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Book Review-Cognitive Dissonance: Reexamining a Pivotal Theory in Psychology

There’s a lot of research that has been done on cognitive dissonance.  Cognitive Dissonance: Reexamining a Pivotal Theory in Psychology is a guide to evaluate the research and what we’ve learned over the 60+ years since it was first proposed.  (See A Theory of Cognitive Dissonance for Leon Festinger’s original work.)  The perspective of the editor is to provide differing points of view to allow readers to draw their own conclusions.  Contrast this a bit with Joel Cooper’s views in Cognitive Dissonance: Fifty Years of a Classic Theory, which doesn’t include criticisms of his proposed revisions to the model – some of which are relatively serious concerns.

The Cases

It’s convenient to speak of cognitive dissonance as a single unified theory as Festinger originally formulated it.  However, since his initial formulation, several special cases have appeared:

  • Free-Choice – People reevaluate their choices after making them, and often show a greater preference for the choice they’ve chosen.
  • Belief-Disconfirmation – Rather than changing a belief that has been contradicted by the evidence, a person works hard to protect that belief.
  • Effort Justification – The more effort a person puts into something, the more likely they are to like it.
  • Induced (Forced) Compliance – One can justify their behavior by claiming that their compliance was forced, thereby eliminating the dissonance between their actions and their beliefs.

The Theories

There are several variations of the theory that have emerged as well:

  • Self-Perception – Proposed by Daryl Bem, this revision states that people form their attitudes from their behavior. Bem proposed that people cannot access their mood and cognition to develop their attitudes.
  • Impression Management – The intersection of Erving Goffman’s work (see Stigma) on impression management and cognitive dissonance, this theory proposes that the dissonance is due to the impact on our ability to manage the impression of others about us.
  • Self-Affirmation – People want to affirm themselves.
  • Self-Consistency – People want their experiences to be consistent with their self-view.
  • Aversive-Consequences – People experience distress when their choices lead to adverse consequences. This is Joel Cooper’s perspective as fully described in Cognitive Dissonance: Fifty Years of a Classic Theory.

Misattribution

One of the ways that developing cognitive dissonance can go awry is if the person has another way to attribute their discomfort.  If they believe that a situation is inherently discomforting, then they may misattribute the dissonance created by their conflicting cognitions to the situation.  This “resolves” the dissonance, but only in a short-term way, as it’s likely the discrepancy will arise again in different circumstances.

When trying to make people aware of their inconsistencies, it’s important not to give them an easy “out.”  If you do, they make take that easy exit and neutralize the power the dissonance has to help them change.

The Role of Commitment

The power of dissonance comes from the difference between ideas and the degree to which those ideas are difficult to move.  Cognitions, which are not difficult to move, will not arouse much dissonance, because the cognition will be changed before it registers much dissonance.  The commitment to the ideas can be that they’ve communicated their beliefs to others (see Change or Die) or that it seems fundamental to who they are.

Lack of Choice

Another danger when trying to rely on the effects of cognitive dissonance for behavior change is the risk that you may accidentally trigger a reinforcement effect.  Cognitive dissonance only occurs when the person believes that they have a choice.  If they feel that they are directly or indirectly being coerced into a behavior, they’ll generate no dissonance.  Instead, there may be a reinforcement of their opposition to the behavior.

The tricky bit is visible when we look at some of the classic experiments in psychology which failed to replicate.  Walter Michel’s marshmallow test hasn’t replicated well.  (See The Marshmallow Test for the core experiment.)  Maybe there’s something to the fact that the nursery was connected to Stanford.  Asch has said that his conformity effect may have been a sign of the times.  (See The Upswing for more.)  The experiments of Stanley Milgram on people’s willingness to inflict seemingly lethal electrocution were powerful on the Yale campus (even in an unimportant basement room) but failed to replicate when moved down the street to a strip mall.  (See The Lucifer Effect and Moral Disengagement for more on these experiments.)  Even the Stanford Prison Experiment performed by Phillip Zimbardo has controversy about the degree to which Zimbardo coached the bad behavior he wanted.

What these have in common is a variable (which wasn’t replicable) that subtly influenced the results and therefore it made their experiments not replicate.  The introduction of a lab coat, title, or something about the environment led people to believe that they didn’t have a choice – or that led them to a different choice.

Justification for Behaviors

At the time, it was heretical.  Classic learning theory said that the stronger the reinforcement, the greater the learning.  Economists predicted that if you gave people $20, they’d change their behavior more than if you gave them $1.  Greater rewards led to greater results, but cognitive dissonance predicted something else.  Cognitive dissonance predicted that people would use the $20 they got as justification for their behavior.  It was enough to make most people decide they weren’t doing the behavior – they were earning money.

Those who received the paltry offering couldn’t often complete the mental gymnastics to believe they didn’t do it of their own accord.  The result was greater cognitive dissonance and therefore greater long-term behavior change.  This counter-intuitive hypothesis was confirmed.  People who were offered little for a variety of behaviors seemed to have more dissonance and more attitude and behavior changes.

Another pitfall that we have when using cognitive dissonance to motivate change is that if we offer too much in the way of incentives, we’ll break the effect.  This is like Edward Deci’s observation that explicit rewards often break intrinsic rewards.  (See Why We Do What We Do.)

Organizing Stories

The work of James Pennebaker is clear that allowing people to write down their stories has a positive effect on their ability to process their trauma.  (See Opening Up.)  Lisa Feldman Barrett speaks of her own challenges with decoding what she was feeling in How Emotions Are Made – including how she confused illness with love.  What this says is that our grasp of how we feel and what our body is doing is more tenuous than we’d like to believe.

When people are asked about their feelings before giving them a chance to build a narrative, we see amplification of feelings – and distorted perceptions.  That is to say that if we want the effects of cognitive dissonance to work in the right direction, we have to create space for people to process their experiences into their autobiography before asking them about their feelings.

Discrepancies Without Consequences

As was mentioned earlier, Joel Cooper proposed a revision that has cognitive dissonance only occurring when there’s a negative outcome.  The outcome didn’t need to be predictable, only foreseeable.  The requirement for free choice remains in Cooper’s revision.  The real challenge to this is where cognitive dissonance effects seem to occur when there are no discernable consequences.

While this is problematic for Cooper’s theory, it’s important to remember that all models are wrong – though some are useful.  Cooper’s revision captures a non-trivial percentage of the space of cognitive dissonance and provides a useful thought framework for trying to trigger cognitive dissonance.  It may be that it is wrong, as the evidence implies, but it may still be a good framework for creating action.

Belief Intensification

What if, rather than changing beliefs to match the reality that you’ve observed, your beliefs morph into a more virulent and intense form?  That’s what seems to happen when cults that make predictions are confronted with the reality that their predictions are wrong.  Their beliefs become even more extreme.  The dates move, and the reasoning becomes more complex.

Sometimes, people react to disconfirming evidence by strengthening their resolve that they’re right –and that can be problematic if your goal is to change their perspectives.

Weak and Strong Reinforcement

The forces that drive cognitive dissonance to change are like the slingshot effect that NASA uses to fling satellites into outer space.  The slingshot effect works because of the proximity of the satellite to the source of gravity.  It’s the proximity that does the work.  Similarly, it’s the degree to which two options are of equal strength that powers the cognitive dissonance-driven change.  As a result, the more even the options are, the more they’ll be driven apart by cognitive dissonance.

Sometimes, the learning behaviors that should be more highly coupled to bigger rewards show the reverse results with reinforcement working better when the reward is small.  Even pigeons seem to favor the treats that require more work.

Forced Reevaluation

In the end, dissonance forces the reevaluation of beliefs.  This is something that we rarely do as humans.  While we know that the Earth isn’t flat and it’s rotating, we speak of sunrise as if the sun is rising above a flat earth.  While this is a simple linguistic aspect of our world, it surfaces a deeper awareness that the things we learned as children – or that our ancestors learned as children – are rarely tested.  The need for consistency and the awareness of this inconsistency can force us to reevaluate our beliefs in ways that allow us to more accurately represent reality in our minds.

Many speak of meditation and downtime to allow for reevaluating life’s priorities, but nothing has a focusing effect like knowing that two beliefs that you hold dear are utterly incompatible.

Dissonance Reduction Strategies

As we’ve seen above, there is an alternative to resolving the discrepancy.  Here are some of those alternatives:

  • Ignore – Simply failing to recognize the discordant belief.
  • Discount – Providing a reason why the belief isn’t that important.
  • Provide Alternate Explanations – Providing alternative explanations that don’t require the beliefs to be in conflict.
  • Exception to the Rule – Viewing the data as a fluke or exception, thereby discounting it or limiting the degree to which is should be considered discordant.
  • Blame – Blame someone else so that the results can be explained away without internally discordant beliefs.
  • Numbing (e.g. alcohol) – Temporarily delaying awareness by numbing, often but not exclusively through alcohol or drugs. Binge-watching television, surfing the internet, and chronic business can all be forms of numbing.

Protecting Beliefs

Often, we will protect our beliefs so that we don’t realize conflicting beliefs, or we process them in ways that prevent falsification of our cherished beliefs.  Some of the strategies for protecting our beliefs are:

  • avoiding exposure to such information,
  • reducing negative feelings arising from inconsistency,
  • actively discounting the inconsistent information,
  • generating alternative explanations for the contradictory information,
  • deeming it as an exception to the rule, or
  • reinterpreting the status of one’s beliefs in a manner that makes them unfalsifiable.

Cognitive Dissonance Comes from Sense Making

As humans, we’re constantly trying to make sense of the world around us.  (See The Righteous Mind.)  We experience cognitive dissonance, because we can’t find a way to represent reality to ourselves.  We’re forced to find new ways to think and new beliefs to form.  Maybe it’s time to make sense of Cognitive Dissonance.

