everyday psychology

Scroll down for more ...

2010-04-22T23:58:00.000-07:00

Recent

Clues to personality found in Austin plane crash pilot's diatribe ... a lengthy discussion of the "manifesto/suicide note" and the pathology of a domestic terrorist.

On Camera: Dr. Mattiuzzi speaks about the Phillip Garrido case and the victim Jaycee Lee Dugard ... with comment about the Stockholm Syndrome and Patty Hearst.

Psychology in the Emergency Room: psychotherapy reduces return visits

Those people are like this, these people are like that ... our tendency to "ascribe" traits to others

Anti-Depressant medication may not be an effective treatment for mild or moderate symptoms

Stress and Depression reduce worker productivity ... new study, old news

Psychologists Reject Science? ... Oh My!

When Leadership Fails: a short story about administrative incompetence

The Psychology of Netflix

Will Forensic Psychologists be involved in the Phillip Garrido case?

Workplace stress: Does anyone hear the workers screaming in their cubicles? Is anyone listening?

Psychological Health Care: A prescription for health care cost savings.

Burnt-out on stress management? It's time to change the organization.

Psychological Health and Psychological Issues

What is Psychological Health? ... take the Health Stress Inventory.

The Sense of Coherence ... essential for optimal well-being and stress resistance.

The Recession, Depression and Depression ... coping with the economic downturn, take the psyris depression screening test.

How is mourning possible? ... normal bereavement and the grieving process.

Mourning and mesothelioma ... bereavement in unnatural circumstances.

Can loneliness affect your health?

Compulsive shopping: If the psychiatrists put it in the diagnostic manual, does that make it an illness? ... no, but it's still worth studying.

Stressed out on campus? ... understanding stress, what is stress?

Crimes and Violence

Why do people kill: A Typology of Violent Offenders

Why do kids commit murder?

Why did the astronaut crash to earth? ... the strange behavior of Lisa Nowak.

Why do kidnap victims sometimes fail to escape, even when they have the chance to run? ... Shawn Hornbeck, Patty Hearst, Steven Staynor, Elizabeth Smart and now Jacyce Dugard ... also known as the Stockholm Syndrome.

Is existence too painful to endure? ... comment on the Virginia Tech rampage.

Parenting and Education

Helicopter Parents: disturbing trend or urban myth?

Helicopter Parents: disturbing trend or urban myth? ... a shorter version

Zero Tolerance Policies: no substitute for good judgment

Internet safety: do kids really know what's going on?

Career, Workplace and in the Organization

Does the handshake matter? ... yes.

Is your boss paying attention to you? ... Probably not, he doesn't need to.

Leadership Research: are we asking the right questions?

Emotonal Intelligence? I'm not feeling it

Telling them off (or not) on your way out the door: the departure email

Burnt-out on stress management? It's time to change the organization.

Articles about Psychology and Psychologists

What is Psychology?

What is a Psychologist?What do Psychologists do?

Are all therapists psychologists?

Psychologists and other professionals

Does therapy work? ... Yes!

Psychologists and Prescription Medications

Is Clinical Psychology an overated career?

Is Dr. Phil actually a psychologist? ... not really.

... and other topics

What we have here is a failure to communicate ... relationship conflicts.

The psychology in art. What can we learn?

Who's that elephant in the mirror?

Red State, Blue State: is it a state of mind or just the colors on a map?

When Leadership Fails

2010-04-22T23:55:00.000-07:00

About twenty years ago at Sacramento State (California State University, Sacramento: CSUS), the campus administration learned that an engineering professor had been harassing a recent graduate in a very overt manner. The male professor had developed a "friendly" relationship with a heterosexual male student and was upset when the kid realized he was being "chickenhawked" (the professor was making a sexual advance). The alum told the professor that they would no longer be friends and the professor began stalking him and trying to ruin his career.

Cici (my wife, and the Director of Career Services in the College of Engineering and Computer Science) got involved when the alum's employer complained that Professor Miroslav Markovic was engaging in some rather strange and bizarre behavior. Actually, the behavior was scary and traumatic.

The campus administration was fully informed about the situation and basically did nothing. As it would become known later, this was not the first time that Professor Markovic had tried to "hook up" with young male students, and it would not be the last. Markovic was a tenured professor and he was therefore "protected" or "tolerated." No warning was ever given to other students.

In subsequent years, there would be many other complaints about Markovic. From off-campus, employers wanting to contribute to the campus development complained about strange and potentially threatening emails he sent. Women and minorities complained about how he treated them in class. There was an incident in which he went in to a rage and destroyed projects students had built. From off-campus, there were more reports about him "doing it again," trying to develop inappropriate relationships with young men.

And then there were the reports about his having assaulted staff members and having threatened to shoot others.

Cici got involved because students and employers came to her with their complaints. She also complained when Markovic called her a "bitch," and when he threatened her and when he assaulted her. She complained about him a lot during the past 15 years or so because the campus taught her that these are matters that must be reported. She also complained because she thought the campus would do something, that the leaders would lead, and because she wanted to protect her students.

While all of this was going on, Cici was also trying on a regular basis to get reclassified. She wasn't being paid what the men were being paid to do similar work. She actually had been promoted once, many years ago when she founded the Career Service office in engineering. But that promotion was taken away when she returned from maternity leave.

Now it could be that Cici was never promoted like the men simply because of gender discrimination. It certainly wasn't because she was less productive as an employee. Like the men who did similar work, she taught classes and counseled students. but she also created an entire program of services.

The other possibility was that she was held back in retaliation for being a "whistle blower." That's how the Sacramento Bee would describe it.

In the Fall of 2008, Cici hired an attorney and in August of 2009, she sued Sac State. She was pushed her over the edge when Markovic threatened to shoot a pregnant staff member. She reported this to Kent Porter, the Vice President of Human Resources, and he did absolutely nothing. He didn't investigate, take action or warn staff.

Nine months before she filed the suit, her attorney wrote the campus and demanded that they do something about Markovic. President Alex Gonzales never responded to that letter, but the campus did hire attorneys to investigate. The investigation confirmed much of what Cici said about Markovic, but until the lawsuit was filed, the campus hid the reports.

The leadership failure in this case went up and down the line, from the Dean of Engineering Emir Macari, through the head of Human Relations, David Wagner, and to the President himself. Cici was screaming about a hostile work environment and nobody would lift a finger to either acknowledge it, resolve it or simply do something to avoid an embarrassing lawsuit.

After Cici filed the lawsuit, Markovic immediately "retired." The campus Affirmative Action Officer also retired in short order, right after he wrote a letter confirming that Cici had in fact been subjected to a hostile work environment. He had the investigation reports.

Right after she filed the lawsuit, Cici was told that she could no longer teach any of the classes that she had been teaching for 25 years. The campus said it was a union issue: she wasn't classified properly to do the job she had been doing all those years.

This looked like more retaliation, despite what the campus said. The irony is that for no good reason at all, the campus shut down a program designed to help students get jobs on graduation - they shut it down right in the middle of the worst recession in generations. Accreditation teams have described Cici's career program as "a model for the nation."

In January of 2010, after Cici had been off work for five months (spending much of her time relieving stress with Yoga classes), the campus finally settled. You can read about the settlement in the Sacramento Bee.

Clearly, in the end, Cici "won." She got rid of the professor, received a meaningful promotion and obtained a settlement that was enough to cover her costs. The un-reimbursed psychic toll was tremendous, but Cici is back at work, doing what she loves to do. She has received nothing but positive support for what she did, and there was a lot of support.

Somebody had to do something and the leadership on campus failed completely. It cost them some money, but more importantly, they squandered their status. It was all completely preventable.

Did Sac State learn anything? Nah ...

Human Resources VP Kent Porter handled the settlement negotiations for the campus, and he was just plain pissy about it. The campus position was that Cici was just an "overzealous" employee, a nuisance to be dealt with.

And after it looked like it was over, Markovic was invited back to campus to enjoy the privileges of a retired professor, an "honored" professor emeritus. Human Resources told the IT technicians in Engineering that Markovic would be coming to campus to have his computer fixed. The day he was scheduled to arrive, three employees took the day off because they didn't want to see him again and didn't want to have to fix his computer. They were among those who had been threatened by him.

Consider that for a moment. The leadership knows that this guy created all kinds of turmoil. They have investigative reports saying that people are afraid of him. They know that he creates stress and discomfort for other staff. And what do they do? They ignore the well-being of their workers and treat him like he's done nothing wrong. Markovic threatened to shoot people on campus! What's not to get about that?

I don't think he will be returning to campus. After the lawsuit was filed, Markovic kind of disappeared for a while. He was named in the suit but couldn't be found to be served. The day he showed up on campus again, the process server was sitting there waiting for him.

After he was served, he didn't look too happy:

There's just a bit more to the story. After Cici was back at work, she was speaking with an employer. He told her that he had recently spoken to Dean Emir Macari and that she should apologize to him. Obviously, her boss Macari was bad mouthing her in the community.

Cici complained to the head of Human Relations, Vice President David Wagner. When she settled the lawsuit, the campus insisted that no party could speak ill of the other. She also complained about Markovic being invited back to campus.

Dave Wagner's response? Markovic had a right to be on campus. Essentially, to hell with the well-being of the employees.

About the bad mouthing? Well, Dave Wagner basically just noted that she had, after all, sued them and publicly so.

What should Cici have expected? In the end, she should have expected nothing more from the leadership at Sacramento State than she had ever seen in the past.

The "leaders" at Sacramento State seemed to have learned nothing, so what do we learn?
This is a companion piece to three of my other posts. I think this story illustrates: that employers often don't pay attention to their employees; that it makes no sense to talk about work related stress unless we talk about the organizational causes; that rather than "treating" those who are affected, we need to change the environment; and that even when employees suffer hostile work situations, and even when they complain, "leaders" often fail to get it.

Here are my thoughts on those topics:

Is your boss paying attention to you?
Burnt-out on stress management? It's time to change the organization.
Workplace stress: Does anyone hear the workers screaming in their cubicles?

This is a shorter and final version of an article I posted some time ago, while this was all in play. The earlier version provides more detail and basically tells the whole story. If you are interested, it is still posted here. Additional materials, including the news stories and the 200 page lawsuit can be found here.

Clues to personality found in Austin plane crash pilot's diatribe

2010-02-18T16:00:00.000-08:00

Before crashing his airplane into an IRS building in Austin Texas, 53 year old software engineer Joseph Andrew Stack posted a lengthy note online. It begins: "If you're reading this" - thereby leaving no doubt that his acts were planned over at least some period of time. It is dated today, February 18th, 2010, and before it ends, he makes clear that he does not expect to survive his violent act.

Across the internet news sources, his statement has widely been described as a "manifesto," which is a statement of aims or intentions. At the document source The Smoking Gun (which is where I found the text), it is correctly referred to as a "diatribe," which is defined as a "bitter speech or writing."

I am writing this now because a TV news crew asked me to comment on the story as it was still breaking today. Much more will be known about Joe Stack in the coming days. But for now, there is much to be learned from what he wrote.

Here are some of my first thoughts:

Was he crazy?

In some sense, anyone who commits an act of domestic terrorism, while believing it is justified, is crazy in some way. In his writing, however, I did not see indications of delusional thinking or a clinically disordered thought process. There are some hints of paranoia of the type that are common among those with anti-establishment attitudes and beliefs, but there is none of the irrational and delusional paranoia that one would expect from a psychotic or schizophrenic individual. He didn't say that the IRS was targeting him specifically or that the IRS put bugs in his bed or was communicating with him through laser beams.

His writing is essentially coherent, although it is rather self-contained and self-referential. In other words, you need to understand his world view to know what he's talking about. It would have made more sense to him than to anyone else, and he assumes that you know and understand the things that he thinks he knows.

Is his writing the work of an irrational mind? Not in a clinical sense.

Was he insane?

That's a legal conclusion, not a clinical one. That question will never be tested in Court. In legal terms, the sanity question is: did he know what he was doing and was he capable of knowing that it was wrong? From his writing, there is no reason to doubt that he was sane ... in a legal sense.

So if he's not crazy, does that mean he's a normal average guy?

Obviously not. What you see in his writing is evidence of a "personality disorder." Also known as "character disorders," these are long-standing, deeply ingrained patterns of thinking, feeling and behaving. These disorders are formed from a person's attitudes, values and beliefs.

Ordinarily, we say that these characteristics are part of one's "personality style." When a personality style is disruptive or maladaptive or a source of problems and troubles, then we call it a disorder.

What about his personality was disordered?

What you see in his writing is that he was a self-righteous, grandiose, resentful and narcissistic individual who tends to externalize blame and responsibility for his shortcomings and failures. We also see that he was striving for power and omnipotence in the face of his fundamental human inadequacy.

How do we see that?

Let's start with his first line, where he writes: "why did this have to happen?" This is a classic assertion of non-responsibility. Rather than saying that he "did something," he is saying that "something happened." It is external to himself, something about which he is suggesting he did not have control. He could have written instead: "you are probably wondering why I did this."

Stack goes on to say that his writing is meant to be a form of "therapy," adding that "there isn't enough therapy in the world that can fix what is really broken." At first, you think he is saying that he tried to get help and it didn't work. But as you read on, you realize that he does not see himself as one who is broken or in need of help. It's the world around him that is beyond fixing. He's OK, the "system" is not. The therapy he is talking about is not for him, it's for the broken system.

In the first paragraph, Stack signals that he feels a sense of powerlessness and futility. Even in writing about the reasons for his impending act of terror, and before he tells us that he is actually trying to accomplish something by his death, he says that the writing exercise might actually be "pointless."

He also gives us an indication in the first paragraph that he is feeling a sense of anger. His comment is that there is "a storm raging in my head." What is interesting is that he does not refer to this feeling again. Instead, he simply provides a history detailing why he is so angry. And as he details how he has suffered and been abused, from the earliest days of his childhood, he makes it clear that it is all the fault of others. In essence, he is saying that his anger is righteous and justified, rational and reasonable. No where is he at fault or to blame. He is telling us that he worked hard, struggled mightily and always tried to play by the rules of the game. He is telling us that it is the game itself that is not fair, that the rules were stacked against him, and that while he was honest and forthright, he never had a chance and never caught a break.

His grandiosity is evident in many ways. The line that captures it best is his comment about moving from Lincoln California (the Sacramento region) to Austin Texas. He said that he moved, "only to find out that this is a place with a highly inflated sense ofself-importance and where damn little real engineering work is done." He is saying that he knows best. He is a highly skilled and knowledgeable engineer and everyone else is some type of hack.

We see the grandiosity also in his over-intellectualized analysis of the tax code he complains about. He lets us know that he has studied it and absorbed it and that his understanding must certainly supersede that of the experts who administer it. He refers us to an online resource describing these complex issues (having to do with the difference between employees and independent contractors) and refers to that resource as "our discussion," as if it is his work and his thinking. In referring to his obsession with the tax code and wasted efforts in trying to change it, he says that "the best we could get" was nothing at all. What he is saying is that he is not a lone crusader, but instead a central player in a movement. He refers to those in the movement with him as members of "disorganized professional groups," telling us again that in whatever he does, he is surrounded by incompetents.

Stack's fundamental narcissism is seen in his view that he is nothing other than a successful and accomplished individual whose failures in life are (again) entirely the fault of others. And from his letter, we learn that his failures are significant. He refers to a failed marriage, a lack of success in business, the loss of his retirement funds on two occasions, and an inability to secure wages commensurate with what he believes he deserves. The troubles he got into with the IRS are not, in his view, the result of his having failed to take care of business. He positions himself as responsible and successful, even while he documents his failings. He tells us through his analysis that he knows better than everyone else. He is the one who sees through everything and understands the corruption. There is nothing that he did wrong, because like any narcissist, he is not one who can do wrong.

