services and twenty other areas.” He said that, were such a bill passed, public businesses could no longer separate locker rooms and bathrooms by gender, which he claimed would lead to a situation where, “every woman and little girl will have to fear that a predator, bisexual, cross-dresser or even a homosexual or heterosexual male might walk in and relieve himself in their presence.”

Political and Social Influence

Although Dobson initially remained somewhat distant from Washington politics, in 1981 he founded the Family Research Council as a political arm through which “social conservative causes” could achieve greater political influence. In 1996, he cast a vote for US Taxpayers’ Party Presidential candidate Howard Phillips.

In late 2004, Dobson led a campaign to block the appointment of Arlen Specter to head of the Senate Judiciary Committee because of Specter’s pro-abortion rights stance. Responding to a question by Fox News personality Alan Colmes on whether he wanted the Republican Party to be known as a “big-tent party,” he replied, “I don’t want to be in the big tent … I think the party ought to stand for something.” In 2006, Focus on the Family spent more than a half million dollars to promote a constitutional amendment to ban same-sex marriage in its home state of Colorado.

A May 2005 article by Chris Hedges in Harper’s Magazine described Dobson as “perhaps the most powerful figure in the Dominionist movement” and “a crucial player in getting out the Christian vote for George W. Bush.” Discernment Ministries, a site that describes dominionism as a heresy, characterized Dobson as belonging to the “Patriotic American” brand of dominionism, calling him “One of its most powerful leaders.”

In November 2004, Dobson was described by the online magazine Slate as “America’s most influential evangelical leader.” The article stated:

“Forget Jerry Falwell and Pat Robertson, who in their dotage have marginalized themselves with gaffes … Dobson is now America’s most influential evangelical leader, with a following reportedly greater than that of either Falwell or Robertson at his peak … Dobson may have delivered Bush his victories in Ohio and Florida.”

Further, “He’s already leveraging his new power. When a thank-you call came from the White House, Dobson issued the staffer a blunt warning that Bush “needs to be more aggressive” about pressing the religious right’s pro-life, anti-gay rights agenda, or it would “pay a price in four years”. Dobson has sometimes complained that the Republican Party may take the votes of social conservatives for granted, and has suggested that evangelicals may withhold support from the GOP if the party does not more strongly support conservative family issues: “Does the Republican Party want our votes, no string attached—to court us every two years, and then to say, ‘Don’t call me, I’ll call you’—and not to care about the moral law of the universe? … Is that what they want? Is that the way the system works? Is this the way it’s going to be? If it is, I’m gone, and if I go, I will do everything I can to take as many people with me as possible.”

However, in 2006, Dobson said that, while “there is disillusionment out there with Republicans” and “that worries me greatly,” he nonetheless suggested voters turn out and vote Republican in 2006. “My first inclination was to sit this one out,” but according to The New York Times, Dobson then added that “he had changed his mind when he looked at who would become the leaders of Congressional committees if the Democrats took over.”

Dobson garnered national media attention once again in February 2008 after releasing a statement in the wake of Senator John McCain’s expected success in the so-called “Super Tuesday” Republican primary elections. In his statement, Dobson said: “I cannot, and will not, vote for Senator John McCain, as a matter of conscience,” and indicated that he would refrain from voting altogether if McCain were to become the Republican candidate, echoing other conservative commentators’ concerns about the Senator’s conservatism. He endorsed Mike Huckabee for president.[citation needed] After McCain selected an anti-abortion candidate, Sarah Palin, as his running mate, Dobson said that he was more enthusiastic in his support for the Republican ticket. When Palin’s 17-year-old daughter’s pregnancy was revealed, Dobson issued a press release commending Palin’s stance, saying:

We have always encouraged the parents to love and support their children and always advised the girls to see their pregnancies through, even though there will of course be challenges along the way. That is what the Palins are doing, and they should be commended once again for not just talking about their pro-life and pro-family values, but living them out even in the midst of trying circumstances.

On 24 June 2008, Dobson criticized statements made by US Presidential candidate Barack Obama in Obama’s 2006 “Call to Renewal” address. Dobson stated that Obama was “distorting the traditional understanding of the Bible to fit his own world view.” On 23 October 2008, Dobson published a “Letter from 2012 in Obama’s America” that proposed that an Obama presidency could lead to: mandated homosexual teachings across all schools; the banning of firearms in entire states; the end of the Boy Scouts, home schooling, Christian school groups, Christian adoption agencies, and talk radio; pornography on prime-time and daytime television; mandatory bonuses for gay soldiers; terrorist attacks across America; the nuclear bombing of Tel Aviv; the conquering of most of Eastern Europe by Russia; the end of health care for Americans over 80; out-of-control gasoline prices; and complete economic disaster in the United States, among other catastrophes. In the days after the 2008 presidential election, Dobson stated on his radio program that he was mourning the Obama election, claiming that Obama supported infanticide, would be responsible for the deaths of millions of unborn children, and was “going to appoint the most liberal justices to the Supreme Court, perhaps, that we’ve ever had.”

Dobson supports intelligent design and has spoken at conferences on the subject, and frequently criticizes evolution. In 2007, Dobson was one of 25 evangelicals who called for the ouster of Rev. Richard Cizik from his position at the National Association of Evangelicals because Cizik had taken a stance urging evangelicals to take global warming seriously.

On 13 June 2007, the National Right to Life Committee ousted Colorado Right to Life after the latter ran a full-page ad criticising Dobson.

On 30 May 2010, Dobson delivered the pre-race invocation at the NASCAR Coca-Cola 600 automobile race, raising criticism about his association with a sport associated with sponsors and activities which would not meet his definition of family-friendly.

At a National Day of Prayer event in the US Capitol, Dobson called Barack Obama “the abortion president.” He said, “President Obama, before he was elected, made it very clear that he wanted to be the abortion president. He didn’t make any bones about it. This is something that he really was going to promote and support, and he has done that, and in a sense he is the abortion president.” Among others, Rep. Janice Hahn complained because Dobson used the National Day of Prayer for partisan purposes. She said, “Dobson just blew a hole into this idea of being a nonpartisan National Day of Prayer. It was very disturbing to me … and really a shame. James Dobson hijacked the National Day of Prayer—this nonpartisan, nonpolitical National Day of Prayer—to promote his own distorted political agenda.”

Dobson endorsed Ted Cruz in the 2016 Republican primaries. Dobson would later go on to endorse Trump in the general election against Hillary Clinton. Dobson has been named by Christianity Today as one of the Trump Administration’s top “Evangelical Faith Advisers”.

In 2020, Dobson worked alongside other conservative Evangelicals and Evangelical organizations, including Jim Daly and Focus on the Family, to support the re-election of President Donald Trump. He echoed his support of the President throughout the impeachment proceedings earlier that year.

Ecumenical Relations

Dobson and Charles Colson were two participants in a 2000 conference at the Vatican on the global economy’s impact on families. During the conference, the two Protestants met with Pope John Paul II. Dobson later told Catholic News Service that though he has theological differences with Roman Catholicism, “when it comes to the family, there is far more agreement than disagreement, and with regard to moral issues from abortion to premarital sex, safe-sex ideology and homosexuality, I find more in common with Catholics than with some of my evangelical brothers and sisters.”

In November 2009, Dobson signed an ecumenical statement known as the Manhattan Declaration calling on evangelicals, Catholics and Eastern Orthodox Christians not to comply with rules and laws permitting abortion, same-sex marriage and other matters that go against their religious consciences.

Who was Philippe Pinel?

Published on by Andrew Marshall1 Comment

Introduction

Philippe Pinel (20 April 1745 to 25 October 1826) was a French physician, precursor of psychiatry and incidentally a zoologist.

He was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy. He worked for the abolition of the shackling of mental patients by chains and, more generally, for the humanisation of their treatment. He also made notable contributions to the classification of mental disorders and has been described by some as “the father of modern psychiatry”.

After the French Revolution, Dr. Pinel changed the way we look at the crazy (or “aliénés”, “alienated” in English) by claiming that they can be understood and cured. An 1809 description of a case that Pinel recorded in the second edition of his textbook on insanity is regarded by some as the earliest evidence for the existence of the form of mental disorder later known as dementia praecox or schizophrenia, although Emil Kraepelin is generally accredited with its first conceptualisation.

“Father of modern psychiatry”, he was credited with the first classification of mental illnesses. He had a great influence on psychiatry and the treatment of the alienated in Europe and the United States.

Early Life

Pinel was born in Jonquières, the South of France, in the modern department of Tarn. He was the son and nephew of physicians. After receiving a degree from the faculty of medicine in Toulouse, he studied an additional four years at the Faculty of Medicine of Montpellier. He arrived in Paris in 1778.

He spent fifteen years earning his living as a writer, translator, and editor because the restrictive regulations of the old regime prevented him from practicing medicine in Paris. The faculty did not recognize a degree from a provincial university like Toulouse. He failed twice in a competition which would have awarded him funds to continue his studies. In the second competition, the jury stressed his ‘painful’ mediocrity in all areas of medical knowledge, an assessment seemingly so grossly incompatible with his later intellectual accomplishments that political motives have been suggested. Discouraged, Pinel considered emigrating to America. In 1784 he became editor of the medical journal the Gazette de santé, a four-page weekly. He was also known among natural scientists as a regular contributor to the Journal de physique. He studied mathematics, translated medical works into French, and undertook botanical expeditions.

At about this time he began to develop an intense interest in the study of mental illness. The incentive was a personal one. A friend had developed a ‘nervous melancholy’ that had ‘degenerated into mania’ and resulted in suicide. What Pinel regarded as an unnecessary tragedy due to gross mismanagement seems to have haunted him. It led him to seek employment at one of the best-known private sanatoria for the treatment of insanity in Paris. He remained there for five years prior to the Revolution, gathering observations on insanity and beginning to formulate his views on its nature and treatment.

Pinel was an Ideologue, a disciple of the abbé de Condillac. He was also a clinician who believed that medical truth was derived from clinical experience. Hippocrates was his model.

During the 1780s, Pinel was invited to join the salon of Madame Helvétius. He was in sympathy with the French Revolution. After the revolution, friends he had met at Madame Helvétius’ salon came to power. In August 1793 Pinel was appointed “physician of the infirmeries” at Bicêtre Hospital. At the time it housed about four thousand imprisoned men – criminals, petty offenders, syphilitics, pensioners and about two hundred mental patients. Pinel’s patrons hoped that his appointment would lead to therapeutic initiatives. His experience at the private sanatoria made him a good candidate for the job.

The Bicêtre and Salpêtrière

Soon after his appointment to Bicêtre Hospital, Pinel became interested in the seventh ward where 200 mentally ill men were housed. He asked for a report on these inmates. A few days later, he received a table with comments from the “governor” Jean-Baptiste Pussin. In the 1770s Pussin had been successfully treated for scrofula at Bicêtre; and, following a familiar pattern, he was eventually recruited, along with his wife, Marguerite Jubline, on to the staff of the hospice.

Appreciating Pussin’s outstanding talent, Pinel virtually apprenticed himself to that unschooled but experienced custodian of the insane. His purpose in doing this was to “enrich the medical theory of mental illness with all the insights that the empirical approach affords”. What he observed was a strict nonviolent, nonmedical management of mental patients that came to be called moral treatment or moral management, though psychological might be a more accurate term.

Although Pinel always gave Pussin the credit he deserved, a legend grew up about Pinel single-handedly liberating the insane from their chains at Bicetre. This legend has been commemorated in paintings and prints, and has lived on for 200 years and is repeated in textbooks. In fact, it was Pussin who removed the iron shackles (but sometimes using straitjackets) at Bicêtre in 1797, after Pinel had left for the Salpêtrière. Pinel did remove the chains from patients at the Salpêtrière three years later, after Pussin joined him there. There is some suggestion that the Bicetre myth was actually deliberately fabricated by Pinel’s son, Dr Scipion Pinel, along with Pinel’s foremost pupil, Dr Esquirol. The argument is that they were ‘solidists’, which meant then something akin to biological psychiatry with a focus on brain disease, and were embarrassed by Pinel’s focus on psychological processes. In addition, unlike Philippe, they were both royalists.

While at Bicêtre, Pinel did away with bleeding, purging, and blistering in favour of a therapy that involved close contact with and careful observation of patients. Pinel visited each patient, often several times a day, and took careful notes over two years. He engaged them in lengthy conversations. His objective was to assemble a detailed case history and a natural history of the patient’s illness.

In 1795, Pinel became chief physician of the Hospice de la Salpêtrière, a post that he retained for the rest of his life. The Salpêtrière was, at the time, like a large village, with seven thousand elderly indigent and ailing women, an entrenched bureaucracy, a teeming market and huge infirmaries. Pinel missed Pussin and in 1802 secured his transfer to the Salpêtrière. It has also been noted that a Catholic nursing order actually undertook most of the day to day care and understanding of the patients at Salpêtrière, and there were sometimes power struggles between Pinel and the nurses.

Pinel created an inoculation clinic in his service at the Salpêtrière in 1799, and the first vaccination in Paris was given there in April 1800.

In 1795 Pinel had also been appointed as a professor of medical pathology, a chair that he held for twenty years. He was briefly dismissed from this position in 1822, with ten other professors, suspected of political liberalism, but reinstated as an honorary professor shortly thereafter.

A statue in honour of Pinel now stands outside the Salpêtrière.

Publications

In 1794 Pinel made public his essay ‘Memoir on Madness’, recently called a fundamental text of modern psychiatry. In it Pinel makes the case for the careful psychological study of individuals over time, points out that insanity is not always continuous, and calls for more humanitarian asylum practices.

In 1798 Pinel published an authoritative classification of diseases in his Nosographie philosophique ou méthode de l’analyse appliquée à la médecine. Although he is properly considered one of the founders of psychiatry, this book also establishes him as the last great nosologist of the eighteenth century. While the Nosographie appears completely dated today, it was so popular in its time that it went through six editions between its initial publication and 1818. Pinel based his nosology on ideas of William Cullen, employing the same biologically-inspired terminology of ‘genera’ and ‘species’ of disorder. Pinel’s classification of mental disorder simplified Cullen’s ‘neuroses’ down to four basic types of mental disorder: melancholia, mania (insanity), dementia, and idiotism. Later editions added forms of ‘partial insanity’ where only that of feelings which seem to be affected rather than reasoning ability.

The first mental derangement is called melancholia. The symptoms are described as “taciturnity, a thoughtful pensive air, gloomy suspicions, and a love of solitude.” It is noted that Tiberius and Louis XI were subjected to this temperament. Louis was characterised by the imbalance between the state of bitterness and passion, gloom, love of solitude, and the embarrassment of artistic talents. However, Louis and Tiberius were similar in that they both were deceitful and planned a delusional trip to military sites. Eventually both were exiled, one to the Isle of Rhodes and the other to a province of Belgium. People with melancholia are often immersed with one idea that their whole attention is fixated on. On one hand they stay reserved for many years, withholding friendships and affection while on the other, there are some who make reasonable judgment and overcome the gloomy state.  Melancholia can also express itself in polar opposite forms. The first is distinguished by an exalted sense of self-importance and unrealistic expectations such as attaining riches and power. The second form is marked by deep despair and great depression.  Overall individuals with melancholia generally do not display acts of violence, though they may find it wildly fanciful. Depression and anxiety occurs habitually as well as frequent moroseness of character.  Pinel remarks that melancholia can be explained by drunkenness, abnormalities in the structure of the skull, trauma in the skull, conditions of the skin, various psychological causes such as household disasters and religious extremism, and in women, menstruation and menopause. 

The second mental derangement is called mania without delirium. It is described as madness independent of a disorder that impairs the intellectual faculties. The symptoms are described as perverse and disobedient.  An instance where this type of species of mental derangement occurs where a mechanic, who was confined at the Asylum de Bicetre, experienced violent outbursts of maniacal fury. The paroxysms consisted of a burning sensation located in the abdominal area that was accompanied by constipation and thirst. The symptom spread to the chest, neck, and face area. When it reached the temples, the pulsation of the arteries increased in those areas. The brain was affected to some length but nonetheless, the patient was able to reason and cohere to his ideas. One time the mechanic experienced furious paroxysm at his own house where he warned his wife to flee to avoid death. He also experienced the same periodical fury at the asylum where he plotted against the governor.  The specific character of mania without delirium is that it can either be perpetual or sporadic. However, there was no reasonable change in the cognitive functions of the brain; only pervasive thoughts of fury and a blind tendency to acts of violence.

The third mental derangement is called mania with delirium. It is mainly characterised by indulgence and fury, and affects cognitive functions. Sometimes it may be distinguished by a carefree, gay humour that can venture off path in incoherent and absurd suggestions. Other times it can be distinguished by prideful and imaginary claims to grandeur. Prisoners of this species are highly delusional. For example, they would proclaim having fought an important battle, or witness the prophet Mohammad conjuring wrath in the name of the Almighty. Some declaim ceaselessly with no evidence of things seen or heard while others saw illusions of objects in various forms and colours. Delirium sometimes persists with some degree of frenzied uproar for a period of years, but it can also be constant and the paroxysm of fury repeat at different intervals. The specific character of mania with delirium is the same as mania without delirium in the sense that it can either be continued or cyclical with regular or irregular paroxysms. It is marked by strong nervous excitement, accompanied by a deficit of one or more of the functions of the cognitive abilities with feelings of liveliness, depression or fury.

The fourth mental derangement is called dementia, or otherwise known as the abolition of thinking. The characteristics include thoughtlessness, extreme incorrectness, and wild abnormalities. For instance, a man who had been educated on the ancient nobility was marching on about the beginning of the revolution. He moved restlessly about the house, talking endlessly and shouting passionately on insignificant reasons. Dementia is usually accompanied by raging and rebellious movement, by a quick succession of ideas formed in the mind, and by passionate feelings that are felt and forgotten without attributing it to objects.  Those who are in captive of dementia have lost their memory, even those attributed to their loved ones. Their only memory consists of those in the past. They forget instantaneously things in the present – seen heard or done. Many are irrational because the ideas do not flow coherently.  The characteristic properties of dementia are that there is no judgment value and the ideas are spontaneous with no connection.  The specific character of dementia contains a rapid progression or continual succession of isolated ideas, forgetfulness of previous condition, repetitive acts of exaggeration, decreased responsiveness to external influence, and complete lack of judgement.

The fifth and last mental derangement is called idiotism, or otherwise known as “obliteration of the intellectual faculties and affections.”  This disorder is derived from a variety of causes, such as extravagant and debilitating delight, alcohol abuse, deep sorrow, diligent study, aggressive blows to the head, tumours in the brain, and loss of consciousness due to blockage in vein or artery. Idiotism embodies a variety of forms. One such form is called Cretinism, which is a kind of idiotism that is relative to personal abnormalities. It is well known in the Valais and in parts of Switzerland.   Most people who belong in this group are either deficient in speech or limited to the inarticulate utterances of sounds. Their expressions are emotionless, senses are dazed and motions are mechanical. Idiots also constitute the largest number of patients at hospitals. Individuals who have acute responsiveness can experience a violent shock to the extreme that all the activities of the brain can either be arrested in an action or eradicated completely. Unexpected happiness and exaggerated fear may likely occur as a result of a violent shock.  As mentioned previously, idiotism is the most common among hospital patients and is incurable. At the Bicetre asylum, these patients constitute one fourth of the entire population. Many die after a few days of arrival, having been reduced to states of stupor and weakness. However, some who recover with the progressive regeneration of their strength also regain their intellectual capabilities. Many of the young people that have remained in the state of idiotism for several months or years are attacked by a spasm of active mania between twenty and thirty days.  The specific character of idiotism includes partial or complete extermination of the intellect and affections, apathy, disconnected, inarticulate sounds or impairment of speech, and nonsensical outbursts of passion.