Book Review-Cognitive Dissonance: Fifty Years of a Classic Theory

We do not like inconsistency.  That’s the fundamental driver behind Cognitive Dissonance: Fifty Years of a Classic Theory.  Joel Cooper provides appropriate nods to Leon Festinger – and those he studied with.  (See A Theory of Cognitive Dissonance, Festinger’s book, for his direct perspective.)  Cooper’s perspective is one that isn’t fully embraced across all the research on cognitive dissonance.  However, there is some research supporting his perspectives and lots of confusing results.  Cooper does a good job of summarizing what we’ve learned and acknowledging some of the challenges in the results we’ve seen.

Best Rewards

One of the great advancements that was brought forth by cognitive dissonance is a push back against classical operant conditioning, which suggests that the greater the reward, the better the learning.  What cognitive dissonance research discovered was that smaller rewards actually create a bigger change in behavior.  This counter-intuitive answer changed the way that people thought about learning.  If there’s too big a reward, the change is minimal.  This is similar to Deci’s discovery that external rewards break intrinsic rewards.  (See Why We Do What We Do.)  What we “knew” about motivation and how to change behaviors was broken by the reality: experiments proved that classic behavioral modification therapy couldn’t explain these results.

It’s described as “inverse linear relationship between incentive magnitude and attitude change.”  In short, the larger the reward, the smaller the change.  It mattered.

Suffering

Another curious finding appeared with connections to cognitive dissonance.  The greater the struggle to obtain something – particularly membership in a group – the more people liked the achievement.  The groups were better, and the awards were more meaningful.  All of this served to minimize the occasional torture that was endured to get there.  Hazing rituals are officially forbidden for Greek organizations (fraternities and sororities), yet there are still news stories about how these rituals have gone awry and people are injured.  Members of these organizations frequently stand by these rituals that they themselves endured.

Classical theories of change and conditioning cannot explain the transformation from pain and self-questioning to assurance that these goals were worth the effort.  However, cognitive dissonance posits that the gap between the memory of the hard work and the reality of the result must be resolved.  We have to think the work was worth it to address the effort we put in.

Threats and Punishment

Every parent wants to know how to teach their children right from wrong.  They want to shape their behaviors in ways that lead to productive and happy adults.  Here, cognitive dissonance and the research that tested the theory have another surprising suggestion.  Make the threats and consequences mild rather than severe.  When the threats are mild, the child can believe that the desired behavior was their idea, and cognitive dissonance can slowly but steadily change their attitudes and motivations in the desired direction.

Practically, it means offering a subtle reprimand for eating candy before dinner rather than an explosion.  The severe threat or punishment absolves the systems that drive cognitive dissonance from their need to engage.

Disengagement

Albert Bandura wrote a guide for how to bypass some of our built-in morality.  In Moral Disengagement, he explains the mechanisms that would separate people from their morality with striking regularity.  They essentially come down to ways that a person doesn’t need to accept responsibility – or complete responsibility – for their actions.  Der Führer ordered me, so it wasn’t really my decision.  Cognitive dissonance faces the same forces that disable its power for resolving inconsistencies in our lives.

By being able to claim that the decision wasn’t ours, or that we had no choice, cognitive dissonance is disabled and rendered helpless.  That’s why it’s important to consider how we may be subtly or overtly creating “outs” for people when we’re trying to leverage cognitive dissonance for positive change.  Many research efforts have been undone by subtle coercion that the researcher didn’t intend.

Learning

Not every result in the study of cognitive dissonance has yielded clear results – even those where the confounding problem of coercion has been eliminated.  One such set of experiments is around the impact of dissonance on learning.  The theory – coupled with learning theory – predicted that simple learning should be enhanced by cognitive dissonance while complex learning should be inhibited.

Conceptually, simple learning is enhanced by motivators.  Malcolm Knowles et al. explain the forces that drive learning in adults in The Adult Learner, and one of those factors is the need to know.  Cognitive dissonance can provide that reason.  This amplification of simple learning was what the research found.

However, contrary to what the coupling of cognitive dissonance and learning theory would predict, complex learning tasks weren’t inhibited.  The distinction between simple and complex learning may seem abstract, but the line is drawn, because we’ve recognized that stress and fear inhibit complex learning.  There are many perspectives and theories about the gap between the two.  Often, we’re reminded of the apparent division between lower-level, implicit types of learning from the more complex, prefrontal cortex types of learning.  Kahneman uses the analogy of System 1 and System 2 in Thinking, Fast and Slow, and the model holds up for learning.

The question remains why researchers didn’t see a reduction of complex learning in scenarios of cognitive dissonance.  My answer is that cognitive dissonance is a different kind of stressor that’s not about short-term survival and therefore may influence learning differently.  Researchers will argue that the mechanisms they use for stress are often completely arbitrary and fake, but they still seem to have impact.  A classic approach is to create a time pressure either in the form of instruction or as an incentive for time-based performance.

Complicating the situation is that other research results indicated precisely the opposite – with no effect on simple learning and an inhibitory impact on complex learning.  Clearly, the forces at play in the intersection of cognitive dissonance and learning are nuanced.  While I’m convinced that simple learning is encouraged with dissonance with no ill effects for complex learning, that may not universally be the case.

Fear

In Emotion and Adaptation, Richard Lazarus explains fear as a cognition.  He explains the evaluation process and how that process works.  Ultimately, he proposes that we evaluate a situation to determine the degree of appropriate fear.  Cooper recounts research by Schachter and Singer, which proposed that fear is a label we can apply to arousal.  In other words, we have a biological, unconscious response to something, and we label that arousal with the word fear.

This explains a curious result of research, where cognitive dissonance’s impact was disabled when participants were provided with an alternative explanation for the arousal that dissonance created.  When injected with a placebo and told of expected anxiety, participants attributed their dissonance arousal to the drug – and then failed to change their attitudes to resolve the inconsistency of thought.

This finding shows us that we need to be careful to not provide an excuse for the arousal that cognitive dissonance provides lest we nullify its effect on changing attitudes.

Curiously, it was discovered that the valence of arousal could be experimentally manipulated.  Participants in research could be encouraged to lean towards excitement or anxiety with the subtle manipulation of prompts and responses.  This suggests that the way people interpret cognitive dissonance may be subjective.

Amphetamine

When the placebo mentioned above was changed to an amphetamine, a stimulant, the results changed.  In the placebo research, people attributed their arousal to the drug and therefore didn’t change.  However, when given an amphetamine, people in every group showed more attitude change.  One potential explanation for this is the arousal was of greater magnitude and therefore demanded a greater response.  Even low-choice participants, who could have claimed that they didn’t have to address their behavior discrepancy because they weren’t given options, changed.

Perhaps the low-choice condition failed to generate arousal and therefore there was no need to change, but the addition of amphetamine caused an arousal that needed to be addressed.

Commitment

Another interesting factor at play in cognitive dissonance is the degree to which someone commits to the behavior.  People with stronger commitments seem to have greater moves towards consistency.  Commitment is a bit of an odd word, because it implies an internal state, but that state can be driven externally.  Write an essay that’s destroyed afterwards, and the commitment is low – even if you passionately believe in what you’ve written.  Write it and share it to a disinterested party, and it goes up slightly.  Write it and have it shared with a decision-maker, and it goes up again.  Deliver a public speech, where we believe the audience can be persuaded, and commitment soars.

The greater the commitment to the position, the greater the forces at play and the more attitude or behavior adjustment we’d expect to see from the forces of cognitive dissonance.

It’s important to note that the effect seems to be eliminated if the person or people we’re speaking with seem to be unmoved or unmovable.  If we believe that our counter-attitudinal statements were rejected, no attitude change occurs.  Our perceptions of efficacy matter.

Unwanted Consequences

The major revision to cognitive dissonance proposed by Cooper and his colleagues is the idea that cognitive dissonance requires a consequence, and it only appears when that consequence was foreseeable.  Foreseeable is a standard less than predictable; it’s only reasonably possible.  (See The Suicide Lawyers.)  Even if there’s a 10% chance that something can come as a result of a behavior, it may be sufficiently foreseeable and therefore something that causes cognitive dissonance.

While this perspective is partially supported, it limits the scope of cognitive dissonance and requires us to stretch the limits of consequences to their maximum extreme.  We’ve got to believe that the consequences can be very small – like someone forming a negative impression of us.

As a framework for story telling and converting a desire to change into a framework for action, it is useful.  You simply expose someone to the potential negative consequence as a result of their actions and then you allow those consequences to happen.  This should be sufficient to cause an attitude shift – presuming that none of the ways that cognitive dissonance can be subverted are present.

Personal Responsible

One of the predecessors, then, that comes as a part of this proposed revision is that for a person to experience cognitive dissonance, they must accept some level of responsibility for their action having caused the negative consequences.  A failure to take personal responsibility because of one of the previously discussed ways or other, less common ways eliminates the need to address the dissonance – because they won’t experience any.  When perceived as random events, there is no need for someone to modify their beliefs or behaviors.

Self-Consistency and Self-Affirmation

Two other proposed revisions to Festinger’s cognitive dissonance theory are a theory of self-consistency and a theory of self-affirmation.  Self-consistency says that we strive to resolve how our behaviors don’t match our values.  Self-affirmation proposes that our attitudes and behaviors should be self-affirming (positive).  Both revisions have mixed but ultimately negative evidence.

Self-consistency struggles with the challenge of articulating a single belief system for an individual.  As Reiss’ work in both Who Am I? and The Normal Personality and the work of Jonathan Haidt in The Righteous Mind point out, our behavior is driven by a set of conflicting values and fundamental beliefs that we must constantly reconcile.  This means it’s hard to believe that people are recognizing their inconsistency.

Self-affirmation struggles when we realize that affirmation may be discordant with how a person feels and therefore may make the inconsistency and discrepancy worse rather than better.  (See Compassion and Self-Hate.)  Fundamental structural problems like this, in addition to the evidence, has made it difficult for either of these revisions to the theory of cognitive dissonance to be accepted.

