Autism and the DSM-5

19 December 2012

There has been a lot of talk in the media about the forthcoming DSM-5 and the diagnosis of Autism.  The DSM-5 is the Fifth Edition of the Diagnostic and Statistical Manual used by Doctors to make diagnoses pertaining to Autism and other behavioral and mental health disorders.  There are in fact two major changes in this newest edition regarding Autism.  The first has to do with changes to the name of the diagnosis.  The second has to do with the actual diagnostic criteria used to make a diagnosis.

 

Currently, when presented with a child who exhibits some characteristics of Autism, Doctors have to determine whether or not the child exhibits a sufficient array of clinically significant symptoms to warrant a diagnosis.  This process requires the clinician to rule out other disorders that may instead be causing the problematic symptoms.  The clinician also has to make a differential diagnosis to determine which of the Pervasive Developmental Disorders best describes the child.  Many professionals, me included, believe that the dividing lines between the various forms of Autism are difficult to distinguish.  The new DSM does away with this problem by eliminating the different labels (Autistic Disorder, Asperger’s Disorder, PDD-NOS, Childhood Disintegrative Disorder) and instead puts in place a more general term – Autism Spectrum Disorder (ASD).  Many researchers and clinicians agree that this change is warranted.

 

When the DSM-5 is published in May of 2013, children who previously would have been diagnosed with Autistic Disorder, Asperger’s Disorder, or PDD-NOS, will be given the new diagnosis – Autistic Spectrum Disorder (ASD).  A differentiation will then be made by indicating the degree of symptom severity.  Specifically, those with more classical Autism will be diagnosed with ASD-Severe.  At the other end of the spectrum, children diagnosed with Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) will likely get an ASD-Mild designation.  Those with Asperger’s may fall anywhere from ASD-Severe to ASD-Mild, depending on the degree of impairment.  Many with Asperger’s will likely fall in the Moderate range.  To be clear however, Classical Autism may span Severe to Mild ASD while PDD-NOS will likely span Moderate to Mild ASD.  Again, the severity designation depends on the number and severity of symptoms present.  If your child already carries a diagnosis, little will change, except perhaps how professionals refer to the disorder itself.   Your child will be referred to as being on the Autistic Spectrum.

 

The second change involves a modification of the Diagnostic Criterion used to provide a diagnosis.  When making a diagnosis, a clinician such as myself, has to have evidence of a sufficient array of behaviors listed in the DSM in order to provide a diagnosis.  The behaviors commonly associated with Autism make up the list of Diagnostic Criterion in the manual.  The new DSM includes an update of the behaviors used as these criteria.  It defines ASD by two sets of core features, namely: 1) impaired social communication and social interactions; and 2) restricted and repetitive behavior and interests. It more appropriately reorganizes the symptoms in these domains and adds sensory interests and sensory aversions to the list.

 

The new version is touted as an improvement because it adds to and reorganizes the diagnostic criterion so that they better address the needs of people with ASD across all developmental levels and ages.  It also includes improvements to better address the atypical symptom presentation of girls.  The goal of DSM-5 is to apply what is detailed in the scientific literature so as to add precision and validity to the diagnostic process.

 

As with any change, there have been some concerns expressed in the media.  Perhaps the most frequently heard concern is the fear that those at the mildest end of the spectrum with strong cognitive capabilities will no longer qualify for the diagnosis and thus may lose services.  Advocacy groups such as Autism Speaks have been actively engaging in this reorganization process and the American Psychiatric Association (the publisher of the DSM) has made statements aimed to calm the concerns.  They suggest that clinical judgment remains a crucial piece of the diagnostic process and that the new criteria are designed to be completely inclusive of those diagnosed using the current DSM-IV.  The research released by the American Psychiatric Association shows improved reliability and validity of diagnoses using the DSM-5 and strong inclusiveness of those already diagnosed using the DSM-IV.  I have seen the proposed diagnostic criterion and upon review I did not have any serious concerns with regard to how it will affect my ability to make diagnoses.

 

The bottom line is that for most parents, there will be no appreciable change other than how we refer to your child.  In anticipation of this change we have already been using the phrase Autism Spectrum Disorder or “on the spectrum” for quite some time now.  Diagnoses in the near term will still be made using the current DSM-IV, and thus, we will still be using the terms Autistic Disorder, Asperger’s Disorder, and PDD-NOS.   It is advisable for clinicians/diagnosticians to commence using both sets of terminology so as to minimize confusion in the future.  Sharing a document such as this one with the parents of the newly diagnosed is also advised.

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The Power of an Apology

15 November 2012

Saying “I’m sorry” can be very difficult for some of us.  We routinely make mistakes.  As coined by Alexander Pope: “To err is human; to forgive, divine.”  Within any interpersonal relationship there will be inadvertent missteps or even acts of anger that hurt those close to us.  Its not a matter of if, it’s a matter of when.  Forgiving is important, as Pope emphasizes: and it is also quite often a difficult thing to do.  But the act of apologizing, it seems to me, can be even harder.

 

But why?

 

Obviously it necessitates swallowing one’s pride and accepting responsibility for one’s misdeeds.  It also requires a departure from one’s unique view of the world and the adoption of another person’s perspective.  Swallowing one’s pride is hard enough and perspective taking stirs the feelings of guilt.  For these reasons alone, I believe that saying the two simple words “I’m sorry” is perhaps one of the bravest things a person can do.

 

There are other factors that contribute to the difficulty associated with an apology.   Some view it as a tacit acknowledgement of one’s weakness.  It does tend to elicit a personal feeling of vulnerability and perhaps pangs of subjugation, defeat, and loss of status.  It can entwine and envelope one in a aura of incompetence and humility.  No one likes such feelings: none of them elevate one’s sense of  well being.  The opposite is true: they instead elicit dysphoric feelings that essentially punish the inclination to apologize.   Thus, many avoid, ignore, or steep themselves in denial.  Pointing outward and blaming the other party for causing the problem strips one of responsibility and allows escape from the unpleasantness of having to apologize.  It is the easy way out, and ultimately it tends to bankrupt a relationship.

