Positive psychology revisited

I recently wrote on some concepts from positive psychology in a post entitled On grit, flow and 'vasbyt'. Now an extensive review about positive psychology, entitled An intellectual movement for the masses, has just appeared in The Chronicle of Higher Education. The following quotes highlight some of the issues facing positive psychology:

"The world of positive psychology is vast and varied. The term is not trademarked, after all. Google it and you can find links not only to Seligman's Positive Psychology Center at the University of Pennsylvania but also to self-styled gurus describing their own "path of self-discovery" and to sites like Enlightenment Central, advertising neurofeedback and "consciousness exploration." A segment about positive psychology on National Public Radio in 2007 still makes researchers cringe: Its prime example of the field was the best seller The Secret, in which the television producer Rhonda Byrne argues that everything in the universe vibrates on a particular frequency; if people attune their thoughts to the same frequency as, say, money, they will attract wealth; ditto love, health, and unlimited happiness."

and

"Researchers in positive psychology are constantly fighting its image as a New Agey, self-help movement, a reputation that has plagued it from its inception and that persists not only in the news media but also among many in the broader discipline. 'The curse of working in this area is having to distinguish it from Chicken Soup for the Soul,' "

The whole article makes for good reading.

What is encouraging is that positive psychology seems to headed for a greater measure of evidence based methodology.

David Cameron on disability

David Cameron's son, Ivan, who suffered from cerebral palsy and epilepsy, died tragically earlier this year. In a recent article in The Independent, Cameron poignantly described his family's experiences and the lessons he learned about disability. Those of us who work with children with disabilities and with their families would do well to take note of his views.

Photograph by Roger Taylor from The Telegraph.

"The first lesson I learned was the importance of early intervention and help. The day you find out your child has a disability you're not just deeply shocked, worried and upset – you're also incredibly confused."

and,

"The second lesson was that life for parents of disabled children is complicated enough without having to jump through hundreds of government hoops. After the initial shock of diagnosis you're plunged into a world of bureaucratic pain."

I quote Cameron's third lesson fully, as it relates to inclusive education versus special schools. South African educational authorities have, somewhat reluctantly, accepted that there is a place for special schools. Overzealous inclusionists, however, often mislead parents with empty promises about support that never happens.

"The third lesson is that we've got to make it easier for parents to get the right education for children with disabilities. So many parents get stuck on a merry-go-round of assessments, appeals and tribunals to get a statement of special needs and the extra help their child needs. There's a structural reason for that. The people that decide who gets specialist education – the local education authorities – are also the ones who pay for it. We're seriously looking at how we can resolve that conflict of interest so that parents don't have to enter into such a huge battle for special education.

Something else that many parents have to fight tooth and nail for is a place in special school. Following the gospel of inclusion, the Government has closed dozens of special schools down in the last decade. Inclusion is great for some, but it's often the case that putting a disabled child in a mainstream classroom is a square peg-round-hole situation. So we're going to stop the closure of special schools and give parents more information and greater choice."

and,

"The fourth lesson is that like all other carers, parents need a break. One of the biggest challenges when your child is severely disabled is finding time to do normal family stuff – playing in the park with your other children, doing the weekly shop, mum and dad going out for a meal."

finally,

"The fifth and final lesson I'm going to share is this. The very painful thing about disability – whether your own or your loved one's – is the feeling that the situation is out of your control. When the system that surrounds you is very top-down, very bureaucratic, very inhuman, that can only increase your feelings of helplessness. So a really big difference we can make is to put more power and control right into the hands of parents, carers or those with disabilities ..."

Cameron concluded:

"This is the support, trust and respect that parents of those with disabilities deserve.

Because we can never forget what an amazing job they do. ... We need to recognise that by staying strong and holding their families together, these parents are doing a great, unsung service to our society."

Cameron's is a voice of reason in a field where emotion and sentiment often rule.

In the DSM-V by popular acclaim?

A campaign is currently on the go to include Sensory Processing Disorder, also known as Sensory Integration Dysfunction, in the DSM-V. It has been launched by the SPD Foundation and claims to currently have about 10 000 signatories. It is accompanied by a campaign to get physicians to support the diagnosis of SPD. This is an extract from the general letter from the SPD Foundation launching the campaign:

"We need your immediate help with an important effort to obtain diagnostic recognition of Sensory Processing Disorder (SPD) in the upcoming revision of the Diagnostic and Statistical Manual (DSM).

The DSM committee has asked us to provide research showing that doctors would use an SPD diagnosis if it were added to the DSM-V. Showing use by international physicians is important, too, because diagnostic recognition in the DSM will lead to inclusion in comparable international manuals. In response to the DSM committee’s request, we have developed a very short online physician survey (it literally takes a doctor three minutes to complete).

WE NEED TO GET THIS SURVEY INTO THE HANDS OF PHYSICIANS WHO UNDERSTAND AND SUPPORT SPD AS A DIAGNOSIS.

You and everyone you know are crucial to this effort.

If you are a parent, please ask the pediatrician, psychiatrist, other physician (MD), or osteopathic doctor (DO) who treats your child to go online and take our survey. If you are a clinician, a teacher, or another professional, please ask any physicians you know - especially those familiar with SPD - to take survey. They will do this as a favor to you."

The physicians' survey can be found here. It has no control that I could see to ensure that only physicians take it.