In his book Traité médico-philosophique sur l’aliénation mentale; ou la manie, published in 1801, Pinel discusses his psychologically oriented approach. This book was translated into English by D.D. Davis as a Treatise on Insanity in 1806, although Davis substituted Pinel’s introduction for his own, leaving out among other things Pinel’s strong praise for Alexander Crichton. Pinel’s book had an enormous influence on both French and Anglo-American psychiatrists during the nineteenth century. He meant by alienation that the patient feels like a stranger (alienus) to the world of the ‘sane’. A sympathetic therapist living in that world might be able to journey into the patient’s experience, understand the ‘alienated’, their language, and possibly lead them back into society.

In 1802 Pinel published La Médecine Clinique which was based on his experiences at the Salpêtrière and in which he extended his previous book on classification and disease.

Pinel was elected to the Académie des Sciences in 1804 and was a member of the Académie de Médecine from its founding in 1820. He died in Paris on 25 October 1826.

Clinical Approach

Psychological Understanding

The central and ubiquitous theme of Pinel’s approach to aetiology (causation) and treatment was “moral,” meaning the emotional or the psychological not ethical. He observed and documented the subtleties and nuances of human experience and behaviour, conceiving of people as social animals with imagination.

Pinel noted, for example, that:

“being held in esteem, having honor, dignity, wealth, fame, which though they may be factitious, always distressing and rarely fully satisfied, often give way to the overturning of reason”.

He spoke of avarice, pride, friendship, bigotry, the desire for reputation, for conquest, and vanity. He noted that a state of love could turn to fury and desperation, and that sudden severe reversals in life, such as “from the pleasure of success to an overwhelming idea of failure, from a dignified state—or the belief that one occupies one—to a state of disgrace and being forgotten” can cause mania or ‘mental alienation’. He identified other predisposing psychosocial factors such as an unhappy love affair, domestic grief, devotion to a cause carried to the point of fanaticism, religious fear, the events of the revolution, violent and unhappy passions, exalted ambitions of glory, financial reverses, religious ecstasy, and outbursts of patriotic fervour.

Treatments

Pinel developed specific practical techniques, rather than general concepts and assumptions. He engaged in therapeutic conversations to dissuade patients from delusions. He offered benevolent support and encouragement, although patients who persistently resisted or caused trouble might be threatened with incarceration or punishment if they were not able to control themselves.

Pinel argued that psychological intervention must be tailored to each individual rather than be based solely on the diagnostic category, and that it must be grounded in an understanding of the person’s own perspective and history. He noted that “the treatment of insanity (l’aliénation mentale) without considering the differentiating characteristics of the patients [la distinction des espèces] has been at times superfluous, rarely useful, and often harmful”, describing the partial or complete failures of some psychological approaches, as well as the harm that the usual cruel and harsh treatments caused to patients before they came to his hospital. He saw improvement as often resulting from natural forces within the patient, an improvement that treatment could at best facilitate and at worst interfere with.

Pinel’s approach to medical treatments has been described as ambiguous, complex, and ambivalent. He insisted that psychological techniques should always be tried first, for example:

“even where a violent and destructive maniac could be calmed by a single dose of an antispasmodic [he referred to opium], observation teaches that in a great number of cases, one can obtain a sure and permanent cure by the sole method of expectation, leaving the insane man to his tumultuous excitement… …and [furthermore] seeing, again and again, the unexpected resources of nature left to itself or wisely guided, has rendered me more and more cautious with regard to the use of medications, which I no longer employ—except when the insufficiencies of psychological means have been proven.”

For those cases regarded as psychologically incurable, Pinel would employ baths, showers, opium, camphor and other antispasmodics, as well as vesicants, cauterisation, and bloodletting in certain limited cases only. He also recommended the use of laxatives for the prevention of nervous excitement and relapse.

Pinel often traced mental states to physiological states of the body, and in fact could be said to have practiced psychosomatic medicine. In general, Pinel traced organic causes to the gastrointestinal system and peripheral nervous system more often than to brain dysfunction. This was consistent with his rarely finding gross brain pathology in his post-mortem examinations of psychiatric patients, and his view that such findings that were reported could be correlational rather than causative

Management

Pinel was concerned with a balance between control by authority and individual liberty. He believed in “the art of subjugating and taming the insane” and the effectiveness of “a type of apparatus of fear, of firm and consistent opposition to their dominating and stubbornly held ideas”, but that it must be proportional and motivated only by a desire to keep order and to bring people back to themselves. The straitjacket and a period of seclusion were the only sanctioned punishments. Based on his observations, he believed that those who were considered most dangerous and carried away by their ideas had often been made so by the blows and bad treatment they had received, and that it could be ameliorated by providing space, kindness, consolation, hope, and humour.

Because of the dangers and frustrations that attendants experienced in their work, Pinel put great emphasis on the selection and supervision of attendants in order to establish a custodial setting dedicated to norms of constraint and liberty that would facilitate psychological work. He recommended that recovered patients be employed, arguing that “They are the ones who are most likely to refrain from all inhumane treatment, who will not strike even in retaliation, who can stand up to pleading, menaces, repetitive complaining, etc. and retain their inflexible firmness.” Pinel also emphasized the necessity for leadership that was “thoughtful, philanthropic, courageous, physically imposing, and inventive in the development of manoeuvres or tactics to distract, mollify, and impress” and “devoted to the concept of order without violence”, so that patients are “led most often with kindness, but always with an inflexible firmness.” He noted that his ex-patient and superintendent Pussin had showed him the way in this regard, and had also often been better placed to work with patients and develop techniques due to his greater experience and detailed knowledge of the patients as individuals.

Moral Judgements

Pinel generally expressed warm feelings and respect for his patients, as exemplified by: “I cannot but give enthusiastic witness to their moral qualities. Never, except in romances, have I seen spouses more worthy to be cherished, more tender fathers, passionate lovers, purer or more magnanimous patriots, than I have seen in hospitals for the insane, in their intervals of reasonableness and calm; a man of sensibility may go there any day and take pleasure in scenes of compassion and tenderness”. He argued that otherwise positive character traits could cause a person to be vulnerable to the distressing vicissitudes of life, for example “those persons endowed with a warmth of imagination and a depth of sensitivity, who are capable of experiencing powerful and intense emotions, [since it is they] who are most predisposed to mania”.

Pinel distanced himself from religious views, and in fact considered that excessive religiosity could be harmful.

However, he sometimes took a moral stance himself as to what he considered to be mentally healthy and socially appropriate. Moreover, he sometimes showed a condemnatory tone toward what he considered personal failings or vice, for example noting in 1809: “On one side one sees families which thrive over a course of many years, in the bosom of order and concord, on the other one sees many others, especially in the lower social classes, who offend the eye with the repulsive picture of debauchery, arguments, and shameful distress!”. He goes on to describe this as the most prolific source of alienation needing treatment, adding that while some such examples were a credit to the human race many others are “a disgrace to humanity!”

Influence

Pinel is generally seen as the physician who more than any other transformed the concept of ‘the mad’ into that of patients needing care and understanding, establishing a field that would eventually be called psychiatry. His legacy included improvement of asylum conditions; broadly psychosocial (incl. milieu) therapeutic approaches; history-taking; nosography (the science of the description of syndromes); broadly-numerical assessments of courses of illness and treatment responses; and a record of clinical teaching.

Pinel’s actions took place in the context of the Enlightenment, and a number of others were also reforming asylums along humanitarian lines. For example, Vincenzo Chiarugi, in the 1780s in Italy, removed metal chains from patients but did not enjoy the same renown bestowed on the more explicitly humanitarian Pinel who was so visible from late 18th century revolutionary France. In France, Joseph D’Aquin in Chambéry permitted patients to move about freely and published a book in 1791 urging humanitarian reforms, dedicating the second edition in 1804 to Pinel. The movement as a whole become known as moral treatment or moral management, and influenced asylum development and psychological approaches throughout the Western world.

Pinel’s most important contribution may have been the observation and conviction that there could be sanity and rationality even in cases that seemed on the surface impossible to understand, and that this could appear for periods in response to surrounding events (and not just because of such things as the phase of the moon, a still common assumption and the origin of the term lunatic). The influential philosopher Hegel praised Pinel for this approach.

The right psychical treatment therefore keeps in view the truth that insanity is not an abstract loss of reason (neither in the point of intelligence nor of will and its responsibility), but only derangement, only a contradiction in a still subsisting reason; – just as physical disease is not an abstract, i.e. mere and total, loss of health (if it were that, it would be death), but a contradiction in it. This humane treatment, no less benevolent than reasonable (the services of Pinel towards which deserve the highest acknowledgement), presupposes the patient’s rationality, and in that assumption has the sound basis for dealing with him on this side – just as in the case of bodily disease the physician bases his treatment on the vitality which as such still contains health.

Pinel also started a trend for diagnosing forms of insanity that seemed to occur ‘without delerium’ (confusion, delusions or hallucinations). Pinel called this Manie sans délire, folie raisonnante or folie lucide raisonnante. He described cases who seemed to be overwhelmed by instinctive furious passions but still seemed sane. This was influential in leading to the concept of moral insanity, which became an accepted diagnosis through the second half of the 19th century. Pinel’s main psychiatric heir, Esquirol, built on Pinel’s work and popularised various concepts of monomania.

However, Pinel was also criticised and rejected in some quarters. A new generation favoured pathological anatomy, seeking to locate mental disorders in brain lesions. Pinel undertook comparisons of skull sizes, and considered possible physiological substrates, but he was criticised for his emphasis on psychology and the social environment. Opponents were bolstered by the discovery of tertiary syphilis as the cause of some mental disorder. Pinel’s humanitarian achievements were emphasized and mythologised instead.

With increasing industrialisation, asylums generally became overcrowded, misused, isolated and run-down. The moral treatment principles were often neglected along with the patients. There was recurrent debate over the use of psychological-social oppression even if some physical forces were removed. By the mid-19th century in England, the Alleged Lunatics’ Friend Society was proclaiming the moral treatment approach was achieved “by mildness and coaxing, and by solitary confinement”, treating people like children without rights to make their own decisions.

Similarly in the mid-20th century, Foucault’s influential book, Madness and Civilisation: A History of Insanity in the Age of Reason, also known as History of Madness, focused on Pinel, along with Tuke, as the driving force behind a shift from physical to mental oppression. Foucault argued that the approach simply meant that patients were ignored and verbally isolated, and were worse off than before. They were made to see madness in others and then in themselves until they felt guilt and remorse. The doctor, despite his lack of medical knowledge about the underlying processes, had all powers of authority, and defined insanity. Foucault also suggested that a focus on the rights of patients at Bicetre was partly due to revolutionary concerns that it housed and chained victims of arbitrary or political power, or alternatively that it might be enabling refuge for anti-revolutionary suspects, as well as just ‘the mad’.

Scull argues that the “…manipulations and ambiguous ‘kindness’ of Tuke and Pinel…” may nevertheless have been preferable to the harsh coercion and physical “treatments” of previous generations, though he does recognise its “…less benevolent aspects and its latent potential … for deterioration into a repressive form….” Some have criticised the process of deinstitutionalisation that took place in the 20th century and called for a return to Pinel’s approach, so as not to underestimate the needs that mentally ill people might have for protection and care.

Who was Joseph Wolpe?

Published on by Andrew Marshall2 Comments

Introduction

Joseph Wolpe (20 April 1915 to 4 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behaviour therapy.

Wolpe grew up in South Africa, attending Parktown Boys’ High School and obtaining his MD from the University of the Witwatersrand.

In 1956, Wolpe was awarded a Ford Fellowship and spent a year at Stanford University in the Center for Behavioral Sciences, subsequently returning to South Africa but permanently moving to the United States in 1960 when he accepted a position at the University of Virginia.

In 1965, Wolpe accepted a position at Temple University.

One of the most influential experiences in Wolpe’s life was when he enlisted in the South African army as a medical officer. Wolpe was entrusted to treat soldiers who were diagnosed with what was then called “war neurosis” but today is known as post traumatic stress disorder. The mainstream treatment of the time for soldiers was based on psychoanalytic theory, and involved exploring the trauma while taking a hypnotic agent – so-called narcotherapy. It was believed that having the soldiers talk about their repressed experiences openly would effectively cure their neurosis. However, this was not the case. It was this lack of successful treatment outcomes that forced Wolpe, once a dedicated follower of Freud, to question psychoanalytic therapy and search for more effective treatment options. Wolpe is most well known for his reciprocal inhibition techniques, particularly systematic desensitisation, which revolutionised behavioural therapy. A Review of General Psychology survey, published in 2002, ranked Wolpe as the 53rd most cited psychologist of the 20th century, an impressive accomplishment accentuated by the fact that Wolpe was a psychiatrist.

Reciprocal Inhibition

In Wolpe’s search for a more effective way in treating anxiety he developed different reciprocal inhibition techniques, utilising assertiveness training. Reciprocal inhibition can be defined as anxiety being inhibited by a feeling or response that is not compatible with the feeling of anxiety. Wolpe first started using eating as a response to inhibited anxiety in the laboratory cats. He would offer them food while presenting a conditioned fear stimulus. After his experiments in the laboratory he applied reciprocal inhibition to his clients in the form of assertiveness training. The idea behind assertiveness training was that you could not be angry or aggressive while simultaneously assertive at same time. Importantly, Wolpe believed that these techniques would lessen the anxiety producing association. Assertiveness training proved especially useful for clients who had anxiety about social situations. However, assertiveness training did have a potential flaw in the sense that it could not be applied to other kinds of phobias. Wolpe’s use of reciprocal inhibition led to his discovery of systematic desensitisation. He believed that facing your fears did not always result in overcoming them but rather lead to frustration. According to Wolpe, the key to overcoming fears was “by degrees”.

Systematic Desensitisation

Systematic desensitisation is what Wolpe is most famous for. Systematic desensitisation is when the client is exposed to the anxiety-producing stimulus at a low level, and once no anxiety is present a stronger version of the anxiety-producing stimulus is given. This continues until the individual client no longer feels any anxiety towards the stimulus. There are three main steps in using systematic desensitization, following development of a proper case formulation or what Wolpe originally called, “behaviour analysis“. The first step is to teach the client relaxation techniques.

Wolpe received the idea of relaxation from Edmund Jacobson, modifying his muscle relaxation techniques to take less time. Wolpe’s rationale was that one cannot be both relaxed and anxious at the same time. The second step is for the client and the therapist to create a hierarchy of anxieties. The therapist normally has the client make a list of all the things that produce anxiety in all its different forms. Then together, with the therapist, the client makes a hierarchy, starting with what produces the lowest level of anxiety to what produces the most anxiety. Next is to have the client be fully relaxed while imaging the anxiety producing stimulus. Depending on what their reaction is, whether they feel no anxiety or a great amount of anxiety, the stimulus will then be changed to a stronger or weaker one. Systematic desensitisation, though successful, has flaws as well. The patient may give misleading hierarchies, have trouble relaxing, or not be able to adequately imagine the scenarios. Despite this possible flaw, it seems to be most successful.

Achievements

Wolpe’s effect on behavioural therapy is long-lasting and extensive. He received many awards for his work in behavioural science. His awards included the American Psychological Associations Distinguished Scientific Award, the Psi Chi Distinguished Member Award, and the Lifetime Achievement Award from the Association for the Advancement of Behaviour Therapy, where he was the second president. In addition to these awards, Wolpe’s alma mater, University of Witwatersrand, awarded him an honorary doctor of science degree in 1986. Furthermore, Wolpe was a prolific writer, some of his most famous books include, The Practice of Behaviour Therapy and Psychotherapy by Reciprocal Inhibition. Joseph Wolpe’s dedication to psychology is clear in his involvement in the psychology community, a month before his death he was attending conferences and giving lectures at Pepperdine University even though he was retired. Moreover, his theories have lasted well beyond his death.

Wolpe developed the Subjective Units of Disturbance Scale (SUDS) for assessing the level of subjective discomfort or psychological pain. He also created the Subjective Anxiety Scale (SAS) and the Fear Survey Plan that are used in behaviour research and therapy.

Wolpe died in 1997 of mesothelioma.

Who was Frances Ames?

Published on by Andrew Marshall1 Comment

Introduction

Frances Rix Ames (20 April 1920 to 11 November 2002) was a South African neurologist, psychiatrist, and human rights activist, best known for leading the medical ethics inquiry into the death of anti-apartheid activist Steve Biko, who died from medical neglect after being tortured in police custody.

When the South African Medical and Dental Council (SAMDC) declined to discipline the chief district surgeon and his assistant who treated Biko, Ames and a group of five academics and physicians raised funds and fought an eight-year legal battle against the medical establishment. Ames risked her personal safety and academic career in her pursuit of justice, taking the dispute to the South African Supreme Court, where she eventually won the case in 1985.

Born in Pretoria and raised in poverty in Cape Town, Ames became the first woman to receive a Doctor of Medicine degree from the University of Cape Town in 1964. Ames studied the effects of cannabis on the brain and published several articles on the subject. Seeing the therapeutic benefits of cannabis on patients in her own hospital, she became an early proponent of legalization for medicinal use. She headed the neurology department at Groote Schuur Hospital before retiring in 1985, but continued to lecture at Valkenberg and Alexandra Hospital. After apartheid was dismantled in 1994, Ames testified at the Truth and Reconciliation Commission about her work on the “Biko doctors” medical ethics inquiry. In 1999, Nelson Mandela awarded Ames the Star of South Africa, the country’s highest civilian award, in recognition of her work on behalf of human rights.

Early Life

Ames was born at Voortrekkerhoogte in Pretoria, South Africa, on 20 April 1920, to Frank and Georgina Ames, the second of three daughters. Her mother, who was raised in a Boer concentration camp by Ames’ grandmother, a nurse in the Second Boer War, was also a nurse. Ames never knew her father, who left her mother alone to raise three daughters in poverty. With her mother unable to care for her family, Ames spent part of her childhood in a Catholic orphanage where she was stricken with typhoid fever. Her mother later rejoined the family and moved them to Cape Town, where Ames attended the Rustenburg School for Girls. She enrolled at the University of Cape Town (UCT) medical school where she received her MBChB degree in 1942.

Medical Career

In Cape Town, Ames interned at Groote Schuur Hospital; she also worked in the Transkei region as a general practitioner. She earned her MD degree in 1964 from UCT, the first woman to do so. Ames became head of the neurology department at Groote Schuur Hospital in 1976. She was made an associate professor in 1978. Ames retired in 1985, but continued to work part-time at both Valkenberg and Alexandra Hospital as a lecturer in the UCT Psychiatry and Mental Health departments. In 1997, UCT made Ames an associate professor emeritus of neurology; she received an honorary doctorate in medicine from UCT in 2001. According to Pat Sidley of the British Medical Journal, Ames “was never made a full professor, and believed that this was because she was a woman.”

Biko Affair

South African anti-apartheid activist Steve Biko, who had formerly studied medicine at the University of Natal Medical School, was detained by Port Elizabeth security police on 18 August 1977 and held for 20 days. Sometime between 06 and 07 September, Biko was beaten and tortured into a coma. According to allegations by Ames and others, surgeon Ivor Lang, along with chief district surgeon Benjamin Tucker, collaborated with the police and covered up the abuse, leading to Biko’s death from his injuries on 12 September. According to Benatar & Benatar 2012, “there were clear ethical breaches on the part of the doctors who were responsible” for Biko.

