Psych 635 Shaping And Chaining, Reinforcement Schedules And One-Trial Learning Week 3

HEALTH AND SPORTS PSYCHOLOGY REVIEW

Running head: HEALTH AND SPORTS PSYCHOLOGY REVIEW

HEALTH AND SPORTS PSYCHOLOGY REVIEW

Health and Sports Psychology Review

Psych 635

February 9, 2015 Health and Sports Psychology Review

The foundation of sports psychology centers on helping players maximize their performance and strengthen motor learning skills, by learning techniques to overcome mental blocks. The first publication of sports psychology focused on how spectators influence athletes competing in competitive bicycling (Brown & Mahoney, 1984). Health and sports psychology focuses on the influences of athletics and the psychological and physiological impact it has on humans. A sports psychologist assists athletes through the application of shaping and chaining, reinforcement schedules, and one-trial learning techniques in teaching new technical skills.

Shaping and Chaining

As a sports psychologist, one must comprehend the concepts of shaping and chaining when teaching and implementing unfamiliar technical skills to athletes. Before a behavior arises, an athlete cannot associate his or her skills and performance to a behavior, therefore shaping is only useful when linking behaviors that can help athletes perform adequately and comprehensively. “The basic operant conditioning method of behavioral change is shaping, or differential reinforcement of successive approximations to the desired form or rate of behavior” (Schunk, 2012). The process of shaping identifies behaviors not yet present, and assists athletes retrieve a specific behavior, mindset, and skill expansion. The process of shaping in sports psychology consists of the identification of the current abilities of an athlete, identification of a behavior, identification of possible reinforcement within an athlete’s environment, dividing the goal into smaller goals, and ultimately, guide the athlete to his or her desired behavior through the use of reinforcements (Schunk, 2012). For instance, when an athlete complains of weak leg muscles, he or she can begin with leg muscle development that fosters strength, stamina, and confidence. Once an athlete works toward a desired behavior, he or she will need to continue to reinforce the behavior until the desired results are achieved. A good example of this is hurdles.

Hurdles is a type of sports activity that requires athletes to run and leap over a bar at pre-determined intervals thus building leg muscles, strength and increasing versatility. An athlete accomplishing a hurdles race builds confidence and physical strength. By receiving corrective feedback, an athlete can achieve his or her desired goal. A sports psychological can assist an athlete by monitoring speed, versatility, and strength and encouraging an athlete to do more, go faster, and untimely achieve their goal.

According to B.F. Skinner, “Chaining is the process of producing or altering some of the variables that serve as stimuli for future responses” (Schunk, 2012, p. 99). Chaining identifies when an athlete desired skill acquisition without reinforcement of successful elements of monitor behavior an athlete cannot improve or achieve higher performance (Greene, 2012). “The operant principle of chaining has been widely researched and implemented with motor skill acquisition and improvement, therefore, in order to ensure proper motor learning, reinforcement of specific behaviors must occur” (Greene, 2012, p.1). Every step offers a signal of action for the next step; a chain is a sequence of cues and behaviors, therefore when one’s behavior in a chain of reactive step generates another signal for the next course of action. Chaining is very useful for sports psychologists when assisting athletes enhance performance and achieve their goals. For example, when an athlete is struggling while training for an event, or merely has a desire to improve his or her performance, a sports psychologist can develop a plan for the athlete to follow on a daily, weekly, and monthly basis. When an athlete follows these guidelines, he or she is creating a chain. Many times athletes develop psychological hindrances that prevent them from performing at an optimal level, therefore a sport psychologist can analyze those factors and examine methods of motivation, enhancing, or eliminating self-esteem issues and offer encouragement throughout stages of progress. Shaping and chaining is a useful tool for sport psychologists in assisting athletes by focusing on the psychological and physiological factors athletes need to succeed.

Reinforcement Schedules

Primarily known for his theory of operant conditioning, B.F. Skinner believed behaviors were dependent on the after-effect of a response called operant behavior. In operant conditioning, scheduling reinforcements are crucial components of learning. There are two types of reinforcement schedules: continuous and partial reinforcement. The schedule of frequency for behavioral reinforcement has a significant impact on the intensity and timeline of the desired response. Continuous reinforcement is more effective during the initial stages of learning to develop a solid connection of the behavior and response. This occurs through the presentation of reinforcement every time an undesired or desired behavior appears. Partial reinforcement is the response of reinforcement only part of the time rather than continuously. Reinforcement schedules can help athletes learn new technical skills through reward or punishment. These schedules help ensure an athlete’s dedication and focus toward his or her goals. When an individual suffers from a psychological or physiological issue, positive reinforcement is pure joy such as an enjoyable evening with friends or a day without working out, therefore the experience is pleasurable and desirable. The negative reinforcement and punishment stage is when the joy is taken away or controlled (consequence). For example, an extra workout, or additional laps around the track or denial of participating in an upcoming event. Although it is important for sports psychologists to provide a positive and encouraging environment for their clients, it is also important to use negative reinforcement to motivate athletes to improve perform.

One-Trial Learning Techniques

The one-trial learning technique involves learning by a single paired response and stimulus, not repetitive responses. If a child places his or her hand on a hot stove and burns it, the child will most likely not do so again fearing the pain from the first experience. Sports psychologists can use one-trial learning techniques to teach athletes the type of mistakes not to make more than once, therefore avoiding time and health consuming hindrances. Many times injuries can happen to athletes causing financial, physiological, and psychological setbacks. When an athlete heals, he or she learns from that one-time error, to avoid such a task or move. Many times athletes over-exert themselves and the one-trial learning technique teaches them to realize and respect their limitations. For example, when long-distance runners decide to push themselves to beat their current time or a competitor’s, they may be doing more good than harm, therefore if they pull a ligament or become sore or unable to run on schedule, they will have learned from this learning technique.

Conclusion

According to Division 47 of the American Psychological Association (2013),

Sports psychology, includes a range of topics that include motivation to continue and achieve, psychological considerations in sport injury and rehabilitation, counseling techniques with athletes, assessing talent, exercise adherence and well-being, self-perceptions related to achieving, expertise in sport, youth sport and performance enhancement and self-regulation techniques (para.1).

Health and sports psychology focuses on an extensive spectrum of clinical, scientific, and adapted subject matter regarding exercise and sports. This field of science focuses on the psychological vision of applying motivation and performance improvement and the comprehension of improving mental and physical health. Among these applied techniques are shaping and chaining, reinforcement schedules, and one-trail learning techniques to assist athletes achieving optimal psychological and physiological health.

References

American Psychological Association. (2013). Purpose and goals. Retrieved from http://www.apa.org/divisions/div47/APA%20Div%2047%20(2)/about_purposeandgoals. html

Browne, M. A., & Mahoney, M. J. (1984). Sport psychology. Annual Review of Psychology,

35(1), 605.

Greene, L. M. (2012). Mastery chaining and modeling to improve dart throwing skill acquisition. (Order No. 3549416, Hofstra University). ProQuest Dissertations and Theses, 85. Retrieved from http://search.proquest.com/docview/1283383949?accountid=458. (1283383949).

Schunk, D. H. (2012). Learning theories: An educational perspective (6th ed.). Boston, MA: Pearson Education.

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Initial Assessment homework help

Initial Assessment homework help

Prior to beginning work on this discussion, please read Chapters 2, 6, and 7 in DSM-5 Made Easy: The Clinician’s Guide to Diagnosis. Additionally, please watch the video Beer Is Cheaper than Therapy: Fort Hood’s PTSD Problem . (https://fod.infobase.com/OnDemandEmbed.aspx?Token=49272&aid=18596&Plt=FOD&loid=0&w=640&h=480&ref)

For this discussion, the patient for whom you wrote your transcript in the Week One Initial Call discussion has come to your office for a 15-minute initial assessment. As part of the intake process, you have asked the patient to fill out a biographical form that contains the same information included in the case study. Based on this information, propose three questions you would ask the patient to determine a diagnosis and treatment plan.

Provide a transcript of this brief initial session including your three questions and the answers you would expect the prospective patient to give. Beneath the transcript, provide a rationale for each of the three questions you proposed. Include the case study title you chose for your Week One Initial Call discussion post.

Examine your colleague’s transcript, and write an evaluation of the prospective patient’s apparent symptoms and presenting problem(s) within the context of a theoretical orientation. Theoretical orientations are based on the personality theories you learned about in PSY615, and are referred to as “approaches” in Abnormal and Clinical Psychology: An Introductory Textbook.

Remember that symptoms may not be explicitly mentioned by the patient, but they may be inferred by the patient’s presenting problem(s). Summarize views of these symptoms from at least two historical perspectives. For instance, how have these symptoms have been conceptualized and understood, historically? Finally, suggest diagnostic manuals and handbooks besides the DSM-5 that might be used to assess this patient.

Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The Guilford Press.Retrieved from https://redshelf.com

