Why do we need Positive Psychology, Why now?

•April 23, 2010 • 1 Comment

Positive Psychology is the study of the processes and conditions which contribute to the optimal functioning of individuals, the study of positive aspects of human experiences, positive traits and optimistic institutions in our world today (Gross, 2009). Positive psychological has been influenced by the efforts of Allport’s (1958) work in positive individualistic characteristics. Additionally Maslow’s (1968) interests in exploring positive human experiences, as well as many others who have looked to an understanding of why people require positivity and associations around it. Today this influence of experts in the past has led to the phenomenon of positive psychology which aims at understanding the ways people experience contentment, altruism as well as the existence of satisfied families and organisations. In this comprehension i will outline the future possible positive impacts of a positive psychology, what needs to be done and the outcomes of a positive psychology in out societies today.

In the past psychology has focused on negative aspects associated with disabilities, illnesses, and how to fix them. For instance Social Psychologists have carried out research on the subsistence of negative outcomes related to poor self-esteem and implicit chauvinism (Josephs, Bosson, & Jacobs, 2003). Furthermore, Health Psychologists have highlighted the negative impacts of smoking, alcohol, and other aspects of our surrounding environments which relate to stress and other health issues associated with the world we live in (Dickerson & Kemeny, 2004). The future of positive psychology needs to readdress the problems faced in the past and outline benefits which may increase and promote the stability and quality of living for various groups and individuals themselves.

In addition the reason a positive psychology has not arisen until now is that the world has gone through wars, violence and suffering in the past decades there was no window of positivity. In the past funding was allocated to research on mental illnesses, traumas and associated illnesses with the era (Seligman, 2002). It may have been worthwhile to have focused on keeping people optimistic and positively counselling people who had been affected in this era or due to other individual circumstances at the time. Espirit de Corps or otherwise known as positive affect tone suggests and predicts that a number of positive actions and behaviours in a group including helping others, improving performance, making suggestions speeding good will and influencing others can portray a positive effect in individuals lives (Zhou & George, 2001).

The issue also being they did not zone in on the positives, what makes people happy, succeed, enjoy life and achieve goals. There is a lack of studies related to human strengths, qualities virtues and positive aspects of people’s lives. Positive psychology in today’s world will help people with disabilities, illnesses, people suffering from stress or other deficits life more content and fulfilled lives. Psychologists have seen and viewed negative acts as more diagnostic about individual’s implicit and internal qualities than positive acts (Vonk, 1994). This issue will open doors for psychology and lead to a new way of thinking.

In the future of positive psychology in the subject area as highlighted by Ryff (2003) there is a need to map “the domain of human optimal functioning”. This will in turn help people to become more content in their lives. Psychologists need to understand why people are not happy and positive and come up with clear solutions to the issues which have arisen before and draw from influential studies which have been carried out previously. There is a need for positive thinking in most people’s lives and some individuals need help in reaching such levels of thought. The future task is to clearly understand the aspects which build strength in families, individuals and institutions in today’s contemporary world.

In addition psychologists and practitioners need to outline the context of reliance, figure out the role of positive experiences as well as the outcomes and the functions and effects of positive relations among people. There is a need to understand how these factors will contribute to physical health of people and groups, well being, and promising institutions. Primarily positive psychology needs to incorporate and develop effective and reliable interventions to increase and rely on their processes. There need to be a turning point in which negatives are turned into positives. People today tend to live in an ongoing world in which they are faced with dilemmas, difficult decisions and negative rushes in their lives. People need to learn to slow down and enjoy the small things in life as well as attending to their positive attributes, positive occurrences in their lives, step back and take a look at the bigger picture, the positives.

Allport, G. W. (1958). Becoming: Basic considerations for a psychology of personality. Oxford, England: Verlag.

Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 1–38.

Gross, R. (2009). Themes, Issues and Debates in Psychology. Third Edition.

Josephs, R. A., Bosson, J. K., & Jacobs, C. G. (2003). Self-esteem maintenance processes: Why low self esteem may be resistant to change. Personality and Social Psychology Bulletin, 29, 920–933.

Maslow, A. H. (1968). Toward a psychology of being. New York: Van Nostrand.

Ryff, C. D. (2003). Corners of myopia in the positive psychology parade. Psychological Inquiry, 14, 153–159.

Seligman, M. E. P. (2002). Positive psychology, positive prevention, and positive therapy. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology (pp. 3–9). New York: Oxford University Press.

Vonk, R. (1994). Trait inferences, impression formation, and person memory: Strategies in processing inconsistent information about people. European Review of Social Psychology, 5, 111–149.

Zhou,J., & George, J. M., (2001). When job dissatisfaction leads to creativity: Encouraging the expression of voice. Academy of Management Journal, 44, 682-696.

Positive Roots, Positive Politics

•April 22, 2010 • Leave a Comment

Positive Psychology does not critique the methodologies of psychology, rather it critiques its subject matter. It calls us, as psychologists, to address an imbalance that it claims has been present in the discipline for the last 50 years. It claims that psychology has been almost exclusively focused on understanding the negative aspects of the mind, and fixing the problems of human life, at the expense of the positive aspects such as positive subjective experience, positive character traits, and positive institutions. As such, positive psychology as a sub-discipline that at the core, is characterised by advocacy for increased research in these areas. Given this starting point, the positive psychology movement is inevitably value-laden from the outset. Within ‘pure’ positive psychology research, the value is merely circumstantial, a necessary characteristic of its being included in the category of ‘positive psychology research’. However, proponents of positive psychology have also made the stronger claim that research in this field be applied with the aim of increasing human happiness and improving human lives. This, I believe, requires a more precise definition of the ‘good’, as seen by positive psychology. Deiner and Suh (1997) proposed three ways in which something can be designated ‘good’: things that are regularly chosen by people can be assumed to be good, people’s positive subjective experience of something can indicate that that thing is good, and people treat the things which social norms and traditions designate as ‘good’ as good. I argue that these three bases can be reduced to the second – positive subjective experience. People regularly choose things freely because of implicit or explicit association with positive affect, and social norms and traditions are but another manifestation of the association of things with positive affect. Similarly, of Seligman and Csikszentmihalyi’s (2000) distinction between positive psychology’s areas of study (positive subjective experience, positive character traits, and positive institutions), I argue, following Plato, Bentham (1789), and others, that positive character traits and positive institutions are good only extrinsically, deriving their value from their capacity to produce positive subjective experience. As such, positive subjective experience can be taken to be the only thing which is ‘intrinsically good’, all other things of positive value deriving their value from positive affect. Consequently positive psychology is grounded in this notion of positive affect.