When the South African Medical and Dental Council (SAMDC) along with the support of the Medical Association of South Africa (MASA), declined to discipline the district surgeons in Biko’s death, two groups of physicians filed separate formal complaints with the SAMDC regarding the lack of professionalism shown by Biko’s doctors. Both cases made their way to the South African Supreme Court in an attempt to force the SAMDC to conduct a formal inquiry into the medical ethics of Lang and Tucker. One case was filed by Ames, along with Trefor Jenkins and Phillip Tobias of the University of the Witwatersrand; a second case was filed by Dumisani Mzana, Yosuf Veriava of Coronationville Hospital, and Tim Wilson of Alexandra Health Centre.

As Ames and the small group of physicians pursued an inquiry into members of their own profession, Ames was called a whistleblower. Her position at the university was threatened by her superiors and her colleagues asked her to drop the case. By pursuing the case against the Biko doctors, Ames received personal threats and risked her safety. Baldwin-Ragaven et al. note that the medical association “closed ranks in support of colleagues who colluded with the security police in the torture and death of detainees [and] also attempted to silence and discredit those doctors who stood up for human rights and who demanded disciplinary action against their colleagues.”

After eight years, Ames won the case in 1985 when the South African Supreme Court ruled in her favour. With Ames’ help, the case forced the medical regulatory body to reverse their decision. The two doctors who treated Biko were finally disciplined and major medical reforms followed. According to Benatar & Benatar 2012, the case “played an important role in sensitising the medical profession to medical ethical issues in South Africa.”

Cannabis Research

Ames studied the effects of cannabis in 1958, publishing her work in The British Journal of Psychiatry as “A clinical and metabolic study of acute intoxication with Cannabis sativa and its role in the model psychoses”. Her work is cited extensively throughout the cannabis literature. She opposed the War on Drugs and was a proponent of the therapeutic benefits of cannabis, particularly for people with multiple sclerosis (MS). Ames observed first-hand how cannabis (known as dagga in South Africa) relieved spasm in MS patients and helped paraplegics in the spinal injuries ward of her hospital. She continued to study the effects of cannabis in the 1990s, publishing several articles about cannabis-induced euphoria and the effects of cannabis on the brain.

Personal Life

Ames was married to editorial writer David Castle of the Cape Times and they had four sons. She was 47 years old when her husband died unexpectedly in 1967. After her husband’s death, Ames’s housekeeper Rosalina helped raise the family. Ames wrote about the experience in her memoir, Mothering in an Apartheid Society (2002).

Death

Ames struggled with leukaemia for some time. Before her death, she told an interviewer, “I shall go on until I drop.” She continued to work for UCT as a part-time lecturer at Valkenberg Hospital until six weeks before she died at home in Rondebosch on 11 November 2002. Representing UCT’s psychiatry department, Greg McCarthy gave the eulogy at the funeral. Ames was cremated, and according to her wishes, her ashes were combined with hemp seed and dispersed outside of Valkenberg Hospital where her memorial service was held.

Legacy

South African neurosurgeon Colin Froman referred to Ames as the “great and unorthodox protagonist for the medical use of marijuana many years before the current interest in its use as a therapeutic drug”. J.P. van Niekerk of the South African Medical Journal notes that “Frances Ames led by conviction and example” and history eventually justified her action in the Biko affair.

Ames’s work on the Biko affair led to major medical reforms in South Africa, including the disbanding and replacement of the old apartheid-era medical organisations which failed to uphold the medical standards of the profession. According to van Niekerk, “the most enduring lesson for South African medicine was the clarification of the roles of medical practitioners when there is a question of dual responsibilities. This is now embodied inter alia in the SAMA Code of Conduct and in legal interpretations of doctors’ responsibilities”.

Ames testified during the medical hearings at the Truth and Reconciliation Commission in 1997. Archbishop Desmond Tutu honoured Ames as “one of the handful of doctors who stood up to the apartheid regime and brought to book those doctors who had colluded with human rights abuse.” In acknowledgement of her work on behalf of human rights in South Africa, Nelson Mandela awarded Ames the Order of the Star of South Africa in 1999, the highest civilian award in the country.

Who was Ernst Rudin?

Published on by Andrew Marshall1 Comment

Introduction

Ernst Rüdin (19 April 1874 to 22 October 1952) was a Swiss-born German psychiatrist, geneticist, eugenicist and Nazi.

Rising to prominence under Emil Kraepelin and assuming his directorship at what is now called the Max Planck Institute of Psychiatry in Munich. While he has been credited as a pioneer of psychiatric inheritance studies, he also argued for, designed, justified and funded the mass sterilisation and clinical killing of adults and children.

Early Career

Ernst Rudin, Psychiatrist (1)
Ernst Rudin, 1944.

Commencing in 1893, Rüdin studied medicine at universities in several countries, graduating in 1898. At the Burghölzli in Zurich, he worked as assistant to Eugen Bleuler who coined the term ‘schizophrenia’. He completed his PhD, then a psychiatric residency at a Berlin prison. From 1907, he worked at the University of Munich as assistant to Emil Kraepelin, the highly influential psychiatrist who had developed the diagnostic split between ‘dementia praecox’ (‘early dementia’ – reflecting his pessimistic prognosis – renamed schizophrenia) and ‘manic-depressive illness’ (including unipolar depression), and who is considered by many to be the father of modern psychiatric classification. Rüdin became senior lecturer in 1909, as well as senior physician at the Munich Psychiatric Hospital, succeeding Alois Alzheimer.

Kraepelin and Rüdin were both ardent advocates of a theory that the German race was becoming overly ‘domesticated’ and thus degenerating into higher rates of mental illness and other conditions. Fears of degeneration were somewhat common internationally at the time, but the extent to which Rüdin took them may have been unique, and from the very beginning of his career he made continuous efforts to have his research translate into political action. He also repeatedly drew attention to the financial burden of the sick and disabled.

Rüdin developed the concept of “empirical genetic prognosis” of mental disorders. He published influential initial results on the genetics of schizophrenia (known as dementia praecox) in 1916. Rüdin’s data did not show a high enough risk in siblings for schizophrenia to be due to a simple recessive gene as he and Kraepelin thought, but he put forward a two-recessive-gene theory to try to account for this. This has been attributed to a “mistaken belief” that just one or a small number of gene variations caused such conditions. Similarly his own large study on Mood disorders correctly disproved his own theory of simple Mendelian inheritance and also showed environmental causes, but Rüdin simply neglected to publish and continued to advance his eugenic theories. Nevertheless, Rüdin pioneered and refined complex techniques for conducting studies of inheritance, was widely cited in the international literature for decades, and is still regarded as “the father of psychiatric genetics”.

Rüdin was influenced by his then brother-in-law, and long-time friend and colleague, Alfred Ploetz, who was considered the ‘father’ of racial hygiene and indeed had coined the term in 1895. This was a form of eugenics, inspired by social darwinism, which had gained some popularity internationally, as would the voluntary or compulsory sterilisation of psychiatric patients, initially in America. Rüdin campaigned for this early on. At a conference on alcoholism in 1903, he argued for the sterilisation of ‘incurable alcoholics’, but his proposal was roundly defeated. In 1904, he was appointed co-editor in chief of the newly founded Archive for Racial Hygiene and Social Biology, and in 1905 was among the co-founders of the German Society for Racial Hygiene (which soon became International), along with Ploetz. He published an article of his own in Archives in 1910, in which he argued that medical care for the mentally ill, alcoholics, epileptics and others was a distortion of natural laws of natural selection, and medicine should help to clean the genetic pool.

Increasing Influence

In 1917, a new German Institute for Psychiatric Research was established in Munich (known as the DFA in German; renamed the Max Planck Institute of Psychiatry after World War II), designed and driven forward by Emil Kraepelin. The Institute incorporated a Department of Genealogical and Demographic Studies (known as the GDA in German) – the first in the world specialising in psychiatric genetics – and Rüdin was put in charge by overall director Kraepelin. In 1924, the Institute came under the umbrella of the prestigious Kaiser Wilhelm Society. From 1925, Rüdin spent three years as full Professor of Psychology at Basel, Switzerland. He returned to the Institute in 1928, with an expanded departmental budget and new building at 2 Kraepelinstrasse, financed primarily by the American Rockefeller Foundation. The institute soon gained an international reputation as leading psychiatric research, including in hereditary genetics. In 1931, a few years after Kraepelin’s death, Rüdin took over the directorship of the entire Institute as well as remaining head of his department.

Rüdin was among the first to attempt to educate the public about the “dangers” of hereditary defectives and the value of the Nordic race as “culture creators”. By 1920, his colleague Alfred Hoche published, with lawyer Karl Binding, the influential “Allowing the Destruction of Life Unworthy of Living”.

In 1930, Rüdin was a leading German representative at the First International Congress for Mental Hygiene, held in Washington, US, arguing for eugenics. In 1932, he became President of the International Federation of Eugenics Organisations. He was in contact with Carlos Blacker of the British Eugenics Society, and sent him a copy of pre-Nazi voluntary sterilisation laws enacted in Prussia; a precursor to the Nazi forced sterilisation laws that Rüdin is said to have already prepared in his desk drawer.

From 1935 to 1945, he was President of the Society of German Neurologists and Psychiatrists (GDNP), later renamed the German Association for Psychiatry, Psychotherapy and Neurology (DGPPN).

The American Rockefeller Foundation funded numerous international researchers to visit and work at Rüdin’s psychiatric genetics department, even as late as 1939. These included Eliot Slater and Erik Stromgren, considered the founding fathers of psychiatric genetics in Britain and Scandinavia respectively, as well as Franz Josef Kallmann who became a leading figure in twins research in the US after emigrating in 1936. Kallmann had claimed in 1935 that ‘minor anomalies’ in otherwise unaffected relatives of schizophrenics should be grounds for compulsory sterilisation.

Rüdin’s research was also supported with manpower and financing from the German National Socialists.

Nazi Expert

In 1933, Ernst Rüdin, Alfred Ploetz, and several other experts on racial hygiene were brought together to form the Expert Committee on Questions of Population and Racial Policy under Reich Interior Minister Wilhelm Frick. The committee’s ideas were used as a scientific basis to justify the racial policy of Nazi Germany and its “Law for the Prevention of Hereditarily Diseased Offspring” was passed by the German government on 01 January 1934. Rüdin was such an avid proponent that colleagues nicknamed him the “Reichsfuhrer for Sterilisation”

In a speech to the German Society for Rassenhygiene published in 1934, Rüdin recalled the early days of trying to alert the public to the special value of the Nordic race and the dangers of defectives. He stated: “The significance of Rassenhygiene racial hygiene did not become evident to all aware Germans until the political activity of Adolf Hitler and only through his work has our 30-year-long dream of translating Rassenhygiene into action finally become a reality.” Describing it as a ‘duty of honour’ for society to help implement the Nazi policies, Rüdin declared: “Whoever is not physically or mentally fit must not pass on his defects to his children. The state must take care that only the fit produce children. Conversely, it must be regarded as reprehensible to withhold healthy children from the state.”

From early on, Rüdin had been a ‘racial fanatic’ for the purity of the ‘German people’. However, he was also described in 1988 as “not so much a fanatical Nazi as a fanatical geneticist”. His ideas for reducing new cases of schizophrenia would prove a total failure, despite between 73% and 100% of the diagnosed being sterilised or killed.

Rüdin joined the Nazi party in 1937. In 1939, on his 65th birthday, he was awarded a ‘Goethe medal for art and science’ handed to him personally by Hitler, who honoured him as the ‘pioneer of the racial-hygienic measures of the Third Reich’. In 1944, he received a bronze Nazi eagle medal (Adlerschild des Deutschen Reiches), with Hitler calling him the ‘pathfinder in the field of hereditary hygiene’.

In 1942, speaking about ‘euthanasia’, Rüdin emphasised “the value of eliminating young children of clearly inferior quality”. He supported and financially aided the work of Julius Duessen at Heidelberg University with Carl Schneider, clinical research which from the beginning involving killing children.

Post-War Life

At the end of the war in 1945, Rüdin claimed he had only ever engaged in academic science, only ever heard rumours of killings at the nearby insane asylums, and that he hated the Nazis. However, some of his Nazi political activities, scientific justifications, and awards from Hitler were already uncovered in 1945 (as were his lecture handouts praising Nordics and disparaging Jews). Investigative journalist Victor H. Bernstein concluded: “I am sure that Prof. Rüdin never so much as killed a fly in his 74 years. I am also sure he is one of the most evil men in Germany.” Rüdin was stripped of his Swiss citizenship which he had held jointly with German, and two months later was placed under house arrest by the Munich Military Government. However, interned in the US, he was released in 1947 after a ‘denazification’ trial where he was supported by former colleague Kallmann (a eugenicist himself) and famous quantum physicist Max Planck; his only punishment was a 500-mark fine.

Speculation about the reasons for his early release, despite having been considered as a potential criminal defendant for the Nuremberg trials, include the need to restore confidence and order in the German medical profession; his personal and financial connections to prestigious American and British researchers, funding bodies and others; and the fact that he repeatedly cited American eugenic sterilization initiatives to justify his own as legal (indeed the Nuremberg trials carefully avoided highlighting such links in general). Nevertheless, Rüdin has been cited as a more senior and influential architect of Nazi crimes than the physician who was sentenced to death, Karl Brandt, or the infamous Josef Mengele who had attended his lectures and been employed by his Institute.

After Rüdin’s death in 1952, the funeral eulogy was held by Kurt Pohlisch, a close friend who had been professor of psychiatry at Bonn University, director of the second-largest genetics research institute in Germany, and expert Nazi advisor on Action T4.

Rüdin’s connections to the Nazis were a major reason for criticisms of psychiatric genetics in Germany after 1945.

He was survived by his daughter, Edith Zerbin-Rüdin, who became a psychiatric geneticist and eugenicist herself. In 1996, Zerbin-Rüdin, along with Kenneth S. Kendler, published a series of articles on his work which were criticised by others for whitewashing his racist and later Nazi ideologies and activities (Elliot S. Gershon also notes that Zerbin-Rüdin acted as defender and apologist for her father in private conversation and in a transcribed interview published in 1988). Kendler and other leading psychiatric genetic authors have been accused as recently as 2013 of producing revisionist historical accounts of Rüdin and his ‘Munich School’. Three types of account have been identified:

“(A) those who write about German psychiatric genetics in the Nazi period, but either fail to mention Rüdin at all, or cast him in a favorable light; (B) those who acknowledge that Rüdin helped promote eugenic sterilization and/or may have worked with the Nazis, but generally paint a positive picture of Rüdin’s research and fail to mention his participation in the “euthanasia” killing program; and (C) those who have written that Rüdin committed and supported unspeakable atrocities.”

What is Memory Inhibition?

Published on by Andrew Marshall3 Comments

Introduction

In psychology, memory inhibition is the ability not to remember irrelevant information. The scientific concept of memory inhibition should not be confused with everyday uses of the word “inhibition”. Scientifically speaking, memory inhibition is a type of cognitive inhibition, which is the stopping or overriding of a mental process, in whole or in part, with or without intention.

Memory inhibition is a critical component of an effective memory system. While some memories are retained for a lifetime, most memories are forgotten. According to evolutionary psychologists, forgetting is adaptive because it facilitates selectivity of rapid, efficient recollection. For example, a person trying to remember where they parked their car would not want to remember every place they have ever parked. In order to remember something, therefore, it is essential not only to activate the relevant information, but also to inhibit irrelevant information.

There are many memory phenomena that seem to involve inhibition, although there is often debate about the distinction between interference and inhibition.

Refer to Repressed Memory and Recovered Memory Therapy.

Brief History

In the early days of psychology, the concept of inhibition was prevalent and influential (e.g. Breese, 1899; Pillsbury, 1908; Wundt, 1902). These psychologists applied the concept of inhibition (and interference) to early theories of learning and forgetting. Starting in 1894, German scientists Muller and Shumann conducted empirical studies that demonstrated how learning a second list of items interfered with memory of the first list. Based on these experiments, Muller argued that the process of attention was based on facilitation. Arguing for a different explanation, Wundt (1902) claimed that selective attention was accomplished by the active inhibition of unattended information, and that to attend to one of several simultaneous stimuli, the others had to be inhibited. American Psychologist Walter Pillsbury combined Muller and Wundt’s arguments, claiming that attention both facilitates information that is wanted and inhibits information that is unwanted.

In the face of behaviourism during the late 1920s through the 1950s, and through the early growth of cognitive psychology in the late 1950s and early 1960s, inhibition largely disappeared as a theory. Instead, classical interference theory dominated memory research until as late as 1960. By the early 1970s, however, classical interference theory began to decline due to its reliance on associationism, its inability to explain the facts of interference or how interference applies to everyday life, and to newly published reports on proactive and retroactive inhibition.

Since the mid-1980s, there has been a renewed interest in understanding the role of inhibition in cognition. Research on a wide variety of psychological processes, including attention, perception, learning and memory, psycholinguistics, cognitive development, aging, learning disabilities, and neuropsychology, suggests that resistance to interference (which implies capacity for inhibition) is an important part of cognition.

More recently, researchers suggest that the hippocampus plays a role in the regulation of disliked and competing memories, and fMRI studies have shown hippocampus activity during inhibition processes.

Empirical Research

Part-Set Cuing Effect

The “part-set cuing effect” was initially discovered by Slamecka (1968), who found that providing a portion of to-be-remembered items as test cues often impairs retrieval of the remaining un-cued items compared with performance in a no-cue (free-recall) control condition. Such an effect is intriguing because normally cues are expected to aid recall (e.g. Tulving & Pearlstone, 1966). A prominent figure in retrieval-based inhibition research, Henry L. Roediger III was another one of the first psychologists to propose the idea that retrieving an item reduces the subsequent accessibility of other stored items. Becoming aware of the part-set cueing effect reduces the effect, such that relearning part of a set of previously learned associations can improve recall of the non-relearned associations.

Hasher and Zacks’ Inhibition Account of Ageing

Using inhibition to explain memory processes began with the work of Hasher and Zacks (1988), which focused on the cognitive costs associated with aging and bridging the attention-memory gap. Hasher and Zacks found that older adults show impairments on tasks that require inhibiting irrelevant information in working memory, and these impairments may lead to problems in a variety of contexts.

Retrieval-Induced Forgetting

Anderson and Spellman’s model of retrieval-induced forgetting suggests that when items compete during retrieval, an inhibitory process will serve to suppress those competitors. For instance, retrieval of one meaning for a word (e.g. the verb meaning of the word sock) will tend to inhibit the dominant meaning of that word (e.g. the noun meaning of sock). In 1995, Anderson and Spellman conducted a three-phase study using their retrieval-induced forgetting model to demonstrate unlearning as inhibition.

  • Study phase: Participants study a list of category-exemplar pairings where some exemplars semantically similar in that they belong to another category besides the one they are explicitly paired with (e.g. Food-Cracker, Food-Strawberry, Red-Tomato, Red-Blood).
  • Retrieval-practice phase: Participants are cued to practice remembering some of the exemplars given the category cue (e.g. Red-Bl__).
  • Test phase: Given each category as a cue, the participant tries to recall the exemplar (e.g. Food-C__, Food-S__, Red-T__, Red-Bl__).

Anderson and Spellman observed that items that shared a semantic relationship with practiced information was less recallable. Using the example from above, recall of items related to practiced information, including tomato and strawberry was lower than recall for cracker, even though strawberry is part of a different pair. This finding suggests that associative competition by explicit category cue is not the only factor in retrieval difficulty. They theorised that the brain suppresses, or inhibits, non-practiced attributes. This explains why an item that is very similar to tomato, but not from the same pair, also exhibits decreased recall rate.

