The Academic Life of Eliyahu N Kassorla

Fall 2012 Grades

2012-12-21T06:18:00.003-05:00

Diazepam: A Literature Review of the Primitive Benzodiazepine

2012-12-16T00:59:00.000-05:00

The assignment: research a drug and describe the history, chemistry, indications, treatment effects, side effects. An emphasis on comparing the drug to other indicated drugs was also assigned.

Eliyahu N. Kassorla

Organic Chemistry I – Laboratory

Dr. Kuga

Diazepam: A Literature Review of the Primitive Benzodiazepine

Introduction

Diazepam is a benzodiazepine, a class of drugs that has anxiolytic, sedative, antispasmodic, and anticonvulsant properties. Benzodiazepines superseded the class of drugs called the barbiturates, as well as the carbamates, since their safety is greater and therapeutic range is wider. While there are side effects to the benzodiazepines, the risks are often weighed against their clinical efficacy in treatment and management of indicated disorders.

History and Discovery of Diazepam

The benzodiazepine era began in a laboratory at Hoffman-LaRoche in Nutley, NJ (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 555). The compound was first synthesized by a researcher named Leo Sternbach, who had a research affinity for tricyclic compounds, including the heptoxdiazines her worked on as a postdoctoral student (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 555). A new antipsychotic agent had recently become commercialized, chlorpromazine, which also had a tricyclic structure, led Sternbach to experiment on the effects of his old compounds with lateral side chains attached (p. 555). His development efforts led to the use of 4,5-benzo(hepto 1,2,6-oxdiazine) as an investigational compound (p. 555). The compound was screened, but showed no clinical effect (The discovery of chlordiazepoxide and the clinical intoduction of benzodiazepines: Half a century of anxiolytic drugs, p. 556). After further investigation, it was discovered that a different chemical compound had been made, without the pharmacological properties desired; Sternbach synthesized new analogs which it was though showed no biological activity (p. 556). After a year and a half’s effort, two final compounds remained to be assayed, which were intended to be thrown away; however, a colleague drew his attention to a “crystalized base and its hydrochloride”, of which the “water-soluble salt” submitted for assay (p. 556). The new compounds had properties that were “superior to meprobamate [a centrally acting muscle relaxant] in many trials in terms of anxiolytic effect and as a central muscle relaxant, and also had some sedative properties similar to chlorpromazine, and lacked any significant adverse effects (p. 556). As it turns out, Sternbach “had used methylamine, a primary amine, by mistake, meaning that the reaction had taken a different form (transposition reaction with ring enlargement from the one observed after using secondary amines” (p. 556).

The compound produced, however, was not diazepam. Sternbach produced methaminodiazepoxide, renamed to chlordiazepoxide, and marketed as Librium (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 556.), (Sample, 2005). Librium is a larger and more complex molecule than diazepam, and studies by Sternbach and others at LaRoche found that simpler molecules had better bioactivity (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 557). Simplifying the molecule to the fewest lateral chains yielded diazepam, marketed as Valium (p. 557).

Structure of Diazepam

Diazepam is classified as a heterocyclic compound with two rings, the benzodiazepine and a benzene ring. The IUPAC name is 7-chloro-1-methyl-5-phenyl-3H-1,4-benzodiazepin-2-one (Diazepam, PubChem, 2005). A benzodiazepine ring is a ring structure in which a benzene ring is fused with a diazepine ring, which is structurally similar to benzene, but has a nitrogen substituted for 1,4 on the diazepine ring, known as a 1,4-benzodiazipine (Sankar, 2012, p. 231). A 1,5-benzodiazipine exists, but so far, only one compound shows similar effects, clobazam (Sankar, 2012, p. 231). Diazepam has an oxygen double bonded to 3 of the diazepine ring at the R2 position, and chlorine at the R2’ position along the benzene-side of the benzodiazepine-ring at 7 (Diazepam, PubChem, 2005). Because diazepam is the most basic of the benzodiazepine class of drugs, its structure is prototypical of all classical and pharmacologically useful benzodiazepines, only differing in side-chains at the R1, R2, and R2’ position. It is the 1,4-diazepine ring, along with the small size of the diazepam molecule, which allows diazepam to cross the blood brain barrier.

Metabolism of Diazepam

After oral administration, greater than 90% is bioavailable, and blood plasma directly correlates with brain and cerebrospinal fluid concentrations (Diazepam, PubChem, 2005). Diazepam is metabolized into its main active metabolite desmethyldiazepam by N-demethylation, as well as temazepam and oxazepam by hydroxylation (Valium (diazepam) tablet: [Roche Products Inc]), (Diazepam, PubChem). Diazepam’s active metabolites contributes to effect persistence for seven days, which is clinically desirable and classifies diazepam as a long-acting benzodiazepine (Sankar, 2012, p. 232). The metabolic pathway that metabolizes diazepam is the cytochrome P450 family subunits 3A4 and 2C19 in order to reach desmethyldiazepam, which is again metabolized by 3A4 into temazepam; both are metabolized again to reach oxazepam (Valium (diazepam) tablet: [Roche Products Inc]), (Smith-Kielland, Skuterud, Olsen, & Morland, 2001, p. 237). It can take 48 hours for first pass metabolism to demethylate diazepam to desmethyldiazepam, and 100 hours to metabolize desmethyldiazepam into temazepam and oxazepam through second pass metabolism (Valium (diazepam) tablet: [Roche Products Inc], 2010). Diazepam and its metabolites are excreted through urine (Valium (diazepam) tablet: [Roche Products Inc]). Interactions with 34A inhibitors, such as fungicidals; bergamotten; and some antidepressants, will decrease metabolism rate; those with hepatic insufficiency will also experience a decreased metabolism and a longer effect (Valium (diazepam) tablet: [Roche Products Inc]).

In an investigation into metabolism between non-users and chronic users of diazepam, it was found that diazepam users more quickly and easily metabolize diazepam (Smith-Kielland, Skuterud, Olsen, & Morland, 2001, p. 245). However, drug-users has longer detection times, meaning that diazepam use was still detectable for a longer time than drug users (p. 245). Non-drug users had a much shorter detection period of detection, though a slower conversion rate of diazepam into metabolites (pp. 243-244).

Comparison with Other Medications

The introduction of benzodiazepines co-occurred with a revolution in the field of psychology. The field of psychology had largely divided psychiatric disorders into “neuroses” and “psychoses” (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 554). Anxiety and insomnia were considered “neuroses” (p. 554). Treatment was limited to alcohol, toxic bromides, opiates, and barbiturates (p. 554). The introduction of psychopharmaceuticals that were able to treat these disorders caused a shift in psychological thinking, enabling psychologists to view psychiatric disorders as organic brain disorders (p. 554).

Barbiturates

Before benzodiazepines came into widespread use, barbiturates were the drugs of choice for treatment of anxiety, insomnia, and other assorted “neuroses” (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 555). However, they had very narrow therapeutic ranges, above which could easily overdose. (p. 554). The main barbiturates prescribed were phenobarbital and secobarbital. Other barbiturates were in use, but these represent the two extremes – the least lipid soluble (phenobarbital) to the most lipid soluble (secobarbital) (Secobarbital, PubChem, 2005).

Barbiturates are weak acids, and like benzodiazepines, the barbiturates are also heterocyclic compounds, being a diazine pyrimidone rather than a diazepine, with nitrogens affixex at 2,4, and oxygens double bonded at 1,3,5 (Secobarbital, PubChem). Barbiturates are also small molecules, allowing them to easily cross the blood brain barrier (Secobarbital, PubChem). Barbiturates also activate NMDA receptors, adding to sedative effects, and increasing toxic and deadly overdose symptoms (Argyropoulos & Nutt, 1999, p. S410)

Carbamate

The carbamate series of medicines are best exemplified by the drug meprobamate, the prototypical exemplar of this drug class. Unlike barbiturates and benzodiazepines, meprobamate is a linear organic compound (Meprobamate: Compound Summary - CID 4064, 2005). Meprobamate has is bounded by amine groups on each end of the linear chain; it is the amine group which exhibit the biological activity (Meprobamate: Compound Summary - CID 4064, 2005). Like barbiturates, meprobamate is toxic in overdose, however it is less toxic than barbiturates (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 555). Meprobamate is a strong allosteric agonist of GABA-A, and overdose can mimic brain death and coma (Meprobamate: Compound Summary - CID 4064, 2005).

Mechanism of Action of Diazepam

Benzodiazepines, carbamates, and barbiturates all act on the neurotransmitter GABA, binding to a site near the GABA_A receptor subtype (Campo-Soria, Chang, & Weiss, 2006, p. 984). The binding site, termed the Diazepam Binding Site (DZP) is distinct from the GABA binding site; rather, benzodiazepines alter the receptor function, essentially amplifying the inhibitory signal that GABA produces (Campo-Soria, Chang, & Weiss, 2006, pp. 984-985). By activating the GABA_A receptor, the chloride ion channel of the neuron opens, making the neuron more negative (Sankar, 2012, p. 234). The more negative the electrical gradient, the harder it is for the neuron to depolarize, making neural activation less likely (Sankar, 2012, p. 234).

Classical benzodiazepines are considered full agonists of the GABA_A receptor, in that they bind strongly to the many GABA_A receptor subtypes (Sankar, 2012, p. 239). The primary active GABA_Areceptor subtypes include GABA_A_α1,GABA_A_α2, GABA_A_β2, andGABA_A_γ3,and the most common receptor configuration is GABA-A_α1β2γ3 (p. 239). The GABA_A_α1 receptor subtype is responsible for sedation and retrograde amnesia from diazepam, GABA_A_α2 is responsible for the anxiolytic effects of diazepam, while the GABA_A_α3 receptor subtype is responsible for the anxiolytic effects of diazepam. Anticonvulsant effects are mediated by α1, α2, and α3 receptor subtypes (p. 242). The receptor subtypes are expressed in combinations of five types of any of the sixteen subunits on the synaptic receptor surface, allowing many combinations to be expressed, with two copies of the same α subtype, two copies of the same type of β subtype, and a single γ receptor subtype (p. 230). When a benzodiazepine binds to the subtype for which it is active, the physiological effects are expressed, such as the anxiolytic effects expressed when the α₁ subunit is bound to (p. 240).

When two GABA molecule bind to the GABA binding site, a “structural pertubation” is imparted that “is transferred to the other subunits [of GABA_A] or subunit interfaces” (Campo-Soria, Chang, & Weiss, 2006, p. 989). This binding keeps the chloride channel open, amplifying the effect of GABA. It is this reduction in neural activation that is responsible for the benzodiazepine’s ability to prevent anxiety, by reducing activation in the brain regions responsible for anxiety and fear, and seizures, by reducing the ability of the whole brain from cortical spreading activation. Benzodiazepines cannot directly open the chloride channel, which, unlike the barbiturates and carbamates, allows effects to be reversed (Argyropoulos & Nutt, 1999, p. S410).

Desired Treatment Effects

The desired treatment effects of diazepam are a reduction of anxiety, a release of muscle tension and release of a muscle spasm, which tends to occur between one and one half hour after oral administration (Diazepam, PubChem, 2005). A study in rats and rabbits have indicated that the intranasal route of administration allows diazepam to enter the brain across the blood-brain barrier through the olfactory pathway, with effects occurring ten minutes after administration; intravenous administration showed effects after only five minutes (Kaur & Kwonho, 2008, pp. 27,31-32). The onset of treatment effects were measured by analyzing saccade and eye movement measurements (Kaur & Kwonho, 2008, p. 32).

Diazepam also acts as an antiepileptic, however, newer drugs specific to seizures are preferable because of side effects, discussed below. Further, tolerance to the effects of benzodiazepines, and “breakthrough seizures can occur after weeks or months” after beginning therapy (Argyropoulos & Nutt, 1999, p. S409).

Tolerance to the treatment benzodiazepines can occur because of neural changes that adapt to the presence of the drug, causing neural compensation and gradual loss of efficacy. Tolerance to the effect of sedation develops more rapidly than diazepam’s anxiolytic and anticonvulsant effects (Lister, 1985, p. 91). Chronic administration followed by cessation leads to withdrawal symptoms if diazepam is not tapered or reduced properly. Withdrawal from benzodiazepines, including diazepam, can cause withdrawal symptoms, which need to be managed. The withdrawal symptoms can occur after three weeks of use, followed by cessation (Gerada & Ashworth, 1997, p. 297). Symptoms of benzodiazepine withdrawal include “increased anxiety and perceptual disturbances, especially heightened sensitivity to light and sound; occasionally there are fits, hallucinations, and confusion” (p. 297). Current medical practice is to translate the dose of alternative benzodiazepines into an equivalent dose of diazepam (p. 297). Diazepam has the benefit of being manufactured in dosages of ten, five, and two milligrams, which allow the diazepam to be slowly tapered in a controlled withdrawal (p. 299). By reducing the dose by two milligrams every two weeks, shorter if withdrawing from a small dose, a successful withdrawal can be attained with a minimum of symptoms (p. 299).

Another indication for diazepam is in managing the effects of alcohol withdrawal in alcoholics (Argyropoulos & Nutt, 1999, p. S409). Alcoholics in withdrawal can have seizures, as well as “delirium tremens”, a severe shaking and agitation (Argyropoulos & Nutt, 1999, p. S409).

Side Effects and Adverse Effects

Side effects of the benzodiazepines are typical of any anxiolytic and anticonvulsants, which is sedation (Valium (diazepam) tablet: [Roche Products Inc], 2010). Paradoxical effects occur rarely, but they include a worsening of anxiety, and even possibly even a paradoxical seizure (Valium (diazepam) tablet: [Roche Products Inc], 2010). Respiratory depression is also a potential side effect, since sedation is a side effect (Valium (diazepam) tablet: [Roche Products Inc], 2010). The effects tend to be dose-dependent, with side effects increasing as dose increases (Diazepam, PubChem, 2005).

Diazepam displays teratogenic effects in mice in extremely high doses, “eight times the maximum recommended human dose”, and readily crosses both placental barriers of pregnant women and into the milk of nursing mothers (Valium (diazepam) tablet: [Roche Products Inc], 2010).

Addiction in normal therapeutic doses is not normally pose a problem, however, administrations to patients with a history of drug abuse is cautioned (Valium (diazepam) tablet: [Roche Products Inc], 2010).

A long-term effect of diazepam and other benzodiazepines is anterograde amnesia, including impairments of memory storage and retrieval (Luscher, Baur, Goleldner, & Sigel, 2012, p. 1). Human studies in memory of subjects reveal “diazepam produces its most prominent effect on memory by diminishing acquisition of new information”, but leaves existing memories intact (Petersen & Ghoneim, 1980, p. 88). A memory experiment revealed that imagery recall was impaired, but recall with verbal cues was largely unaffected (Petersen & Ghoneim, 1980, p. 88). Other investigations have revealed that short-term memory is unaffected, but long-term memory is impaired (Lister, 1985, p. 87). Individuals are poor judges of their own abilities on benzodiazepines, as in a memory trial, subjects on benzodiazepines rated their mental abilities as unchanged, while results indicated impairment (Lister, 1985, p. 92).

Drug-Drug Interactions

Any compound capable of interrupting the metabolic breakdown of diazepam will increase the duration of effects, such as grapefruit juice, certain antifungals, and other CYP3A4 inhibitors (Valium (diazepam) tablet: [Roche Products Inc], 2010).. Alcohol further amplifies this effect, as alcohol metabolism acts on GABA pathways (Lopez-Munoz, Alamo, & Garcia-Garcia, 2011, p. 560).

Conclusion

Diazepam has been a drug that has been simultaneously been termed a boon and benefit to those with anxiety and seizure disorders, as well as a scourge to those who withdraw or become addicted. Diazepam has also allowed primitive psychologists to probe biological mechanisms underpinning many psychiatric disorders, causing a shift in paradigm from pseudoscientific reasoning into research into organic brain disorders and other neurological causes of disorders. Out of this revolution, the field of neuroscience and biopsychology. While all drugs must be weighed in terms of patient benefit versus patient risks, diazepam is clearly a “good” drug. Its versatility, available dosages, and efficacy make it an excellent first line choice in treating anxiety. Diazepam, though largely superseded by newer antiepileptic drugs, is still used in diagnostic cases. Diazepam is also the first line emergency-room sedative for agitated patients. Obviously, the risk of abuse and misuse requires a limit on the distribution of diazepam, and the other effects, such as sedation and the risk of harming a developing fetus, necessitate controls over who should be in possession of this drug, but its usefulness as a therapeutic tool is incredibly valuable.

References

Argyropoulos, S., & Nutt, D. (1999). The use of benzodiazepines in anxiety and other disorders. European Neuropsychopharmacology, 9 (Suppl. 6), S407-S412.

Campo-Soria, C., Chang, Y., & Weiss, D. (2006). Mechanism of action of benzodiazepines on GABA-A receptors. British Journal of Pharmacology(148), 984-990.

Gates, M. (1980). New synthesis of diazepam. Journal of Organic Chemistry, 1675-1681.

Gerada, C., & Ashworth, M. (1997, August 2). ABC of Mental Health: Addiction and dependence - I: Illicit drugs. British Medical Journal, 315, 297-300.

Ishikura, M., Mori, M., Ikeda, T., Terashima, M., & Ban, Y. (1981). New Synthesis of Diazepam and the Related 1,4-Benzodiazepines by means of Palladium-Catalyzed Carbonylation. Journal of Organic Chemistry, 2456-2461.

Kaur, P., & Kwonho, K. (2008). Pharmacokinetics and brain uptake of diazepam after intravenous and intranasal administration in rats and rabbits. International Journal of Pharmaceutics(364), 27-35. doi:10.1016/j.ijpharm.2008.07.030

Lister, R. (1985). The amnesic action of benzodiazepines in man. Neuroscience and Behavioral Reviews, 9(1 (Spring)), 87-94.

Lopez-Munoz, F., Alamo, C., & Garcia-Garcia, P. (2011). The discovery of chlordiazepoxide and the clinical intoduction of benzodiazepines: Half a century of anxiolytic drugs. Journal of Anxiety Disorders, 25(2011), 554-562. doi:10.1016/j.janxdis.2011.01.002

Luscher, B., Baur, R., Goleldner, M., & Sigel, E. (2012). Influence of GABA-A receptor α subunit isoforms on the benzodiazepine binding site. PLoSONE, 7(7), 1-8. doi:10.1371/journal.pone.0042101

National Center for Biotechnology Information. (2005, March 25). Diazepam: Compound Summary - CID 3016. Retrieved from PubChem Compound Database: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3016&loc=es_rcs

National Center for Biotechnology Information. (2005, March 25). Meprobamate: Compound Summary - CID 4064. Retrieved from PubChem Compound Database: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=4064&loc=ec_rcs

National Center for Biotechnology Information. (2005, March 25). Penobarbital: Compound Sumamry - CID=4763. Retrieved from PubChem Compound Database: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=4763&loc=ec_rcs

National Center for Biotechnology Information. (2005, March 25). Secobarbital: Compound Summary - CID=5193. Retrieved from PubChem Compound Database: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5193&loc=ec_rcs

National Library of Medicine. (2010, April). Valium (diazepam) tablet: [Roche Products Inc]. Retrieved from DailyMed: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=554baee5-b171-4452-a50a-41a0946f956c

Petersen, R., & Ghoneim, M. (1980). Diazepam and human memory: Influence on aquisition, retrieval, and state dependent learning. Progress in neuro-psychopharmacology, 4(1), 81-89.

Sample, I. (2005, October 2). Leo Stenbach. The Guardian - Obituary, pp. 1-2. Retrieved November 17, 2012, from http://www.guardian.co.uk/society/2005/oct/03/health.guardianobituaries/print

Sankar, R. (2012). GABA-A receptor physiology and its relationship to the mechanism of action of the 1,5-Benzodiazepine clobazam. CNS Drugs, 26(3), 229-244.

Smith-Kielland, A., Skuterud, B., Olsen, K. M., & Morland, J. (2001). Urinary excretion of diazepam metabolites in healthy volunteers and drug users. Scandinavian Journal of Clinical and Laboratory Investigation(61), 237-246.

Sternbach, L., & Reeder, E. (1961). Quinazolines and 1,4-Benzodiazepines. IV. transformations of 7-Chloro-2-methylamino-5-phenyl-3H-1,4-benzodiazepine 4-Oxide. Journal of Organic Chemistry, 4936-4941.

Summer Grades - That Much Closer to That Second Bachelors!

2012-09-08T11:30:00.005-04:00

Subject	Course	Course Title	Campus	Final Grade	Attempted	Earned	GPAHours	Quality Points
BIO	2710	Human Anatomy and Physiology 2	Boston, Main	A-	3.000	3.000	3.000	11.001
BIO	2711	Laboratory for Human Anatomy and Physiology 2	Boston, Main	A-	1.000	1.000	1.000	3.667
BIO	2810	Human Anatomy and Physiology 3	Boston, Main	A	3.000	3.000	3.000	12.000
BIO	2811	Laboratory for Human Anatomy and Physiology 3	Boston, Main	B+	1.000	1.000	1.000	3.333

Undergraduate Summary
	Attempted	Earned	GPA Hours	Quality Points	GPA
Current Term:	8.000	8.000	8.000	30.001	3.750
Cumulative:	29.000	25.000	25.000	87.667	3.507
Transfer:	80.040	80.040	0.000	0.000	0.000
Overall:	109.040	105.040	25.000	87.667	3.507

From the Archives: Rational Basis for Morality

2012-07-06T11:21:00.004-04:00

Another Installment of "Blast From The Past". This paper comes from April, 2008.

Eliyahu N. Kassorla

Human Nature and the Social Order II

Dr. Orme

Rational Basis for Morality

”וַיְדַבֵּר אֱלֹהִים, אֵת כָּל-הַדְּבָרִים הָאֵלֶּה לֵאמֹר“…

“And God spoke all these words, saying…”[1] That is how we all remember reading about how the Ten Commandments were given. The divine revelation, with all of the Israelites circled around Mount Sinai, and the basis for Judeo-Christian morality, spoken by God himself as a rule of law, an idealistic vision of how we should behave. Then the Israelites made a golden calf to worship, and smiting ensued. The central question is whether our morality comes from divine law or whether humans do these anyways.