 

I really like how Stephen Covey, author of Seven Habits of Highly Effective People, conceptualizes relationships.  He analogizes relationships to a bank account.  When you treat another person with dignity and respect, you make deposits in their emotional bank account.  When you hurt someone, you essentially make a withdrawal.  By virtue of being in a sustained relationship, you will, over time, make a series of deposits and withdrawals.  When you hurt another person and then deny your responsibility for having done so, you compound the withdrawal.  And too many withdrawals can drain that person’s emotional bank account.  A drained account stirs contempt and lays the foundation for the end of that relationship.  A genuine apology is typically a deposit and it can go a long way toward bringing the account back into balance.  To be effective, it must be heartfelt, with an acknowledgment of the depth of harm done, and with full acceptance of responsibility.  The results should help heal wounds and it may even strengthen the relationship.  It is a gift, because it can make forgiveness easier for the injured party.  Denial, on the other hand, deepens the wound and widens the gap.

 

Saying “I’m sorry” is supposed to be difficult.  It is an act of contrition, whereby one bares the difficult weight of the misstep and takes responsibility for it.  This courageous endeavor is essential for sustaining a loving and caring relationship.  The world in general, and your relationships specifically, will be better if you endeavor to be brave enough to utter these simple words.  Doing the right thing is ultimately way more important than being right (Ludwig, 2010). To err is human; to apologize, heroic.

 

References:

 

Belkin, L., (2010). Why is it so Hard to Apologize Well? The New York Times

 

Lazare, A., (2004). Making Peace Through Apology.  GreaterGood.berkley.edu

 

Ludwig, R., (2009).  Why is it so Hard to Say “I’m Sorry?”  NBC NEWS.com

 

Mumford & Sons (2010). Little Lion Man

 

O Leary, T. (2007). 5 Steps to an Effective Apology.  Pick The Brain.com

 

 

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Sometimes the quietest moments are the most troubling.  Serenity seems to occasionally pave the way for a sequence of thoughts triggered by a song or a smell, or anything really, that ushers in a blast from the past.  A cavalcade of memories then flow forth both effortlessly and seamlessly.  And all of this occurs outside of conscious control.  For me, it often begins with a pleasant memory, but it can take a circuitous route, bringing me to memories that I would prefer remain inaccessible.  The ending point is usually a moment in time where I come face to face with a mistake I made – usually a long forgotten unintentional misstep that reveled a less sensitive or perceptive side of my persona.

 

Does this sound familiar?  I have long struggled to make sense of this sequence of thoughts.  It’s not as though these distant missteps weigh heavily in my conscious mind.  And most of the time they have no or very little current relevance.   Almost always the events involve a situation where I had no intention of being hurtful.  So why would my brain dredge up painful events and spoil a perfectly pleasant moment?   It makes little sense to me.

 

I have long felt like there is a dark and deeply self effacing entity lurking in the shadows of my mind just waiting for an opportunity to rain guilt on me.   Really, it does feel like there is something lurking inside my mind, stalking my thoughts, waiting for a memory that can be linked back to an event that will make me feel bad about myself.  Freud’s notion of the Super-ego seems particularly relevant, but there is no evidence of such embodied moralistic forces battling it out in the brain.  There are however, brain systems that interact in a way that are compellingly similar to Freud’s model with regard to active decision making.  But it is not clear to me how, or why, these systems would reach back in time to spoil a moment of serenity.

 

As I understand it, the brain is comprised of a complex combinatorial neuronal network that has evolved over millions of years.  With this being the case, there must be either some adaptive value to this capacity to stir up guilty feelings, or it may be a side effect of some other adaptive neurological system.   These hypotheses are made assuming that this propensity is neither pathological or unique to me.  Given the fact that these recall events do not adversely affect my life in any substantive way, beyond briefly bumming me out, and the likelihood that I am not alone in experiencing this – it must be adaptive at some level.

 

As it turns out there appears to be evidence for a relationship between dispositional empathy and one’s proneness to feelings of guilt.  In a study titled Empathy, Shame, Guilt, and Narratives of Interpersonal Conflicts: Guilt-Prone People Are Better at Perspective Taking by Karen P. Leith and Roy F. Baumeister they found that Guilt:

“… seems to be linked to the important cognitive components of empathy, particularly the ability to appreciate another person’s perspective (or at least to recognize that the other’s perspective differs from one’s own). Guilt-proneness is linked to both the ability and the willingness to consider the other’s perspective.”

 

So these feelings of remote guilt may indeed be adaptive in that they fuel my perspective taking capacity.  In other words, they compel me to be all the more careful and sensitive so as to facilitate better outcomes with regard to current social relationships (and thus avoid future negative recollections).  I am inherently driven to look at the other person’s perspective in most of my encounters with people. It seems that those situations that spring forth from the depths of my memory are those occasions when I did not effectively employ good perspective taking.

 

Empathy is widely accepted as being an adaptive skill and perhaps guilt proneness facilitates positive feedback thus driving one toward more effective empathy.  Or perhaps the guilty feelings drudged up are experiential outliers – the memories with stronger visceral tags – the ones that are more easily dragged to the forefront as my brain meanders down memory lane.   Leith and Baumeister’s research did not address the retrospective nature of experiences like mine; therefore, I continue to speculate.  But this link between empathy and guilt makes sense.  Or maybe this is a self-serving bias.

 
If you have a moment, please click on the link below to answer some questions that will give me some preliminary information on this empathy-guilt relationship. It’s only 5 questions – and really, it should only take a minute or so.
Click here to take survey

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We humans like to think of ourselves as strong and dominant forces.  Why shouldn’t we?  After all, we have conquered many of our natural foes and reign supreme as rational and commanding masters of our destiny.  That is what we like to think.  But this may be an illusion because as it turns out, we share our bodies with an unimaginably vast array of organisms that seem to play a substantial role in our well-being.

 

In and on your body, there are ten microorganisms for every single human cell.  They are invisible to the naked eye – microscopic actually.  For the most part they are bacteria, but also protozoans, viruses, and fungi.  This collection of organisms is referred to as the microbiome and it accounts for about three pounds of your total body weight: about the same weight as your brain.  In all, there are an estimated 100 trillion individuals thriving on your skin, in your mouth, in your gut, and in your respiratory system, among other places.  And it is estimated that there are one to two thousand different species making up this community.(2)

Image of Microscopic Bacteria

 

Since wide spread acceptance of the Germ Theory, in the late nineteenth century, we have considered bacteria as the enemy.  These organisms are germs after all, and germs make us sick.  This is accurate in many ways: acceptance and application of the germ theory vastly extended the human life expectancy (from 30 years in the Dark Ages to 60 years in the 1930s).   Other advances have since increased that expectancy to about 80 years.