“CHAPTER 6 Trauma- and Stressor-Related Disorders

“Trauma- and Stressor-Related Disorders Quick Guide to Trauma- and Stressor-Related Disorders Various types of stress and trauma are responsible for the disorders we’ll consider in this chapter. By now, you know the drill: The link indicates where a more detailed discussion begins. Primary Trauma- and Stressor-Related Disorders Reactive attachment disorder. There is evidence of pathogenic care in a child who habitually doesn’t seek comfort from parents or surrogates. Disinhibited social engagement disorder. There is evidence of pathogenic care in a child who fails to show normal reticence in the company of strangers. Posttraumatic stress disorder. These adolescents or adults repeatedly relive a severely traumatic event, such as combat or a natural disaster. Posttraumatic stress disorder in preschool children. Children repeatedly relive a severely traumatic event, such as car accidents, natural disasters, or war. Acute stress disorder. This condition is much like posttraumatic stress disorder, except that it begins during or immediately after the stressful event and lasts a month or less. Adjustment disorder. Following a stressor, an individual develops symptoms that disappear once the cause of stress has subsided. Other specified, or unspecified, trauma- and stressor-related disorder. Patients whose stress or trauma appears related to other presentations may be classified in one of these categories. Other Problems Related to Trauma or Stress Problems related to abuse or neglect. An astonishing number of Z-codes (V-codes in ICD-9) cover the categories of difficulties that arise from neglect or from physical or sexual abuse of children or adults. Separation anxiety disorder. The patient becomes anxious when separated from parent, other attachment figure, or home. INTRODUCTION Another new chapter for the DSMs incorporates certain diagnoses formerly listed as anxiety, developmental, or adjustment disorders. The unifying factor here is that something traumatic or stressful in the patient’s history appears to be at least partly responsible for the symptoms that develop. It is part of a trend toward grouping together patients of any age who have the right mix of symptoms, rather than separating patients by developmental stage. Many diagnoses include statements about what is not causative, but here is the only full DSM-5 section that presumes any etiology at all, let alone one rooted in the psychology of a pathological developmental process. In the instances of reactive attachment and disinhibited social engagement disorders, there must be evidence of pathogenic care; for posttraumatic stress disorder (PTSD) and its cousins, a horrific event; for adjustment disorder a stressful—well, stressor. The respective criteria sets permit us to check off the fulfilled criteria and go on our way, perhaps thinking that we’ve solved the puzzle. While we rejoice that we’ve successfully determined a cause–effect relationship, nagging at the back of our minds must be a sense that there is more to the story. Otherwise, why do some people become symptomatic while others, exposed to the (as nearly as we can tell) exact same stimulus, go untrammeled on their way? Furthermore, studies have demonstrated that, sooner or later, significant stressors will visit the majority of us. Shouldn’t we conclude that the stimulus in question is necessary, but not sufficient, for the outcome observed? At least this DSM-5 chapter has herded most of these etiology-specific diagnoses into one corral, where we can keep a watchful eye on them. F43.10 [309.81] Posttraumatic Stress Disorder Many people who survive severely traumatic events will develop PTSD. Survivors of combat are the most frequent victims, but it is also encountered in those who have experienced other disasters, both natural and contrived. These include rape, floods, abductions, and airplane crashes, as well as the threats that may be posed by a kidnapping or hostage situation. Children can have PTSD as a result of inappropriate sexual experience, whether or not actual injury has occurred. PTSD can be diagnosed even in those who have only learned about severe trauma (or its threat) suffered by someone to whom they are close—children, spouses, other close relatives. One or two in every 1,000 patients who have undergone general anesthesia have afterwards reported awareness of pain, anxiety, helplessness, and the fear of impending death during the procedure; up to half of them may subsequently develop PTSD symptoms. Implicitly excluded from the definition are stressful experiences of ordinary life, such as bereavement, divorce, and serious illness. Awakening from anesthesia while your surgery is still in progress, however, would qualify as a traumatic event, as would learning about a spouse’s sudden, accidental death or a child’s life-threatening illness. Watching TV images of a calamity would not be a sufficient stressor (except if the viewing was related to the person’s job). After some delay (symptoms usually don’t develop immediately after the trauma), the person in some way relives the traumatic event and tries to avoid thinking about it. There are also symptoms of physiological hyperarousal, such as an exaggerated startle response. Patients with PTSD also express negative feelings such as guilt or personal responsibility (“I should have prevented it”). Aside from the traumatic event itself, other factors may play a role in the development of PTSD. Individual factors include the person’s innate character structure and genetic inheritance. Relatively low intelligence and low educational attainment are positively associated with PTSD. Environmental influences include relatively low socioeconomic status and membership in a minority racial or ethnic group. In general, the more horrific or more enduring the trauma, the greater will be the likelihood of developing PTSD. The risk runs to one-quarter of the survivors of heavy combat and two-thirds of former prisoners of war. Those who have experienced natural disasters such as fires or floods are generally less likely to develop symptoms. (Overall lifetime prevalence of PTSD is estimated at about 9%, though European researchers usually report lower overall rates.) Older adults are less likely to develop symptoms than are younger ones, and women tend to have somewhat higher rates than do men. About half the patients recover within a few months; others can experience years of incapacity. In children, the general outline is pretty much the same as the five general points given in the list of typical symptoms, though the emphasis on symptom numbers differs, as discussed below. Mood, anxiety, and substance use disorders are frequently comorbid. A new specifier reflects findings that in perhaps 12–14% of patients, dissociation is important in the development and maintenance of PTSD symptoms. Essential Features of Posttraumatic Stress Disorder Something truly awful has happened. One patient has been gravely injured or perhaps sexually abused; another has been closely involved in the death or injury of someone else; a third has only learned that someone close experienced an accident or other violence, whereas emergency workers (police, firefighters) may be traumatized through repeated exposure. As a result, for many weeks or months these patients: • Repeatedly relive their event, perhaps in nightmares or upsetting dreams, perhaps in intrusive mental images or dissociative flashbacks. Some people respond to reminders of the event with physiological sensations (racing heart, shortness of breath) or emotional distress. • Take steps to avoid the horror: refusing to watch films or television or to read accounts of the event, or pushing thoughts or memories out of consciousness. • Turn downbeat in their thinking: with persistently negative moods, they express gloomy thoughts (“I’m useless,” “The world’s a mess,” “I can’t believe anyone.”) They lose interest in important activities and feel detached from other people. Some experience amnesia for aspects of the trauma; others become numb, feeling unable to love or experience joy. • Experience symptoms of hyperarousal: irritability, excessive vigilance, trouble concentrating, insomnia, or an intensified startle response. The Fine Print The D’s: • Duration (1+ months) • Distress or disability (work/educational, social, or personal impairment) • Differential diagnosis (substance use and physical disorders [especially traumatic brain injury], mood and anxiety disorders, normal reactions to stressful events) Coding Notes Specify if: With delayed expression. Symptoms sufficient for diagnosis didn’t accumulate until at least six months after the event. With dissociative symptoms: Depersonalization. This indicates feelings of detachment, as though dreaming, from the patient’s own mind or body. Derealization. To the patient, the surroundings seem distant, distorted, dreamlike, or unreal. Barney Gorse “They’re gooks! The place is staffed with gooks!” Someone sitting behind Barney Gorse had dropped a book onto the tile floor, and that had set him off. Now he had backed into a corner in the waiting room of the mental health clinic. His pupils were widely dilated, and perspiration stood out on his forehead. He was panting heavily. He pointed a shaky finger at the Asian student who stood petrified on the other side of the room. “Get this goddamn gook out of here!” He made a fist and lumbered off in the direction of the student. “Hang on, Barney. It’s OK.” Barney’s new therapist took him firmly by the elbow and led him to a private office. They sat there in silence for a few minutes, while Barney’s breathing gradually returned to normal and the clinician reviewed his chart. Barney Gorse was 39 now, but he had been barely 20 when his draft number came up and he joined the Ninth Infantry Division in Vietnam. At that time President Nixon was “winding down the war,” which made it seem all the more painful when Barney’s squad was hit by mortar fire from North Vietnamese regulars. He had never talked about it, even during “anger displacement” group therapy with other veterans. Whenever he was asked to tell his story, he would fly into a rage. But something truly devastating must have happened to Barney that day. The reports mentioned a wound in the upper thigh; he had been the only member of his squad to survive the attack. He had been awarded a Purple Heart and a full pension. Barney hadn’t been able to remember several hours of the attack at all. And he had always been careful to avoid films and television programs about war. He said he’d had enough of it to last everybody’s lifetime; in fact, he had gone to some lengths to avoid thinking about it. He celebrated his discharge from the Army by getting drunk, which was how he remained for 6 years. When he finally sobered up, he turned to drugs. Even they hadn’t been enough to obliterate the nightmares that still haunted him; he awakened screaming several times a week. Sudden noises would startle him into a panic attack. Now, thanks to disulfiram and a chaplain in the county jail where he had been held as a persistent public nuisance, Barney had been clean and sober for 6 months. On the condition that he would seek treatment for his substance use, he had been released. The specialists in substance misuse treatment had quickly recognized that he had other problems, and that had led him here. Last week when they met, the therapist had reminded him again that he needed to dig into his feelings about the past. Barney had responded that he didn’t have any feelings; they’d dried up on him. For that matter, the future didn’t look so good, either: “Got no job, no wife, no kids. I just wasn’t meant to have a life.” He got up and put his hand on the doorknob to leave. “It’s no use. I just can’t talk about it.” Evaluation of Barney Gorse Let’s summarize and restate the criteria that must be fulfilled to diagnose PTSD. 1. There must be severe trauma (criterion A). Barney’s occurred in the context of combat, but a variety of civilian stressors can also culminate in death, serious injury, or sexual abuse. Two features must be present for the stressor to be considered sufficiently traumatic: (a) It must involve the fact or threat of death, severe wounds or injuries, or sexual violation; and (b) it must be personally experienced by the patient in some way—through direct observation (not viewed on TV), through personal involvement, or through information obtained after the fact that it involved a relative or close friend. A first responder (police officer, ambulance attendant) could also qualify through repeated exposure to consequences of the horrific event (think workers at Ground Zero shortly after 9/11). Divorce and death of a spouse from cancer, though undeniably stressful, are relatively commonplace and expected; they don’t qualify. 2. Through some intrusive mechanism, the patient relives the stress. Barney had flashbacks (B3), during which he imagined himself actually back in Vietnam. He also experienced rather intense responses to an external cue (seeing a staff member who, to him, resembled a Viet Cong soldier). Less dramatic forms of recollection include recurrent ordinary memories, dreams, and any other reminder of the event that results in distress or physiological symptoms. 3. The patient attempts (wittingly or not) to achieve emotional distance from the stressful event by avoiding reminders of the trauma. The reminders can be either internal (feelings, thoughts) or external (people, places, activities). Barney refused to watch movies and TV programs or to talk about Vietnam (C). 4. The patient experiences expressions (two or more) of negative mood and thoughts related to the trauma. Barney’s included amnesia for much of his time in combat (D1), a persistently negative frame of mind (“I wasn’t meant to have a life”—D4), and the lack of positive mood states (his feelings had “dried up” on him, D7). 