Distraction

While not a permanent strategy, it is possible to defer processing of cognitive dissonance by means of distraction.  This can be either intentional, purposeful distraction, or by simply being too busy to take a step back and reflect.  Dangerous conditions can occur where people are too busy to recognize dissonance for long periods of time: when they suddenly have time, they end up processing all of the dissonance at once – with sometimes tragic results.

We’ve all heard stories of the people who take a vacation and suddenly have an identity crisis.

Comparing Self vs. Other

One of the challenges in developing an irrefutable theory for cognitive dissonance is that it’s an internal, mental process that is therefore not subject to direct observation.  There are simple differences in how you evaluate yourself – whether you use a progress milestone like a growth mindset (see Mindset), or you judge yourself against those around you.  The research on happiness seems to imply that people always want more than their peers.  They want 10% more than they’re currently making – but more than that, they’re also looking to do better than their peer group.  (See Thinking, Fast and Slow and The Righteous Mind.)

Group Salience

Cognitive dissonance is also influenced by forces beyond the individual.  Their group memberships and the social norms created as a part of those groups can have a profound impact on cognitive dissonance – if they’re primed.  In Influence, Robert Cialdini explains how priming people to see themselves a particular way or as a part of a particular group dramatically changes the degree to which they’ll behave in ways that are consistent with their prior statement or with the perceived preferences of the group.

If you want people to behave more like a group, make sure that that group is more salient in their minds while they’re making the decision.

Public Separation

Bill Clinton was known as the Teflon president, because the scandals never seemed to stick to him.  Even when he had to admit to his extra-presidential interactions with Monica Lewinsky, his approval ratings climbed.  Though most admitted that they didn’t approve of his actions, they still approved of him as a president.  This odd response makes sense when people disconnected his personal ethics from what they perceived to be the skills necessary to run the country.

These odd pathways can confound attempts to predict what effect – if any – cognitive dissonance will have.

All Theories Are Wrong

George Box, an economist, said, “All models are wrong, but some are useful.”  This statement captures the core of the discussions about cognitive dissonance and proposed revisions.  The original model has its limitations, and the revisions attempt to get at resolving them.  Ultimately, we need to remember that though Cognitive Dissonance may be wrong, it probably is useful.

Book Review-A Theory of Cognitive Dissonance

It’s a classic.  A Theory of Cognitive Dissonance lays out Leon Festinger’s theory about how and why we change our attitudes.  More than 25 of the books that I’ve reviewed contain a direct reference to “cognitive dissonance.”  It underlies theories of change at personal, organizational, and societal levels.  The fundamental core is simply that individuals strive for consistency in themselves.  They want their behaviors to match their values and their values to match their words.  From this simple premise, research has tried to explain the conditions under which we’ll change to reduce discrepancies.

Competing Cognitions

Festinger’s word for inconsistency is “dissonance.”  Dissonance, he argues, is an unpleasant state for humans; as a result, we’d take actions to reduce the dissonance.  The strategy would depend on the cognitions in conflict.  He describes cognitions as congruent or dissonant with one another and can be placed on a scale from important to unimportant.  He proposes that only important cognitions in dissonance with one another would provide sufficient drive for change.

There are several things that can make thoughts incongruent (dissonant) to one another.

  1. Logical Inconsistency – Logically, the two thoughts cannot both be true.
  2. Cultural Mores – The culture may not accept our thoughts.
  3. Specific Encapsulation – Specific thoughts may be included within generic thoughts. I mentioned in my review of Mistakes Were Made (But Not by Me) that Al Campanis considered Jackie Robinson a good man and a great baseball player – and yet would have been seen as a racist today.
  4. Past Experience – The way that we’ve acted is inconsistent with who we want to be.

Resolving Dissonance

The degree of dissonance is influenced by the number of related cognitions.  Cognitions don’t exist in isolation.  There are many related thoughts and beliefs.  When we experience dissonance, we experience it as the gap between clusters of thoughts.  The greater the number of thoughts and the greater their importance to us, the more likely we will experience dissonance – and change.

Festinger proposes that we’d only move one of the dissonant thoughts (or block of thoughts) to resolve the dissonance.  We’d move whichever seemed easier.  However, changing an opinion isn’t the only approach that we have to resolving the discrepancy.

The truth is that we can change the importance of the cognitions.  For instance, if we see ourselves as a generous person, and we walked past the panhandler without making eye contact, we may decide that not being generous in that situation doesn’t mean we’re not generous – we can decide that they weren’t really in need.  Allowing us to deemphasize our behavior and reduce the pressure of the dissonance.

A different approach is to simply forget.  We know that the more salient things are in our attention, the greater we experience discomfort associated with dissonance.  By reducing our ability to recall the situation – by forgetting – we reduce the dissonance and discomfort we feel – and thus reduce the pressure to change.

The other way to resolve the dissonance, the one that makes it so interesting, is to make a change.  Change or Die explains how difficult it is to create change in an individual: 80% of people don’t change their behaviors after a heart attack, and we have 66% recidivism rate after two years.  (Recidivism refers to previously incarcerated people being convicted again.)  So, while the forces of cognitive dissonance can be powerful, they’re only valuable when harnessed properly.

Why We Don’t Change

With a powerful psychological force driving us towards consistency, why don’t we change our inconsistent beliefs?  The first reason is because once you believe something, it’s hard to “unbelieve” it.  It’s like trying to not think about white bears – it’s not possible.  (See White Bears and Other Unwanted Thoughts.)  If we believe that grass is green, it’s hard to not see the grass as green.

Another factor is the “freezing factor.”  Kurt Lewin proposed that change required unfreezing, changing, and freezing the change.  That is, there’s a certain inertia around the way we do things today.  To accomplish change, we must break through this inertia, make our change, and ultimately recreate inertia around the new, changed, behaviors.  (See Lewin’s change model for more about this change process.)  Following the model, another reason we don’t change is because the freezing effect is overly powerful over time.  Aspects of cognitive dissonance reinforce the decisions that were made and approaches that are in use by amplifying their benefits or minimizing the benefits of the alternatives.

The mere fact that we’ve made a decision creates dissonance at some level.  For everything we’ve decided, we’ve said no to something else, whether directly or indirectly, because of a limitation of resources.  The degree of dissonance seems to increase substantially the more similar the weight and utility of the options are.  The closer the options are, the greater cognitive dissonance will cause them to spread.

Cognitive Disengagement

It is, however, possible to disable the power of cognitive dissonance.  Simply removing the perception of choice eliminates the power of cognitive dissonance to help reinforce the change.  A judge orders a person to attend a rehabilitation program.  The result is the person feels forced, and their perceptions of their abuse of a substance is likely to change less than had they made the choice on their own.  But more importantly, it’s not the degree of coercion that matters, it’s the perception of it.

“But there really wasn’t a choice” is a phrase that indicates the person either sees the decision as not close, and thus doesn’t induce cognitive dissonance, or outside of their control, which also neutralizes any cognitive dissonance forces.  Free choice remains an essential part of the formula for leveraging the power of cognitive dissonance.

Memory

We forget that memory is subject to revision.  We ignore the fact that memories aren’t like film, nor are they immutable.  In fact, there’s plenty of evidence to support the fact that our memories are reconstructed in the moment and incorporate details from our current attitude and mood that weren’t in the original memory.  One of the techniques used to eliminate dissonance is to adjust our historical memories to support our current world view.  For instance, if we previously had seriously considered alternatives to the car we purchased, our decision will reduce the degree to which we can recall having seriously considered those alternatives.

Our memories are wiped clean from our ability to recall them, they’re deemphasized in importance, or we simply rewrite the narrative of the memories to comply with our overall decision.

Mere Ownership

There’s a measurable effect that owning something has on the degree to which we’ll like it.  Barry Swartz shared this in The Paradox of Choice.  However, Festinger explains that the effect, while measurable, isn’t particularly strong.  That is, the ownership effect is something that’s real, but it doesn’t seem to sway our opinions that much.  There are a number of other smaller biases and motivators that are discussed in Influence and Pre-Suasion.  While individually they may not have much impact, collectively they may be a way to motivate change.

Just Enough

There’s a bias in trying to generate change that we should overwhelm the target with reasons why change is the right answer.  It requires a lot of energy and is therefore exhausting.  What cognitive dissonance proposes is that we should provide just enough motivation.  Overwhelming them with evidence is, on the surface, the right answer, but if any of our evidence cracks or is invalidated, the whole commitment can crumble.  If we can find ways to create difficult decisions that demonstrate that there is choice, we can leverage the power of cognitive dissonance to anchor the change – just like Lewin recommended.  (See Resolving Social Conflicts and Field Theory in Social Science.)

Loose Lips Sink Ships

During World War II, there was concern that individual information held by individuals could be assembled into useful information.  The result was a campaign to discourage people speaking about what they did know that might be assembled into useful information.  The problem was the campaign wasn’t particularly effective, and research was done on how people viewed the information that they had.

They didn’t think that mentioning their child had moved from one base to another useful.  Nor did they believe that indicating an order or a shipment of some material could be useful.  However, this is exactly the kind of information the campaign was designed to prevent being shared.  Pamphlets were generated and approaches attempted.  The result was that most people didn’t change their perceptions of whether they had information to keep secret.

The problem, in this case, is that there was no cognitive dissonance, because the idea couldn’t be generated that individuals did have information that they shouldn’t discuss openly.  The desire to be friendly couldn’t be brought into conflict with the need to protect our interests.

Discounting the Individual

One of the ways that we resolve dissonance is the internal equivalent of shoot the messenger.  We discount the information by invalidating the person who delivered the message.  This is a logical fallacy but one we trick ourselves into none the less.  This is one of the drivers for why we are all Going to Extremes.