 

But, as we are increasingly becoming aware, this microbiome plays a crucial role in our ability to live in the first place.  There are “good” and “bad” microbes.  But this dichotomy is not so black and white.  Some good microbes turn problematic only if they get in the wrong place (e.g., sepsis and peritonitis).  But what we must accept is that we would not survive without the good ones.  We are just beginning to learn of the extent to which they control our health and even our moods.

 

For example, some of our nutritive staples would be of very limited value if it wasn’t for Baceroides thetaiotaomicron.  This microbe in our stomach has the job of breaking down complex carbohydrates found in foods such as oranges, apples, potatoes, and wheat germ.  Without this microbe we simply do not have the capability to digest such carbohydrates.(1)  And this is just the tip of the proverbial iceberg.

 

The “beneficial” bacteria in our guts are clearly very important.  They compete with the harmful bacteria, they help us digest our food, and they help our bodies produce vitamins that we could not synthesize on our own.(3)  Surprisingly, these microbes may play a significant role in our mood.  A recent study looking at the bacteria lacto bacillus, fed to mice, resulted in a significant release of the neurotransmitter gaba which is known to have a calming affect.  When this relationship was tested in humans we discovered a relationship between such gut bacteria and calmness to a therapeutic level consistent with the efficacy of anti-anxiety pharmaceuticals.(2)  This alone is amazing.

 

But wait, there’s more.  Take for example Helicobacter pylori (H pylori) whose job seems to be regulating acid levels in the stomach.  It acts much like a thermostat by producing proteins that communicate with our cells signaling the need to tone down acid production.  Sometimes things go wrong and these proteins actually provoke gastric ulcers.  This discovery resulted in an all out war on H pylori through the use of antibiotics.   Two to three generations ago more than 80% of Americans hosted this bacteria.  Now, since the discovery of the connection with gastric ulcers, less than 6% of American school children test positive for it.(1)  This is a good thing! Right?

 

Perhaps not.  As we have recently come to discover, H pylori plays an important role in our experience of hunger.  Our stomach produces two hormones that regulate food intake.  Ghrelin (the hunger hormone), tells your brain that you need food.  Leptin, the second hormone, signals the fact that your stomach is full.  Ghrelin is ramped up when you have not eaten for a while.  Exercise also seems to boost Ghrelin levels.  Eating food diminishes Ghrelin levels.  Studies have shown that H pylori significantly regulates Ghrelin levels and that without it your Ghrelin levels may be unmediated thus leading to a greater appetite and excessive caloric intake.(1)  Sound like a familiar crisis?

 

The long and the short of this latter example is that we really do not understand the down stream consequences of our widespread use of antibiotics.  Obesity may be one of those consequences.  When we take antibiotics, they do not specifically target the bad bacteria, they affect the good bacteria as well.  Its not just medical antibiotics that cause problems – we have increasingly created a hygienic environment that is hostile to our microbiome.  We are increasingly isolating ourselves from exposure to good and bad bacteria, and some suggest that this is just making us sicker.  See the Hygiene Hypothesis.

 

We have co-evolved with our microbiome and as such have developed an “immune system that depends on the constant intervention of beneficial bacteria... [and] over the eons the immune system has evolved numerous checks and balances that generally prevent it from becoming either too aggressive (and attacking it’s own tissue) or too lax (and failing to recognize dangerous pathogens).”(1)   Bacteroides fragilis (B fragilis) for example has been found to have a profoundly important and positive impact on the immune system  by keeping it in balance through “boosting it’s anti-inflammatory arm.”  Auto immune diseases such as Chrones Disease, Type 1 Diabetes, and Multiple Sclerosis have increased recently by a factor of 7-8.  Concurrently we have changed our relationship with the microbiome.(1) This relationship is not definitively established but it clearly merits more research.

 

Gaining a better understanding of the microbiome is imperative, and is, I dare say, the future of medicine.  We humans are big and strong, but we can be taken down by single celled organisms. And if we are not careful stewards of our partners in life, these meek organisms may destroy us.  It is certain that they will live on well beyond our days.  Perhaps they shall reclaim the biotic world they created.

 

Author’s Note:  This article was written in part as a summary of  (1) Jennifer Ackerman’s article The Ultimate Social Network in Scientific American (June 2012).  Information was also drawn from (2) a Radio Lab podcast titled GUTS from April of 2012 and (3) a story on NPR by Allison Aubrey called Thriving Gut Bacteria Linked to Good Health in July of 2012.

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Citizens of the United States are endowed with certain unalienable rights: one of which is the right to pursue happiness.  Governments generally need to attend to the common level of happiness of its citizens in order to sustain power.  As evidenced by the Arab Spring, unhappy people have the capability to overthrow ineffectual governments.  As it turns out, the way politicians and economists presume to measure happiness is through a statistical measure called the Gross Domestic Product (GDP).  Let’s take a closer look at GDP and ponder the questions as to whether it is, in fact, an appropriate measure with regard to overall happiness.

 

Following World War II, a metric called the Gross National Product (GNP) was adopted as the key indicator of a nation’s economic growth.  Eventually GDP replaced GNP and it acquired broader meaning as a proxy of individual well-being (happiness).  But what does GDP really measure?  GDP as defined by InvestorWords.com is:

The total market value of all final goods and services produced in a country in a given year, equal to total consumer investment and government spending, plus the value of exports, minus the value of imports.

 

GDP is the measure we look at to determine whether our economy is growing, in recession, or in depression.  This makes sense.   But the deeper fundamental belief is that GDP equates to personal wealth, and that the more personal wealth individuals posses, the happier they will be.  Our economy grows when people have money and spend it.  The bottom line assumption here is that money buys happiness.

 

Since developed nations have strategically attended to this measure, GDP has skyrocketed.  Concurrently, there have been unequivocal rises in living standards and wealth.  The United States has done relatively well in this regard.   But you might be surprised to know that according to a CIA website, the US ranks 12th in the world on a measure of GDP per capita adjusted for purchasing power parity (PPP) behind countries like Qatar, Luxembourg, Norway, Singapore, Hong Kong, and Brunei.