5. Finally, for PTSD, patients must have at least two symptoms of heightened arousal and reactivity associated with the traumatic event. Barney suffered from insomnia (E6) and a severe startle response (E4); others may experience general irritability, poor concentration, or excessive vigilance. As with all symptoms, the clinician would have to determine that these symptoms of arousal had not been apparent before Barney’s Vietnam trauma. Barney’s symptoms had persisted far longer than the required minimum of 1 month (F); were obviously stressful and impaired his functioning in a number of areas (G); and could not be attributed to the direct effects of substance use—now that he’d been clean and sober for half a year (H). The experience of severe trauma in combat and the typical symptoms would render any other explanation for Barney’s symptoms unlikely. A patient with intermittent explosive disorder might become aggressive and lose control, but wouldn’t have the history of trauma. Still, clinicians must always be alert to the possibility of another medical condition (H) that might produce anxiety symptoms and could be diagnosed instead of or in addition to PTSD. For example, head injuries would be relatively common among veterans of combat or other violent trauma; we’d have to mention and code any accompanying brain injury. Situational adjustment disorder shouldn’t be confused with PTSD: The severity of the trauma would be far less, and the effects would be transient and less dramatic. In PTSD, comorbidity is the rule rather than the exception. Barney had used drugs and alcohol; his clinician would have gathered additional information about use of other substances and mentioned them in his diagnostic summary. Of combat veterans who have PTSD, half or more also have a problem with a substance use disorder, and use of multiple substances is common. Anxiety disorders (phobic disorders, generalized anxiety disorder) and mood disorders (major depressive disorder and dysthymia) are likewise common in this population. Dissociative amnesia may also occur. Any coexisting personality disorder would be explored, but it is hard to make a definitive diagnosis when a patient is acutely ill from PTSD. Malingering is also a diagnosis to consider whenever there appears to be a possibility of material gain (insurance, disability, legal problems) resulting from an accident or physical attack. Although the vignette is imprecise on this point, Barney’s symptoms probably began by the time he was discharged from the military, so he would not rate the specifier with delayed onset. The vignette doesn’t provide encouragement to add with prominent dissociation. I’d give him a GAF score of 35. Pending further information on substance use, Barney’s diagnosis would read as follows: F43.10 [309.81] Posttraumatic stress disorder F10.20 [303.90] Alcohol use disorder, moderate, in early remission Z60.2 [V60.3] Lives alone Z56.9 [V62.29] Unemployed There is still considerable controversy over the specifier with delayed expression. Many experts deny that symptoms of PTSD can begin many months or years after the trauma. Nonetheless, it is there to use, should you ever find it appropriate. Posttraumatic Stress Disorder in Preschool Children There can be no doubt that preschool children are sometimes exposed to traumatic events. Mostly, these are car accidents, natural disasters, and war—in short, all the benefits contemporary life has to offer. The question is, do very young children respond with typical PTSD symptoms? The best evidence would seem to indicate that they do, but with a likelihood much lower (0–12%) than for older children. Table 6.1 compares the DSM-5 criteria for PTSD in young children, PTSD in adults, and acute stress disorder (to be discussed next). The revamped criteria for PTSD in young children are, as we would hope, more sensitive to symptoms in this age group. Based on interviews with parents, they yield rates in children who have survived severe burns of 25% and 10% at 1 month and 6 months, respectively. TABLE 6.1. Comparison of PTSD in Preschool Children, PTSD in Adults, and Acute Stress Disorder Child PTSD Adult PTSD Acute Stress Disorder Trauma Direct experience Direct experience Direct experience Witness (not just TV) Witness Witness Learn of Learn of Repeat exposure (not just TV) Learn of Repeat exposure (not just TV) Intrusion symptoms (1/5)a Intrusion symptoms (1/5) All symptoms (9/14) • Memories • Memories • Memories • Dreams • Dreams • Dreams • Dissociative reactions • Dissociative reactions • Dissociative reactions • Psychological distress• Physiological reactions • Psychological distress• Physiological reactions • Psychological distress or physiological reactions Avoid/Neg. emotions (1/6) Avoidance (1/2) • Avoids memories • Avoids memories • Avoids memories • Avoids external reminders • Avoids external reminders • Avoids external reminders Negative emotions (2/7) • Altered sense of reality of self or surroundings • Amnesia • Amnesia • Negative beliefs • Distortion → self-blame • Negative emotional state • Negative emotional state • Decreased interest • Decreased interest • Social withdrawal • Detached from others • Decreased positive emotions • No positive emotions • No positive emotions Physiological (2/5) Physiological (2/6) • Irritable, angry • Irritable, angry • Irritable, angry • Reckless, self-destructive • Hypervigilance • Hypervigilance • Hypervigilance • Startle • Startle • Startle • Poor concentration • Poor concentration • Poor concentration • Sleep disturbance • Sleep disturbance • Sleep disturbance Duration >1 month >1 month 3 days–1 month Purchasers of this ebook can download a copy of this table from www.guilford.com/morrison2-forms. aFractions indicate the number of symptoms required of the number possible in the following list. F43 [308.3] Acute Stress Disorder Based on the observation that some people develop symptoms immediately after a traumatic stress, acute stress disorder (ASD) was devised several decades ago. Even then, this wasn’t exactly new information; something similar was noted as far back as 1865, just after the U.S. Civil War. For many years it was termed “shell shock.” Like PTSD, ASD can also be found among civilians. Overall rates of ASD, depending on the nature of the trauma and personal characteristics of the individual, center on 20%. Though the number and distribution of symptoms is different, the criteria embody the same elements required for PTSD: • Exposure to an event that threatens body integrity • Reexperiencing the event • Avoidance of stimuli associated with the event • Negative changes in mood and thought • Increased arousal and reactivity • Distress or impairment The symptoms usually begin as soon as the patient is exposed to the event (or learns about it), but they must be experienced farther out than 3 days after the stressful event to fulfill the criterion for duration. This gets us to a period of time beyond the stressful event itself and its immediate aftermath. Should symptoms last longer than 1 month, they are no longer acute and no longer constitute ASD. Then many patients will be rolled over into a diagnosis of PTSD. This is the fate of as many as 80% of patients with ASD. However, patients with PTSD don’t usually enter through the ASD doorway; most are identified farther along the road than one month. Essential Features of Acute Stress Disorder Something truly awful has happened—grave injury or sexual abuse, or perhaps the traumatic death or injury of someone else. (It could have come about through learning another has experienced violence or injury, or through repeated exposure for an emergency worker.) As a result, for up to a month the patient experiences many symptoms such as intrusive memories or bad dreams; dissociative experiences such as flashbacks or feeling unreal; the inability to experience joy or other love; amnesia for parts of the event; attempts to avoid reminders of the event (refusing to watch films or television or to read accounts of the event); pushing thoughts or memories out of consciousness. The patient may also experience symptoms of hyperarousal: irritability, hypervigilance, trouble concentrating, insomnia, or an intense startle response. The Fine Print The D’s: • Duration (3 days to 1 month) • Distress or disability (work/educational, social, or personal impairment) • Differential diagnosis (substance use and physical disorders (especially traumatic brain injury), panic disorder, mood disorders, dissociative disorders, PTSD) Marie Trudeau Marie Trudeau and her husband, André, sat in the intake interviewer’s office. Marie was the patient, but she spent most of the time rubbing the knuckles of one hand and gazing vacantly into the room. André did most of the talking. “I just can’t believe the change in her,” he said. “A week ago, she was completely normal. Never had anything like this in her life. Heck, she’s never had anything wrong with her. Then, all of a sudden, boom! She’s a mess.” At André’s exclamation, Marie jerked around to face him and rose half out of her chair. For a few seconds she stood there, frozen except for her gaze, which darted from one side of the room to the other. “Aw, geez, I’m sorry, honey. I forgot.” He put his arm around her. Grasping her shoulders firmly but gently, he eased her back into the chair. He held her there until she began to relax her grip on his arm. A week earlier, Marie had just finished her gardening and was sitting in the back yard with a lemonade, reading a book. When she heard airplane engines, she looked up and saw two small planes flying high overhead, directly above her. “My God,” she thought, “they’re going to collide!” As she watched in horror, they did collide. She could see perfectly. The sun was low, highlighting the two planes brilliantly against the deep blue of the late afternoon sky. Something seemed to have been torn off one of them—the news media later reported that the right wing of one plane had ripped right through the cockpit of the other. Thinking to call 911, Marie picked up her portable phone, but she didn’t dial. She could only watch as two tiny objects suddenly appeared beside the stricken airplanes and tumbled toward her in a leisurely arc. “They weren’t objects, they were people.” It was the first time she had spoken during the interview. Marie’s chin trembled, and a lock of hair fell across her eye. She didn’t try to brush it back. As she continued to watch, one of the bodies hurtled into her yard 15 feet from where she was sitting. It buried itself 6 inches deep in the soft earth behind her rose bushes. What happened next, Marie seemed to have blanked out completely. The other body landed in the street a block away. Half an hour later, when the police knocked on her door, they found her in the kitchen peeling carrots for supper and crying into the sink. When André arrived home an hour after that, she seemed dazed. All she would say was “I’m not here.” In the 6 days since, Marie hadn’t improved much. Although she might start a conversation, something would appear to distract her, and she would usually trail off in midsentence. She couldn’t focus much better on her work at home. Amy, their 9-year-old daughter, seemed to be taking care of her. Sleep had slipped to a restless struggle, and three nights running Marie had awakened from a dream, trying to cry out but managing only a terrified squeak. She kept the blinds in the kitchen closed, so she wouldn’t even have to look into the back yard. “It’s like someone I saw in a World War II movie,” André concluded. “You’d think she’d been shell-shocked.” Evaluation of Marie Trudeau Anxiety and depressive symptoms are nearly universal following a severe stress. Usually these are relatively short-lived, however, and do not include the full spectrum of symptoms required for ASD. This diagnosis should only be considered when major symptoms last 3 days or more after personal exposure to a horrific event. Such an event was the plane crash Marie witnessed (criterion A2). She was dazed (B6) and emotionally unresponsive (B5), and could not recall what had happened during part of the accident (B7). When she could sleep at all (B10), she had nightmares (B2); she also avoided looking into the back yard (B9), startled easily (B14), and even in the interviewer’s office appeared hypervigilant (B12). From her inability to finish conversations, we infer poor concentration (B13), as she was distracted by intrusive recollections of the event (B1). As far as we are aware, she had had none of these symptoms (DSM-5 requires 9 of the 14 symptoms listed in criterion B) prior to witnessing the accident. Since then, just a week earlier (C), she had been unable to carry on with her work at home (D). Would any other diagnosis be possible? According to André, Marie’s previous health had been good, reducing the likelihood of another medical condition (E). We aren’t told whether she used alcohol or drugs, though the fact that she was drinking lemonade at the time of the crash could suggest that she did not. (OK, I’m definitely out on a limb here; her clinician needs to rule out a substance use disorder.) Brief psychotic disorder would be ruled out by the lack of delusions, hallucinations, or disorganized behavior or speech. Patients with ASD are likely to have severe depressive symptoms (“survivor’s guilt”), to the point that a concomitant diagnosis of major depressive disorder may sometimes be justified; Marie deserves further investigation along those lines. Until then, with a GAF score of 61, her diagnosis would be straightforward: F43.0 [308.3] Acute stress disorder Adjustment Disorder Patients with adjustment disorder (AD) may be responding to one stress or to many; the stressor may happen once or repeatedly. If the stressor goes on and on, it can even become chronic, as when a child lives with parents who fight continually. In clinical situations, the stressor has usually affected only one person, but it can affect many (think flood, fire, and famine). However, almost any relatively commonplace event could be a stressor for someone. Those most often cited for adults are getting married or divorced, moving, and financial problems; for adolescents, they are problems at school. Whatever the nature of the stressor, patients feels overwhelmed by the demands of something in the environment. As a result, they develop emotional symptoms such as low mood, crying spells, complaints of feeling nervous or panicky, and other depressive or anxiety symptoms—which must not, however, meet criteria for any defined mood or anxiety disorder. Some patients have mainly behavioral symptoms—especially ones we might think of as conduct symptoms, such as driving dangerously, fighting, or defaulting on responsibilities. The course is usually relatively brief; DSM-5 criteria specify that the symptoms must not persist longer than 6 months after the end of the stressor or its consequences. (Some studies report that a large minority