“Thou shalt not commit homicide,” reads the sixth commandment. It is a very specific statement against intentional, premeditated, cold-blooded, savage killing. Is it the reason that we do not kill and murder? Frankly, early civilizations with complex religious structures had similar judicial codes forbidding the same practices that many of the Ten Commandments also prohibit. So the Judeo-Christian view that morality comes from the revelation is untenable. Further, considering that the Old Testament contains a total of six hundred and thirteen laws, and people are not overly concerned with Jubilee years or the prohibition against harvesting the corners of their fields, the fact that a law comes from on high is coincidental at best.

Human evolution has been shaped and forged for at least the past 250,000 years. Human behavior and psychology is built on the blueprint model; survival behavior coming from reptiles, emotive behavior coming from canids, social behavior from primates, and lastly our frontal lobes which are uniquely human. Whether it is believed that God began our evolution or that there is no God and evolution is an emergent phenomenon, the end result is the same: that our morality is in our genes. Saying that religion dictates our morality is a fallacious statement, considering religion is at best 10,000 years old in general, with Judaism emerging about 3,000 years ago. So why no great immorality? Naturalistic observations of primate colonies have revealed that when monkeys cheat, the others remember and are less apt to share the rewards of the group. Cognitive psychology has revealed that by using a logic puzzle named the Wason four card task, logical thinking is not something humans are good at; however, by phrasing the logical statement in a rule-violating cheating context, performance is hugely enhanced. Perhaps we have been designed for highly social tasks? Designed by God or designed by evolution? In any case, the history of morality did not begin with revelation. Religion is what teaches us that morality comes from God. If it were the case that morality comes from God, then what accounts for non-Judeo-Christian society’s morality? If the revelation of the Judeo-Christian God is what brought morality, then non-Judeo-Christian societies, by default, must be wanton gluttons that murder, rape, and pillage. But the Buddha teaches that all life is suffering, that self-denial is the key to enlightenment, and kindness and fellowship are important virtues. And Hinduism is not made up of murderers and thieves, either; rather it encourages introspection and reflection.

Adam Smith, in his exploration in the growth of the economy, notes that

“[among] civilized nations, the virtues which are founded upon humanity, are more cultivated than those which are founded upon self-denial and the command of the passions. Among rude and barbarous nations […] the virtues of self-denial are more cultivated than those of humanity. The general security and happiness […] in ages of civility and politeness, afford little exercise to the contempt of danger, to patience in enduring labour, hunger, and pain.” [2]

With the growth of the economy comes the increase in moral behavior. Why is that the case? Adam Smith believed that the economy drives innovation and industrialization, which makes what was once hard very simple, and that frees us to introspect and not be immoral out of desperation.

“Every savage undergoes a sort of Spartan discipline, and by the necessity of his situation is inured to every sort of hardship He is in continual danger: he is often exposed to the greatest extremities of hunger, and frequently dies of pure want. His circumstances not only habituate him to every sort of distress, but teach him to give way to none of the passions which that distress is apt to excite. He can expect from his countrymen no sympathy or indulgence for such weakness.”[3]

According to Adam Smith, less technical and less industrial societies by their virtue of being less developed have a more rudimentary value system. However, notice that the principle of natural rights is not violated. Imagine a normal curve[4], and 68 percent of the people of a given society obey natural law, and 95 percent of the people mostly follow it with a few violations here and there. Those that tend to violate natural law are the outliers, three or more standard deviations from the mean! Evolution is meant to be successful, not accurate. But the way social behaviors emerge from our brains to make and acquire society helps us to identify cheaters and punish them by social isolation. Thankfully, we have moved beyond swift death penalties to the more humane, and moral, institutionalized system of incarceration.

Friedrich Nietzsche, in "The Gay Science", states,

“God is dead. God remains dead. And we have killed him. How shall we comfort ourselves, the murderers of all murderers? What was holiest and mightiest of all that the world has yet owned has bled to death under our knives: who will wipe this blood off us? What water is there for us to clean ourselves? What festivals of atonement, what sacred games shall we have to invent? Is not the greatness of this deed too great for us? Must we ourselves not become gods simply to appear worthy of it?”[5]

Nietzsche appears to mean that God is no longer a tenable explanation for morality. Without the Judeo-Christian moral architecture, we still do not violate the norms of what we call moral behavior. Nihilism would become the norm according to Nietzsche because of the lack of divine order. However, this is in contrast to what is actually seen in the real world when societies do not base their tenants solely on religious law. If we take a divine law interpretation, where are our cities of refuge for accidental murderers? Or should we incarcerate based on negligent homicide?

Religion is good for outlining best case ideals, but a full knowledge of the biblical texts show that there are incongruities with what people interpret the meanings to be and what the scripture actually says.

Religion is a highly personal experience, is an ideal situation, and can be a good thing to aspire to. However, there are natural explanations that do not resort to reduction ad absurdum arguments to explain the occurrence of morality, nor one that is unseeable. Rather than externalizing morality to an outside force, morality is an internal force, congenital, and an emergent property of the brain. Humans are not designed to receive reward later; the nucleus accumbens, the neurological reward structure, does exhibit activation in anticipation of reward, but behavior change only occurs when it is later strongly activated. Humans have an inventory of successful behaviors, just like lions and antelopes, which have kept us alive as a species. If life is good, then human biology is designed to produce low levels of aggression, and high levels of benevolence. When aggression is encountered, aggression increases. When life begins to diminish in its “goodness,” positivity is reduced in favor of a more pragmatic behavior pattern. These traits have made humans especially adept at surviving in less than optimal conditions, and maybe, just maybe – a species worth saving.

References

Cosmides, L.; Tooby, J. (1992). Cognitive adaptions for social exchange. New York: Oxford University Press.

Mechon Mamre. The book of exodus. Retrieved on April 23, 2008. Web site: http://www.mechon-mamre.org/p/pt/pt0220.htm#2

Nietzsche, Friedrich. (1974). The gay science: with a prelude in rhymes and an appendix of songs. Walter Kaufmann, ed, trns. New York: Pocket Books.

Smith, Adam. (2000). The theory of moral sentiments. Amherst, MA: Prometheus Books

Wason, P. C. (1971). Natural and contrived experience in a reasoning problem. Quarterly Journal of Experimental Psychology 23: 63–71.

Figures

Figure 1

68% of all data is within one standard deviation from the mean.

In all sexually reproducing species, traits are distributed approximately normal. Extreme outlying values for traits are typically selected against, while successful ones cluster around the mean.

When the environment exerts selection pressure in either direction, the curve shifts, and the more successful value for the trait tends to become the new mean.

[1] Mechon Mamre. The book of exodus. Retrieved on April 23, 2008. Web site: http://www.mechon-mamre.org/p/pt/pt0220.htm#2[2]Smith, TMS V, Ch.2[3] Smith, TMS V, Ch.2[4] Figure 1[5] GS, 125

From the Archives: Cognitive and Neurobiological Models of Post Traumatic Stress Disorder

2012-06-01T18:40:00.002-04:00

SALUTE

2011-11-03T15:53:00.002-04:00

The Graduation of Eliyahu N Kassorla

2011-06-13T11:05:00.002-04:00

Art Project - A Welcome Diversion

2011-03-23T17:52:00.001-04:00

The assignment: Create a pattern

As anyone who knows me knows, I am no artist. But this pattern works. Or as my art teacher said, "This is a very strong pattern"

On the Value of Currency, and the Policies of the European Central Bank

2011-03-15T07:42:00.003-04:00

On the Trading of Currencies as Commodities

The value of international currency is defined as the faith or speculation that the value of currency will increase. When the Western European countries maintained their own currency, usually indexing them to either a solid material, such as gold or silver, or to other currencies, their central banking policy was focused on domestic growth, as well as protecting against inflation and deflation. The consolidation of the various European currencies has resulted in the fate of one nation, such as France, becoming associated with that of a much poorer nation, such as Bulgaria.

The recent economic crisis, beginning in 2007 and continuing through 2010, has been at least partially attributed to the values of currency. Jörg Bibow, in the article Europe’s Quest for Economic Stability, discusses key decision points of the European Central Bank (ECB). Bibow, writing in 2006, explains both strengths and weaknesses of the Eurozone banking model. The primary objective of the ECB, according to its founding charter, is to maintain price stability across the Eurozone.[1] Price stability, Bibow states, is “essentially a piece of Bundesbank nostalgia,” referring to the former German bank charged with maintaining price parity, and coordinating the now defunct erratic European Monetary System, from which the ECB’s framework is largely derived.[2]

As a matter of general policy, the ECB does not attempt any other ends aside from their primary mandate, only fostering interest in economic development and employment when the ECB views that engaging these ends will not interfere with price stability.[3]

On the Harm Caused by A Centralized Currency

Bibow accurately predicts the contention between the ECB and national central banks (“NCB”).[4] Bibow discusses the issue of self-interested national banks acting in their own interests as an issue that the ECB and NCB’s have yet to reconcile. The provisions of the founding treaties and charters allowed the NCB’s to stay open to regulate domestic affairs, being allowed to act as lenders of last resort; however, the ECB’s role is to make policy decisions on a high level. The effect, however, is that the ECB and NCB’s do not act as a unified actor, with goals that can be in opposition. Kathryn Dominguez, in the article The European Central Bank, the Euro, and Global Financial Markets (2006), cites the loss of NCB’s ability to control inflationary or deflationary pressures. Because the euro is not attached to a single NCB, countries in the Eurozone lack the ability to revalue their currencies, allowing the market to correct for imbalances. Using Germany as an example, Dominguez writes, “nominal exchange rates are fixed within Europe, differences in inflation across countries can still affect real exchange rates. For example, Germany’s low domestic inflation has made the country’s exports relatively cheap, while higher rates of domestic inflation in Greece and Spain make their exports relatively expensive”.[5] Dominguez supports Biblow’s conclusion that the ECB’s increased scope of membership is detrimental because the ECB’s policies may diverge from those of the individual member countries. Further, Dominguez cites a study by Meade and Sheets (2002, in Dominguez, 2006) in writing, “Meade and Sheets argue that monetary policy decisions of the European Central Bank from 1999 to 2001 are consistent with national central bank governors voting in line with their national interests”.[6]

Bibow’s point of contention on this issue is that the ECB is, essentially, an independent institution. The ECB only answers to a board if bankers, and the “ECB refuses to publish minutes and voting records”.[7] Bibow comments that, “there are no effective checks and no real accountability on performance”.[8]

Bibow (2006), cites the ECB’s policy of “price stability above all else,” a mantra Bibow attributes to Otmar Issing, as being actively anti-growth.[9] Bibow attributes this unwavering commitment, despite new information, as being causal to the early decline of the value of the euro, effectively forcing inflationary pressures on the value of the Euro. Bibow writes,

As to the euro’s plunge, the ECB’s role was one of acting as a twofold propogation mechanism as the bank’s words and deeds provoked market opposition. [...] So when the ECB backed up its confusing words with all to clear actions, that is, aggressive interest rate hikes, the market simply took flight, preferring policy makers that were perceived as more growth friendly.[10]

Bibow further discusses the effects of perceived anti-growth policies, and the effects they have on the Eurozone members. Specifically, Bibow mentions that the contingencies required in accession to the European Union “imposes austerity especially on those who are crippled already, whereas stronger members may even have room to cut taxes.”[11] The inequitable treatment of the poorer Eastern European nations, compared to the largely stable Western European nations, has, Bibow states, caused the very condition the euro was designed to avoid: a “beggar-thy-neighbor” situation that allows an unacceptable amount of risk into the banking system.[12] Dominguez contributes to this thought by noting that “five out of the eleven countries in the euro-zone (Greece joined the euro zone in 2002) were in violation of the public debt rule. A strict interpretation of the [Stability and Growth] pact is clearly not being imposed; in 2005, the three largest euro-zone economies – France, Germany, and Italy – were out of compliance with both the budget deficit and public debt rules”.[13] Bigger, Western European economies are being treated preferentially – allowed to break rules when it is convenient – further increasing the probability of inflation, which further hinders growth in Eastern Europe.

Living standards in Germany, for example, are undoubtedly better than Romania; however, inflation in Germany keeps exports relatively high. What the euro has done, by standardizing currencies across Europe, is allow comparisons to be made in the same unit. The ECB, when admitting new countries into the Eurozone, uses a fixed exchange at the time of accession, leaving the same amount of currency buying the same amount of goods. Despite the equality of currency, one euro in Germany has the same value as in Romania, the disparity in economic output between the two separates developed and developing nations into almost separate regions. In Romania, since the potential output of the economy, and relative inability to garner interests in Romanian exports, limits the money supply, the Romanian population is still chasing after a limited amount of purchasing power; in Romania, demand for money outpaces the supply, and ability of the Romanian economy to get euros from international sources is limited. Without a population full of euros, government income from both personal and business tax revenue is likewise limited. With a limited income, and mounting expenses, countries act in the same way as individuals: they borrow money, spending income they haven’t yet earned in order to pay for things they want or need at the time, on the promise that in the future, when payments are due, the money will be there. When the bills are due, and the money is not there, speculation forces a country’s bond yields up, increasing the costs associated with lending, and trigging a liquidity trap. Because the euro in the failing country is now saddled by debt, the value depreciates across the zone.

When It Rains, It Pours…

The last issue that Bibow examines is the potential for the Euro and the Eurozone to invoke a liquidity trap: “cutting short term rates would only undermine confidence and drive up bond yields”.[14] Bibow’s words ring true, especially when considering the system level of analysis that induced the Greek, Irish, and Portuguese debt crises.

Ireland, according to an article disseminated by Reuters, and published on CNBC.com, Worst of Times, Best if Times: Tale of Two Irelands, is undergoing a financial crisis as well. The article discusses the state of the Irish economy, contrasting Northern Ireland, in union with the United Kingdom as stable and continuing on a path to prosperity with an ever increasing trade surplus, with the Republic of Ireland, hampered by recession and job losses equal to one tenth of its population. Northern Ireland, as a member of the UK, does not use the euro as its currency – preferring the British pound, and has been ever increasing its self-rule. The difference in monetary control may seem to be unimportant, until the realization that The UK has a vested interest in the strength of the pound internationally, while the ECB has a plurality of national interests, ready undermine foreign competitors. The Republic of Ireland joined the European Union, uses the euro, and recently enjoyed economic prosperity, is now faced with “a sudden fall in [domestic] output [that] has blown apart what were once exemplary public finances”.[15] The article further discusses the job vacuum left in the wake of a housing bubble, increasing unemployment to 14% from four, and renewed emigration to countries with jobs. The article mentions that firms from the United States “have invested more in Ireland than in Brazil, China, India, and Russia combined”.[16] The significance is only realized when combined with the information that foreign firms are only taxed at a rate of 12.5%, a decision made to entice foreign investment.[17] EU members, however, are less than thrilled, and the article suggests outrage that EU members now must fund a bailout of the Irish economy, while accusing Ireland of competing unfairly with the lowest tax rates on foreign firms in Europe.[18] Traditionally, as has happened to every economy, currency would have been devalued, the market allowed to readjust, cheapening Irish goods, spurring global demand for Irish goods at a now lower price, which will infuse new capital into the economy, leading to recovery. Lacking effective controls over their currency of use, the euro, the Republic of Ireland must now pay a value that it cannot afford, with a currency it does not have, with trade partners who seek to maintain their national interests – for their goods.

According to an article by Antonia Van de Velde, published on CNBC.com, titled Think BIIGS: There’s One Euro Country Under the Radar, Belgium is also facing a currency crisis. Belgium is unique among the troubled euro states today for two reasons: the first, that Belgium currently lacks a national government; secondly, that Belgian “public debt is just under 100 percent of gross domestic product”.[19] Essentially, Belgium is indebted to the world the entire sum of one year’s economic production, having spent money that has not been earned yet. In a traditional “one nation-one bank” system, Belgian currency would fall in value to a level that is sustainable in the market, or short term interest rates might be lowered to decrease the costs associated with moving capital from the central bank though the entire banking system. However, because Belgium is part of the euro zone, the harshest consequence is the increase in the spread of Belgian credit default swaps.[20] Further, despite a debt load that would be considered in most other circumstances as technical insolvency, “Standard and Poor’s wrote that it’s AA+ rating on the country’s long term debt – the second highest rating at the agency – could come under downward pressure if a continued political stalemate were to diminish the authorities’ capacity to address the ‘outstanding challenges’”.[21] The only positive factor, according to Van de Velde, is that the perception in Belgium is that if there is no government, there can be no spending.[22] Despite Belgium’s inability to decide whether it is German or French or Dutch, for a country, about the size of Maryland, it may have acted and spent differently would the true cost of Belgian debt not spread amongst its European neighbors.[23]

While the risk of a country, especially a modern economy, defaulting on its debt has fallen since the turbulence of the 70’s and 80’s, the fact that these conditions are perceived as consequence free encourages countries to spend more money than they have, to buy things they cannot afford (and as Suze Orman would add, to impress people they don’t know). The moral hazard, of removing consequences from bad decisions, has the effect of enticing other countries to engage in similar reckless spending practices – knowing that they would be shielded from their actions.

Dominguez further believes that limiting a government’s ability to control its own currency can not only affect the individual country, but can bleed over and poison healthy economies within the same currency market.[24] Stripping monetary policy from a country, and handing over that power to an outside power, further disrupts a nation’s ability to pursue the goals demanded by their population. Dominguez writes that the euro and the ECB, “was sold to Europeans as the means by which they could achieve political and economic stability”.[25] The euro, a common currency for all of the Eurozone, necessarily is contingent upon the member states’ values; Dominguez questions the ability of the Eurozone to stay together should Germany or France go into recession.[26] Dominguez asks, “If Germany or France go into recession and badly need monetary stimulus, how will the European Central Bank balance their needs against the rest of the euro zone?”[27] Quantitative easing serves to decrease the value of a currency, but with twenty-two member states’ economies crucially dependent on a newly-lowered value euro, the rest of the euro zone is poorly equipped to absorb such capacity.

Conclusions

While the goals of a pan-European currency are admirable, and greatly benefit countries during boon times, the methods that the European Central Bank have chosen to use is of greater harm. Lacking the ability to make independent decisions on monetary policy, relative inflation can occur even between Eurozone countries. Rather than achieving the stated goal of price stability, the euro serves only to increase the amount of countries affected by an economic downturn; the amount of risk is just more broadly distributed. While diversification of a portfolio is, unquestionably, an important aspect of investing, incorporating toxic assets, even while packaged with healthy assets, is not. Not only do Eastern Europeans suffer as a result of unequal inflation, the Eurozone is unnecessarily liable for the debts and deficits of their neighbors that engage in reckless behaviors: Germany, France, and Spain – otherwise first-world countries that have debts beyond the allowances of EU and ECB regulations.

The model of Adam Smith, who clearly describes the relationship and origins of division of labor and the development of market economies, can be applied to states. If the state is the individual in a state of nature, as Smith postulates our origins, then comparative advantage and trade of each nation is the same as the barter economy of individuals before the development of currencies as proxies for labor. The labor of a country is the amount of wealth contained in the country, which itself is related to the capacity of the economy for growth. While unionization into the European Union has proven to be beneficial, with regards to the lowering of trade barriers and establishing mutual trade and peace, the consolidation of currencies cannot be so readily lauded. Decoupling the growth of each economy for the value the country provides invites unnecessary risk into the global financial system. No longer is a country defaulting limited to the debtor countries; the shockwave will be sent throughout the zone, with a collective devaluation of currency. In Smith’s model, the loss of an individual will remove just one operation from the pin-making business – should a significant number of euro countries crash, it may result in the loss of the entire factory.

References

Bibow, Jörg. 2006. "Europe's Quest for Monetary Stability." International Journal of Political Economy 35, no. 1: 24-43. Business Source Premier, EBSCOhost (accessed November 22, 2010).

Central Intelligence Agency. 17 Nov 2010. CIA – The World Fact Book: Belgium. Published on https://www.cia.gov/library/publications/the-world-factbook/geos/be.html.

Dominguez, Kathryn M. E. 2006. "The European Central Bank, the Euro, and Global Financial Markets." Journal of Economic Perspectives 20, no. 4: 67-88. Business Source Premier, EBSCOhost (accessed November 22, 2010).

Reuters News Agency. 26 Nov 2010. Worst of Times, Best of Times: Take of Two Irelands. Published on http://www.cnbc.com/id/40377778

Smith, Adam. The Wealth of Nations. Edited by Alan B Kreuger. Translated by Edwin Cannan. Vols. Based on Cannan, 5th Edition, 1904. New York, NY: Bantam Books Publishing: Random House, Inc., 2003 (1776).

Van de Velde, Antonia. 26 Nov 2010. Think BIIGS: There's One Euro Country Under the Radar. Published on http://www.cnbc.com/id/40379099

[1] Bibow, 1996, pp. 32-33

[2] Bibow, 1996, pp. 32, 24

[3] Bibow, 1996, p. 34

[4] Bibow, 1996, pp. 24-25

[5] Dominguez, 1996, p. 79

[6] Dominguez, 2006, p. 73

[7] Bibow, 1996, p. 30

[8] Bibow, 1996, p. 29

[9] Bibow, 2006, p. 37

[10] Bibow, 2006, p. 37

[11] Bibow, 2006, p. 38

[12] Bibow, 2006, p. 38

[13] Dominguez, 2006, p. 76

[14] Bibow, 2006, p. 39

[15] Reuters, CNBC, 2010

[16] Reuters, CNBC, 2010

[17] Reuters, CNBC, 2010

[18] Reuters, CNBC, 2010

[19] Van de Velde, 2010

[20] Van de Velde, 2010

[21] Van de Velde, 2010

[22] Van de Velde, 2010

[23] Information about Belgium’s size compared to the state of Maryland, CIA World Fact Book Online

[24] Dominguez, 2006, p. 81

[25] Dominguez, 2006, p. 86

[26] Dominguez, 2006, p. 86

[27] Dominguez, 2006, p. 86

On Adam Smith, the Inevitability of the Market Economy, and the Wealth of Nations

2011-02-22T09:53:00.000-05:00

Eliyahu N Kassorla
Economic Principles of Adam Smith
W. Lesperance, Ph.D.