“Think/No-Think” Paradigm and Intentional Inhibition

During the recovered memory debate of the 1990s, cognitive psychologists were dubious about whether specific memories could be repressed. One stumbling block was that repression had not been demonstrated in a research study. In 2001, researchers Anderson and Green claimed to have found laboratory evidence of suppression. They trained their participants with a list of unrelated word pairs (such as ordeal-roach), so they could respond with the second member of the pair (roach) when they saw the other member (ordeal). The more frequently participants had tried to not think about a particular word, the less likely they were to retrieve it on a final memory test. This impairment even occurred when participants were given an “independent probe” test, i.e. given a similar category (insect) instead of the original cue (roach), and asked to fill in the blank on the memory test: insect-r_____. According to Anderson and Green, the fact that participants had a decreased ability to recall items they were told to forget strongly supports the existence of an inhibitory control mechanism and the idea that people have the ability to suppress unwanted memories.

Though Anderson & Green’s (2001) results have been replicated several times, a group of prominent psychology researchers using the same methodology as the original study were unable to replicate even the basic result (Bulevich, Roediger, Balota, & Butler, 2006). They determined that suppression is not a robust experimental phenomenon in the think/no-think paradigm and suggested that Anderson and Green’s findings could be explained by retroactive interference, or simply thinking about X when told to “not think” about Y.

Amnesia for Trauma or Abuse

Amnesia, the forgetting of important personal information, usually occurs because of disease or injury to the brain, while Psychogenic amnesia, which involves a loss of personal identity and has psychological causes, is rare. Nonetheless, a range of studies have concluded that at least 10% of physical and sexual abuse victims forget the abuse. Some studies claim that the rate of delayed recall of many forms of traumatic experiences (including natural disasters, kidnapping, torture and more) averages among studies at approximately 15%, with the highest rates resulting from child sexual abuse, military combat, and witnessing a family member murdered. A 1996 interview survey of 711 women reported that forgetting and later remembering childhood sexual abuse is not uncommon; more than a quarter of the respondents who reported abuse also reported forgetting the abuse for some period of time and then recalling it on their own. Of those who reported abuse, less than 2% reported that the recall of the abuse was assisted by a therapist or other professional. Other studies show that people who have experienced trauma usually remember it, not forget it. (McNally, 2001) found that women who report having either repressed or recovered memories of childhood sexual abuse have no worse memory for trauma cue words than women who have never been sexually abused. Similarly, McNally (1998) found that women who were sexually abused as children and who developed PTSD as a result of their abuse will not have any more trouble recalling trauma related words than healthy adult survivors of childhood sexual abuse or women who were never abused as children.

Although the rate of recall of previously forgotten traumatic events was shown by Elliot and Briere (1996) to be unaffected by whether or not the victim had a history of being in psychotherapy, individuals who report repressed memories are more susceptible to producing false memories than individuals who could always recall the memory. Williams found that among women with confirmed histories of sexual abuse, approximately 38% did not recall the abuse 17 years later, especially when it was perpetrated by someone familiar to them. Hopper cites several studies which indicate that some abuse victims will have intervals of complete amnesia for their abuse. Peer reviewed and clinical studies have documented the existence of recovered memory; one website lists 43 legal cases where an individual whose claim to have recovered a repressed memory has been accepted by a court. Traumatic amnesia, which allegedly involves the forgetting of specific traumatic events for long periods of time, is highly controversial, as is repression, the psychodynamic explanation of traumatic amnesia. Because these concepts lack good empirical support, psychological scientists are sceptical about the validity of “recovered memories”, and argue that some therapists, through suggestive techniques, have (un)knowingly encouraged false memories of victimisation.

Evidence Against

The idea that subjects can actively inhibit a memory has many critics. MacLeod (2003) challenged the idea of inhibition in cognitive control, arguing that inhibition can be attributed to conflict resolution, which is the error-prone act of choosing between two similar values that do not necessarily have the same pair. Re-examine the pairs from above: Food-Cracker, Food-Strawberry, Red-Tomato, and Red-Blood. Memory inhibition theories suggest that recall of strawberry decreases when recall of tomato decreases because tomato’s attributes are inhibited when red-blood is learned. MacLeod argues that inhibition does not take place, but instead is the result of confusion between similar word-pairs like food-tomato and red-strawberry that can lead to errors. This is different from tomato’s attributes being inhibited. “In most cases where inhibitory mechanisms have been offered to explain cognitive performance”, explains MacLeod, “non-inhibitory mechanisms can accomplish the same goal (p.203)”.

What is Recovered Memory Therapy

Published on by Andrew Marshall2 Comments

Introduction

Recovered-memory therapy (RMT) is a catch-all term for a controversial and scientifically discredited form of psychotherapy that utilises one or more unproven interviewing techniques (such as hypnosis, guided imagery, and the use of sedative-hypnotic drugs) to purportedly help patients recall previously forgotten memories.

Proponents of recovered memory therapy claim, contrary to evidence, that traumatic memories can be buried in the subconscious and thereby affect current behaviour, and that these memories can be recovered through the use of RMT techniques. RMT is not recommended by mainstream ethical and professional mental health associations.

Refer to Repressed Memory and Memory Inhibition.

Terminology

The term false-memory syndrome was coined between 1992 and 1993 by psychologists and sociologists associated with the False Memory Syndrome Foundation, an organisation which advocates on behalf of individuals who claim to have been falsely accused of perpetrating child sexual abuse. These researchers argue that RMT can result in patients recalling instances of sexual abuse from their childhood which had not actually occurred. While not a therapeutic technique in and of itself, practitioners of RMT generally utilise methods (such as hypnosis, age regression, guided visualization, and/or the use of substances such as sodium amytal) that are known to support the creation of false memories. A 1994 survey of 1000 therapists by Michael D. Yapko found that 19% of the therapists knew of a case in which a client’s memory had been suggested by therapy but was in fact false. An inquiry by the Australian government into the practice found little support for or use of memory recovery therapies among health professionals, and warned that professionals had to be trained to avoid the creation of false memories. A 2018 survey found that although 5% of a US public sample reported recovering memories of abuse during therapy (abuse they reported having no previous memory of), none of them used the terminology “recovered memory therapy” – instead those recovering memories reported using a variety of other therapy types (e.g. attachment therapy, Emotional Freedom Techniques, etc).

Research

A range of studies have concluded that at least 10% of physical and sexual abuse victims forget the abuse. The rate of delayed recall of many forms of traumatic experiences (including natural disasters, kidnapping, torture and more) averages among studies at approximately 15%, with the highest rates resulting from child sexual abuse, military combat, and witnessing a family member murdered. The rate of recall of previously forgotten traumatic events was shown by Elliot and Briere (1996) to be unaffected by whether or not the victim had a history of being in psychotherapy. Linda Meyer Williams, who interviewed 129 adult women who were treated for verified sexual abuse at a hospital as children between the ages of 12 months to 10 years, found that among women with confirmed histories of sexual abuse, approximately 38% did not recall the reported incident on file at the hospital 17 years later, especially when it was perpetrated by someone familiar to them. This study is routinely cited as evidence of repression, however 88% of women interviewed said they had been molested, despite not reporting the specific incident on file – a figure which suggests the opposite of the repression theory. Additionally, this study was conducted using general interviews and relied on the women interviewed to bring up the specific incident that had led them to be hospitalised as children unprompted, meaning if a participant did not bring up the specific incident on file as part of the general interview, this was reported as indicative of repression of the memory. Since the interviewees included victims who were infants at the time, it is unlikely that these specific participants would remember the event. Hopper cites several studies of corroborated abuse in which some abuse victims will have intervals of complete or partial amnesia for their abuse.

A 1996 interview survey of 711 women reported that forgetting and later remembering childhood sexual abuse is not uncommon; more than a quarter of the respondents who reported abuse also reported forgetting the abuse for some period of time and then recalling it on their own. Of those who reported abuse, less than 2% reported that the recall of the abuse was assisted by a therapist or other professional.

A review article on potentially harmful therapies listed RMT as a treatment that will probably produce harm in some who receive it. Richard Ofshe, a member of the advisory board to the FMSF, describes the practice of “recovering” memories as fraudulent and dangerous.

Studies by Elizabeth Loftus and others have concluded that it is possible to produce false memories of childhood incidents. The experiments involved manipulating subjects into believing that they had some fictitious experience in childhood, such as being lost in a shopping mall at age 6. This involved using a suggestive technique called “familial informant false narrative procedure,” in which the experimenter claims the validity of the false event is supported by a family member of the subject. The study has been used to support the theory that false memories of traumatic sexual abuse can be implanted in a patient by therapists. Critics of these studies argue that the techniques do not resemble any approved or mainstream treatment modality, and there are criticisms that the implanted events used are not emotionally comparable to sexual abuse. Critics contend that Loftus’s conclusions overreach the evidence. Loftus has rebutted these criticisms.

Some patients later retract memories they had previously believed to be recovered. While false or contrived memories are possible reasons for such retractions, other explanations suggested for the retraction of allegations of abuse made by children and adults include guilt, a feeling of obligation to protect their family and a reaction to familial stress rather than a genuine belief that their memories are false. The number of retractions is reported to be small compared to the actual number of child sexual abuse allegations made based on recovered memories.

A study at the Dissociative Disorders and Trauma Program of the McLean Hospital concluded that recovered memories are mostly unconnected to psychotherapeutic treatment and that memories are often corroborated by independent evidence, often appearing while home or with family and friends, with suggestion being generally denied as a factor in recovering memories. Very few participants were in therapy during their first memory recovery and a majority of participants in this study found strong corroboration of their recovered memories.

A 2018 US study is the largest study known that surveys the general public about memory recovery in therapy. The study was presented to participants aged 50 years or older as a “Life Experience” survey and found that 8% of the 2,326 adults had reported seeing therapists, mostly starting in the 1990s, that discussed the possibility of repressed memories of abuse. 4% of adults had reported recovering memories of abuse in therapy for which they had no previous memory. Recovered memories of abuse were associated with most therapy types.

Professional Guidelines

There are several individuals and groups that have published guidelines, criticisms or cautions about recovered memory therapy and techniques to stimulate recall:

  • In the Brandon Report, a set of training, practice, research and professional development recommendations, the United Kingdom’s Royal College of Psychiatrists advised psychiatrists to avoid use of RMT or any “memory recovery techniques”, citing a lack of evidence to support the accuracy of memories recovered in this way.
  • In 2004, the government of the Health Council of the Netherlands issued a report in response to inquiries from professionals regarding RMT and memories of traumatic child sexual abuse. The Health Council stated that while traumatic childhood experiences were major risk factors for psychological problems in adulthood, the fact that most traumatic memories are well-remembered but can be forgotten or become inaccessible though the influence of specific circumstances precludes a simple description of the relationship between memory and trauma. The report also notes that memories can be confabulated, re-interpreted and even apparently vivid or dramatic memories can be false, a risk that is increased when therapists use suggestive techniques, attempt to link symptoms to past trauma, with certain patients and through the use of methods to stimulate memories.
  • The Australian Hypnotherapists Association (AHA) issued a similar statement, for contexts where false memories of child sexual abuse may arise. The AHA acknowledges that child sexual abuse is serious, damaging and at least some memories are genuine, while cautioning that some questioning techniques and interventions may lead to illusory memories leading to false beliefs about abuse.
  • The Canadian Psychological Association has issued guidelines for psychologists addressing recovered memories. Psychologists are urged to be aware of their limitations in knowledge and training regarding memory, trauma and development and “that there is no constellation of symptoms which is diagnostic of child sexual abuse”. The guidelines also urge caution and awareness of the benefits and limitations of “relaxation, hypnosis, guided imagery, free associations, inner child exercises, age regression, body memory interpretation, body massage, dream interpretation, and the use of projective techniques” and special caution regarding any legal involvement of memories, abuse and therapy.

Legal Issues

In Ramona v. Isabella, Gary Ramona sued his daughter’s therapist for implanting false memories of his abuse of her. In the first case putting recovered memory therapy, itself, on trial, he eventually was awarded $500,000 in 1994.

Discussing RMT in the New South Wales Parliament in 1995, the state Minister for Health, Andrew Refshauge – a medical practitioner – stated that the general issue of admissibility of evidence based on recovered memories was one for the Attorney General. In 2004 Australian Counselling Association issued a draft position statement regarding recovered memories in which it informed its membership of possible legal difficulties if they affirm accusations as true based solely upon discussion of a patient’s recovered memories, without adequate corroborating evidence.

A degree of controversy does remain within legal circles, with some holding the view that therapists and courts should consider repressed memories the same as they consider regular memories. Three relevant studies state that repressed memories are “no more and no less accurate than continuous memories.”

Recovered memory therapy was an issue in the criminal trials of some Catholic priests accused of fondling or sexually assaulting juvenile-turned-adult parishioners.

In a 2017 criminal case in Canada, a Nova Scotian clergyman, the Reverend Brent Hawkes, was acquitted in a case involving recovered memories of alleged historical sexual abuse when Justice Alan Tufts described in his ruling that the complainant’s method of re-constructing his memory of alleged events after joining a men’s group and hearing similar accounts from other “survivors” his evidence could not be reliable.

Several court cases awarded multimillion-dollar verdicts against Minnesota psychiatrist Diane Bay Humenansky, who used hypnosis and other suggestive techniques associated with RMT, resulting in accusations by several patients against family members that were later found to be false.

In 1999 the Netherlands Board of Prosecutors General formed The National Expert Group on Special Sexual Matters, in Dutch – Landelijke Expertisegroep Bijzondere Zedenzaken (LEBZ). LEBZ consists of a multidisciplinary group of experts of whom investigating police officers and prosecutors are mandated to consult before considering arresting or prosecuting a person accused of sexual crimes involving repressed memories or recovered memory therapy. The LEBZ released a report for the period of 2003 – 2007 stating that 90% of the cases they consulted on were stopped due to their recommendations that the allegations were not based on reliable evidence.

What is Repressed Memory?

Published on by Andrew Marshall2 Comments

Introduction

Repressed memory is a controversial, and largely scientifically discredited, claim that memories for traumatic events may be stored in the unconscious mind and blocked from normal conscious recall.

Refer to Recovered Memory Therapy and Memory Inhibition.

As originally postulated by Sigmund Freud, repressed memory theory claims that although an individual may be unable to recall the memory, it may still affect the individual through subconscious influences on behaviour and emotional responding.

Despite widespread belief in the phenomenon of repressed memories among laypersons and clinical psychologists, most research psychologists who study the psychology of memory dispute that repression ever occurs at all. While some psychologists claim that repressed memories can be recovered through psychotherapy (or may be recovered spontaneously, years or even decades after the event, when the repressed memory is triggered by a particular smell, taste, or other identifier related to the lost memory), experts in the psychology of memory argue that, rather than promoting the recovery of a real repressed memory, psychotherapy is more likely to contribute to the creation of false memories. According to the American Psychological Association, it is not possible to distinguish repressed memories from false ones without corroborating evidence.

In part because of the intense controversies that arose surrounding the concepts of repressed and recovered memories, many clinical psychologists stopped using those terms and instead adopted the term dissociative amnesia to refer to the purported processes whereby memories for traumatic events become inaccessible, and the term dissociative amnesia can be found in the DSM-V, where it is defined as an “inability to recall autobiographical information. This amnesia may be localised (i.e. an event or period of time), selective (i.e. a specific aspect of an event), or generalised (i.e. identity and life history).” The change in terminology, however, has not made belief in the phenomenon any less problematic according to experts in the field of memory. As Richard J. McNally, Professor and Director of Clinical Training in the Department of Psychology at Harvard University, has written:

“The notion that traumatic events can be repressed and later recovered is the most pernicious bit of folklore ever to infect psychology and psychiatry. It has provided the theoretical basis for ‘recovered memory therapy’ — the worst catastrophe to befall the mental health field since the lobotomy era.”

Brief History

The concept of repressed memory originated with Sigmund Freud in his 1896 essay Zur Ätiologie der Hysterie (“On the etiology of hysteria”). One of the studies published in his essay involved a young woman by the name of Anna O. Among her many ailments, she suffered from stiff paralysis on the right side of her body. Freud stated her symptoms to be attached to psychological traumas. The painful memories had separated from her consciousness and brought harm to her body. Freud used hypnosis to treat Anna O. She is reported to have gained slight mobility on her right side

Issues

Case Studies

Psychiatrist David Corwin has claimed that one of his cases provides evidence for the reality of repressed memories. This case involved a patient (the Jane Doe case) who, according to Corwin, had been seriously abused by her mother, had recalled the abuse at age six during therapy with Corwin, then eleven years later was unable to recall the abuse before memories of the abuse returned to her mind again during therapy. An investigation of the case by Elizabeth Loftus and Melvin Guyer, however, raised serious questions about many of the central details of the case as reported by Corwin, including whether or not Jane Doe was abused by her mother at all, suggesting that this may be a case of false memory for childhood abuse with the memory “created” during suggestive therapy at the time that Doe was six. Loftus and Guyer also found evidence that, following her initial “recall” of the abuse during therapy at age six, Doe had talked about the abuse during the eleven years in between the sessions of therapy, indicating that even if abuse had really occurred, memory for the abuse had not been repressed. More generally, in addition to the problem of false memories, this case highlights the critical dependence of repression-claims cases on the ability of individuals to recall whether or not they had previously been able to recall a traumatic event; as McNally has noted, people are notoriously poor at making that kind of judgement.

An argument that has been made against the validity of the phenomenon of repressed memories is that there is little (if any) discussion in the historical literature prior to the 1800s of phenomena that would qualify as examples of memory repression or dissociative amnesia. In response to Harrison Pope’s 2006 claim that no such examples exist, Ross Cheit, a political scientist at Brown University, cited the case of Nina, a 1786 opera by the French composer Nicolas Dalayrac, in which the heroine, having forgotten that she saw her lover apparently killed in a duel, waits for him daily. Pope claims that even this single fictional description does not clearly meet all criteria for evidence of memory repression, as opposed to other phenomena of normal memory.

Despite the claims by proponents of the reality of memory repression that any evidence of the forgetting of a seemingly traumatic event qualifies as evidence of repression, research indicates that memories of child sexual abuse and other traumatic incidents may sometimes be forgotten through normal mechanisms of memory. Evidence of the spontaneous recovery of traumatic memories has been shown, and recovered memories of traumatic childhood abuse have been corroborated; however, forgetting trauma does not necessarily imply that the trauma was repressed. One situation in which the seeming forgetting, and later recovery, of a “traumatic” experience is particularly likely to occur is when the experience was not interpreted as traumatic when it first occurred, but then, later in life, was reinterpreted as an instance of early trauma.

A review by Alan Sheflin and Daniel Brown in 1996 found 25 previous studies of the subject of amnesia of childhood sexual abuse. All 25 “demonstrated amnesia in a subpopulation”, including more recent studies with random sampling and prospective designs. On the other hand, in a 1998 editorial in the British Medical Journal Harrison Pope wrote that “on critical examination, the scientific evidence for repression crumbles.” He continued, “asking individuals if they ‘remember whether they forgot’ is of dubious validity. Furthermore, in most retrospective studies corroboration of the traumatic event was either absent or fell below reasonable scientific standards.”

Authenticity

Memories can be accurate, but they are not always accurate. For example, eyewitness testimony even of relatively recent dramatic events is notoriously unreliable. Memories of events are a mix of fact overlaid with emotions, mingled with interpretation and “filled in” with imaginings. Skepticism regarding the validity of a memory as factual detail is warranted. For example, one study where victims of documented child abuse were re-interviewed many years later as adults, 38% of the women denied any memory of the abuse.