of patients continue to have symptoms longer than the 6-month limit.) Of course, if the stressor is one that will be ongoing, such as a chronic illness, it may take a very long time for the patient to adjust. Although AD has been reported in 10% or more of adult primary care patients, and in huge percentages of mental health patients, one recent study found a prevalence of only 3%; many of these patients were being inappropriately treated with psychotropic medications, and in only two cases had the AD diagnosis been made. The discrepancies probably rest on the rather poorly developed criteria and on the (mistaken) view of AD as a residual diagnosis. AD is found in all cultures and age groups, including children. It may be more firmly anchored in adults than in adolescents, whose early symptoms often evolve into other, more definitive mental disorders. The reliability and validity of AD tend to be quite low. In a recent study, in under two-thirds of patients receiving the clinical diagnosis of AD could it be subsequently confirmed with ICD-10 criteria. Personality disorders or cognitive disorders may make a person more vulnerable to stress, and hence to AD. Patients in whom AD is diagnosed often misuse substances as well. Essential Features of Adjustment Disorder A stressor causes someone to develop depression, anxiety, or behavioral symptoms—but the response exceeds what you’d expect for most people in similar circumstances. After the stressor has ended, the symptoms might drag on, but not longer than 6 more months. The Fine Print The D’s: • Duration (starts within 3 months of stressor’s onset, stops within 6 months of stressor’s end) • Distress or disability (work/educational, social, or personal impairment) • Differential diagnosis (just about everything you can name: substance use and physical disorders, mood and anxiety disorders, trauma-related disorders, somatic symptom disorder, psychotic disorders, conduct and other behavior disorders, milder reactions to life’s stresses, normal bereavement) Coding Notes Specify: F43.21 [309.0] With depressed mood. The patient is mainly tearful, sad. F43.22 [309.24] With anxiety. The patient is mainly nervous, tense, or fearful of separation. F43.23 [309.28] With mixed anxiety and depressed mood. Symptoms combine the preceding. F43.24 [309.3] With disturbance of conduct. The patient behaves inappropriately or unadvisedly, perhaps violating societal rules, norms, or the rights of others. F43.25 [309.4] With mixed disturbance of emotions and conduct. The clinical picture combines emotional and conduct symptoms. F43.20 [309.9] Unspecified. Use for other maladaptive stress-related reactions, such as physical complaints, social withdrawal, work or academic inhibition. Specify if: Acute. The condition has lasted less than 6 months. Persistent (or chronic). 6+ months duration of symptoms, though still not lasting more than 6 months after the stressor has ended. Clarissa Wetherby “I know it’s temporary, and I know I’m overreacting. I sure don’t want to, but I just feel upset!” Clarissa Wetherby was speaking of her husband’s new work schedule. Arthur Wetherby was foreman on a road-paving crew whose current job was to widen and resurface a portion of the interstate highway just a few miles from the couple’s house. Because the section the crew was working on involved an interchange with another major highway, the work had to be done at night. For the past 2 months, Arthur had slept days and gone to work at 8:00 P.M. Clarissa worked the day shift as cashier in a restaurant. Except on weekends, when he tried to revert to a normal sleep schedule so he could be with her, they hardly ever saw one another. “I feel like I’ve been abandoned,” she said. The Wetherbys had been married only 3 years, and they had no children. Each partner had been married once before; each was 35. Neither drank or used drugs. Clarissa’s only previous encounter with the mental health system had occurred 7 years earlier, when her first husband had left her for another man. “I respected his right not to continue living a lie,” she said, “but I felt terribly alone and humiliated.” Clarissa’s symptoms now were much as they had been then. Most of the time when she was at work, she felt “about normal” and maintained good interest in what she was doing. But when alone at home in the evenings, she would be overwhelmed by waves of sadness. These left her virtually immobilized, unable even to turn on the television for company. She often cried to herself and felt guilty for giving in to her emotions. “It’s not as if someone had died, after all.” Although she had some difficulty getting to sleep at night, she slept soundly in the morning. Her weight was constant, her appetite was good, and she had no suicidal ideas or death wishes. She did not report any problems with her concentration. She denied ever having mania symptoms. The previous time she’d sought help, she had remained depressed and upset until a few weeks after the divorce was final. Then she seemed suddenly able to put it behind her and begin dating once again. “I know I’ll feel better, once Arthur gets off that schedule,” she said. “I guess it just makes me feel worthless, playing second fiddle to an overpass.” Evaluation of Clarissa Wetherby As she herself recognized, Clarissa’s reaction to the stress of her husband’s work schedule might be considered extreme by some observers. That is one of the important points of this diagnosis: The patient’s misery seems disproportionate to the apparent degree of the stress that has caused it (criterion B1). Her history provides a clue as to the source of her reaction: She was reminded of that awful time when her previous husband abandoned her—for good, and under circumstances that she considered humiliating. It is important, however, always to consider carefully whether a patient’s reaction occurs as a nonpathological response to a genuine danger, which was not the case with Clarissa. The time course of Clarissa’s symptoms was right for AD: They developed shortly after she learned about Arthur’s new work schedule (A). Although we have no way of knowing how long this episode might last, her previous episode ended after a few months, when the aftermath of her divorce had subsided (E). Of course, bereavement didn’t enter into her differential diagnosis (D). Note that AD is not intended as a residual diagnosis, though it is often used that way. Nonetheless, it does come at the end of a long differential diagnosis that comprises every other condition listed in DSM-5 (C). For Clarissa, the symptoms of mood disorder were the most prominent. She had never been manic, so could not qualify for a bipolar disorder. She had low mood, but only when alone in the evenings (not most of the day). She maintained interest in her work (rather than experiencing loss of interest in nearly all activities). Without at least one of these symptoms, there could not be a diagnosis of major depressive disorder, regardless of her guilt feelings, low energy, and trouble getting to sleep at night. Of course, her symptoms had lasted far less than 2 years, ruling out dysthymia. Although she remained fully functional at work, she was seriously distressed, fulfilling the severity requirement. The question of PTSD (and acute stress disorder) often arises in the differential diagnosis of AD. Each of those diagnoses requires that the stressor threaten serious harm and that the patient react with a variety of responses; Clarissa did not fulfill these conditions. She similarly did not have symptoms that would suggest generalized anxiety disorder, another diagnosis prominent in the differential for AD. A personality disorder may worsen (and hence become more apparent) with stress, but there is no hint that Clarissa had any lifelong character pathology. I’d assign her a GAF score of 61. F43.21 [309.0] Adjustment disorder, with depressed mood, acute Although some data support the utility of AD, which has been used clinically for decades, I recommend reserving it as a diagnosis of “almost last resort.” There are several reasons for this warning. For one thing, we probably too often use it when we simply have no better idea of what is going on. For another, the DSM-5 criteria do not tell us how we are to differentiate ordinary events from those that are stressful enough to cause depression, anxiety, or aberrant behavior. I suspect that an event is singled out solely on the basis that it causes and emotional or behavioral problem, and that seems to me a tad circular. F94.1 [313.89] Reactive Attachment Disorder F94.2 [313.89] Disinhibited Social Engagement Disorder In two apparently rare but extremely serious disorders, children who have been mistreated (by accident or design) respond by becoming either extremely withdrawn or pathologically outgoing. For neither disorder do we have a lot of information, placing these two among the least well understood of mental disorders that affect children (or adults, for that matter). Each disorder is conceived as a reaction to an environment in which the child experiences caregiving that is inconstant (frequent change of parent or surrogate) or pathological (abuse, neglect). One of two patterns then develops. In reactive attachment disorder (RAD), even young infants withdraw from social contacts, appearing shy or distant. Inhibited children will resist separation by tantrums or desperate clinging. In severe cases, infants may exhibit failure-to-thrive syndrome, with head circumference, length, and weight hovering around the 3rd percentile on standard growth charts. By contrast, a child’s response in disinhibited social engagement disorder (DSED) borders on the promiscuous. Small children eschew normal wariness and boldly approach strangers; instead of clinging, they may instead appear indifferent to the departure of a parent. In both subtypes, the abnormal responses are more obvious when the main caregiver is absent. Factors that indicate increased risk for either RAD or DSED include being reared in an orphanage or other institution; protracted hospitalizations; multiple and frequent changes in caregivers; severe poverty; abuse (the gamut of physical, emotional, and sexual); and a family riven by death, divorce, or discord. Complications associated with these disorders include stunted physical growth, low self-esteem, delinquency, anger management issues, eating disorders, malnutrition, depression or anxiety, and later substance misuse. In either disorder, a constant, nourishing relationship with a sensitive caregiver is required to reestablish adequate physical and emotional growth. Without such a remedy, the conditions tend to persist into adolescence. There has been almost no follow-up into adult life; despite a dearth of reliable information, you will (of course) find websites. DSM-IV listed these two conditions as subcategories of one disorder. Because of differences in symptoms, course, treatment response, and other correlates, DSM-5 now treats them as separate diagnoses—despite their supposed common etiology. However, some children will appear withdrawn when very young, then become disinhibited later, whereas others have symptoms of both conditions simultaneously. The upshot is that some observers find the dichotomy a bit forced. Essential Features of Reactive Attachment Disorder Adverse child care (abuse, neglect, caregiving insufficient or changed too frequently) has apparently caused a child to withdraw emotionally; the child neither seeks nor responds to soothing from an adult. Such children will habitually show little emotional or social response; far from having positive affect, they may experience periods of unprovoked irritability or sadness. The Fine Print The presumption of causality stems from the temporal relationship of the traumatic child care to the disturbed behavior. The D’s: • Demographics (begins before age 5; child has developmental age of at least 9 months) • Differential diagnosis (autism spectrum disorder, intellectual disability, depressive disorders) Coding Notes Specify if: Persistent. Symptoms are present longer than 1 year. Severe. All symptoms are present at a high level of intensity. Essential Features of Disinhibited Social Engagement Disorder Adverse child care (abuse, neglect, caregiving insufficient or changed too frequently) has apparently caused a child to become unreserved in interactions with strange adults. Such children, rather than showing typical first-acquaintance shyness, will little hesitate to leave with a strange adult; they don’t “check in” with familiar caregivers, and readily become excessively familiar. In so doing, they may cross normal cultural and social boundaries. The Fine Print The presumption of causality stems from the temporal relationship of the traumatic child care to the disturbed behavior. The D’s: • Demographics (child has developmental age of at least 9 months) • Differential diagnosis (autism spectrum disorder, intellectual disability, ADHD) Coding Notes Specify if: Persistent. Symptoms are present longer than 1 year. Severe. All symptoms are present at a high level of intensity. F43.8 [309.89] Other Specified Trauma- or Stressor-Related Disorder This diagnosis will serve to categorize those patients for whom there is an evident stressor or trauma, but who for a specific, stated reason don’t fulfill criteria for any of the standard diagnoses already mentioned above. DSM-5 gives several examples, including two forms of adjustment-like disorders (one form with delayed onset and another with prolonged duration relative to adjustment disorder). Others are as follows: Persistent complex bereavement disorder. For at least a year, a patient experiences intense grief for someone close who has died. There may be yearning and preoccupation of thoughts for the person, or continuing ruminations over the circumstance of death. A number of other symptoms express the patient’s loss of identity and reactive distress. Proposed criteria and discussion are given in Section III of DSM-5 on page 789. Various cultural syndromes. You’ll find a number of these in an appendix in DSM-5, page 833. F43.9 [309.9] Unspecified Trauma- or Stressor-Related Disorder This diagnosis will serve to categorize those patients for whom there is an evident stressor or trauma, but who don’t fulfill criteria for any of the standard diagnoses already mentioned above, and for whom you do not care to specify the reasons why the criteria are not fulfilled.”