On Adam Smith, the Inevitability of the Market Economy, and the Wealth of Nations

Introduction
  Adam Smith, in Wealth of Nations, attempts to model ideal economic development using observations of history and European development. Under the Wealth of Nations model, labor is an exchange for goods or services, which is then converted to currency as a proxy for direct barter. Smith further describes the progression from agricultural beginnings to market economies, and the resultant social organization that is causal to market forces – the differences between pastures and cities, wealth and poverty, and state and empire. The model of societal development that Smith advances is used to explain economic growth and trade relations. Smith, then, applies his findings of trade relations to those between the British Empire and the American colonies, leading him to the conclusion that overseas colonies are expensive, and are better served as independent nations. Smith’s works still have many vital lessons to teach both nations and international organizations, even after nearly two and a half centuries.
On the Division of Labor
In the Smith model derived from Wealth of Nations, Smith begins by describing the effects of division of labor on the pin industry. Smith found this industry to both be “trifling” as well as a solid footing to start with.[1] It is because of the perception of unimportance that Smith chooses pin making, for if it works in such an insignificant industry, it must likewise apply to more substantial industries. Smith observed that a lone pin maker, “could scarce, perhaps, with his utmost industry, make one pin in a day, and certainly not make twenty”.[2] Smith concludes that changing from task to task is a drain on productivity, necessitating changes in tools as well as a change in thought: “When he [a laborer] first begins his new work he is seldom very keen and hearty; his mind […] does not go to it, and for some time he rather trifles than applies to good purpose”.[3] The specialization that results from a defined division of labor increases the amount of work performed per unit, per labor time, without the loss of productivity from “chang[ing] his work and his tools every half hour, and to apply his hand in twenty different ways”.[4]
Smith lists the different tasks required to make and package pins:
One man draws out the wire, another straightens it, a third cuts it, a fourth points it, a fifth grinds it at the top for receiving the head; to make the head requires two or three distinct operations; to put it on, is a peculiar business, to whiten the pins is another, it is even a trade by itself to put them into the paper; and the important business of making a pin is, in this manner, divided into about eighteen different operations […] [5]
This round-robin method of dividing the tasks among different employees ensures that no individual is left waiting for another employee. Further, division of labor in this manner reduces or removes the queue of pins, maximizing individual productivity. In modern usage, this is known as the assembly line process. Smith thought this process so good at maximizing productivity that he predicted that, given ten employees, output would reach “forty-eight thousand pins in a day”.[6] Had each pin “been wrought separately and independently,” Smith concludes, “they certainly could not each of them made twenty, perhaps not one pin in a day”.[7] Smith attributes this to the efficiency conferred by the division of labor.[8]

On Durable Goods and the Market
Smith applies these observations to naturalistic settings, determining that the origin of division of labor is also the origin of trade. Smith finds that exchanges are “more likely to prevail if he [an individual] can interest their [another person] self-love in his favor, and shew [sic] them that it is for their own advantage to do for him”.[9] In the past, this was accomplished by direct exchanges and bartering, trading ability in one skill or craft for another.[10] In Smith’s example of a naturalistic setting, when one is good at making bows and arrows, they should devote all of their time and resources to making bows and arrows, and using them to trade for meat and clothing; likewise, the clothier will trade his clothes for meat, freeing up the hunter to focus exclusively on hunting and acquiring more meat to use as his barter.[11] Lacking infrastructure, goods can only be exchanged locally; however, the goods provided for in this system of exchanges are only limited by their ability to be procured.[12] The largest centers of commerce, Smith’s model predicts, are those who have both a transportation system as well as a route of exchange.[13] Navigation by sea, Smith explains, has historically been the most successful and commercially important routes for trade. In the Americas, sailing ships provided the transportation and the trade winds provide the route; just as in Egypt, where canals along the Nile allowed easy trade; and India, the Ganges was an important trade route.[14]

On Money
In Smith’s model of societal advancement, once division of labor is established, there is a tendency of an individual to amass more resources than he can use himself.[15] Once trade is established, each member of society becomes a merchant for his own wares, beginning the age of “a commercial society”.[16] As the infrastructure of the market evolves, direct exchange of goods becomes cumbersome and inefficient.[17] While a number of proxies may have been tried, pure precious metals have become preferred. Smith’s notes that the benefits to using metals are that they are not perishable commodities, metals are able to be stored for a long time without loss of value, and that metals are divisible, able to be broken apart – and later rejoined by the same process used to forge them.[18] Smith also notes that the metal of value likewise evolved with cultural development, stating that “iron was the common instrument of commerce among the antient [sic] Spartans; copper among the antient [sic] Romans; and gold and silver among all rich and commercial nations”.[19][20] The currency, through evolution, became standardized by governments, both to fix the exchange rate and protect against fraud of adulteration.
Smith notes two factors in the use of currency as a proxy for goods or services, which define the value of the currency: “The one may be called ‘value in use;’ the other, ‘value in exchange’”.[21] Smith observes that items of great value in use, such as water, have little to no exchange value; on the contrary, objects with little value in use have considerable value of exchange, such as the precious metals or diamonds.[22]

On the Value of Labor in Relation to Money
With the foundations of the market and the use of money in place, Smith returns to labor. Labor, Smith writes, is the real measure of value: “The real price of every thing, what everything really costs to the man who wants to acquire it, is the toil and trouble of acquiring it”.[23] Therefore, currency is a proxy for acquiring the labor of others: “When barter ceases, and money has become the common instrument of commerce, every particular commodity is exchanged for money than for any other commodity”.[24] Further, while currency values may fluctuate, the “cost” of labor is fixed at the rate of labor per unit of time: “Equal quantities of labour, at all times and places, may be said to be of equal value to the labourer,” but the value of that labor to another may vary according to the value of the goods produced by the labor.[25] Smith states that “labour, like commodities, may be said to have a real and a nominal price”.[26]
The value of skills provided by labor is priced according to the demand of the skill; if the skill is scarce, the cost and value of the skill increases, thus increasing wages paid to the laborer. Likewise, if there are many more people with a skill than are jobs to utilize them, the value decreases, in the form of lower wages. Labor, currency, and goods are subject to these same market forces of supply and demand. Smith uses, as his example, the consequence of metal mines in the Americas: “The discovery of the abundant mines of America reduced, in the sixteenth century, the value of gold and silver in Europe to a third of what it had been before. As it costs less labour to bring those metals from mine to the market, so when they were brought thither they could purchase or command less labour”.[27]

On the Development of Society, Trade, and the Market
  Smith writes that human societies develop through three stages: agriculture, manufacture, and finally foreign commerce.[28] Critical to these developmental stages are the evolution of pastoral communities toward towns and cities. While agrarian communities are of benefit to the production of food, Smith observes that cities and towns “arrived at liberty and independency much earlier than the occupiers of land in the country”.[29] This seems, as Smith writes, to have been a consequence of market trade; goods coming from the countryside were subject to taxes and tolls when crossing bridges, passing through other communities (“when they passes through certain manors”), and when selling goods in the marketplace.[30] The liberties that were gained in the towns and cities also consolidated power under the “sovereign” of the nation; previously, the lords of land, having “slaves or vassals” were autonomous, having great power on the lands under their control.[31] Cities, further, were given the power to regulate their own taxation: “the sovereign could impose no tax, besides the stated farm-rent of the town, without their [city’s citizens] consent”.[32]
  The product of these new freedoms enabled cities to become large central hubs. Smith writes that, “the inhabitants of a city, it is true, must always ultimately derive their subsistence […] from the country”.[33] Powerful cities of trade, however, if in proximity to infrastructure of trade, “are not necessarily confined to derive them [goods] from the country of their neighbourhood”.[34] The large amount of regional trade would become the birth of globalization, and the golden ages of antiquity were measured in trading power. Smith mentions that Italy benefited from the crusades, being the first to reach “opulence”.[35] The benefit of the crusades came from the flow of goods from temporarily controlled lands of the Turks, shipping through “Venice, Genoa, and Pisa”.[36]
  The principle of comparative advantage is also mentioned by Smith. While Smith did not use the term “comparative advantage”, he was clearly aware of the principles. Smith writes, “The inhabitants of trading cities, by importing the improved manufactures and expensive luxuries of richer countries, afforded some food to the vanity of the great proprietors, who eagerly purchased them with great quantities of the rude produce of their own lands”.[37] When combined with Smith’s observations that every country both has a manufacture, as well as the observation that “no large country […] ever did or could subsist without” manufactures produced elsewhere, this is exactly the importance of trade in comparative advantage.[38]
Were the marketplace diluted among vastness of Europe, the Middle East, and Asia, trade would be inefficient; rather than wandering about randomly until the desired good is found, the centralized nature of the cities and towns, then, becomes about easing access to the markets, decoupling the origin of a good from its sale.[39] Foreign commerce allows regions to focus on industries that they are good at, trading what they have a surplus for what they have in scarcity.[40] In these terms, comparative advantage is simply an extension of the division of labor that precedes the use of currency.

On Colonialism
Smith retraces the ancient history of colonialism. Before the age of exploration, Europe was limited to the known lands. Colonies in Europe had been established to expand a city’s influence beyond its borders, as well as provide a new source of land when the old city became fully populated.[41] While the “mother-city” enjoyed a preferential relationship with the colony, the usual practice was to allow the colony self-government and autonomy.[42] Further, colonies were also established to maintain stable sources of trade with foreign lands, such as the European colonies in the West Indies.
It was the desire to “share in the profitable traffic of the Venetians” that directed the European powers to the west, searching for an alternate route to “the countries from which the Moors brought them ivory and gold dust across the Desart [sic]”.[43] After the discovery of the Americas, the European powers established colonies with a minimum of interference, leading Smith to conclude that the lack of interference was causal to their prosperity.
  “Towards the end of the end of the fifteenth, and during the greater part of the sixteenth century, Spain and Portugal were the two great naval powers upon the ocean”; however, “The Spaniards, in virtue of the first discovery, claimed all America as their own; and though they could not hinder so great a naval power as that of Portugal from settling in Brazil”.[44] Despite their early start in colonizing the Americas, the defeat of the Spanish Armada enabled other European powers to establish colonies of their own. While Sweden established the colony of New Jersey, their neglect of the colony allowed the Dutch colony of New York to subsume the Swedish colony.[45][46] The Dutch, divided between the Americas and the East Indies, chose the latter as their preferred colony, allowing the English to rule the North American colonies.

On the Prosperity of the Colonies
Although the history of colonial empires is complex, and despite the continued English rule of the North American colonies as of the time of his writing, Smith notes several factors that contributed to the prosperity of the English colonies.
  The first is that of the practice of exclusive companies to manage trade between the colonies.[47] Smith observed this in the French colony of Canada, enjoying prosperity after the dissolution of the French exclusive company.
  The second factor Smith observes is the effect of liberal treatment and policies between Britain and her colonies. Smith notes the relative autonomy of the American colonies, unprecedented in history, and likens them to independent nations. Smith explains that the effect of the liberal treatment of the American colonies is responsible for the development of American liberties and the egalitarian political structure. With the exception of British mercantilism, where the British required the colonies use Britain as the sole gateway for trade, the American colonies by then already acted as an independent nation.[48]
The last factor Smith observes is the moderate taxation of goods, both from and to the American colonies. The lower taxes in the American colonies allowed the colonists to purchase more goods from England, which collected taxes on both sides of the transaction. However, Smith critically remarks, repeatedly, about the expense to the British treasury in defending the colonists, the colonies, and shipping convoys, the cost of which was disproportionately paid for by English citizens in England: “The English colonists have never yet contributed any thing towards the defence of the mother country [England], or towards the support of its civil government. They themselves, on the contrary, have hitherto been defended almost at entirely at the expence of the mother country.”[49] It is for this reason that Smith advocates for the voluntary withdrawal from the management of the American colonies, noting that while the nation’s pride may suffer, the relationship may even prove to be more beneficial to both sides. Smith writes,
“Great Britain would not only be immediately freed from the whole annual expence of the peace establishment, of the colonies, but might settle with them such a treaty of commerce as would effectively secure to her a free trade, more advantageous to the great body of the people, less so to the merchants, than the monopoly which she presently enjoys.”[50]

Smith believes that the trade relationship, while open to free trade with other nations, without the mother country as an intermediary, would be more advantageous for Great Britain. Smith justifies this position by explaining that the true costs of maintaining the colonies are not being paid by the colonists, but by British citizens in Britain, and that the removal of capital from Great Britain is detrimental to British industry. Were the American colonies spun-off into an independent entity, American merchants would bear the cost of shipping and the British would no longer need to remove such a vast quantity of capital from their economy to maintain soldiers for defense, and sailors for convoys.[51] These costs prompted Smith to state that, although the possession of the American colonies has benefitted Britain with increased wealth, the amount of increase is not as great as could be if the colonies of the Americas became independent foreign nations.[52] The monopoly of trade with the American colonies makes the purchase of American goods in Britain less expensive, but the true costs are hidden in the cost of maintaining the infrastructure to support this trade. The hidden costs are passed along in Britain’s trade of American goods, such as corn and tobacco, to other European nations in the form of higher prices. In order for the other European nations to make up for the money lost, the prices of foreign goods destined to either Britain or the Americas are increased.[53] From this, Smith concludes that abandoning the trade monopoly with the colonies, in addition to eliminating the expense of maintaining the shipping infrastructure, would lower the cost of American goods to the European countries, and lower the cost of European goods sold to Britain.[54]

Smith's Four Roles of Government
  Smith’s fifth book is his elaboration of the four fundamental roles of government. Smith, having rejected mercantilism as too great an expansion of a nation, impresses the importance of the core responsibilities to an effective and effectual government. These are the common defense of the country by way of an army, the system of courts and justice to protect private property, and the infrastructure of the market, including roads and banks, and public education.

Common Defense
  Smith’s first government role is that of defense of self-defense, through the military. In a hunter society, Smith writes, the cost of defense is nothing because, “every man is a warrior as well as a hunter.”[55] In the next stage of societal development, the animal husbandry stage, the cost of war is still intangible. Smith states that shepherds are “accustomed to a wandering lifestyle,” and therefore their entire society physically moves to war.[56] “When such a nation goes to war, the warriors will not trust their herds and flocks to the feeble defence of their old men, their women and children, and their old men, women and children, will not be left behind without defence and without subsistence.”[57] The benefit of winning the battle, therefore, entitles the victor to the possessions and belongings of the defeated; likewise, if defeated, the cost is the loss of life, loss of property, and Smith states, “their women and children become booty of the conqueror.”[58] Thus, it is through the division of labor, which Smith introduced in the very beginning of Wealth of Nations, that the cost of war begins to emerge. When the market economy begins to emerge, and the division of labor begins to separate the population by occupation, it becomes necessary to develop a professional military. Smith gives two methods to accomplish this: the first is the enforcement of compulsory military service, the second is to “render the trade of soldier a particular trade, separate and distinct from all others.”[59] The first, which Smith calls a militia, has historically been composed of ordinary people who periodically train, but are not “attached to any particular body of troops” until called up to engage in warfare.[60] The second is composed of regular troops that receive constant training and are subject to military discipline, and are thus more knowledgeable and become experts in warfare. Comparing a militia to a standing army, Smith writes, “The soldiers, who are exercised only once a week, or once a month, can never be so expert use of their arms, as those who are exercised every day, or every other day.”[61] Smith further defends standing armies as being necessary for the safety and preservation of a civilization, the only way to stave off “invasion of a poor and barbarous neighbor.”[62] However, Smith has reservations about the expense of a standing army, recognizing not only the cost of both provisions and equipment during wartime, but also provisions, equipment, and training during peacetime.[63]

Justice and Courts
  Smith continues his discussion of the essential roles of government, naming a system of justice as the second of the four roles. Smith states, “the second duty of the sovereign, that of protecting, as far as possible, every member of the society from the injustices or oppression of every other member of it, or the duty of establishing an exact administration of justice”.[64] While the role of the military is the protection of the nation from outsiders, a system of justice has the responsibility of protecting the insiders from each other. In Smith’s model of societal development, a hunter society has no property, except for the products of labor for subsistence. When the division of labor allowed the production of a surplus of goods, and surplus goods became a proxy for wealth and lead to the emergence of social classes, there emerged a real need to protect private property.[65] While Smith notes that the courts are a cost to government, the social stability that justice enables more than offset the expense, and that governments can use court fees to offset this cost. It is Smith who, more than theoretically, believes the reason that the judiciary must be independent from the executive power is so that the judicial branch could specialize and focus on the law, and provide “the undivided attention of the persons to whom it [justice] was entrusted”; likewise, the executive should focus on the business of administration of the country.[66]

Public Works
  Smith’s third role of government is the development and maintenance of infrastructure. Smith lists roads, bridges, canals, and harbors as components of infrastructure that the government is responsible for.[67] Smith does not believe, though, that taxes from the general public need to be the only source of revenue; rather, tolls and charges for use and privilege of the infrastructure is a potential – and more equitable method of defraying the costs of infrastructure. Smith was a supporter of differential taxation, advocating “toll upon charges of luxury, upon coaches, postchaises, &c. made somewhat higher in proportion to their weight, than upon that carriages of necessary use, such as carts, wagons, &c.” as a means of allowing both the rich and poor access to the same infrastructure.[68] The practicality of paying for the bridge with usage charges, Smith argues, is necessary to prevent infrastructure explosion beyond what can be borne by the market; “A magnificent high road cannot be made though a desart [sic, recte desert] country where there is little or no commerce, or merely because it happens to lead to the country villa of the intendant of the province, or to that of some great lord to whom the intendant finds it convenient to make his court.”[69] Smith believes, though, that only canals should belong to individuals, both for accountability and as incentive to maintain the infrastructure in good condition, to reap a profit when the canal is paid for, and to avoid the loss of use of a canal if it is in a state of disrepair. Smith believes that a government official, who does not hold personal equity and interest in the canal would be less attentive to maintenance and upkeep.[70] Roads, however, Smith believes should be reserved to a group of trustees, rather than a private individual, because “the proprietors of the tolls upon a high road, therefore, might neglect the road altogether the repair of the road, and yet continue to levy very nearly the same tolls.”[71]
  A second component of the public works that Smith believes is a necessary role of government is the banking infrastructure. While a transportation infrastructure is certainly necessary for commerce, there are other requirements for stable trade. For this, Smith lists forts, garrisons, embassies and ambassadors, as well as a banking system. For these, Smith allows funding to be provided for by taxes, suggesting “a particular of so much per cent. upon the goods which they either import into, or export out of”.[72] A stable banking sector is also important to a commerce society, so much so that Smith explicitly allows them to be contained in a monopoly; their stability is crucial to providing credit, liquidity, and even acting as a lender of last resort to the government.[73]

Education
  Smith’s final role for the government is the education of youth. Smith, in examining the legacy of division of labor, has come to the conclusion that the division of labor has the effect of stifling the mind of a worker:
“The man whose whole life is spent in performing a few simple operations, of which the effects to are the same, or very nearly the same, has no occasion to exert his understanding, or to excuse his invention in finding out expedients for removing difficulties which never occur. He naturally loses, therefore the habit of such exertion, and generally becomes as stupid and ignorant as it is possible for a human creature to begin.[74]
  Despite the benefit of economic growth, stupidity, Smith states, is the natural consequence. Education of the youth, therefore, is the natural antidote for this consequence. Smith advocates for, at the very least, a national requirement to learn how to “read, write, and account”; Smith states that even those in the “lowest occupations” will have need for these skills, and that “for a very small expense the public can facilitate, can encourage, and can even impose upon almost the whole body of the people the necessity of acquiring those most essential parts of education.”[75]

On Public Debt
Throughout the Wealth of Nations, Smith constantly makes reference to debt. In the individual, credit is a method that industry uses to multiply and leverage its own buying power, and credit allows an individual to multiply his purchasing power – trading future labor for the ability to have now what he will have the money for in the future. Smith has repeatedly mentioned that in wartime, the sovereign of a nation must go into debt when the wealth of the nation runs short of cash to maintain its troops, as happened during the Seven Years’ War in the Americas – and that the American colonies had paid almost none of the cost. The debt of the government is properly called the public debt. Smith notes that prior to the advancement of Europe, national monetary policy was focused on the hoarding of money: “All the ancient sovereigns of Europe accordingly […] had treasures.”[76] With no luxuries or manufactures, forced savings was the effect; however, the rise of industry, advanced trade, and maintaining infrastructure increases expenditure to the level of revenue.[77] In wartime, rising costs bring already high expenses above the amount of income, necessitating sovereign debt to be incurred: “An immediate and great expence must be incurred in that moment of immediate danger, which will not wait for the gradual and slow returns of the new taxes. In this exigency government can have no other resource but in borrowing.”[78]
Easy access to credit enables the government to think of its credit as a part of its wealth and currency reserves, freely spending and not seeing the need to save.[79] However, when the credit markets freeze, and there is no more money to lend, the government returns to saving: “In such a state of things few people would be able, and nobody would be willing, to lend their money to government on extraordinary exigencies. The sovereign feels that he must provide for such exigencies by saving because he foresees the absolute impossibility of borrowing.”[80]
Smith cautions against the reliance on credit, and warns against thinking of credit as additional capital. Despite the role of credit in the short term multiplication of buying power, Smith sees that the government “does not consider that the capital which the first creditors of the public advanced to government was, from the moment in which they advanced it, a certain portion of the annual produce turned away from serving in the function of a capital to serve in that of a revenue”.[81]
Smith, foreseeing a problem not with borrowing, but with repayment, observes that whatever public revenue is collected, even after the imposition of further taxes, tends not to cover much more than even the interest on debt; further, Smith notes that the imposition of new taxes to pay the debts encourages evasive behavior, such as non-repatriation of money so that taxes are not paid.[82] Finally, between taxation and tax-evasion, there is the probability of removing money from the national money supply, which drains the wealth of the nation. By moving money from the many to repay creditors, the capital of industries and farms is reduced, and lessens the owner’s ability to expand and improve, further causing a decline in output, further draining the wealth of a nation.[83]
The only end to unchecked debt accumulation, Smith predicts, is bankruptcy:

When national debts have once been accumulated to a certain degree, there is scarce, I believe, a single instance of their having been fairly and completely paid. The liberation of the public revenue, if it has ever been brought about by bankruptcy; sometimes by an avowed one, but always by a real one, though frequently by a pretended payment.[84]

The only possible way, Smith states, of repaying the debt with a “pretend payment” is with a devalued currency. If the currency is worth less, the debtor is not paid on proportion, but on the fixed quantity; “A national debt of about a hundred and twenty-eight millions, nearly the capital of the funded and unfunded debt of Great Britain, might in this manner be paid with about sixty-four millions of our present money.”[85] When the value of the coin is worth so much less, and the cost of goods is constant, the value needed to purchase the goods is still fixed, and it is necessary to use more coin of the currency, which is again worth less – driving a cycle of inflation.[86]
With regards to the British debt of Smith’s time, Smith sees the British with two options: force the Americans to pay their portion of the accumulated debt, or divest itself of the colonies. With regards to the first suggestion, the colonies would surely revolt requiring another costly war, and without Britain’s “coercive power” holding the colonial factions at bay, the colonies would descend into “open violence and bloodshed.”[87] The second solution, “If it should be found impracticable for Great Britain to draw any considerable augmentation of revenue from any of the resources above mentioned, the only resource which can remain to her is a diminution of her expence.” [88] Smith, advises Britain to withdraw from the American colonies, precisely by letting go of the colonies, which continue to hemorrhage capital, and not to throw good money after sunken costs.[89]

Conclusions
  Smith’s model of societal development is a good generalization of the history of Europe, and the model seamlessly flows from the first to the next premises. Smith’s examination of individual development, from hunter, to barterer, to specialist in the division of labor – a salesman of his own wares, to the more advanced commerce consumer is well juxtaposed with the model of national development. A nation begins as a hunter-gatherer civilization – banded together of common clans, moves to an agrarian society where there is barely more than subsistence, to a commercial society that trades advanced industry for labor, labor for currency – and that currency for food. Once the nation is producing extra goods internally, their surplus may be sold to other nations. Smith would now say that the reliance and interdependence of trade brings peace, peace brings stability, and stability brings profit to all the nations involved. The only wars would be those of commerce, not arms; it would be the market, not the governments who would be the mediators and referees.
  It is in the last two pages of Wealth of Nations, that Smith hides his real advice for the sovereigns. The goal of Wealth of Nations, at the conclusion, seems to be an analysis of mercantilism, and an assessment of the benefits of this trade to Britain in comparison to the costs spent to maintain and hold the colonies. Smith was writing Wealth of Nations between 1773 and 1774, and was experiencing the same resentment the British populace felt. The British debt at that time explains the various taxes and tariffs on the colonies, and being used to low or no taxes for decades, then being forced to pay them, is what brought on the American War of Independence. As surreal as it is to read about New England when it was indeed new, when the Carolinas were just plantations and tobacco fields, and when New York was known for high wages of laborers, Smith delivers, nonetheless, sound advice from an economic perspective. Smith, wisely, knew that the best way for the British to benefit from the trade of the colonies was to stop paying for the living expenses of the colonies. An independent America would make the Americans responsible for their own defense, and wean them off the teat of their mother country, which was sucking British resources and wealth dry.

Modern Applications
Smith’s ideas of the effects of sovereign debt are still salient today, especially because of the ongoing global liquidity crisis. According to an article by Antonia Van de Velde, published on CNBC.com, titled Think BIIGS: There’s One Euro Country Under the Radar, Belgium is also facing an economic crisis. Belgium is unique among the troubled euro states today for two reasons: the first, that Belgium currently lacks a national government; second, that Belgian “public debt is just under 100 percent of gross domestic product”.[90] Essentially, Belgium is indebted to the world the entire sum of one year’s economic production; applying Smith’s ideas to Belgium, it is obvious that capital is being diverted from useful stock and productivity towards unproductive debt repayment.
  The Republic of Ireland is also in a crisis, now indebted to the entirety of the Eurozone and the United States; applying the ideas of Smith with regards to public debt: the Republic of Ireland must now pay a value that it cannot afford, with a currency it does not have, owing money to trade partners who are only concerned with their own national. Smith believed that the end goal of all public debt is bankruptcy or hyperinflation of the nation’s currency. A particularly relevant question is uncovered in this line of inquiry: what happens to the value of the euro as the countries that use it default at different times. Ireland cannot make pretend payment, as the result of the government increasing the supply of money without increasing real money, causing the value of the money to decrease. Since the other option is bankruptcy, what effect will a bankrupt Belgium or Ireland have on the value of the euro in the Netherlands, in France, in Romania? These are important questions for our time, and have been influenced, as well as informed, by these arguments of Smith.

[1] Smith, Book I, Ch. 1, p. 10
[2] Smith, Book I, Ch. 1, p. 10
[3] Smith, Book I, Ch. 1, p. 16
[4] Smith, Book I, Ch. 1, p. 16
[5] Smith, Book I, Ch. 1, p. 11
[6] Smith, Book I, Ch. 1, p. 11
[7] Smith, Book I, Ch. 1, p. 11
[8] Smith, Book I, Ch. 1, p. 11-12
[9] Smith, Book I, Ch. 2, p. 23
[10] Smith, Book I, Ch. 2, p. 24
[11] Smith, Book I, Ch. 2, p. 24
[12] Smith, Book I, Ch. 3, p. 28
[13] Smith, Book I, Ch. 3, p. 30
[14] Smith, Book I, Ch. 3, p. 30
[15] Smith, Book I, Ch. 4, p. 33
[16] Smith, Book I, Ch. 4, p. 33
[17] Smith, Book I, Ch. 4, p. 33
[18] Smith, Book I, Ch. 4, p. 35
[19] Smith, Book I, Ch. 4, p. 36
[20] Smith, Book I, Ch. 4, p. 37-38
[21] Smith, Book I, Ch. 4, p. 41
[22] Smith, Book I, Ch. 4, p. 41
[23] Smith, Book I, Ch. 5, p. 43
[24] Smith, Book I, Ch. 5, p. 45
[25] Smith, Book I, Ch. 5, p. 47
[26] Smith, Book I, Ch. 5, p. 48
[27] Smith, Book I, Ch. 5, p. 46
[28] Smith, Book III, Ch. 1, p. 486
[29] Smith, Book III, Ch. 3, p. 506
[30] Smith, Book III, Ch. 3, p. 505
[31] Smith, Book III, Ch. 3, p. 508
[32] Smith, Book III, Ch. 3, p. 511
[33] Smith, Book III, Ch. 3, p. 512
[34] Smith, Book III, Ch. 3, p. 512
[35] Smith, Book III, Ch. 3, p. 513
[36] Smith, Book III, Ch. 3, p. 513
[37] Smith, Book III, Ch. 3, p. 513
[38] Smith, Book III, Ch. 3, p. 514
[39] Smith, Book III, Ch. 4, p. 519
[40] Smith, Book III, Ch. 3, p. 521
[41] Smith, Book IV Ch. 7, p. 704-705
[42] Smith, Book IV Ch. 7, p. 704-705
[43] Smith, Book IV Ch. 7, p. 707
[44] Smith, Book IV Ch. 7, p. 721
[45] Smith, Book IV Ch. 7, p. 723
[46] Smith, Book IV Ch. 7, p. 723
[47] Smith, Book IV, Ch. 7, p. 725
[48] Smith, Book IV, Ch. 7, p. 742
[49] Smith, Book IV, Ch. 7, p.727
[50] Smith, Book IV, Ch. 7, p. 783
[51] Smith, Book IV, Ch. 7, p. 781.
[52] Smith, Book IV, Ch. 7, p. 796
[53] Smith, Book IV, Ch. 7, p. 796
[54] Smith, Book IV, Ch. 7, pp. 761-762
[55] Smith, Book V, Ch.1, Part I, p. 879
[56] Smith Book V, Ch. 1, Part I, p. 880
[57] Smith Book V, Ch. 1, Part I, p. 880
[58] Smith Book V, Ch. 1, Part I, p. 880
[59] Smith Book V, Ch. 1, Part I, p. 888
[60] Smith Book V, Ch. 1, Part I, p. 889
[61] Smith Book V, Ch. 1, Part I, p. 890
[62] Smith Book V, Ch. 1, Part I, p. 898
[63] Smith Book V, Ch. 1, Part I, p. 899
[64] Smith Book V, Ch. 1, Part II, p. 901
[65] Smith Book V, Ch. 1, Part II, p. 901
[66] Smith Book V, Ch. 1, Part II, p. 915
[67] Smith Book V, Ch. 1, Part III, p. 917
[68] Smith Book V, Ch. 1, Part III, Article I, p. 919
[69] Smith Book V, Ch. 1, Part III, Article I, p. 919
[70] Smith Book V, Ch. 1, Part III, Article I, p. 920
[71] Smith Book V, Ch. 1, Part III, Article I, p. 920
[72] Smith Book V, Ch. 1, Part III, Article I, p. 928
[73] Smith Book V, Ch. 1, Part III, Article I, p. 960
[74] Smith Book V, Ch. 1, Part III, Article I, p. 987
[75] Smith Book V, Ch. 1, Part III, Article I, p. 990
[76] Smith Book V, Ch. 3, p. 1155
[77] Smith Book V, Ch. 3, p. 1155
[78] Smith Book V, Ch. 3, p. 1156
[79] Smith Book V, Ch. 3, p. 1158
[80] Smith Book V, Ch. 3, p. 1159
[81] Smith Book V, Ch. 3, p. 1159
[82] Smith Book V, Ch. 3, p. 1181
[83] Smith Book V, Ch. 3, p. 1182
[84] Smith Book V, Ch. 3, p. 1184
[85] Smith Book V, Ch. 3, p. 1185
[86] Smith Book V, Ch. 3, p. 1188
[87] Smith Book V, Ch. 3, p. 1205
[88] Smith Book V, Ch. 3, p. 1207
[89] Smith Book V, Ch. 3, p. 1207
[90] Van de Velde, 2010
.

References

Smith, Adam. The Wealth of Nations. Edited by Alan B Kreuger. Translated by Edwin Cannan. Vols. Based on Cannan, 5th Edition, 1904. New York, NY: Bantam Books Publishing: Random House, Inc., 2003 (1776).
Van de Velde, Antonia. 26 Nov 2010. Think BIIGS: There's One Euro Country Under the Radar. Published on http://www.cnbc.com/id/40379099

Dean's List Fall 2010

2011-02-04T13:53:00.003-05:00

Dean's List Fall 2010

Final Grades for Fall 2010

2010-12-23T12:18:00.001-05:00

Fall 2010 Final Grades

On Adam Smith, Natural Rights, and the Theory of Moral Sentiments

2010-12-19T19:50:00.003-05:00

On Adam Smith, Natural Rights, and the Theory of Moral Sentiments

Eliyahu N Kassorla

Economic Principles of Adam Smith

W. Lesperance, Ph.D.

Introduction

Liberal theory predicts that the outcomes of social development are increased rights of the individual, an advanced economy, and a system of justice that protects property and rights. John Locke explains how these rights are derived, while Adam Smith explains how these are inevitable consequence of human development. The works of John Locke and Adam Smith have created and shaped our modern definition of liberalism, and their works overlap in scope. The concept of natural rights, as explained by John Locke, was a new principle within the Scottish Enlightenment period. John Locke explains how individuals derive their basic rights, and these notions of liberalism would later influence Smith, who explains the relationship of society to the individual and the economy. Through the pairing of the Locke’s Two Treatises of Government and Smith’s Theory of Moral Sentiments, the reader is exposed to the idea that man creates his own rights, and the rights are a natural consequence of human development and economic advancement.

John Locke, Natural Rights, and Individual Freedoms

Locke’s fundamental assertion is that mankind is born with irrevocable natural rights. Locke explains that the rights of a person are derived from nature itself, and that all men are considered “equal one amongst another without Subordination or Subjugation”[1]. Locke, however, rejects the notion that a “state of nature” is equivocal to a “state of license,” where Natural Law is consent to infringe upon other rights. Rather, Locke explains, “reason, which is that Law teaches all Mankind […] that being all equal and independent, no one ought to harm another in his Life, Health, Liberty, or Possessions”[2]. Life and health, Locke believes, is inherited from a divine origin, as is liberty. Liberty, Locke explains, is derived from a rejection that any human has dominion over another. Property, as the only tangible right, is made more valuable with the addition of personal labor, “for ‘tis Labour indeed that puts the difference of value on everything”[3]. “Thus labor”, being the only commodity that is innate to man, “gave a Right of Property, where-ever any one was pleased to employ it”[4].

John Locke, Natural Rights, and the Rule of Law

Law, Locke argues, is the method society uses to restrain others “from invading others Rights, and from doing hurt to one another, and the Law of Nature be observed which willeth the Peace and Preservation of all Mankind, the Execution of the Law of Nature is in that State, put into every Mans hands, whereby every one has a right to punish the transgressors of that Law”[5]. Societal punishment is intended to protect the rights of an individual, and discourage the violation of natural law. Violations of natural rights “may be punished to that degree, and with so much Severity as will suffice to make it an ill bargain of the Offender”[6]. Two fundamental powers exist in a “State of Nature”: “the first is to do whatsoever he thinks fit for the preservation of himself and others within the permission of the Law of Nature”, the “other power a Man has is […] the power to punish the Crimes committed against that [natural] Law”[7].

John Locke, Natural Rights, and the Social Contract

“But though Men when they enter into Society, give up the Equality, Liberty, and Executive Power they had in the State of Nature, into the hands of the Society, to be so far disposed of by the Legislative, as the good of Society shall require”[8]. The return, public good, must be greater than what is given up. Indeed, it is the Lockean assertion that the benefit of entering into the social contract is better than the individualistic anarchy of the state of nature.

Adam Smith and the Relationship between Natural Law and Collective Society

Since the origin and development of the model of natural rights has been discussed, we must move from the individual to the collective. While Locke discusses the value of trading individual rights for the collective benefits, Smith further observes that what is good for the individual is not necessarily good for the society, and that the good of society is composed of more than the sum of its parts[9].

When we are always so much more deeply affected by whatever concerns ourselves, than by whatever concerns other men; what is it which prompts the generous, upon all occasions, than the mean upon many, to sacrifice their own interests to the greater interests of others? […] It is reason, principle, conscience, the inhabitant of the breast, the man within, the great judge and arbiter of our conduct [10].

Smith begins framing his model of civil society by advancing the opinion that humans act out of self-interested motives, but societal structure is beneficial because of reciprocity. Smith argues that “by concerning what we ourselves should feel in the like situation […] we can form any conception of what are his sensations”^{^[11]}. This ability to imagine what others, in the same situation, would think or feel is termed “sympathy” by Smith. Sympathy, Smith regards, is the framework that provides each person with their natural rights, and provides the basis of personal interaction. Smith’s contention that were a man to lose his own little finger, he would display more sorrow than would be evoked by a calamity that decimated the whole of China, is both an example, and a reminder that man is fundamentally self-serving. While Smith understands “we are always so much more deeply affected by whatever concerns ourselves than by whatever concerns other men,” he believes that “Nature has lighted up in the human heart”[12]. Smith writes, “One individual must never prefer himself so much even to any other individual as to hurt or injure that other in order to benefit himself”[13]. This rule explains that the interactions between people rely on reciprocal sympathy. “Nature, too, had taught us, that as the prosperity of two was preferable to one, that many, or of all, must be infinitely more so”[14].

Adam Smith and the Origin of Sympathy

The psychology of humankind is primed to experience sympathy, empathize with another, and form a fair and equitable transaction. Were people to interact solely on the basis of self-interest, society would surely collapse. Smith finds this principle so fundamental to his system that Theory of Moral Sentiments begins with this thought: “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortune of others, and render their happiness necessary to him”[15].

Morality, Smith reasons, is the product of sympathy. Sympathy, then, is the expression of what a man wants done to himself, were he to find himself in the same or similar situation. The ability to abstract and infer the inner thoughts of the observed lays the basis of morality. The social contract requires that members of the society act towards the common benefit, thus requiring the ability to know what another person is thinking or feeling. When actions are consistent with the benefit principle, the actions are labeled as moral.

Smith takes a historical approach to understanding the origins of morality, and through an examination of the past, explores the development of human rights and economics in light of the historical evolution of humankind. Smith, a moral philosopher and observer of society and history, examines both the evolution of cultures and the origin of morality. Civilizations tend to begin as hunter-gatherer-type societies, then progress to herding animals, then discover agriculture, and, finally, engage in commerce. As a moral society, Smith believes, economic rights must be protected, as any other private property must. As the society moves from the primitive systems to commerce societies, individuals become further from their works of labor. End products, however, are still proxies for investment time and labor, according to the abilities and skill of the individual. Advanced commerce societies should protect individual property rights, recognizing that property is an abstraction of personal cost, despite being removed from the direct manufacture of a good.

Adam Smith, in his exploration in the growth of the economy, notes that:

[Among] civilized nations, the virtues which are founded upon humanity, are more cultivated than those which are founded upon self-denial and the command of the passions. Among rude and barbarous nations […] the virtues of self-denial are more cultivated than those of humanity. The general security and happiness […] in ages of civility and politeness, afford little exercise to the contempt of danger, to patience in enduring labour, hunger, and pain [16].

Adam Smith and Morality as a Function of Societal Development

With the growth of the economy comes the increase in moral behavior. Adam Smith believed that the economy drives innovation and industrialization, which makes what was once hard very simple, and that frees us to introspect and not be immoral out of desperation.

Every savage undergoes a sort of Spartan discipline, and by the necessity of his situation is inured to every sort of hardship. He is in continual danger: he is often exposed to the greatest extremities of hunger, and frequently dies of pure want. His circumstances not only habituate him to every sort of distress, but teach him to give way to none of the passions which that distress is apt to excite. He can expect from his countrymen no sympathy or indulgence for such weakness [17].

According to Adam Smith, less technical and less industrial societies, by their virtue of being less developed, have a more rudimentary value system. Smith, by examining the historical development of moral sentiments, elucidates his model of the development of rights. Smith argues that the development of morality is paced with the level of development of the culture. A savage culture, Smith argues, is “more occupied with their own wants and necessities to give much attention to those of another”[18]. Members of a primitive culture are expected to be self-reliant and strong, while sympathy is regarded as weakness. Natural law provides a savage society with protection of works of labor of each man, protecting individual property. Conversely, in a civilized society, where every want and need may be satisfied easily, with division of labor so advanced as to extricate a civilized man from his creations, self-denial and command of the basic passions are virtues expected[19].

Conclusion

The development of justice is a necessary and proper advancement of a society. “The wisdom of every state or commonwealth endeavours, as well as it can, to employ the force of the society to restrain those who are subject to its authority from hurting or disturbing the happiness of one another”[20]. Smith argues that there exists a universal standard of natural law, and that humans are bound to both live by and protect their natural rights. Smith was clearly influenced by the Lockean assertion that the protection of natural rights provides for a system of justice, which is an acceptable gain compared to the rights waived by submitting to justice.

Having a systematic justice system is the culmination of both moral and social development. An economic system that respects the rights of an individual is crucial to protections of private property, as Locke notes that products of labor contain the essence of the individual. As civilizations develop and progress, the relationship between person and property becomes removed, and the rule of law abstracts the value of labor for procuring property. The protections afforded to individuals under natural law are necessary preconditions for economic development, which drives social progress. In a self-reinforcing cycle, social progress drives further economic development. It is the prediction of Smith that social and economic development invariably leads to greater liberal freedoms, and that liberalism is the inevitable outcome of progress.

References

John, Locke. Two Treatises of Government Cambridge. 14th. Cambridge: Cambridge University Press, 2003.

Smith, Adam. The Theory of Moral Sentiments. 1st. Amherst, NY: Prometheus Books, 2000.

[1]Locke, p. 269

[2] Locke, pp. 270-1

[3] Locke, 296

[4] Locke, p. 299

[5] Locke, 271

[6] Locke, p. 257

[7] Locke, p. 352

[8] Locke, p. 353

[9] Smith, Part VI, Sec. 2, Introduction, p. 319

[10] Smith, Part III, Ch. 3, p. 193-4

[11] Smith, Part I, Section I, Ch. 1, p.3

[12] Smith, Part III, Ch. 3, p. 193

[13] Smith, Part III, Ch. 3, p. 195

[14] Smith, Part VII, Sec. II, Ch. 1, p. 403

[15] Smith, Part I, Section I, Ch. 1, p. 3

[16] Smith, Part V, Ch. 2, p. 297

[17] Smith, Part V, Ch. 2, p. 297

[18] Smith, Part V, Ch. 2, p. 297

[19] Smith, Part V, Ch. 2 , p. 297

[20] Smith, Part VI, Sec. 2, Introduction, p. 319

Summer Break

2010-06-10T16:32:00.001-04:00

Yes, Summer Break is here. That means it's time for a look back at my favorite posts over the past year!

Human Sexual Dimorphism
What I Learned: in this paper,I learned that almost every feature associated with behavior can be explained in evolutionary terms. Evolutionary psychology, while great on its own, REQUIRES evolution as its basis. The more I learn about either, the stronger the model gets. My goal of this whole blog was to integrate EVERYTHING I know into a large body of knowledge. In this paper, human behavior, human condition, human expressions, and human emotion are deftly linked to microbiology, climate, population size, and population genetics.