Various manipulations are considered to be able to implant false memories (sometimes called “pseudomemories”). Psychologist Elizabeth Loftus has noted that some of the techniques that some therapists use in order to supposedly help the patients recover memories of early trauma (including such techniques as age regression, guided visualisation, trance writing, dream work, body work, and hypnosis) are particularly likely to contribute to the creation of false or pseudo memories. Such therapy-created memories can be quite compelling for those who develop them, and can include details that make them seem credible to others. In a now classic experiment by Loftus (widely known as the “Lost in the Mall” study), participants were given a booklet containing three accounts of real childhood events written by family members and a fourth account of a wholly fictitious event of being lost in a shopping mall. A quarter of the subjects reported remembering the fictitious event, and elaborated on it with extensive circumstantial detail. This experiment inspired many others, and in one of these, Porter et al. convinced about half of the participants that they had survived a vicious animal attack in childhood.

Critics of these experimental studies have questioned whether their findings generalise to memories for real-world trauma or to what occurs in psychotherapeutic contexts. However, when memories are “recovered” after long periods of amnesia, particularly when extraordinary means were used to secure the recovery of memory, it is now widely (but not universally) accepted that the memories have a high likelihood of being false, i.e. “memories” of incidents that had not actually occurred. It is thus recognised by professional organisations that a risk of implanting false memories is associated with some similar types of therapy. The American Psychological Association advises:

“…most leaders in the field agree that although it is a rare occurrence, a memory of early childhood abuse that has been forgotten can be remembered later; however, these leaders also agree that it is possible to construct convincing pseudomemories for events that never occurred.”

Not all therapists agree that false memories are a major risk of psychotherapy and they argue that this idea overstates the data and is untested. Several studies have reported high percentages of the corroboration of recovered memories, and some authors have claimed that among sceptics of idea of recovered memory there is a “tendency to conceal or omit evidence of corroboration” of recovered memories.

A difficult issue for the field is that there is no evidence that reliable discriminations can be made between true and false memories. Some believe that memories “recovered” under hypnosis are particularly likely to be false. According to The Council on Scientific Affairs for the American Medical Association, recollections obtained during hypnosis can involve confabulations and pseudomemories and appear to be less reliable than nonhypnotic recall. Brown et al. estimate that 3 to 5% of laboratory subjects are vulnerable to post-event misinformation suggestions. They state that 5-8% of the general population is the range of high-hypnotisability. 25% of those in this range are vulnerable to suggestion of pseudomemories for peripheral details, which can rise to 80% with a combination of other social influence factors. They conclude that the rates of memory errors run 0-5% in adult studies, 3-5% in children’s studies and that the rates of false allegations of child abuse allegations run 4-8% in the general population.

Mechanisms

Those who argue in favour of the validity of the phenomenon of repressed memory have identified three mechanisms of normal memory that may explain how memory repression may occur: retrieval inhibition, motivated forgetting, and state-dependent remembering.

Retrieval Inhibition

Retrieval inhibition refers to a memory phenomenon where remembering some information causes forgetting of other information. Anderson and Green have argued that for a linkage between this phenomenon and memory repression; according to this view, the simple decision to not think about a traumatic event, coupled with active remembering of other related experiences (or less traumatic elements of the traumatic experience) may make memories for the traumatic experience itself less accessible to conscious awareness. However, two problems with this viewpoint have been raised: (1) the evidence for the basic phenomenon itself has not consistently replicated, and (2) the phenomenon does not meet all criteria that must be met to support memory repression theory, particularly the lack of evidence that this form of forgetting is particularly likely to occur in the case of traumatic experiences.

Motivated Forgetting

The motivated forgetting phenomenon, which is also sometimes referred to as intentional or directed forgetting, refers to forgetting which is initiated by a conscious goal to forget particular information. In the classic intentional forgetting paradigm, participants are shown a list of words, but are instructed to remember certain words while forgetting others. Later, when tested on their memory for all of the words, recall and recognition is typically worse for the deliberately forgotten words. A problem for viewing motivated forgetting as a mechanism of memory repression is that there is no evidence that the intentionally forgotten information becomes, first, inaccessible and then, later, retrievable (as required by memory repression theory).

State-Dependent Remembering

The term state-dependent remembering refers to the evidence that memory retrieval is most efficient when an individual is in the same state of consciousness as they were when the memory was formed. Based upon her research with rats, Radulovic has argued that memories for highly stressful traumatic experiences may be stored in different neural networks than is the case with memories for non-stressful experiences, and that memories for the stressful experiences may then be inaccessible until the organism’s brain is in a neurological state similar to the one that occurred when the stressful experience first occurred. At present, however, there is no evidence that what Radulovic found with rats occurs in the memory systems of humans, and it is not clear that human memories for traumatic experiences are typically “recovered” by placing the individual back in the mental state that was experienced during the original trauma.

Amnesia

Amnesia is partial or complete loss of memory that goes beyond mere forgetting. Often it is temporary and involves only part of a person’s experience. Amnesia is often caused by an injury to the brain, for instance after a blow to the head, and sometimes by psychological trauma. Anterograde amnesia is a failure to remember new experiences that occur after damage to the brain; retrograde amnesia is the loss of memories of events that occurred before a trauma or injury. Dissociative amnesia is defined in the DSM-5 as the “inability to recall autobiographical information” that is

  • “traumatic or stressful in nature”;
  • “inconsistent with ordinary forgetting”;
  • “successfully stored”;
  • involves a period of time when the patient is unable to recall the experience;
  • Is not caused by a substance or neurological condition; and
  • Is “always potentially reversible”.

McNally and others have noted that this definition is essentially the same as the defining characteristics of memory repression, and that all of the reasons for questioning the reality of memory repression apply equally well to claims regarding dissociative amnesia.

Effects of Trauma on Memory

The essence of the theory of memory repression is that it is memories for traumatic experiences that are particularly likely to become unavailable to conscious awareness, even while continuing to exist at an unconscious level. A prominent more specific theory of memory repression, “Betrayal Trauma Theory”, proposes that memories for childhood abuse are the most likely to be repressed because of the intense emotional trauma produced by being abused by someone the child is dependent on for emotional and physical support; in such situations, according to this theory, dissociative amnesia is an adaptive response because it permits a relationship with the powerful abuser (whom the child is dependent upon) to continue in some form.

Psychiatrist Bessel van der Kolk divided the effects of traumas on memory functions into four sets:

  • Traumatic amnesia; this involves the loss of memories of traumatic experiences. The younger the subject and the longer the traumatic event is, the greater the chance of significant amnesia. He stated that subsequent retrieval of memories after traumatic amnesia is well documented in the literature, with documented examples following natural disasters and accidents, in combat soldiers, in victims of kidnapping, torture and concentration camp experiences, in victims of physical and sexual abuse, and in people who have committed murder.
  • Global memory impairment; this makes it difficult for subjects to construct an accurate account of their present and past history. “The combination of lack of autobiographical memory, continued dissociation and of meaning schemes that include victimization, helplessness and betrayal, is likely to make these individuals vulnerable to suggestion and to the construction of explanations for their trauma-related affects that may bear little relationship to the actual realities of their lives”.
  • Dissociative processes; this refers to memories being stored as fragments and not as unitary wholes.
  • Traumatic memories’ sensorimotor organization. Not being able to integrate traumatic memories seems to be linked to posttraumatic stress disorder (PTSD).

According to van der Kolk, memories of highly significant events are usually accurate and stable over time; aspects of traumatic experiences appear to get stuck in the mind, unaltered by time passing or experiences that may follow. The imprints of traumatic experiences appear to be different from those of nontraumatic events, perhaps because of alterations in attentional focusing or the fact that extreme emotional arousal interferes with memory. van der Kolk and Fisler’s hypothesis is that under extreme stress, the memory categorisation system based in the hippocampus fails, with these memories kept as emotional and sensory states. When these traces are remembered and put into a personal narrative, they are subject to being condensed, contaminated and embellished upon.

A significant problem for trauma theories of memory repression is the lack of evidence with humans that failures of recall of traumatic experiences result from anything other than normal processes of memory that apply equally well to memories for traumatic and non-traumatic events. In addition, it is clear that, rather than being pushed out of consciousness, the difficulty with traumatic memories for most people is their inability to forget the traumatic event and the tendency for memories of the traumatic experience to intrude upon consciousness in problematic ways.

Evidence from psychological research suggests that most traumatic memories are well remembered over long periods of time. Autobiographical memories appraised as highly negative are remembered with a high degree of accuracy and detail. This observation is in line with psychological understanding of human memory, which explains that highly salient and distinctive events – common characteristics of negative traumatic experiences – are remembered well. When experiencing highly emotional, stressful events, physiological and neurological responses, such as those involving the limbic system, specifically the amygdala and hippocampus, lead to more consolidated memories. Evidence shows that stress enhances memory for aspects and details directly related to the stressful event. Furthermore, behavioural and cognitive memory-enhancing responses, such as rehearsing or revisiting a memory in one’s mind are also more likely when memories are highly emotional. When compared to positive events, memory for negative, traumatic experiences are more accurate, coherent, vivid, and detailed, and this trend persists over time. This sample of what is a vast body of evidence calls into question how it is possible that traumatic memories, which are typically remembered exceptionally well, might also be associated with patterns of extreme forgetting.

The high quality remembering for traumatic events is not just a lab-based finding but has also been observed in real-life experiences, such as among survivors of child sexual abuse and war-related atrocities. For example, researchers who studied memory accuracy in child sexual abuse survivors 12 to 21 years after the event(s) ended found that the severity of PTSD was positively correlated with the degree of memory accuracy. Further, all persons who identified the child sexual abuse as the most traumatic event of their life, displayed highly accurate memory for the event. Similarly, in a study of World War II survivors, researchers found that participants who scored higher on posttraumatic stress reactions had war memories that were more coherent, personally consequential, and more rehearsed. The researchers concluded that highly distressing events can lead to subjectively clearer memories that are highly accessible.

Legal Status

Serious issues arise when recovered but false memories result in public allegations; false complaints carry serious consequences for the accused. A special type of false allegation, false memory syndrome, arises typically within therapy, when people report the “recovery” of childhood memories of previously unknown abuse. The influence of practitioners’ beliefs and practices in the eliciting of false “memories” and of false complaints has come under particular criticism.

Some criminal cases have been based on a witness’s testimony of recovered repressed memories, often of alleged childhood sexual abuse. In some jurisdictions, the statute of limitations for child abuse cases has been extended to accommodate the phenomena of repressed memories as well as other factors. The repressed memory concept came into wider public awareness in the 1980s and 1990s followed by a reduction of public attention after a series of scandals, lawsuits, and license revocations.

A US District Court accepted repressed memories as admissible evidence in a specific case. Dalenberg argues that the evidence shows that recovered memory cases should be allowed to be prosecuted in court.

The apparent willingness of courts to credit the recovered memories of complainants but not the absence of memories by defendants has been commented on: “It seems apparent that the courts need better guidelines around the issue of dissociative amnesia in both populations.”

In 1995, the Ninth Circuit Court of Appeals ruled, in Franklin v. Duncan and Franklin v. Fox, Murray et al. (312 F3d. 423, see also 884 FSupp 1435, N.D. Calif.), that repressed memory is not admissible as evidence in a legal action because of its unreliability, inconsistency, unscientific nature, tendency to be therapeutically induced evidence, and subject to influence by hearsay and suggestibility. The court overturned the conviction of a man accused of murdering a nine-year-old girl purely based upon the evidence of a 21-year-old repressed memory by a lone witness, who also held a complex personal grudge against the defendant.

In a 1996 ruling, a US District Court allowed repressed memories entered into evidence in court cases. Jennifer Freyd writes that Ross E. Cheit’s case of suddenly remembered sexual abuse is one of the most well-documented cases available for the public to see. Cheit prevailed in two lawsuits, located five additional victims and tape-recorded a confession.

On 16 December 2005, the Irish Court of Criminal Appeal issued a certificate confirming a Miscarriage of Justice to a former nun, Nora Wall whose 1999 conviction for child rape was partly based on repressed-memory evidence. The judgement stated that:

There was no scientific evidence of any sort adduced to explain the phenomenon of “flashbacks” and/or “retrieved memory”, nor was the applicant in any position to meet such a case in the absence of prior notification thereof.

On 16 August 2010 the United States Second Circuit Court of Appeals in a case reversed the conviction that relied on claimed victim memories of childhood abuse stating that “The record here suggests a “reasonable likelihood” that Jesse Friedman was wrongfully convicted. The “new and material evidence” in this case is the post-conviction consensus within the social science community that suggestive memory recovery tactics can create false memories” (p.27 FRIEDMAN v. REHAL Docket No. 08-0297). The ruling goes on to order all previous convictions and plea bargains relying in repressed memories using common memory recovered techniques be reviewed.

Recovered Memory Therapy

The term “recovered memory therapy” refers to the use of a range of psychotherapy methods that involve guiding the patient’s attempts to recall memories of abuse that had previously been forgotten. The term “recovered memory therapy” is not listed in DSM-V nor is recovered memory therapy recommended by mainstream ethical and professional mental health associations. Critics of recovered memory therapy note that that the therapy can create false memories through its use of powerful suggestion techniques. It has also been found that patients who retract their claims – after deciding their recovered memories are false – may suffer PTSD due to the trauma of illusory memories.

Summary

The Working Group on Investigation of Memories of Child Abuse of the American Psychological Association reached five key conclusions:

  1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged;
  2. Most people who were sexually abused as children remember all or part of what happened to them;
  3. It is possible for memories of abuse that have been forgotten for a long time to be remembered;
  4. It is also possible to construct convincing pseudo-memories for events that never occurred; and
  5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.

What is Positive Psychology?

Published on by Andrew Marshall4 Comments

Introduction

Positive psychology is the scientific study of what makes life most worth living, focusing on both individual and societal well-being.

It studies “positive subjective experience, positive individual traits, and positive institutions…it aims to improve quality of life.” It is a field of study that has been growing steadily throughout the years as individuals and researchers look for common ground on better well-being.

Positive psychology began as a new domain of psychology in 1998 when Martin Seligman chose it as the theme for his term as president of the American Psychological Association. It is a reaction against past practices, which have tended to focus on mental illness and emphasized maladaptive behaviour and negative thinking. It builds on the humanistic movement by Abraham Maslow, Rollo May, James Bugental, and Carl Rogers, which encourages an emphasis on happiness, well-being, and positivity, thus creating the foundation for what is now known as positive psychology.

Positive psychology focuses on eudaimonia, an Ancient Greek term for “the good life” and the concept for reflection on the factors that contribute the most to a well-lived and fulfilling life. Positive psychologists often use the terms subjective well-being and happiness interchangeably.

Positive psychologists have suggested a number of factors may contribute to happiness and subjective well-being. For example, social ties with a spouse, family, friends, colleagues, and wider networks; membership in clubs or social organisations; physical exercise; and the practice of meditation. Spirituality can also be considered a factor that leads to increased individual happiness and well-being. Spiritual practice and religious commitment is a topic researchers have been studying as another possible source for increased well-being and an added part of positive psychology. Happiness may rise with increasing financial income, though it may plateau or even fall when no further gains are made or after a certain cut-off amount.

Refer to Positive Neuroscience and Positive Psychotherapy.

Definition and Basic Assumptions

Definition

Martin Seligman and Mihaly Csikszentmihalyi define positive psychology as “the scientific study of positive human functioning and flourishing on multiple levels that include the biological, personal, relational, institutional, cultural, and global dimensions of life.”

Basic Concepts

Positive psychology is concerned with eudaimonia, meaning “the good life” or flourishing. It is focused on living according to what holds the greatest value in life and other such factors that contribute the most to a well-lived and fulfilling life. While not attempting a strict definition of the good life, positive psychologists agree that one must live a happy, engaged, and meaningful life in order to experience “the good life.” Martin Seligman referred to “the good life” as using your signature strengths every day to produce authentic happiness and abundant gratification.

Positive psychology complements, without intending to replace or ignore, the traditional areas of psychology. By emphasizing the study of positive human development, this field helps to balance other approaches that focus on disorder, which may produce only limited understanding. Positive psychology has also placed a significant emphasis on fostering positive self-esteem and self-image, though positive psychologists with a less humanist direction are less likely to focus as intently on such topics.

The basic premise of positive psychology is that human beings are often intrigued by the future more than they are driven by the past. It also suggests that a combination of positive experiences and emotions concerning the past, the present, and the future leads to a pleasant, happy life. Another aspect of this may come from our views outside of our own lives. Author of Grit, Angela Duckworth, might view this as having an other-centred purpose, of which could have a positive psychological effect on our lives. Seligman identified other possible goals: families and schools that allow children to grow, workplaces that aim for satisfaction and high productivity, and teaching others about positive psychology. Psychologist Daniel Gilbert has also written extensively on the affects of time perception and happiness.

Those who practice positive psychology attempt psychological interventions that foster positive attitudes toward one’s subjective experiences, individual traits, and life events. The goal is to minimise pathological thoughts that may arise in a hopeless mindset and to develop a sense of optimism toward life. Positive psychologists seek to encourage acceptance of one’s past, excitement and optimism about one’s future experiences, and a sense of contentment and well-being in the present.

Related concepts are happiness, well-being, quality of life, contentment, and meaningful life.

  • Happiness: Has been sought after and discussed throughout time. Research has concluded that happiness can be thought of in the way we act or what we do and how we think in relative terms to it.
  • Well-Being: Has often been referred to what is inherently good for an individual both physically and mentally, though other aspects could be added in to define well-being.
  • Quality of life: Quality of life encompasses more than just physical and mental well-being, it involves socioeconomic factors. It is also perceived differently in different cultures and regions around the world, but can come down to how well you are living and functioning in life.

Research Topics

According to Seligman and Peterson, positive psychology addresses three issues: positive emotions, positive individual traits, and positive institutions. Positive emotions are concerned with being content with one’s past, being happy in the present and having hope for the future. Positive individual traits focus on one’s strengths and virtues. Finally, positive institutions are based on strengths to better a community of people.

According to Peterson, positive psychologists are concerned with four topics: positive experiences, enduring psychological traits, positive relationships, and positive institutions. He also states that topics of interest to topics of interest to researchers in the field are states of pleasure or flow, values, strengths, virtues, talents, as well as the ways that these can be promoted by social systems and institutions.

Brief History

Origin

While the formal discipline of positive psychology has only existed since 2000, the concepts that form the basis of it have been the subject of empirical study since at least the 1980s, and present in religious and philosophical discourse for thousands of years. It has been influenced by humanistic as well as psychodynamic approaches to treatment. Predating the use of the term “positive psychology”, researchers within the field of psychology had been focusing on topics that would now be included under this new denomination.

The term positive psychology dates back at least to 1954, when Maslow’s first edition of Motivation and Personality was published with a final chapter titled “Toward a Positive Psychology.” In the second edition published in 1970, he removed that chapter, saying in the preface that “a positive psychology is at least available today though not very widely.” There have been indications that psychologists since the 1950s have been increasingly focused on the promotion of mental health rather than merely treating mental illness. From the beginning of psychology, the field has addressed the human experience using the “Disease Model,” specifically studying and identifying the dysfunction of an individual.

Positive psychology grew as an important field of study within psychology in 1998 when Martin Seligman chose it as the theme for his term as president of the American Psychological Association. In the first sentence of his book Authentic Happiness, Seligman claimed: “for the last half century psychology has been consumed with a single topic only – mental illness,” expanding on Maslow’s comments. He urged psychologists to continue the earlier missions of psychology of nurturing talent and improving normal life.

Development

The first positive psychology summit took place in 1999. The First International Conference on Positive Psychology took place in 2002. More attention was given by the general public in 2006 when, using the same framework, a course at Harvard University became particularly popular. In June 2009, the First World Congress on Positive Psychology took place at the University of Pennsylvania.