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Psychology Chapter 1 Practice Problems homework help

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

Psychology Chapter 1 Practice Problems homework help

Name:

Chapter 1 Instructions

Practice Problem 12, 15, 19, 20, 21, & 22

Due Week 2 Day 6 (Sunday)

Follow the instructions below to submit your answers for Chapter 1 Practice Problem 12, 15, 19, 20, 21, & 22.

1. Save Chapter 1 Instructions to your computer.

2. Type your answers into the shaded boxes below. The boxes will expand as you type your answers.

3. Resave this form to your computer with your answers filled-in.

4. Attach the saved form to your reply when you turn-in your work in the Assignments section of the Classroom tab. Note: Each question in the assignments section will be listed separately; however, you only need to submit this form one time to turn-in your answers.

Read each question in your text book and then type your answers for Chapter 1 Practice Problem 12, 15, 19, 20, 21, & 22 in the corresponding spaces below.

12a. equal-interval –

12b. rank-order –

12c. nominal –

12d. ratio scale –

12e. continuous –

15. Type your answers to Practice Problem 15a in the shaded boxes below. The “X” represents the speed; “f” represents the frequency; and “%” represents the relative percentage for each score. Round to the nearest whole percentage. For example, if your remainder is .5 or greater, round up (i.e. 2.5 = 3). Note: Fill-in each box. Please do not delete any scores.

X	f	%
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19. Give an example, in words, of something having the distribution shapes listed below.

19a. bimodal –

19b. approximately rectangular –

19c. positively skewed –

20. Describe an example of a misleading graph: Note: Either copy and paste a graph in the first shaded box below, or fully describe the graph if it will not paste. You may also cut and paste a misleading graph onto a Word document and send as an attachment. Please do not include a link to a graph in lieu of pasting a graph onto a Word document. I will not navigate to a link to view your chosen graph.

In the second shaded box, discuss specific characteristics that make the graph misleading.

21a. Explain the idea of frequency table 1-10 below:

21b. Explain the meaning of the pattern of results below:

22a. Explain the idea of frequency table 1-11 below:

22b. Explain the meaning of the pattern of results below:

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Psychology Response homework help

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

Psychology Response homework help

1. Responded to message below. Should be at least 250 words. Responses should be informative and contribute to advancing knowledge of the topic. Include at least 2 APA-cited references.

Frank, Greitzer & Holimer (2011) makes powerful augments about the difficulties surrounding the trail before the fact. I agree with them. It really is difficult to determine if threats are bogus and if they should be taken seriously. However, once a threat is made it must be taken seriously and that it is highly possible for the individual to carry out their plan. It is also difficult to know the individual’s state of mind or if the individual has psychological issues. Frank, Greitzer & Holimer (2011) states, “there are several factors that should taken into consideration regarding picking up the trail before the fact, (a) the lack of sufficient real-world data that has “ground truth” adequate scientific verification and validate of proposed solutions; (b) the difficulty in distinguishing between malicious insider behavior and what can be described as normal or legitimate behavior (c) the potential quantity of data, and the resultant number of “associations” or relationships that may emerge produce enormous scalability challenges; and (d) despite ample evidence suggesting that in a preponderance of cases, the perpetrator exhibited observable ‘concerning behaviors’. All threats should be taken into account and noted as warning signals and reported to the proper authorities.

Sometimes the most damage is done by individuals who had a personal insight into the company or one who became disgruntled. They know the outs an ins of the organization and how to cause the most damage. I also agree that the methods and skills of the perpetrators have changed in recent years. With all of the new technology, the generations have become wiser and smarter. Therefore, all threats should be observed.

2. Responded to message below. Should be at least 250 words. Responses should be informative and contribute to advancing knowledge of the topic. Include at least 2 APA-cited references.

What Frank, Greitzer & Hohimer (2011) argue about difficulties of picking up the trail before the fact, in order to provide time to intervene and prevent an insider cyber attack?
I agree with Greitzer and Hohimer that insider threat is a serious concern for cyber security that has to be addressed successfully. Unfortunately this is much easier said than done. The nature of insider threat makes it very difficult to detect and as Grietzer and Hohimer (2011) point out, there is a lack of real world data, it is difficult to differentiate between normal and abnormal behavior, there would be scalability challenges in data collected and no one has really decided to tackle this issue with technology yet (p.27). This means that devising a way to identify an insider threat prior to that insider launching an attack is a task that will not be easy to complete. That doesn’t mean that this is not a goal that we should be working towards, quite the opposite actually. This is something that should be given attention and professionals should be working on methods that can help catch insider threats before the damage is done.
Do you agree with them? Why? Why not?
I do agree with Greitzer and Hohimer that insider threat is a big problem. I also agree that there is a lack of data that can be used to help identify patterns and help develop methods and technology that can catch insider threat early. I have to admit that much of what they discussed in the article was a bit over my head. I don’t fully understand how the technology they discussed would work and I also can’t say that I believe that a technological solution would the perfect solution for this issue. Humans can be very unpredictable. This means that any technology developed to be an early identifier of insider threat will not work every time. I do think that more often than not there will be indicators prior to an insider attack occurring but there is always that chance that someone just snaps. With that being said I do think that there should still be research and work done to mitigate the risk of insider attacks.

Quantification: 2 Pages

Assignment: Chapter 2 & Chapter 3

Question1:

(Problem 1): If a program has 471 bytes and will be loaded into page frames of 100 bytes each, and the instruction to be used is at byte 132, answer the following questions:

a. How many pages are needed to store the entire job?

b. Compute the page number and the exact displacement for each of the byte addresses where the data is stored. (note: page numbering starts at zero).

a) 471/100 + 1=5

b) To store page number: 3 bits

To store offset:7 bits

(Problem-2): Given that main memory is composed of only three page frames for public use and that a seven-page program (with Pages a, b, c, d, e, f, g) that requests pages in the following order:

a, c, a, b, a, d, a, c, b, d, e, f

(a). Using the FIFO page removal algorithm, indicate the movement of the pages into and out of the available page frames (called a page trace analysis). Indicate each page fault with an asterisk (*). Then compute the failure and success ratios.

(b). Increase the size of memory so it contains four page frames for public use. Using the same page requests as above and FIFO, do another page trace analysis and compute the failure and success ratios.

Given that main memory is composed of three page frames for public use and that a seven-page program (with pages a, b, c, d, e, f, g) requests pages in the following order: a, b, a, c, d, a, e, f, g, c, b, g

page request

page fault

page 1

page 2

page 3

Total faults: 10

Failure: 10/12

83.33e %

Total faultless: 2 Success: 2/12 16.66e%

page request

page fault

page 1

page 2

page 3

page 4

Total faults: 9

Failure: 9/12

75 %

Total faultless: 3 Success: 3/12 25%

Question2:

(Problem 1): Given the following information:

a. Use the best-fit algorithm to indicate which memory blocks are allocated to each of the three arriving jobs.

b. Use the first-fit algorithm to indicate which memory blocks are allocated to each of the three arriving jobs.

a) For the best fit algorithm, allocates the smallest free partition which meets the requirement without wasting much memory. So Job A needs 57k so it can fit in any block of the four. but it takes Block 3 so that much memory is not wasted.

Job B needs 920k it cannot fit in both Block 2 and block 1, but it has to use two blocks to fit. Even so much memory is wasted so it fits in Block 2 and takes remaining from other block.

Job C also fits in block 3

Job D can fit in Block 1 and 2 but it fits in block 1 as block 2 is used.

b) For the first fit algorithm, means pick the first block that meets the requirement.

For Job A, it takes first block 1

Job B it takes block 2 but does not fit so it has to wait for Job A

Job C it takes block 3 as per the requirement.

Job D it takes Block 4 but does not fit so it has to wait for other blocks as Job A or Job C to finish which has free space and then fits.

(Problem-2): Next-fit is an allocation algorithm that starts by using the first-fit algorithm but keeps track of the partition that was last allocated. Instead of restarting the search with Block 1, it starts searching from the most recently allocated block when a new job arrives. Using the following information:

Indicate which memory blocks are allocated to each of the three arriving jobs, and explain in your own words what advantages the next-fit algorithm could offer.

For Job A it takes for the block 1 and uses it 100k in it and then takes for block 2 for remaining to fit in it. The unused memory in block 2 would be 410k.

For job B it takes for the block 2 and use 50k so remains 360k

For job C it takes block 2 and uses 275k and the remaining memory of the block 2 is 85k

For job D, it takes block 2 which has 85k and uses it and then moves to block 3 uses it and for remaining 95k it moves to block 4 and uses 95k thus leaving 500k remaining unused in block 4.