Where does the striving for power and omnipotence come in?

Read the final paragraphs where he begins to talk about the justification for his act of terror.

Even though he says that he has "just had enough" (i.e., he's mad as hell and isn't going to take it any more), he does not formulate his actions as an expression of his rage. What he says, in essence, is that he is standing on principle and that he is undertaking the journey of a hero. His hero quest is cast in mythic terms, including where he aligns his purpose with the struggles of "the blacks and poor immigrants." Earlier in his note, he cast himself as one who was in sympathy with the struggles of the union workers in the "steel mills of central Pennsylvania." Most people will say that his act was cowardly. In his message, he has cast himself instead as a brave soldier in the fight against the man.

When he tells us what he hopes will come of his act, we see that in his view, it is political. He is not a pathetic loser who has failed and given up. He is not saying that he could no longer tolerate life or the frustrations he created for himself. He is not describing it as an act of despair or despondency.

What he is telling us in his final paragraphs is that his intent is to spark a revolution. His claim is that he is one of those who is "dying for their freedom in this country." He is suggesting that others will follow his path and that it is through this ostensibly selfless act of heroism that things will actually change. Violence, he says, "is the only answer." He sees himself as one who is willing to act to "stop the insanity." As I read it, he is not talking about the insanity raging in head. He is talking about the insanity that ails the country as a whole.

What he is striving for, in his formulation, is the significance and the power of martyrdom. His life, as he describes it, was unremarkable, unaccomplished and insignificant. His dream is that he will become a beacon and an icon. Referring to himself as the one who will light the fuse (and the lamp), he says: "I can only hope that the numbers quickly get too big to be white washed and ignored that the American zombies wake up and revolt." He expects that "people wake up and begin to see."

What is the significance of this type of pathological narcissism?

As I said above, he is not describing himself as despondent or as a victim of despair. He is not saying that his existence has become so painful that he chose to tear reality apart through an act of horrific violence. Through intellectualization and political affectation, he is denying that his motives are common and base or that he was simply discharging his anger and frustration. His intention is to elevate his battle to a higher plane of sanity, describing it as a noble cause. He is telling us that he is acting in response to a purity of heart.

The narcissism belies his entire argument. Indeed, it is exquisitely an act of self-aggrandizement for him to have even thought that anyone might accept or endorse his rationale (anyone that is, except for other lunatics). The narcissism tells us that it is really all just about him. Because he is such a noble character (in his view), he is justified in inflicting harm on the innocents in the building.

My argument that he is a fundamental narcissist helps us understand how a seemingly rational individual could commit such a horrific crime. Narcissism is the essential psychodynamic underpinning for the anti-social personality. Individuals with this personality type are also commonly referred to as psychopaths, sociopaths or common criminals. They are individuals who seem to care not at all about others, people like Bernie Madoff, who seemed to have no inhibitions or sense of shame or guilt when it came to stealing great fortunes. They don't experience guilt and they are deficient in their ability to feel remorse. Their needs and desires are so important, and their desires for satisfaction and gratification are so great that they have no reason to care at all about the feelings of others. Where they live, in their minds, is at the center of the universe. They have no need to empathize and so they feel entirely free to victimize.

The point is that no matter how he chose to rationalize his actions, there was nothing at all noble, heroic or transcendent in what he did.

Is that really why he did it? Is that really what it's about?

Probably not. His words and his explanation are not to be trusted.

His statement is a self-indulgent form of intellectualization. He is telling us that he was rational and acting with good cause. His purpose in writing seems to have involved a desire not to simply be written off as another angry lunatic who couldn't cope with the adversities one naturally faces in life. It is certain that he would have bristled at being described as just another "disgruntled" figure who decided to indulge his fantasies and satisfy his rage.

But that is what we are left with when we look at what he did. In a perverse way, acts of violence are often self-indulgent and self-fulfilling. It is probable that as he flew towards his victims, he felt a sense of power, purpose and satisfaction beyond anything that he ever experienced during the course of his miserable life.

In reading his "manifesto," I am reminded of the scene in the movie Michael Clayton when the character played by George Clooney finally accomplishes his heroic task. A man asks him who is he is, and Michael Clayton replies: "I am Shiva, the God of Death." That is the status, I believe, that Joe Stack was seeking to achieve.

This wasn't an heroic act, as Stack suggests. This was not, as he tells us, a matter of his choosing to stand for the good. In a sense, it wasn't even a political act. That is just the veneer he applied. This was in all likelihood just a way for him to relieve his frustrations and to achieve the sense of power, potency and significance that eluded him in life.

So was it really just about anger and rage, frustration and hostility?

That is not what I would focus on. There are many who commit explosive acts of violence and who can be described as having "over-controlled hostility." They can't cope with their anger, it builds up, and then, like with a pressure cooker, they explode. In those cases, there is often an immediacy to the crime and traces of the rage to be found in the evidence.

I'm reminded of a case I worked on a few years ago. A "really nice" man watched as his marriage imploded, and without explanation he stabbed his son forty something times and then bludgeoned him further with a hammer. The man survived, and to him, his acts were entirely incomprehensible. Joe Stack, on the other hand, contemplated his act and prepared for some time. It was deliberate and entirely intentional. His note tells us that he is not a man who "exploded in a fit of rage" or that he is a person who "lost control" of his senses.

His note tells us that he nurtured his anger and probably took pleasure from it (again, in a perverse way). He did not simply "go off" and act on impulse. He made a decision and coldly created a document that he thought would serve as his excuse.

The anger cannot be discounted. But the anger has to be understood in the context of his having let us know that he was self-righteous, resentful, grandiose and narcissistic. Whatever rage might have consumed him, he let us know clearly that this was nothing less than premeditated decision.

Was it a crime or an act of terror?

It was an act of horrific violence. Technically, it was a crime, but that term does not satisfy our need to understand or categorize his behavior.

What he wrote is that it was a political act. What he implied is that it was an expression of the mythic-heroic ideal. He wanted to be remembered as "Joe the Revolutionary." He signed his note: "Joe Stack (1956 - 2010)," as if his were a life complete and he would be an historical figure.

He placed his crime in a political context. He offered it as an act of war. He fired a shot against his own government and against a civilian population. Call it treason or call him a traitor. And call it what he said it was: a politically motivated act of war intended to inflict civilian casualties and to serve as propaganda, rather than to achieve a strategic goal. For that, there would seem to be no word better than "terrorism."

Could this really be part of a movement?

There is in this country today, it seems to me, a gathering storm of mindlessly angry people who are "fed up" for reasons they can barely explain. There are people in the media who are telling them they should be angry, and perhaps more importantly, that they should be afraid.

Fear and loathing is not unexpected in times of economic turmoil, distress and uncertainty.

What concerns me is that some people have come to identify the government as an enemy of the people. They are grandiose in their belief that they understand it all better than anyone else. They are self-righteous in their indignation and in their resentment. They express a sense of entitlement, arguing that they have a right not just to their own opinions, but also to their own facts. They shout until no one can hear them and then complain that no one is listening. They expect their individual voice to prevail and then complain that they have been denied representation. They do not wish to contribute to the common good, but demand all the benefits they have been promised. Like Stack, they bemoan corporate greed while demanding that greed be unfettered.

No movement that takes it self seriously should find inspiration in the death of Joe Stack. He demonstrated that he is simply part of the lunatic fringe. A movement has to stand for something other than chaos and anarchy. If we say that his act symbolizes anything more than his individual psychopathology, then what it symbolizes is nothing more than death, despair and defeat.

Will others be inspired?

Let's hope not. Let's hope that what he inspires is a return to sanity and an end to the craziness. Let's hope that he gives us reason to restore civil discourse, to recognize that social and political nihilism is not a philosophy of any type, and that domestic terror is not part of the solution.

In his diatribe, Joe Stack wanted us to believe that in his abject failure, he had achieved success. It's as if he listened to only part of what Bob Dylan once sang ("there's no success like failure"), without bothering to stick around and hear the end of the lyric: "and failure's no success at all."

On camera: Dr. Mattiuzzi speaks about the Phillip Garrido case and the victim Jaycee Lee Dugard

2010-02-12T11:30:00.000-08:00

Recorded on February 11th, 2010. KXTV Channel 10 News in Sacramento.

Comments about recent case developments and the Stockholm Syndrome, and comment about Patty Hearst. The raw video:

And the story as it appeared on KXTV:

Psychology in the Emergency Room: psychotherapy reduces return visits

2010-01-28T01:41:00.000-08:00

The "medical cost offset effect" is well known and has long been documented. In brief: when emotionally distressed medical patients receive therapy, they tend to reduce their utilization of all forms of medical care, and it saves money.

A recent demonstration of this cost saving strategy is of particular interest because it focused on patients who were admitted to the emergency room. Published in the Canadian Journal of Emergency Medicine, the study was titled: "Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study."

More typically, studies of this type focus on patients seen in the offices of general practice physicians, even though many have tracked subsequent hospital visits as an outcome measure.

In this case, patients who arrived at the emergency room with "medically unexplained symptoms" were referred to a therapist, and on average they were seen for about four sessions. One of the study's authors noted that among patients arriving at the emergency room with chest pains, there are no physical findings in three out of four cases.

The patients who were referred to therapy were matched with patients who had similar rates of emergency room utilization or who had presented with similar complaints. The implication is that this group (those who come in with chest pains that tests could not explain) tend to seek medical care quite regularly. In the hospital where the study was conducted, the identified patient group was averaging 4.6 emergency visits per year!

What was the outcome? The result was an almost 70% reduction in return visits to the hospital. According to the lead author: "For every 100 people seen by the staff psychologist, there will be 300fewer emergency visits a year, which adds up to a huge savings andreduction in unnecessary tests."

These results are not at all surprising. If you are distressed, depressed, experiencing anxiety and having a panic attack, you are likely to have shortness of breath and to experience chest pain and perhaps light-headedness. Of course you are going to call or go to the emergency room.

If you resolve the feelings and understand the emotions that lead to panic and anxiety, or if you relieve the stress that might be causing distress, the chances are that you are not going to panic and end up needing emergency medical care.

That is one of the reasons we know that therapy works. It saves money.

Those people are like this, these people are like that ... our tendency to "ascribe" traits to others

2010-01-06T14:57:00.000-08:00

It's a real common tendency, describing certain people as being a certain way. We all do it. We all "ascribe traits" to others.

Sometimes it's a matter of convenience. Sometimes it's a matter of necessity. As we navigate the social world, it's often necessary to make judgments and decisions based on our assumptions about the people around us.

You can imagine situations in which you might need others to provide help. In those situations, it helps to assume that people will be helpful. It happens all the time while you're driving. You assume that when you need to make a merge or a lane change, people will accommodate your needs when you turn on your turn signal. If you are struggling with your luggage in an airport, you want to assume that someone will be willing to help, before you look around and express your immediate neediness.

In an article that appeared some years ago in the Journal of Research in Personality, Professor David Funder noted that "most people have pretty definite ideas about where they and the people they know fall on a variety of trait dimensions like friendly-unfriendly, cautious-bold, and so on."

But in making judgments like this, we are also prone to making errors when we assume that people have certain characteristics or tendencies, or when we fail to take into account the particular situation in which they find themselves.

What Dr. Funder found is that the "tendency to ascribe traits" to others is in itself a measurable psychological trait. In other words, some people tend to do it more than others.

When you are judging someone else (trying to say how they are, what they are like, or how they might act) you can make a judgment based on what you think "those people" are like. Instead, you can also think to yourself: "it depends on the situation."

If you say "it depends on the situation," your judgment is said to be state-related ("it's the state they're in"). If you say "that's just how that person is," your judgment is said to be trait-dependent ("they're always like that").

Whether you are more or less likely to make either state or trait based judgments is itself a trait that is related to your to your personality characteristics.

In general, people are more likely to say "it depends on the situation" when they are making judgments about people they know well. If someone is just an acquaintance, rather than a close friend, you are more likely to say that their behavior is the result of their traits. In other words, the better you know someone, the more flexible and forgiving you are when you assess their behavior.

The really interesting finding is that those who are less flexible in their judgments of others also tend to be less well-adjusted themselves. Those who are tend to say that others do things because of their personality traits tend to have less adaptive personalities themselves. Those who judge others in a rigid way are found to have less charm and appreciation of humor, to be less considerate and sympathetic of others, to be more sensitive to criticism, to be fussier about small things, and to be less warm, cheerful and interesting as a person. Those who tend to ascribe more traits to others also tend to be more anxious, less confident and less capable of dealing with stress than others.

Yes, it is important in life to make judgments about the personality traits of others. Sometimes it helps us understand people and situations. But, it is often more important to understand that everyone is an individual and that anyone might react differently in different situations.

Keep in mind that we tend to be less flexible in how we judge people we don't know. Which tends to suggest that when we say "those people are like this," we are more likely to be making an error in judgment. Keep in mind also that those who are harsh in their judgments are less likely to "have room to talk."

Anti-Depressant medication may not be an effective treatment for mild or moderate symptoms

2010-01-05T15:44:00.000-08:00

Almost 7% of the population will suffer from clinical depression in any given year. For those who seek treatment, the most common treatment involves a course of anti-depressant medications, typically prescribed by a general practice physician.

A new study published in the Journal of the American Medical Association finds that the effectiveness of medication varies significantly, depending on the severity of the depressive symptoms. Those who suffer from severe or major depression benefit "substantially." When the depression is mild or moderate, the medication does not produce an effect that is greater than the benefit obtained by taking a placebo.

This is already in the news and bears comment.

1. Individuals reading this should not assume that they should suffer in silence or fail to seek help. If for any reason you think you may be depressed, take the Psyris Depression Screening at the Psychology Resource Information System (psyris.com).

2. If things in your life are not right, or if you are not feeling right, it typically makes sense to see your physician to make certain that you are not suffering from some type of medical or dietary condition.

3. This new study does not mean that treatment will not be helpful or that you shouldn't try medications. Until you consult with someone, it's hard to know if your feelings of depression are severe, or simply part of the expected ups and downs in life.

4. As a psychologist, I would never recommend that someone feeling depressed should simply start taking a pill. It is well established that psychotherapy is an essential component in the treatment of any mood disorder. If your physician is telling you that your condition warrants the use of medication, then it is certainly the case that you should be seeing someone to talk about how you are feeling. If you need medication, you also need to talk to a therapist.

This is an important study for a few different reasons.

First, the fact that the placebo performs as well as the medication in mild and moderate cases reminds us that depression is not simply medical and biological in nature. It involves thoughts and psychological processes. It is not just a type of "brain disease." It has to do with your mind.

Second, the fact that medication is effective in more severe cases reminds us that depression can involve medical factors as well. Sometimes medications are necessary.

In general, what this study confirms is that the treatment should be designed to meet the needs of the specific, individual patient. Psychological health care will always be a component of that treatment.

Depression is common and it can be severely disabling. It is highly treatable. No one should suffer in silence.

Take the take the Psyris Depression Screening at the Psychology Resource Information System (psyris.com)!

Update (01/14/2010): The blowback from the JAMA depression study has started. Writing in the New York Times, Richard A. Friedman, M.D. has challenged the findings, arguing that the question is much more complex. He says that this new study "does not stand up to the mountain of earlier evidence" showing that medication is effective for a "wide array of depressed patients."

Some of his points are well taken (e.g., the original study only looked at two particular anti-depressants). Other points are less compelling (e.g., he disparages the well established "meta-analysis" method, or at least how it was used in this case). His primary point involves an endlessly complex theoretical issue that empirical science has not resolved: what is the meaning of the placebo effect?

Perhaps most importantly, in my view, is that Dr. Friedman gives short shrift to the importance of psychological care in the treatment of what is typically a psychological problem.