Microfinance
What I Learned: I have to say, when I first approached this assignment, I did not knw a lot about microfinance. I knew of many internartional organizations efforts to raise people out of poverty, but I had no idea how. This assignment taught me to really think about how economies of scale really work. Rather than just hand money to people, which removes the motivation to make their OWN money, you could encourage people to try and innovate. The inital cost of microfinance, and thereby the risk, is so small - a few cents here, a dollar there - that any failures, or defaulting debtors, is more than made up for by volume. I highly recommend The Blue Sweater: Bridging the Gap between Rich and Poor in an Interconnected World to anyone interested in international social justice or economics. This book, by the way, was really amazing.
Imagine what microfinance could do to the United States. - Imagine the amount of risk in the financial sector reduced. You would have credit lines for big things: houses, boats, refrigerators; but there could also be microfinance loans available to people: ten or twenty dollar short term loans, maybe a month. The more you borrow and repay, the more you can borrow. Instantly, a family of four who needs twenty dollars to afford food, or an hour of baby-sitting, or to pay for power after a heat wave, can borrow exactly what they need, and pay it off over five weeks, or one extra hour of labor a week for five weeks - because hourly wage is still the norm for struggling families. If they do default, there would be no expensive collections process, no harassing calls all day long - just termination of their ability to borrow until their debt is paid off!
This post went longer than I wanted it too, but I threw down a great idea.

CBT v. psychodynamics - what parts work
What I Learned: Psychodynamic therapies are amongst the most maligned in modern psychological models. And for good reason: there is evidence that Freud falsely represented his claims, Freud's beliefs were not supported by any evidence or scientific analysis, Freud attempted to abstract "the mind" into a model that does not reflect any Knowles of biology, &tc. But modern psychodynamic practitioners have developed treatments that, while still use Freud;s language and - however misguided - Freud's theory of cure, look and act like CBT. If I throw lithium into water, it's going to react whether I call lithium "bananas" or if I call the water "Ted" - it does not need me to react. The most important elements are: that the patient believe that they are being helped (subject-expectancy effect) and that behavior and feelings are changed. "That's how any therapy is gauged, by behavior change" - thank you Dr. Daniels, that was your statement. And just like a chemistry formula, you tell things to people in a certain way and they feel better. The whole point of the comparisons I did was to find out WHICH pieces work best, and not to do the pieces that either don;t work well or at all. It may seem obvious to do that, but as an outsider (because I've studies neuroscience, not therapy) it seems that there could be less "monolithic model" in therapy and more "modular modules" that are put together based on the responsivity of the patient (subject). An while I'm on the subject - write everything down that you do to a subject and gauge what works - and make use of the scientific method to assess how a patient (subject) is functioning.

Human Sexual Dimorphism in Biology, Neurology, Morphology, Development, and Behavior

2010-05-16T17:07:00.007-04:00

Eliyahu N. Kassorla

Evolution

Dr. D. Dunlop

Human Peacocks:

Human Sexual Dimorphism in Biology, Neurology, Morphology, Development, and Behavior

It is a truth, universally acknowledged, that recombinant genetics creates genetic diversity. The creation and elimination of organisms less adapted to their environment is a process known as natural selection. Sexual selection, a second process, describes the competition within species for access to mates. Most sexually reproducing species have a sex-determining system, and this system codes for different traits. In humans, the sex-determination systems are the sex chromosomes, named “X” and “Y”. Since any human will receive a copy of the X-chromosome from their mother, the Y-chromosome differentially codes for male, and thus sexually dimorphic, traits. Evolution has shaped the key differences between human males and females, and these differences will be examined through a literature review of biological, neurological, morphological, behavioral, and developmental human sexual dimorphism.

Biology: Hormones, Sex and Gender

The first piece of sexual dimorphism is biological and endocrinological. The article Hormones, Sex, and Gender (1995) by C. Worthman, discusses the effects of endogenous hormones on the human body, on gender-specific traits. The author defines hormones as “chemicals secreted into the blood stream at one body site that exert effects at a remote site” (Worthman, 1995, 594). Worthman relates the complexity of hormones, because “different functional domains of the body may make competing physiologic demands that are mediated through hierarchies of physiologic regulation largely negotiated by endocrine action. Worthman also states that not only does the endocrine system respond to genetic levels, according to natural variation, but that the endocrine system responses are experientially responsive. The author discusses the adaptive role of gender, stating that “sexual reproduction enhances genetic variability among progeny and thus their ability to meet variable selection pressures”, compared to asexual reproduction. The author states the evolution of gender has been successful, considering it exists in almost all higher organisms, and that gender must confer some fitness advantage (602).

The author describes three categories of sex difference, as proposed by Darwin. The first category is the primary sex features, or the features that are involved in reproductive acts, such as genital size or the length of the reproductive tract. The second category is the secondary sex features that enhance mating success, such as displays of fitness, like peacock feathers, bird songs, or moose antlers. The third categories are the ecological features, which are related to “sex-differentiated ‘habits of life’”, such as access to food, clothing, and shelter in humans (602).

The author also describes the interactional mechanisms of action of sex differentiation in response to hormones, primarily estrogen and testosterone. A gene, known as TDF, or testis determining factor, is on the Y-chromosome, and this gene is responsible for triggering the testosterone cascade and masculinizing the embryo (604). The TDF gene is counterbalanced by the estrogen produced by the placenta, which explains the need for males to produce testosterone in amounts similar to an adult level, both in-utero as well as during the twelve weeks after birth (605). The next time the male child produces large amounts of testosterone is in the puberty phase, which is responsible for inducing male primary sex differences (605). In female fetuses, as well as recently born female babies, there is a similarly high level of estrogen, in cooperation with the mother’s placental estrogen (605). The authors summarize that “the [sex differentiation] process involves prolonged, complex developmental sequences coordinated among multiple axes… [and the] action of any hormone is variable and mediated, not intrinsic” (606).

Neurology: Associated Cortical Regions Are Proportionally Larger…

The second component of human sexual dimorphism is neurological. In an article by Harasty, et al., Language-Associated Cortical Regions Are Proportionally Larger in the Female Brain (1997), the authors assess the brains of 21 subjects free of neuropathology. This included a sample of ten males and eleven females. The brains were weighed at autopsy, fixed in formaldehyde, and sliced in coronal slices. The authors specifically discuss the findings as they relate to the areas known for language acquisition, production, and meaning. They find that female speech is “less dependent of the left hemisphere” and female visuospatial functions are “less dependent on the right hemisphere” (Harasty, et al., 1997, 171). The authors compare these findings to previous findings that females perform significantly better on tasks of verbal fluency and verbal memory.

The authors also report that the mean female brain has larger proportions of grey matter in the dorsolateral prefrontal cortex, known is neuroscience as Broca’s area, which is responsible for speech production (172). Females also have more grey matter in the superior temporal gyrus, an area known as Wernickie’s area, which is responsible for language understanding (172). The authors note that both this morphological study as well as previous fMRI studies reveal that females are also extremely bilateral in these areas; the extent of male bilateralism are very small areas in the non-dominant hemisphere, opposite the normal sized area in the dominant hemisphere (174). The authors state that, relative to weight and size, females have 20.4% larger Broca’s areas than males, as well as 13% larger Wernickie’s area (174).

Morphological: Waist-To-Hip Ratio across Cultures

The third component of human sexual dimorphism is morphological. In an article by Cashdan, Waist-To-Hip Ratio across Cultures: Trade-Offs between Androgen- and Estrogen-Dependent Traits (2008), the author describes the female waist-to-hip ratio (WHR). The author states that previous studies have declared a WHR of 0.7 as ideal “or even lower”, because of the low risk of cardiovascular disease and high probability of conception (Cashdan, 2008, 1099). The author notes that “low WHR signals both fertility and good health” (1099). Across human cultures, however, this ratio varies, but not because of modern diets or obesity. Rather, it is an interaction between genetics and environmental pressures that interact and influence the WHR.

The author uses compiled data from the World Health Organization, and analyzes the body mass index, WHR, ethnicity, and geographic location to analyze the scarcity of food. The author found no significant correlation between WHR and BMI. The question the author asks is: what are the advantages of a high WHR to the success of mating or producing healthy offspring. The author proposes that there are reproductive benefits in a high WHR, despite the negative health effects (1099). The authors propose several hypothesis, the first being a “better adaptation to cold”, as well as protection against fluctuating food sources (1101). The author notes that in societies with unstable food sources, and where females need to do most of the food procurement and child supporting, a high WHR is beneficial. In these societies, “women must work hard to support their children, compete directly for resources with them, and cope with resource scarcity”, and that “rarely can a woman depend solely on an investing man or even other allomothers to do this for her; she must also depend heavily on her own competitive efforts” (1101). The author describes these reasons why a higher than optimal WHR may be advantageous, and her hypothesis is:

In societies where women are expected to provide most of the food, through hard physical work and in difficult environmental conditions, the balance should be tipped in toward a hormonal profile consistent with a high WHR. In more benign conditions, where women are sedentary and get most of their resources from investing men, a hormonal profile consistent with a low WHR may be adaptive. (1102).

Cashdan discusses key hormones involved with the WHR, which are cortisol, androgens, and estrogens. The author states that approximately 70% of these hormone effects are environmentally dependant (1102). The author discusses the physiological effects of each hormone. Cortisol, a key stress hormone, decreases the levels of leg and thigh fat, and increases the level of visceral fat (1102). This is adaptive because it shifts energy from storage sites to the bloodstream; it moves fat deposits away from a position ready to support a growing fetus to a source that is more easily used for the mother. “The accumulation of visceral fat under stress, therefore, is likely to be adaptive in stressful, dangerous environments and in environments where food abundance is variable” (1102). Further, when all of a mother’s offspring are outside of her body, but still needing care, the success and survivability of her offspring are dependent on her continued maternal care. The hypothesis here is that increased levels of visceral fat, and thus cortisol, increases survivability in societies with variable levels of food or high amounts of environmental stressors and environmental pressures.

Androgen effects, Cashdan describes, are the increase in competitive behaviors, drive, motivation, and energy. The author notes that women with high WHR have “more free testosterone” and “less sex hormone-binding globulin (SHBG) the protein that binds to testosterone [in females] and keeps it biologically inactive” (1102). The hypothesis proposed here is that a higher WHR, and thus higher amounts of androgens, is an adaptive trait that is useful “when a woman must depend on her own resources to support herself and her children” (1102). Additionally, androgens promote visceral fat storage in females, lending weight to the previous two hypotheses taken together.

The effect of estrogen on the female body decreases visceral fat, increases leg and thigh fat, and prepares the female body for carrying a child. Estrogen levels facultatively decrease in response to “negative energy balance, physical activity and stress [which are] circumstances that favor deferring fertility” (1103). The hypothesis stated here is that when there are environmental stressors or extreme environmental pressures, the ability to conceive and bear offspring is reduced. The fact that females are disproportionately invested in their offspring indicates that this process is evolutionarily adaptive in increasing maternal survivability and, by extension, her current offspring.

Behavioral: An Evolutionary Perspective of Sex-Typed Toy Preferences

The fourth component of human sexual dimorphism is behavioral. Behavior, however, operates within a biological framework, and so must be explained with biology and evolution. In An Evolutionary Perspective of Sex-Typed Toy Preferences: Pink, Blue, and the Brain (2003), G. Alexander discusses the retinal ganglion cells, their relation to gender, and the types of toys children play with. Alexander rejects social learning theories, and instead describes the effects of hormones on physiological systems (Alexander, 2003, 8). Alexander states that the processes of sex-differentiation creates sexually dimorphic behaviors, and that “experimental manipulation of gonadal hormones [by castration or injection] during nonhuman development shows unequivocally that hormone-dependent masculinization of the brain increases the frequency of subsequent rough and tumble play” (8). Alexander furthers this statement by noting that girls with congenital adrenal hyperplasia, a disorder characterized by increased levels of androgens, show greater levels of aggression, enhanced visuospatial abilities, increased male-typical occupations, and a greater tendency toward “bisexual or homosexual orientations in fantasy and/or behavior” (8).

Alexander describes female-typical drawings: form, color detail, and faces; and relates them to toy preferences. Females, Alexander states, prefer toys that embody these four things (9). Male-typical drawings include motion, movement, and spatial orientation (9). Alexander relates these dichotomous features to neurological and physiological pathways in the brain and how information is processed. There are two main types of retinal ganglion cells, the cells that combine and send stimulation from rods and cones to the visual cortex, and these two types have direct connections to the processing areas.

The first pathway is the M-Cell pathway, which corresponds to the magnocellular retinal ganglion cells. The M-Cell pathway codes for spatial location and visual scenes, and testosterone is implicated in increasing the proportion of M-Cells in the male retina (10). Males, along with androgenized females, have more M-Cells, have more matter in the dorsal parietal lobe, which is responsible for the processing of M-Cell input, and do better on motion and visual tasks (10).

Females, comparatively, have more of the other main type of retinal ganglion cell, the parvocellular cells. The P-Cells code for object recognition, detail, and color, and are processed in the inferior temporal lobe. Females, as well as estrogenized males, have a greater proportion of P-Cells compared to M-Cells, and thus have more brain matter and regions associated with this function (9).

Alexander relates previous comparative genetic studies indicating that the genes that code for the M-Cell pathway is evolutionarily older, and also codes for the colors blue and yellow (9). Further, Alexander notes that genetic analysis has shown that the M-Cell pathway is carried on an autosomal gene, and is thus not sex-linked (11). This corresponds to the sun and the sky, an important distinction in a diurnal species. Alexander also notes that the P-Cell pathway is newer, codes for the colors red and green, and its presence in humans and nonhuman Old World monkeys implicates its role in finding ripe fruit in a dense layer of foliage (10). However, the P-Cell pathway is carried on the X-chromosome, giving females two copies of this color coding gene. The implications of this finding is also addressed, finding that males are more likely to have color-blindness, and that the continued existence of this defective X-chromosome may have adaptive significance (11). The conclusion Alexander draws is that color-blindness is adaptive for detecting “texture and color camouflaged objects” and “evading predation” (11). A crucial tenant of evolution is that natural selection eliminates unfit individuals, or organisms poorly adapted to their environment, so any conservation of a trait in the genome must have adaptive value (11). Since males, in evolutionary history, tended to be hunters rather than detail oriented foragers, color blindness and visuospatial acuity is beneficial; likewise, for females, who tended to be foragers rather than hunters, the ability to distinguish subtle shade variations in berries, tubers, and plants provided protection against toxicity (11). Further, females’ ability to distinguish subtle differences in color, shade, and hue may have also been beneficial in detecting the health of their offspring (11).

Clearly the effects of androgens, which are produced in the gonads, are not confined to genitalia, but also have effects on the physiology and neurology of the brain and sensory systems. Alexander notes that the retina has estrogen receptors, and the post-natal surge of androgens is implicated heavily in the more masculine-typical visual abilities. The testosterone surge nurtures the M-Cell pathways and primes the male or androgenized female for motion and movement. A female post-natal surge of estrogen is implicated in the increase in the ratio of P-Cells, which prime the female infant, or feminized males, to be more receptive to color, detail, and form (9). Alexander states that “this visual bias at birth ensures that developing cortical circuits are preferentially exposed to faces, which provides the necessary learning experiences that shape the further development of cortical brain areas specialized for face-identification” (10). Alexander is stating a well known principle of human development: the structures already exist in the brain, but are experientially-dependant for the proper functioning in the brain. The brain is born with more circuits than necessary, and a pruning process takes effect to eliminate redundant pathways, as well as make the pathways more specialized. Infants just a few weeks old move their entire body when trying to move their hands, but proprioception develops quickly as the specialized pathways are laid down; by six months an infant can move their limbs independently. This is credited to the strengthening and specialization of pathways from the motor cortex to spinal cord, and then to the correct muscle.

Alexander states, “sex-dimorphic visual preferences consistent with M-Cell or P-Cell processing efficiencies precede experience with gender linked preferences” (10). Further, Alexander states that “neonatal visual preferences support the hypothesis that androgens may initiate the specialization of visual pathways that contribute to visual biases for object movement or form/color” (10). Alexander seems to be indicating that social learning theories are likely incomplete or wrong. Alexander infers that biological fact is more parsimonious than the contrived social learning theories, and that biology has more explanatory power (12). This model is consistent with both human infant studies, especially using the preferential looking technique, as well as nonhuman primate toy play (12).

Developmental: Evolution and Developmental Sex Differences

The last piece of the sexual dimorphism puzzle is the development of sexual characteristics. In an article by D. Geary, Evolution and Developmental Sex Differences (1999), Geary explains how sex-specific traits develop. Geary states that childhood is the time when future adult behaviors are refined (Geary, 1999, 115). Geary, like Alexander, rejects the social learning theories, and instead supports an evolutionary explanation. “From an evolutionary perspective, cultural and ecological factors are expected to influence the expression of developmental sex differences” (115). Geary compares human childhood to animal maturation periods. “Females typically choose mates on the basis of indicators of physical, genetic, or behavioral fitness … on the basis of traits that signal a benefit to them” (116). Geary uses the example of the “long and symmetric male hummingbird” as a trait that advertises genetic and reproductive health. Geary compares childhood to the period that juvenile male Bower birds spend observing older males building their bowers, learning how to attract females from the previous generation (117). This is a nonhuman example of how culture is acted upon by evolution and natural selection.

Geary compares the competitive nature of both males and females. Males compete over resources: food, money, status, and property. Females tend to compete with each other for paternal investment, and do so by “relational aggression. They [females] gossip, shun, and backbite their competitors” (117). This is inferentially related to the bilateral female language areas. Curiously, when females fight over a potential male, they utilize terms and phrases that indicate that a male should be wary of assured paternity; when men verbally compete for the affections of a female they question the ability of their competitor to provide resources (117-118). Geary notes that males by the age of three are already engaged in “rough-and-tumble play … six times more frequently than groups of girls do” (119). Geary also describes the group-level cooperation play that male children engage in, known as team sports. Geary hypothesizes that these are evolved tendencies to engage in male-male competition, as well as group hunting tendencies (118). Differences in the social development of males and females, Geary notes, are also seen in chimpanzees, and is very likely that “these are indeed evolved tendencies in humans” (118). In female group interactions, females show “greater empathy; more concern for the wellbeing of other girls; and more nurturing, intimacy, and social and emotional support” (118). Geary states that the social behavior of men is “focused on achieving status and dominance and developing coalitions for competing against other groups of boys”, while females behavior is “focused on developing and maintain a network of personal relationships and social support” (118). Geary’s conclusion is that childhood is the time where children practice their competition and cooperation (118).

Geary further notes that the aggressive play that male children engage in increases their endurance while decreasing their sensitivity to pain (119). Cultural norms discourage males from expressing pain, which is likely an evolved tendency that increases the ability of males to be better hunters (119). In cultures where there is no limit to harem size, male competitive behavior increases and becomes more aggressive (119). The reverse is also true, that the more monogamy is encouraged, the more the competition takes on token or symbolic meaning (119). In females, there is also a divide based on cultural factors: in cultures where females can hold power and are encouraged to be independent and self-reliant, the less “obedient, more aggressive, and more achievement oriented” the females become.

Testosterone: Testosterone and Men’s Depression, Influences of Serotonin and Testosterone

The primary male hormone is testosterone, with males producing seven times more testosterone than females (Booth, 1999, 130). Booth, et al. in Testosterone and Men’s Depression: The Role of Social Behavior (1999), the authors describe the relationship to losing struggles for dominance and the decrease in testosterone levels (138). This article studies the association between testosterone levels and depression levels (132). . The authors utilized a sample of 4393 males who performed only one term in the Army, with a mean age of 37. The sample was drawn on the inference that men who served in the military already had higher testosterone levels, and that the higher levels would display a larger effect size. The authors discovered a significant effect size (137). Lower levels of testosterone are implicated with higher levels of depression, while high testosterone males had reduced levels of depression. Average level testosterone males had the largest effect size, which the authors link to the increased antisocial and risk taking behaviors of the males with increased levels of aggression (138). One of the authors, Booth, cites his previous study relating testosterone and aggression levels, along with his findings that lower status individuals show more signs of stress and lower serum testosterone levels (139).

Further, an article by P. Bernhardt, Influences of Serotonin and Testosterone in Aggression and Dominance: Convergence with Social Psychology (1997), discusses the role of testosterone and serotonin in mediating aggression. Bernhardt extricates aggression from hostility and anger (Bernhardt, 1997, 45). Aggression, Bernhardt states, is a tool used to attain dominance (45). In this article, Bernhardt quotes his almost impossible to get article, Testosterone changes during vicarious experiences of victory and defeat in spectators of sporting events (1997), by noting the “connection of testosterone to status (and presumable feelings of dominance) without the presence of aggressive acts can also be seen in studies of [sports] fans” (46). The evolutionary explanation predicts correctly the findings that levels of serum testosterone in males are higher when the supported team won, and lower when the supporting team lost (46). The visual system evolved before sociality, and before sports, and thus the prediction is that when seeing aggressive acts take place, there is a neural mechanism that primes the individual for engaging in aggression (46).

Bernhardt quotes a rat study where dominance behavior was elicited with intramuscular injections of testosterone and serotonin, while an injection of serotonin agonists mitigated the effects of the injected testosterone – “returning the rats to a non-dominant status” (46).

Bernhardt hypothesizes, and correctly since the 13 years since publication, that the responsible structures in the brain are the amygdala and hypothalamus (47). The amygdala responds to testosterone by increasing activation, which increases aggressive output (48). The hypothalamus mediates the activity of the amygdala, preferentially responding to serotonin to lower aggressive output (48). Further, studies with low serotonin animals have shown them to be “hyperresponsive to aversive stimuli”, reinforcing the connection of testosterone with aggression (48).

Conclusion

Human sexual dimorphism is expressed more complexly than in other animals. The many gender specific attributes are interactional. Many of them have implications on human culture and human behavior, but their value is in understanding their root cause. Human behavior, in order to make sense, must be examined in light of evolution and biology. Evolution has created and forged the gender differences to what we see today, and society is a construct of our biology. Without our biology, our adaptations through hundreds of thousands of years of natural selection, sociality could not be possible. The way humans express their behavior today is a direct reflection on environmental and selection pressures in the past. The male advantage in visual acuity, the high rate of color blindness in men, and the role of aggression and male-typical behaviors all have added to the survival of the human species, Homo sapiens sapiens. Hunting, killing, fighting, these are all things that have fitness advantages for males. Common features in most sports that are male-dominated involve acts that rely on physicality and motion. Baseball, basketball, football, lacrosse, and soccer all rely on individuals on opposite teams competing, individuals on the same team cooperating, and one team emerging victorious. Studies in psycho-endocrinology have revealed that males who engage in sports have higher serum testosterone, and increases when they win (Bernhardt, 1997, 46). Combined with the Alexander article, the inference that can be drawn is that male play styles mimic hunting, using the weapons of the day – whether it is an arrow or a gun is irrelevant, what is important is the child understands what the object does – practicing for killing their food, and that evolution forged these activities to be fun for children. These play styles activate and strengthen the pathways that code for motion and spatial arrangement so that through play, the child practices the activities that his ancestors needed to be good at for survival.