Reality

Ultimately, one expects that reality will change people to be more in line with what they experience.  However, reality’s power to change beliefs of people is limited.  There is no end to the capacity of the human mind to come up with theories for an experience.  Geocentricism required complex corrections to account for the fact that it was fundamentally wrong, but it didn’t stop people from believing it – vehemently.  Reality was the same.  It was sending clear messages, and these messages were being interpreted incorrectly.

Science has a long history of scientists who believe things that have been long disproven.  Despite clear evidence, some people remain unmoved.

Immovable Beliefs

A portion of Japanese nationals who requested repatriation during World War II were held in camps and ultimately shipped back to Japan.  Despite being told repeatedly that the US had won the war, they returned on the ships hoping to hear the “truth” that Japan had conquered the US.  These beliefs persisted even after they landed and were told by Japanese nationals of the devastation and the surrender.

Similarly, numerous cults have made prophesies about the end of the world.  Their dates come and go, and instead of accepting that the prophecy was false, they invent elaborate stories about how they were wrong about the date – or how their faithfulness has saved the world.  So, while reality can be a powerful force, it’s not an all powerful force that can combat all delusion.  Sometimes, we need to recognize that we can’t get everyone into the conflict position required to recognize the power of A Theory of Cognitive Dissonance.

Book Review-Communication of Innovations: A Cross-Cultural Approach

There are a few people whose name is synonymous with the study in a field.  For me, Everett Rogers is that name for change.  Communication of Innovations: A Cross-Cultural Approach is a follow up to his Diffusion of Innovations book that many people quote without even realizing it.  If you’ve ever talked about laggards or the adoption curve, you’re speaking of his work.

Roger’s career took him many places, from Iowa to Ohio to Michigan, California, and New Mexico with brief stints of lecturing in Columbia, France, Mexico, Germany, and Singapore.  While Diffusion of Innovations was focused on the US and the adoption of farming innovations, this work is focused on how the lessons learned in Iowa cornfields might apply more broadly to farming across the world.

Meeting People Where They Are At

When you’re trying to change behavior, you can’t start from the position where you want people to be.  You must start from where they actually are.  Experts want to share their knowledge with the uneducated, and in doing so, they expose their differences.  As we gain experience, we build more elaborate and higher fidelity models of how something works.  (See Sources of Power.)  The problem, as Efficiency in Learning and The ABCs of How We Learn explain, is that the learners cannot process the messages, because their model isn’t sufficiently complete and nuanced.  They get lost quickly, and as a result, they disengage.  (See also The Adult Learner.)

As change agents entered villages that had become disconnected from the rest of the world, they tried to teach germ theory to the villagers – and it was too much for them to process.  They couldn’t understand how tiny bugs could impact them.

Another, related problem, is a failure to understand and account for the local customs.  Boiling water is a simple intervention that will kill the microbes that can harm people.  It’s a place where you can avoid the discussion of germ theory and simply describe the behavior – unless the culture has a hot-cold distinction.  In another case, the innovation of boiling water was rejected, because the culture associated hot with sickness.  Thus, it made no sense to make something hot to make it healthy.

Difficult situations like this may require the gradual teaching about pathogens in ways that are visible to the people you’re trying to change the behavior of.  Don’t forget that Fleming’s discovery of penicillin was an accident because he saw mold growing.

Berlo’s SMCR Model of Communication

Rogers shares Berlo’s model of communication, built on four steps:

  • Source – Sender
  • Message – The content
  • Channels – The medium of the communication
  • Receiving – The receiving individual

Important to this model is that every component can interact with the others to produce desirable – and sometimes undesirable – results.

The model itself has limitations, including the lack of feedback.  It’s treated as an isolated event devoid of context or patterns.  It doesn’t explicitly address noise that may occur in any component and simplifies the process to a simple linear progression.

Many of these objections can be addressed by recognizing that this communication is much like the packetization of messages that happens on computer networks.  Each SMCR can be considered a packet that travels linearly through the system in one direction.  When we consider multiple packets of communication happening, we can see non-linearity, feedback, and the complexity that the model itself doesn’t surface.

Consequences

The consequences of a successful change will fall somewhere inside of three separate classifications:

  • Functional/Dysfunctional – Will the overall consequences to the social system be desirable or undesirable for the system? Will they move things forwards or backwards?
  • Direct/Indirect – Will the consequences come as a direct result of the change, or will they come from the results of the results?
  • Manifest/Latent – Will the members of the system recognize the consequences or not?

At some level, the results will be a roll of the dice.  It’s possible to influence some of the outcomes, but the outcomes still are just a probability.

Opinion Leaders and Change Agents

As change agents are deployed to their jungles – even if they’re a corporate jungle – they are necessarily somewhat different than their target audience.  They clearly are more educated in the target innovation.  But they differ in other ways as well.  Effective change agents have developed skills for empathy and listening either because they come from the target group they’re trying to create change in or through techniques designed to develop understanding.  (For example, see The Ethnographic Interview.)

Opinion leaders are generally more exposed to communications both from the mass media and through relationships with diverse groups.  They tend to have higher social status – either because of their position or because of the respect they’ve earned.  They also, perhaps by nature of their relative affluence, are more open to innovation.

The relationship is symbiotic in that opinion leaders need to show their ability to innovate to be perceived as a leader, and change agents are often incapable of the change without the support of the opinion leader.  One of the tensions in the relationship is the rate of change.  Opinion leaders can be stripped of their ability to lead if their constituents believe they’re no longer enough like them or interested in their interests.  Change agents can overuse opinion leaders and thereby remove the power that they were engaged for in the first place.

Diffusion Research Traditions

Rogers outlines what he believes are seven major diffusion research traditions:

  • Anthropology
  • Early sociology
  • Rural sociology
  • Education
  • Medical sociology
  • Communication
  • Marketing

The reason for making these categories is to be able to identify the way that the researchers approached the problem of innovation.  Often, the methods of data gathering differ, as does the unit of analysis.  Communication of Innovations is a synthesis of what has been learned from these traditions.

Teaching the Innovation

One of the key catalysts for learning is an understanding of the big picture.  In information architecture and learning alike, we need to be able to understand how the information is structured.  (For information architecture, see Infonomics; for learning, see The Adult Learner.)  One of the common problems with change approaches is that they fail to show the big picture of how the change will be positive for them (relative advantage) and what must be done (at a high level) for those benefits to be achieved.

If you’re trying to persuade someone to adopt an innovation, start with the big picture benefits, and then help them understand how those results are achievable.

Dissatisfaction

When a change agent approaches someone with an innovation for adoption, there’s a desire to create some dissatisfaction in the mind of that person.  It’s the dissatisfaction with the status quo that will provide the energy for the change.  However, sometimes the dissatisfaction doesn’t stay channeled in the way that change agents might prefer.  The dissatisfaction may exceed the capacity of the person for change.

One form of dissatisfaction, when “wants” outrun “gets,” is hard to manage.  The person will alternate between overcommitment and overwhelm, making the process of adoption more difficult.

Underlying Conditions and Relationships

Sometimes, the first work of a change agent isn’t to propose a change or share the change they’re interested in getting people to adopt.  Sometimes, the first step is working to change the general attitude, so that people more favorably view any kind of change.  It may involve the introduction of some smaller changes that can be successfully implemented with less resistance and greater initial reward.  These kinds of approaches are particularly necessary when previous innovations and change attempts have failed.  Trust must be built as a starting point.

It’s all about the relationships that people have with change – and the relationships they have with each other.  Taking the time to build a bit of trust can go a long way to improving the chances for change to be successful.

Immunity to Change

It’s quite common for someone to say one thing and then do another.  It’s entirely possible for someone to profess their commitment to a change and for them to fail to make the changes necessary.  Sometimes, there are unconscious beliefs or counter-commitments that prevent the change from happening.  (See Immunity to Change.)  These counter-beliefs are difficult to identify because they’re not subject to conscious control.

Noise and Discontinuity

We’ve experienced a global pandemic that radically changed the adoption of many things.  Work from home jumped.  Telemedicine became accepted.  Some school systems did away with snow days (because kids can just do their work at home).  These big events create discontinuities in the adoption of technologies, repressing some and jump-starting others.

These discontinuities can’t be anticipated or relied upon.  Instead, we need to plan for the mundane immediacy of reward and the relative advantage.  In these spaces, our changes must find ways to demonstrate clear value.  The longer between the change and the result, the more impactful it must be.  If it’s not a substantial advantage, it may get lost in the noise floor of random results.

Failure Is Necessary

The innovators must accept that their super innovativeness must be paid for by the occasional failure.  If we’re going to make something new, we must accept that sometimes we’ll fail.  Sometimes, those failures will hurt.  The innovators must plan for failures, because without failures, we can’t create anything meaningful.

Homophily

The degree to which people in the target for change are similar the greater the likelihood of success and, generally, the faster the rate of change.  As Richard Hackman points out in Collaborative Intelligence, homophily has both advantages and disadvantages.  It tends to have fewer creative ideas – but that is what most adoptions need.

Adoption and Decision Units

Often, the people making an innovation decision differ from those who will implement the decision when the decision is being made from an authority rather than optional or collective decisions.  The gap between those who will implement the decision and those who make the decision opens the innovation up to subversion.  Those who are asked to implement the decision may, rightly, decide that the invention was “not invented here” and rebel against it.  (See Advice Not Given and Collaboration for more.)

Subversion is a powerful force that can derail the most well-intended change.  As a result, it’s a good idea to ensure that both the adoption and the decision units are in concurrence about the implementation of the innovation – including the changes it will mean for them.

In one example shared in the book, programmed instruction was introduced to schools to allow students to work at their own pace.  However, the teachers expected to be leading instruction and subverted the innovation so they could control the pace of learning in their classrooms.  The result was worse performance, not better.