The advantage of next fit is such that, when a new job is called it searches from the remaining block of memory so that much space is saved rather than wasting some amount of space in each block. Thus speed also is improved in next fit since if memory is released that is earlier in the heap for an application, it will check for that block first and fits there.

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Biological Psychology Worksheet

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

Biological Psychology Worksheet

PSYCH/575 Version 3

University of Phoenix Material

Biological Psychology Worksheet

Answer the following questions with 50-to 100-word responses. Prepare to discuss your answers.

1. What are the core assumptions of the biopsychological approach?

Biopsychological approach is also known as physiological psychology, which focuses on the relationship between behaviors, biological makeup, and experiences (Carlson, 2010). Studies of the functions of the nervous system include examples of brain damage, by damaging or disconnecting conscious brain functions from the speech mechanisms in the left hemisphere (Carlson, 2010). The phenomenon of blindsight is partial damage to the visual system on one side of the brain (Carlson, 2010). The phenomenon of unilateral involves consciousness operations of the verbal mechanisms of the left hemisphere (Carlson, 2010). The understanding of the language functions of the brain will lead to an understanding of how the brain may be conscious of its own existence (Carlson, 2010).

2. What historical disciplines converge to create biological psychology?

Physiological psychologists use both reduction and generalization to explain behavior (Carlson, 2010). Generalization refers to the classification of phenomena according to their essential features so that general laws can be formulated (Carlson, 2010). Reduction refers to the description of phenomena in terms of more basic physical processes (Carlson, 2010). Generalizations use the traditional methods of psychology whereas reduction explains behaviors in terms of physiological events within the body primarily within the nervous system (Carlson, 2010). Physiological psychology builds upon the tradition of both experimental psychology and experimental physiology (Carlson, 2010).

3. What are some of the earliest examples of a biological approach to studying behavior?

The most popular example is the evolution of the Darwin’s theory, which is based upon the concepts of natural selection (Carlson, 2010). The theory suggests that it is important to have an understanding of the performing functions of organs, body parts, and behavior (Carlson, 2010). Changes in genetics may cause the production of different proteins, which alters physical characteristics (Carlson, 2010). After the changes confer with a selective advantage, the new genes will be transmitted to other members of the species (Carlson, 2010). Behaviors may also evolve, through the selective advantage of alterations in the structure of the nervous system (Carlson, 2010). Examples of homo neanderthalis evolving into homo sapiens is the perfect study.

4. What are some examples of modern careers that have resulted from studying biological psychology? Include an overview of the careers.

A career in physiological psychology must be obtained with a graduate degree and serve years as junior scientist. Physiological psychology includes the study of neuroscience (Carlson, 2010). A career as a Neuroscientists concerns there study with all aspects of the nervous system: its anatomy, chemistry, physiology, development, and functioning (Carlson, 2010). The research of neuroscientists ranges from the study of molecular genetics to the study of social behavior (Carlson, 2010). Most professional physiological psychologists are employed by colleges and universities, where they are engaged in teaching and research (Carlson, 2010).

5. How is biological psychology viewed by other professionals in psychology today?

The field provides a unique forum for the collaboration and interaction of professionals unparalleled in other areas of scientific and clinical study (Rosenzweig, Breedlove & et al, 2001). Biological psychology contributes to the advancement of empirical and theoretical perspectives (Rosenzweig, Breedlove & et al, 2001). The diverse professionals include representation of investigators trained in the areas of anatomy, anthropology, behavioral medicine, biochemistry, clinical neuropsychology, endocrinology, genetics, molecular biology, paleontology, psychiatry, and psychophysiology (Rosenzweig, Breedlove & et al, 2001). Working together, the professionals study the structural and functional aspects of behavior across species, explore the developmental processes of biology and behavior across the life span, and utilize findings to formulate practical applications that promote human health while respecting each other views and opinions (Rosenzweig, Breedlove & et al, 2001).

Reference:

Carlson, N. R. (2010). Physiology of behavior. (10th ed.). Boston, MA: Allyn & Bacon.

Rosenzweig, M.R., Breedlove, S.M. & Leiman, A.L. (2001). Biological Psychology: An Introduction to Behavioral, Cognitive, and Clinical Neuroscience. (3rd ed.). Sunderland, MA.

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Dissociative Disorders And Trauma Assignment help

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

Dissociative Disorders And Trauma Assignment help

8 somatic symptom and dissociative disorders

learning objectives 8

· 8.1 What are somatic symptom disorders?

· 8.2 What is illness anxiety disorder?

· 8.3 What is conversion disorder (functional neurological symptom disorder)?

· 8.4 What is the difference between a factitious disorder and malingering?

· 8.5 What are the primary features of dissociative disorders?

· 8.6 What is depersonalization/derealization disorder?

· 8.7 What is dissociative amnesia?

· 8.8 What is dissociative identity disorder?

Have you ever had the experience, particularly during a time of serious stress, when you felt like you were walking around in a daze or like you just weren’t all there? Or have you known people who constantly complained about being sure they had a serious illness even though medical tests failed to show anything wrong? Both of these are examples of mild dissociative and somatic symptoms experienced at least occasionally by many people. However, when these symptoms become frequent and severe and lead to significant distress or impairment, a somatic symptom or dissociative disorder may be diagnosed. Somatic symptom disorders (formerly known as somatoform disorders ) and dissociative disorders appear to involve more complex and puzzling patterns of symptoms than those we have so far encountered. As a result, they confront the field of psychopathology with some of its most fascinating and difficult challenges. Unfortunately, however, we do not know much about them—in part because many of them are quite rare and difficult to study.

As we have seen ( Chapter 6 ), both somatic symptom and dissociative disorders were once included with the various anxiety disorders (and neurotic depression) under the general rubric neuroses, where anxiety was thought to be the underlying cause of all neuroses whether or not the anxiety was experienced overtly. But in 1980, when DSM-III abandoned attempts to link disorders together on the basis of hypothesized underlying causes (as with neurosis) and instead focused on grouping disorders together on the basis of overt symptomatology, the anxiety, mood, somatic symptom, and dissociative disorders each became separate categories.

Somatic Symptom and Related Disorders

The somatic symptom disorders lie at the interface between abnormal psychology and medicine. They are a group of conditions that involve physical symptoms combined with abnormal thoughts, feelings, and behaviors in response to those symptoms (APA, 2013 ). Soma means “body,” and somatic symptom disorders involve patterns in which individuals complain of bodily symptoms that suggest the presence of medical problems but where there is no obvious medical explanation that can satisfactorily explain the symptoms such as paralysis or pain. Despite a wide range of clinical manifestations, in each case the person is preoccupied with some aspect of her or his health to the extent that she or he shows significant impairments in functioning.

In DSM-IV a great deal of emphasis was placed on the idea that the symptoms were medically unexplained. In other words, although the patient’s complaints suggested the presence of a medical condition no physical pathology could be found to account for them (Allen & Woolfolk, 2012 ; Witthöft & Hiller, 2010 ). In DSM-5 this idea is less prominent, because it is recognized that medicine is fallible and that a medical explanation for symptoms cannot always be provided. Nonetheless, medically unexplained symptoms are still a key part of some disorders (such as conversion disorder) that we will describe later.

Equally key to these disorders is the fact that the affected patients have no control over their symptoms. They are also not intentionally faking symptoms or attempting to deceive others. For the most part, they genuinely believe something is terribly wrong with them. Not surprisingly, these patients are frequent visitors to their primary-care physicians.

Sometimes, of course, people do deliberately and consciously feign disability or illness. Also placed in the somatic symptoms and related disorders category in DSM-5 is factitious disorder. In factitious disorder the person intentionally produces psychological or physical symptoms (or both). Although this may strike you as strange, the person’s goal is to obtain and maintain the benefits that playing the “sick role” (even to the extent of undergoing repeated hospitalizations) may provide, including the attention and concern of family and medical personnel. However, there are no tangible external rewards. In this way factitious disorder differs from malingering. In malingering the person is intentionally producing or grossly exaggerating physical symptoms and is motivated by external incentives such as avoiding work or military service or evading criminal prosecution (APA, 2013 ; Maldonado & Spiegel, 2001 ).

In our discussion, we will focus on four disorders in the somatic symptom and related disorders category. These are (1) somatic symptom disorder; (2) illness anxiety disorder; (3) conversion disorder; and (4) factitious disorder.

Somatic Symptom Disorders

This new diagnosis includes several disorders that were previously considered to be separate diagnoses in DSM-IV. The old disorders of (1) hypochondriasis, (2) somatization disorder, and (3) pain disorder have all now disappeared from DSM-5. Most of the people who would in the past have been diagnosed with any one of these disorders will now be diagnosed with a somatic symptom disorder. In each case, individuals must be experiencing chronic somatic symptoms that are distressing to them and they must also be experiencing dysfunctional thoughts, feelings, and/or behaviors. In the past, the diagnosis required evidence that the symptoms were medically unexplained. However, as we noted earlier, this is no longer required for the diagnosis (in part because it is very difficult to prove something is medically unexplainable). Instead the focus in DSM-5 is on there being at least one of the following three features: (1) disproportionate and persistent thoughts about the seriousness of one’s symptoms; (2) persistently high level of anxiety about health or symptoms; and/or (3) excessive time and energy devoted to these symptoms or health concerns (Allen & Woolfolk, 2013). Symptoms have to have persisted for at least six months.

Patients with somatic symptom disorder are usually seen in medical clinics. They are more likely to be female, nonwhite, and less educated than are people with symptoms that have an obvious medical basis. Patients with somatic symptom disorder frequently engage in illness behavior that is dysfunctional, such as seeking additional medical procedures or diagnostic tests when the physician fails to find anything physically wrong with them. Whereas most of us are relieved when tests do not reveal any problems, people with somatic symptom disorder are likely to think something was missed and therefore seek help from another physician, leading to needlessly high medical bills due to unnecessary tests, hospitalizations, and even surgeries. High levels of functional impairment are common, as is comorbid psychopathology—especially depression and anxiety.

Research suggests that people with somatic symptom disorders tend to have a cognitive style that leads them to be hyper-sensitive to their bodily sensations. They also experience these sensations as intense, disturbing, and highly aversive. Another characteristic of such patients is that they tend to think catastrophically about their symptoms, often overestimating the medical severity of their condition.

In the following sections, we will be discussing hypochondriasis, pain disorder, and somatization disorder. It’s important to note that in DSM-5, these disorders were technically dropped and are now part of the somatic symptom disorders. However, the history of and the research on these disorders is still important to understand.