Females, as evolution has forged them, are typically weaker, physically, than males. Their contributions, from an evolutionary standpoint, are the typical home and hearth cultural norms. Females raise children, rear them, and give them the best chance of survival that they possibly can. The female advantage in color, object perception, and sociality are also reflections of our evolutionary past. According to Alexander (2003), the early role of females tended to be in foraging nuts, berries, tubers, herbs, plants, and child rearing (Alexander, 2003, 11). Because of the need to discriminate between toxic plants and non-toxic food, females have evolved the neuronal and physiological structures associated with object discrimination and color perception. Additionally, while males were on hunting parties, females tended to stay at the campsite together, where their cooking and child-rearing took place. Because of the need for cooperation and coordination required for communal living, females have undergone selection pressure to increase their ability to produce and understand complex social language, as well as non-verbal behaviors (Harasty, et al, 1997, 175). Further, the female infant preference for faces strengthens the area in the fusifom facial area, allowing females to discriminate subtle differences in facial expression. In combination with the enhanced female perception of color, females are regarded as superior in understanding and empathizing with other’s emotional states (Alexander, 11-12). . Alexander also reveals that female children also play with their toys as if they were offspring. In combination with studies that reveal that female monkeys who engage in this type of play have lower infant mortality rates, this play is interpreted as practice for future offspring.

The complex interaction between biological, neurological, and evolutionary forces maintains the differences in males and females. While not as striking as a peacocks tail, the male and female differences all contribute to survival and reproductive advantages. No doubt exists that natural selection and sexual selection together have equipped each gender with the tools they need to be successful. In an evolutionary perspective, success is not measured by survival and offspring. Rather success is measured in grandchildren – because your experiment, the F2 generation, was adapted well enough to survive and pass down their genes. That is the goal of every organism.

References

Alexander, G. M. (2003). An evolutionary perspective of sex-typed toy preferences: pink, blue, and the brain. Archives of Sexual Behavior, 32, 7-17.

Bernhardt, P. C. (1997). Influences of serotonin and testosterone in aggression and dominance: Convergence with social psychology. Current Directions in Psychological Science. 6:2, 44-48.

Booth, A., Johnson, D., Granger, D. (1999). Testosterone and men’s depression: The role of social behavior. Journal of Health and Social Behavior. 40:2, 130-140.

Cashdan, E. (2008). Waist-to-hip ratio across cultures: trade-offs between androgen- and estrogen-dependent traits. Current Anthropology, 49(6), 1099-1107.

Geary, D. (1999). Evolution and developmental sex differences. Current Directions in Psychological Science (Wiley-Blackwell), 8(4), 115-120.

Harasty J., Double, K. L., Halliday, G. M., Kril, J. J., McRitchie, D. A. (1997). Language-associated cortical regions are proportionally larger in the female brain. Archives of Neurology, 54:171–176.

Worthman, C. M. Hormones, sex and gender. Annual Review of Anthropology. 24, 593-617.

Final Grades are IN

2010-01-21T11:37:00.002-05:00

Yes, Pilates is the reason I did not get a 4.0

Dean's List

2010-01-14T12:46:00.001-05:00

Fall 2009 Dean's List

There's plenty here for everyone!

2009-12-17T13:18:00.000-05:00

This semester I took 3 academic classes.

Global Social Problems
Abnormal Psychology
and
Philosophy and Star Trek

Since Philosophy and Star Trek was a 100-level throw-away class, intended to round out my schedule after two years out of school, I won't be uploading those papers.

Included here, though, are the papers I am most proud of, mostly psych and political science.

Enjoy!

The Genocide in Darfur

2009-12-16T14:19:00.006-05:00

The assignment: Desribe the genocide in Darfur, including the major players, to someone with no knowledge of the situation.
The book: Not On Our Watch, by Don Cheadle and John Prendergast

Eliyahu N. Kassorla

Global Social Problems

C. Dale, Ph.D.

Darfur: A Brief Explanation

There is a country in Africa named Sudan. Sudan is independent now, but it was not always. The age of imperialism brought the Egyptians the north, and the British to rule the south. The Egyptians instituted Muslim rule and encouraged the spreading of Islamic values. The Egyptians were neglectful of the region of Darfur, and funneled their support and resources to the Arab north. The British, in control of the south, were also neglectful of the Darfur sultanate, devoting resources to the southern ports. The British did institute many reforms, including making English the official language and increasing the activity of Christian missionaries, to reduce the Islamic influence (53). Additionally, the northern-Sudanese are ethnic Arab, while the southern Sudanese are ethnic African (52).

As time progressed, the northern and southern halves of Sudan drifted apart and became very different. When the British withdrew after World War II, they left control and rule of south Sudan to the elites of north Sudan. Two years later, conflict began when General Ibrahim Abboud began violently proselytizing Islam in southern Sudan. This Islamisation triggered the first of many conflicts, using religion to justify mass murder and wanton human destruction. The Muslim north is very intolerant to non-Muslim beliefs and religions, and this immediately led to rebellion in the non-Muslim South. This conflict later took over baggage from the United States and Soviet Union, each attempting to win their ideological battle during the Cold War era. The Soviet Union regularly sold weapons to the north Sudanese, arming the militant Islamist government. Other governments armed the south Sudanese. After a failed military coup in the north, however, the north and south signed a peace agreement in 1972 (54). Nearly four years later, another Islamist dictatorship emerged. In 1983, the government ordered the southern Sudanese soldiers to abandon their weapons. When the soldiers refused this order, the northern Sudanese army was sent to attack, and the south Sudanese sought refuge in Ethiopia (56). Islamists, acting under the National Islamist Front, continued to enact laws demeaning the non-Arabs, such as declaring Arabic the official language, or imposing Islamic law (56-58). Three southern rebel groups emerged, the Justice and Equality Movement, Sudan People’s Liberation Army/Movement, and the Sudanese Liberation Army. In 1991, the Sudan People’s Liberation Army entered Darfur to spread pro-southern rebellion. In retaliation, northern forces burned dozens of villages.

All of these conflicts left Darfur underdeveloped, and the tribes of Darfur blamed the Arabs. Darfur is home to about eighty tribes, some of which are the Fur, the Masalit, and the Zaghawa. Further, the northern policies left Darfur with many displaced persons. To escape the conflict, many of the displaced persons crossed the border, in to Chad. Northern Sudanese were responsible for abduction and impressments into slavery of the Darfur people. These slaves were forcibly converted to Islam and denied education (61). Northern Sudanese were also responsible for 550,000 deaths by starvation (61). The Janjaweed, pro-Islamic-Arab mercenaries, continued to burn homes, mass killings, looting, rapes, and aerial bombardment of villages of non-Arabs (71).

Additionally, because of the famine, many more people died. Darfur is home to many nomadic tribes who depend on livestock for their sustenance. The encroaching desert reduced the grazeable area and the available water, leading to dramatic decline in the ability of the people of Darfur to provide food. Compounding this, the widespread theft of livestock by Janjaweed, as well as poisoning of the wells, left even more to starve (76). The north controlled government also diverted humanitarian aid, further compounding the starvations (77). Between 2003 and 2004, the northern Sudanese government impeded, and essentially blocked, international aid workers, relief supplies, equipment, and medicines (82). Further, the northern Sudanese government denied the ability of aircraft to fly the humanitarian aid (82). Further, upon arrival of aid workers to Sudan, on visas that were extremely difficult to obtain, the north Sudanese government further required the aid workers to attain travel permits to go to Darfur (83).

Although the conflict is seemingly complicated, one unalienable truth rings loud: it is unquestionably wrong to intentionally target non-combatant civilians, women and children. The goal of every civilized human being must be the extermination of any practice which contributes to the intentional destruction of innocent and non-combatant human life. Darfur is just one in a long list of conflicts intended to deprive persons of their inalienable, and Lockean, natural rights.

The Genocide in Rwanda

2009-12-16T14:16:00.004-05:00

The Assignment: Describe the genocide in Rwanda, identifying the major players, to someone who has no knowledge of the situation.

Eliyahu N. Kassorla

Global Social Problems

C. Dale, Ph.D.

Understanding Rwanda

It is a sad fact that the majority of people believe that the last of the genocides ended in 1948. World War II had concluded and the Nuremberg Trials reflected our evolution into a more evolved species. It is therefore no great surprise that the world was inactive when, in 1994, the Rwandan government began to systematically target and destroy the Tutsi.

In Rwanda, there are two primary ethnic groups: the Hutu and the Tutsi. The first tensions were laid down in 1990, when the Tutsi invaded Rwanda from Uganda, under the auspices of the Rwandan Patriotic Front (RPF) (Novogratz, 148). This group was composed of the displaced Tutsi of a previous attempt to exterminate the Tutsi. The government of Rwanda, dominated by the Hutu, attempted to fight back, but had not achieved a decisive victory against the RPF. “This marked the beginning of fear. And with fear began the disinformation campaigns, the lying, and the manipulation by Rwanda’s leaders to instill even more defensiveness–and paranoia […] For the next five years, the questions would be asked [… a]re you a Hutu or a Tutsi?” (Novogratz, 149).

In 1994, the plane of Rwandan president Habyarimana, with Burundi president Ntaryamina – a Hutu – onboard, was shot down outside Kigali International Airport. The government both attributed the attack to the Tutsi, and began to speak openly about extermination of the Tutsi. Almost immediately, the already strained Arusha Accords were, in effect, nullified, and the RPF stationed in Kigali were fired upon. “All across the country, government officials were whipping up the populace with a paranoid torrent of words [, …] the message was consistent: The Tutsis had invaded Rwanda to regain power and subjugate the Hutus. [… O]rdinary Rwandan citizens resorted to murdering their neighbours, cheered on by local authorities” (Novogratz 150).

The Interhamwe, along with the Impuzamugambi, were two violent militia groups. They were responsible for most of the violence in the Rwandan genocide. Both groups included youth wings, employing child soldiers to commit grave atrocities to human life. The Interhamwe and Impuzamugambi organized marches on the street declaring the Tutsi “inyeni,” or cockroaches, to galvanize support for their agenda of wanton murder. There is no question that support for these groups came directly from the Rwandan government. Both the government and these groups adopted the idea that both the Tutsi and moderate Hutus, including those who refused to participate in the slaughter of the Tutsi, must die. “The government’s grand plan was to ensure the collective guilt of every Rwandan, while exterminating every single Tutsi and moderate Hutu” (Novogratz, 151).

The government of France cannot be held blameless. Rwanda was a French colony, and Uganda a British colony. When the RPF crossed the border from Uganda, the French supported the Hutus against what they believed to be was an English plot to disrupt French influence. Further, many crimes of murder and rape occurred in the French held areas in Zaire. Further, France continued arms shipments in to Rwanda before the genocide, in violation of the Arusha Accords, arming the Hutus to the teeth.

The government of the United States, bogged down in bureaucracy, was also slow to react. Though the genocide began in April, government officials would not use the term genocide until May.

The United Nations is also a major actor who shares the fault. Their unbelievably slow response to the killings is a major reason that the genocide continued. Despite a UN presence, the peacekeeping force was prohibited from using their weapons. The lack of investigation into the genocide allowed it to continue. The UNAMIR, or United Nations Assistance Mission for Rwanda, was not a peacekeeping force; rather it was a spectator to the violence. Unclear of their mission and their mandate, the UNAMIR troops did nothing to stop the violence from spreading. Belgum, previously a member of UNAMIR, recalled their forces, leaving the remaining 270 soldiers impotent to stop the widespread massacres around them. Since the end of the 100-day genocide, UNAMIR, however, has been recognized for saving the lives of thousands with humanitarian aid.

Human Trafficking - The Underground Human Slave Trade

2009-12-16T14:13:00.000-05:00

The film: Human Trafficking
The assignment: What are your reactions to the film?

Eliyahu N. Kassorla

Global Social Problems

C. Dale, Ph.D.

Reaction to Human Trafficking

The film Human Trafficking explores the complicated web of the world of illicit human trafficking, their sale and exploitation in bondage. The film follows several victims, Nadia Tagarov and Helena Votrubova from the former Soviet Union, as well as Annie and her mother, Samantha Gray; victims from closer to home: Unites States citizens.

I felt that the film did an excellent job of portraying the struggle between crime syndicates and law enforcement officers. From the beginning, in discovering the death of an illegal immigrant, there was a constant cat-and-mouse game of finding the Mafia’s safe houses, keeping the women segregated, locking the doors from the inside, and keeping the women silenced. This maltreatment for women, as well as a constant recruiting, reinforces the belief that these women are expendable.

Another struggle portrayed is getting witnesses to testify. Helena, fearful of her daughter’s safety, negotiates with the Immigration and Customs Enforcement. She will testify if her mother and daughter are bought to the United States, away from the close reach of the Russian Mafia. When Helena’s location is discovered and she is killed, the other women do not want to cooperate with the ICE investigation – they do not want to die like Helena.

Annie Gray, a victim taken while vacationing in the Philippines, is a normal vacationer. While millions of people go on vacation every year, none expects an innocent weekend getaway to become a hunt to find a loved one. Samantha Gray, Annie’s mother, franticly searches for her daughter. Annie’s impact is that she shows us that it’s not just a problem in a far-away locale, but a problem that is far too easy to stumble into.

Life and Debt - Jamaica and Global Debt

2009-12-16T14:06:00.004-05:00

The film: Life and Debt
The Assignment: According to the film, answer these questions:
1. Why is Jamaica in poverty
2. What keeps Jamaica in poverty
3. What are the barriers that hinder Jamaica's elevation from poverty?
(Click to open - the original Word file has been destroyed by a catastrophic hard drive failure)

Global Social Problems - The Blue Sweater and Microfinance

2009-12-16T13:56:00.006-05:00

The book:The Blue Sweater.

The assignment: Describe what the book is about, and how does the author aim to fix poverty?

(Click to open - the original Word file has been destroyed by a catastrophic hard drive failure)

Exploration on the Efficacy of CBT and Psychodynamic Treatment Models for PTSD

2009-12-16T13:27:00.006-05:00

The assignment: Pick any mental disorder from DSM-IV-TR and evaluate the literature to answer a question.

My chosen question: Which treatment model provides the highest treatment effect for PTSD. The answer is not as simple as originally believed. Let's read...

Exploration on the efficacy of treatments for PTSD

Eliyahu N. Kassorla

New England College
Abnormal Psychology
Dr. A. Daniels
Exploration on the efficacy of treatments for PTSD

This paper is intended to serve as an overview of treatment models for Post Traumatic Stress Disorder (PTSD). PTSD is seen with increasing prevalence in the United States, likely because of current military operations in Iraq and Afghanistan. Other potential causes of PTSD include childhood abuse, sexual abuse, rape, and exposure to violent crime.

Neurobiology and Neuropsychology of PTSD

The neurobiology of PTSD is an emergent topic in modern psychology. Many tools are used to investigate the underlying neural systems that are effected by, and expressed from, PTSD. While the label PTSD is just a name for a cluster of symptoms consistent with the DSM–IV–TR description, there are actual changes on the physical, neurological layer in the brain that tends to correspond with expression of PTSD symptoms.

The authors of Neurobiology of PTSD: A Review of Neuroimaging Findings, Garfinkel and Liberzon, 2009, discuss four areas that show changes in the neuronal activity in response to exposure to trauma, which trigger expression of PTSD symptoms. Further, they note five different tools for neural imaging: single–photon emission tomography (SPECT), positron emission tomography (PET), magnetic resonance spectroscopy (MRS), magnetic resonance imaging (MRI), and functional magnetic resonance imaging (fMRI).

First, the authors discuss the effects of trauma on the hippocampus, noting that “[t]he hippocampus is a known target for stress hormones” (Garfinkel & Liberzon, 2009, p. 371). The reason that the hippocampus is so important, the authors state, is the role of the hippocampus in all they types of memory – from episodic to declarative, to sensory short term memory (p. 371). The authors note that the volume of the hippocampus, following trauma, has been noted to reduce by “5% to 26%, and have tended to be found bilaterally across studies” (p. 371). This seems to indicate that the entire hippocampus is affected by trauma, not just portions of the hippocampus. The authors mention that the reductions are not seen in all cases, and mention the limitations of analyzing just the hippocampus for PTSD–effects. The authors note that it is currently unclear whether a reduced hippocampus is a PTSD–byproduct or a predisposing factor for PTSD symptoms. Twin studies, long the mainstay of determining the relative effects of environment and biology, have been inconclusive, largely because of small sample size. The authors note one study on Vietnamese twins, one with PTSD and one without – but both exposed to trauma, have shown both reduced size and impairment in hippocampus–related functional tests (p. 371). The authors indicate that this study seems to indicate that reduced hippocampus size is a predisposing factor (p. 371).

The anterior cingulated cortex (ACC) is another area that shows change in response to exposure to trauma. The authors state, “the ACC shares close neuroanatomical relationships with subcortical components of the ‘central fear system’” (Garfinkel & Liberzon, 2009, p. 371). The ACC has been demonstrated to be “smaller in patients with PTSD, relative to control patients” (p. 371). This reduction, the authors state, is in the grey matter, and that meta-studies suggest that the ACC is smaller in patients with PTSD, compared to trauma-exposed controls (pp. 371–2). Twin studies, the authors note, have shown that the ACC in combat–exposed twins is significantly smaller than non–combat exposed twins (p. 372). The authors discuss the functional structures of the ACC, indicating that the dorsal ACC is involved in cognitive functions, while the ventral ACC is in involved in emotional information (p. 372). The authors note that studies indicate that combat–exposed veterans have an increased regional cerebral blood flow (rCBF) in the ventral ACC, and decreased activity in the dorsal ACC, as well as other areas involved in mood (p. 376). The authors note that studies reveal that reduced ACC activation may also be characteristic of pediatric PTSD (p. 376). The authors note that most studies have focused on adults; however, studies with adolescent subjects corroborate the research with adults and show its applicability to children (p. 376). The authors state that neuroimaging has “repeatedly demonstrated ACC to be implicated in the neurocircuitry associated with PTSD (p. 377). The author notes several studies, using PET and fMRI, that agree in the lower activation of the ACC, and reduced rCBF in the ACC. “Taken together, these data provide compelling evidence that functional impairments of the ACC and mPFC [medial prefrontal cortex] are associated with the neurocircuitry implicated in PTSD, and this holds for both symptom provocation and cognitive activation studies” (p. 377).

The amygdala is another structure that is involved with emotional processing (Garfinkel & Liberzon, 2009, p. 377). The amygdala, the authors note, “is a region implicated in rapidly assessing the salience of emotional and especially threat–related stimuli”, in addition to its role in “generat[ing] and maintenance of emotional responses” (p. 377). Imaging studies shown limited reduction in size, but thus far not any statistically significant size differences (p. 372). However, the authors note a study by Rauch, et al., which shows the increased rCBF in the limbic structures (p. 377). Another study confirmed the activation of the amygdala in PTSD, subjecting combat–exposed veterans to combat noise or white noise; only the combat noise subjects experienced increase rCBF in the amygdala (p. 377). The authors note that the findings suggest that “PTSD is associated with increased amygdala responsivity to threat–related […] stimuli” (p. 377).

The insula is a large cortical structure which connects to the amygdala on the anterior, and the sensory cortex on the posterior (Garfinkel & Liberzon, 2009, pp. 377–8). The dorsal anterior insula, the authors state, is responsible for “developing and updating emotional states, autobiographical memory, cognitive control, affective processing, and pain” (p. 378). The authors note that “[a]bnormal functioning of the insula has been linked to anxiety”, and imaging studies have linked the insula with “anticipating the arrival of aversive stimuli” (p. 378). The insula is one of the “key regions involved in PTSD,” and especially the anterior portion of the insula (p. 378).

Another article that develops a neuropsychological perspective of PTSD is that of Perry, et al. . The article Childhood Trauma, the Neurobiology of adaptation, and “Use–dependent” Development of the Brain: How “States” Become “Traits”, describes PTSD symptoms, and their activity on the developing brain. In a child, responses occur on a continuum from “calm” to “terror,” and these responses correspond to the brain level at which the subject is operating on. (Perry, et al., 1995, p. 274). As stress increases, the level of processing decreases in a linear fashion, from top to bottom of the brain (p. 274). Calm is linked with the neocortex, and involves abstract cognition; arousal is linked with the subcortical system, and is involved with concrete thought; alarm is linked with the limbic system, and is involved with emotional thought; fear is linked with midbrain structures, and is involved in reactive thought; and terror is linked with the brainstem, and is involved in reflexes (p. 274). The authors state that when threatened, the individual moves down the continuum, and arrives at the highest level capable of reacting to a threat. The lower the level of processing, the more “primitive” the behavior and cognition becomes (p. 274). The authors state that state–dependent memory is built into the organizing framework of a child, and the trauma can become the organizing framework for new experiences (p. 275). The brain “develops in a sequential and hierarchical fashion” from back to front, and right to left, and the higher brain regions become fully functional at different times during childhood (p. 276). Because the layers of the brain are built one atop another, the developing brain is crucially dependent upon stability at both the “critical periods” and the “sensitive periods”, and disruption of these periods are implicated in deficits in neurocognitive functioning (p. 276). The authors state that “although experience may alter the behavior of an adult, experience literally provides the organizing framework for an infant and child”, and the enormous plasticity of a developing brain makes childhood critical for proper development (p. 276).