Form, Function, and Meaning

Change agents can command a great deal of technical knowledge about the innovation itself, including the mechanisms it operates on and the way that it functions.  But ultimately, it’s the person implementing the innovation who must decide what the innovation means to them.  Rogers recounts Lawrence Sharp’s Steel Axe Heads for Stone-Age Australians research as he used in Diffusion of Innovations as well as other examples where the effects of an innovation were not predictable.  In some cases, the long-term impact of implementing an innovation was worse results – the opposite of what was initially experienced.

While there is a substantial overlap with Diffusion of Innovations, there’s something to be said for how one approaches Communication of Innovations.

Book Review-Facing Suicide: Understanding Why People Kill Themselves and How We Can Stop Them

It started with a movie.  Facing Suicide: Understanding Why People Kill Themselves and How We Can Stop Them started with James Barrat’s film of the same name (without the subtitle).  The book is an expansion of the content in the video.  It’s a contemporary view of suicide in America and what the experts see as opportunities to change the outcomes.

Preventable

From the very start, there’s solid information about suicide – and there are fine points where the coverage requires clarification.  A big one is whether suicide is preventable.  It’s a myth I tackle on SuicideMyths.org.  At some level, it’s clear from works like Suicide: Inside and Out that there’s no stopping another person from suicide if their mind is set on it.  However, what Barrat is talking about isn’t others intervening.  He’s saying that people’s minds can be changed and that they can see life as a better option than death.  In that sense, he’s right.  Some suicides can be prevented.  The challenge is that not all of them can be.

Blame Barnacles

One of the challenges of being a suicide survivor – that is, being impacted by someone else’s suicide – is that you’ll be blamed for the suicide death.  Fathers weren’t loving enough.  Mothers must have ignored them.  Friends must have dismissed them.  In a vast number of the situations I’ve seen, it’s not that straightforward.

Mothers and fathers feel guilt from claims that there are always signs.  The implication is that the signs were there, and they failed to act.  (See Myth: Every Suicide Attempt Has Warning Signs.)  They may transition from guilt about what they did or didn’t do into a sense of shame.  That is, they may believe they’re bad people.  (See I Thought It Was Just Me (But It Isn’t) for more on guilt and shame.)

In most cases, they’re good people who didn’t see the signs.  They didn’t know that their loved one, friend, or neighbor was considering suicide.  One could argue that you should always be asking those you care for whether they’re considering suicide.  It won’t plant the idea.  (See Myth: Asking About Suicide Will Plant the Idea.)  Whether we should or not, it’s not the sort of thing that we normally ask.

Regardless of their innocence, many families and friends suffer by being shunned by others at the very moment they need them most.

Pride

There’s good reason for America’s farmers to be proud.  They feed the nation and to some degree the world.  They are – for the most part – hardworking, salt-of-the-Earth type people.  Many have had farming handed down from their fathers – who, in turn, received the farm from their father.  It’s more than a profession.  It’s a legacy.  Unfortunately, the desire to preserve that legacy for their children becomes a burden as they struggle against forces that are larger than so many farmers can bear.  Increasing production led to lower per bushel pricing.  Global trade wars changed tariffs and further reduced crop prices.  Interest rates climbing on the money borrowed to buy seed to plant made it impossible for many.

There became a sort of minimum number of acres you could farm to make it work.  You can’t afford to buy and maintain the equipment if you don’t have enough acreage to amortize the capital investments over.  That’s why we see farms that have thousands of acres instead of the original 40 acres granted to most during the westward expansion.

The pressure between the pride for the land and the realities of the economy made far too many decide that suicide was a better option.

Gun Storage

Sometimes, the narrative is more impressive than the research – and sometimes, it isn’t supported by research at all.  The data is clear that if you have guns, you should secure them.  This mostly means locking them, but could mean storing the ammunition and firearm separately.  The problem is that the data supporting these conclusions is weak.  To get enough statistical power, they had to combine all forms of “safe” storage.  That means we don’t really know if storing guns and ammunition separately matters much – or even at all.

People who sit on the gun control side of the issue have taken the research to mean that you must do everything.  The result is a recommendation to store guns and ammunition both locked and separate.  There is simply no research to support this approach.  Intuitively, it makes sense, but we’re found lots of things intuitively make sense that don’t really work that way.  Barrat falls into this trap and suggests storing guns and ammunition separately.

This is despite the fact that around 70% of all gun purchasers and gun owners say they have their gun to protect themselves (personal protection) or their home (inclusive of family).  If you tell them that they need to store the gun and the ammunition separately – as many do – they’ll simply stop listening.

We can say with clarity that guns should be locked up to prevent their theft, unauthorized use, and potential use in a suicide.  That’s acceptable to those who want it for protection.  It’s also often not done, because we continue to message in ways that invalidate the reasons that people buy guns in the first place.

When you message in a way that people will not accept, nothing changes – and you’ve wasted everyone’s time.

Connection is Prevention

“Thwarted belongingness,” a key component of Thomas Joiner’s Interpersonal Theory of Suicide, is, Joiner claims, a fancy way of saying loneliness.  (See Why People Die By Suicide for Joiner’s model).  Whether you prefer IPTS or something different, we know that loneliness increases the risk of suicide.  (See Loneliness and A Biography of Loneliness.)  When we consider suicide risk from the viewpoint of loneliness, we can see that the solution is to increase the degree to which people feel connected to others.

In The Anxious Generation, Jonathan Haidt explains how disconnected we are.  Robert Putnam expresses the relative concentration of importance on the individual in The Upswing (which could be seen, like Our Kids, as following up on the themes laid down in his landmark book, Bowling Alone).  Haidt builds a case that one of the causes is our increasingly technologically connected lives, particularly social media.  Sherry Turkle, in Alone Together, shared this sentiment over a decade ago.

Harried Learner in The Dance of Connection speaks to the delicate dance of staying connected to others, and Dr. Ruth Westheimer discusses practical tips in The Joy of Connections.  They stop short of claiming a cure for loneliness or suicide prevention, but there is good reason to believe that the more connected people are, the less likely they are to die by suicide.

Removing Stigma

Echoes of the ghosts that we shouldn’t talk about suicide lead to fear about removing all stigma from suicide for fear that it may elevate suicide rates.  After all, we don’t want others to think it’s a good idea.  The argument is that we know that there is a media “contagion” effect.  Glorification of deaths by suicide may set off a suicide cluster that will claim more lives.  (See Life Under Pressure.)

We’re in a scary place where we know that stigma is preventing people from getting the help they need – and it’s in some ways reducing suicides by preventing those who believe in the stigma.  Many people believe it’s morally wrong, and that’s enough to keep them from considering it.  We’ve got to find a careful path through making it okay to talk about suicide – and to think about it – without releasing the concerns about people acting on those thoughts.

A Roll of the Dice

There’s a problem with prediction in suicide prevention.  We can’t screen or assess in a way that reliably separates those who will and will not attempt suicide.  Craig Bryan makes this point clear in Rethinking Suicide.  Neither screening tools nor assessments are much better than a coin flip in identifying those who will make an attempt.  Despite this, we want to believe these tools are predictive.

Here’s the problem.  Suicide is too rare statistically and, tragically, too high societally.  If we had a screening tool that always said there was no need for enhanced services, we’d be right more than 99% of the time.  It would also be clinically unacceptable.  We’re struggling, because we’re trying to predict the unpredictable.

You Can Kill Yourself Later

The truth of the situation is that people can always kill themselves.  The goal is to get them to decide to do it later (and hopefully never).  A suicide death is permanent.  There’s no coming back from it and, as a result, it’s a good idea to defer that decision to the last possible moment.  If we did this more often – if we could be honest with people – we’d save lives.  Too frequently after hearing of suicidal ideation, clinicians rush to inpatient hospitalization.  What they don’t know is that there is no evidence that inpatient hospitalization works – much less that it is best.  There is, however, plenty of evidence that the highest possible risk is immediately after discharge from an inpatient setting.  Clinically, there is sometimes no choice but to hospitalize someone – but it should be the very last resort, because it’s necessarily a risky decision.

Far Transfer

In the language of education, it’s called “far transfer.”  It’s when the differences between the learning environment and the place that the skills must be used are large.  The difference can be physical environment, but it’s more frequently frame of mind.  If we’re learning emotional regulation in a safe classroom, it will be harder to recall that training in the midst of a difficult situation.

It’s one of the concerns about some of the recent research that teaches mindfulness to potentially suicidal individuals.  The results aren’t positive – and that may be because they’re unable to access these ideas from the point of considering suicide.

Drivers

Many people hear of the problem with veteran suicide – how more service members have died of suicide than of combat.  We fail to recognize that though military service increases risk, it does so regardless of battle experience.  It doesn’t seem to matter whether they were sitting at a desk in Texas, in a base in Afghanistan, or were in a firefight.  The driver seems to be service in any way.

Other, more pertinent, drivers seem to be problems with relationships, the law, or finances.  All these are possible factors for veterans – particularly those who suffer from some sort of PTSD.

The Strategy That Isn’t

At the time of Barrat’s writing, the latest national suicide strategy was published in 2012.  The problem is that most people who were working in suicide prevention in America weren’t even aware of the plan.  The 2024 refresh of the plan suffers from many of the same issues as its 2012 predecessor.

First, it’s not a strategy.  It’s a list of aspirational things that it hopes the states will implement.  Thus, when it was evaluated in 2017 almost no one had fully implemented the plan.  Second, the efficacy of the interventions was never measured, yet many of them are in the 2024 plan with slightly different wording.

Proponents will say that there is a federal action plan outlining what the federal government will be doing to support the strategy.  However, the federal action plan is a long list of activities – most of which have been ongoing.  There’s no measurement of change, just the appearance of trying to make it better.

Without a set of tools that states can use to implement the plan, we can wait another decade to realize we’ve not implemented the strategy and issue a new one with minimal changes.  It may be a cynical view, but it’s the one you develop when you see the gaping holes that never get addressed when Facing Suicide.