Dr. Friedman's final comment was: "there is no question that the safety and efficacy of antidepressants rest on solid scientific evidence."

His earlier statement perhaps deserves more attention: "antidepressants are not panaceas, and their advocates have sometimes been overly optimistic about their efficacy."

Stress and Depression reduce worker productivity ... new study, old news.

2010-01-04T14:17:00.000-08:00

I saw it in the paper the other day, and then it came into my email box from a few different sources.

There's a new study out demonstrating that when workers are depressed, or when they are stressed at work, they are not as productive.

I read it carefully, thinking there must be something new to the story. But no, there's nothing new to report. Writing in the American Journal of Health Promotion, Professor Debra Lerner reported the findings from a study sponsored by the Tufts University Program on Health, Work andProductivity.

According to Dr. Lerner, depressed workers are:

"often very fatigued and have motivational issues. Theyalso may have difficulty handling the pacing of work, managing aroutine, performing physical job tasks and managing their usual workload."

Commenting on this "new" study, Harvard Medical School Professor Ronald Kessler said that these findings:

"are consistent with a growing body of evidence that depression has important adverse effects on work performance, both absenteeism and on-the-job performance."

This is not part of a "growing body of evidence." Instead, it's an established fact, repeatedly demonstrated. We've known this for years!

Dr. Kessler also commented that studies are "beginning to show" that workplace intervention programs aimed at distressed workers are cost-effective. Once again, it's entirely old news ... decades old.

Do companies profit from workplace wellness programs focusing on psychological health? Is there a payoff? Anyone in corporate America who doesn't know the answer to these questions hasn't been paying attention for the past thirty or forty years.

This study did include one interesting finding. It said that the cost of stress and depression may be greater than most all other health related concerns affecting workplace performance, except for "musculoskeletal problems and insomnia." What the study should have pointed out, however, is that there is a significant correlation between back pain and distress and that insomnia is a symptom commonly associated with depression. Factor that into the equation and you are left with the conclusion that stress may be the single most important workplace health concern.

What should also be factored into the equation is an awareness that depression is highly treatable and that workplace stress is largely the result of workplace conditions that can ordinarily be fixed.

The take away message for anyone reading about this study should be this: There is money to be saved and money to be earned by paying attention to the psychological health of workers.

Are you a distressed or depressed worker? I have two online screening tests you can take at the Psychology Resource Information System: psyris.com ... one is a depression screening instrument, the other asks about your psychological well being. Both are brief and both are free (and anonymous).

I have been a psychologist for more than 25 years

2010-01-01T10:48:00.000-08:00

I have been working in the field of psychology since 1976, starting at the Master's level. In 1982, I completed my doctorate degree at the Berkeley campus of the California School of Professional Psychology (CSPP-Berkeley). I have been licensed to practice as psychologist, and to use that title, since 1984 (California License PSY8693).

By the time I completed the Ph.D., I had worked for 4 years as an assistant to a forensic psychologist and had interned for three years in community mental health centers. After finishing my studies, I was a staff psychologist at the California Youth Authority for almost five years.

Before pursuing a doctorate, my studies were concentrated on research in the areas of perception, working memory, attention and cognitive processes. My subsequent training was primarily in the field of clinical psychology.

Although I practiced for a number of years as a psychotherapist, my career has been largely focused on conducting diagnostic interviews and evaluations. For the past 15 years, I have worked almost exclusively in the field of criminal forensic psychology. I have qualified as an expert witness throughout California, and also in Federal Courts, as an expert in the field of psychology.

Throughout my career, I have retained an interest in health psychology and I have lectured frequently on the connection between health, stress and well-being. In this regard, a particular focus of my writing has been on the assessment of depression, anxiety and wellness. My interests in the field are broad and my fascination with the science of psychology is enduring.

One of the best compliments I ever received from a client (an indigent criminal defendant) was: "he told me exactly what he thought."

The best compliment I ever received from a juror (following a difficult court trial) was: "we understood what he was saying ... he spoke to us in plain language."

My professional profile and a link to my resume is here.

Psychologists Reject Science? ... Oh My!

2009-12-02T17:30:00.000-08:00

The psychotherapy community is all atwitter about an article (1) recently published in Psychological Science in the Public Interest, an article that purports to describe "psychology's failure to develop as an applied science."

The article by Baker et al wanders across a range of topics while making a variety of assertions. According to the authors:

Psychologists are "deeply ambivalent about the role of science and research."
Psychologists are "not accountable to anyone and are unconstrained by procedural guidelines or practice standards (except, perhaps, for the prohibition regarding sexual relations with a patient)."
Rather than being licensed to practice independently, psychologists should "have their practices monitored to ensure adherence to good standards of practice."
Psychologists don't know if their work is of any value to the patient.
Rather than listening to science, psychologists tend instead to view experience as important and to view "each patient as unique."
During training, psychologists spend too much time on "arbitrary breadth requirements" (i.e., we're too broadly educated), too much time actually working with clients, and not enough time studying "molecular genetics."
Some of the most effective psychological treatments can be delivered "without highly trained personnel," or by health educators "with little or no prior experience" who have "received only a modest level of training" in the treatment technique.

"Dolphin-assisted therapy" is not likely to ever pass scientific muster.
Psychotherapy causes global warming .

Ordinarily, this article would have been widely ignored and roundly dismissed as the naive polemic that it is. But before they went to press, the authors hooked Newsweek Science Editor Sharon Begley on the story and it became an issue. You can't really blame Begley for buying it. It's pretty juicy stuff for the popular press: "psychologists reject science" and use "dolphin therapy."

Begley's assessment was that this publication signaled a "fight brewing among therapists," one that was "getting ugly" and where "the gloves have come off." Her assessment was dead wrong.

The argument that Baker et al made is tired and old, and therapists did not start taking up arms. Instead, what I observed in a series of online discussion groups is that psychologists turned their attention to reviewing and discussing the science. Research that might not otherwise have been carefully studied became widely discussed. Contrary to expectations, psychologists did not reject science. They embraced it anew.

A consistent theme in the responses to the Newsweek article was the concern that the public might take this criticism of psychology seriously, and that it might discourage people from seeking treatment that they need. Historically, only about twenty percent of individuals suffering mental or emotional distress will seek or receive help. For those who do not obtain assistance, the costs can be measured in many ways.

What this is really about (3). The Baker et al article is the latest attempt by the "empirically supported treatment (EST) movement" to plant its flag. What this movement argues is that when it comes to psychological therapy, the only thing that really counts are the procedures and techniques that are employed. And in order to "earn EST status," a therapeutic approach must demonstrate its effectiveness via one particular research method, the "randomized clinical trial (RCT)." This is the method that you would use if you were studying the effectiveness of aspirin, but it is only one of a number of scientific methods that can be used to inform practice.

The EST proponents say that RCT is the "gold standard" of research methods and are essentially saying that treatments should be designed and selected not on the basis of theory or demonstrated potential, but instead, on the basis of the research method used to study them. Commenting on this, Dr. Larry Beutler (who is extensively published on psychotherapy outcome research) said:

"the effort to identify EST or research informed psychotherapies is viewing evidence through the lens of a single or preferred research methodology, when there are several competent methods available ... the scientist has fallen prey to worshiping the method rather than the 'truth.'"

It is in fact the case that EST research is significant and useful, as one among a number of scientific approaches. For example, the finding that for the treatment of depression, cognitive behavioral therapy (CBT) works just as well (or better) than medications has been enormously important in establishing that "talk therapy" works. But this research method has also tended to obscure other important and significant factors that contribute to effective practice. Yes, the techniques work and the cookbook is handy, but that doesn't mean that CBT is always the best treatment for depression or that everyone walks into the clinic with a specific problem that meets the "strict inclusion and exclusion criteria" demanded by the EST/RCT prescription. In arguing that psychologists reject science, Baker et al chide clinicians for sometimes believing that "each patient or prediction problem is unique."

One of the things that has been obscured by the EST research is that other forms of treatment work just as well. The randomized clinical trial method compares a treatment to "no treatment" and a placebo condition (the placebo can be something like an educational program or a waiting list). A number of "meta-analytic" studies (a statistical technique that combines the results of hundreds of studies) have shown that in the real world, the prescribed cognitive treatments are no better than TAU (that's "therapy as usual"). The evidence is compelling that in the real world, outside the lab, psychodynamic, insight oriented, problem focused and relationship based treatment strategies are often more effective than procedure-driven cognitive strategies.

The reason "empirically proven" procedures are not always best is simple: people are complex, as are the difficulties they suffer. People seeking care have different personalities, different life situations, different life experiences and different coping styles. The "fit" between the patient and the therapist makes a difference, as does the the "fit" between the patient and the methods chosen. Some therapists have more experience in helping people solve problems and more skill in adapting their approach to the needs of the individual. And the "placebo" factor cannot be ignored: it makes a difference if the client has confidence in the person providing care and if they hope and expect to obtain benefit.

The EST movement dismisses all of the above as "non-specific factors," elements of the treatment process that should be ignored because they cannot be randomly assigned for the purpose of an experiment. These factors are considered to be part of the error equation. The EST assumption is that for research purposes and for "scientific" purity, the therapist doesn't matter and the person doesn't matter. In their view, all that matters to the scientist is what the therapist actually does. That is the type of "science" that they say we have rejected.

What psychologists have not rejected (not for a moment) is the use of both theoretical and empirical science to inform practice and to provide a foundation for our work. The research that tells us that therapy works also tells us that these "non-specific factors" are meaningful and significant and worthy of study. In a review of the literature, Dr. Larry Beutler had this to say about the "non-specific factors" that the "real scientists" dismiss as error:

"If, as we have proposed, these aspects of character, preference, fit, and expectation contribute more and stronger predictive power in outcome assessments than the technical aspects of the interventions, then they are the treatment."

In saying that psychologists reject science, a central datum for Baker et al is a finding that more than half of clinical practitioners will say that their experience is more important than the research, or that experience should be given equal weight. These authors would perhaps be dismayed to learn that all 50 States and the Canadian Provinces have bought in to this assertion. To practice, they all demand that we be well trained and amply experienced. They demand supervised experience in order to protect consumers, rather than assuming that anyone can practice competently just by being taught a few empirically validated techniques.

The licensing boards also demand that psychologists be broadly educated in the science of psychology.

What's the take-away message?

If you are troubled or distressed, anxious or depressed, it makes good sense to seek help or to talk to a psychologist.
To help you decide if you are in need, here is a brief psychological health questionnaire and a brief depression symptom inventory. Both provide guidance as part of the results.
In most cases, therapy will help. Therapy works (that's what Consumer Reports and the U.S. Surgeon General say).
The therapist's experience is one of the things you should consider in choosing someone to work with. How you get along with the person isn't the only consideration, but it is something to consider and think about.
You don't need to say "I need this specific treatment I read about in Newsweek." What you need to do is to talk to someone to help figure out how best to proceed.
There are some brands of treatment that people will say are special and unique, miraculous and wonderful, and guaranteed to work. Be careful about those. Yes, there are some empirically validated treatments that are of proven effectiveness for certain conditions. But there are some therapists (including some psychologists) who sell methods and models that either don't work or that can be harmful. In most cases, what you should be looking for is TAU (Therapy as Usual).
TAU might be short-term and problem focused. Or it might need to be longer term and focused on more fundamental personality change. An experienced therapist can help you decide on a course of action. There are a lot of variables involved.
If you are depressed, your therapist might recommend some things that have not been the subject of rigorous scientific validation: eat right, get more exercise, try some relaxation techniques, go to yoga, stop watching so much TV, keep a journal, take a vacation, buy a dolphin ...

Final Comment: In the days since the Newsweek article hit the stands and brought this "inside baseball" argument to the attention of the general public, Dr. Baker has gotten an op-ed piece published in the Washington Post. Yesterday, his co-author Richard McFall was featured on NPR's Science Friday show. The EST movement is on a roll. As I said, it's an old topic of discussion and not one that is of practical significance. What is of practical significance is that therapy works and can be recommended. In response to being accused of rejecting science, psychologists are going to continue to review and discuss the science.

Notes:

(1) Baker, McFall and Shoham. Current Status and Future Prospects of Clinical Psychology: Towards a Scientifically Principled Approach to Mental and Behavioral Health Care. In: Psychological Science in the Public Interest, November 2009. (return)

(2) Actually, I just made that up. They didn't really say that psychotherapy causes global warming. But you should know that psychoanalysis (that's where you lay on the couch) does have an unnecessary carbon footprint. When you lay on the couch, they usually put a tissue paper under your head. All that paper, all those trees ... it all points to global warming. (return)

(3) For much of the discussion that follows, I have relied on the following article: Beutler, Larry E. Making Science Matter in Clinical Practice: Redefining Psychotherapy. In: Clinical Psychology: Science and Practice, September 2009. (return)

The Psychology of Netflix

2009-09-23T13:47:00.001-07:00

Netflix has just awarded a $1 million prize to an international, seven member team of engineers, mathematicians and computer scientists for solving "the Napolean Dynamite problem."

You know how Netflix tells you: "if you liked that movie, you're sure to love this one?" That's what the prize was about.

Three years ago, Netflix launched a contest to try to find a better mathematical algorithm to predict what you like. More than fifty thousand "contestants," many of whom formed teams, tried to find a solution. People from all around the globe (186 countries!) participated.

On the face of it, it seems rather simple. People rate movies (1 to 5 stars), and from those ratings and the ratings of others, it should be simple to say what they like. But it's actually not simple at all. There are all kinds of different reasons a person might like one particular movie and why they might like or hate movies that are very similar or entirely different. And there are all kinds of different people rating the movies. Netflix has tons of data (i.e., movie ratings), and those numbers come from "people like you" and people who are nothing like you at all.

The problem is: how do you crunch the numbers when there are so many variables involved? How do you make sense out of all those ratings when you have so much "variance" floating out there that you can't account for? It's like the old saying, "there's no accounting for other people's tastes."

The million dollar prize was to be awarded to the person or team who could come up with a better way to crunch the numbers and the goal was to make the predictions just 10% more accurate than what they were. That's no simple feat.

Clive Thompson wrote a detailed article about the contest last year (November 21, 2008) in The New York Times Magazine. The contestants who got a quick jump on reaching the goal were using a statistical technique called "singular value decomposition." This wasn't a new form of math. It's a variant of an established statistical method called "factor analysis" in which a researcher takes huge chunks of information and boils them down to just a few factors.

This method is commonly used in research on human judgment and perception. When people make a choice between two things (are you going to buy the Mac or the PC?), they will typically say they had a hundred different reasons. In reality, it usually boils down to just two or three factors, or maybe even one.

Clive Thompson called it "the Napolean Dynamite problem" because it turns out that this is one of the movies that makes the math so hard and disrupts the whole system. "Miss Congeniality" and "Lost in Translation" are two other movies that are on that list. They are movies that people don't just "either love or hate." They're movies that are particularly good at stirring up all types of conflicting and maddeningly inconsistent reactions.

So what does this have to do with psychology? I think it was said best by an AT&T scientist, Chris Volinsky, who was quoted in the New York Times article. Describing his work on the Netflix prize, he said: "we're teasing out very subtle human behaviors" while trying (in the words of Clive Thompson) "to draw exceedingly sophisticated correlations and offer incredibly nuanced recommendations."

"Teasing out very subtle human behaviors" is exactly what the science of psychology is about. And it can be argued that this contest had everything to do with understanding and predicting human behavior.

There are psychologists whose work would seem to have nothing to do human behavior. There are psychologists who do hardly anything other than study and publish mathematical equations, and then tell the rest of us how to conduct research. More importantly, they tell us how to make sense out of the numbers we gather in our research. When I was in graduate school, I turned in a take home final exam question on which I wrote a five page essay. I got an A on the paper, but I understood the question in a completely different way than the guy who sat next to me in class. He got an A for turning in one page of math equations in response to the same question.