 

In poor nations where GDP is very low, quality of life and subjective measures of happiness are indeed low.  As GDP increases, there is a correlated increase in both quality of life and happiness.  But that relationship holds up, only to a certain point, and then it falls apart.  For example, in developed Western Democracies such as the United States, UK, and Germany, since the 1970’s, GDP has grown, but on a variety of measures, the happiness of its citizens has stagnated or declined.  See the chart below from James Gustave Speth’s book The Bridge at the Edge of the World.

Average Income and Happiness in the USA

As it turns out, when a nation’s GDP rises above $10,000.00 per capita there is no relationship between GDP and happiness.  For a reference point, in the United States our GDP per capita rose above this $10k point in the 1960s and is currently around $50k per capita.  The reality is that despite a five-fold increase in personal wealth, people as a whole, are no more happy today than they were in the 1970s.  This suggests a fundamental flaw in the thinking of our policy makers.

 

I am not alone, nor am I first to point out the problem with assuming that GDP equates to citizen happiness.  James Gustave Speth, provides a ground shaking critique of our current political, economic, and environmental policies in his 2008 book The Bridge at the Edge of the World.  This GDP-Happiness issue is a prominent theme in his book and he explores what actually accounts for happiness.  What follows is a summary of Speth’s discussion of this topic.

 

Research suggests that there are a number of important factors associated with individual happiness.  What is interesting is that the major factors are relativistic, innately internal, as well as social and interpersonal.  Yes, below a certain point, when people are impoverished and struggling to survive, happiness is indeed tied to GDP.  But above that $10K GDP per capita line, these other human factors play a major role.

 

Let us start with perhaps the most powerful factor associated with happiness, our genes.  It is estimated that about one-half of the variability in happiness is accounted for by our genetic composition.  One’s happiness is much like one’s personality, to a large extent it is written in our DNA.  Some people are just congenitally happier than others.  Some are chronic malcontents no matter what the circumstances provide.  Such proclivities are difficult to over ride.  But the remaining 50% of variance in happiness does seem to be rooted in variables that we can influence.

 

One’s relative prosperity is a clear variable.  There is an inverse relationship between happiness and one’s neighbors’ wealth.  If you are relatively well-off compared to those around you, you are likely to experience more happiness.  If however, you are surrounded by people doing much better than you, you are likely to experience discontent.  It is more about relative position rather than absolute income.  And as everyone’s income rises, one’s relative position generally remains stable.  So more money does not necessarily equate to more happiness.

 

Yet another innately human factor that plays out in this happiness paradox is our incredible tendency to quickly habituate to our income and the associated material possessions that it affords.  We seem to have a happiness set point. There may be an initial bump in happiness associated with a raise, a bigger better car, or a new house; however,  we tend to return to that set point of happiness pretty quickly.  We habituate to the higher living standards and quickly take for granted what we have.  We then get a relative look at what’s bigger and better and begin longing for those things.  This is the hedonic treadmill.

 

Happiness is to a large extent associated with seven factors:

  1. Family relationships
  2. One’s relative financial situation
  3. The meaningfulness of one’s work
  4. Ties to one’s community and friends
  5. Health
  6. Personal freedom
  7. Personal values

 

Speth notes that “except for health and income, they are all concerned with the quality of our relationships.”  We clearly know that people need deeply connected and meaningful social relationships.  Yet we are living increasingly disconnected and transient lifestyles where we relentlessly pursue increasing affluence all the while putting distance between us and what we truly need to be happy.   We are on that hedonic treadmill convinced that happiness comes from material possessions, all the while neglecting the social bonds that truly fulfill us.

 

Obviously, GDP misses something with regard to happiness.  Speth quotes Psychologist David Meyers who wrote about this American Paradox.  At the beginning of the twenty-first century he observed that Americans found themselves:

“with big houses and broken homes, high incomes and low morale, secured rights and diminished civility.  We were excelling at making a living but too often failing at making a life.  We celebrated our prosperity but yearned for purpose.  We cherished our freedom but longed for connection.  In an age of plenty, we were feeling spiritual hunger.  These facts of life lead us to a startling conclusion: Our becoming better off materially has not made us better off psychologically.”

 

The reality is that there is a great deal of disillusionment in this country.  And we are falling behind in other areas of significant importance.  Our healthcare systems ranks 37th in the world with regard to life expectancy.  The efforts of our education system finds us loosing touch with the world’s top performers.  A 2010 US Department of Education report releasing the 2009 Program for International Student Assessment (PISA) scores indicated that 15-year-old students from the US scored in the average range in reading and science, but below average in math. Out of the 34 countries in the study, the US ranked 14th in reading, 17th in science and 25th in math.  The US students ranked far behind the highest scoring countries, including South Korea, Finland, Canada, and Singapore, Hong Kong and Shanghai each in China.  Secretary Duncan, at the time of the PISA announcement, said that:

“The hard truth is that other high-performing nations have passed us by during the last two decades…In a highly competitive knowledge economy, maintaining the educational status quo means America’s students are effectively losing ground.”

 

Although GDP is an important economic measure, many economists and some leaders suggest that we should assess well-being more precisely.  For example, alternatives include the Genuine Progress Index (GPI) that factors into the equation environmental and social costs associated with economic progress.  See the graph below for how we in the US have fared on GPI.

GDP and GPI Growth

This GPI data suggests that since the early seventies there has been a clear divergence between GDP and the well-being of the citizens of the United States.  This GPI line correlates strongly with the relative happiness line over the same time period.

 

Another effort made with regard to measuring the well-being of the citizens is the Index of Social Health put forward by Marc and Marque-Luisa Miringoff.  They combined 16 measures of social well-being (e.g., infant mortality, poverty, child abuse, high school graduation rates, teenage suicide, drug use, alcoholism, unemployment, average weekly wages, etc.) and found that between 1970 and 2005 there has also been a deteriorating social condition in the United States despite exponential growth in GDP.

 

The New Economics Foundation in Britain has developed the Happy Planet Index (HPI) that essentially measures how well a nation converts finite natural resources into the well-being of its people.  The longer and happier people live with sustainable practices the higher the HPI.  The United States scores near the bottom of this list.  At the top of the list in the Western Developed nations are countries like Malta, Austria, Switzerland, Italy, Iceland, and the Netherlands (due to long happy lives and lower environmental impact).  At the bottom across all nations are countries like the US, Qatar, UAE, Kuwait (each as a result of atrocious environmental impact) and Rwanda, Angola, Sudan and Niger (due to significantly shortened life spans).