Book Review-Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery

It wasn’t work with addiction, depression, or hope that led to a Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery.  It was the fact that Adam Hill discussed his suicide attempts – and that his history is from Indiana and Indianapolis.  A colleague recommended the book, and despite my relative resistance to reading stories, I decided it was worth an investment.

Cultural Indoctrination

Context is important.  If you’ve not been a physician, it can be hard to understand the culture of medicine and its training process today.  The training process is bipolar, that on one hand tells us that they’re “baby doctors” and leads them to expect greatness from themselves and their peers, while on the other hand simultaneously asks how they could have made such a stupid mistake.

It starts with the competition to get into medical school.  Hill recounts his struggle as a waiter while he awaited news that he’d be accepted to school – and the internal struggle with inferiority.  Once there, top spots are coveted, because they mean that there are more options.  However, the winnowing process has elevated the competition so that students who were used to being at the top of their class find themselves struggling to get by.  Everyone is clear that the curve has changed.

The final, unspoken, piece is the recognition that peoples’ lives are literally in your hands.  Few professions routinely make life-or-death decisions, and that can weigh on physicians.  It’s one of the reasons why people can be ostracized.  Their peers wonder if they have “what it takes” to be a doctor.

It’s in the context of this culture that doctors are discouraged from admitting their weaknesses and seeking help – particularly if the struggle is a mental one.  It’s okay to get tutoring on anatomy, but it’s not okay to say that you’re struggling to cut into a cadaver.  This destructive system pushes many to the brink and beyond.  Luckily, Hill came back.

Hiding in Plain Sight

Sometimes, the seeds of destruction were with us and visible all along – if anyone were able to put the clues together.  Hill shares his social anxiety and his strive for perfection.  It’s a recipe for concern.  He had learned to hide his imperfections.  Life Under Pressure explains what a culture like that does to create the conditions for a suicide clusterPerfectionism explains the dangers of perfectionism itself – in the failure to accept that anything less than perfect is good enough.  In The Paradox of Choice, Barry Swartz explains how satisficers learn to accept what’s good enough while maximizers must have the absolute best – and how the psychological consequences aren’t good.  Maximizers is another way of saying perfectionist.

The problem with hiding imperfections is captured in the saying, “You’re only a sick as your secrets.”  It’s such a prevalent topic that it’s come up in numerous book reviews, including Opening Up, The New Peoplemaking, The End of Hope, Safe People, and more.

Visible Scars

Hill recounts a fractured tibia requiring crutches, and how this was an outer sign of injury.  For this, others questioned and commented – to the point his sister made him a t-shirt with the answers.  However, while the outer injury was visible and the topic of conversation, his internal brokenness was unspoken – by either him or by others.  The visible was easy.  The hidden and the mental were culturally inappropriate to discuss.

Hill suggests what a shirt might look like with the inner struggle: “Yes, I am broken.  It happened during medical school.  It really hurts.  I do not feel like a good person.”  While I struggle to disagree with how someone feels, I do believe that the roots of the problems were present before medical school, like the tiniest of fractures that is barely able to be detected being aggravated by continued stress (abuse).  Athletes – particularly child athletes today – encounter these microfractures and must take time for them to heal.  However, that’s not a luxury we’ve ever afforded to those who are struggling with their own worth as a human outside of what they can do or who they will become.

The Stigma

Stigma is simply different than “normal.”  It’s different than the socially prescribed path that you’re supposed to walk – and it matters.  (See Stigma for more on the concept of stigma.)  It’s important to understand that stigma is resolved by normalization.  The more that we normalize a behavior, the less power stigma holds.  Thoughts of suicide at some point in their lives are present in more than 1/3rd of the population – and it appears to be growing.  The belief that suicidal thoughts are rare is a myth.  (See https://SuicideMyths.org.)

When I grew up in the 1980s into the 1990s, gays were to be feared.  I don’t know why, but the social message was clear.  (True to my nature, I really didn’t care.)  Books like After the Ball, which advocated techniques for normalizing alternate sexuality, were scooped up by zealots and largely destroyed.  I still think After the Ball is a great guidebook for how to make things more normal – thereby evaporating the stigma.

One of the barriers to anyone speaking out about their struggles is the fear of repercussions; one part of that is the reality, and the other is the fear.  In Dreamland, Sam Quinones shares about the terror tactics used by the Mexican cartels to ensure that people would remain afraid.  The incidence rate was low, but the message was clear.

We face these twin barriers in stigma within the medical community.  There are some real problems with the ways that licensure boards ask questions that violate ADA standards.  These must be fixed, and it’s one of the missions of the Dr. Lorna Breen Heroes Foundation.  Beyond the literal requirements of the ADA, they’re pushing for licensure and credentialing standards that don’t penalize people for seeking appropriate help.

The other barrier is the stories that we hear of people who were penalized or condemned for their stories – and fear that if we share our weaknesses it could be us develops.  That’s where finding approaches that maximize protecting the public (what licensing boards are for) and provider dignity are needed.

Numbing

There are echoes of workaholism throughout the medical industry, whether it’s coming back to work early after surgery, those insane number of hours in residency, or the tendency to slip back into work when things were getting harder to deal with.  But, across the planet, the big tool for numbing is alcohol.

While we find books like The Globalization of Addiction and Chasing the Scream that are focused on narcotics, the number one tool for numbing is alcohol.  Alcohol is not, however, inherently bad.  Neither is numbing.  Numbing is used for procedures to make the process easier.  We encourage it for short-term use – it’s the long-term use that creates a problem.

It’s a hard line.  How much numbing is too much?  How much numbing do you need to be able to process the day-to-day trauma of life?

Numbing as the only strategy doesn’t work, because it becomes less effective over time.  That’s the trap of numbing and how it leads to suicide.  Numbing is used without healing.  Short-term numbing is fine – but only when used in a pathway towards healing.

Suicide

Hill recounts the fellow medical student who died by suicide and how their death was never spoken of in a public forum.  He shares that even in the first few years of his career, he lost five people to suicide.  Between his words you can hear echoes of confusion: on the one hand, some of these people seemed outwardly fine – on the other, he recognizes that he appeared okay on the outside as well.

Suicide happens when the numbing is no longer effective enough.  The pain gets to be too much.  (See Suicide as Psychache.)

The title of the book comes from the pivotal moment for Hill when his wife called him at just the right time to interrupt his suicide attempt.  The literal is a part of his figurative Long Walk Out of the Woods.

Book Review-Life Under Pressure: The Social Roots of Youth Suicide and What to Do About Them

What causes suicide clusters to form?  That’s the fundamental question behind Life Under Pressure: The Social Roots of Youth Suicide and What to Do About Them.  The book follows a community known by the pseudonym of “Poplar Grove.”  It recounts stories and quotes from interviews to understand what has made Poplar Grove such a hot spot for youth suicide – and what can be done about it.

Clustering

Usually, a suicide cluster is two deaths plus an attempt or three deaths in a short period of time in a constrained geographic region.  The real question is what causes them and what can be done to prevent them.  There are several factors that lessen the barrier to suicide for those exposed to one.  First, suicide is brought to mind as an option that may have never been considered before.  Second, the death of someone close necessarily causes grief – and that makes life seem a little less worth living.

But not every suicide death (or any death, for that matter) sets off a suicide cluster – far from it.  While suicide clusters aren’t frequent, they are painful for the people who are left behind and communities they occur in.  Understanding what conditions create or allow clusters to form allows us to design interventions to prevent them – at least in theory.

The Setup

Life under Pressure is a bit repetitive.  It focuses attention to the intense performance pressure and dense social ties of a “must-be-seen as” community as the contributing factors that led to so many youths deciding that death looked better than life.  (See Leadership and Self-Deception for more about “must-be-seen-as.”)

Performance Pressure

Some communities value educational and professional attainment to a degree that they place pressure on their children to be the best, to be involved, and to not show faults.  (See The Years that Matter Most, which was later republished as The Inequality Machine: How College Divides Us, for more.)  The result is that we’ve developed youth with greater anxiety and perfectionism.  (See Perfectionism for more on what it is.)

To be fair, this pressure provides growth opportunities that are needed.  (See Antifragile.)  It can even be argued that peak performers need some degree of pressure.  (See Peak.)  The problem is that this community didn’t create the kind of “air bags” that Robert Putnam describes in Our Kids.  (See also Putnam’s Bowling Alone for background.)

Parents and community members said they were available for youth that needed help – but the youth didn’t believe it, or at least didn’t use it.  They didn’t believe that they were psychologically safe enough to share.  (See The Fearless Organization for more on psychological safety.)  They also didn’t believe that others would or could help.

Dense Social Ties

Generally, we speak of connectedness and social capital in a positive way.  It has protective factors.  (See Analyzing the Social Web for a technical analysis of social ties.)  However, as Richard Hackman explains in Collaborative Intelligence, sometimes teams (his context) have connections and boundaries that are so rigid that they inhibit growth and results.  From Jesuits (see Heroic Leadership) to economics (see Trust), ethics (see How Good People Make Tough Choices), and sociology (see Delinquent Boys), we’ve learned that rigid cultural control of people can have negative consequences, and it sometimes takes real skill to avoid getting wrapped up in them.

Everyone knows everyone else’s business.  That’s the problem.  High performance expectations and dense social ties means that if you admit to a challenge, a limitation, or a fault, everyone will know it in an instant.  This is the driver that makes psychological safety so hard.

Everyone knows that if they admit a problem, everyone will know – and everyone will judge them for it.  Maybe they’ll be overt about it, or maybe they’ll be silent.

Community Pride

There’s a shared ethos of pride and expectations in the community.  They’re all there because the parents wanted to give their children the best chances to succeed.  They’re into athletic excellence as well as academic excellence.  The parents made it far enough in their lives and careers to make it possible for their children to grow up with good schools and support.  They never thought that it would lead to so many with anxiety and so many of their children considering or attempting suicide.  They never saw it coming.