The field of positive psychology today is most advanced in the United States and Western Europe. Even though positive psychology offers a new approach to the study of positive emotions and behaviour, the ideas, theories, research, and motivation to study the positive side of human behaviour is as old as humanity.

Influences

Several humanistic psychologists, most notably Abraham Maslow, Carl Rogers, and Erich Fromm, developed theories and practices pertaining to human happiness and flourishing. More recently, positive psychologists have found empirical support for the humanistic theories of flourishing. In addition, positive psychology has moved ahead in a variety of new directions.

In 1984, Diener published his tripartite model of subjective well-being, positing “three distinct but often related components of wellbeing: frequent positive affect, infrequent negative affect, and cognitive evaluations such as life satisfaction.” In this model, cognitive, affective and contextual factors contribute to subjective well-being. According to Diener and Suh, subjective well-being is “based on the idea that how each person thinks and feels about his or her life is important.”

Carol Ryff’s Six-factor Model of Psychological Well-being was initially published in 1989, and additional testing of its factors was published in 1995. It postulates six factors which are key for well-being, namely self-acceptance, personal growth, purpose in life, environmental mastery, autonomy, and positive relations with others.

According to Corey Keyes, who collaborated with Carol Ryff and uses the term flourishing as a central concept, mental well-being has three components, namely hedonic (c.q. subjective or emotional), psychological, and social well-being. Hedonic well-being concerns emotional aspects of well-being, whereas psychological and social well-being, c.q. eudaimonic well-being, concerns skills, abilities, and optimal functioning. This tripartite model of mental well-being has received extensive empirical support across cultures.

Influences in Ancient History

While the formal title “positive psychology” has only been in common use since around 2000, the concepts that form the basis of this field have been present in religious and philosophical discourse for thousands of years. The field of psychology predating the use of the term positive psychology has seen researchers who focused primarily on topics that would now be included under the umbrella of positive psychology. Some view positive psychology as a meeting of Eastern thought, such as Buddhism, and Western psychodynamic approaches. The historical roots of positive psychology are found in the teachings of Aristotle, whose Nicomachean Ethics teach the cultivation of moral virtue as the means of attaining happiness and well-being, which he referred to as eudaimonia.

Core Theory and Methods

There is no accepted “gold standard” theory in positive psychology. However, the work of Seligman is regularly quoted. So too the work of Csikszentmihalyi and older models of well-being, such as Carol Ryff’s Six-factor Model of Psychological Well-being and Diener’s tripartite model of subjective well-being.

Initial Theory: Three Paths to Happiness

In Authentic Happiness (2002) Seligman proposed three kinds of a happy life that can be investigated:

  • Pleasant life: research into the Pleasant Life, or the “life of enjoyment,” examines how people optimally experience, forecast, and savour the positive feelings and emotions that are part of normal and healthy living (e.g. relationships, hobbies, interests, entertainment, etc.). Despite the attention given, Martin Seligman says this most transient element of happiness may be the least important.
  • Good Life: investigation of the beneficial effects of immersion, absorption, and flow felt by individuals when optimally engaged with their primary activities, is the study of the Good Life, or the “life of engagement.” Flow is experienced when there is a positive match between a person’s strength and their current task, i.e. when one feels confident of accomplishing a chosen or assigned task.
  • Meaningful Life: inquiry into the Meaningful Life, or “life of affiliation,” questions how individuals derive a positive sense of well-being, belonging, meaning, and purpose from being part of and contributing back to something larger and more permanent than themselves (e.g. nature, social groups, organisations, movements, traditions, belief systems).

PERMA

In Flourish (2011) Seligman argued that the last category of his proposed three kinds of a happy life, “meaningful life,” can be considered as 3 different categories. The resulting summary for this theory is Seligman’s PERMA acronym: Positive Emotions, Engagement, Relationships, Meaning and purpose, and Accomplishments. It is a mnemonic for the five elements of Martin Seligman’s well-being theory:

ElementOutline
Positive EmotionsInclude a wide range of feelings, not just happiness and joy. Included are emotions like excitement, satisfaction, pride and awe, amongst others. These emotions are frequently seen as connected to positive outcomes, such as longer life and healthier social relationships.
EngagementRefers to involvement in activities that draws and builds upon one’s interests. Mihaly Csikszentmihalyi explains true engagement as flow, a state of deep effortless involvement, feeling of intensity that leads to a sense of ecstasy and clarity. The task being done needs to call upon higher skill and be a bit difficult and challenging yet still possible. Engagement involves passion for and concentration on the task at hand and is assessed subjectively as to whether the person engaged was completely absorbed, losing self-consciousness.
RelationshipsAre essential in fuelling positive emotions, whether they are work-related, familial, romantic, or platonic. As Christopher Peterson puts it simply, “other people matter.” Humans receive, share, and spread positivity to others through relationships. They are important not only in bad times, but good times as well. In fact, relationships can be strengthened by reacting to one another positively. It is typical that most positive things take place in the presence of other people.
MeaningIs also known as purpose, and prompts the question of “why.” Discovering and figuring out a clear “why” puts everything into context from work to relationships to other parts of life. Finding meaning is learning that there is something greater than one’s self. Despite potential challenges, working with meaning drives people to continue striving for a desirable goal.
AccomplishmentsAre the pursuit of success and mastery. Unlike the other parts of PERMA, they are sometimes pursued even when accomplishments do not result in positive emotions, meaning, or relationships. That being noted, accomplishments can activate the other elements of PERMA, such as pride, under positive emotion. Accomplishments can be individual or community-based, fun- or work-based.

Each of the five PERMA elements was selected according to three criteria:

  • It contributes to well-being.
  • It is pursued for its own sake.
  • It is defined and measured independently of the other elements.

Character Strengths and Virtues

The development of the Character Strengths and Virtues (CSV) handbook (2004) represented the first attempt by Seligman and Peterson to identify and classify positive psychological traits of human beings. Much like the Diagnostic and Statistical Manual of Mental Disorders (DSM) of general psychology, the CSV provided a theoretical framework to assist in understanding strengths and virtues and for developing practical applications for positive psychology. This manual identified 6 classes of virtues (i.e. “core virtues”), underlying 24 measurable character strengths.

The CSV suggested these 6 virtues have a historical basis in the vast majority of cultures; in addition, these virtues and strengths can lead to increased happiness when built upon. Notwithstanding numerous cautions and caveats, this suggestion of universality hints threefold:

  1. The study of positive human qualities broadens the scope of psychological research to include mental wellness;
  2. The leaders of the positive psychology movement are challenging moral relativism, suggesting people are “evolutionarily predisposed” toward certain virtues; and
  3. Virtue has a biological basis.

The organisation of the 6 virtues and 24 strengths is as follows:

  • Wisdom and knowledge: creativity, curiosity, open-mindedness, love of learning, perspective, innovation, prudence.
  • Courage: bravery, persistence, vitality, zest.
  • Humanity: love, kindness, social intelligence.
  • Justice: citizenship, fairness, leadership, integrity, excellence.
  • Temperance: forgiveness and mercy, humility, self control.
  • Transcendence: appreciation of beauty, gratitude, hope, humour, spirituality.

Recent research challenged the need for 6 virtues. Instead, researchers suggested the 24 strengths are more accurately grouped into just 3 or 4 categories: Intellectual Strengths, Interpersonal Strengths, and Temperance Strengths, or alternatively, Interpersonal Strengths, Fortitude, Vitality, and Cautiousness. These strengths, and their classifications, have emerged independently elsewhere in literature on values. Paul Thagard described examples, which included Jeff Shrager’s workshops to discover the habits of highly creative people. Some research indicates that well-being effects that appear to be due to spirituality are actually better described as due to virtue.

Flow

In the 1970s, Hungarian-American psychologist Csikszentmihalyi began studying flow, a state of absorption where one’s abilities are well-matched to the demands at-hand. Flow is characterised by intense concentration, loss of self-awareness, a feeling of being perfectly challenged (neither bored nor overwhelmed), and a sense that “time is flying.” Flow is intrinsically rewarding; it can also assist in the achievement of goals (e.g. winning a game) or improving skills (e.g. becoming a better chess player). Anyone can experience flow and it can be felt in different domains, such as play, creativity, and work. Flow is achieved when the challenge of the situation meets one’s personal abilities. A mismatch of challenge for someone of low skills results in a state of anxiety and feeling overwhelmed; insufficient challenge for someone highly skilled, results in boredom.

Flow can be extremely beneficial when it comes to parenting children. When flow is enhanced between parents and their children, the parents are more capable of thriving in their role as a parent. A parenting style that is positively oriented will also result in children that experience lower levels of stress and overall improve the child’s well-being.

Research Advances and Applications

Topical and methodological development has expanded the field of positive psychology. These advances have enabled the field of positive psychology to grow beyond its core theories and methods. Positive psychology is now a global area of study, with various national indices tracking citizens’ happiness ratings.

Research Findings

Research in positive psychology, well-being, eudaimonia and happiness, and the theories of Diener, Ryff, Keyes and Seligman cover a broad range of topics including “the biological, personal, relational, institutional, cultural, and global dimensions of life.” A meta-analysis on 49 studies in 2009 showed that Positive Psychology Interventions (PPI) produced improvements in well-being and lower depression levels, the PPIs studied included writing gratitude letters, learning optimistic thinking, replaying positive life experiences and socialising with others. In a later meta-analysis of 39 studies with 6,139 participants in 2012, the outcomes were positive. Three to six months after a PPI the effects for subjective well-being and psychological well-being were still significant. However the positive effect was weaker than in the 2009 meta analysis, the authors concluded that this was because they only used higher quality studies. The PPIs they considered included counting blessings, kindness practices, making personal goals, showing gratitude and focusing on personal strengths. Another review of PPIs published in 2018 found that over 78% of intervention studies were conducted in Western countries.

In the textbook Positive Psychology: The Science of Happiness, authors Compton and Hoffman give the “Top Down Predictors” of well-being as high self esteem, optimism, self efficacy, a sense of meaning in life and positive relationships with others. The personality traits most associated with well being are extraversion, agreeability and low levels of neuroticism.

In a study published in 2020, students were enrolled in a positive psychology course that focused on improving happiness and well-being through teaching about positive psychology. The participants answer questions pertaining to the 5 categories known as PERMA. At the end of the semester those same students reported significantly higher scores in all categories (p <.001) minus engagement which was significant at p <0.05. One of the aims of this study was to make it rewarding for positive psychology interventions to stay in the participants lives. The authors stated:

“Not only do students learn and get credit, there is also a good chance that many will reap the benefits in what is most important to them—their health, happiness, and well-being.”

Academic Methods

Quantitative

Quantitative methods in positive psychology include p-technique factor analysis, dynamic factor analysis, interindividual differences and structural equation modelling, spectral analysis and item response models, dynamic systems analysis, latent growth analysis, latent-class models, hierarchical linear modelling, measurement invariance, experimental methods, behaviour genetics, and integration of quantitative and qualitative approaches.

Qualitative

In a 2012 Journal of Positive Psychology article published by Grant J. Rich, the usage of qualitative methodology to study positive psychology is explored and considered. Author Rich addresses the popularity of quantitative methods in studying the empirical questions that positive psychology presents. He argues that there is an “overemphasis” on quantitative methods and suggests implementing qualitative methods, such as semi-structured interviews, observations, fieldwork, creative artwork, and focus groups. Rich states that qualitative approaches are valuable approaches to studying positive psychology. He writes that usage of qualitative methods will further promote the “flourishing of positive psychology” and encourages such practice.

Behavioural Interventions

Changing happiness levels through interventions is a further methodological advancement in the study of positive psychology. Enhancing happiness through behavioural interventions has been the focus of various academic and scientific psychological publications. Happiness-enhancing interventions include expressing kindness, gratitude, optimism, humility, awe, and mindfulness.

In 2005, Sonja Lyubomirsky, Kennon M. Sheldon, and David Schkade co-authored an academic paper published in the Review of General Psychology. In their research, they created a behavioural experiment using two 6-week interventions. One intervention studied was the performance of acts of kindness. The other was focused on gratitude and emphasized the counting of one’s blessings. The study participants who went through the behavioural interventions reported higher levels of happiness and well-being than those who did not participate in either intervention. The paper provides experimental support for the effect of gratitude and kindness on enhancing subjective well-being and happiness.

Further research conducted by Sonja Lyubomirsky, Rene Dickerhoof, Julia K. Boehm, and Kennon M. Sheldon, published in 2011 in the academic journal Emotion, found that the interventions of expressing optimism and expressing gratitude enhanced subjective well-being in participants who took part in the intervention for 8 months. The researchers concluded that interventions are “most successful when participants know about, endorse, and commit to the intervention.” The article provides support that when individuals enthusiastically take part in behavioural interventions, such as expression of optimism and gratitude, they may be engaging in an approach to increase happiness and subjective well-being.

In 2014, Elliott Kruse, Joseph Chancellor, Peter M. Ruberton, and Sonja Lyubomirsky published an academic article in the journal Social Psychology and Personality Science. In their research, they study the interaction effects between gratitude and humility through behaviour interventions. The interventions they studied were writing a gratitude letter and writing a 14-day diary. In both interventions, Kruse et al. found that gratitude and humility are connected and are “mutually reinforcing.” The article also discusses how gratitude, and its associated humility, may lead to more positive emotional states and subjective well-being.

Researchers Melanie Rudd, Kathleen D. Vohs, and Jennifer Aaker conducted a series of experiments that showed a positive effect of awe on subjective well-being, publishing their results in 2012 in the academic journal Psychological Science. Their research found that individuals who felt awe also reported feeling higher availability of time, more preference for experiential expenditures than material expenditures, and greater life satisfaction. Experiences that heighten awe may lead to higher levels of life satisfaction and, in turn, higher levels of happiness and subjective well-being.

Mindfulness interventions may also increase happiness. In a Mindfulness article published in 2011 by Torbjörn Josefsson, Pernilla Larsman, Anders G. Broberg, and Lars-Gunnar Lundh, it was found that meditation improves subjective well-being for individuals who mindfully meditate. The researchers note that being mindful in meditation includes awareness and observation of one’s meditation practice, with non-reaction and non-judgemental sentiments during meditation.

National Indices of Happiness

The creation of various national indices of happiness have broadened and expanded the field of positive psychology to a global scale.

In a January 2000 academic article published in American Psychologist, psychologist Ed Diener proposed and argued for the creation of a national happiness index in the United States. Such an index would provide measurements of happiness, or subjective well-being, within the United States and across many other countries in the world. Diener argued that national indices would be helpful markers or indicators of population happiness, providing a sense of current ratings and a tracker of happiness across time. Diener proposed that the national index include various sub-measurements of subjective well-being, including “pleasant affect, unpleasant affect, life satisfaction, fulfillment, and more specific states such as stress, affection, trust, and joy.”

In 2012, the first World Happiness Report was published. The World Happiness Report was initiated by the UN General Assembly in June 2011, which passed the Bhutanese Resolution. The Bhutanese Resolution called for nations across the world to “give more importance to happiness and well-being in determining how to achieve and measure social and economic development.” The data for the World Happiness Reports is collected in partnership with the Gallup World Poll’s life evaluations and annual happiness rankings. The World Happiness Report bases its national rankings on how happy constituents self-report and believe themselves to be.

The first World Happiness Report, published in 2012, is a 170-page report that details the state of world happiness, the causes of happiness and misery, policy implications from happiness reports, and three case studies of subjective well-being for:

  • Bhutan and its Gross National Happiness index;
  • The UK Office for National Statistics Experience; and
  • Happiness in the member countries within the OECD.

The World Happiness Report published in 2020 is the 8th publication in the series of reports. It is the first World Happiness Report to include happiness rankings of cities across the world, in addition to rankings of 156 countries. The city of Helsinki, Finland was reported as the city with the highest subjective well-being ranking, and the country of Finland was reported as the country with the highest subjective well-being ranking for the third year in a row. The 2020 report provides insights on happiness based on environmental conditions, social conditions, urban-rural happiness differentials, and sustainable development. It also provides overview and possible explanations for why Nordic countries have consistently ranked in the top ten happiest countries in the World Happiness Report since 2013. Possible explanations include Nordic countries’ high-quality government benefits and protections to its citizens, including welfare benefits and well-operated democratic institutions, as well as social connections, bonding, and trust.

Additional national well-being indices and reported statistics include the Gallup Global Emotions Report, Gallup Sharecare Well-Being Index, Global Happiness Council’s Global Happiness and Well-being Policy Report, Happy Planet Index, Indigo Wellness Index, OECD Better Life Index, and UN Human Development Reports.

Influences on other Academic Fields

Positive psychology has influenced a variety of other academic fields of study and scholarship. It has been applied to various other areas of scholarship, most notably organizational behaviour, education and psychiatry.

Positive Organisational Scholarship (POS)

Positive Organisational Scholarship (POS), also referred to as Positive Organisational Behaviour (POB), began as a direct application of positive psychology to the field of organisational behaviour. One of the first times the term was officially defined and published was in 2003, in the text Positive Organisational Scholarship: Foundations of a New Discipline edited by University of Michigan Ross School of Business professors Kim S. Cameron, Jane E. Dutton, and Robert E. Quinn. In the first chapter of the text, Cameron, Dutton, and Quinn promote “the best of the human condition,” such as goodness, compassion, resilience, and positive human potential, as an organisational goal as important as financial organisational success. The goal of POS is to study the factors that create positive work experiences and successful, people-oriented organisational outcomes.

A large collection of POS research is contained in the 2011 volume The Oxford Handbook of Positive Organisational Scholarship, edited by University of Michigan Ross School of Business Professors Kim S. Cameron and Gretchen M. Spreitzer. This 1076-page volume encompasses nine sections and 79 chapters spanning various topics. Major topics include positive human resource practices, positive organisational practices, and positive leadership and change. Much of the volume expands upon and applies core concepts of positive psychology to the workplace context, covering areas such as positive individual attributes, positive emotions, strengths and virtues, and positive relationships. A further definition of POS, as written by editors Cameron and Spreitzer:

Positive organizational scholarship rigorously seeks to understand what represents the best of the human condition based on scholarly research and theory. Just as positive psychology focuses on exploring optimal individual psychological states rather than pathological ones, organizational scholarship focuses attention on the generative dynamics in organizations that lead to the development of human strength, foster resiliency in employees, enable healing and restoration, and cultivate extraordinary individual and organizational performance. POS emphasizes what elevates individuals and organizations (in addition to what challenges them), what goes right in organizations (in addition to what goes wrong), what is life-giving (in addition to what is problematic or life-depleting), what is experienced as good (in addition to what is objectionable), and what is inspiring (in addition to what is difficult or arduous). (Cameron, Kim S.; Spreitzer, Gretchen M. (2011). “Chapter 1. Introduction: What is Positive about Positive Organizational Scholarship?”. In Spreitzer, Gretchen M.; Cameron, Kim S. (eds.). The Oxford Handbook of Positive Organizational Scholarship.)

Psychiatry

Positive psychology has influenced psychiatry by providing additional therapeutic and cognitive behaviour shifts, including well-being therapy, positive psychotherapy, and practicing an integration of positive psychology in therapeutic practice.

In an 2015 academic article published in Journal of Occupational Rehabilitation, Mills and Kreutzer argue for the principles of positive psychology to be implemented to assist those recovering from traumatic brain injury (TBI). They make the case that TBI rehabilitation practices rely on the betterment of the individual through engaging in everyday practices, a practice significantly related to tenets of positive psychology. Their proposal to connect positive psychology with TBI vocational rehabilitation (VR) also looks at happiness and its correlation with improvements in mental health, including increased confidence and productivity, as well as others. While the authors point out that empirical evidence for positive psychology is limited, they clarify that positive psychology’s focus on small successes, optimism and prosocial behaviour is promising for improvements in the social and emotional well-being of TBI patients.