 

Right now,” Speth notes, “the reigning policy orientation and mindset hold that the way to address social needs and achieve better, happier lives is to grow – to expand the economy.  Productivity, wages, profits, the stock market, employment, and consumption must all go up.  Growth is good.  So good that it is worth all the costs.  The Ruthless Economy [however] can undermine families, jobs, communities, the environment, a sense of place and continuity, even mental health, [but] in the end, it is said, we’ll somehow be better off.  And we measure growth by calculating GDP at the national level and sales and profits at the company level.  And we get what we measure.

 

All this taken together seems to suggest that we would be better off as a citizenry if we radically re-prioritized our economic, social, and environmental policies with increased focus on factors that more closely align with human well-being.   Yet, we continually forge ahead striving unquestionably for economic growth because we believe it will make us better off.  Closer scrutiny suggests that we should broaden our thinking in this regard.  If we were to focus our energies on GPI and/or HPI, like we have on GDP over the last 50 years, just imagine what we could accomplish.

 

References:

 

Central Intelligence Agency. The World Fact Book: GDP per capita adjusted for purchasing power parity (PPP).

 

Guild, G. (2011). We’re Number 37! USA! USA! USA!

 

Happy Planet Index. NEF

 

Johnson, J. (2010). International Education Rankings Suggest Reform Can Lift U.S. US Department of Education.

 

Speth, James Gustave.  (2008).  The Bridge at the Edge of the World. New Haven: Yale University Press.

 

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What drives you crazy about your partner? Dirty dishes left piled in the sink. Several days worth of laundry strewn about the bedroom. The toilet paper roll is never replenished. She talks too much – he doesn’t talk enough. He’s always late – she’s a compulsive neat freak. These are a few of the common complaints that spouses have about their loved ones. It is well known that close intimate relationships can be very tough to sustain over time. There is something about living with someone for a long period of time that turns idiosyncratic quirks into incendiary peeves. Why is this?

 

I’ve recently finished reading Annoying: The Science of What Bugs Us by Joe Palca and Flora Lichtman. This fascinating read dives into a topic that has escaped much direct scientific scrutiny. This fact is amazing because “although everyone can tell you what’s annoying, few, if any, can explain why” (Palca & Lichtman, 2011). One of the topics that these authors explore is this issue of the bothersome habits of intimate partners. It’s exceedingly common – if your partner drives you crazy – you are not alone.

 

What is very curious is that often the very things that attracted you to your partner, are the things that, in the end, foster contempt. Palca and Lichtman explore the concept of Fatal Attraction coined by sociologist Diane Felmlee of UC – Davis. Felmlee has explored this concept for years and she has seen this tendency in couples all over the world. In the first stage of love (Romantic Love), we are drawn in, in part, by the cute little things, the person’s novel traits, that trigger affection. But, over time, those initially positive attractors often have an annoying flip side.

 

Why does something that attracted you to your partner get flipped into a detractor? Felmlee believes that this disillusionment occurs due to Social Exchange Theory where “extreme traits have [their] rewards, but they also have costs associated with them, especially when you are in a relationship.”

  • If you were drawn to partner because he was nice and agreeable, he may later be seen as passive and prone to letting people walk all over him.
  • If you were attracted to your partner because of her assertiveness, confidence, and self-directed demeanor, you may later find her to be stubborn and unreasonable.
  • If you were swooned by his strong work ethic and motivation to be successful, you may later be disappointed because you now have an inattentive, inaccessible, workaholic.
  • Someone who is a romantic, attentive, and caring suitor may later be viewed as a needy and clingy partner.
  • The passionate may become the dramatic or explosive hot-head.
  • The calm, cool, and collected becomes the aloof stoic.
  • The laid back guy becomes the lazy slob.
  • The exciting risk taker becomes the irresponsible adrenaline junkie.
  • The gregarious life of the party becomes the clown who takes nothing seriously.

 

And so it goes. Repetition seems to be a crucial contributor notes Elaine Hatfield, a psychologist from the University of Hawaii. “The same thing keeps happening over and over again in a marriage” she notes. Michael Cunningham, a psychologist from the University of Louisville has come to refer to these annoying attributes as Social Allergens. The analogy with an allergen is played out in the dose effect. He notes that “small things don’t elicit much of a reaction at first” but that with repeated exposure over time, they “can lead to emotional explosions.” Palca and Lichtman note that:

People frequently describe their partners as both “the love of my life” and “one of the most annoying people I know.”

 

Elaine Hatfield also believes that these social allergens get amplified when there is an imbalance in equity within a relationship. Equity Theory, she notes, suggests that when there is an imbalance of power, commitment, or contribution in a relationship, these quirks take on a disproportionate amount of negative value. However, if there is balance in the relationship (equity), the annoyance value of a partner’s quirks is more easily tolerated. So, if your partner is a good contributor and there is a balance of power, you are less likely to be annoyed. If, on the other hand, your needs are left unmet, or you do the lion’s share of the work around the house, or you feel unappreciated or diminished by your spouse, there is likely to be more annoyance associated with his or her quirks.

 

It is also important to note that the nature of a relationship changes over time. During the initial passionate Romantic Love stage, the couple tends to be on their best behavior. Once commitment and comfort are attained, one’s truer attributes tend to come to the surface. There tends to be less effort to conceal one’s quirks and thus increased occurrences of these social allergens.

 

Over time, increased and accelerated exposure take their toll and if there are equity issues, it’s a recipe for disaster. So, what is one to do?

 

The first step is to think about the issues that get to you with regard to how the value of those attributes may have a positive side. We all have our strengths and our quirks – yes, you too have your annoying tendencies! Michael Cunningham suggests that you should try to be accepting of your partners quirks. These behaviors are a part of who the person is. He notes that “You’ve got to take this if you want all of the other good things.

 

Own your feelings and explore them at a deeper level, particularly with regard to the equity issues in your relationship. Arthur Aaron, a psychology professor at the State University of New York at Stony Brook urges couples to nurture their relationship. “Celebrate when something good happens to your partner” he notes. Attend to and accentuate the positive. He also suggests engaging in novel, challenging and exciting activities fairly often. “Anything you can do that will make your relationship better will tend to make your partner less annoying.” My suggestion is to think of a relationship as a garden that needs attention, maintenance, and nurturance. It’s impossible to rid the garden of all its weeds and pests. But the more attention and nurturance you provide, the more it will flourish. As Stephen Covey is fond of saying: “Love is a verb. Love the feeling is the fruit of love the verb.” So do loving things.