Sensory Processing Disorder is strongly linked to two specific therapies, Ayres's Sensory Integration therapy (SI) and Tomatis and Berard's Auditory Integration therapy (AIT). Both of these are controversial, both because of theoretical issues and lack of evidence for effectiveness. SI gained some respectibility because it is widely practiced by occupational therapists. AIT on the other hand (especially the devices used in it), has been widely rejected by professional organisations.

Is Sensory Processing Disorder a valid diagnosis that can be reliably made and has an existence outside of the therapies mentioned? Dr. Peter Heilbroner in Quackwatch does not think so, but there should be only one question - is it supported by scientific evidence? Surely popular acclaim and pressure should not influence the decision?

In closing, I believe that a quote from Dr. Allen Francis's now well-known critique of the DSM-V process, has some relevance to my concern about SPD:

"There is also the serious, subtle, and ubiquitous problem of unintended consequences. As a rule of thumb, it is wise to assume that unintended consequences come often and in very varied and surprising flavors. For instance, a seemingly small and reasonable change can sometimes result in a different definition of caseness that may have a dramatic and totally unexpected impact on the reported rates of a disorder. Thus are false "epidemics" created. For example, although many other factors were certainly involved, the sudden increase in the diagnosis of autistic
disorder, attention‐deficit/hyperactivity disorder, and bipolar disorder may in part reflect changes made in the DSM‐IV definitions."

On grit, flow and 'vasbyt'

Gifted neuropsychologist Jonah Lehrer recently wrote on the psychology of grit in his blog, The Frontal Cortex, and in the Boston Globe. He described grit as:

"(grit is) ... about setting a specific long-term goal and doing whatever it takes until the goal has been reached. It’s always much easier to give up, but people with grit can keep going."

The primary researcher in the psychology of grit is Angela Duckworth. A grit questionnaire is available online. The concept seems to be drawing a lot of attention. The whole spring 2009 edition of In Character for instance, is devoted to the concept of grit. It is filled with entertaining anecdotes (in the best sense of the word) with examples of grit from Einstein to Seabiscuit.

I have seen many examples of what is described at grit in a career in special education. We would have described it as perseverance or "vasbyt" (An Afrikaans term which originated in the Border War, according to the Oxford Dictionary of South African English 'vasbyt': [fas beit] verb. usually imperative, interjection, equivalent of 'hang on', 'grin and bear it', 'keep going' etc. meaning endure). While I consider intelligence a very important attribute, I have often observed children with cerebral palsy achieve through pure grit, despite lacking what is conventionally described as intelligence. Certainly a concept worth looking into.

There are many other similar concepts and one would need to do some clarification and defining. The fields of Positive Psychology and Social Learning Theory may be especially important for this.

A commenter on Lehrer's blog linked grit with the concept of flow, which according to Wikipedia is:

"... the mental state of operation in which the person is fully immersed in what he or she is doing by a feeling of energized focus, full involvement, and success in the process of the activity."

Other related concepts include resilience, locus of control and self-efficacy.

A few provocative (I hope) questions in closing:

Would Bernie Madoff, who systematically defrauded clients for the best part of two decades, be considered to have exhibited grit?

Lance Armstrong would without doubt be a prime example of grit in action. Should, however, the drug allegations that dogged his career prove true, will it still be considered grit?

What about Carlos Hathcock, who single-mindedly pursued a career as a top target rifle shooter and later as the top American marine sniper (93 confirmed kills)in Vietnam? He later battled burn injuries and multiple sclerosis, but continued to train military and police snipers.

Mostly wrong, but never in doubt

How do quacks and charlatans so easily gain the confidence of their victims? I have long believed that the answer was to found in their ostensible utter confidence in their products. Rarely will these hucksters admit to any doubt about the scientific merits of their snake oil, in fact most could't care less. Hat tip to Tracy Allison Altman from Evidence Soup for pointing me to scientific evidence to substantiate my view.

A simposium of the Association for Psychological Science entitled Often in Error, Rarely in Doubt provided some answers. Don Moore, the chairperson, summarised the conference as follows:

"Excessive confidence in the precision of one’s knowledge is both the most robust and the least understood form of overconfidence. This symposium investigates its ultimate causes. The evidence suggests that overprecision is caused by limitations on the working capacity in human memory, conversational norms, and social pressure."

I would have liked to add greed and gullibility, but that is just my opinion.

A hat tip again to Evidence Soup for the article Humans prefer cockiness to expertise in the NewScientist. Quoting Don Moore, the article points out that people tend to believe the more confident message, regardless even of a poor track record of the messenger. This creates difficulties for scientists who, ethically acknowledging the limits of their knowledge, will always be at a disadvantage against activists and lobbyists.

I would extend this to the medical and educational arenas, where individuals who emphasize the necessity of evidence supported practices will always be at a disadvantage to unscrupulous quacks who ostensibly have no doubt about their scams.

There are also legal reasons for quacks not to admit to any doubt about their snake oil cures (and for critics not to allege that quacks know they're quacks). A case in point is the legal battle about libel between Simon Singh and the British Chiropractic Association (BCA). The key issue is this battle revolves around the word bogus. The judge ruled that in using the word bogus, Singh implied that the BCA knew that their cures were worthless. Read about it in my post UK chiropractors sue themselves in the foot.