After 10 years of research, positive psychology has become well-established, having now got dedicated journals, masters degrees, college textbooks (Gable and Haidt, 2005). However, as Gable and Haidt (2005) note, despite the three pillars of positive psychology mentioned above, the majority of research has been conducted on positive subjective experience and positive character traits, with positive institutions being neglected. If positive psychology is to fulfill its goal of increasing human happiness, in addition learning about and developing interventions to increase happiness, it must also engage society at a wider level. This represents an opportunity to improve the lives of people on a large scale, something which is a goal not only of psychology but also a political and moral goal. Below I will discuss some of these possibilities in more detail.

Diener and Biswas-Diener (2001) present a literature review comparing subjective well-being and income levels. The paper provided evidence that happiness and income were strongly correlated only to the point at which one’s basic needs were met. After this point, a law of diminishing returns is in effect, with income level only a very weak predictor of happiness, especially in wealthy, developed nations. In a widely cited study, Easterlin (1974) found that while average income in the United States increased between 1946 and 1970, happiness did not and even declined at points during this period. Taken together, these data suggest that in countries where gross domestic product is adequate to meet the basic needs of its citizens, money quickly loses its importance for well-being. However, policy in almost every country in the world, including developed nations, is judged on the basis of economic/monetary indicators (Diener and Seligman, 2004).

If one accepts that happiness is important and that increasing it is a worthwhile aim, then positive psychology has a role to play. By researching happiness and the conditions that promote it, positive psychology may be able to support and facilitate a re-focusing and re-direction of policy-making and governance at a national level. This support will come from the provision of empirically-based research findings to guide policy decisions that are more likely to increase the public well-being. For example, state funding could support programs such as the ‘Penn Prevention Program’ which has been demonstrated to reduce risk of developing depressive symptoms in children (aged 10-13) by teaching ‘learned optimism’ techniques (Jaycox et al., 1994). Since research has also found happiness to be related to strong social ties (Baumeister and Leary, 1995) and freedom from mental illness (Packer et al., 1997), policies which build strong communities and increase funding for mental health services could serve to raise national happiness.

As Linley et al. (2006) indicate, small movements towards this objective have already begun. The United Nations University WIDER project has produced some work on developing measures of subjective well-being to supplement traditional economic measures (Veenhoven, 2004). One extremely noteworthy case is that of Bhutan, a small country in South Asia. Bhutan has one of the lowest GDP per capita in the world (5,400 US$ in 2009) – 137th (CIA World Factbook, 2010). Yet in 1972 the King of Bhutan introduced the concept of Gross National Happiness to reflect his approach to the development of Bhutan (Braun, 2009). The Centre for Bhutan Studies opened in 1999, which conducts research into happiness, including the development of a index of ‘Gross National Happiness’ (Braun, 2009). The information from this instrument, which measures many facets of well-being, is used to identify areas needing more input and guide policy-making (Braun, 2009). For example, one project initiated by the government involved setting up health services, dormitories and food in temples, in order to facilitate the elderly who wish to remain at their temple in their old age for a life of meditation, as opposed to moving to a nursing home (Braun, 2009). White (2007) presented evidence that Bhutan ranked 8th in the world on subjective well-being, and the only country in the top 20 with a low GDP. This clearly supports the idea that policy at a national level can be effective in increasing the happiness of the public.

Positive psychology therefore presents an opportunity to bolster developments of this kind with scientifically tested concepts. The contributions of positive psychology to date have been great, providing us with interventions to be used at an individual level. However, I believe positive psychology holds great promise in getting involved at the higher levels of society, and hope that the field will make good on its promise and progress in this direction.

Baumeister, R., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497-529.

Bentham, J. (1789). An Introduction to the Principles of Morals and Legislation. Oxford University Press: London.

‘Bhutan’, https://www.cia.gov/library/publications/the-world-factbook/geos/bt.html, 2010, accessed 22/04/10

Braun, A. A., (2009). Gross National Happiness in Bhutan: A Living Example of an Alternative Approach to Progress. (Unpublished doctoral dissertation). University of Pennsylvania: Pennsylvania.

Diener, E., & Biswas-Diener, R. (2002). Will money increase subjective well-being? A literature review and guide to needed research. Social Indicators Research, 57, 119–169.

Diener, E., & Seligman, M. E. P. (2004). Beyond money: Toward an economy of well-being. Psychological Science in the Public Interest, 5, 1–31.

Diener, E., & Suh, E. (1997). Measuring quality of life: Economic, social, and subjective indicators. Social Indicators Research, 40, 189 –216.

Easterlin, R. A. (1974). Does economic growth improve the human lot? Some empirical evidence. In P. A. David & M. W. Reder (Eds.), Nations and Households in Economic Growth (pp. 89- 125). New York: Academic Press.

Gable, S. L., & Haidt, J. (2005). What (and why) is positive psychology? Review of General Psychology, 9, 103–110.

Jaycox, L. H., Reivich, K.J., Gillham, J., & Seligman, M. E. (1994). Prevention of depressive symptoms in school children. Behaviour Research and Therapy, 32, 801-816.

Linley, P., Joseph, S., Harrington, S., & Wood, A. (2006). Positive psychology: Past, present, and (possible) future. Journal of Positive Psychology, 1, 3 – 16.

Packer, S., Husted, J., Cohen, S., & Tomlinson, G. (1997). Psychopathology and quality of life in schizophrenia. Journal of Psychiatry & Neuroscience, 22, 231–234.

Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55, 5-14.

Veenhoven, R. (2004), Subjective measures of wellbeing, in M. McGillivray (ed.), Measuring Human Wellbeing. World Institute for Development Economics Research; United Nations University.

White, Adrian G. (2007). A Global Projection of Subjective Well-being: A Challenge to Positive Psychology? Psychtalk, 56, 17-20.

Emotion as object and the enactive approach

•April 22, 2010 • 1 Comment

Great confusion has arisen from the dominance of two approaches to the human experience: Descartes mind/body problem and likening cognitive functions to computer processing. The two seem to lead us to think of the mind as something internal and robotic. Enactive psychology is a step away from traditional theories of the mind. It allows us to explore the mind through lived human experience. Enactive psychology is a cognitive approach to the mind, placing human experience at the centre of the enquiry. The controversy is the enactive approach itself, but I wish to discuss the implications and evidence for enactive psychology through the enactive work done on emotion and perception.