Popular Culture

The study of positive psychology has been translated into various popular media outlets, including books and films, and has been an influencing factor in the wellness industry.

Books

There have been several popular psychology books written by positive psychologists for a general audience.

Ilona Boniwell, in her book Positive Psychology in a Nutshell, provided a summary of the current research. According to Boniwell, well-being is related to optimism, extraversion, social connections (i.e. close friendships), being married, having engaging work, religion or spirituality, leisure, good sleep and exercise, social class (through lifestyle differences and better coping methods) and subjective health (what you think about your health). Boniwell further writes that well-being is not related to age, physical attractiveness, money (once basic needs are met), gender (women are more often depressed but also more often joyful), educational level, having children (although they add meaning to life), moving to a sunnier climate, crime prevention, housing and objective health (what doctors say).

Sonja Lyubomirsky, in her book The How of Happiness, provides advice and guidance on how to improve happiness. According to The How of Happiness, individuals should create new habits, seek out new emotions, use variety and timing to prevent hedonic adaptation, and enlist others to motivate and support during the creation of those new habits. Lyubomirsky gives 12 happiness activities, including savouring life, learning to forgive, and living in the present.

Stumbling on Happiness by Daniel Gilbert is another popular book that shares positive psychology research findings for a general readership audience. Gilbert presents research suggesting that individuals are often poor at predicting what will make them happy in the future and that individuals are prone to misevaluating the causes of their happiness. He also notes that the subjectivity of subjective well-being and happiness often is the most difficult challenge to overcome in predicting future happiness, noting that our future selves may have different subjective perspectives on life than our current selves.

Films

Coverage of positive psychology has entered the film industry. Similarly, films have provided the basis of new research within positive psychology.

Happy (2011 film) is a full-length documentary film covering overviewing the fields of positive psychology and neuroscience. It also highlights various case studies on happiness across diverse cultures and geographies. The film features interviews with notable positive psychologists and scholars, including Daniel Gilbert, Ed Diener, Sonja Lyubomirsky, and Mihaly Csikszentmihalyi.

The Positive Psychology News website includes a section on annual Positive Psychology Movie Awards. The Positive Psychology Movie Awards ranks a short list of feature films of 2009, 2014, and annually between 2016 and 2018 that feature powerful messages of positive psychology. The rankings are according to the website’s author, Ryan Niemiec, Psy.D, who is a psychologist, coach, and education director of the VIA Institute on Character. The Positive Psychology Movie Awards presents separate awards for categories including: Best Positive Psychology Film, Award for Positive Relationships, Award for Meaning, Award for Achievement, Award for Mindfulness, Award for Happiness, Signature Strengths Use, among others.

Further research done on positive psychology as represented in feature films has been done in association with the VIA Institute. Contemporary and popular films that promote or represent character strengths are the basis for various academic articles.

Wellness Industry

The growing popularity and attention given to positive psychology research has influenced industry growth, development, and consumption of products and services meant to cater to wellness and well-being.

According to the Global Wellness Institute, as of 2018, the global wellness economy is valued at $4.5 trillion and the wellness industry represents 5.3% of global economic output. Key sectors of the wellness industry include workplace wellness, fitness and mind-body, personal care, and wellness lifestyle.

Highlighting happiness and well-being has been a strategy harnessed by various companies in their marketing strategies. Food and beverage companies such as Coca-Cola and Pocky, whose motto is “Share happiness!”, emphasize happiness in their commercials, branding, and descriptions. CEOs at retail companies such as Zappos have profited by publishing books detailing their deliverance of happiness, while Amazon’s logo features a dimpled smile.

Criticism

Positive psychology has been criticized in many different aspects from its conception continuing into the present day.

Reality Distortion

In 1988, psychologists Shelley E. Taylor and Jonathan D. Brown co-authored a Psychological Bulletin article that coined the phrase positive illusions. Positive illusions are the cognitive processes individuals engage in when self-aggrandising or self-enhancing. They are the unrealistically positive or self-affirming attitudes that individuals hold of themselves, their position, or their environment. In essence, positive illusions are attitudes of extreme optimism that endure even in the face of facts and real conditions. Taylor and Brown suggested that positive illusions protect individuals from negative feedback that they might receive, and this, in turn, preserves their psychological adaptation and subjective well-being. However, later research has found that engaging in positive illusions and related attitudes has led to psychological maladaptive conditions. These conditions include poorer social relationships, expressions of narcissism, and negative workplace outcomes, thus reducing the positive effects that positive illusions have on subjective well-being, overall happiness, and life satisfaction.

Kirk Schneider, editor of the Journal of Humanistic Psychology, has said that positive psychology fails to explain past heinous behaviours such as those perpetrated by the Nazi party, Stalinist marches and Klan gatherings, to identify but a few. He also pointed to a body of research showing high positivity correlates with positive illusion, which effectively distorts reality. The extent of the downfall of high positivity or flourishing is one could become incapable of psychological growth, unable to self-reflect, and tend to hold racial biases. By contrast, negativity, sometimes evidenced in mild to moderate depression, is correlated with less distortion of reality. Therefore, Schneider argues, negativity might play an important role within the dynamics of human flourishing. To illustrate, conflict engagement and acknowledgement of appropriate negativity, including certain negative emotions like guilt, might better promote flourishing. Overall, Schneider provided perspective: “perhaps genuine happiness is not something you aim at, but is…a by-product of a life well lived – and a life well lived does not settle on the programmed or neatly calibrated.”

Narrow Focus

In 2003, Ian Sample, writing for The Guardian, noted that, “Positive psychologists also stand accused of burying their heads in the sand and ignoring that depressed, even merely unhappy people, have real problems that need dealing with.” He also quoted Steven Wolin, a clinical psychiatrist at George Washington University, as saying that the study of positive psychology is just a reiteration of older ways of thinking, and that there is not much scientific research to support the efficacy of this method. Gable responds to criticism on their Pollyanna view on the world by saying that they are just bringing a balance to a side of psychology that is glaringly understudied. To defend his point, Gable points to the imbalances favouring research into negative psychological well-being in cognitive psychology, health psychology, and social psychology.

Martin Jack has also maintained that positive psychology is not unique in its optimistic approach to looking at optimal emotional well-being, stating that other forms of psychology, such as counselling and educational psychology, are also interested in positive human fulfilment. He goes on to mention that, while positive psychology has pushed for schools to be more student-centred and able to foster positive self-images in children, he worries that a lack of focus on self-control may prevent children from making full contributions to society. If positive psychology is not implemented correctly, it can cause more harm than good. This is the case, for example, when interventions in school are coercive (in the sense of being imposed on everyone without regard for the individual child’s reason for negativity) and fail to take each student’s context into account.

Role of Negativity

Barbara S. Held, a professor at Bowdoin College, argued that while positive psychology makes contributions to the field of psychology, it has its faults. She offered insight into topics including the negative side effects of positive psychology, negativity within the positive psychology movement, and the current division in the field of psychology caused by differing opinions of psychologists on positive psychology. In addition, she noted the movement’s lack of consistency regarding the role of negativity. She also raised issues with the simplistic approach taken by some psychologists in the application of positive psychology. A “one size fits all” approach is arguably not beneficial to the advancement of the field of positive psychology; she suggested a need for individual differences to be incorporated into its application. By teaching young people that being confident and optimistic leads to success, when they are unsuccessful they will begin to believe it is because they are insecure or pessimistic. This could lead them to believe that any negative internal thought or feeling they may experience is damaging to their happiness and should be steered clear of completely.

Toxic Positivity

A recent critical response to the field of positive psychology is that around toxic positivity. Toxic positivity is the phenomenon in which individuals do not fully acknowledge, process, or manage the entire spectrum of human emotion, including anger and sadness. This genre of criticism against positive psychology argues that the field of positive psychology places too much importance on “upbeat thinking, while shunting challenging and difficult experiences to the side.” Individuals who engage in a constant chase for positive experiences or states of high subjective well-being may be inadvertently stigmatizing negative emotional conditions, such as depression, or may be suppressing natural emotional responses, such as sadness, regret, or stress. Furthermore, by not allowing negative emotional states to be experienced, or by suppressing and hiding negative emotional responses, individuals may experience harmful physical, cardiovascular and respiratory consequences. Proponents of combating toxic positivity advocate allowing oneself to accept and fully experience negative emotional states.

Methodological and Philosophical Critiques

Richard Lazarus, who was well known in psychology for his Cognitive-Motivational-Relational theory of emotions, has thoroughly critiqued positive psychology’s methodological and philosophical components. He holds that giving more detail and insight into the positive is not bad, but not at the expense of the negative aspect because the two (positive and negative) are inseparable. The first methodological issue noted is positive psychology’s use of correlational and cross-sectional research designs to indicate causality between the movement’s ideas and healthy lives; there could be other factors not researched and time differences that account for healthier lives that the researchers do not account for. Secondly, he considers that emotions cannot be categorised dichotomously into positive and negative; by nature, emotions are subjective and rich in social/relational meaning. Additionally, he claims that emotions are fluid, meaning that the context they appear in changes over time. He states that “all emotions have the potential of being either one or the other, or both, on different occasions, and even on the same occasion when an emotion is experienced by different persons” The third issue is the neglect of individual differences in most social science research. Many research designs focus on the statistical significance of the groups while overlooking differences among individuals. Lazarus’s final methodological complaint is social science researchers’ tendency to not adequately define and measure emotions. Most assessments are quick checklists and do not provide adequate debriefing. Many researchers do not differentiate between fluid emotional states and relatively stable personality traits.

Lazarus further holds that positive psychology claims to be new and innovative although the majority of research on stress and coping theory make much of the same claims as positive psychology. The movement attempts to uplift and reinforce the positive aspects of one’s life, but everyone in life experiences stress and hardship. Coping through these events should not be looked at as adapting to failures, but should be regarded as successfully navigating stress, but the movement doesn’t hold that perspective.

The US Army’s Comprehensive Soldier Fitness Programme

The Comprehensive Soldier Fitness (CSF) programme was established in 2008 by then-Chief of Staff of the United States Army, General George W. Casey, Jr., in an effort to address the increasing rates of drug abuse, family violence, PTSD, and suicide among soldiers. The Army contracted with Martin Seligman’s Positive Psychology Centre at the University of Pennsylvania to supply a program closely based on the centre’s Penn Resiliency Programme, which was designed for 10- to 14-year-old children. Although Seligman proposed starting with a small-scale pilot-test, General Casey insisted on immediately rolling out the CSF to the entire Army. Interviewed for the journal Monitor on Psychology of the American Psychological Association, Seligman said that “This is the largest study—1.1 million soldiers—psychology has ever been involved in.” According to journalist Jesse Singal, “It would become one of the largest mental-health interventions geared at a single population in the history of humanity, and possibly the most expensive.”

Some psychologists have criticized the CSF for various reasons. Nicholas J.L. Brown wrote that “The idea that techniques that have demonstrated, at best, marginal effects in reducing depressive symptoms in school-age children could also prevent the onset of a condition that is associated with some of the most extreme situations with which humans can be confronted is a remarkable one that does not seem to be backed up by empirical evidence.” Stephen Soldz of the Boston Graduate School of Psychoanalysis cited Seligman’s acknowledgment that the CSF is a gigantic study rather than a program based on proven techniques, and questioned the ethics of requiring soldiers to participate in research without informed consent. Soldz also criticised the CSF training for trying to build up-beat attitudes toward combat: “Might soldiers who have been trained to resiliently view combat as a growth opportunity be more likely to ignore or under-estimate real dangers, thereby placing themselves, their comrades, or civilians at heightened risk of harm?”

In 2021 the Chronicle of Higher Education carried a debate between Singal and Seligman about whether, with the CSF well into its second decade, there was any solid evidence of its effectiveness. Singal cited studies that, he said, failed to find any measurable benefits in such positive psychology techniques, and he criticized the Army’s own reports as methodologically unsound and lacking peer review. Seligman said that Singal had misinterpreted the studies and ignored the Army’s positive feedback from soldiers, one of whom told Seligman that “if I had had this training years ago, it would have saved my marriage.”

What is Positive Disintegration?

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Introduction

The theory of positive disintegration (TPD) by Kazimierz Dąbrowski is a theory of personality development.

Unlike some other theories of development such as Erikson’s stages of psychosocial development, it is not assumed that even a majority of people progress through all levels. TPD is not a theory of stages, and levels do not correlate with age.

Unlike mainstream psychology, Dąbrowski’s theoretical framework views psychological tension and anxiety as necessary for growth. These “disintegrative” processes are therefore seen as “positive”, whereas people who fail to go through positive disintegration may remain for their entire lives in a state of “primary integration”, lacking true individuality. Advancing into disintegration and into the higher levels of development is predicated on having developmental potential, including overexcitabilities, above-average reactions to stimuli.

Dąbrowski’s Theory

Kazimierz Dąbrowski (1902-1980), a Polish psychiatrist and psychologist, developed the Theory of Positive Disintegration which led to the 1964 publication of the eponymous book, Positive Disintegration. He believed that the key to the treatment of mental illness was intense personal suffering and hence singled out the self-infliction of suffering as essential to personal development.

Dąbrowski’s theory of personality development emphasised several major features including:

  • Personality is not a given universal trait, it must be created – shaped – by the individual to reflect his or her own unique character (personality shaping)
  • Personality develops as a result of the action of developmental potential (DP) (overexcitability and the autonomous factor), not everyone displays sufficient DP to create a unique personality.
  • Developmental potential is represented in the population by a normal (bell) curve. Dąbrowski used a multilevel approach to describe the continuum of developmental levels seen in the population.
  • Developmental potential creates crises characterized by strong anxieties and depressions – psychoneurosis – that precipitate disintegration
  • for personality to develop, initial integrations based on instinct and socialisation must disintegrate – a process Dąbrowski called positive disintegration
  • The development of a hierarchy of individual values – emotional reactions – is a critical component in developing one’s personality and one’s autonomy, thus, in contrast to most psychological theories, emotions play a major role in this approach
  • Emotional reactions guide the individual in creating his or her individual personality ideal, an autonomous standard that acts as the goal of individual development
  • The individual must examine his or her essence and subsequently make existential choices that emphasize those aspects of essence that are higher and “more myself” and inhibit those aspects that are lower or “less myself” based upon his or her own personality ideal
  • Critical components of individual development include autoeducation and autopsychotherapy

Factors in Personality Development

Dąbrowski observed that most people live their lives in a state of “primary or primitive integration” largely guided by biological impulses (“first factor”) and/or by uncritical endorsement and adherence to social conventions (“second factor”). He called this initial integration Level I. Dąbrowski observed that at this level there is no true individual expression of the autonomous human self. Individual expression at Level I is influenced and constrained by the first two factors.

The first factor channels energy and talents toward accomplishing self-serving goals that reflect the “lower instincts” and biological ego – its primary focus is on survival and self-advancement. Often talents are used in antisocial or asocial ways. For example, at the lowest edge of Level I many criminals display this type of selfish behaviour. They tend to advance their own goals at the expense of others.

The second factor, the social environment (milieu) and peer pressure, constrains individual expression and creativity by encouraging a group view of life and discouraging individual thought and expression. The second factor externalises values and morals, thereby externalising conscience. Social forces shape expectations. Behaviour and one’s talents and creativity are funnelled into forms that follow and support the existing social milieu. “My mom says we should always be aware of what our lawn looks like because we want other people to think well of us when they drive by.” Because conscience is derived from an external social context, so long as society holds ethical standards, people influenced by the second factor will behave ethically. However, if a society becomes corrupt, people strongly influenced by second factor will not dissent. Socialisation without individual examination leads to a rote and robotic existence (the “robopath” described by Ludwig von Bertalanffy). Individual reactions are not unique, they are based upon social contexts (“I cry at funerals and laugh at weddings—everyone does”). According to Dąbrowski, people primarily motivated by second factor represent a significant majority of the general population.

Dąbrowski felt that society was largely influenced by the two lower factors and could be characterised as operating at Level I. For example, society’s emphasis on corporate success (“a dog eat dog mentality”) means that many CEOs operate on the basis of first factor – they will quickly sacrifice another to enhance their own advancement. As well, society’s educational, political, corporate, and media systems are self-promoting and discourage real examination or individual autonomy – the second factor. Alternatively, social justifications are often used: “Of course I break the speed limit, everyone does.” Or a soldier may explain that he or she was simply “following orders”. Thus, this external value system absolves the individual of any individual responsibility.

Dąbrowski also described a group of people who display a different course: an individualised developmental pathway. Such people break away from an automatic, rote, socialised view of life (which Dąbrowski called negative adjustment) and are said to move into and through a series of personal disintegrations. Dąbrowski saw these disintegrations as a key element in the overall developmental process. Crises challenge the status quo and cause people to review the self, ideas, values, thoughts, ideals, etc. If development continues, one goes on to develop an individualised, conscious and critically evaluated hierarchical value structure (called positive adjustment). This hierarchy of values acts as a benchmark by which all things are now seen, and the higher values in society’s internal hierarchy come to direct behaviour (no longer based on external social mores). These higher, individual values characterise an eventual second integration reflecting individual autonomy and for Dąbrowski, mark the arrival of true human personality. At this level, each person develops his or her own vision of how life ought to be and lives it. This higher level is associated with strong individual approaches to problem solving and creativity. One’s talents and creativity are applied in the service of these higher individual values and visions of how life could be – how the world ought to be. The person expresses his or her “new” autonomous personality energetically through action, art, social change, and so on.

Development Potential

Advanced development is often seen in people who exhibit strong developmental potential (“DP”). Developmental potential represents a constellation of genetic features, expressed and mediated through environmental interaction. Many factors are incorporated in developmental potential but three major aspects are highlighted: overexcitability (OE), specific abilities and talents, and a strong drive toward autonomous growth, a feature Dąbrowski called the “third factor”.

Overexcitability

The most evident aspect of developmental potential is overexcitability (OE), a heightened physiological experience of stimuli resulting from increased neuronal sensitivities. The greater the OE, the more intense are the day-to-day experiences of life. Dąbrowski outlined five forms of OE:

  • Psychomotor;
  • Sensual;
  • Imaginational;
  • Intellectual; and
  • Emotional.

These overexcitabilities, especially the latter three, often cause a person to experience daily life more intensely and to feel the extremes of the joys and sorrows of life profoundly. Dąbrowski studied human exemplars and found that heightened overexcitability was a key part of their developmental and life experience. These people are steered and driven by their value “rudder”, their sense of emotional OE. Combined with imaginational and intellectual OE, these people have a powerful perception of the world.

Although based in the nervous system, overexcitabilities come to be expressed psychologically through the development of structures that reflect the emerging autonomous self. The most important of these conceptualisations are dynamisms: biological or mental forces that control behaviour and its development. Instincts, drives, and intellectual processes combined with emotions are dynamisms. With advanced development, dynamisms increasingly reflect movement toward autonomy.

Abilities and Talents

The second aspect of developmental potential, specific abilities, and talents tends to serve the person’s developmental level. As outlined, people at lower levels use talents to support egocentric goals or to climb the social and corporate ladders. At higher levels, specific talents and abilities become an important force as they are channelled by the person’s value hierarchy into expressing and achieving the person’s vision of his or her ideal personality and his or her view of how the world ought to be.