Psychology is a science only because we have mathematicians telling us how to make sense out of our observations. And that's the reason that in psychology programs, students have to take all of those dreaded statistics courses.

The math involved in the Netflix challenge is amazing, and for most of us, largely beyond comprehension. It is hugely important to companies like Netflix, iTunes and Amazon, or any company that uses people's preferences to sell products. If they can make relevant suggestions, they're going to sell more. That's why they do it.

What is even more amazing is that they are doing this math with data from just a single and simple "Likert-type" scale. Imagine how much more they would know if they had people rate the movies on five different variables (but then, they would lose information because more people would probably not bother to submit ratings).

That could be the next challenge for a company like Netflix: how do you get more information from just one action of the mouse? Here's my suggestion (and my official contest entry): show the movie cover along with two others and ask the rater to drag the movie to either the first, second or third position. A "paired-comparison" judgment like that could provide tons of information for the math guys to go after.

Will Forensic Psychologists be involved in the Phillip Garrido case?

2009-09-21T11:50:00.000-07:00

A reporter called me the other day to ask a hypothetical question about the parolee, who along with his wife Nancy, stands accused of kidnapping and sexually assaulting Jaycee Lee Dugard. Our conversation turned to a discussion of what might happen as the case proceeds. I mentioned that forensic psychologists would likely be called into the case at a few different phases.

{The attorney for Phillip Garrido has already asked the Court to appoint either a psychologist or psychiatrist to conduct an examination. The Court's approval of that request has been described in the media in a few different ways. The attorney could have just hired someone for this task, without asking the Court. The only reason to have asked the Court to appoint someone is so that the funding would come from the Court, and not from the Public Defender's budget. In El Dorado County, there are currently some real serious budget issues and this is going to be a very expensive case.}

At the current time, we know very little about Garrido's mental health status and history. What we know is that his father has told the news media that he was a "good boy" who changed after a motorcycle accident and after drug use. We know that Garrido wrote on a blog that he developed an ability and/or a device to control sound with his mind. We know that he called Walt Grey, a well known Sacramento TV news reporter (KCRA Channel 3) and told him that he had an incredible story to tell. He said it as if he thought people would welcome his story and like it was a good thing. There is enough in these bits of information to conclude that he is somehow and in someway psychologically disturbed. If it's true that he "changed" suddenly after a motorcycle accident, it could be the case that he suffered some type of brain injury.

We also know that Garrido was described by a psychologist years before as being a "sexual deviant." And, we know that he was previously convicted for a horrific crime.

It could be that Garrido "just" has a warped personality or what we call a character disorder. Whatever his mental health status, we know at least that much from his criminal history.

So will forensic psychologists or psychiatrists be involved as his case proceeds towards trial? The answer is almost certainly yes. Although we know much less about her from the news reports, the same is also true for his wife Nancy, who has also been arrested in this matter.

There are at least three phases in which psychologists might be involved.

Psychologists might first be involved in consulting with the defense attorneys and helping them understand: "what's going on?"

In cases like this, where there are strange circumstances and strange behavior, it is common for defense attorneys to hire forensic psychologists for the purpose of understanding the case and understanding the defendant. The attorney will turn to the available evidence to figure out what the accused might have done. And they will often turn to a psychologist to figure out why the person did it. In a case like this, the motive might be simple, or it might involve a complex set of psychological dynamics. The motive might be of little or no significance as the attorney formulates a defense strategy, but on the other hand, it could be that the attorney needs to consider some type of "mental defense." For many types of crimes, the prosecution must prove that the accused acted with a certain "intent." Even if it seems obvious on the surface, the defense attorney needs to figure out exactly what the person had in mind.

A consulting psychologist is typically able to answer these questions and to make certain that the defense attorney has all the information needed to provide a full, fair and effective defense. One of the first things the defense attorneys will have to determine is whether there is any doubt about the mental competency of either Phillip or Nancy Garrido and whether or not there is reason to pursue an insanity defense in either case. It is something that the attorneys at least have to consider.

If the defense decides that it must "declare a doubt" about the competency of either defendant, two psychologists and/or psychiatrists will be appointed to examine them. The competency question doesn't have anything to do with whether or not they were crazy when they committed the crime. It has to do with whether or not they are mentally disordered now. Competency is about whether or not mental disorder is serving to prevent them from enjoying due process and effective representation. It's about whether or not mental disorder might prevent them from getting a fair trial. If they are disordered in some way that prevents them from understanding the proceedings or that prevents them from working with their attorney in a rational way, then they could be found incompetent.

People often think that competency proceedings are just a defense tactic. But in fact, both the prosecution and the defense have an interest in making sure that the accused knows what's going on. If the question comes up and is not clearly settled, the defendants end up with an issue that they can raise on appeal, a basis for arguing that they didn't get a fair trial.

In competency proceedings, it's sometimes the case that the psychologists will find that the person cannot understand the proceedings. More often, people are found incompetent because they cannot rationally assist their attorney. Often times, this has to do with some crazy idea that they have about how they want to defend their case. They insist that the attorney put on evidence that will certainly lead to conviction, or they insist that the attorney make some argument that is inherently crazy and self-defeating.

As an example, a defendant might insist that their attorney subpoena the President, the head of the CIA and the Prime Minister of Russia to prove that they really did own the World Bank and that the Army intelligence services were trying to poison them and steal their thoughts. Stuff like that often comes up in homicide cases where the disordered offender wants to say that the crime involved necessity or self-defense. In the Unabomber case (Ted Kaczynski), the defense asked for a competency examination because the defendant would not give any consideration to an insanity defense and wanted to argue that he had to do it. In the Garrido case, it could be like the Unabomber situation where the defense decides that the only possible defense is to argue insanity. If for some crazy reason Garrido refuses to at least consider their advice, they might need to express the doubt about his competency.

The doctors who would be appointed to examine him (or his wife Nancy) are not the ones who will make the final decision. They will offer opinions. After their reports are received, the defense and prosecution could decide to submit the matter to the Court and let the Judge decide. If there is a competency trial for either Phillip or Nancy, the prosecution will undoubtedly insist that it be a jury trial and not a trial in front of a Judge. The prosecution will want members of the community to consider the evidence and make the decision.

What happens if either of them are found incompetent for some reason? They would then be committed to a State Hospital for treatment and the case would be delayed. It won't go away and they will not have escaped judgment. The hospital will send them back to be tried as soon as possible, perhaps as in little as a few months.

It may be that the defense attorneys will not raise the competency question. This is one of the reasons they would have obtained consultation from a psychologist early on in the case. It is often the case that I write letters for attorneys saying that competency is not an issue. They put that report in their file and it is never seen unless the issue comes up on appeal.

The third way in which psychologists might be involved is if either Phillip or Nancy decide to pursue an insanity defense. There are occasions when defendants really have no other defense to offer. Sometimes, the evidence pointing to guilt is substantial and overwhelming and the only thing the defense can do is to try to argue that they were crazy when they did it. That was how it was in the Unabomber case.

If the defense enters an insanity plea, two more Doctors will be appointed to examine the defendants. Under California case law, this will typically not be the Doctors who offered opinions in any competency proceeding.

The difference between competency and insanity is this: competency is about how they are doing now (does mental disorder prevent them from receiving a fair trial?); sanity is about how they were thinking when the crime was committed (at that time, did they know what they were doing and did they know that it was wrong?).

The sanity question will be considered by the jury only if they are found guilty. In other words, it will be a separate, second trial. Evidence about any mental illness they might have been suffering can be admitted to the "guilt phase trial" only under certain circumstances and only with certain limitations.

If someone is found to be insane, they are committed to the State Hospital for a period of time that is not any longer than what they would have been sentenced to if they were simply found guilty and sent to prison.

If either of them is found insane, could they ever get out of the State Hospital? The proceedings involved in getting "restored to sanity" and getting out are rather complex. In this case, the short answer is that as a practical matter, no, they would never get out of a locked and secure facility.

What are the odds that Phillip or Nancy might actually be found insane? Not good. It is a judgment made by a jury, reflecting the judgment of the community. This is not a commonly successful defense, no matter what you might have seen on TV. Juries don't like this defense and rarely rule that a defendant is insane unless the circumstances of the case are exceedingly compelling. In the media, we have already gotten a good sense about how the community feels about this crime and these defendants.

The reporter I spoke to about this case also asked me if Garrido might be offered a plea bargain and whether this might be resolved without a trial. My answer was no, there won't be any plea bargain offered. In this case, there is nothing to bargain with. It's not a death penalty case, so the prosecutor can't offer life in prison in exchange for a guilty plea. And given the nature of the case, no prosecutor will offer anything that does not make it certain that Garrido spends the rest of his life in prison. In other words, there is no room for negotiation. In many cases, psychologists provide information about a defendant that helps the DA and the defense understand the case, and sometimes that information is used to help inform the plea bargain negotiations. I don't think that will happen with either of the Garridos.

On a final note, people sometimes ask about the role of psychologists in the criminal courtroom. Some people will say that we are like the "whores of the court." That is not at all the reality. Most of us who do this type of work typically have little or no interest in how the case turns out. We provide explanation, not excuse, and what we do is mostly about insuring that the accused has enjoyed due process. No matter how heinous the crime and no matter how "obvious" it might be that a person is guilty, our system and our values require that they be fully represented and that they get a fair trial. When someone is put away, the last thing we ever want is for someone to say that it was because the system wasn't fair or that the verdict wasn't just.

When Leadership Fails: a short story about administrative incompetence

2009-09-17T20:05:00.000-07:00

This story is a companion piece to three of my other posts:
Is your boss paying attention to you?
Burnt-out on stress management? It's time to change the organization.
Workplace stress: Does anyone hear the workers screaming in their cubicles?

My wife, Cici, has filed a lawsuit against her employer: California State University, Sacramento (CSUS or "Sacramento State").

If you want, you can read the stories written about this action in the Sacramento Bee or the Sacramento State Hornet. The Hornet also published an editorial. The 200 page lawsuit is also online.

Cici has worked for the campus for more than thirty years. For most of that time, she has been the Director of Career Services in the College of Engineering and Computer Science. She was the first to hold that position, and even though she is the only staff member in the Career Services Office, she has created an entire service delivery system. She has developed an extensive network of contacts between the community and the campus and between the engineering school and employers from a wide range of industries and government agencies. She has brought in substantial donations of equipment and funds, and the money necessary to run her operation. She regularly employs a group of student assistants and a webmaster, and she funds the annual Engineering and Computer Science Career Day, along with other special events. Integral to her program of services is a set of career development courses she has been teaching for more than 25 years.

In the stories appearing in the Hornet and the Bee, it says that one of her complaints is that she has repeatedly been denied any "promotion" while serving in this position. It is more accurate to say that she has been denied proper classification, or a classification that is consistent with her job description and responsibilities. Her lawsuit alleges that her requests to be reclassified as an "academic related professional" have been denied in retaliation for complaints she has made. The campus says this isn't so.

Her lawsuit also alleges that she has been refused "academic related" standing in response to gender discrimination. It's a glass ceiling issue (yes, there are a number of men - all men - doing similar but less demanding student service, student advising jobs while enjoying "academic related" status). There are female student service professionals on campus who do have academic status, but they are in health center jobs (licensed therapists), not in student advising.

Cici's other complaints against the campus relate to one particular Professor, Miroslav Markovic.

Cici's problems with Miroslav began in 1991 when a company in Reno called to say that they had received somewhere between 12 and 15 phone calls and two visits from the professor. Markovic wanted them to fire a recent Sac State graduate whom they had hired. It turns out that Miroslav had tried to develop a sexual relationship with the student and was angered when his advances were spurned. The student documented his experiences with Markovic in a letter to the campus in which he said that it was only too late that he came to realize that Markovic was a "sexual predator." His letter made clear that he had been "groomed" (my word) and that Markovic was "chicken hawking" him (as they say in the criminal arena where I work). The situation evolved into threats and stalking behavior. Markovic wrote to one of the student's friends: "I love him, and I do not know why he does not return my love. I helped him so much and he just ignores me … I must get back at him."

It was an alarming circumstance and Cici was drawn into it because the complaints came to her and because the Dean asked her to help straighten things out with the employer. Markovic was placed on leave for a while, but was allowed to return to campus. I have spoken with this student, and 18 years later he is still traumatized by the experience.

In subsequent years, the campus continued to receive student complaints about Markovic. Some students wrote to the administration, but many of them came to Cici. In the school of engineering, she is the only student services professional, the only student advisor. She is the one who helps students with their careers, and usually the complaints were around issues that would affect their careers. One group complained that Markovic threatened to fail them in class if they skipped a session to meet with a company that was coming to recruit and offer jobs. Others documented unfair grading practices.

Many of the complaints came from women who said that Markovic displayed distinctly sexist attitudes in the classroom, telling women that they "don't belong in engineering." International and minority students also regularly complained about classroom discrimination. As she had been instructed to do in her mandatory sexual harassment training, Cici passed these complaints along to the campus Affirmative Action Officer.

In 2002, a hiring manager for a large California utility company (PG&E) called Cici to tell her that Markovic had threatened to smear his company's name if they worked with anyone other than him to hire graduates. Markovic wrote to PG&E and said if they tried to work with anyone else on a project that was developing, they were wasting their time and might as well be speaking with "Osama Bin Laden." That resulted in the loss of a partnership that PG&E was developing with the campus. The company walked away, citing the risks involved.

Later in 2002, a Department Chair in engineering took a long list of signed student complaints about Markovic to the campus attorney. Nothing happened in response.

In 2003, a student sent the campus president a letter saying that he thought Markovic was a "loose cannon and a potential danger to students." He said that while in a tirade, Markovic told the student that Cici had "slept her way into her position."

In 2007, a staff member wrote to Cici and told her that he was concerned about her safety. Markovic hadn't threatened her directly, but there was something about the circumstances and the way in which he called her a bitch that alarmed the staff member.

In January of 2008, Cici and I both met with the Campus Affirmative Action Officer, Peter Lau. A utility company hiring manager had recently told Cici that "it was happening again." He had good reason to believe that Markovic was again "chicken hawking" students. The industry contact assumed that "everyone knows." It was certainly no secret off-campus.

Peter Lau said he would open a 60 day investigation. Six months later, he wrote to say there wasn't enough evidence to do anything. Summer vacation began.

On the day Cici returned from summer break, a staff member told Cici that he was planning to quit. He had been on campus all summer and was demoralized by having to interact with Miroslav on a regular basis. In the engineering building, there is no shortage of people who have been abused by him.

The very next day, Markovic forcefully and intentionally bashed into Cici at a reception. Actually, he bashed into her twice. The message from Markovic was clear: he could do whatever he wanted and get away with it. Which happened to be true. I informed the campus using clear and forceful language.

A few days later, after the campus received my note, Kent Porter, the Vice President of Human Resources wrote to the Engineering Dean and asked: "does Cici want to pursue this matter?" I received a copy and wrote back that she has pursued this before, to no avail, and that it was time for the campus to do something. I outlined the history.

Cici then spoke to the campus police. They said it was an administrative matter. Two weeks later, Kent Porter wrote and said she hadn't done anything to report the incident. Cici informed Porter that she had spoken with the police. Porter wrote back and said that "if" she had spoken to the police, they could do something. Porter invited her to tell Human Resources what had happened. Somehow, he couldn't hear the screams coming from her office.

On September 24th, 2008, Cici called Porter from her office. A fellow staff member was there with her for the phone call. That woman was aware of what was happening and told Cici that during the summer, Markovic had shouted at her and threatened to "get a gun and shoot her" (not Cici, but the pregnant staff member). They said they were afraid and Porter asked them how tall they were.