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 | Posted by | Categories: Psychology | Tagged: , |

The more I learn about the workings of the human brain – the more I am stirred by feelings that Freud may have been right.  Although his theories have long since been discredited, he characterized the brain as a battle ground where three forces jockeyed  for control over your decision making.  There was the Id whose hedonistic impulse drove us toward self pleasuring.  And then there was the conscientious Superego whose role was to compel us to make moral decisions.  Finally, he believed there was the Ego whose job was to mediate between the drives of Id and Superego so as to facilitate adaptive navigation of the real world.

Sigmund Freud

 

Freud’s theories have always been compelling because they feel right.  I often feel as if there is a tug of war going on inside my head.  The struggles occur in the form of decisions to be made – whether its about ordering french fries or a salad, fish or steak, having a cookie or an apple, exercising or relaxing, jumping over that crevasse or avoiding it, buying a new coat or saving the money.  These battles are seemingly between good choices and bad ones.  But, where you place the good and the bad is highly contingent on one’s priorities in the moment.  The fries, steak, cookie, relaxing and that new coat all seem like good ideas in the moment – they’d bring me pleasure.  On the other hand, there are the downstream consequences of unnecessary calories from fat and sugar or squandered resources.  It’s a classic Id versus Superego battle.

 

But of course there are no entities in the human brain whose express duties are defined as Freud characterized them.

 

Or are there?

 

Well actually, there are brain regions that do wage contentious battles for control over your behaviors.  Across time, different modules assert greater amounts of control than others, and thus, the choices we make, do likewise vary in terms of quality.  As a result of advances in technology and understanding, we are becoming increasingly aware of the key factors associated with this variation.

Nucleus-Accumbens (NAcc) highlighted in red

 

One of the centers that play out in our multi-component brain is the dopamine reward pathway. Dopamine is a neurotransmitter that serves a number of important functions in the brain. One of its most significant roles plays out as a result of activation of the Nucleus Accumbens (NAcc). When the NAcc is activated it floods the brain with dopamine and we experience pleasure. Desire for an item activates the NAcc. Being in the presence of the desired item activates it further. The greater the arousal of the NAcc the more pleasure we experience. It is your NAcc that is responsible for the happiness you feel when you both anticipate and eat those fries or that steak or buy that new coat.  It is also responsible for that rush you feel when your team wins the big game (Lehrer, 2009).

Insula highlighted in teal

 

Then there is the Insula – a brain region that produces, among other sensations, unpleasantness. This center “lights up” in brain scans when people feel pain, anticipate pain, empathize with others, see disgust on someone’s face, are shunned in a social settings, or decide not to buy an item. In many cases we avoid exciting the Insula as it is the system that produces the unpleasantness of caffeine or nicotine withdrawal and the negative feelings associated with spending money (Blakslee, 2007; Lehrer, 2009).  When you are jonesing for that coffee or nicotine fix, it is your Insula that is making you feel badly – necessarily compelling you to feed the habit.  And when you satisfy the craving it is your NAcc that gives you that Ahhhhh!that sense of well being.

 

Perhaps the NAcc is Freud’s Id and the Insula Freud’s Superego?  It is actually much more complicated than this, but the overlap is interesting.

 

In an article I posted last month I wrote about the concept of an Alief.  An Alief is a primal and largely irrational fear (emotion) that arises from the deep unconscious recesses of your brain and plays a significant role in guiding some of the decisions you make.  At a very basic level, we know of two major driving forces that guide our decisions.  Broadly, the two forces are reason and emotion.  So how does this work? How do we process and deal with such diverse forces?

Orbitofrontal-Cortex (OFC) highlighted in pink

 

Neuroscientists now know that the OrbitoFrontal Cortex (OFC) is the brain center that integrates a multitude of information from various brain regions along with visceral emotions in an attempt to facilitate adaptive decision making.  Current neuroimaging evidence suggests that the OFC is involved in monitoring, learning, as well as the memorization of the potency of both reinforcers and punishers.  It analyzes the available options, and communicates its decisions by creating emotions that are supposed to help you make decisions.  Next time you are faced with a difficult decision, and you experience an associated emotion – this is the result of your OFC’s attempt to tell you what to do.  Such feelings actually guide most of our decisions without us even knowing that it is happening.

 

The OFC operates outside your awareness: opaquely communicating with your rational decision making center using the language of feelings.   Our rational center, the Prefrontal Cortex, the more apt Freudian Ego analogy, is not as predominant as he suggested.  In fact, it is limited in capacity – both easily fatigued and overly taxed.  See my post on Willpower for a deeper discussion of this issue.

 

So, as crazed as we view Freud’s notions today, there were some aspects of his explanation of human behavior that were rooted in actual brain systems.  As I previously noted, these systems are much more complicated than I have described above, but in essence, there are battles waged in your head between forces that manipulate you and your choices through the use of chemical neurotransmitters.  A portion of these battles occur outside your awareness, but it is the influence of the emotions that stem from these unconscious battles that ultimately make you feel as though there is a Devil (Id) on one shoulder and an angel (Superego) on the other as your Prefrontal Cortex (Ego) struggles to make the best possible decision.

 

By understanding these systems you may become empowered to make better decisions, avoid bad choices, and ultimately take more personal responsibility for the process.  It’s not the Devil that made you do it, and it’s not poor Ego Strength – necessitating years of psychotherapy.  It is the influence of deeply stirred emotions and manipulation occurring inside of you and perhaps some over dependence on a vulnerable and easily over burdened Prefrontal Cortex that leads you down that gluttonous path.

 

References

 

Blakeslee, Sandra. 2007. Small Part of the Brain, and Its Profound Effects. New York Times.

 

Gladwell, M. 2005.  Blink: The Power of Thinking Without Thinking. Little, Brown and Company: New York.

 

Guild, G. 2010. Retail Mind Manipulation.  How Do You Think?

 

Guild, G. 2010. What Plato, Descartes, and Kant Got Wrong: Reason Does Not Rule.  How Do You Think?

 

Guild, G. 2010. Willpower: What is it really? How Do You Think?

 

Guild, G. 2011. Irrational Fear: It’s Just an Alief. How Do You Think?