Enactive theory rejects computationalism, that is, that the mind can be likened to a computer. Traditional cognitive theories propose that the mind ‘computes’ or interprets stimuli in the world and produces outputs, which can be seen in reaction behaviour. Evidence is growing however, that this explanation of how the mind works is insufficient. So what are we actually talking about when we hypothesise perception?

There are five aspects of the enactive approach which have been discussed in related blogs. For the sake of word count, I will not discuss them in detail but mention them. They are: autonomy (humans as self-generating and self maintaining agents); a rejection of computationalism (mind as computer, hierarchy of cognitive processes); cognition as embodied action (cognition involves one’s experience of oneself as a bodily subject situated in the world); ‘inner’ and ‘outer’ are not separate spheres connected through representational interfaces {enaction through an autonomous agency and mode of coupling with the environment (Colombetti and Thompson, forthcoming)}; experience central to an understanding of the mind.

Embodied perception: mirror neurons

Mirror neurons and body loops can help us understand how the body acts in certain circumstances and what may actually be going on in the brain. These are the two attempts which give an account of how one enacts in the world as a bodily agent.

Mirror neurons rely on the triggering of a neural pathway from an event, which may not specifically relate to the event. For example, consider hearing your car alarm go off in the middle of the night only to remember that you left your car at your friend’s house for the night. You find yourself in a state of panic and have increased heart-rate and sweat before the realisation calms you. The mirror neurons prepared you for a situation in which you were adequately aroused to deal with the situation. While this is an extreme example, I hope you get the idea. These neurons are mirrored when a situation arises of which the neurons associated with particular instances are activated.  Mirror neurons have been proposed as in play when recognising the emotions of others.

Advances in dynamic neural approaches to perception have allowed us to explore the sensorimotor aspects of embodied cognition. Hurley (1998) has explored dynamical systems of cognition with embodied experience as key to understanding perception and action. Although not an embodied or enactive theorist, she proposes that perception is a kind of action. This supports notions that perception is not something that happens to us or in us: it is something that we do (perception is action, action is perception). Mental activity is deeply linked to embodied presence. Cognition is grounded in embodied presence and experience.

Embodied emotion: body loops

In phenomenological research it has been suggested that an individual is considered as an embodied ‘being-in-the-world’ (Merleau-Ponty, 1962). This means that human action and human experience are not separable phenomena. Damasio (2000) states that we are not conscious of all of our feelings. He makes the distinction between ‘feeling’ and knowing that one has a feeling. “A perceptual experience is an embodied experience because it is an experience of the body in the act of perceiving” (Colombetti, 2007 p. 62).

Different emotions are associated with different bodily changes. Our capacity to perceive presupposes the ability to orient in the environment. Damasio (1999) proposes that we view emotion as an object. This allows us to examine causal effect of emotion (object) on the organism.

Damasio (1999) proposes that if the psychological and physiological context is right: an emotion will ensue. We do not need to be conscious of the inducer of an emotion and often are not, and we cannot control emotions wilfully. Embodiment is central to understanding the ‘lived body’. It allows a better understanding of what we call consciousness and the mind. It is proposed that emotions are acquired and processed through ‘lived’ or corporeal (i.e. bodily) interaction with stimuli.

Damasio (1999) proposed that the body loop occurs through hormonal and neural communication. Emotion occurs within the organism through these changes. Hormonal changes occur through the bloodstream, one’s feelings during an instance involving the interpretation of a situation or object. Neural signals are possible through electrochemical signals transmitted through nerves. It is at this level that theorists have opposed an embodied view – what happens to people who are partly or completely paralysed or people with ‘locked in’ syndrome and cannot rely on bodily interactions. However, it is important to note that ‘as-if’ loops are just one part of the causal underpinnings of emotion, so ‘locked in’ syndrome or paralyses does not discredit this approach. If we consider the ‘extended mind’ approach to cognition, we see that the brain and body incorporates other external players in the web of processes subserving emotions and feelings (Damasio, 1999).

Perceiving an object causes a set of values about a situation (Damasio, 1999). Emotions can be seen as personal responses to the environment. This suggests that it involves a subjective processes of interpretation i.e. appraisal (Colombetti, 2007). As Colombetti (2007) states: even though I know that my ‘euphoria’ at a party is caused by alcohol, it does not reduce it! The emotional response of an aroused body is available to the subjects experience. We can see therefore that traditional cognitive theories which often speak of the mind as a separate entity from the body are insufficient.

The Enactive Approach to Psychology requires further empirical investigation. For sure, enactive perspectives seem to have substantial merits and insights into the mind, especially explaining the phenomena of emotion, and other areas such as language which was not included in this blog. In relation to human experience, enactive psychology is preparing to provide answers to cognitive functionality. “Our face to face understanding of one another involves a similarity of bodily structure and sensorimotor skills, the capacity for visual reactions, and body proximity” (Colombetti & Thomson, forthcoming, p. 63).

References

Colombetti. (2007). Enactive Appraisal. Phenomenological Cognitive Psychology , 527–546.

Colombetti, G. and Thompson, E. (forthcoming). The feeling body: Towards an enactive approach to emotion, in W. F. Overton, U. Müller and J. Newman (eds), Body in Mind, Mind in Body: Developmental Perspectives on Embodiment and Consciousness. Hillsdale, NJ: Lawrence Erlbaum.

Damasio, A. (1999). The feeling of what happens. London: Vintage.

Hurley, S. L. (1998). Consciousness in action. London: Harvard University Press.

Merleau-Ponty. (1962). Phenomenology of perception. London: Routledge.

Positive Psychology turning “victims”into “survivors”

•April 22, 2010 • 2 Comments

The world breaks everyone and afterward some are strong at the broken

places.”  E. Hemmingway. (1929)

This paper highlights a specific area where Positive Psychology could benefit society in changing the “victim” attitude towards trauma. Any experience can be defined as traumatic, from the 9/11 attack   to failing exams. What is imperative is that people get the opportunity to realise that everyone experiences this feeling in their lifetime and that it is not a reason to detach from living life fully.  There are many positive experiences hidden in the traumatic experience and this fact needs further emphasis so people will avail of appropriate healing methods that do not involve drug therapy. The benefits of detaching and engaging in learned helplessness will be highlighted as well as the positive affect a therapeutic encounter would provide and an alternative to learned helplessness.     