In early October, two other people on campus (one a student and the other a staff) told Cici that Markovic had recently threatened to shoot them. Cici called the police. Porter was no longer responding to her calls or emails.

By December 2008, Cici had hired an attorney. The attorney sent a lengthy note to the campus president, Alex Gonzalez. The president didn't respond, but the campus hired an investigator.

Six months later, in May of 2009, affirmative action officer Peter Lau wrote to Cici and told her that based on their investigation, when Markovic bashed into her (nine months earlier) it must have been an accident. He said that she had never suffered any retaliation from the campus and that she had not been subjected to any gender discrimination relative to her employment classification. It was a "we covered our ass" letter.

We don't yet know what the investigator actually found. The letter Cici received basically just said that none of her complaints would be taken seriously. Nothing was said and nothing has been said about the fact that staff members might be upset about a faculty member threatening to shoot them.

While this was all happening in Fall 2008 and Spring 2009, the campus decided that Cici could no longer teach her classes (which are integral to her program of services), at least not under her own name. She would no longer have access to her class rosters and could no longer report grades.

The campus had ample notice that a lawsuit was in the works. A few days after Cici filed the lawsuit, in August 2009, the campus canceled all of her classes except one (students were already enrolled). The course they didn't cancel is a required class. It was given to a professor who immediately wrote to Cici and asked how to teach the class.

Why did the campus cancel her classes? She can't teach the classes she's taught for 25 years because she's not classified as "academic related." That's what the campus will say. The campus will say it's a union issue. Even though she meets the criteria, the campus repeatedly refused to classify her as having academic status. Then, they took away all of her classes because she didn't have academic status. Catch 22.

What did the campus do in response to the three reports it received about Markovic threatening to shoot people? Nothing. It's not like this is Virginia Tech.

What happened to Markovic? He retired a few days after Cici filed the lawsuit. But in the interim, in the Spring of 2009, while the campus was ostensibly conducting an investigation, the campus made him a member of a really important project team. Sac State has teamed up with the Sacramento Municipal Utilities District (SMUD) to create a "Smart Grid" institute to go after what they expect to be millions of dollars in Federal stimulus money. The State Energy Commission has already promised 2 million in seed money. After all of the harm he had done to faculty, students and staff, and to the reputation of the campus, the Dean of Engineering, Emir Macari made him part of the team.

How do things stand with Cici? After reading in the newspaper that Markovic had retired, Cici returned to work on the first day of the Fall 2009 term. She thought he was gone. He was still there. She left and remains on leave. Cici doesn't know what is going to happen next. Yes, she sees a therapist, and spends a lot of time at the yoga studio. She's doing what one needs to do to "manage stress."

After Cici returned to work and found that Markovic was still there, I wrote to President Alex Gonzalez. The campus attorney, Edmundo Aguilar responded: "I disagree with your characterization of this situation as a 'workplace hazard and safety' issue." He told me that I should speak with Cici's attorney if I have any further concerns. In other words, he doesn't understand that workplace stress is a safety issue and apparently doesn't want to hear any more about it.

Long story short? If not before, then certainly in August of 2008 - that's more than a year ago - Sac State should have heard the screams coming from one of its employees. In my view, this series of events confirms my argument that workplace stress is primarily a result of leadership and organizational failure. This was a situation that could easily have been resolved.

Why did Cici sue? Ask her, and what she will tell you is that she didn't want to see any more students hurt. When a student draws a bad grade in a class just because she's a woman or because he's a foreign student, it affects that student's entire career. When a young male student realizes that a "friendly" professor is a "sexual predator," it undermines their sense of self-esteem. There were people on campus who were frightened and demoralized, and somebody had to do something about it. The University wouldn't.

Her program is important to the mission of the campus. It is always cited in the engineering accreditation studies. The last accreditation team to visit to visit the engineering school said that Cici's career services program "should be a model for the country." Her classes, the ones that have been canceled, are an important and integral part of that program. When students come to a University like Sac State, they expect to land a job when they are done. It's not like why they would go to UC (the University of California).

How will the story end? I don't know.

Updates:

On September 21st, the campus Affirmative Action Officer wrote and confirmed that the University had allowed Cici to be subjected to a hostile work environment, in violation of law and policy. He retired a few days later.

The campus attorney has left his position with the University.

The University has hired an outside attorney, David Tyra, to handle this matter. He has asked for additional time to respond to the lawsuit and is expected to file a response on October 17th.

In mid-November: Rather than filing a response, the campus attorneys and the HR VP Kent Porter met with Cici's attorney to try to resolve the matter. They showed up to the meeting late, unprepared, absent authority and without seriousness of purpose. Markovic is gone, so the first issue on the table was the gender discrimination and classification issue. They just blew that off like it was nothing and said they would have to check with someone who has authority.

In early December: Another meeting. Similar experience. Cici walked out.

Workplace stress: Does anyone hear the workers screaming in their cubicles? Is anyone listening?

2009-09-11T17:00:00.000-07:00

I don't actually know the answer to this question. As far as I know, no one can really say to what extent employers are, as a rule, effective and proactive in responding to the complaints of their employees.

Unless someone files a lawsuit, complaining that their complaint wasn't heard and asserting that their complaint involves an issue of law, there is really no way to know how often the screams of employees go unheard. There are no hard data I can find and no research articles that provide the answer.

What I do know is that workplace stress is ubiquitous. The National Institute for Occupational Safety and Health (NIOSH, which is part of the CDC, Centers for Disease Control) describes workplace stress as one of the 10 leading causes of work-related disease and injury. NIOSH describes it as a safety issue, not just as an unfortunate consequence of work.

In describing the prevalence of work-related stress, NIOSH cites a study by Northwest National Life that found that 40% of workers report that their job is "very or extremely stressful."

NIOSH also quotes a finding from the St. Paul Fire and Marine Insurance Co.: "Problems at work are more strongly associated with health complaints than are any other life stressor - more so than even financial problems or family problems."

In a related post on workplace stress, I argued that workplace stress should be considered an organizational issue, and as NIOSH has said, that the first response should be prevention. In most cases, it is not the necessary and unavoidable stressful events in the work place that cause people harm. Instead, it is the stressors that need not be: those things that could just as easily be changed.

There are indeed workplace stress factors that result simply from the nature and the demands of work. But the stress literature is clear in noting that people will adapt, adjust, thrive and survive in response to even the most extreme stressors, if they have a sense of purpose or a sense of coherence. It is hard to imagine anything that might violate a worker's sense of meaning and purpose more than the experience that management is not listening and that management does not care.

Again, there is no way to know whether it is either typical or uncommon for organizations to be indifferent to the needs of their employees, but if you consider the above in combination, it tends to suggest an answer.

We can say that 40% of workers find their jobs to be "very or extremely stressful." Or on the other hand, you could conclude that 40% of workers operate in the face of toxic conditions that the organization has failed to recognize and remedy. You can argue that workers become distressed because organizations have either failed to remedy unpalatable working conditions or because they have failed to provide the motivation and incentive that would enable workers to maintain health in the face of challenge.

If, as NIOSH says, workplace stress is a safety issue (one of the top ten causes of industrial injury), then consider what that 40% figure means in terms of the safety of the American workplace. And consider what that tells us about the effectiveness of management in providing a safe workplace.

Another way to approach the question of whether or not anyone hears the screams of workers is to consider the fact that some employees feel a need to file lawsuits against their employers. Yes, there are some people who sue because they are just naturally litigious. Yes, there are some who are carrying out personal grudges or other psychological agendas. Yes, there are some who are at fault themselves and seeking to project blame onto others. And yes, there are some who are trying to profit or gain.

The reality, however, is that there are substantial hurdles that exist for those who "want" to sue. There are hard dollar costs involved and there are psychic tolls that can be overwhelming. The idea that it is easy to sue, or that anyone can do it is an idea that has no basis in reality. Sure, it's something that can easily be done if you are the victim of medical malpractice or a medical injury. But it is not at all easy or rewarding if your claim has to do with a violation of your sense of well-being. It is not easy at all if your claim is about mistreatment in the workplace. Years of effort and a complex set of legal rulings stand between a worker and a judgment. And in just about every case, it is the defendant (i.e., the organization) that has the resources necessary to prolong the process.

It is an entirely imprecise measure, but the fact that some workers feel that they have no other choice but to sue tells us something about whether or not anyone heard their complaints and was willing to do something about them.

Some years ago, on the 100th anniversary of the American Psychological Association, I was privileged to attend a lecture by J. Donald Millar, M.D. He was then the Assistant Surgeon General and the Director of NIOSH. He spoke about the science behind the decision at NIOSH to include psychological disorders on the list of leading workplace injuries, noting that the agency had previously been preoccupied with "hard hats and hard science." Occupational stress became part of the worker safety agenda on the basis of three criteria: 1) frequency of occurrence; 2) the severity of injuries; and 3) preventability by available measures.

To illustrate his understanding of occupational stress and safety, Dr. Millar told a gruesome (warning!) story. His daughter was a scientist involved in toxic waste site cleanups and was working at a site where logs (e.g., telephone poles) were chemically treated in large pressure cookers. On opening one of the vats, they found that a worker had been trapped inside and "cooked with the logs."

This is how Dr. Millar told it:

"As a physician in the Public Health Service for 30 years, I've heard lots of things. I have felt the helpless outrage provoked by unnecessary tragedy. Few things really 'get to me.' But I tell you the truth, I simply cannot get out of my mind the image of that worker in there, realizing he was trapped - screaming at the top of his lungs - pounding his fists bloody on the walls of the vat, trying at the extremity of desperation to get somebody's - anybody's - attention, as time and options ran out. Can you imagine how that was? Can you imagine the stress?"

Dr. Millar offered this vignette as a paradigm for workplace stress and how workers might experience their situation. In his words, "clearly this was an extreme case, but I believe it is a valid example of an individual helplessly trapped between an unbreachable barrier and an overwhelming on-rushing threat."

What has always stuck with me about this story is the image of someone trapped in a place where no one can hear their screams. In the workplace, I believe it is more often the case that no one is listening and that no one is paying attention (on this subject, see my post: Is your boss paying attention to you?).

As I said above, I don't know whether there are any data that tell us whether or not management really pays attention or whether or not it is either typical or uncommon for organizations to recognize and remedy stressful conditions.

I'd like to hear your comments on this: in your experience, does management pay attention? Are they listening? Is effective indifference the exception, or is it the rule?

Psychological Health Care: A prescription for health care cost savings

2009-09-07T15:56:00.000-07:00

It has long been recognized that emotional and psychological factors can affect one's health in a variety of ways. What is also known, but not well appreciated is that health plans can actually reduce their costs by providing psychological health care to subscribers.

The fact is that patients who receive psychotherapy tend to reduce their use of other, more expensive medical services. Despite this well documented finding, it is not uncommon for health plans to discourage mental health care usage, at a cost to themselves, to consumers, and to the employers who typically pay for coverage.

National Institute of Mental Health (NIMH) studies reliably estimate that almost 15% of the population will suffer from some type of emotional disorder during the course of any given year. Most of these people are normal and well adjusted and are simply responding to stress or to a crisis in their lives. These individuals are often referred to as the "worried well."

Only about one fifth of these people will actually seek or receive specialized treatment. Most of those remaining will not, however, simply suffer in silence until their symptoms go away.

NIMH researchers have found that the majority will be treated by their primary care physicians in what has been described as the "de facto U.S. mental health system." Health care dollars will be spent, regardless of whether or not specialized care is made available.

That this is the case is not readily apparent. Rather than complaining about psychological distress, patients will complain about physical symptoms which are caused, aggravated or maintained by emotional factors. Many will experience symptoms for which no organic basis exists.

This is not to suggest that the physical distress is not real. It simply means that real physical complaints can result from emotional concerns. While the patient may be complaining about disturbed sleep, headaches, back pain, dizziness, nausea, chest pains, diarrhea, indigestion, shortness of breath or sexual difficulties, the causative factors and curative means are often not strictly medical in nature.

If these sufferers were simply and effectively treated by their physicians, then insurance carriers would have little reason to be concerned about underwriting a de facto mental health system. Concern is warranted, however, because patients suffering from stress tend to use medical services at a disproportionate rate. It is not just that they seek medical care for problems which are actually psychological in nature, but that they use a great deal more care of all types.

Distressed patients use almost twice as many physician office visits, irrespective of their health status. They use more preventive services, more urgent care, and more hospital days, and they suffer more injuries and accidents. Distressed individuals are more likely to receive inconclusive diagnoses, are usually at greater medical risk, and when ill, are more likely to actively seek treatment.

It has been frequently estimated that at least half of all physician office visits are for symptoms that are primarily emotional or psychological in nature.

While obviously a problem, this situation actually represents an opportunity. A leading researcher in this field (and former American Psychological President), Dr. Nicholas Cummings, has argued for years that the systematic use of psychotherapeutic treatment is probably "the most significant untapped source of health care cost savings" available.

It was Dr. Cumming's studies (conducted some 40 years ago in the 1960's) with a population of some 10,000 Kaiser patients which provided the first demonstration of the potential cost savings. The patients were followed for five years. Those using mental health care during that time were matched with a control group.

Cummings found that those who were seen during that time in psychotherapy reduced their use of physician visits and hospital days to an extent sufficient to fully offset the cost of the treatment and to produce a net savings in general medical costs.

I first wrote on this topic more than ten years ago. At that time, there had been at least 58 studies replicating the original findings. Subsequent studies showed reductions in the use of medical care ranging anywhere from 5% to 79%, depending on the design of the service delivery plan.

The conclusion is simple: as part of a health maintenance strategy, outpatient psychotherapy saves money.

Given the above, it would be reasonable to expect that health plan administrators would actively promote the use of psychological health care. It should also be expected that when purchasing plans, employers would demand ready access to psychotherapy and that consumers would demand as much for themselves. In fact, it has remained the case that health plans often discourage the use of mental health benefits and that those who buy their plans give this service little consideration.

In practice, consumers often face a variety of subtle and not-so-subtle disincentives and barriers to obtaining treatment. Large co-payments, benefit limitations and exclusions, understaffed clinics, waiting lists, limited provider pools, complicated referral procedures and treatment review mechanisms all tend to discourage use. In many cases, physicians serve as "gatekeepers," receiving financial incentives for limiting referrals.

"Cost containment" is a legitimate reason to create disincentives. From the research, however, it can be argued that the potential for even greater savings is being wasted.

Even in plans which emphasize "wellness' programs, benefits are generally designed around the fear that once the doors to the therapist's office are opened, endless waves of patients will flow in to spend years on the couch for basically frivolous reasons. Each of these assumptions is wrong.

Do patients seek therapy they really do not need? Rand Corporation health insurance studies have demonstrated what every therapist knows: people seek help because they are in pain and distress, not because they want to contemplate the meaning of life.

Do liberal benefits produce uncontrollable utilization rates? If access to treatment is improved, there are temporary increases, but the rates quickly stabilize.

Do patients remain in therapy forever? Less than 10% of those entering treatment will require and use long term care. The majority respond to short-term methods, and contrary to the fears of the underwriters, they will have no desire to pursue years or even months in therapy. In any case, the fact that some will continue interminably is of little significance given that it is the average number of visits per patient that determines the cost of the service per subscriber. With a handful of patients using long-term care and the vast majority using just a few visits, the averages remain reasonably low, no matter what type of service delivery plan is provided.

What is most important with respect to utilization rates is that they are thoroughly predictable and therefore insurable. The potential direct service costs are not at all unreasonable. And again, if the treatment is not accessible, the dollars will be spent anyway on even more costly forms of care.

What are the implications of the above?

First, it means that if the Nation is in anyway intent on achieving health care reform and saving the money necessary to make it happen, psychological health care should be at the forefront, and not on the back burner.