 

Lehrer, J. 2009. How We Decide. Houghton Mifflin Harcourt: New York.

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Often things are not as they first appear. This was point of the hit Broadway play Wicked.  My wife, Kimberly, and I, went to see this show in New York City and we walked away very satisfied and at the same time, moved by this not so subtle message.

 

The show was based on the popular children’s story The Wizard of Oz. It was a prequel and a postquel of sorts, that told a story with very different implications than those popularized in the 1939 movie version. It portrayed the Wicked Witch (whose name in Wicked was Elphaba) as a wise and caring person both gifted with magical powers and cursed with a different skin color.  She also was imbued with a powerful sense of right and wrong. Elphaba struggled with life in part due her father’s rejection but also as a result of sweeping societal prejudice that valued an increasingly narrow subset of the preferred “people” of Oz.

Once she was sent off to University (primarily to care for her physically disabled sister), Elphaba showed great potential as a sorcerer.  However, she was outside the norm.  She just did not fit in – she was smart, her skin was green (as a result of her mother’s consumption of an illicit drug when she was conceived), and she questioned the morays of the day.  Essentially, because she was different, she was bullied.  She also threatened those in power because of her assertions for justice.

 

The twists and turns of Elphaba’s University experience both alienated her further and highlighted rampant and unappreciated societal injustices. Ultimately, due to these sweeping and strengthening ideological changes, as well as Elphaba’s own deeds (as righteous as they were), she was labeled the equivalent of a terrorist.  Concurrently, a closer look at the Wizard revealed his sheepish compliance with the up swell of prejudicial ideology.  It became apparent that not only was the Wizard of Oz merely a man behind the curtain pulling the strings of the idyllic Wizard, but that he was more of a naive puppet himself, both riding the tide of ideology and sustained by those with true power.

 

There is much more to Wicked that tells the back story of the characters and situations in the Wizard of Oz.  It was a clever story, entertaining in it’s own right, but much more than just a story.  It clearly serves as a social commentary about the ideological tendencies and injustices of our unique economic and social policies.

 

If one looks past the white washed American History spoon fed school children throughout our land, one will discover unpleasant, if not deeply troubling realities carried out by our government and corporations in the name “freedom.”  All you have to do is look at the facts underneath the story and you may be shocked by what we have done in foreign lands. Our popular media outlets, owned by corporate interests, also white wash these events.  It is indeed alarming to learn what the rest of the world knows of our endeavors in places like Iran, Indonesia, Saudi Arabia, Ecuador, Panama, Chile, Argentina, and Columbia.   Most Americans know nothing of it.

 

Democrats as well as Republicans have been active players in these atrocities.  Its about globalization, free trade, and unabated profit seeking.  It’s about the Corporatocracy that we embrace without question.  I’m not suggesting a conspiracy – it’s rather a consequence of a way of thinking and our ravenous consumption.  It takes courage and substantial effort to suspend one’s nationalistic tendencies and the presumptuous notions of American Exceptionalism.  I dare you to take a closer look (here, or here, or read this and perhaps this).  You won’t like it – really it is Wicked!

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 | Posted by | Categories: Politics | Tagged: , , |

I have always said that there is a fine line between intelligence and fear.  Some fear is adaptive and entirely reasonable: particularly when the catalyst truly involves danger. There are some anxieties however, that take hold and profoundly affect behavior in unreasonable ways.

 

One personal example comes to mind to illustrate this. Last winter I was backpacking on a trail that traversed some rock city formations with deep, but relatively narrow, crevasses. Many of the cracks were unintimidating and easily traversed. There was one however, that stopped me in my tracks. The gap was 36-40 inches across a sheer 25 foot drop. Under more typical circumstances, this gap would have not phased me. Yet, in this situation, I was completely frozen.

Rock City Crevasse

To be clear there was some risk associated with this crossing. But, in my mind, the risk took on unreasonable proportions.

 

Frankly, I was both embarrassed and befuddled by this situation. Were it a stream of equal width, I would have easily hopped over it.

 

I stood there at battle with myself for what seemed like an eternity. In reality, it was probably only a minute or two.  My body was hostage to a cognitive tug-of-war between my rational brain urging me to leap. “Come-on” I uttered to myself “It’s only three feet across!” “You can do this!”

 

Another force in my brain countered with incapacitating doubt.  Kevin, my backpacking companion, patiently waited on the other side of the crevasse after easily leaping across. I saw him do it with no difficulty.  I had clear evidence that the crossing was easily within my capabilities; but, the cost of a slip and a fall, far overshadowed my confidence. The frustration I felt over this coup of sorts, was immense. Finally, I was able to muster up enough confidence to take the leap. It was, in fact, quite easy.  We hiked on and no further mention of this humbling pause was made.

 

Many fears are like this. Whether it is a fear of mice, or bees, spiders, or snakes. These stimuli impose, in most circumstances, no grave threat, but the flight response they trigger in the phobic is immense. Even when a person knows that there is no reason for fear, it persists.

 

This response is akin to the reluctance that most people have about eating chocolate fudge in the shape of dog feces, or eating soup from a clean unused bedpan, or drinking juice from a glass in which a sterile cockroach has been dipped. Psychologist Paul Rozin, in his famous studies on disgust, discovered that when presented with these circumstances, most people choose not to eat the fudge or the soup, or drink from the glass – even knowing there is no real danger in doing so.  It is the irrational essence of contagion that drives these inhibitions.

 

These situations are all very different than rock climbing without ropes, where there is clear and present danger. When we are compelled to flee a truly benign stimulus, we are likely driven by an internal cognitive force that screams “RISK!” even when there is no true danger.  Intriguing isn’t it, that this innate force is so powerful that even our capacity to use reason and evidence pales in comparison.

 

Philosopher Tamar Gendler has coined the word “alief” to describe this cognitive phenomenon.  She fashioned the word around the word “belief,” which is a conscious manifestation of how we suppose things to be.  An alief is a deep and powerful feeling of sorts that can and does play an important role in decision-making, but it is not based in reason or evidence.  Beliefs can be more susceptible to such rational forces.  But aliefs defy reason and exert powerful influence despite one’s attempts to rationally dispel them.  This voice is intuitive and its origins are outside your awareness.  They typically appear in an attempt to facilitate self-preservation.