 Gillham (2000) highlights essays written by Martin Seligman. In these essays Seligman discusses his theory on Victimology or learned helplessness.  He begins by highlighting the fact that the youth in America are experiencing an epidemic of depression, pessimism and sadness. In investigating this further he see’s the epidemic as partially caused by the negativity involved with the social sciences and psychology.  The social sciences perspective on human virtues such as altruism and honesty see’s them as illusions but yet human weakness such as greed and fear are considered authentic.    In the last 30 years (Myers, 2000) discovered that there have been 46,000 papers published on depression and only 400 on joy. Social scientists highlight authoritarianism, religion and child discipline and report on the negative consequences of these but over look the positive aspects of the human experience. Psychology since World War 2 has highlighted the negative effects of trauma, abuse and illness but failed to highlight the fact that such experiences often produce growth, strength and creativity. Our society has become focused on “isms” racism, sexism, alcoholism but has excluded the notion of personal responsibility, decision-making and free-will. People can be viewed as mere external stimuli in an environment. All of these factors contribute to Victimology and do not serve our society. There have been some benefits to advances in thinking around the victim theory and many costs; these are highlighted by (Seligman, 2000).

 In the pre-1930’s era the stigma attached to alcoholism involved words such as evil or sinners. In 1953 the civil rights movement changed the bias towards African people from lazy, stupid and unemployable to a people experiencing severe discrimination. These have been positive steps towards reducing prejudice within society but the costs seem to outweigh the benefits.  (Seligman, 2000) highlights three costs of Victimology.  

The first is that one can temporarily feel good in indulging in the victim role but it is not sustainable due to the fact that the causes of the pain have not been investigated. The second cost is that some people are classed as victims of a situation when in fact it is not the disease causing the negativity but the individual themselves. Victimology erodes any sense of responsibility on the individual and induces learned helplessness. When people feel no control over their lives they act as if they are helpless (Seligman, 2008).  We are a society of people who are running away from dysphoria. Dysphoria is classified as an unpleasant mood which is a result of life events. Grief, loss, trauma and sadness are integral to living and yet when encountered with these emotions we look to avoid. (Seligman, 2000) highlights that people need to experience these feelings and realise that they can overcome them, and that it is through overcoming these experience that individuals grow and learn.

 We are missing out on the positive experience of trauma (Linley, 2000).  Gross (2009) states that research conducted by Calhoun and Tedeschi (1999) on survivors of trauma uncovered the fact that 30-90 per cent of them report experiencing positive changes as a result of the experience. Individuals can change their approach to living as a result of trauma and this amazing human quality is not focused on enough.

 In a paper by Fosha (2002) the writer highlights that when helping people overcome trauma, the aim is to help people get stronger in broken places. What is amazing is that through this treatment clients often discover amazing places within themselves that have always been strong. When faced with the worst we can find our best. Also Fosha (2002) highlights that through trauma others become strong and trauma can awaken extraordinary capacities that would otherwise lie dormant. Without the trauma these discoveries may never be uncovered.  In the face of trauma people connect to one another, help strangers and on some level have the desire to transform them selves. People become heroic and extraordinary kindness is visible. It is in the aftermath that the risk arises, when the adrenaline decreases. People can look to trivialise, totally detach and continue. It is this dissociation that the causes traumatic side-effects. The need for discussion with a therapist or loved on is vital for individuals to have their heroic acts highlighted, recognised and praised. This serves to provide the individual with a sense of purpose and meaning and decreases the risk of the person detaching fully and then subconsciously drawing further traumatic events into their lives. Positive Psychology would provide them with this opportunity without the risk of diagnosing PSTD or prescribing drug therapy to them instead.  We must live as fully functioning people, not semi-functioning, semi-drugged people. Societies “quick fix” method of treatment is not effective and is promoting drug use.  People need to realise that the triumph in the face of traumatic experiences is in the healing as it provides an opportunity to reclaim the self.

Fosha (2002) highlights the need for therapists to help clients to tolerate and accept feeling good, feeling joyful and feeling loved. Traumatic experiences can cause people to feel unworthy of such feelings. She advocates for therapists to embrace their own fear in fully meeting a client with love and acceptance. The positive psychology movement would be hugely beneficial in helping those who view themselves as “victims” of trauma to seeing themselves as “survivors”.

But there was no need to be ashamed of tears, for tears bore witness that a man had the greatest of courage, the courage to suffer”.  Frankl  (1969).

References:

E. Hemmingway, (1929). A Farewell to Arms. US author & journalist (1899 – 1961)

Frankl, (1969).Man’s Search For Meaning. Simon and Schuster Inc. NY

Fosha, (2002). Trauma reveals the roots of resilience. Constructivism in the human sciences. 6(1+2) 7-15.

Gross (2009). Themes Issues and Debates in Psychology.3rd Edition. Hodder Education. Oxon.

Gillham (2000). The Science of Optimism and Hope. Templeton Foundation Press. London

Perhaps “Happily Ever After” is possible?

•April 20, 2010 • 7 Comments

Positive psychology is an attempt to shift psychology’s focus away from “deficits, disabilities, and disorders” (pg 348) and aim it towards the more positive aspects of human nature such as love and goodness (Zimbardo, 2004). It tries to comprehend positive emotions, strengths, and virtues by justifying in a scientific manner how the aforementioned develop and the role they play in enhancing people’s lives (Bacon, 2005). The umbrella term of positive psychology allows researchers from different areas of psychology to come together and share an interest they have in common and this merging of different viewpoints may cause new research ideas to come about or a new reading of previous research (Bacon, 2005). It also unites “scattered and disparate lines” (pg 410) of research on positive experiences, emotions, etc. (Seligman et al, 2005). It “strives toward an understanding of the complete human condition” (pg 109) which encompasses both positive and negative aspects of psychology (Gable & Haidt, 2005). It does not intend however to make it appear that the rest of psychology is negative; it grows from an effort to resolve the imbalance in psychology, which has previously concentrated on mental illness (Gable & Haidt, 2005). There are many areas of positive psychology which can be looked at such as: Happiness, the three desirable lives of Positive Psychology, Subjective Well Being, and Optimism to name a few. This article will focus on the notion of Happiness in positive psychology.