The Third Factor

The third aspect of developmental potential (DP), which is simply referred to as ‘the third factor’, is a drive toward individual growth and autonomy. The third factor is critical as it applies one’s talents and creativity toward autonomous expression, and second, it provides motivation to strive for more and to try to imagine and achieve goals currently beyond one’s grasp. Dąbrowski was clear to differentiate third factor from free will. He felt that free will did not go far enough in capturing the motivating aspects that he attributed to third factor. For example, an individual can exercise free will and show little motivation to grow or change as an individual. Third factor specifically describes a motivation – a motivation to become one’s self. This motivation is often so strong that, in some situations, one can observe that one needs to develop oneself and that in so doing, it places one at great peril. This feeling of “I’ve gotta be me” especially when it is “at any cost” and especially when it is expressed as a strong motivator for self-growth is beyond the usual conceptualization ascribed to free will.

A person whose DP is high enough will generally undergo disintegration, despite any external social or family efforts to prevent it. A person whose DP is low will generally not undergo disintegration (or positive personality growth) even in a conducive environment.

The notion that some people have an innate potential for development that is determined by a higher sensitivity or overexcitability (analogous to the first aspect of DP) and by a related tendency to develop individual differences and autonomy from the group (analogous to the third aspect of DP) was independently developed by Elaine Aron (see Highly sensitive person) (although Aron’s approach is substantially different from Dąbrowski’s).

Developmental Obstacles

Dąbrowski called OE “a tragic gift” to reflect that the road of the person with strong OE is not a smooth or easy one. Potentials to experience great highs are also potentials to experience great lows. Similarly, potentials to express great creativity hold the likelihood of experiencing a great deal of personal conflict and stress. This stress both drives development and is a result of developmental conflicts, both intrapsychic and social. Suicide is a significant risk in the acute phases of this stress. The isolation often experienced by these people heightens the risk of self-harm.

Dąbrowski advocated autopsychotherapy, educating the person about OEs and the disintegrative process to give him or her a context within which to understand intense feelings and needs. Dąbrowski suggested giving people support in their efforts to develop and find their own self-expression. Children and adults with high DP have to find and walk their own path, often at the expense of fitting in with their social peers and even with their families. At the core of autopsychotherapy is the awareness that no one can show anyone else the “right” path. Everyone has to find their own path for themselves. Alluding to the knights on the Grail Quest, the Jungian analyst, Joseph Campbell allegedly said: “If a path exists in the forest, don’t follow it, for though it took someone else to the Grail, it will not take you there, because it is not your path”.

The Levels

The first and fifth levels are characterised by psychological integration, harmony, and little inner conflict. There is little internal conflict at Level I because just about every behaviour is justified – it is either good for the individual and is therefore “right”, or the individual’s society endorses it and it is therefore “right”. In either case, with a high level of confidence the individual acts as he or she perceives anyone else would, and does what anyone is “supposed to do”. At Level V there is no internal conflict because what a person does is always in accord with their own internal sense of values. Of course, there is often external conflict at both Levels I and V.

Levels II, III, and IV describe various degrees and types of disintegration and literal disease.

Dąbrowski was very clear that the levels he presents “represent a heuristic device”. In the process of development the structures of two or even three contiguous levels may exist side by side, although it must be understood that they exist in conflict. The conflict is resolved when one of the structures is eliminated, or at least comes under complete control of another structure.

Level I: Primary Integration

As outlined above, the first level is called primitive or primary integration. People at this level are often influenced primarily by either prominent first factor (heredity/impulse) and/or second factor (social environment) forces. The majority of people at Level I are integrated at the environmental or social level (Dąbrowski called them average people); however, many also exhibit shades of both impulse and socialization. Dąbrowski distinguished the two subgroups of Level I by degree: “the state of primary integration is a state contrary to mental health. A fairly high degree of primary integration is present in the average person; a very high degree of primary integration is present in the psychopath”.[9] Marked by selfishness and egocentrism (both reticent and explicit), those at level one development generally seek self-fulfilment above all, justifying their pursuits through a sort of “it’s all about me” thinking; or, more simply put, they adhere strongly to the phrase “the end justifies the means”, sometimes disregarding the severity of the “means”. Many people who are considered “leaders” often fall into this category.

A vast majority of people either do not break down their primitive integration at all or after a relatively short period of disintegration, usually experienced at the time of adolescence and early youth, end in a reintegration at the former level or in partial integration of some of the functions at slightly higher levels, without a transformation of the whole mental structure. Primary integration in the average person was proposed to be of a certain value due to its stability and predictability, and when accompanied by kindness and good-will, could represent persons who can provide support and stability to those experiencing disintegration.

Level II: Unilevel Disintegration

The prominent feature of this level is an initial, brief and often intense crisis or series of crises. Crises are spontaneous and occur on only one level. These crises involve alternatives that may appear to be different but ultimately are on the same level.

Unilevel disintegration occurs during developmental crises such as puberty or menopause, in periods of difficulty in handling some stressful external event, or under psychological and psychopathological conditions such as nervousness and psychoneurosis. Unilevel disintegration consists of processes on a single structural and emotional level; there is a prevalence of automatic dynamisms with only slight self-consciousness and self-control.

Conflicts on the same level (horizontal) produce ambitendencies and ambivalences: the person is equally attracted by different but equivalent choices on the same level (ambitendencies) and is not able to decide what to do because he or she has no real preference between the choices (ambivalences). If developmental forces are strong enough, ultimately, the person is thrust into an existential crisis: one’s social rationales no longer account for one’s experiences and there are no alternative explanations. During this phase, existential despair is the predominant emotion. The resolution of this phase begins as individually chosen values begin to replace social mores that have been ingrained by rote and are integrated into a new hierarchy of personal values. These new values often conflict with the person’s previous social values. Many of the status quo explanations for the “way things are,” learned through education and from the social order, collapse under conscious, individual scrutiny. This causes more conflicts focused on the person’s analysis of his or her own reactions to the world at large and of the behaviour of self and others. Common behaviours and the ethics of the prevailing social order come to be seen as inadequate, wrong or hypocritical. Positive maladjustment prevails. For Dąbrowski, these crises represent a strong potential for development toward personal growth and mental health. Using a positive definition, mental health reflects more than social conformity: it involves a careful, personal examination of the world and of one’s values, leading to the development of an individual personality.

Level II is a transitional period. Dąbrowski said you either fall back (reintegration on a lower level), end negatively, in suicide or psychosis or move ahead to Level III.

The transition from Level II to Level III involves a fundamental shift that requires a phenomenal amount of energy. This period is the crossroads of development: from here one must either progress or regress. The struggle between Dąbrowski’s three factors reflects this transitional crisis: “Do I follow my instincts (first factor), my teachings (second factor) or my heart (third factor)?” The developmental answer is to transform one’s lower instincts (automatic reactions like anger) into positive motivation, to resist rote and social answers, and to listen to one’s inner sense of what one ought to do.

Level III: Spontaneous Multilevel Disintegration

Level III describes a new type of conflict: a vertical conflict between two alternatives that are not simply different, but that exist on different levels. One is genuinely higher and the other is lower in comparison. These vertical conflicts initially arise from involuntary perceptions of higher versus lower choices in life.

“You just look at something, maybe for the 1000th time (to use the words of G. K. Chesterton), and it strikes you—you see this one thing differently and once you do, it changes things. You can no longer ‘go back and see it the way you did before.'”

Dąbrowski called this vertical dimension multilevelness. Multilevelness is a gradual realisation of the “possibility of the higher” (a phrase Dąbrowski used frequently) and of the subsequent contrasts between the higher and the lower in life. These vertical comparisons often illustrate the lower, actual behaviour of a person in contrast to higher, imagined ideals and alternative idealised choices. Dąbrowski believed that the authentic individual would choose the higher path as the clear and obvious one to follow (erasing the ambivalences and ambitendencies of unilevel conflicts). If the person’s actual behaviour subsequently falls short of the ideal, internal disharmony and a drive to review and reconstruct one’s life often follow. Multilevelness thus represents a new and powerful type of conflict, a conflict that is developmental in Dąbrowski’s approach.

Vertical conflicts are critical in leading to autonomy and advanced personality growth. If the person is to achieve higher levels, the shift to multilevelness must occur. If a person does not have the developmental potential to move into a multilevel view, then he or she will fall back from the crises of Level II to reintegrate at Level I. In the shift to multilevelness, the horizontal (unilevel), stimulus-response model of life is replaced by a vertical and hierarchical analysis. This vertical view becomes anchored by one’s emerging individual value structure, and all events are seen in relation to personal ideals. These personal value ideals become the personality ideal: how the person wants to live his or her life. As events in life are seen in relation to this multilevel, vertical view, it becomes impossible to support positions that favour the lower course when higher goals can be identified (or imagined).

Level IV: Directed Multilevel Disintegration

In Level IV the person takes full control of their development. The involuntary spontaneous development of Level III is replaced by a deliberate, conscious and self-directed review of life from the multilevel perspective. This level marks the real emergence of the third factor, described by Dąbrowski as an autonomous factor “of conscious choice (valuation) by which one affirms or rejects certain qualities in oneself and in one’s environment”. The person consciously reviews his or her existing belief system and tries to replace lower, automatic views and reactions with carefully thought out, examined and chosen ideals. These new values will increasingly be reflected in the person’s behaviour. Behaviour becomes less reactive, less automatic and more deliberate as behavioural choices fall under the influence of the person’s higher, chosen ideals.

Social mores are reviewed and re-accepted by a conscious internalisation when the individual feels it is appropriate. Likewise, when the person feels it is proper, a social value is reviewed and may be rejected to be replaced by a self-perceived higher alternative value. One’s social orientation comes to reflect a deep responsibility based on both intellectual and emotional factors. At the highest levels “individuals of this kind feel responsible for the realization of justice and for the protection of others against harm and injustice. Their feelings of responsibility extend almost to everything.”

This perspective results from seeing life in relation to one’s hierarchy of values (the multilevel view) and the subsequent appreciation of the potential of how life could be, and ought to be, lived. One’s disagreements with the (lower level) world are expressed compassionately in doing what one can to help achieve the “ought”.

Given their genuine (authentic) prosocial outlook, people achieving higher development also raise the level of their society. Prosocial here is not just support of the existing social order. If the social order is lower and you are adjusted to it, then you also reflect the lower (negative adjustment in Dąbrowski’s terms, a Level I feature). Here, prosocial is a genuine cultivation of social interactions based on higher values. These positions often conflict with the status quo of a lower society (positive maladjustment). In other words, to be maladjusted to a low-level society is a positive feature.

Level V: Secondary Integration

The fifth level displays an integrated and harmonious character, but one vastly different from that at the first level. At this highest level, one’s behaviour is guided by conscious, carefully weighed decisions based on an individualised and chosen hierarchy of personal values. Behaviour conforms to this inner standard of how life ought to be lived, and thus little inner conflict arises.

Level V is often marked by creative expression. Especially at Level V, problem solving and art represent the highest and noblest features of human life. Art captures the innermost emotional states and is based on a deep empathy and understanding of the subject. Often, human suffering and sacrifice are the subjects of these works. Truly visionary works, works that are unique and novel, are created by people expressing a vision unrestrained by convention. Advances in society, through politics, philosophy and religion, are therefore commonly associated with strong individual creativity or accomplishments.

Applications

Therapy

The theory of positive disintegration has an extremely broad scope and has implications for many areas. One central application applies to psychological and psychiatric diagnosis and treatment. Dąbrowski advocated a comprehensive, multidimensional diagnosis of the person’s situation, including symptoms and developmental potentials.

Symptoms and Developmental Potential

If the disintegration appears to fit into a developmental context, then the person is educated in the theory and encouraged to take a developmental view of his or her situation and experiences. Rather than being eliminated, symptoms are reframed to yield insight and understanding into life and the person’s unique situation.

The Importance of Narratives

Dąbrowski illustrated his theory through autobiographies of and biographies about those who have experienced positive disintegration. The gifted child, the suicidal teen or the troubled artist is often experiencing the features of TPD, and if they accept and understand the meaning of their intense feelings and crises, they can move ahead, not fall apart. The completion of an extensive autobiography to help the individual gain perspective on his or her past and present is an important component in the autopsychotherapy process. In this process, the therapist plays a very small role and acts more as an initial stimulus than an ongoing therapist. Dąbrowski asked clients to read his books and to see how his ideas might relate to their lives.

Autopsychotherapy

For Dąbrowski, the goal of therapy is to eliminate the therapist by providing a context within which a person can understand and help oneself, an approach to therapy that he called autopsychotherapy. The client is encouraged to embark on a journey of self-discovery with an emphasis on looking for the contrast between what is higher versus what is lower within his or her personality and value structure. The person is encouraged to further explore his or her value structure especially as it relates to the rationale and justification of positions. Discrepancies between values and behaviour are highlighted. The approach is called autopsychotherapy to emphasize the important role that the individual must play in his or her own therapy process and in the larger process of personality development. The individual must come to see that he or she is in charge of determining or creating his or her own unique personality ideal and value structure. This includes a critical review of social mores and values that have been learned.

Dąbrowski was very concerned about what he called one-sided development, in which people display significant advanced development in only one aspect of life, usually intellectual. He believed that it is crucial to balance one’s development.

Overexcitability

Dąbrowski also encouraged people to see their reactions (overexcitabilities) and their phenomenological view of the world in the context of their developmental potential. The experience of, and reaction to, crises are a very important aspect of this approach and people are encouraged to experience personal crises with a positive and developmental view.

Dąbrowski reminds clients that without internal disease there is little stimulus for change or growth. Rather than trying to rapidly ameliorate symptoms, this approach encourages individuals to fully experience their feelings and to try to maintain a positive and developmental orientation to what they may perceive as strong depression or anxiety. Of course, this is a unique approach in today’s world of seeking immediate and total relief of any unpleasant psychological experience (although it can be compared to Aron’s to some extent).

Dąbrowski and the Gifted Individual

In an appendix to Dąbrowski (1967), results of investigations done in 1962 with Polish youth are reported. Specifically, “a group of gifted children and young people aged 8 to 23” were examined (p.251). Of the 80 youth studied, 30 were “intellectually gifted” and 50 were from “drama, ballet, and plastic art schools” (p.251). Dąbrowski found that every one of the children displayed overexcitability, “which constituted the foundation for the emergence of neurotic and psychoneurotic sets. Moreover it turned out that these children also showed sets of nervousness, neurosis, and psychoneurosis of various kinds and intensities, from light vegetative symptoms, or anxiety symptoms, to distinctly and highly intensive psychasthenic or hysterical sets” (p.253). Dąbrowski asked why these children should display such “states of nervousness or psychoneurosis” and suggested that it was due to the presence of OE (p.255). “Probably the cause is more than average sensitivity which not only permits one to achieve outstanding results in learning and work, but at the same time increases the number of points sensitive to all experiences that may accelerate anomalous reactions revealing themselves in psychoneurotic sets” (p.255).

The association between OE and giftedness appears to be borne out in the research (Lysy and Piechowski 1983; Piechowski 1986; Piechowski and Miller 1995). It appears that at the least OE is a marker of potential for giftedness/creativity. Dąbrowski’s basic message is that the gifted will disproportionately display this process of positive disintegration and personality growth.

Key Ideas

The theory is based on key ideas that may be listed as follows:

  • That lower animal instincts (first factor) must be inhibited and transformed into “higher” forces for people to be Human (this ability to transform instincts is what separates people from other animals).
  • That the common initial personality integration, based upon socialisation (second factor), does not reflect true personality.
  • At the initial level of integration, there is little internal conflict as when one “goes along with the group”, there is little sense of individual wrongdoing. External conflicts often relate to the blockage of social goals – career frustrations for example. The social mores and values prevail with little question or conscious examination.
  • True personality must be based upon a system of values that are consciously and volitionally chosen by the person to reflect their own individual sense of “how life ought to be” and their “personality ideal” – the ideal person they feel they “ought to be”.
  • The lower animal instincts and the forces of peer groups and socialisation are inferior to the autonomous self (personality) constructed by the conscious person.
  • To break down the initial integration, crises and disintegrations are needed, usually provided by life experience.
  • These disintegrations are positive if the person can achieve positive and developmental solutions to the situation.
  • “Unilevel crises” are not developmental as the person can only choose between equal alternatives (go left or go right?).
  • A new type of perception involves “multilevelness”, a vertical view of life that compares lower versus higher alternatives and now allows the individual to choose a higher resolution to a crisis over other available, but lower, alternatives – the developmental solution.
  • “Positive disintegration” is a vital developmental process.
  • Dąbrowski developed the idea of “developmental potential” to describe the forces needed to achieve autonomous personality development.
  • Developmental potential includes several factors including innate abilities and talents, “overexcitability” and the “third factor”.
  • Overexcitability is a measure of an individual’s level of nervous response. Dąbrowski found that the exemplars he studied all displayed an overly sensitive nervous system, also making them prone to angst, depression and anxiety – psychoneuroses in Dąbrowski’s terms, a very positive and developmental feature.
  • The third factor is a measure of an individual’s drive toward autonomy.
  • Dąbrowski’s approach is very interesting philosophically as it is Platonic, reflecting the bias of Plato toward essence – an individual’s essence is a critical determinant of his or her developmental course in life. However, Dąbrowski also added a major existential aspect as well, what one depends upon the anxieties felt and on how one resolves the day to day challenges one faces. Essence must be realised through an existential and experiential process of development. The characterisation advanced by Kierkegaard of “Knights of faith” may be compared to Dąbrowski’s autonomous individual.
  • Reviewed the role of logic and reasoning in development and concludes that intellect alone does not fully help people know what to do in life. Incorporates Jean Piaget’s views of development into a broader scheme guided by emotion. Emotion (how one feels about something) is the more accurate guide to life’s major decisions.
  • When multilevel and autonomous development is achieved, a secondary integration is seen reflecting the mature personality state. The individual has no inner conflict; they are in internal harmony as their actions reflect their deeply felt hierarchy of values.
  • Rejected Abraham Maslow’s description of self-actualisation (Dąbrowski was a personal friend and correspondent of Maslow’s). Actualisation of an undifferentiated human self is not a developmental outcome in Dąbrowski’s terms. Dąbrowski applied a multilevel (vertical) approach to self and saw the need to become aware of and to inhibit and reject the lower instinctual aspects of the intrinsic human self (aspects that Maslow would have people “embrace without guilt”) and to actively choose and assemble higher elements into a new unique self. Dąbrowski would have people differentiate the initial self into higher and lower aspects and to reject the lower and actualise the higher in creating unique personalities.

Secondary Integration versus Self-Actualisation

People have often equated Maslow’s concept of self-actualisation with Dąbrowski’s level of secondary integration. There are some major differences between these two ideas. Fundamentally, Maslow described self-actualisation as a process where the self is accepted “as is”, so both higher and lower aspects of the self are actualised. Dąbrowski introduces the notion that although the lower aspects may initially be intrinsic to the self, as human beings we are able to become aware of their lower nature. People are able to develop self-awareness as to how they feel about these low levels – if they feel badly about behaving in these lower ways, then they are able to cognitively and volitionally decide to inhibit and eliminate these behaviours. In this way, the higher aspects of the self are actualized while the lower aspects are inhibited and, for Dąbrowski, this is what is unique about humans and sets people apart from other animals – no other animal is able to differentiate their lower instincts and therefore can not inhibit their animalistic impulses, an idea also expressed in Plessner’s eccentricity.

Controversy

Few psychological tests exist that measure Dąbrowskian constructs. The most widely known instrument is the Overexcitability Questionnaire – Two.

According to some, Dąbrowski was influenced by his Catholic upbringing and pursued a lifelong obsession with self-mutilation resulting in his semi-autobiographical 1937 work, Psychological Basis of Self Mutilation. It is claimed by Majorie Battaglia that his personal experience as a victim of medical torture by Nazis for several months as a member of the Polish resistance, being only one of the 38 surviving psychiatrists in Poland out of the 400 practicing at the beginning of World War II, almost definitely informed his world view.