During the 2009 health care debate, the Mayo Clinic has repeatedly been cited as a model for progressive care and as a cost saving model. A study released this year by the Mayo Clinic noted that over a four year period of time, the total cost of care provided to patients with major mood disturbances (i.e., bipolar disorder), exceeded the cost for patients with chronic conditions such as coronary artery disease and diabetes. And it wasn't the cost of their psychiatric treatments that made them the most expensive to treat. It was the fact that they used all manner of specialty care. The only group of patients that created greater expenses for the system were those who suffered from both coronary artery disease and diabetes.

Second, it means that rather than being viewed as a form of specialty care, psychological health care should be viewed as an essential component of the primary health care treatment system. While much is being said about the critical role of the primary care physician in guiding patients towards wellness and thereby reducing costs, there should be just as much attention paid to insuring that psychological and emotional concerns are attended to routinely and proactively.

A first step in this direction is to insure that physicians are following the recommendation of the U.S. Preventive Health Service for the routine administration of screening devices for depression and emotional well being.

Health care plans have a role to play in this effort. Insurance companies have the ability to shape practice by the way in which they set reimbursement policies. If it were known that psychological screenings will routinely be reimbursed, physicians would be more likely to employ them. When it is known that psychological consultation is regularly available for patients at high risk for emotionally based complications, it is more likely that physicians will include this service in their regular treatment plans.

Rather than assuming that the use of psychotherapy needs to be controlled, health plans should promote its use as part of a marketing strategy and in a spirit of enlightened self-interest.

Third, there is a role to be played by the employers who most typically pay for health insurance coverage. Employers paying for health care coverage should keep in mind that psychological well-being affects the bottom line. When choosing plans for their employees, they should keep in mind not just the cost of the plan, but the cost of stress related problems such as lost productivity, absenteeism, accidents, sick leave usage, disability claims and employee turnover. Those paying for the health plan need to shop on the basis of whether or not psychological health care is a priority.

Rather than viewing psychological assessment and psychotherapy as an unwarranted and unpredictable drain on resources, health plans would benefit from viewing psychological health care as a central component of a health maintenance strategy which seeks to reduce costs by promoting wellness.

Burnt-out on stress management? It's time to change the organization.

2009-09-07T14:30:00.000-07:00

Some years ago, I received a call from an organization that wanted me to conduct a stress-management workshop. I had done this many times, but I found myself hesitating. "Perhaps I could speak to your group about something else," I said.

And then, before I had a chance to think or to stop myself, I heard the words coming from my mouth: "You know, I'm really getting burnt-out on stress management."

I was stunned. How could I say such a thing? As a psychologist, I am in the stress management business. I don't hear my banker complaining about too many deposits. How could I complain about too many people striving for health and self improvement?

After taking time to reflect and consider my remark, I realized what I must have been thinking: stress management is a dead topic, or it least it should be. This was perhaps an unusual thought, but it was also one worth pursuing.

By way of explanation, I should begin with what I usually say about stress. I usually begin by saying that stress is something that everyone recognizes but which few understand or can describe or explain.

We know that stress can cause harm and that it generates costs. In order to account for the harm and the costs, there are four factors that need to be considered as part of the health stress equation:

1. Stress involves a physical response, a physiological state of arousal that prepares the body to take action.

2. The arousal occurs in response to events. They might be big, life change events or just daily hassles.

3. The stress reaction depends on how the events are perceived. Depending on the perception, an event might be considered a challenge or an opportunity, or a disruptive source of distress.

4. Finally, the extent to which stressful events will harm an individual depends on the coping resources that a person brings to bear on the problem.

Given this analysis of the stress and well-being equation, there are in turn four avenues for dealing with the problem.

1. Manage the physical response and change the way you body reacts.
2. Change the events in your life.
3. Change your perceptions or change the way you look at things.
4. Manage stress by enhancing your coping skills.

The list of techniques for managing stress is endless, and for the most part, they serve to illustrate why I have come to believe that stress management is not the correct topic for discussion in the workplace or in an organization.

To manage the physical response: exercise regularly, breathe correctly, get enough sleep, practice relaxation, etc.

To change the events: quit your job or stop working so hard; don't push yourself to be so efficient or to produce and accomplish so much; stop trying to take care of every little complaint your customers bring to you; stop sweating the details and stop listening to all of those orders from the boss.

To change your perceptions: understand that your job and your performance are not that important in the larger scheme of life; realize that deadlines are just artificial barriers to creativity; stop believing that every customer has to be satisfied; understand that there is no essential reason why your company or division has to be the best. In other words, develop a more relaxed attitude about your responsibilities.

To manage stress by increasing your coping abilities: take another week off at a time management seminar; become more assertive so that you don't feel so anxious and upset when you tell your boss what you really think; learn how to get others to do more of the tasks you don't enjoy; and remember to put your feet up on your desk every afternoon and meditate for a half hour or so.

The problem with the stress management agenda is that it starts with the assumption that the individual must adapt to an unhealthy situation. Whenever we talk about managing the stress, we are failing to talk about altering the noxious events that give rise to the stress in the first place. And as can be seen above, the goals of effective stress management are in many ways in conflict with the objectives of good organizational management.

We know that hard work, attention to detail and organizational discipline are required for profitability. We therefore assume that work must necessarily involve stress factors which the individual is responsible for "managing."

Instead, we should realize that demanding conditions are not stressful when they are experienced as challenges. Pressure is something on which most people thrive when they experience the demands of work as personally relevant and meaningful.

In most cases, it is not the necessary and unavoidable stressful events in the work place that cause people harm. Instead, it is the stressors that need not be: those things that could just as easily be changed. The functioning of individuals is impaired by events which if not viewed as "stressors" would otherwise be recognized for what they are: impediments to organizational performance.

Even those who are overwhelmed by the tasks that they face and who believe that they have no control over events will not be harmed by stress if they believe that their efforts are valued and that their work has purpose and is worthwhile. People will adapt and will have no need to "manage" their responses if they feel there is good reason to tolerate the pressures. People can thrive, even in the face of stress, if they experience themselves as having a Sense of Coherence.

Rather than trying to "manage" the problem, or to "therapize" the individuals who suffer from the effects of stress, the intelligent strategy is to focus on changing and curing the work environment itself. As with any other safety problem, the keyword is prevention. This is precisely what the National Institute for Occupational Safety and Health (NIOSH) has said: "Stress management treats only the symptoms of the problem--not the cause."

From the employer's perspective, it is simply good business. If your workers are distressed, you might as well just forget about trying to be competitive.

On the day that I precipitously announced that I was burnt-out on stress management, I was not prepared to offer the suggestion that would have been appropriate to the request. The next time I received such a call, I was ready.

"I would be happy to talk about stress management," I said. "But first, let's talk about what you are doing to enhance worker satisfaction. What are you doing to sustain morale and to improve employee motivation? Let's look at the prevention side first, and then, if you still have a problem, I would be pleased to teach your people how to relax."

Mourning and Mesothelioma

2009-07-28T18:51:00.000-07:00

In my article, How is Mourning Possible?, I discussed some of what we understand about the process of bereavement. I described it as a necessary and normal process, one in which the pain of loss diminishes over time and in which the process serves to keep the pain alive for an extended period of time. There are situations, however, in which the grief may seem insufferable and in which the circumstances of the loss make it nearly impossible to grieve in the normal way. Death from Mesothelioma is one of those situations.

Richard Moyle, the National Awareness Coordinator for the Mesothelioma Cancer Center recently wrote to me to share some of what he has observed among the patients and survivors his organization is seeking to help. This particular cancer is not the only disease that kills in a seemingly cruel way, and it is not the only type of death that seems unfair, unexpected and undeserved. But I agreed to comment on the mourning process in these cases because it is an experience that seems to exemplify some of the peculiar circumstances that can make mouring more difficult, if not relatively impossible.

Mesothelioma is a rare type of cancer, and the only known cause is exposure to asbestos. It is now well known that this naturally occuring mineral is a carcinogen. This was not so well known during most of the 20th century when it was routinely used in military and indusrial applications. Valued for its durability and resistance to fire, asbestos was used for insulation, flooring, piping, in brake linings and in other ways. While the general public, and many working in the asbestos industry did not know about the dangers, there were many manufacturers of asbestos products who turned a blind eye to the risks in order to gain a profit. The majority of diagnosed cases of mesothelomia can be traced back to occupational asbestos exposure. Many of those who were exposed did not know they were at risk and were not told how to protect themselves.

The symptoms of mesothelioma typically emerge 25 or even 50 years after the exposure to asbestos. When the symptoms emerge and the diagnosis is established, it is generally too late for any effective treatment. The symptoms show up when the cancer is already in an advanced stage and the average life expectancy after diagnosis is only about a year. In other words, by the time it is detected, death is almost certain and certain to come in a short period of time.

In the normal course of events, we expect that we might lose a loved one in a natural and inevitable fashion. A person gets old, becomes infirm, and slips peacefully into the twilight. That is how it is supposed to be. In Greek mythology, it was said that the Fates would measure the span of your life when you were born, and it was assumed that their string stretched out to a full span.

Grieving is a naturally painful process. It is even more painful when a life is cut short, and cut short without rhyme or reason.

Think of the young soldiers who die in defense of our country. Whether they are 19 or 54, we all grieve the loss and mourn the fact that they were taken away in an instant. Think then about the young adult whose life is cut short in an auto accident or a random act of violence. We see the same sudden finality, but we are left without the sense that they died for a cause and with purpose and nobility.

One of the factors that can make a loss ultimately more tolerable is the belief that it had meaning. Senseless death makes no sense, and the inability to understand it makes grieving more difficult and the loss harder to accept. The survivors are left not just with the need to unbind the psychic energy that was attached to the deceased, but also with the question of "why?"

Sometimes the "why" question is answered or resolved by the circumstances of the death. The person was drinking and driving, or being foolish or reckless in some other way. It is because of the need to answer the "why" question that we are often quick (when hearing about the death of someone unknown to us) to attribute responsibility to them personally. We tell ourselves that they were somehow at fault to ease our fears that a similar fate might await us or our loved ones: "Yes, it's tragic, but if they hadn't been ..."

Mesothelioma deaths encapsulate a number of factors that complicate the mourning process. It is a manner of death that is relatively sudden and unexpected. During the months that remain after the diagnosis is made, those who will be left behind must endure the feeling of powerlessness, their inability to stop it or prevent it. Rather than being able to view it as a matter of time and fate, there is the awareness that it was preventable. And rather than being able to rationalize the loss by attributing responsibility to the victim ("he should have stopped smoking and drinking"), they see only that it was someone else who made the decision to expose the victim to the carcinogen. It wasn't an accident, a twist of fate, and it was not for some noble purpose. Too often, what they see is that their loss came only because someone else chose to put profit before human decency. And with these feelings in mind, they are forced to watch a loved one endure a tortured and painful passing.

Again, asbestos related cancers are not the only types of deaths in which these experiences are shared. There are many other, similar circumstances. Some of those other experiences of loss also share with cases of mesothelioma the fact that there might be a protracted set of legal entanglements to resolve over a long period of time. When the victim is laid to rest, the family must decide whether to sue and seek redress. If they do, they are taking on another battle that will seem endless and prove frustrating. Rather than attending to the task of mourning - the task of letting go and moving on - they are stuck in a process that is consuming and that keeps the anger alive. When they should be seeking peace or finding a way to forgive, they are trapped by the need to "right the wrong" or to achieve justice. The same dynamic is seen among those who lose loved ones to acts of criminal violence. The need to achieve justice prevents them from attending to their own more pressing emotional needs.

This struggle to obtain redress is not necessarily unhealthy, and in fact, it may be absolutely essential. Anger is one of the feelings that naturally accompanies almost every unnatural death. Legal action almost always takes a significant psychological toll, but as painful and protracted as it may be, it is sometimes the only choice one has for the purpose of putting the anger to rest and getting on with the ordinarily difficult tasks of mourning.

There is one additional aspect of asbestos related deaths that is shared in common with other unnatural ways of passing and that bears mention. When death occurs in this way, there is actually an opportunity to find purpose in the loss, to find purpose where none might seem apparent. We see this all the time: survivors take on the task of raising awareness about a threat that exists. They crusade and campaign to tell their stories to others, to provide warnings, to prevent similar experiences and to provide support to those who suffer from similar tragedies. Along with the ordinary task of grieving and mourning, individuals and groups create meaning for themselves and their loved ones by making their loss a cause. This is healthy, and it is the message that the National Awareness Coordinator for the Mesothelioma Cancer Center asked me to share.

For more on this topic, see my article about grief in unusual or traumatic circumstances: Mourning and Mesothelioma

How is mourning possible?

2009-07-28T16:10:00.000-07:00

This was the title of an article written in 1966 by psychoanalyst Martha Wolfstein. It is considered a classic. I have an old and faded copy of her paper in my files, a copy on which I wrote extensive notes, and that years ago I heavily underlined. I can't say that I can immediately remember much of what she wrote, but I have always clearly remembered the title.

Wolfstein's focus was on the bereavement process in children and the observation that until children reach certain developmental stages, they may actually not be capable of mourning successfully (i.e, without suffering enduring emotional harm). While she was focused on grief in children, what always struck me was the question in the title: how is it in fact possible to suffer the loss of a loved one and to survive psychologically? In the face of great loss, how is it even possible to return to a normal state of well-being?

The process of grieving is familiar, and much of what can be said about it is reflected in the ancient proverb: "time heals all wounds." But there must be something more involved, some psychological process by which time works its wonders on the ailing heart. The death of a loved one is the most painful and grievous emotional wound that we can suffer as human beings. How does it come about that this wound can, over time, turn into just a scar on the psyche?

Our most essential and enduring insights about the bereavement process can be found in Sigmund Freud's famous paper, Mourning and Melancholia. Summarizing Freud's analysis, Wolfstein wrote that grieving involves "a painful and protracted struggle to acknowledge the reality of the loss, which is opposed by a strong unwillingness to abandon the libidinal attachment to the lost object."

Freud's formulation requires some explanation.

First, the term "libidinal" is used here to refer to psychic or emotional energy. When someone is important in our lives, there is a whole range of thoughts, feelings, passions, memories, associations and experiences that are attached to their existence and their presence in our life. Imagine one who is used to waking in the morning with their lover next to them in bed. The simple act of waking and rising involves a series of thoughts and feelings connected to the expectation that this person will be there next to them. That is the reality that they have come to know, and it is a reality to which they have attached their psychic energy.

The loss that one feels when someone close has died is not insignificant or inconsequential. The feeling is not just that someone is gone, but that someone has been taken. In its original use, the word "bereaved" means to be deprived. It means that death has stolen from you.

The task in mourning is to acknowledge that reality has changed and to free up one's psychic energy to invest in new experiences and relationships, or in the new realities of one's life. That energy is needed to connect to the world in new ways, and to the new reality that has been created by the absence of the loved one.

Freud described this process as a struggle, acknowledging that it is painful to let go and (in the words of author Michael Kahn) to "retrieve the psychic energy" from every object, memory and experience associated with the lost person. At the breakfast table, there are memories and feelings associated with the chair in which he sat. Her favorite coffee cup is still filled with the words that she spoke, the way she smelled and the sound of her voice.

In every encounter with a sound, a smell, a word, an image or an object that brings the loved one back to mind, there is an intensification of the feeling of their presence, and also of their absence. This is what prolongs the process. You look at their picture or recall that vacation and you are faced with an intense desire to relive and recall and recover the lost reality. The natural human tendency is to deny the new reality and to infuse the memory with enough feeling so that the loss is undone and the world returns, for a moment, to the way it was. The pain is recalled as you hold the object they touched in your hand and long for them to return.

The process of grieving involves touching the memories, bringing the memories and the person back to life, and gradually connecting to the awareness that in reality, it is something of the past, not the present. Wolfstein described the process by saying that it is a matter of "separating memory from hope."