Scientific rationality can be used to study happiness in the same way it is used to study other human experiences (Sugarman, 2007). It can cause effects other than feeling good to occur, such as improved health and success (Seligman et al, 2005). Gross (2009) discusses how the issue of happiness has been debated for thousands of years and a consensus on a definition of happiness has still not been reached. Gross discusses two possible types of happiness which fall under the heading of Subjective Well Being (SWB): Eudaimonic and hedonic happiness. Eudaimonic happiness is happiness that occurs when the person feels that their life has meaning and/or purpose, and when they take part in activities that let them realize their potential. Hedonic happiness occurs when people are satisfied with their lives because there is a low occurrence of negative happenings and a high occurrence of positive happenings. However Gross reveals that there may be problems with defining happiness in this way. He tells us that happiness is “what life’s all about” (pg 20) and it is therefore what every person strives for.

Another aspect of happiness known as Positive Affect (PA) has been said to improve people’s health (Gross, 2009). Pressman & Cohen (2005 as cited in Gross, 2009) explain two types of PA: Trait PA and State PA. Trait PA is a dispositional attribute and State PA is a short period of positive emotion. Gross (2009) claims that there is an association between Trait PA and lower morbidity, also decreased pain is associated with higher levels of both types of PA.

However, people have a tendency to adapt to feeling happy and can then return to a baseline level of happiness rather than maintaining an increased level of happiness (Seligman et al, 2005). It is because of this finding that Seligman et al (2005) began a study into the possibility of maintaining happiness over a period of time. They created a questionnaire designed to detect changes in happiness levels called the Steen Happiness Index (SHI) and used it to reveal changes in happiness levels after participating in allocated assignments over a period of 6 months. They used a Randomized Control Trial (RCT) through the internet to gain participants. They had 5 happiness exercises and one placebo control exercise. The participants had a week to complete their assignment and their happiness levels upon completion were followed for the space of 6 months. The 6 exercises were: (1) Early memories (this was the placebo control) whereby they had to write about their early memories every night for a week, (2) Gratitude Visit whereby the participants wrote a letter of gratitude to someone they had never properly thanked and had to deliver it to them, (3) Three Good Things In Life whereby they had to write about three things that went well during the day and why every night for a week, (4) You at Your best whereby they had to write about a point in time where they were at their best and reflect on it every night for a week, (5) Using Signature Strengths In a New Way whereby they took a test to find their top 5 signature strengths and had to use one of them in a new and different way every day for a week, and finally (6) Identifying Signature Strengths whereby participants had to take the aforementioned test and use all 5 strengths more often during the week. It was found that Using Signature Strengths in a New Way and Three Good Things in Life increased happiness and decreased depressive symptoms for six months. The gratitude visit increased positive changes dramatically for one month. The others had positive but not long lasting effects on happiness. Seligman et al conclude that while six months is far away from “happily ever after” that “lasting increased happiness might be possible even outside fairy tales” (pg 419) through the use of positive psychology.

From this evidence we can gather that despite some criticisms about Positive Psychology and its methods (Sugarman, 2007; Gable & Haidt, 2005) it is possible to increase happiness and maintain it over a period of time. Thus there may be good reason to use a positive psychological method alongside a “normal” psychological method in the treatment of people’s problems. Of course if there are negative issues in a person’s life these need to be addressed and not ignored, but focusing on the positive aspects of a person’s life as well and using such interventions as already stated to increase their feelings of happiness, may help to reduce anxiety felt toward their issues and therefore make them easier for the person to deal with. There is also reason to use it as a preventative measure against negative occurrences (Gable & Haidt, 2005) by using positive psychology on already well functioning people. Perhaps, with the use of Positive Psychology, we may all be able to find our “Happily Ever Afters” after all.

REFERENCES

Bacon, S. F. (2005). Positive Psychology’s Two Cultures. Review of General Psychology, Vol. 9, No. 2, 181–192.

Gable, S. L. & Haidt, J. (2005). What (and Why) Is Positive Psychology? Review of General Psychology, Vol. 9, No. 2, 103–110.

Gross, R. (2009). Themes, Issues and Debates in Psychology. London: Hodder Education.

Seligman, M. E. P., Steen, T. A., Park, N. & Peterson, C. (2005). Positive Psychology Progress: Empirical Validation of Interventions. American Psychologist, Vol. 60, No.5, 410-421.

Sugarman, J. (2007). Practical Rationality and the Questionable Promise of Positive Psychology. Journal of Humanistic Psychology , Vol. 47 No. 2, 175-197.

Zimbardo, P. G. (2004). Does Psychology Make a Significant Difference in Our Lives? American Psychologist, Vol. 59, No. 5, 339–351.

 

Further elaborations upon possible materialistic explanations of consciousness with a look at the emergence of qualia. (This posting is intended as a continuation of my previous posting.)

•April 19, 2010 • Leave a Comment

Controversial issues concerning consciousness may be understood as constituted by the debate between dualistic and monistic world views. The dualistic notion of separate mental and physical realms suffers greatly from the difficulty of explaining their interaction. The complete separation of a mental realm also precludes any physical explanation of mental phenomena. The monistic assertion of an entirely idealistic existence is difficult to absolutely refute since our awareness is ever constrained within a subjective and ideal reality but we sensibly assume that this results from a shared objective world. My previous posting adhered strongly to a monistic, materialistic paradigm and attempted to outline functionalism as an approach which may provide an adequate explanation of the emergence of consciousness. Suffering, as I do, from a severe case of confirmation bias, this posting further elaborates on the possibility of a materialistic explanation through exploration of the subjective side of the explanatory gap in the form of qualia. The acceptance of a materialistic standpoint does not eliminate controversy but, instead, situates it amongst various current psychological explanations. Due to respect for the wealth of experience and research offered, I hesitate to assert the superiority of any one particular stance from amongst these theories, preferring to simply outline plausible alternatives. The functionalist approach was one such alternative. This posting centres on John Taylor’s (2001) theory of relational consciousness and how it addresses the existence of qualia.