The article is primarily concerned with two types of childhood responses to trauma: arousal and dissociation. These responses are the familiar “fight or flight”, only expressed differently (Perry, et al., 1995, p. 277). Children exposed to trauma can express a hyperarousal response to trauma. This response plays a role in “vigilance, affect, behavioral irritability, locomotion, attention, […], sleep and the startle response” (p. 278). When a child is exposed to trauma, the hyperarousal state is stored as a state–dependent memory; upon a reminder of the traumatic event, these systems are “reactivated” at the heightened level of activation, and these reminders may generalize (p. 278). The authors note “everyday stressors that previously may not have elicited any response now elicit an exaggerated reactivity” (p. 278).

Another behavioral pattern is that of the dissociative response, which the authors call the “freeze or surrender responses (Perry, et al., 1995, p. 279). Children, especially younger children and females, use this response, and report going “to a ‘different place,’ or assuming persona of heroes or animals, a sense of ‘watching a movie that I was in’, or ‘just floating’" (p. 281). This response seems to be adaptive if the child lacks control of a situation, and there seems to be nothing they can do to avoid being victimized (p. 283).

An important characteristic of these responses is that repeated use of either style of threat response lowers the amount of perceived–threat needed to elicit the same response, a concept called use–dependent sensitization (Perry, et al., 1995, pp. 275–8). Neurons in the fear–system will need less and less input to put out a high response to threat, and thus these “states” can very well become “traits”, disrupting both life as a child and life as an adult (p. 275).

WIIFM – What’s In It For Me (or why I should care about neuropsychology?)

Neuropsychology is a rapidly developing field. It is also expensive and not widely available to clinicians. The question is continuously brought up: “This is all great stuff, but why do I need to know about it?” The answer lies in the practical applicability of the research.

Neuropsychology has provided clinicians with tools to assess brain functioning, such as the Wisconsin Card Sorting Task for frontal lobe functioning or the Stroop Test for assessing the ACC. Knowledge of the effects of impairment in the brain must inform the treatment. A child who externalizes their trauma can present symptoms that can look like a conduct disorder, but the interventions for conduct disorder and PTSD are very different. An adult with PTSD who experiences memory deficits will need both occupational therapy and other interventions that target working around the presenting memory deficits.

Treatment must be targeted to the level of brain functioning the client presents with. A highly anxious client may be receptive to anti–anxiety interventions, such as breathing or relaxation exercises. Other clients may present with anger or aggression, and treatment needs to be directed to reduce the incidence of the expression of the “fight” portion of the “fight–or–flight” response. A clinician who can adjust treatment to the level of functioning of the client can achieve a targeted and efficient response, tailoring treatment to the individual. Clinicians need to know what the differences in abilities of lower portions of the brain in order to decide which treatment intervention is necessary.

Another facet is the psychopharmaceutical approach, a client with high anxiety may need a short–term anxiolytic to get to a low level of stress before examining the source of anxiety, just as a depressed presenting client may need short–term anti–depressants to be able to meaningfully evaluate and interpret the cause of depression. These interventions need to occur before addressing the trauma.

Cognitive Behavioral Therapy

Perhaps the most empirically validated, and highly utilized, treatment model, is that of cognitive behavioral therapy (CBT). CBT is centered on a triad of thoughts, emotions, and behaviors. The literature suggests that an intervention of any one of these can influence the others. A key article for understanding the cognitive–behavioral model is Toward a Cognitive–Behavioral Model of PTSD in Children and Adolescents, 2002, by Meiser–Stedman. The article discusses two models of PTSD, and the applicability of those models to children.

Underlying CBT theoretical models of PTSD
The first model, by Brewin, Dalgleish, and Joseph, states that “memories of the traumatic event are stored in a manner different to that of normal memories,”, and that these memories are encoded in different neural structures than normal memories (Meiser–Stedman, 2002, p. 220). The Brewin model is informed by neuropsychology, and suggests that “’traumatic memories’ are laid down in a way that bypasses the hippocampus” (p. 220). The hippocampus is responsible for processing and consolidation of memories (p. 220). The traumatic memories are saved with the “sensory […], physiological, and motor aspects” that allow the “memory to be recreated” (p. 220). These “situationally accessible memories” bypass the hippocampus, and are elicited as a result of trauma–related cues (p. 220). The difference in pathways, compared to normal memories, “means that traumatic memories are not easily accessible by conscious means” (p. 220). Part of the consolidation of autobiographical memories is their conversion to verbal, explicit facts. These “secondary emotional reactions arising from subsequent conscious appraisal may interfere with the emotional processing of the traumatic experience” and impede the memory consolidation processes (p. 220). The author stresses that these secondary emotions must be dealt with prior to exposure treatment (p. 221). Completion of treatment is the integration of the memory into the sense of self, and is a key approach in Brewin’s model of PTSD (p. 221). When the memories are integrated, they are said to have been “worked through” (p. 221). When PTSD symptoms persist, the subject is undergoing “chronic emotional processing”, which may be the result of secondary emotions interfering with the integration of the trauma memory (p. 221).

The second model, proposed by Ehlers and Clark, is built upon the Brewin model. The Ehlers model focuses on the “pathological role of the trauma memory” and the “cognitions [and metacognitions [...] involved in the maintenance of PTSD” (Meiser–Stedman, 2002, p. 221). The PTSD symptoms serve to reinforce the sense of “current threat”, which continues the maintenance of heightened arousal (p. 221). Further, negative evaluations, such as a “dysfunctional meaning attached to symptoms […,] perceived negative responses from others […,] a sense of permanent change […,] and a change in global beliefs” add to the secondary emotions, and interfere with normal processing of the traumatic event (p. 221). The dysfunctional cognitions and metacognitions “produces a sense that the trauma continues to have damaging implications”, generating apprehension, and maintaining the sense of current threat (p. 221). Thought control, where a subject actively tries to avoid thoughts, paradoxically, increases the frequency of the intrusive thoughts (p. 221).

“The early onset of intrusive phenomena is considered a normal reaction to an extreme event [but the] maintenance of such symptoms is considered to result from a variety of maladaptive responses”, meaning that the subject is using the right reaction to the wrong situation (Meiser–Stedman, 2002, p. 222). The child’s response to PTSD is concordant with the adult models, but a child model must accommodate differences in neurodevelopment (p. 222).

More treatments applied to a subject do not mean better outcomes

Another article describing the use of CBT is Randomized Trial of Prolonged Exposure for Posttraumatic Stress Disorder With and Without Cognitive Restructuring: Outcome At Academic and Community Clinics, by Foa, et al. The article describes a randomized trial of two treatment groups: prolonged exposure, and prolonged exposure with cognitive restructuring. Of an initial intake group of 285, 179 were admitted for treatment in this study, with 96 completing the trials, and 26 waitlisted. Subjects were primarily rated on the PTSD Symptom Scale—Interview, but were also evaluated on the Beck Depression Inventory, the Social Adjustment Scale, and the PTSD Symptom Scale—Self–Report. Subjects were evaluated pretreatment and post-treatment at three, six, and 12–month intervals (Foa, et al., 2005, p. 956). Both groups were seen once a week for 90 to 120 minute sessions (p. 957).

The prolonged exposure group was made to close their eyes and recount the story of their trauma as many times as would fill 45–60 minutes. A tape recording was made for the subjects, and the subjects were encouraged to listen to the tape daily (Foa, et al., 2005, p. 957). In the first session, subjects made a list of activities they avoided because of feelings associated with the trauma, and the beliefs associated with the avoidances were evaluated in the final session (p. 957).

The prolonged exposure–cognitive restructuring group was “identical to the [prolonged exposure group] alone with two exceptions” (Foa, et al., 2005, p. 957). First, the clinician presented “the idea that post-trauma symptoms are maintained in part by trauma–related thoughts and beliefs”, and the subjects were provided information on the use of cognitive restructuring to break out of the cycle of maladaptive thoughts. Second, subjects were instructed to utilize a daily diary, recording their thoughts, assertions, and attitudes – and to challenge the maladaptive statements (p. 957).

Waitlisted subjects were informed that treatment would start in 9 weeks, and were called half way through the study. The waitlisted subjects were encouraged to call if they were having problems, or their symptoms worsened (Foa, et al., 2005, p. 957).

Of the 96 subjects who completed the trial, 40 terminated at between eight to nine sessions, 27 because they met termination standards, and 13 who declined additional sessions (Foa, et al., 2005, p. 958). The standard for CBT–based interventions for PTSD is 8 sessions (p. 952). The remaining 56 terminated at between 10 and 12 sessions (p. 958). Although the study criteria was met, “33 participants received at least three sessions of therapy during follow–up”, with 14 from the prolonged exposure group and 19 from the prolonged exposure–cognitive restructuring group (p. 960).

The outcome of the study seems to indicate that prolonged exposure alone is more effective than the prolonged exposure–cognitive restructuring, but the disparity is only slightly statistically significant. A surprise effect was also uncovered during this study – that treatment from masters–level clinicians performed better than CBT experts (Foa, et al., 2005, p. 962). The authors note that when combining the two treatments, subjects may not be receiving the full dose of cognitive restructuring. However, the success in the prolonged exposure group underlies the need for CBT practitioners to reevaluate what they believe to be critical components of CBT, and focus on what intervention is best for the client. If a component is not needed or is less effective, it should be left out and simplified. The authors note that “combining separately efficacious psychological treatments does not yield better outcome[s]”, and that alternate models of treatment are still needed to increase treatment effect sizes (p. 963). The authors conclude with a call for increased training in the use of CBT in community mental health because of its effectiveness (p. 958).

The difference between short and long term effects is all in the recipe

A third article, by McDonagh, et al., titled Randomized Trial of Cognitive–Behavioral Therapy for Chronic Posttraumatic Stress Disorder in Adult Female Survivors of Childhood Sexual Abuse, focuses on women with a history of childhood sexual trauma. This is the first article examining this issue – PTSD secondary to female childhood sexual abuse, the authors note (McDonagh, et al., 2005, p. 515). Subjects were evaluated using the Clinician Administered PTSD Scale, and were selected on the basis of “sexual contact with anyone or more years older when the study participant was under the age of 16 years”, and subjects experiences “intrusive and avoidance symptoms […] clearly related to [childhood sexual abuse] (p. 516).

Subjects were divided into two treatment groups: CBT and present–centered therapy, and utilized a waitlist group as a control. Both treatment conditions were allotted 14 individual sessions, the first seven of which were two hours long, and the remaining sessions were one and a half hours long (McDonagh, et al., 2005, p. 518). All of the clinicians were female, and all had specialized training in female sexual assault. (p. 518).

The CBT treatment group utilized the treatment protocols designed by Foa et al., utilizing prolonged exposure (McDonagh, et al., 2005, p. 518). At the fourth session, cognitive structuring was employed and taught to the subjects, and psychoeducation was provided as well (p. 518). Adherence to these protocols by the subjects was 87.8% (p. 518).

The present–centered therapy group was “designed to describe an active therapeutic intervention that non–CBT clinicians might use in the treatment of PTSD–CSA” (McDonagh, et al., 2005, p. 518). The technique was specifically designed to omit what the authors believe to be the magical (“hypothesized active”) ingredients in CBT: “breathing retraining, [prolonged exposure], in vivo exposure, and cognitive restructuring” (p. 518). Adherence to these protocols by the subjects was 88.5% (p. 518).

The authors noted a very high dropout rate in this study, 23% total: 41% in the CBT group and 13% in the present–centered therapy group (McDonagh, et al., 2005, p. 519). Further, 27.6% of subjects in the CBT group no longer met criteria for PTSD post-treatment, and 31.8% of the present–centered therapy group no longer met criteria for PTSD post-treatment (p. 519). However, the effect of present–centered therapy diminished at the three and six month follow–up, with “CBT [being] associated with greater reductions in [Clinician Administered PTSD Scale] scores”, and indicated a “moderate to large effect size” (p. 519). The authors note that the high dropout rate is a serious limitation the generalizability of this study, and may have been a confounding variable (p. 522).

More than one type of crazy at a time

A fourth article by Mueser, et al., is titled A Randomized Controlled Trial of Cognitive–Behavioral Treatment for Posttraumatic Stress Disorder in Severe Mental Illness. This article discusses CBT treatment of PTSD when PTSD is comorbid with schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, borderline personality disorder, and substance use/abuse (Mueser, et al., 2008, p. 266). Subjects were divided into two treatment groups, CBT and TAU, or treatment as usual.

The CBT treatment group consisted of a structured program, and was conducted at the subjects’ local community health center (Mueser, et al., 2008, p. 265). Each subject was randomly tested for their compliance with treatment protocols, and the clinicians ensured that subjects completed at least six sessions. The authors wanted to ensure that at least three sessions were devoted to cognitive restructuring, which is the assumed active variable (p. 263).

The TAU group was given no active therapy, and they continued receiving the treatments they had been outside the study, as the community mental health facilities offered neither cognitive restructuring nor exposure therapy (Mueser, et al., 2008, p. 263).

This study seems to indicate a medium effect size for CBT compared to the TAU group, but the TAU group still showed improvement. The authors note that this may be a result of supportive counseling that clients receive at the community mental health centers (Mueser, et al., 2008, p. 266). Key differences between this and the Foa, et al., article, which this trial attempted to replicate, is the use of a comorbid with severe Axis I and Axis II population, and the use of community mental health facilities that provide long–term care to clients with severe comorbid disorders (p. 265).

Traffic collisions cause PTSD? I guess if you and your car are one with the mangling

The fifth article, this one by Taylor, et al., is called Posttraumatic Stress Disorder Arising After Road Collisions: Patterns of Response to Cognitive–Behavior Therapy. This article aims to analyze subjects’ responses both pretreatment and post-treatment following motor vehicle accidents. Subjects were assessed on the Clinician Administered PTSD Scale. This study utilized three treatment groups: individual CBT, group CBT, and a waiting list group (Taylor, et al., 2001, p. 544).

CBT groups were provided psychoeducation in the first session, cognitive restructuring in the next three sessions, applied relaxation in the fifth through twelfth sessions, imaginal exposure for the fifth through eighth sessions, and in–vivo exposure in the eighth though twelfth sessions (Taylor, et al., 2001, p. 544). Session twelve serves to review the gains made during the sessions, and discusses “methods for maintaining and extending treatment gains” (p. 544). Inter–rater reliability was maintained by comparing Clinician Administered PTSD Scale with assessments by doctoral–level psychologists, who rated fifteen recorded sessions. The concordance rate between the Clinician Administered PTSD Scale and the doctoral–level psychologist was 87% (p. 544).

This study contained 8 dropouts, compared to 50 who completed the study. Both groups had markedly high and statistically significant improvement in Clinician Administered PTSD Scale scores, with a reduction of four or more points compared to the pretreatment assessments. Further, the data indicates that scores continued to decrease at the three month follow–up (Taylor et al., 2001, p. 547).

The authors discuss limitations of this research, indicating that the data set precludes spontaneous remission of the symptoms of PTSD, but recognizes the effects of time in easing the symptoms of PTSD (Taylor et al., 2001, p. 550). The authors further acknowledge that comorbidity with pain and depression may confound the response rate to CBT. The authors address this by hypothesizing that more treatments, especially individual sessions, may be required to address the partial responding group (p. 550).

Psychodynamic Therapy

Freud explored differences between “’normal’ grieving and ‘pathological melancholia in response to loss’” (Krupnick, 2002, p. 919). In the article, Brief Psychodynamic Treatment of PTSD, Krupnick describes the most empirically validated psychodynamic treatment of PTSD, named “brief trauma–focused psychotherapy”, developed by Horowitz (p. 919). The model is a twelve session treatment that involves elements from

general psychodynamic psychotherapy, for example bringing conflicts into conscious awareness, helping individuals gain insight into their difficulties through scrutiny of the therapist–client relationship, with particular attention paid to ways in which clients may react to their therapists on the basis of unresolved feelings related to significant figures of the past, and analysis of how they keep threatening thoughts, feelings, and impulses from awareness. (p. 920)

The author states that psychodynamic research suggests that patients respond in “characteristic” ways to traumatic events, with shock and disbelief gradually turning into intrusive thoughts (p. 920). Individuals seeking psychotherapeutic help “typically do so because of intrusive thoughts and heightened arousal [… and] feel that their emotions are out of control and that they cannot cope” (p. 920). The authors state that the aim of the practitioner is to evaluate what stage the client may be stuck at, what barriers exist that prevents processing of the event, and to help the client process and integrate the trauma.

The authors note that the client must have a pre–trauma history of emotional stability, stating that “dynamically oriented PTSD treatment, although offering structure and support, also can be painful and intense” (Krupnick, 2002, p. 921). The clinician needs to be able to “inquire about the nature and circumstances of the traumatic event, including the events leading up to the trauma and the circumstances and reactions following it, [as well as] a comprehensive development history” (p. 921). The author notes that brief dynamic therapy advocates, such as Milan, advocated this intervention only if the client has a history of at least one meaningful relationship (p. 921). In the assessment, the clinician is to note the “psychological strengths and weaknesses” of the client, which helps to target the best way to help the client cope with the trauma (p. 921).

Krupnick conceptualizes the brief psychodynamic therapy as existing with three phases, each with discrete tasks and goals: initial, middle, and final. The client and clinician should be able to arrive at a mutual focus, but clinician needs to use the trauma to organize and focus the treatment (Krupnick, 2002, p. 922). The initial phase consists of four sessions, emphasizing to the client that the session is a safe–space, reinforcing that the clinician is solution–oriented, and allowing the client to tell their story (p. 922). Rather than having the client use thought suppression to control their intrusive thoughts, the author suggests that clinicians encourage the repeated narrative. This serves to reinforce to the client that the clinician is able to tolerate the story and emotions, allowing the clinician to foster a sense of safety (p. 922). Pursuant to fostering feelings of safety, the clinician will tell their client that the therapy will go at the client’s pace and depth, again, reinforcing the feeling of safety and tranquility in the session (p. 923). Unconditional acceptance of the client, not judgment, the author states, will motivate the client to set aside the fear in sharing their experience (p. 923).

Krupnick describes the middle phase of treatment, as “the ‘working–through' phase of therapy” (Krupnick, 2002, p. 923). This phase centers on the beliefs and attitude which “have made the particular trauma so difficult to integrate” (p. 923). Clients are advised to be aware of their expectations for themselves, and to examine the effects of trauma on their relationships, and how their reaction to the trauma may be influenced by their past experiences (p. 923). In other words, it’s the right reaction to the wrong situation. A client who learns this lesson, the author states, is provided with a sense of “control and coherence to individuals who felt only chaos and disorganization” (p. 924).

The final sessions should focus on termination, Krupnick states. Krupnick seems to indicate that the feelings of loss can be transferred from the trauma to the session, and that the anticipated feelings of loss can allow the client to plan and mourn the loss of the sessions (Krupnick, 2002, p. 924). Clinicians are supposed to direct this time of loss, allowing the client to resolve their feelings of loss, which vicariously resolves their outstanding feelings of grief from the trauma (p. 924).

Another example of psychodynamic treatment of PTSD comes from Schottenbauer, Glass, Arnkoff, and Gray. Their article, Contributions of Psychodynamic Approaches to Treatment of PTSD and Trauma: A Review of the Empirical Treatment and Psychopathology Literature, analyzes the psychodynamic approach to PTSD. The authors assert that while CBT may have high rates for treatment efficacy, it is plagued by high drop–out rates, and thus cannot provide a true solution. The authors assert that psychodynamic treatment can be used as a model for alternative treatment (p. 13). The authors cite a randomized controlled study whose results seem to indicate that brief psychodynamic therapy has a similar treatment effect as CBT, but benefits from the psychodynamic models’ ability to address “various personality traits” (p. 14).

The authors make note of the two related, but different concepts of trauma: simple and complex (Schottenbauer, et al, 2008, p. 14). Simple PTSD consists of a single “discrete traumatic event”, while complex trauma consists of “prolonged, repeated trauma” (p. 14). As a reaction to the large non–response rate, as well as the high dropout rate, of CBT–approaches to PTSD, several short term psychodynamic therapies have been developed for PTSD (p. 15). The authors cite an article by Krupnick, where 87.5% reported a good outcome, compared to 12.5% who reported a fair outcome (p. 16). It should be noted, however, that this is an uncontrolled trial had a sample size of just eight, less than half of those who were offered treatment (p. 16). The article states that 18 were offered treatment, 11% declined, and 13% dropped out (p. 16). The authors also state that this intervention is only applicable to those who were relatively well functioning before the trauma (p. 16).

Complex PTSD, the authors note, has a high co–morbidity with Axis I and Axis II disorders (Schottenbauer, et al, 2008, p. 17). The authors believe that psychodynamic treatments are superior to CBT interventions for complex trauma because of the psychodynamic model is grounded on the person in relation to their relationships and the world around them, compared to CBT’s specific symptom–targeted approach (pp. 16–7).

Interpersonal problems are areas that psychodynamic therapy excels at, the authors note (Schottenbauer, et al, 2008, p. 17). The authors state that patients expressing PTSD symptoms tend to have more interpersonal problems, like divorce and disturbance in relationships, and that the rates are twice as high as the normal population (p. 17). The authors note that when patients have stable social relationships, their ability to cope with the stress of trauma increases (p. 17). When personality disorders are mixed in, the patient can experience even further complications when their social network is taxed and face social rejection (p. 17). This social rejection can increase the likelihood of severe disturbances from PTSD symptoms (p. 17).

Since “psychodynamic psychotherapy, unlike CBT […], focuses on the interpersonal relationships of the client” it is uniquely qualified to address the issues that arise from discrepancies related to psychosocial disturbances caused by PTSD symptoms (Schottenbauer, et al, 2008, p. 18). The authors note that through the relationship with the clinician, clients can reflect on normal and healthy interpersonal relationships (p. 19). Based on the Krupnick article, the authors determined that the interpersonal skills gained from psychodynamic therapy can induce PTSD symptoms into remission (p. 19).