Hypochondriasis

DSM-5 criteria for: Somatic Symptom Disorder

· A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.

· B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

· 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

· 2. Persistently high level of anxiety about health or symptoms.

· 3. Excessive time and energy devoted to these symptoms or health concerns.

· C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Approximately 75 percent of people previously diagnosed with hypochondriasis will be diagnosed with somatic symptom disorder in DSM-5 (APA, 2013 ). In hypochondriasis the person is preoccupied either with fears of contracting a serious disease or with the idea that of having that disease even though they do not. These very distressing preoccupations are thought to all be based on a misinterpretation of one or more bodily signs or symptoms (e.g., being convinced that a slight cough is a sign of lung cancer). Of course the decision that a complaint is hypochondriacal and is based on a misinterpretation of bodily signs or symptoms can only be made after a thorough medical evaluation has failed to find a medical condition that could account for the signs or symptoms. Another typical feature of hypochondriasis is that the person cannot be reassured by the results of a medical evaluation. In other words, the fear or idea of having a disease persists despite lack of medical evidence. Indeed, these individuals are sometimes disappointed when no physical problem is found. The condition has to persist for at least 6 months for the diagnosis to be made so as to not diagnose relatively transient health concerns.

Not surprisingly, people with hypochondriasis usually first see a medical doctor for their physical complaints. Because they are never reassured for long and are inclined to suspect that their doctor has missed something, they sometimes shop for additional doctors, hoping one might discover what their problem really is. Because they repeatedly seek medical advice (e.g., Bleichhardt & Hiller, 2006 ; Fink et al., 2004 ), it is hardly surprising that their annual medical costs are much higher than average (e.g., Fink et al., 2010 ; Hiller et al., 2004 ). People with hypochondriasis are generally resistant to the idea that their problem is a psychological one that might be best treated by a psychologist or psychiatrist.

Prior to DSM-5, hypochondriasis was one of the two most commonly seen somatic symptom disorders with a prevalence in general medical practices of 2 to 7 percent (APA, 2000 ). Hypochondriasis occurs about equally often in men and women and can start at almost any age, although early adulthood is the most common age of onset. Hypochondriasis is regarded as a persistent disorder if left untreated, although its severity can fluctuate over time. Individuals with hypochondriasis often also suffer from mood disorders, panic disorder, or other types of somatic symptom disorders (Creed & Barsky, 2004 ). This is one reason why hypochondriasis is now not differentiated from other somatic symptom disorders in DSM-5.

MAJOR CHARACTERISTICS

Individuals with hypochondriasis tend to be highly preoccupied with bodily functions (e.g., heart beats or bowel movements), or with minor physical abnormalities (e.g., a small sore or an occasional cough), or with vague and ambiguous physical sensations (such as a “tired heart” or “aching veins”). They attribute these symptoms to a particular disease and often have intrusive thoughts about it. The diagnoses they make for themselves include cancer, exotic infections, AIDS, and numerous other diseases. Watchthe Video Henry: Hypochondriasis on MyPsychLab

Although people with hypochondriasis are usually in good physical condition, they are sincere in their conviction that the symptoms they detect represent real illness. In other words, they are not malingering—consciously faking symptoms to achieve a specific goals such as winning a personal injury lawsuit. Not surprisingly, given their tendency to doubt the soundness of their doctors’ conclusions (i.e., that they have no medical problem) and recommendations, the relationships they have with their doctors are often marked by conflict and hostility.

The following case captures the typical clinical picture in hypochondriasis. It also demonstrates that a high level of medical sophistication does not necessarily protect someone from developing this or a related disorder.

An “Abdominal Mass” This 38-year-old physician/radiologist initiated his first psychiatric consultation after his 9-year-old son accidentally discovered his father palpating (examining by touch) his own abdomen and said, “What do you think it is this time, Dad?” The radiologist describes the incident and his accompanying anger and shame with tears in his eyes. He also describes his recent return from a 10-day stay at a famous out-of-state medical diagnostic center to which he had been referred by an exasperated gastroenterologist colleague who had reportedly “reached the end of the line” with his radiologist patient. The extensive physical and laboratory examinations performed at the center had revealed no significant physical disease, a conclusion the patient reports with resentment and disappointment rather than relief.

The patient’s history reveals a long-standing pattern of overconcern about personal health matters, beginning at age 13 and exacerbated by his medical school experience. Until fairly recently, however, he had maintained reasonable control over these concerns, in part because he was embarrassed to reveal them to other physicians. He is conscientious and successful in his profession and active in community life. His wife, like his son, has become increasingly impatient with his morbid preoccupation about life-threatening but undetectable diseases.

In describing his current symptoms, the patient refers to his becoming increasingly aware, over the past several months, of various sounds and sensations emanating from his abdomen and of his sometimes being able to feel a “firm mass” in its left lower quadrant. His tentative diagnosis is carcinoma (cancer) of the colon. He tests his stool for blood weekly and palpates his abdomen for 15 to 20 minutes every 2 to 3 days. He has performed several X-ray studies of himself in secrecy after hours at his office.

Source: Adapted with permission from DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (pp. 88–90). Washington, DC: (Copyright © 2002). American Psychiatric Association.

CAUSAL FACTORS

Our knowledge of causal factors involved in somatic symptom disorders, including hypochondriasis, is quite minimal. This is especially true when compared to knowledge about the mood and anxiety disorders discussed in the preceding chapters. Currently, cognitive-behavioral views of hypochondriasis are perhaps most widely accepted. These have as a central tenet that it is a disorder of cognition and perception. Misinterpretations of bodily sensations are currently a defining feature of the syndrome, but in the cognitive-behavioral view these misinterpretations also play a causal role. It is believed that an individual’s past experiences with illnesses (in both him- or herself and others, and as observed in the mass media) lead to the development of a set of dysfunctional assumptions about symptoms and diseases that may predispose a person to developing hypochondriasis (Marcus et al., 2007 ; Salkovskis & Warwick, 2001 ). These dysfunctional assumptions might include notions such as, “Bodily changes are usually a sign of serious disease, because every symptom has to have an identifiable physical cause” or “If you don’t go to the doctor as soon as you notice anything unusual, then it will be too late” (Salkovskis & Bass, 1997 , p. 318; see also Marcus et al., 2007 ).

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Individuals with hypochondriasis are preoccupied with unrealistic fears of disease. They are convinced that they have symptoms of physical illness, but their complaints typically do not conform to any coherent symptom pattern, and they usually have trouble giving a precise description of their symptoms.

Because of these dysfunctional assumptions, individuals with hypochondriasis seem to focus excessive attention on symptoms, with experimental studies showing that these individuals do in fact have an attentional bias for illness-related information (Owens et al., 2004 ; see also Jasper & Witthöft, 2011 ). Although their physical sensations probably do not differ from those in normal controls (Marcus et al., 2007 ), they perceive their symptoms as more dangerous than they really are and judge a particular disease to be more likely or dangerous than it really is. Once they have misinterpreted a symptom, they tend to look for confirming evidence and to discount evidence that they are in good health; in fact, they seem to believe that being healthy means being completely symptom-free (Rief et al., 1998a ). They also perceive their probability of being able to cope with the illness as extremely low (Salkovskis & Bass, 1997 ) and see themselves as weak and unable to tolerate physical effort or exercise (Rief et al., 1998a ). All this tends to create a vicious cycle in which their anxiety about illness and symptoms results in physiological symptoms of anxiety, which then provide further fuel for their convictions that they are ill.

If we also consider the secondary reinforcements that individuals with hypochondriasis obtain by virtue of their disorder, we can better understand how such patterns of thought and behavior are maintained in spite of the misery these individuals often experience. Most of us learn as children that when we are sick special comforts and attention are provided and, furthermore, that we may be excused from a number of responsibilities. Barsky and colleagues ( 1994 ) found that their patients with hypochondriasis reported much childhood sickness and missing of school. People with hypochondriasis also tend to have an excessive amount of illness in their families while growing up, which may lead to strong memories of being sick or in pain (Pauli & Alpers, 2002 ), and perhaps also of having observed some of the secondary benefits that sick people sometimes reap (Cote et al., 1996 ; Kellner, 1985 ).

Interestingly, one study retested patients with hypochondriasis 4 to 5 years later and found that those who had remitted at follow-up had acquired significantly more (real) major medical problems than their nonremitting counterparts (Barsky et al., 1998 ). In other words, it appears that hypochondriacal tendencies were reduced by the occurrence of serious medical conditions. The authors suggested that having a serious medical illness “served to legitimize the patients’ complaints, sanction their assumption of the sick role, and lessen the skepticism with which they had previously been regarded …. As one noted, ‘Now that I know Dr. X is paying attention to me, I can believe him if he says nothing serious is wrong’” ( p. 744 ).

TREATMENT OF HYPOCHONDRIASIS

More than a dozen studies on cognitive-behavioral treatment of hypochondriasis have found that it can be a very effective treatment for hypochondriasis (e.g., Barsky & Ahern, 2004 ; Tyrer, 2011 ; see also Hedman et al., 2011 , for an example of Internet-based Cognitive Behavioral Therapy). The cognitive components of this treatment approach focus on assessing the patient’s beliefs about illness and modifying misinterpretations of bodily sensations. The behavioral techniques include having patients induce innocuous symptoms by intentionally focusing on parts of their body so that they can learn that selective perception of bodily sensations plays a major role in their symptoms. Sometimes they are also directed to engage in response prevention by not checking their bodies as they usually do and by stopping their constant seeking of reassurance. The treatment is relatively brief (6 to 16 sessions) and can be delivered in a group format. In these studies such treatment produced large changes in hypochondriacal symptoms and beliefs as well as in levels of anxiety and depression.

Somatization Disorder

The DSM-IV diagnosis of somatization disorder is another disorder that has now been subsumed into the broader category of somatic symptom disorder in DSM-5. Somatization disorder is characterized by many different physical complaints. To qualify for the diagnosis, these had to begin before age 30, last for several years, and not be adequately explained by independent findings of physical illness or injury. They also had to have led to medical treatment or to significant life impairment. Not surprisingly, somatization disorder has long been seen most often among patients in primary medical care settings (Guerje et al., 1997 ; Iezzi et al., 2001 ). Indeed, patients with this variant of somatic symptom disorder are enormously costly to health care systems because they often have multiple unnecessary hospitalizations and surgeries (Barsky et al., 2005 ; Hiller et al., 2003 ).