Qualia may be introduced by revisiting the zombie of my in-class presentation. She was like you in every way, every atom arranged in just the same manner, all past experience exactly the same. The question asked was ‘is it possible that she has no subjective awareness? Is she a zombie?‘ If, for you, it is possible, then you aren’t a materialist concerning theories of mind, since the material of your zombie replica doesn’t give rise to the subjective awareness that I presume, no, am sure, that you possess. If you believe that, given the exact same material components and organisation as yourself, your zombie would continue to experience almost the same awareness as you do (only from about three feet to one side!) then you accept the materialistic view that consciousness results from purely physical processes. The proposed similarity of experience also points to its dependence on similar relational organisation of the physical constituents of consciousness.

The subjective awareness which we (may) have granted our zombies is often discussed in terms of qualia; ‘the introspectively accessible, phenomenal aspects of our daily lives’ (http://plato.stanford.edu/entries/qualia, as cited in Dennett 2006)

Despite the difficulties of the singular form of ‘a quale’ (how to delimit a single aspect of experience?), qualia are a useful tool in the discussion of consciousness even if only providing a shorthand for ‘aspects of subjective experience’. To further detail the concept of qualia it may be interesting and informative to restate the philosophical argument of Mary the colour scientist.

Although she knows all there is to know about the neural mechanisms of colour vision, Mary has never directly experienced colour (due to a perverse captivity arrangement, or perhaps a physical defect in her eyes). When, at last, she is released, or undergoes surgery, she encounters the full colour experience of a banana; how does she respond? Does she show surprise at the new experience or does she, through her extensive knowledge of colour vision, already have a fair idea of what it would be like to see a banana? Dennett (2006) argues that failure to imagine the possibility of knowing ALL there is to know about colour vision obscures the question and leads us to suppose that she would be surprised. He has been described as an eliminativist and, indeed denies the existence of qualia (p.79, Dennett, 2006). The intuitive response seems to be that she would be surprised by her new experience. Knowing is distinguishable from experiencing in the sense that we may theoretically know something without ever having done it. The experience of seeing a banana in full Technicolor is new for a Mary who possessed only the normal knowledge of the ‘recipe’ for colour vision but perhaps not new for a Mary who truly embodied the entire field of knowledge related to seeing in colour. To elucidate further; if we knew ALL the intricacies of sensual awareness, interactive, motivational and experiential possibilities of being a bat, might we not be able to anticipate what it was like? That we have limited knowledge of these things may be the only limitation of our imaginative capability.

The two thought experiments of zombiehood and Mary, the colour scientist, are intended to emphasise the subjective, introspectively accessible nature of experience and the distinction this has from objective knowledge. The difficulty then ensues as to how we may bridge the ‘explanatory gap’ between the physical observations of the behaviour of the body (at all levels) and the subjective experience which is a feature of consciousness; how to give a physical account of qualia.

Functionalism progressed theories of mind through largely ignoring details of the mechanism of activity and concentrating on the combinations of the abilities of various modules and how they may globally function to produce purposeful activity. Homuncular functionalism as outlined in the previous posting recognised that some emergent properties of the modules may depend upon the qualities of their constituent components. In the case of the functioning mind, the components are (almost) ultimately the neural physiology, neurons and neural nets. To this end, and with the advancements in brain imaging and neuroanatomy, the physical underpinnings of local brain activity may usefully contribute to the understanding of more global brain functions such as consciousness. The teleological functionalism, briefly touched upon in my last post, would attempt to answer WHY we should have any qualia rather than none. Here we are only concerned with HOW qualia may arise. What follows is a possible materialistic account of phenomenal consciousness in terms of a brief outline of Taylor’s relational model.

John Taylor has incorporated much compelling evidentiary psychological research into his theory of relational consciousness (Taylor, 2001). He argues that consciousness develops along with the organism and may be the result of the comparison of a current state with previously experienced states; consisting of the difference between them rather than being identified with one state or the other.

Taylor identifies at least three broad types of consciousness which may be experienced on a daily basis. Due to the relational nature of consciousness, these naturally involve different types of memory; perceptual, non-declarative and declarative; including semantic and episodic. He suggests that passive or phenomenal consciousness results from mainly semantic and perceptual memory systems. Self consciousness is mostly concerned with episodic memory. Active or intentional consciousness again involves semantic memory, and hence elements of passive consciousness, as well as an inhibition of episodic memory (unless in an active problem solving capacity). The results of brain lesions are cited by Taylor as indicating that these different forms of consciousness arise independently from different brain regions. Passive or phenomenal consciousness is mainly centred in posterior regions after processing in the appropriate primary audio, visual or somatosensory cortices. Both active and self conscious processes rely on regions of the frontal lobes, with episodic memories located in posterior areas.

In consideration of the visual illusions offered in-class (and readily available on the web); active awareness that the stimuli is stationary (or the same length/size) along with the retained perception that it is moving (or shorter/smaller) highlights the independence of these forms of consciousness.

Taylor suggests that phenomenal consciousness may be present in a wide variety of species, active (intentional) consciousness may be somewhat more limited and self consciousness limited to some higher primates (including ourselves of course).

A physical explanation of the most basic, phenomenal aspect of consciousness will suffice to bridge the ‘explanatory gap’ and to that extent we again turn our attention to qualia. Taylor sidesteps the philosophical difficulties of the actual existence of qualia in the brain. Instead he uses the concept of qualia as adequately encapsulating some of the qualities of the ‘raw feel’ of experience; that is the indescribable, indivisible and transparent ‘just so’-ness of passive awareness. He asserts that this includes perceptual awareness and memories. These are formed from pre-processed stimuli. Consideration of the stage at which they emerge as awareness rather than unconscious processing is the crucial question of materialist accounts of consciousness.

Taylor develops an argument that consciousness arises from self reinforcing (as well as locally inhibiting) ‘activity loops’ in groups of neurons in regions of working memory buffers. He terms these ‘bubbles’ with regards to their development and duration. Activity may be sustained for up to two seconds in the posterior working memory sites and up to thirty seconds in the frontal lobe active working memory sites. ‘Pre-processing neural nets’ support various ‘working memory nets’ in these sites which gives rise to consciousness in a ‘winner take all’ manner rather than in an additive, global manner. As evidence for this view he offers the phenomena of our alternating viewpoint of ambiguous visual stimuli. When looking at the duck-rabbit picture or the Necker cube for instance, we can only perceive one of the possible interpretations at a time and we tend to jump from one to the other with no intermediate representations. Taylor demonstrates that we show ongoing neural activity relating to each representation but only one at a time gains access to our conscious awareness (much akin to Dennett’s, 2006 ‘fame in the brain’ model).