Another psychodynamic approach is called Control Mastery Theory (CMT), which derives from “psychodynamic ego therapy” (Schottenbauer, et al, 2008, p. 19). This intervention focuses on “facilitating patients’ inherent unconscious capacity to solve problems” (p. 19). This approach centers on the client identifying evidence that both supports and refutes their beliefs, both positive and negative (p. 19). Clinicians are to remain neutral, but provide the client with tests of logic that elicit the supporting evidence provided by the client (p. 19). This allows the client to be aware of the effects of their behavior on their interpersonal relationships, allowing the client to identify maladaptive behaviors and make changes to their interpersonal behavior (p. 19). The authors also discuss the implications of attachment theory, and that the clinician must also take into account the style of attachment to increase the chances of successful treatment (p. 20).

The authors discuss developmental issues, and that these issues can impair a mature coping style in response to trauma (p. 20). The authors note that significant trauma before the age of 18 is highly correlated to greater impairment as an adult (p. 20). The reverse is also true, that a higher level of functioning serves as a protective factor in coping with trauma (p. 20).

Another issue that psychodynamic models are excellent at catering to is the presence of comorbid Axis I or Axis II disorders, which can be as high as 99% (p. 25). The authors note that PTSD is often comorbid with “major depressive disorder, substance use or dependence, panic disorder, agoraphobia, obsessive–compulsive disorder, generalized anxiety disorder, social phobia, specific phobias, and bipolar disorder” (Schottenbauer, et al, 2008, p. 25). Further, child abuse has been found to be related to “borderline, self–defeating, narcissistic, histrionic, sadistic, and schitzotypal traits” (p. 25). Whether the personality disorder preceded the trauma, or is a response to childhood trauma, psychoanalysis is well suited for dealing with both the trauma and the personality disturbances (p. 26). Research suggests that CBT has reduced treatment outcomes with comorbid Axis I or Axis II disorders, but psychodynamic interventions do work for these patients (p. 26).

Conclusions

So which one is it? Cake, or the eating of it?

Should clinicians practice cognitive–behavioral therapy or psychodynamic therapy? It seems like an easy question, considering the glut of research focused on CBT, but the answer is both, and neither. The question of which approach to use sets up a false dichotomy, as both have tremendous strengths – as well as weaknesses.

CBT is a highly empirically validated treatment; it is efficient, rapidly deployable, and symptom focused. A key goal of CBT is making sure that the clinician is interchangeable, a sure way to ensure that it is the treatment that is effective – and not the clinician. A very important aspect of CBT is its response to new research in neuropsychology. CBT realigns with factual findings in neuropsychology, assuring that CBT stays current as a model of treatment.

A client comes into the office complaining of intrusive thoughts, and we explore those thoughts in a critical light. “I’m a failure because I can’t deal with these feelings on my own” gets a response of, “No, you are not a failure. You have kids, a family that loves you, and the feelings you have are perfectly normal considering what has happened to you.” CBT is focused on the triad of thoughts (cognitions)–emotions–behavior, and CBT practitioners try to influence the thoughts – which is really all that can be dealt with in a 90–minute session.

CBT, however, has its limitations. It provides poor support for comorbidity with other Axis I and Axis II disorders. A review of the literature reveals few studies that even attempt to address a population that includes Axis I disorders, save for a few anxiety disorders. CBT is also lacking true standardization, leaving bits and pieces up to individual clinicians. This is undesirable because the term CBT may, in fact, refer to different mixes and ratios of ingredients. And this is seen in the published literature, to say nothing of practitioners who do not publish.

The psychodynamic approach is the treatment that won’t die. It has existed since the 1800’s, and has long since evolved from Freudian introspection to a client–centered model that is highly capable of incorporating comorbidity. A key strength of psychodynamic therapy is the close, intimate relationship between client and clinician. Engendering an environment of trust, and a nonjudgmental attitude, seems to be a key factor in the reduction of symptoms. Clients for whom CBT may not work, or clients who need closeness to be able to address their issues, will certainly find psychodynamic approaches a meaningful, worthwhile, and effective intervention. Further, psychodynamic models better allow the client to perceive relationships around them; psychodynamic models as the primary focus is not only symptom reduction, but normal functioning in all domains of life – including the psychosocial.

Despite the favorable press, psychodynamic models do have limitations. First, psychodynamic models tend to lack generalizability. This is because of the intense focus on the client–clinician relationship; these strong, intimate relationships are not easily forged, especially in patients who exhibit states of constant fear. Second, psychodynamic models really rely on the ability of the clinician. Because the relationship between client and clinician is so crucial, the psychodynamic clinician cannot allow the client to feel unsafe – even for an instant. Clients who come for psychological intervention may be expecting social rejection, and feelings of safety are crucial in successful psychodynamic approaches. Third, psychodynamic research tends to be limited to case studies, which inherently lack generalizability. Lastly, psychodynamic models work – only not necessarily why the clinicians or clients believe they do. Psychodynamic theories need to incorporate the realities of neuropsychology and cognitive neuroscience into their underlying model, as they are more reflective of the biological reality. The software cannot solely be explained in a vacuum, as the software necessarily interacts with the hardware it is running on.

So what is the right question?

Asking which treatment model is the best is the wrong question. The correct questions are: what parts of each treatment form the best and most effective treatments, and when should each treatment model be used. By asking these different questions, we get out of the false dichotomy, and we are left with a better understanding of treatment options that can help clients.

The Magic of CBT Isn’t Just Pixie Dust

CBT is particularly noted for its rapid deployability and large effect size. It is good for using when simple trauma presents, not comingled by the presence of active Axis I or Axis II disorders, which complicate treatment. Complex trauma can be approached with CBT, however, the effect size may be limited.

Parts of CBT that seem to involve a reduction in symptoms are: breathing retraining, prolonged exposure, in vivo exposure, and cognitive restructuring, as elucidated by the article by Foa, McDonagh, and others.

Breathing retraining is a controversial component of CBT. Studies have failed to show any long term treatment effects between breathing retraining and CBT without breathing retraining. However, the short–term effect of providing relaxation to the client probably maintains its status in most CBT models.

Prolonged exposure is a component of trauma–related CBT, in which clients are made to close their eyes and recount the story of their trauma as many times as would fill the session. In the Foa article, tape recordings were made for the subjects, and subjects were encouraged to listen to the tape daily (Foa, 2005, p. 957). The underlying mechanism of prolonged exposure seems to be narrative rehearsal, a low–level method for remembering. The hope is that since narrative rehearsal is low–level, it may precede the level of the trauma memory, aiding in the processing and integration. Further, clients may be able overcome dissociation because the memory is integrated into the explicit memory–and a clear ownership of the memory is established.

In-vivo exposure is the actual real-world use of the learned skills, bringing the skills from the clinician’s office to actual daily situations. A key measure of the effects of PTSD symptoms is the ability to integrate back into normal society, free from avoidance of situations which may have previously been too stressful or painful to be near. All of the different checklists, inventories, and measures cannot compare with an objective fact: the client can again do things they previously could not because of symptoms.

Cognitive restructuring sounds ominous, but is really simple. Cognitive restructuring focuses on the thoughts of the client and presents either confirmatory or refutatory evidence that corresponds to the truth value of the thought. “My life is ruined,” is an example thought. The clinician would have the client come up with evidence that the statement, now known as a “thought distortion”, is false, as well as having the client change the statement to a more positive, self-referential statement, such as “I have the ability to change my life, starting now, and it can only improve”. When thought distortions pop-into the client’s head, clients are encouraged to change their inner monologue to reflect positive assertions.

As a note, the Foa article specifically mentioned that adding more CBT techniques does not a better treatment make. Short-term effects of a control group, lacking any of the above key components of CBT, showed a larger effect size than a combination of cognitive restructuring and prolonged exposure, yet smaller than prolonged exposure alone.

Psychodynamic models required components

Psychodynamic treatments are noted for their ability to reintegrate the client back into normal functioning. The models work because they simultaneously target the primary, secondary, and tertiary facets of the trauma. Primary emotions are those of panic, stress, and loss, while secondary emotions are the beliefs that maintain these feelings. The tertiary facet is the relation of the client to the world around him. Psychodynamic models are very adept at addressing issues that CBT either misses, or is not designed to handle.

Both articles indicate that any successful psychodynamic treatment requires one major factor: an adept clinician. A good, well–educated clinician will be able to assess the client, determine their level of capacity, and tailor the intervention to the client’s needs.

Another key factor is the clinician’s ability to conceptualize the client’s relationships. Because the main treatment goal is it to integrate the client back into their normal social functioning, clinicians need to be able to offer advice, analysis, and reassurance to the client over the range of their interpersonal relationships.

Clinicians also need to be able to move the client toward termination in a tactful and emotionally meaningful way. Termination is the end goal of psychodynamic treatment, second only to the relief of symptoms. The transition out of treatment is intended to serve as a surrogate for the trauma and feelings of loss. The transference of feelings from the trauma to the session enables the client to deal with the feelings on a concrete basis, rather than the vague feelings of trauma.

Mutual symbiosis, or why we should all just get along

Each approach has many things to learn from the other. CBT should be considered the first-line therapy for PTSD, as it may be able to quickly and simply reduce the effect of PTSD on global functioning across domains. As a second line, the much more expensive and involved psychodynamic therapies should be utilized for clients that continue to face disturbances. Why should psychodynamic therapies be utilized second? The simple answer is because it requires more expertise, time, work, and money to be effective. Much education is required to properly administer psychodynamic therapy, and CBT’s effects can significantly lighten the caseload on psychodynamic clinicians. CBT has been empirically validated in both individual and group sessions, and the high effect sizes of CBT treatments means that psychodynamic clinicians can spend adequate time with the clients who need their expertise the most.

References

Foa, E., Hembree, E., Cahill, S., Rauch, S., Riggs, D., Feeny, N., et al. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953–964.

Garfinkel, S., & Liberzon, I. (2009). Neurobiology of PTSD: A review of neuroimaging findings. Psychiatric Annals, 39(6), 370.

Krupnick, J. (2002). Brief psychodynamic treatment of PTSD. Journal of Clinical Psychology, 58(8), 919–932.

McDonagh, A., Friedman, M., McHugo, G., Ford, J., Sengupta, A., Mueser, K., et al. (2005). Randomized Trial of Cognitive–Behavioral Therapy for Chronic Posttraumatic Stress Disorder in Adult Female Survivors of Childhood Sexual Abuse. Journal of Consulting and Clinical Psychology, 73(3), 515–524.

Meiser–Stedman, R. (2002). Towards a Cognitive–Behavioral Model of PTSD in Children and Adolescents. Clinical Child and Family Psychology Review, 5(4), 217–232.

Mueser, K., Rosenberg, S., Xie, H., Jankowski, M., Bolton, E., Lu, W., et al. (2008). A randomized controlled trial of cognitive–behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 76(2), 259–271.

Perry, B. D., Pollard R. A., Blakley T. L., Baker, W. L., and Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and "use–dependent" development of the brain: how "states" become "traits". Infant Mental Health Journal, 16(4), 271–291.

Schottenbauer, M., Glass, C., Arnkoff, D., & Gray, S. (2008). Contributions of psychodynamic approaches to treatment of PTSD and trauma: A review of the empirical treatment and psychopathology literature. Psychiatry: Interpersonal and Biological Processes, 71(1), 13–34.

Taylor, S., Fedoroff, I., Koch, W., Thordarson, D., Fecteau, G., & Nicki, R. (2001). Posttraumatic stress disorder arising after road traffic collisions: Patterns of response to cognitive–behavior therapy. Journal of Consulting and Clinical Psychology, 69(3), 541–551.

Reflections - synthesizing research with class topics

2009-12-16T13:19:00.011-05:00

The assignment: Pick a topic from class and synthesize it with a peer-reviewed journal article.

Eliyahu N. Kassorla

Abnormal Psychology

Dr. A. Daniels

Reflections

My education has been primarily research focused, and now I am looking at treatment options and outcomes. Being empirically validated means that a treatment is general enough to have broad implications, something that psychodynamic theories and psychoanalysis cannot do. In the search for emerging and empirically validated treatments, I have been looking at articles that branch clinical realities with cool research, despite a glaring lack of sharks with laser beams on their heads.

In class, Dr. Daniels (“you”), described schizophrenia as a disruption in the organization of the self, and as “a deterioration of the self.” You further stated that the ability to distinguish the difference between “me and not me” has been disrupted (Daniels). I found an article about integrative therapy and its use for sufferers of schizophrenia. The article was written by Paul Lysaker, Kelly Buck, and David Roe (“the authors”). Integrative therapy is a technique that combines many different theoretical orientations, “combining the best features of each, ignoring the theoretical inconsistencies to help the subject” (Garvey). The point is not to get an overarching conceptual framework of the mind, but to use what works to help a patient.

This article is meta-study, which means it does a review of many individual cases and studies. This article reviews the transcripts of “8 therapists serving 30 clients” (28). The authors “suggest that an integrative psychotherapy that focuses on narrative could be of unique use to persons recovering from schizophrenia by assisting them to construct a greater sense of personal continuity” (29). You stated that schizophrenics have deficiencies in organizing their sense experience, so maybe a narrative therapy may help put the experience back into the normal “subroutine” in the schizophrenics “main program code”. The authors state that “Impairments in encoding that may be a direct consequence of the underlying neuropathology of schizophrenia may also limit the accrual of autobiographic details following illness onset” (29).

What I think is great is the data section, which first describes the sample population:

“Clients were adults treated in an outpatient clinic of a medical center under voluntary and routine conditions. The average age was 44 (SD=4.4), and the average participant had 12.3 years of education (SD=1.2) and 10.2 lifetime hospitalizations (SD = 3.4). Twenty-eight (93%) clients were male and 2 (7%) were female. Two (7.3%) were employed full time, 1 (3%) was employed part time, 1 (3%) was a student, 7 (23.3%) were actively involved in vocational rehabilitation, and 19 (63.3%) were retired and lived off a disability pension. Twenty (67%) had never married, 7 (23%) were divorced, 2 (7%) were married and 1 (3%) was engaged to be married. Ten (34%) were African American, 18 (60%) were Caucasian, 1 (3%) was Asian and 1 (3%) was Latino. All but one client were prescribed antipsychotic medication. Clients’ participation in psychotherapy ranged from 3 months to several years.” (30).

These statistics are great because it humanizes the sample group, but also gives the readers a cross section of who the patients are. It shows how broad the touch of this disorder is: it can be anyone.

The methods section is also critically important. The authors describe their sessions to be broken into three phases: beginning, middle and end. The beginning phase was generally between one to five minutes, and consisted of “A signal of readiness to hear from the client, immediate placing of the client’s agenda as preeminent, attention to the client’s immediate experience, and showing an interest in the meaning of the client’s speech from the first utterance” (31). The middle phase has the therapist guide the client in a “reflection about the client as protagonist in the stories they tell, reflection about the therapist as an audience for the story, and a responses to client’s difficulties thinking of themselves, recognition of client’s right to have/create their own story, invitation to help link, filter, or change perspective, reflection of possible issues not mentioned” which generally lasted for fifteen to forty minutes (31). The end phase, generally five to ten minutes, made “Mention of sessions approaching end [and an] invitation for client to frame their experience of the session [, and a m]ention of scheduling of next session” (31).

In conclusion, the authors seek to make a point that a great way to have a positive treatment outcome is to keep the schizophrenic in touch with his sense of self, so a coherent narrative must be produced. This can organize the perceptual framework, helping to make sense of an already chaotic sensory experience. But don’t take my word for it:

“We assert that this treatment is potentially useful to individuals regardless of their phase of illness as long as they seek to make sense of what is and is not wrong in their lives, what they grieve and hope for, and what is to be done. Making sense of all of this seems likely to make it easier for individuals to navigate their way through the terror and losses of schizophrenia and find a way to live more personally satisfying lives. In this way, we may expect greater narrative coherence to be linked with better long-term outcomes” (34).

The authors note that the small sample size inhibits generalizability, but similar research on these foundations can help to either support or refute the contents of the article. They also note that they are uncertain if schizophrenics without a high level of intellectual functioning can benefit from this therapy.

“The elements outlined are well-recognized ones, and thus a new psychotherapy has not been invented. Instead, we have sought to spell out and make transparent an organization of established practices that could be applied to help persons recover a coherent sense of self” (34).

The authors, not inventing science, should be commended on this innovative fusion of existing techniques. Clinicians need always be on the lookout for new techniques and practices, regardless of theoretical orientation, in order to better suit their clients. It is their wellbeing, not a clinician’s ego, which must be the primary focus. If strictly cognitive, behavioral, or psychodynamic practitioners cannot be open to new information, then they are doing their clients a disservice, and fall into the confirmation bias.

References

Daniels, A. Abnormal Psychology. Fall 2009. New England College: Henniker, NH.

Garvey, Kilian J. Cognitive Psychology. Spring 2007. University of New England: Biddeford, ME

Lysaker, P., Buck, K., & Roe, D. (2007). Psychotherapy and recovery in schizophrenia: A proposal of key elements for an integrative psychotherapy attuned to narrative in schizophrenia. Psychological Services, 4(1), 28-37. http://search.ebscohost.com.nec.gmilcs.org, doi:10.1037/1541-1559.4.1.28

Eliyahu N. Kassorla

Abnormal Psychology

Dr. A. Daniels

Reflections Upon Class Topics

In class we discussed eating disorders. One group, more than others, stands out with high prevalence rates: adolescents. An article by Rhode, Gau, and Shaw explores a treatment known as “dissonance intervention”.

The article documents the effectiveness of a dissonance intervention treatment of eating disorders. This intervention begins with engaging the subject in “verbal, written, and behavioral exercises” in which they are meant to critique their ideal body image (Rhode, Gau, and Shaw, 2009, 825). The authors intend to create “psychological discomfort,” inducing cognitive dissonance; hopefully the subject will resolve their dissonance by rejecting the idealized thinness (Rhode, Gau, and Shaw, 825).

The article included three hundred and six subjects who met the DSM-IV criteria for the eating disorders of “anorexia nervosa, bulimia nervosa, or binge eating” (Rhode, Gau, and Shaw, 2009, 827). Of these, one hundred and thirty nine were assigned to the dissonance intervention; the remaining one hundred and sixty seven were assigned to the control group. The control group “received a two-page brochure” and psychoeducation. However, the authors state that “[…] there is evidence that receiving a psychoeducational brochure results in greater reductions in risk factors and eating disorder symptoms relative to assessment-only control conditions” (Rhode, Gau, and Shaw, 2009, 829). The authors note this, presumably to note that this control may provide a treatment outcome.

Dissonance intervention ran between one and four sessions. In these sessions, subjects were expected to “[…]apply the skills […] learned in the sessions (Rhode, Gau, and Shaw, 2009, 828). The first session was “interactive, with participant-driven discussions of the definition and origin of the thin ideal; how it perpetuated”, and the messages received from family and peers (Rhode, Gau, and Shaw, 2009, 828). Homework was given to the subjects, to “[…] write a letter to a hypothetical younger girl to discuss the costs of persuing the thin ideal and to examine their reflection in a full length mirror, recording positive aspects of themselves” (Rhode, Gau, and Shaw, 2009, 828). This is classic CBT at work: the subject is made to buy-in to negative feelings about the thin ideal, and eventually they will believe it. The subject is further made to make positive statements about their body image, eventually changing this positivity into what they really believe. These changes in the cognitions are expected to lead a positive change in behavior, further reducing negative feelings.

The second session reviewed the previous session, but made the subject make affermations out-loud. They were also involved in “counterattitudinal role-play”, where the subject must make statements contrary to their own belief (Rhode, Gau, and Shaw, 2009, 828). The subjects were also made to make a list of ten things people can do to resist the ideal.

The third session, again, reviewed the prior session, examined the pressures causing the subject to skew their idea of the ideal. The subjects were required to develop “quick comebacks that challenge thin-ideal statements made by peers (Rhode, Gau, and Shaw, 2009, 828). This typifies the inoculation-effect, where a subject is rehearsed in rejecting these socially-motivated cognitions in a controlled environment. This hopefully leads to them adopting the rejection attitude in the uncontrolled real-world social setting. Subjects were also primed to act in a way inconsistent with their previous body-issues, “e.g.: wearing shorts if they have avoided doing do because of body dissatisfaction” (Rhode, Gau, and Shaw, 2009, 828). This is also a key function in behavioral-activation therapy, where the behavior changes a cognition solely by doing the action.

Session four built upon the previous session, enabling the subjects to challenge themselves by allowing the subject to free-respond to statements, and then elaborating on how it “perpetuates the thin ideal” (Rhode, Gau, and Shaw, 2009, 828). Subjects were encouraged to “talk about their bodies in a positive, rather than a negative way” (Rhode, Gau, and Shaw, 2009, 828). Another letter to a “hypothetical younger girl” was written, this time on how to “avoid developing body image concerns” (Rhode, Gau, and Shaw, 2009, 828). The key these sessions built on is that they elicited subject buy-in, forcing them to take these thoughts, cognitions, emotions, and beliefs in.

The results indicated a positive outcome with dissonance-therapy, compared to the before condition as well as the control group. One year after, forty-two percent of the subjects continue to show “clinically significant change”, compared with only twenty-four percent of the control group. The authors described the effect size as medium; a medium effect size clearly shows promise as one type of possible treatments available to clinicians. There are other treatments available to clinicians, but many of those require many visits or inpatient treatment; both options are costly and long in treatment duration.

Clinicians should be very interested at using these cognitive mechanisms to effect change in client behavior. Although cognitive-behavioral models, as well as other paradigms, are in use, this one shows promise in being fast and potentially long lasting, at least a year with the medium effect persisting. Further, this trial was conducted with relatively inexperienced clinicians, themselves having “delivered the prevention program an average of only twice” (Rhode, Gau, and Shaw, 2009, 831). This is noted by the author, comparing this trial to one of their other trials, where the facilitator had presented an average of eighteen times. Using their treatment handbook exactly as described shows promise, so busy, or innovative, clinicians can quickly add this program to their repertoire. Further, the authors noted that their previous trial used an assessment-only condition for the control. In this trial, the authors used a psychoeducational brochure, possibly reducing the apparent effect size in this trial. This control condition seems better in a real clinical setting, where literature can be made available. I am interested in seeing a trial where the brochure is combined with these trials, seeing if the effect size increases. Clinicians can work with a client, but augment the care with the results of this trial.

References

Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77(5), 825-834.

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