What we have learned is that it is time, and the repetition of these painful experiences that gradually allows us to attach our thoughts, feelings and psychic energy to new memories, new events and new experiences. In order to "retrieve" the energy invested in the past, one has to suffer the loss over and over again in a number of small ways, prolonging the process each step of the way.

Acknowledging that mourning is possible, Freud said that: "normally, respect for reality gains the day. Nevertheless, its orders cannot be obeyed at once. (Those orders) are carried out bit by bit, at great expense of time and psychological energy."

In his description of the grieving process, Freud also introduced the concept of "introjection of the lost object." What he meant by this was that in order to fend off the pain of loss and to keep the person alive, people seek to believe that the person has become a part of them, a part of who they are and how they think and feel. Originally, Freud described this as a process motivated by a desire to resolve unfinished business with the one who has departed, and he described it as an unhealthy adjustment. Viewed in this way, it would be said that the survivor was haunted or possessed by the deceased.

In later writings, Freud recognized that it is actually healthy, normal and natural for the one who was lost to inhabit a space in the identity of the survivor. Indeed, "introjection of the lost object" may be a universal mechanism for achieving positive psychological adjustment through the grieving process. Viewed in this way, it is a matter of retaining images and memories of the departed, or retaining beliefs, understandings or fantasies about their continued presence in one's life. This process is an explicit part of many religions, Christianity being just one. The idea that someone lives on somehow, or somehow within you, is an entirely healthy and adaptive response. It allows those who survive to call up the internalized images and to take comfort from them. The images can comfort and also guide one along the continued path of life.

Beyond knowing that mourning is possible, it is widely understood by psychology that the process is necessary. Emotionally and psychologically, one cannot survive if their libido or psychic energy is not released from the dead and applied to the reality of life. One cannot be healthy if the internalized images of the departed are allowed to consume all of one's thoughts and feelings. Painful as it may be to endure and to accomplish over time, the goal is to achieve mourning and to avoid melancholia.

Telling them off (or not) on your way out the door: the departure email

2009-03-16T16:05:00.000-07:00

As millions are losing their jobs, there is no end of discussion about how to leave and how to survive.

At Slate.com, author Megan Hustad commented on "the strange psychology of the workplace departure e-mail," questioning the implications of the conventional advice: "just be positive."

I tend to think that it is not such "strange psychology" and that there is more than just a pearl of wisdom in the conventional advice.

In the words of author Hustad, "the parting note that offers nothing but affirmation to (now-former) employer and employees seems ill suited to 2009—and more bloodless than it needs to be. Have we collectively grown so skittish that even those with legitimate grievances won't give voice to their dissatisfaction?"

Her point was that perhaps we have gone too far in maintaining workplace pleasantry and propriety. Perhaps the forced smile and the artificial sweetness is not a good substitute for genuine human emotion. That is what she meant by the "strange psychology," the idea that we always have to be polite, even when departing.

In fact there is research indicating that with respect to employee stress and customer satisfaction, there is a downside to employers' demands that staff keep remain friendly and cheerful, even when they are not feeling it. It takes a toll on workers, and customers know when the emotion is not genuine. Not everyone who walks into a store, office or a restaurant wants to be greeted like a long lost friend. Among co-workers, the person who is always having a great day can be a bit scary - you never know what they are really thinking.

But if you are the person who's on the way out the door with pink slip in hand, you really should think twice about telling everybody what you really think, especially in writing. Perhaps you're angry, or hurt or resentful. Or maybe you're ready to laugh it off or maybe you want to wax philosophical about your fate. Maybe you want to do it like an Oscar award speech, thanking everybody and their dog. If that's the case, don't hit the send button.

Consider this simply as a practical matter. The people who remain behind could be the ones who help you find your next job. They may hear of a new job, or they may come across information that helps you in your job search. You do indeed want them to know how to contact you, but you don't want to leave any impressions that might cause them to hesitate before contacting you.

You also want to make certain that you don't do anything that might cause anyone to question your judgment. Some of those you work with now might soon be in new jobs themselves. They might be starting their own business and looking to hire, or they might be end up in a position where they can recruit or hire others in your field. The way you leave this job may be instrumental in whether you land the next one.

Here are some things to consider:

If you leave angry, you could be the one who reminds them that they hate their job just as much as you did. That increases the burden they carry as they continue. No reason you should remind them. And if they like their job, they're going to think there was something wrong with you.

If you leave sad and dejected, you could be contributing to the common sense of "survivor guilt" that is often felt by those who are spared the knife. If you leave on any type of sour note, some of those who might have felt guilty are going to think to themselves, "yeah, that's a guy who really did deserve to go."

If you leave completely upbeat and positive, thanking everyone you can think of, some of them are bound to think about how you treated them while you were there. Maybe you weren't always so nice. And some will know that you are in a time of hardship and that your expressions of gratitude are not genuine and truly heartfelt. They know you are disappointed and that you didn't just win an Oscar.

You could be philosophical, penning a note of the type that author Hustad described as suitable, a note expressing "existential resignation." The problem is that you don't know how people will react. When you say goodbye, you are speaking to an audience that is scared, scared that they might be next. You don't want to suggest to them that they should be resigned to their fate, or that they shouldn't feel hurt and sad if it happens to them. From you, they don't want to hear that there is nothing to fear.

You also don't want to say this is all just part of the journey of life and that you are looking forward to what ever happens next. That suggests that you aren't planning and seriously focused on finding a new opportunity and your next job. It suggests that maybe you might end up on a beach in the tropics, or wherever else the winds might blow you.

Don't try to be funny or humorous. There is nothing funny about being laid off.

So how should you leave?

My advice is that you leave graciously and effectively, with a seriousness of purpose. Positive is good, but it involves more than "just be positive."

As to how you should do it, I consulted a career adviser, Cici Mattiuzzi, who is now in the process of publishing (on the web) her second text book: The Serious Job Seeker. This is her advice:

Don't wait until the termination notice arrives to start planning your goodbye. Do it now! When you get the notice, it may be too late. Your email account and your contact list may be terminated immediately. So, make sure you have all your contacts and that you have an email address that you will be using for professional purposes (like at gmail).
Don't send anyone any notes until you've taken some time to get some exercise and fresh air and think about what you are going to say. Next week is soon enough.
Let people know that you view this as an opportunity to explore your options, consider new directions or to gain some education, training or experience that you have long considered.
If you have some enterprise or activity already lined up, let them know how you will be actively engaged and involved. Let them know if you have a side business or project that you will be focusing on (this is also an advertising opportunity). If you know what your next career objective is, tell them. Let them know what you are looking for.
Let them know that you would appreciate hearing from them, especially if they have any ideas or suggestions, or if they hear of any opportunities. Ask them to keep you informed if their contact information should change. Above all else, make certain that they know how to contact you by email, and through LinkedIn or some other location on the web where they can easily access your resume.

The departure email is not where you want to share your feelings or look back on the past. It's OK to say that it was a pleasure working with them, that you appreciate their support and/or friendship, and to express "best wishes." But it is not a time to be maudlin or sentimental. By way of your attitude, you want to let them know that you are not depressed and that you have passed The Serious Job Seeker IQ Test.

Zero Tolerance Policies: no substitute for good judgment

2009-03-11T11:19:00.000-07:00

The term "zero tolerance" suggests that it is a consistent, no-nonsense approach, and that such policies must therefore obviously be an effective and beneficial disciplinary strategy. These policies are prominent in the educational system, and so in the interest of school accountability, it is relevant to ask: does it really work?

The American Psychological Association considered that question and created a task force to look at the data and the research. Recently published in the American Psychologist, the Task Force report suggests that when put to the test, the policy flunks.

The analysis focused on five key assumptions underlying the use of zero tolerance policies in the schools:

1. It is assumed that zero tolerance policies are necessary because school violence is increasing and increasingly out of control. The reality is that the rates of violence and disruption in schools have remained steady or have actually declined over the past twenty years or so. Obviously, violence prevention efforts are absolutely necessary to protect against both common place incidents and critical acts of aggression. However, disciplinary policies should be formulated in response to the actual threat, and not in response to the "feeling" that the problem is out of control.

2. It is also assumed that mandatory and inflexible punishments serve to create consistent discipline and clarity in the disciplinary message. In fact, they do not. Within school districts that have adopted such policies, there remains a great deal of variation across schools with respect to how many kids are actually disciplined (or need to be disciplined), and there is just as much variation across school districts with similar policies. Whether or not a school is orderly has much less to do with the disciplinary guidelines than with the quality of teachers and the quality of school governance. Indeed, the quality of the school may be more important that the attitudes and behavior of the students.

3. It is assumed that the removal of disruptive students provides for a school climate more conducive to learning. In fact, the opposite is true. Schools in which expulsions and suspensions are common tend to have less satisfactory school climate ratings and are found to spend a disproportionate amount of time on disciplinary issues. And after taking into account the socioeconomic status of students, they tend to have lower academic achievement rates.

4. It is assumed that zero tolerance punishments will deter those expelled or suspended from misbehaving in the future. Instead, what is found is that those who are disciplined in this fashion will in the future be more likely to continue misbehaving, more likely to drop-out and less likely to graduate. Perhaps it would be justified if some benefit accrued to the school and the student body, but it is not justified if it simply involves making it a problem to be dealt with by someone else.

5. The final assumption considered is the idea that parents and students overwhelmingly support zero-tolerance policies. Here, the data are mixed. Some parents applaud such efforts, especially when the punishment is applied in specific cases that have caused public alarm. On the other hand, there are just as many cases in which parents and other students are left feeling that the punishment was unfair and that some measure of forbearance should have been granted. The concept of "a second chance" is deeply rooted in our consciousness, as is the idea that "the punishment should fit the crime."

School discipline is important. Punishments are often necessary. If it could be shown that arbitrary rules made schools safer or that they eased the administrative burdens associated with exercising discipline, then of course a zero tolerance approach would be recommended. But what seems to make sense does not always in fact meet the test of common sense.

After considering whether or not zero tolerance policies have any unique benefit, the APA Task Force also looked at whether there is a downside or dark side to such policies.

On the dark side, there are important implications. First, it appears quite certain that rather than being "color blind," arbitrary punishment strategies tend to disproportionately effect students of color and students who suffer from various forms of psychological disturbance. Second, there is clear evidence that zero tolerance policies tend to increase the likelihood that those disciplined will end up as clients of either the juvenile justice or criminal justice system. In general, these policies violate the old adage: "an ounce of prevention is worth a pound of cure."

The APA Task Force did not in any way seek to suggest that disciplinary actions are unimportant, or to argue for excuse and tolerance. Instead, they outlined a set of recommendations focused on the benefits of flexibility. In any situation where a disciplinary response is required, there are indeed different and "alternative strategies" to be considered.

With respect to making schools safe, the weight of the evidence shows that there is little benefit to be obtained from abandoning individual case analysis and judgment. There is no apparent benefit to be obtained from arbitrary rules. There are in fact a number of disciplinary alternatives available in any situation. The task is to evaluate every situation on its own merits.

Further comment: As a long-time observer of the criminal justice system, I am particularly aware of the fact that arbitrary rules are counter-productive. Set rules do not provide respect for authority. Justice demands that every crime and every offender should be judged individually. That is what Judges should do.

Arbitrary rules serve to diminish the role of Judges. In the school setting, arbitrary rules serve to diminish the role of the School Principal.

From my perspective, the danger presented by zero tolerance policies (and mandatory sentencing guidelines) is that they provide the offender with an excuse and a justification. Rather than taking responsibility for their behavior, they blame the system for its rigidity. There is hardly anything more dangerous than an offender who believes the system did not afford them justice. Rather than having the punishment serve to correct their behavior, the belief that they were treated unfairly is used as a justification for future misbehavior.

And in the school, I believe that a zero-tolerance policy sends exactly the wrong message. It is often the case that when someone is expelled simply as a matter of course and in a reflexive way, other students will rally to their cause, rather than condemning their behavior.

Authority figures have a responsibility to exercise judgment and discretion. When they wash their hands and abandon that responsibility, they lose respect and credibility in the eyes of those they are meant to guide.

Recession, Depression and Depression

2009-01-06T12:21:00.000-08:00

When the report came, showing that the economy had shed more than half a million jobs in November, the stock market staged a brief rally. The thinking was that with news this bad, surely the government would step in to help. It's like the story of the child who wakes up on Christmas to find a pile of manure: excited, the child begins digging, assuming their must be a pony in there somewhere.

It is not at all likely, however, that those who have been thrown out of work in recent months will be looking to find a silver lining.

There is an extensive literature on the connection between unemployment and psychological well-being, and the news is not good. In a recent report on work and health from the American Psychological Association, it was noted that: "the loss of work has been consistently linked to problems with self-esteem, relational conflicts, substance abuse, alcoholism and other more serious mental health concerns." In every respect, and not just financial, one's quality of life is at risk when unemployed.

The fact is that work is often essential for psychological health. It is the "playing field" for our dreams and aspirations, and an important source of pride and satisfaction. Work is where we find challenges and a sense of meaning, and the chance for self-determination and personal empowerment. It is not just a matter of survival and security. Work plays a complex role in our social lives. It is a link to the broader cultural fabric of life and a regular source of social support.

Clinical depression is a common and expected result of the experience of loss. Beyond the sense of loss, those who have been displaced from the economy can expect to experience shame, fear and uncertainty, and a whole series of stress factors related to survival and adaptation. Imagine what happens to your identity when you are no longer a breadwinner or when you suddenly become dependent on an unemployment check. Imagine the adjustments you might have to make in your lifestyle or your role in the family or your daily routine.

The effects will also be felt by those who remain on the job. Their future is no longer certain, and it is often observed that they can suffer "survivor's guilt." It is a whole new stress at work: "Am I next?" Time that was previously devoted to productivity and engagement will be spent worrying, wondering and watching.

Depression is a genuine and significant health concern. The current unemployment numbers are pointing towards a potential public health crisis.

So how should you respond if you have become one of the "walking wounded?"

First, if you are feeling depressed, don't worry about it. It is normal and expected. There is no reason to worry more about the fact that you are worried. You don't want to be depressed about the fact that you are depressed.

Watch for the signs. What you may notice is: you are feeling sad or empty most days; life no longer feels interesting or satisfying; you can't sleep or you can't eat, or you are eating too much; you are unusually restless or fatigued; you are feeling worthless or guilty; it is harder to think or to concentrate; or you seem to have unusual pain or physical discomfort. These are the symptoms of clinical depression.

If you are depressed, you might also notice that you are drinking more, fighting more often with your spouse, and more likely to be irritable and impatient with your kids.

If you have thoughts of death or suicide, that is the only sign necessary to know that you are depressed.

If you are depressed, don't hide from it. Don't pretend it's not happening to you. Talk to your friends, your family and the people you love. If you are a person of faith, talk to your faith leader.

You also want to stay active. Stick to a routine, exercise regularly and think about working as a volunteer. When you are out of work, a real good use of your time is to go back to school. Classes will keep you occupied, interested and motivated. Education is a good way to fill that hole that is starting to grow in the middle of your work history and to prepare yourself what comes next in your career.

Unemployment cannot readily be cured. Depression, however, can be cured. If it is becoming too much to handle, speak to your Doctor or find a therapist. Get help. Don't be ashamed. (Take the Psyris Depression Screening.)

This recession is going to be deep. The rates of depression are going to rise. The research shows quite clearly that many who suffer emotionally will not fully recover, even when they return to work. We all need to understand that we are facing a pile of manure and that there is no pony to be found.

The task now is to survive, to hold on, and to reach for the future. The best way to do that is to take care of yourself, and to remain optimistic, confident, and filled with a sense of meaning and purpose, despite all indications that this is an uphill battle.