The temporal and continuous aspects of phenomenal awareness also supports Taylor’s model of consciousness arising as a result of competition between pre-processing neural nets. Awareness results from neural activity in a buffer working memory which can sustain activity at a given level for a short period of time. As the activity of any given working memory net wanes there are further pre-processing nets competing for dominance. This can then explain both the temporal and the continuous nature of qualia.

Taylor uses Libet’s experiments of 1964 and 1987 to demonstrate that conscious awareness depends upon a minimum level of stimulation as well as requiring a certain amount of time to emerge and that ongoing awareness requires ongoing stimulation. (Libet produced tactile awareness by electrically stimulating the cortex during brain surgery on Parkinson’s disease patients). This supports the competitive model of consciousness insofar as it is those ‘successful’ neural nets which make it to the buffer working memory; this takes time (allowing irrelevant or transient stimulation to fall out of the competition). The existence of a threshold stimulation level also suggests that competition due to enhanced activity of some elements and inhibition of others gives rise to conscious awareness of a stimulation. Below a certain level the stimulation fails to attain any level of awareness as it is subsumed by other, more vigorous neural activity.

The explanation of emergence of passive awareness through competitive neural activity within regions of buffer working memory, as briefly described above, gives rise to predicted aspects of consciousness which are similar to the qualities ascribed to qualia by Metzinger (1995);

The temporal presence of qualia are said to possess qualities of persistence, latency and seamlessness. These properties are exhibited by the ‘bubbles’ in that they have duration, constantly developing and waning as other ‘bubbles’ seamlessly take their place. Qualia are further described as complete, intrinsic and ineffable. These qualities are produced in Taylor’s model due to the ‘bubbles’ representing the final stage of processing (thus complete and integrated) with no feedback to earlier processing and thus no awareness of attaining these conscious states, only a sense of immediate presentation. The sense of uniqueness ascribed to qualia is also modelled here by the ‘winner takes all’ nature of attaining awareness; only one ‘bubble’ at a time contributes to subjective experience.

This posting represents an attempt to ‘flesh out’ otherwise overly philosophical assertions of materialistic explanations of consciousness. Functional explanations attempt to describe emergence from a global and interactive perspective. Taylor offers detailed neuro-anatomical descriptions of processes which accord well with experimental observations of conscious phenomena. He demonstrates the possibility of arriving at a detailed biological description of how consciousness emerges. This supports the materialistic approach to consciousness. Physical explanations of consciousness are seen to be possible, albeit complex and extensive. We should not expect otherwise; simple explanations would indicate a phenomena that was far more widespread and ordinary than this wonderful awareness which illuminates our entire existence. Why we are conscious still remains a mystery, it doubtless confers some adaptive advantage but the prevalence of suicide, depression and ideological warfare suggests that that advantage may not be as great as we might wish. Perhaps consciousness is simply an epiphenomena from previous selection or perhaps an indubitable reason for conscious awareness may yet be realised.

References

Dennett, D.C. (2006). Sweet Dreams: Philosophical obstacles to a science of consciousness. MIT Press

Taylor, J.G. (2001). The race for consciousness. MIT Press

Libet, B., Alberts, w.w., Wright, E.W. Jr., Delattre, D.L., Levin, G. and Feinstein, B. (1964). Production of threshold levels of conscious sensation by electrical stimulation of human somato-sensory cortex. J. Neurophysiol 27, 546-578

Libet, B. (1987). Consciousness: Conscious, subjective experience. In Encyclopaedia of Neuroscience I, Adelman, G. (ed). Boston: Birkhauser.

Metzinger, T. (1995). The problem of consciousness. In Conscious Experience, Metzinger, T. (ed). Paderborn: Shoeningh: pp 3-40

Cultural bias in psychology

•April 18, 2010 • 10 Comments

“To ignore these realities, or to trivialize them, is to contribute to a science while wearing blinders” (Lonner & Malpass, 1994).

A typical psychology text book contains hundreds of terms and theories to help explain human behaviour. Most of these texts appear to suggest that all of these fantastic concepts are universally applicable; we are all basically the same, and that is that. This is a very dangerous assumption to make. It has been estimated that over 90 percent of all psychologists who have ever lived are from the Western world (Lonner & Malpass, 1994). The majority of theories in counselling psychology have evolved primarily from the experiences of White, upper class men, conducting research on White, upper-class clients (Lee & Richardson, 1991). This article shall focus on the cultural biases that are clearly visible in much of the research conducted in psychology, with particular emphasis on the controversy over the resultant definitions and diagnosis of mental illnesses. 

Culture can be defined as the “transmitted and created content and patterns of values, ideas and other symbolic-meaningful systems as factors in the shaping of human behaviour and the artefacts produced through behaviour” (Kroeber and Parsons, 1958, p583).

Psychologists and other social scientists have long been interested in the influence of culture on psychopathology, or abnormal behaviours.

We have been provided with the basic components and attributes of what constitutes a mentally healthy and ‘normal’ individual. Self-sufficiency, independence, competitiveness, confidence and an internal locus of control are all characteristics that are required to be deemed ‘mentally stable’ (Pederson, 1987). These are the stereotypical characteristics of [typically American, but can be generalised to those living in a Western Society] White, middle-class men (Ritchie, 1994). Individuals who exhibit connectedness, stability, cooperation and an external locus of control are therefore often seen as less psychologically healthy, even though these characteristics are viewed as positive and virtuous attributes in other cultures (Ritchie, 1994).  Do definitions of normality and abnormality vary across cultures, or are there universal standards of normality?

Correct definitions of mental and emotional health are critical in psychology, as they guide counsellors and psychologists in the diagnosis, support and assistance of patients. If the definitions are narrow and biased in favour of particular cultural or social groups, it could lead to wrong diagnoses and unmerited assumptions about the mental health of certain individuals or groups (Richie, 1994). Pederson (1987) was passionate about the problems these assumptions cause, in fact, he claimed that “the consequences of these assumptions are institutionalized racism, ageism, sexism and cultural bias” (p16).