 

You may believe that the feces shaped fudge is “JUST FUDGE!” but it is your alief that the fudge is excrement (as a result of it’s characteristic size, shape, and color) that makes it very hard to eat.  I believed that hopping over the crevasse was easily within my capabilities, but it was my “alief” that – leaping over the gap is DANGEROUS – that kept me frozen in my tracks.

 

You see, you can simultaneously hold opposing beliefs and aliefs and it was, in fact, these opposing forces that waged war as I stood at the edge of the precipice.  You might believe that a bee is generally harmless and unlikely to sting you unless you threaten it.  But, it is your alief, that the bee will sting and hurt you that triggers the autonomic arousal that compels you to flee.  It is this deeply primal alief that often wins, no matter how rational you attempt to be.

 

In my situation, my belief in my leaping ability ultimately prevailed.  Perhaps this was due to my machismo or humiliation, but ultimately I fought down and defeated the alief.  It was a hard fought battle that left me feeling like a chicken despite my “victory.”

 

In retrospect, getting an understanding of this internal process has helped me come to grips with my hesitation.  And as such, I stand in awe of the internal brain systems that play out in such circumstances.

 

Perhaps in the future, when in a similar situation, I will be better prepared to deal with self doubt as it springs forth from my lizard brain so that I will more effectively cope with it before it builds incapacitating momentum.  After all – it’s just an alief!

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The year 2011 proved to be a challenging year.  A number of serious health issues in close family members took center stage.  The frequency of my posts declined in part due to these important distractions but other factors also played a major role.  Although I published fewer articles, the number of visits to my blog increased substantially.

 

Over the course of the year, I had 18,305 hits at my website by 15,167 unique visitors, accounting for over 25,000 page views.  I had visitors from every state in the Union and visits from people from 140 nations around the world.  Visitors from the United States accounted for the vast majority of those hits, but the UK, Canada, and Australia also brought in a large contingent of visitors.

 

One article in particular far outpaced all other posts.  My post on Brain Waves and Other Brain Measures accounted for as many visits as the next three most popular posts combined.  Of my posts published in 2011, only four made it to this year’s top ten list.  The other six were published in 2010.  Of those six from 2010, four were also on the top ten list last year.

 

Great interest persisted in my post entitled Nonmoral Nature: It is what it is.  This review of Stephen Jay Gould’s most famous article sustained a number two ranking for a second straight year.  I had also reviewed in 2010 a very popular New York Time’s article by Steven Pinker entitled The Moral Instinct.  This article moved up a notch this year, ultimately ranking number three.  My critical article on the Implicit Associations Test ranked number four this year, versus a number six ranking last year.  And my Hedgehog versus the Fox mindset piece ranked number ten this year, compared to a number seven ranking last year.

 

So here is the Top Ten list for 2011.

  1. Brainwaves and Other Brain Measures (2011)
  2. Non Moral Nature: It is what it is (2010)
  3. Moral Instinct  (2010)
  4. IAT: Questions of Reliability and Validity  (2010)
  5. Where Does Prejudice Come From?  (2011)
  6. Cognitive Conservatism, Moral Relativism, Bias, and Human Flourishing  (2011)
  7. What Plato, Descartes, and Kant Got Wrong: Reason Does Not Rule.  (2010)
  8. Intuitive Thought  (2010)
  9. Effects of Low SES on Brain Development  (2011)
  10. Are you a Hedgehog or a Fox?  (2010)

It’s interesting to me that this list includes the very foundational issues that have driven me in my quest.  And each was posted with great personal satisfaction.   This encompassing cross section of my work is, in fact, a good starting point for those who are new to my blog.  There are several popular 2011 posts that ranked outside the top ten but ranked highly relative to other posts published in 2011.  These other posts include:

One article I published late in 2011 has attracted significant attention.   I believe that it is perhaps one of the most important posts I’ve written.  As I was writing this retrospective, Conspicuous Consumption and the Peacock’s Tail was far outpacing all other posts.

 

The most emotional and personally relevant articles pertained to significant problems in healthcare in the United States and my wife’s battle with breast cancer.  These articles include: (a) What not to say to someone with cancer: And what helps; (b) Up and Ever Onward: My Wife’s Battle With Cancer; (c) Cancer, Aging, & Healthcare: America, We Have a Problem; (d) We’re Number 37! USA USA USA!; and (e) Tears of Strength in Cancer’s Wake.  The latter pertains to perhaps the proudest parental moment of my life.

 

Another very important issue that I wrote a fair amount about includes the pernicious affect of poverty on child development.  Clicking here takes you to a page that lists all of the articles on this topic.  Knowing the information in this series should motivate us, as a society, to truly evaluate our current political and economic policies.

 

One of my favorite articles tackled my long standing curiosity about the geology of the place I live.  The article itself did not get a lot of attention, but I sure loved writing it.

 

This two-year journey, thus far has resulted in perhaps unparalleled personal and intellectual growth.  It has changed the way I look at life, the world around me, and my fellow human beings.   It is my sincerest hope that those who have seen fit to read some of my material have experienced shifts of perception or at least a modicum of enlightenment.

 

The bottom line:

 

The human brain, no matter how remarkable, is flawed in two fundamental ways.  First, the proclivities toward patternicity (pareidolia), hyperactive agency detection, and superstition, although once adaptive mechanisms, now lead to many errors of thought.  Since the age of enlightenment, when human kind developed the scientific method, we have exponentially expanded our knowledge base regarding the workings of the world and the universe.  These leaps of knowledge have rendered those error prone proclivities unessential for survival.  Regardless, they have remained a dominant cognitive force.  Although our intuition and rapid cognitions have sustained us, and in some ways still do, the subsequent everyday illusions impede us in important ways.

 

Secondly, we are prone to a multitude of cognitive biases that diminish and narrow our capacity to truly understand the world. Time after time I have written of the dangers of ideology with regard to its capacity to blindfold its disciples.  Often those blindfolds are absolutely essential to sustain the ideology.  And this is dangerous when truths and facts are denied or innocents are subjugated or brutalized.  As I discussed in Spinoza’s Conjecture:

“We all look at the world through our personal lenses of experience.  Our experiences shape our understanding of the world, and ultimately our understanding of [it], then filters what we take in.  The end result is that we may reject or ignore new and important information simply because it does not conform to our previously held beliefs.

Because of these innate tendencies, we must make additional effort in order to discover the truth.

 

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