Warning Signs

While the repetitiveness of the book can be frustrating, it’s nothing compared to the promotion of falsehoods.  It says, “To correct another myth, we should address the belief that suicide rarely occurs without warning. There are almost always warning signs. Unfortunately, our society is not very good at recognizing those warning signs and intervening.”  First, if they were dispelling a myth, one would think they’d offer evidence, but no evidence is offered.  Instead, the authors push forward a statement that isn’t based in fact – and is problematic on multiple levels.

The argument is often that, in retrospect, people identify signs.  There are two fundamental problems with this.  First, they’ll claim to see signs that were never present.  Recall-based approaches have been proven faulty repeatedly.  There’s no way to say that what they recall actually happened.  Second, and more importantly, these signs don’t have any predictive value.  Often warning signs include “behavior change.”  The problem is that people change their behaviors all the time – and a vanishingly small number of people are going to attempt suicide because of it.

I have 3+1 signs.  The 3 signs are when they say, “I’m going to die/kill myself/suicide,” “(It doesn’t matter) I’m not going to be here anyway,” and “I want to give you this (prized possession) because I know you like it.”  The +1 is sleep disturbances.  For the first three, we’ve got a clear message we can and should respond to.  For the +1, it’s a reason to check in – and continue checking in.  Sleep challenges lead to cognitive challenges – and cognitive constriction, which can be dangerous.

I’m not suggesting we can’t start a conversation about suicide when we see one of the signs on the numerous “warning signs” lists.  I’m saying we should be starting a conversation about suicide without them.  The warning signs just aren’t predictive of risk in an individual.

The problem isn’t “recognizing.”  The problem is that we’ve included so many signs that they’re meaningless.  If you don’t believe me, you’ll find the evidence at Myth: Every Suicide Attempt Has Warning Signs.  (Direct journal articles and research are linked from this page.)

No Mulligans

In golf, a mulligan is an attempt to do the same shot again.  Live doesn’t have mulligans, but too many parents treat their children like their own personal mulligans.  If they didn’t get the starring role in the high school or college play, their child surely will.  They missed out on an athletic scholarship to college, certainly that won’t happen with their child.  Whatever dream they missed, their child won’t.

The problem is that life isn’t designed to work this way.  They get their shot – and their children should get theirs.  If they force their will on their children, both the parent and the child tend to be disappointed, frustrated, angry, and confused.  It’s not healthy – but it’s something that I see all too often.

School Responses

The school in Poplar Grove was criticized for their responses.  However, even the guide, “After a Suicide: A Toolkit for Schools,” from which the authors draw their perspective isn’t perfect.  There are simple things like treating all deaths the same and ensuring that the suicide isn’t glamorized.  However, as you dig into the guide, you’ll find an inappropriate coupling of mental health to suicide, implying or directly stating that this should be a part of messaging to parents and students.  There is no research support for this approach – and it necessarily further couples and stigmatizes both.

While insisting that all deaths should be handled the same – and they should – the guide continues to prescribe different messaging and approaches for suicide.  The guide itself (and the authors of this book) are inadvertently doing the very thing they’re telling others not to do.

Shaky Ground

Qualitative research is very difficult to get right, and often it suffers from biases.  The questions that are asked (even in structured interviews) are often driven by the perspective of the interviewer.  That’s just a part of the process as we move from qualitative to quantitative research.  However, one can practically hear the rumblings, as statements like, “we are fairly convinced that large, well-attended memorials have unintended negative mental health consequences,” clearly reflect the bias of the authors (as indicated) – but no proof or theory is offered to support these type of statements.

While I can appreciate the delicate nature of interacting with a community in the midst of a suicide cluster, I cannot fathom statements like, “We did not feel it was appropriate for us to attend any of these memorial services or vigils ourselves, so we cannot provide an observational account.”  I liken it to the person who records a video of someone else getting injured rather than rendering assistance.  I see no reason why someone researching how to prevent more death can’t approach an official to ask for permission to listen to the service.  It strikes me that this decision might be based more in fear of the awkward conversation. “How did you know the deceased?”  The answer is simple.  “I didn’t, but I want to prevent others from dying like they did so I’m here to learn from family and friends.  I hope to learn more about him/her.”

There is some good to be learned from pressure.  However, it’s not right to have an entire Life Under Pressure.

Book Review-The Prediction of Suicide

Aaron (Tim) Beck, Harvey Resnik, and Dan Lettieri are the editors of The Prediction of Suicide.  The assembled work brings together the best minds in the prediction of suicide in 1974.  The arguments made then are like the arguments that could be made today.  In the preface, they state, “Despite the voluminous research reports, there is a very flimsy basis of knowledge that can contribute in a scientific sense to the problems of the worker in this field.”  It’s a challenge that hasn’t changed substantially in the fifty years since this publication – but hopefully it’s one that will change soon.

The Process

The point is made that, “Suicide is the end result of a process, not the process itself.”  This belies the problem of prediction and identification.  We speak of the outcome, but even today, we struggle to articulate the pathways that lead to this outcome.  It’s understanding these pathways that provides hope for our ability to do some level of prediction of suicide.

The one differentiation that can be made about the process – even in 1974 – is related to the outcomes.  “But the unsuccessful suicides are no doubt quite different from the successful, and the former cannot be regarded as representative of the latter.”  The categorization is that attempts must be categorically different than deaths, because the outcomes are different.

I think this hides the reality of the randomness to the process.  Silvia Plath arguably wanted to be found and her attempt to be aborted.  (See The Savage God and Suicide and Its Aftermath.)  Even though she eventually died, her process may have been closer to that of an attempter who didn’t die.  In short, while we can presume that there’s a difference between attempts and those who die, we can’t really know.

Zeigarnik

Blume Zeigarnik was a student and colleague of Kurt Lewin.  She noticed an odd thing about the memory of servers.  They could remember orders without writing them down – until they relayed the order to the kitchen.  After that point, they promptly forgot the order.  This led to the discovery of what we call the “Zeigarnik effect,” where uncompleted tasks are held more prominently in memory.

Joseph Subin, in the first chapter, hypothesizes that the Zeigarnik effect may have an influence on attempters, providing some subtle draw towards “completion.”

Call Centers

Suicide call centers are an important part of the overall system of care to try to prevent suicide, but the book notes that “only 4 percent of suicide attempts and even a smaller percent of the eventually successful suicides called suicide prevention centers.”  So, they’re an important part of the overall strategy – even if the overall match to those who make attempts is low.  We see this same sort of calling pattern in 988 today.

The Perception of Control

We often underestimate our need for the feeling of control.  The belief that someone has control and the presence of options has consistently demonstrated a positive effect on mood for people.  We see this in places where there are suicide options for those with terminal illnesses.  The number of people who use the suicide option after having been approved is very low.  (See November of the Soul.)  They’ll go through great lengths to acquire the ability to die by suicide – and simultaneously decide not to use the option.

At its heart is our perceptions of control.  When we feel we have control, we have a greater capacity for self-soothing and down-regulation of fears.

Mental Health Disorders

Mental health disorders are, for the most part, time-limited with or without therapy.  That’s striking, but not totally unexpected, news.  For most of human evolution, mental health disorders have occurred before the introduction of psychotherapies and the like.  This is not to say that mental health assistance is a bad thing – far from it.  Antibiotics, in most cases, merely decrease the time it takes to heal, but we still use them anyway.  Similarly, mental health supports are good things.  But understanding that mental health disorders typically self-resolve can help us to understand how suicidal crisis can also self-resolve.

To be clear, this is not to say that all mental health disorders will self-resolve – they won’t.  However, the argument made by Zubin is that they largely self-resolve.

Actuarial Versus Clinical

One of the big challenge in the prediction of suicide is the difference between aggregating various risk factors to develop a risk score for an individual and the need to sit next to someone and make a decision about whether they are a risk to themselves.  (Ideally, sit next to them rather than across from them, as still often happens – see Motivational Interviewing and Managing Suicidal Risk.)

In the development of actuarial risk, demographics and history are combined into a single score based on previous research and factors that can be identified to raise or lower the risk.  Being an “old white guy” raises one’s risk – my risk.  Other factors are loaded into the assessment to create a score.  However, this score has nothing to do with me personally and everything to do with the statistical abstractions made for groups of people.

Time and time again, we’ve demonstrated that such actuarial risk summarizations have almost no utility in the assessment of individuals.  Compiling the most comprehensive profile still doesn’t yield the ability to predict which individuals are at risk.  The statistical (actuarial) process simply has eliminated all of the distinctiveness in the data and with it the ability to see the risk of individuals.

Later in the volume, Beck states it clearly: “The belief that suicidal behaviors are predictable can be valid only as a belief in principle, not in fact.”

Psychological Autopsy

Even in 1974, the limitations of psychological autopsies was well known.  Alex Pokorny explains the difficulty of discovering intent: “It also appears to require a ‘psychological autopsy,’ which is not practical for general use and which also introduced the possibility of circular reasoning.”  He first identifies the effort and therefore cost of doing psychological autopsies.  They’re time consuming.  They require willing participants of the survivors, which isn’t always the case.  That makes them somewhat impractical for broad use.

The more challenging aspects of psychological autopsies are the problems of retrospective reasoning.  After a determination of suicide is reached (preliminarily), the scales tilt towards that, and there is some bias towards confirmatory evidence.  This is held back by the stigma and extra pain associated with suicide death, but the degree to which one of these forces is more powerful than another is both situational and effectively immeasurable.

We’re left with serious doubts about whether psychological autopsies create a real picture of the person’s mind or whether they create a fiction that roughly fits the facts.  This fiction may help us feel better about understanding – but it does not necessarily create actual understanding.