A plethora of research has discovered differences in the levels of mental illnesses present in people from varying ethnic and racial backgrounds For example, Hispanics have been diagnosed with schizophrenia 1.5 times more frequently than Whites, and African Americans are more likely than Whites to be diagnosed with schizophrenia, substance abuse, and/or dementia (DelBello, Lopez-Larson, Soutullo, & Strakowski, 2001). The essential question raised from these results is: are these differences in diagnostic rates due to cultural diversities, or the misdiagnosis from psychologists and counsellors due to their own personal biases? There have been similar concerns raised about cultural biases inherent in IQ testing, with the generalisations that Asian children have, on average, higher IQs than white children, and African children have, on average, lower IQs. Research in this field has indicated that there might be cultural implications inherent in the IQ test themselves, which lead to this perceived difference (Scarr, 1981). It is highly likely that such cultural differences could also manifest themselves in the diagnosed rates of mental illness.

A recent study by Hays, Prosek & McLeod (2010) aspired to explore how culture affects the clinical decision making progress, and cited selecting participants who were “culturally diverse”, with experience in clinical settings. But, of the 41 participants, 28 were White, 10 were African-American, 1 was Hispanic, 1 was multiracial, and 1 identified themselves as ‘other’. This is clearly still a very much Western world based sample. Even studies attempting to understand the influence of culture in clinical diagnoses can be culturally biased, with such a high number of White participants, the results cannot be generalised to every country.  

The World Health Organisation (WHO, 1973, 1979, 1981) sponsored the international pilot study of schizophrenia to compare the prevalence of the disorder in 1, 202 patients, in several countries. The investigators were able to identify a set of symptoms that were present across all cultures in the schizophrenic samples, including: lack of insight, auditory and visual hallucinations and delusions of grandeur (Leff, 1977). But, it was found that the course of the illness was easier for patients in developing countries compared to those in highly industrialized countries. Patients in India and Nigeria, for example, recovered at faster rates than those in England, or the United States. These differences were attributed to cultural factors, such as the presence of extended family networks, community support, and the emphasis on returning to work in developing countries.

Cultures may differ in their tolerance for particular symptoms, the Nigerian culture as a whole is more accepting of the presence of voices. In cultures where Shamanism is prevalent, such voices, and indeed visions, are taken as a manifestation of power and of major religious significance, whereas in Western Culture, they would be taken as symptomatic of mental illness (Krippner, 2002). Even in the Western World, there are significant differences as regards how historical instances of “voices” and “a sense of mission” are viewed. Whilst English Professionals in the field might have their doubts about Joan of Arc, such a diagnosis would be very poorly received by French professionals, who have an all together different historical perspective on this individual (Allen, 1975).

In an early study of New York psychiatric cases, Opler and Singer (1959) found that Irish- American schizophrenic patients were more likely to experience paranoid delusions than Italian- American patients. The authors cited possible cultural differences in parenting and upbringing in order to account for the difference. Another possibility, which is not often discussed, might be genetic differences in the actual structure of the brain. There is increasing evidence that many forms of mental illness stem from subtle “mis-wiring” in the brain, it is quite plausible that there could actual be a genetic bias behind this (Phelan, 2002: in relation to schizophrenia). The prevalence of sickle cell anaemia amongst the African population, whilst very rare in the white population, has long been accepted. Indeed, there is a theory that genetic tolerance towards malaria (which isn’t prevalent in the Western World due to the mosquito disease vector not being present) has, as a side effect, increased the likelihood of sickle cell anaemia (Aidoo et al, 2002). Further research could well uncover similar predispositions towards certain types of mental illness in genetically different populations.

There are universal aspects of the symptoms and presentation for at least some of the major psychopathologies, such as schizophrenia. At the same time, however, many psychopathologies are thought to be heavily influenced by culture, especially in terms of the specific behavioural and contextual manifestations of the abnormal behaviour, and the perceived effect of the behaviour on the everyday lives of the individuals (Matsumoto & Juang, 2004).

Classification systems need to contain both etic and emic elements in order to display a rounded view of the symptoms and disorders in question. Where to draw the lines, and how to measure psychological traits and characteristics within this fluid and ever changing system, is the challenge that faces the area of psychology today. Although the field has made vast improvements in this area in the past few years, future research will need to elaborate further on these issues so that the classification and measurement can be made more precise, meaningful and relevant. Inclusion of more diverse populations in pluralistic countries such as England, the United States, and now more recently Ireland, is also needed in this area of research. If this can be done, proper understanding, assessment and diagnosis of mental disorders will in turn develop effective preventions and treatments that will improve and enhance people’s lives, all over the world.

Works Cited

Aidoo, M., Terlouw, D., Kolczak, M., McElroy, P., ter Kuile, F., Nahlen, B., Lal, A., & Udhayakumar, V. (2002). Protective effects of the sickle cell gene against malaria morbidity and mortality. The Lancet, 359, 9319, 1311-1312.

Allen, C. (1975). The schizophrenia of Joan of Arc. History of Medicine, vol. 6.

DelBello, M, P, Lopez-Larson, M, P, SoutuUo, C, A,, & Strakowski, S, M, (2001), Effects of race on psychiatric diagnosis of hospitalized adolescents: A retrospective chart review. Journal of Child and Adolescent Psychopharmacology, 11, 95-103

Hays, D. G., Prosek, E. A., & McLeod, A. L. (2010). A Mixed Methodological Analysis of the Role of Culture in the Clinical Decision-Making Process. Journal of Counselling, 88, 114-121

Kroeber, A. L., & Parsons, T. (1958). The concepts of culture and of social system. American Sociological Review, 23, 582-583.

Lee, C. L., & Richardson, B. L. (Eds.). (1991). Multicultural issues in counselling: New approaches to diversity. Alexandria, VA: American Association for Counselling and Development.

Leff, J. (1977). International variations in the diagnosis of psychiatric illness. British journal of psychiatry, 131, 329-338.

Matsumoto, D., and Juang, L. (2004). Culture and Psychology, 3rd Edition. USA: Thomson and Wadsworth.

Opler, M. K., & Singer, J. L. (1959). Ethnic differences in behaviour and psychopathology. International journal of social psychiatry, 2, 11-23.

Pederson, P. (1987). Ten frequent assumptions. Cultural bias in counselling. Journal of Multicultural Counselling and Development, 15, 16-24.

Phelan, J. (2002). Genetic bases of mental illness – a cure for stigma? Trends in Neurosciences, 25, 8, 430-431.

Ritchie, M. H. (1994). Cultural and Gender Biases in Definitions of Mental and Emotional Health and Illness. Counsellor Education & Supervision, 33, 4.