Emotional Intelligence? I'm not feeling it.

2008-12-05T16:01:00.000-08:00

Emotional Intelligence is a confused and confusing concept.

Indeed, a key group of proponents of the Emotional Intelligence (EI) construct recently published a defense of their work in the American Psychologist (September 2008), essentially arguing that the meaning of the term has been subverted. Professors John Mayer, Peter Salovey and David Caruso acknowledged that there is a "schism in the field" and that the term is now being used "in too many different ways" and to "cover too many things."

Writing in the Journal of Organizational Behavior, Professor Edwin Locke worded his criticism more bluntly by asking rhetorically: "What does EI not include?"

It was in 1990 that Mayer and Salovey first outlined their views on EI, suggesting that it represented a distinct set of abilities. The idea that the human skill set involves something more than just IQ was not new at the time, nor was the term "emotional intelligence." What Mayer and Salovey provided was a model that could serve as the foundation for research and a "test" that purported to measure EI. Their focus was on the ability to perceive and understand emotions and to use them to facillitate thinking.

In 1995, Daniel Goleman published his hugely successful book, "Emotional Intelligence: why it can matter more than IQ," and with it's release, the term found a permanent place in the popular imagination and in the annals of pop psychology. What Goleman and others added to the model was the idea that EI can refer to any number of positive personality traits, such as self-esteem, optimism and need for achievement, and any number of social skills, habits and behavioral preferences.

When I was in school, there was no literature on "emotional intelligence," and the term had not yet first been coined. I became aware of the topic by reading Time magazine's cover story on Goleman's work and was skeptical from the start. Everything I read about EI seemed to suggest that it was just a re-packaging of standard and well-established ideas from the psychological literature. And the package wasn't pretty.

Before the advent of EI, we already knew that performance and achievement is responsive to motivation. There was never any question about the fact that there are a variety of different ego-strengths that serve to complement intellectual abilities and to enhance performance. Our ability to describe individuals as having different levels of social and interpersonal skills was never in question. Our understanding of personality traits was already intensely developed. We knew all along that the ability to use insight, introspection and personal reflection to understand our feelings and those of others was useful. A term that was used to describe those who tended to think about their thoughts and their feelings was "psychological mindedness."

What the EI theorists introduced was the idea that there is a specific set of personality traits and/or a specific set of skills relating to the understanding or use of emotions that can be interpreted as "an intelligence." What they violated was the idea that constructs have meaning. In other words, there is a distinction between an ability and an achievement, a skill and a habit, an attitude and a value, a personality trait and an emotional state, and so on. Those distinctions are central to science and theory construction.

In arguing that EI is not a valid concept, Professor Locke put it like this:

"The fundamental problem here is that one cannot 'reason with emotion.' This is a contradiction in terms. Reason and emotion are two very different cognitive processes, and they perform very different psychological functions ... One cannot 'reason with emotion;' one can only reason about it ... what they (EI advocates) are actually referring to is not another form or type of intelligence, but intelligence applied to a particular life domain: emotions."

In their recent American Psychologist article, Mayer, Salovey and Caruso were attempting to defend the idea that one can "reason with emotion," and at the same time, to fend off the pop psychology advocates of EI who have hijacked the term and essentially defined it as including anything at all psychological. An author and hiring consultant says that the "ability to learn from mistakes" is a form of EI. Another says that if a manager has a "democratic" leadership style, that is an example of EI. The ability to make friends and to control impulses have also been added to the definition of EI.

While there are certainly many recognizable competencies that help us navigate life, it makes no sense to say that everything that is not a function of IQ is a function of EI. "Emotional intelligence" has come to bear little resemblance to what we would ordinarily refer to as either an emotional function or an intellectual one. Mayer, Salovey and Caruso say that "managing emotions" is part of the EI equation. Conceptually, it makes no sense to say that emotional control is any type of "intellectual task."

So what sustains the use of the term EI?

As researchers, Mayer, Salovey and Caruso are professionally invested in their model and wish to reclaim it for a scientific purpose (by the way, they believe that EI is best measured by their commercially available test instrument).

In the pop psychology field, EI serves an industry of authors and consultants, ready to sell their insights.

And in the popular imagination, EI is the concept that levels the playing field. In the words of Professor Locke, EI is about "egalitarianism: redefining what it means to be intelligent so that everyone will, in some form, be equal in intelligence to everyone else." EI consultants have floated the notion that success and performance in life requires everything but actual intelligence: you don't have to be smart and you don't have to be a rocket scientist. "Joe the Plumber's" common sense is just as good as a Harvard Law degree. Intelligence and scholarship are simply the values of the elite.

In the end, it remains quite obvious that raw intellect is not necessarily worth as much as some give it credit for. Intelligence is not a substitute for good judgment. Practical wisdom does not follow from the conferring of a degree. My gardener tells me things that make sense that I would never have figured out on my own. The guys who were described as "the smartest guys in the room" are the same ones who brought down the Enron Corporation. Great political failures have been perpetrated by those who were chosen because they were the "best and the brightest." The "absent minded professor" is a well-known stereotype.

For many of life's endeavors, intellect may be necessary, but not sufficient. Does the concept of "emotional intelligence" provide a satisfactory explanation for whatever else is necessary? I'm not feeling it.

Is your boss paying attention to you?

2008-08-20T13:44:00.000-07:00

Probably not, he doesn't need to.

Above, the choice of the pronoun "he" was intentional. The article I reviewed for this post appeared in the American Psychologist and was focused primarily on the tendency of people in power to view their subordinates through stereotypes, rather than bothering to understand them as individuals. The assumption that the boss is a man is a stereotype.

When Princeton University Professor Susan Fiske wrote the article, her emphasis was on the fact that stereotypes function as a powerful tool for controlling people. To illustrate her research on the control function of stereotypes, she used work place examples of gender discrimination and sexual harassment.

What I want to focus on here is what Dr. Fiske had to say about why those in power are not likely to pay attention and to get to know their subordinates as individuals, why they tend to lump them into categories.

The simple fact is that people pay attention to those who have power and control, those who can have an impact on their lives and effect their fate and their future. "Attention follows power" is how Professor Fiske described it.

In any organization, it is easy to observe that those at the bottom will spend a lot of time watching and thinking and talking about those at the top. The employee is motivated to construct a unique and detailed portrait of the manager because the employee wants to be able to predict what the leader might do in any situation. What the employee "knows" about the supervisor may or may not be accurate, but it is simply natural for a subordinate to have a clear picture in mind for the sake of survival.

On the other hand, because the leader does not necessarily depend on the subordinate for approval, success or promotion, "he" has a lot less riding on his ability to understand or appreciate what's going on with the followers. The "clueless" boss is a stereotype that appears to be grounded in reality.

There are two other reasons why those in power may not bother to form accurate and detailed impressions of those who are below them on the organizational hierarchy.

First, those in power simply have more people competing for their attention. At some point, the situation involves information overload (or TMI, "too much information"). The strain on their capacity to pay attention to everyone is also amplified by the fact that those in power are busy focusing their attention on those with even more power.

The other reason has to do with motivation. Those in power are typically motivated (if not expected) to control and dominate others. As noted, stereotyping can serve as a form of control. Those without power have even less power when they are perceived as relatively nameless and faceless. The research also indicates that leaders may be motivated to ignore others either because they are "power hungry" or because they have a precarious sense of their grip on power. When groups of employees are in revolt against leadership, those in power can be even more likely to tune out the noise.

The tendency of those in leadership positions to compress their perceptions of subordinates is not just "a guy thing." It is the result of powerful social structures, fundamental cognitive processes, and individual personality dynamics.

For the organization, the downside risk of oblivious or "clueless" leaders is that leaders do in fact depend on their employees in a variety of ways. The fate of the organization can be tied to the actions of individuals at the very bottom of the power structure. That is obviously the case when those on the bottom rungs have to interact with the public. Less obvious are the situations in which leadership fails to pay attention to how employees experience the work environment.

Every organization is concerned about work place stress, but too often, complaints are dismissed with convenient generalizations (e.g., "he's a whiner" or "it's just a personality conflict" or "she's just too sensitive"). Professor Fiske provided examples of companies losing major sexual harassment suits because they weren't paying attention. Perhaps more common are situations in which companies lose their investment in valuable employees because they either quit or suffer stress related disabilities. Employees who are unhappy and misunderstood are probably going to say bad things about the company before they leave, and even worse things afterwards. That's not a good thing from a PR standpoint.

What can an organization do? From my reading of the literature, it appears that the most useful way to motivate leaders to pay attention to the powerless is to highlight and amplify the sense of interdependence. When the employees are stake holders in the company or when the leader's success is dependent on the judgment of subordinates, those in power are more likely to invest energy in employee appreciation. When leaders are held to account for maintaining commitment and satisfaction among subordinates, they will suddenly have a reason to pay attention to those at the bottom.

Helicopter Parents: disturbing trend or urban myth?

2008-08-15T10:37:00.000-07:00

This is a shorter version of an article I posted in the Spring, updated for back-to-school and off-to-college time. The original article (more discussion of the research and references to the "empty nest") can be found here.

Permission is granted to re-print this article if the credit line at the bottom is included.

It's back-to-school and off-to-college time. Soon, we will be hearing stories about college freshmen and their "helicopter parents." These are the parents who hover and can't let go, the ones who are overly involved, overprotective and excessively supportive.

This story has been written many times. In a November 2006 MSNBC online article, a college counselor was quoted as saying that the "problem" of hovering parents "has now reached epidemic proportions." In a March 2008 Sacramento Bee article, a college counselor estimated that the rate of parental hovering stands at 30 percent and is increasing 2 to 3 percent a year. An online guide to college life offers a list of "signs and symptoms" so you can check to see if you suffer from this disorder. If you help your kid write a paper, or provide extra money, you may be afflicted. On the Today Show in October 2007, "national mom expert" Stacy DeBroff said that this problem afflicts 60 to 70 percent of "all" college parents and advised that some may need to "get help."

There are actually three reliable sources of data on this topic, each based on large scale studies.

Surveying SAT applicants, the College Board found that there is "little evidence of extreme or intrusive parental involvement" and that "much of the reported parental involvement is actually very positive and supportive."

The Higher Education Research Institute (HERI) has reported that on measures of parental involvement, more college students said that they received "too little" help from parents, rather than "too much." A sizable majority said that they received the "right amount" of help.

Finally, the National Survey of Student Engagement (NSSE) showed that when parents maintained frequent contact with their children and helped them deal with problems on campus, the students were more engaged in the academic process, maintained better study habits, were more satisfied with their college experience and reported having gained more from college.

A USA Today story from Februray 2007 touted "what's believed to be the first scholarly research on parents who hover too closely over offspring." This "scholarly research" was based entirely on interviews with 50 "college officials." In other words, it was nothing more than a collection of anecdotes. College advisers and administrators obviously have stories to tell. They have seen the extreme examples.

The reality is that there is no disturbing trend or epidemic to be observed. Obviously, there will be cases in which parents go overboard. But the hovering actually seems to be more of a problem for educators than for students. Administrators have to deal with the parents who complain.

In fact, parental involvement is a good thing, as common sense would tell us. Yes, kids need to grow up and become independent. But that is not something that can be accomplished just by moving into a dorm. College involves many challenges, and it makes no sense to insist that young adults do this on their own, without help, and by trial and error. Freshmen enter college with different skill sets, different coping abilities and different levels of maturity. For some, the transition from home is a smooth ride with no bumps. Others encounter nightmare scenarios and need help.

What colleges and universities should be concerned about are all of the students who enter and then fail. The average retention rate for entering freshmen is less than 75 percent.

Here is the correct response a college adviser should give when asked to comment on this urban myth: "We sometimes encounter what you might call a helicopter parent, but we are actually more concerned about getting parents involved. That's what most students want and what they actually need. We're less concerned about the helicopters and more concerned about students who come to us without a parachute."

Paul G. Mattiuzzi is a psychologist and developer of the psychology resource information system: psyris.com. An extended version of this article appears at his blog: everydaypsychology.com.

Why do people kill? A Typology of Violent Offenders

2008-07-30T16:37:00.000-07:00

At various times, I have been asked to lecture on the topic: why do people kill? Why do they commit murder? How do we explain acts of violence. The following is not an exhaustive explanation. It's a handout I use when I speak about different types of killers and the motivations for different crimes. But it describes many, if not most types of homicide and most acts of violence. It describes most of the killers and most of the violent individuals I have interviewed.

Chronically Aggressive Individuals

Easily frustrated, limited or poor impulse control
Frequently express anger or hostility
Resents authority, defiant with supervisors.
May express hostility through “passive-aggressive” behavior
Believes violence and/or aggression are legitimate responses to various interpersonal problems in life (i.e., if someone provokes you, you fight back)
Although they might never admit it, pleasure or reinforcement is derived from the expression of anger (i.e., it feels good to blow someone off; it makes you feel alive; it gives you a sense of power)
Often display the characteristics of a “stimulus seeker” - they engage in bold, fearless, or reckless behavior and are prone towards substance abuse
Most typically, violence occurs in a situational context: an offense, fight, or disagreement
Sometimes just get carried away in a particular situation (domestic violence, child battering)
Less likely to engage in acts of unexpected “explosive” violence

The Over-Controlled Hostility Type

Rarely display or express anger - they don’t cuss or yell, and may be offended by such
Emotionally rigid and inflexible: appear to be polite, serious, and sober, rarely “loose” or jocular
Cognitively rigid and inflexible: very strict about interpreting rules; usually go for the letter, rather than the spirit of the law
Morally righteous and upstanding: see themselves as “good people”
Often judgmental: see others as “not such good people”
Non-assertive or passive; their passivity causes others to take advantage of them
Anger builds up like in a pressure cooker, before they explode
After the violence, people say that they never expected it, “he always seemed like such a nice guy; he was always so quiet”

The Hurt and Resentful

Feel that people walk on them and that they are never treated fairly
When they are passed over, there is always someone else to blame
Things are easier for everyone else: other people get more and have more advantages.
They do not accept criticism well
In response to reprimands, they develop grudges, which are sometimes deeply held
They are often whiners and complainers, as a matter of attitude
They wallow in their victimization and are psychologically impotent
Violence occurs because they hold grudges and are “impotent” to deal with their anger in other ways

The Traumatized

Aggression occurs in response to a single, massive assault on their identity
Something happens that is potently offensive, absolutely intolerable, and which strips them of all sense of personal power
The essence of their existence (or their manhood) will be destroyed if they do not respond
Violence is predictable & preventable

The Obsessive

Immature and narcissistic individuals who demand or crave attention and affection
Absolutely cannot stand to be deprived of desired gratifications, like a baby who cries because mother removes the breast
When deprived of love, they continue crying: repeated phone calls, following the object of their obsession, etc.
As frustration continues, they escalate: “dead flowers”, punctured tires, suicide gestures
Violence because: “if I can’t have her, nobody can.” ... or: “if she won’t have me, she won’t have anything.”

The Paranoid

Jealous Type: Delusionally believes their lover is unfaithful
Persecuted Type: Delusionally believes that people are out to get him
Typically engage in behaviors which make their paranoid beliefs come true
Delusions may reach the point at which the person is grossly out of contact with reality (may be insane).

The Insane

Rare: does not understand the nature and quality of their actions.
More typical: fundamental misperceptions of reality, incapable of rational behavior, delusional beliefs deprive them of the ability to know that their behavior is wrong, beliefs and perceptions are incongruent with reality.
Twisted, psychotic beliefs about what is right, what is wrong, and what is necessary.

The Just Plain Bad & Angry

A combination of most of the above (except for insane): angry, hostile, jealous, resentful, impotent, and disturbed individuals, who are socially isolated, socially inadequate, and who feel worthless
May be seeking attention
May be seeking revenge