The Categories

One of the challenges of creating good research on suicide is the need for clear and consistent categories.  The categories proposed are completed suicide (CS), suicide attempt (SA), and suicide ideas (SI).  These are good, broad categories, but they miss some of the nuances and challenging situations.

In particular, non-suicidal self-injury (NSSI) is problematic in this framework.  There is a relationship between NSSI – particularly cutting – and later suicidal behavior, but the narrow and coarse framework proposed here doesn’t connect NSSI to suicide.

Screening

Aaron (Tim) Beck was one of the earliest proponents of finding scales to measure risk.  He was developing what became the first risk screening tools – some of which are still used today because of their efficacy.  However, he states, “Nevertheless, even the best of these produces a very high proportion of false positive errors, that is, cases that are unjustifiably labeled as high suicide risks.”  Later, he continues by saying, “For there is currently no detection scheme that can be set to identify half of the available genuine suicide risks without erroneously identifying along with them a lot of people who are not suicide risks at all.”  He acknowledges that because suicide is a statistically rare (and tragically too common) event, it’s hard to develop tools to identify it.

He argues that, in order to get sufficient sensitivity to detect people who may have suicide in their immediate future, many must be identified and later assessed out of the system.  My “back of the napkin” calculations put the false positive rate at about 300-600 times the number of actual positives based on current tooling.  Despite the insistence on the use of these tools, the behavioral health system can’t cope with the false positives that must be screened out.  Even if these clinical assessments were 100% accurate, the sheer volume of work puts a strain on an already burdened system.  The tragedy is that even clinician assessment is a poor predictor of outcomes, as is explained in The Practical Art of Suicide Assessment.

Predictors and Postdictors

Hindsight is 20-20.  It’s a common cliché that pushes us towards an understanding that we can see things in the past that might have never been identifiable before the event.  We can understand the factors and methods that lead to outcomes only after the kind of careful study and clarity that comes after the event.  One of my great frustrations is with lists of suicidal risks, because they include things that frequently occur, including in a proportion of those who attempt suicide.

Things like a change in mood or behavior is often listed.  The problem is that, when applied to teenagers, this is almost universal – with or without suicide risk.  Also listed are statistics like 95% of people with suicide have a mental illness.  That’s misleading, because a very small percentage of those with mental illness will die by suicide (<5%).

David Lester makes the point that what we call “predictors” are all assessed after-the-fact and therefore should more accurately be called “postdictors.”  They have little predictive value.  They do, however, encourage a great deal of guilt and shame on the part of loved ones who feel that they missed signs that they should have seen.

Infrequency

Chapter after chapter in the book has authors saying that suicide is a statistically rare event and is therefore nearly impossible to predict at an individual level.  George Murphy explains how a statistically good screener would be unacceptable clinically owing to the intersection of statistics and outcomes: “From the numerical standpoint, a prediction of ‘no suicide’ in every case would be highly accurate (1,336/1,350 x 100 = 98.96%). It would also be entirely unacceptable clinically.”

Extending out some basic math approaches, he concludes, “More to the point, the predictive accuracy assumed (80 percent) is far beyond our present capabilities. The population chosen for the example (suicide attempters) is one of relatively high risk, and yet prediction of the infrequent event, suicide, is poor. It would be very much poorer in a population unselected for risk.”  The threshold he used of 80% accuracy exceeds the capacity of our tooling even today, 50 years later.  Screening is still required by accrediting bodies in high – and not so high – risk situations despite our awareness that they simply aren’t effective.

The funniest thing is that the more we pay attention to the details, the more we can recognize that it’s a fool’s errand to believe in The Prediction of Suicide.

Book Review-Suicide and Homicide

Suicide and Homicide: Some Economic, Sociological and Psychological Aspects of Aggression proposes that both suicide and homicide are acts of aggression that flow through different channels based on either external or internal constraints.  There are others who have held – and do hold – this perspective.  Karl Menninger spoke of suicide in Man Against Himself as murder in the 180th degree.  More recently, Thomas Joiner in The Perversion of Virtue highlights the common component of killing in both suicide and homicide.

Aggression as a Consequence of Frustration

There are three theories about where aggression comes from.  Freud’s theory places aggression as an outcome of “Thanatos” – death instinct.  Konrad Lorenz challenged Freud’s perspectives based on his observations of how animals controlled their aggression.  The second theory is that aggression comes from frustration.  The third theory is Albert Bandura’s social learning theory.  He proposes that we learn aggression by seeing it in others.  (See Moral Disengagement – The Cases for more.)

Given Lorenz’ criticism of Freud’s theory and mine of Bandura’s, we’re left with the theory that aggression comes as a result of frustration.  One might conceptualize this as “Nothing else is working (or can work), so I’ll try the risky thing.”  Aggression is risky.  Certainly, at a physical level, one can get hurt while attacking another; but at a societal level, even non-physical attacks can backfire.  One can become labeled as difficult to get along with or problematic.

However, this sense that what is being tried is being blocked or is simply ineffective leads to an escalation through aggression.  We’ve been taught not to back an animal – particularly a wild animal – into a corner, because the behavior that we’ll see out of the animal in those conditions – when they feel as if they have no other options – can be harmful to us.

Business Cycles and Status

Much has been made of how suicide relates to business cycles.  It turns out that when business cycles are down – and things are more challenging – we do tend to see a rise in suicide deaths.  While there is some disagreement on the specific timing, the general relationship is generally well accepted.  Conversely, when the business cycle is at its peak, we tend to see more homicides.

We also see that upper and lower ends of the socioeconomic scale tend to be more and less sensitive.  In the low times of a business cycle, suicides increase in the higher socioeconomic status (SES) more than in the lower.  The theory is that those in the higher socioeconomic status are more greatly impacted.  During the peaks, we tend to see greater homicide rates but initiated by those in a lower SES.

Restraints

The fundamental theory is that weak external restraints drive suicide and strong external constraints drive homicide.  In the case of suicide, those who are most at risk as those who are the most affluent.  In terms of homicide, it occurs mostly in those who are at lower SES and therefore have greater external constraints.

Conceptually, those who have fewer external constraints need to impose more internal constraints to function.  If these internal constraints become too tight or difficult, the aggression felt is self-directed.

Perfectionism

The internal constraints that drive suicide may come in the form of perfectionism and the constant failure to meet impossible standards.  (See Perfectionism.)  It could be that we’ve become exhausted on our way to peak performance, realizing that we’ll never reach the goals we set for ourselves.  (See Peak.)  Even in the general form of maximizing rather than satisficing, we know that we’ll be less happy.  (See The Paradox of Choice.)

These are the kinds of constraints that we can impose on ourselves.  It’s not the outside world setting our standards.  It’s our own drive and determination that sets goals that we can’t meet and therefore suicide is a concern.

Social Ties that Bind

Social ties and strong communities are important protectors against suicide that may function in part due to their strong social conformity bond.  Robert Putnam described the erosion of social capital in Bowling Alone.  He later revisited how the decline of social capital wasn’t occurring evenly, with upper-middle class families finding ways to work together and insulate their children from some of the challenges of the world.  (See Our Kids.)

Perhaps if we pay attention to what and who binds us, we’ll realize how little difference there is between Suicide and Homicide.

Book Review-Attachment in Adults: Clinical and Developmental Perspectives

The attachment system that John Bowlby first theorized has spawned a great deal of research and knowledge (in part due to Mary Ainsworth’s contributions).  Attachment in Adults: Clinical and Developmental Perspectives shares some of the interesting and intriguing results of this continued research.

Multi-Generational

One of the more confusing results of the continued research is how a parent’s – particularly a mother’s – attachment style can influence the attachment style of their children.  Securely attached mothers tend to produce securely attached infants.  In short, parents can help their children’s lifelong trajectory by focusing on their own mental wellness.

Another confusing corollary is that children who are securely attached have more complex and mature representation of their parents.  They seem to understand the nuances and details of how the parents will interact in ways that their insecure counterparts do not.

Timing

There’s an odd thing about the timing of attachment styles.  First, attachment styles seem to appear between 9 and 18 months after birth – the same timeframe as object permanence.  In other words, from the very first moments we can recognize something not in our sight – something for which we have a mental model – we start working on attachments.

As adults, the research seems to indicate that a relationship with a securely attached individual has the effect of moving an insecurely attached partner towards secure attachment – over a two-year period.  It seems as if there’s an importance to the period of time that the secure relationship is available.

Individualism

The challenges with the Western/American view of rugged individualism has surfaced before.  I’ve addressed the challenges with the illusion in my reviews of How Good People Make Tough ChoicesHumble Inquiry, and Our Kids.  However, as the power of attachment to shape our lives for good or bad is brought to the forefront, the degree to which we believe that we’re able to survive as an individual seems even more of a pernicious delusion.  Whether it’s the data from Loneliness or the research around attachment, we know that we can’t live life alone.

Fathers Be Good to Your Daughters

John Mayer’s song, Daughters, includes the lyrics, “Fathers be good to your daughters / Daughters will love like you do.”  Strangely, research has found that the best predictor of a daughter’s emotional security in a love relationship is a close emotional bond with her father.  The degree of impact that fathers have in this regard is stunning given the relatively low amount of time that fathers spend directly interacting with their daughters.

Approval Competition

In some families, approval is a scarce resource that must be saved.  It may be that there is only one person who is receiving approval at one time.  There’s a favorite child.  The problem with this is that it develops anxiety in the children who feel that they must earn love, acceptance, and approval.  They believe that they’re one mistake away from losing their status within the family, with disastrous consequences to their long-term relationships.

Network Maps

If you ask people to map out their important relationships, they’ll often include people who are deceased.  As mentioned in New Models of Bereavement Theory and Treatment, people develop internal representations for people that are no longer with them.  It’s a plausible explanation that they still feel that person’s presence through the internalized concept of them.  It could also be that they just aren’t thinking clearly.  Either way, it signals that there’s more to our world than we realize and a great role for Attachment in Adults to play.