The DSM-IV-TR (APA, 2000 ) criteria required that patients report a large number of symptoms across a wide range of domains (e.g., 4 pain symptoms, two gastrointestinal symptoms, one sexual symptom and one neurological-type symptom). Thus, to qualify for a diagnosis of somatization disorder, a patient had to have experienced at least 8 out of 33 specified symptoms (Rief & Barsky, 2005 ). Over time, the rather arbitrary nature of this became increasing apparent and the formal diagnostic criteria began to be modified by many researchers and clinicians (e.g., Rief & Broadbent, 2007 ). Following suit, in DSM-5 the long and complicated symptom count is no longer required and somatization disorder is now considered to be just another variant of somatic symptom disorder.

Another advantage of the recent change in DSM-5 is that it is no longer necessary for us to be concerned about whether somatization disorder and hypochondriasis are really two different and distinct disorders. There are indeed significant similarities between the two conditions. They also sometimes co-occur (Mai, 2004 ). Some years ago leading researchers in this area expressed concerns about whether somatization disorder and hypochondriasis could really be regarded as separate disorders (e.g., Creed & Barsky, 2004 ). Combining them both into a common category in DSM-5 and considering them to be variants of somatic symptom disorder is probably a wise move.

The main features of somatization disorder are illustrated in the following case summary, which also involves a secondary diagnosis of depression.

Not-Yet-Discovered Illness This 38-year-old married woman, the mother of five children, reports to a mental health clinic with the chief complaint of depression, meeting diagnostic criteria for major depressive disorder …. Her marriage has been a chronically unhappy one; her husband is described as an alcoholic with an unstable work history, and there have been frequent arguments revolving around finances, her sexual indifference, and her complaints of pain during intercourse.

The history reveals that the patient … describes herself as nervous since childhood and as having been continuously sickly beginning in her youth. She experiences chest pain and reportedly has been told by doctors that she has a “nervous heart.” She sees physicians frequently for abdominal pain, having been diagnosed on one occasion as having a “spastic colon.” In addition to M.D. physicians, she has consulted chiropractors and osteopaths for backaches, pains in her extremities, and a feeling of anesthesia in her fingertips. She was recently admitted to a hospital following complaints of abdominal and chest pain and of vomiting, during which admission she received a hysterectomy. Following the surgery she has been troubled by spells of anxiety, fainting, vomiting, food intolerance, and weakness and fatigue. Physical examinations reveal completely negative findings.

DEMOGRAPHICS, COMORBIDITY, AND COURSE OF ILLNESS

Somatization disorder usually begins in adolescence and is believed by many to be about three to ten times more common among women than among men. It also tends to occur more among less educated individuals and in lower socioeconomic classes. The lifetime prevalence has been estimated to be between 0.2 and 2.0 percent in women and less than 0.2 percent in men (APA, 2000 ). Somatization disorder very commonly co-occurred with several other disorders including major depression, panic disorder, phobic disorders, and generalized anxiety disorder. It has generally been considered to be a relatively chronic condition with a poor prognosis, although sometimes the disorder remits spontaneously (e.g., Creed & Barsky, 2004 ).

CAUSAL FACTORS IN SOMATIZATION DISORDER

Despite its prevalence in medical settings, researchers are still not certain about the developmental course and specific etiology of somatization disorder. There is evidence that somatization disorder runs in families and that there is a familial linkage between antisocial personality disorder in men (see Chapter 10 ) and somatization disorder in women. That is, one possibility is that some common, underlying predisposition, probably at least partly genetically based, leads to antisocial behavior in men and to somatization disorder in women (Cale & Lilienfeld, 2002b ; Guze et al., 1986 ; Lilienfeld, 1992 ). Moreover, somatic symptoms and antisocial symptoms in women tend to co-occur (Cale & Lilienfeld, 2002b ). However, we do not yet have a clear understanding of this relationship. One possibility is that the two disorders are linked through a common trait of impulsivity.

It has also become clear that people with somatization disorder selectively attend to, and show perceptual amplification of, bodily sensations. They also tend to see bodily sensations as somatic symptoms (Martin et al., 2007 ). Like patients with hypochondriasis, they tend to catastrophize about minor bodily complaints (taking them as signs of serious physical illness) and to think of themselves as physically weak and unable to tolerate stress or physical activity (Martin et al., 2007 ; Rief et al., 1998).

TREATMENT OF SOMATIZATION DISORDER

Somatization disorder was long considered to be extremely difficult to treat, and general practitioners experienced a great deal of uncertainty and frustration in working with these patients. However, in the past 15 years some treatment research has begun to suggest that a certain type of medical management along with cognitive-behavioral treatments may be quite helpful and that general practitioners can be educated in how to better manage and treat somatization patients and be less frustrated by them (Rosendal et al., 2005 ; see also Edwards & Edwards, 2010 ). One moderately effective treatment involves identifying one physician who will integrate the patient’s care by seeing the patient at regular visits (thereby trying to anticipate the appearance of new problems) and by providing physical exams focused on new complaints (thereby accepting her or his symptoms as valid). At the same time, however, the physician avoids unnecessary diagnostic testing and makes minimal use of medications or other therapies (Looper & Kirmayer, 2002 ; Mai, 2004 ). Several studies have found that these patients show substantial decreases in health care expenditures over subsequent months and sometimes an improvement in physical functioning (although not necessarily in psychological distress; e.g., Rost et al., 1994 ). This type of medical management can be even more effective when combined with cognitive-behavioral therapy that focuses on promoting appropriate behavior, such as better coping and personal adjustment, and discouraging inappropriate behavior such as illness behavior and preoccupation with physical symptoms (e.g., Bleichhardt et al., 2004 ; Mai, 2004 ).

Pain Disorder

The third DSM-IV diagnosis subsumed into the new category of somatic symptom disorder is pain disorder. Pain disorder is characterized by persistent and severe pain in one or more areas of the body that is not intentionally produced or feigned. Although a medical condition may contribute to the pain, psychological factors are judged to play an important role. Indeed psychological factors play a role in all forms of pain. The pain disorder may be acute (duration of less than 6 months) or chronic (duration of over 6 months). When working with patients with pain disorder it is very important to remember that the pain that is experienced is very real and can hurt as much as pain that comes from other sources. It is also important to note that pain is always, in part, a subjective experience that is private and cannot be objectively identified by others.

When one physician integrates a patient’s care, the physical functioning of patients with somatization disorder may improve. Why should this be?

The experience of pain is always subjective and private, making pain impossible to assess with pinpoint accuracy. Pain does not always exist in perfect correlation with observable tissue damage or irritation. Psychological factors influence all forms of pain.

The prevalence of pain disorder in the general population is unknown. It is definitely quite common among patients at pain clinics. It is diagnosed more frequently in women than in men and is very frequently comorbid with anxiety or mood disorders, which may occur first or may arise later as a consequence of the pain disorder. People with pain disorder are often unable to work (they sometimes go on disability) or to perform some other usual daily activities. Their resulting inactivity (including an avoidance of physical activity) and social isolation may lead to depression and to a loss of physical strength and endurance. This fatigue and loss of strength can then exacerbate the pain in a kind of vicious cycle (Bouman et al., 1999 ; Flor et al., 1990 ). In addition, the behavioral component of pain is quite malleable in the sense that it can increase when it is reinforced by attention, sympathy, or avoidance of unwanted activities (Bouman et al., 1999 ). Finally, there is suggestive evidence that people who have a tendency to catastrophize about the meaning and effects of pain may be the ones most likely to progress to a state of chronic pain (Seminowicz & Davis, 2006 ).

TREATMENT OF PAIN DISORDER

Perhaps because it is a less complex and multifaceted disorder than somatization disorder, pain disorder is usually easier to treat. Indeed, cognitive-behavioral techniques have been widely used in the treatment of both physical and more psychological pain syndromes. Treatment programs generally include relaxation training, support and validation that the pain is real, scheduling of daily activities, cognitive restructuring, and reinforcement of “no-pain” behaviors (Simon, 2002 ). Patients receiving such treatments tend to show substantial reductions in disability and distress, although changes in the intensity of their pain tend to be smaller in magnitude. In addition, antidepressant medications (especially the tricyclic antidepressants) and certain SSRIs have been shown to reduce pain intensity in a manner independent of the effects the medications may have on mood (Aragona et al., 2005 ; Simon, 2002 ).

ILLNESS ANXIETY DISORDER

Illness anxiety disorder is new to DSM-5. In this newly identified disorder, people have high anxiety about having or developing a serious illness. This anxiety is distressing and/or disruptive but there are very few (mild) somatic symptoms. (see the DSM-5 criteria box below).

It is estimated that around 25 percent of people who would have been diagnosed with hypochondriasis in DSM-IV will be diagnosed with illness anxiety disorder in DSM-5 (APA, 2013 ).

Conversion Disorder (Functional Neurological Symptom Disorder)

DSM-5 criteria for: Illness Anxiety Disorder

· A. Preoccupation with having or acquiring a serious illness.

· B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.

· C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.

· D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).

· E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.

· F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

Conversion disorder is one of the most intriguing and baffling patterns in psychopathology, and we still have much to learn about it. It involves a pattern in which symptoms or deficits affecting the senses or motor behavior strongly suggest that the patient has a medical or neurological condition. However, upon a thorough medical examination, it becomes apparent that the pattern of symptoms or deficits cannot be fully explained by any known medical condition. A few typical examples include partial paralysis, blindness, deafness, and pseudoseizures. The person is not intentionally producing or faking the symptoms, Rather, psychological factors are often judged to play an important role because symptoms usually either start or are exacerbated by preceding emotional or interpersonal conflicts or stressors.

Early observations dating back to Freud suggested that most people with conversion disorder showed very little of the anxiety and fear that would be expected in a person with a paralyzed arm or loss of sight. This seeming lack of concern (known as la belle indifférence—French for “the beautiful indifference”) in the way the patient describes what is wrong was thought for a long time to be an important diagnostic criterion for conversion disorder. However, more careful research later showed that la belle indifférenceactually occurs in only about 20 percent of patients with conversion disorder, so it was dropped as a criterion from recent editions of the DSM (Stone et al., 2006 , 2011).

The term conversion disorder is relatively recent. Historically this disorder was one of several disorders that were grouped together under the term hysteria .

Freud used the term conversion hysteria for these disorders (which were fairly common in his practice) because he believed that the symptoms were an expression of repressed sexual energy—that is, the unconscious conflict that a person felt about his or her repressed sexual desires. However, in Freud’s view, the repressed anxiety threatens to become conscious, so it is unconsciously converted into a bodily disturbance, thereby allowing the person to avoid having to deal with the conflict. For example, a person’s guilty feelings about the desire to masturbate might be solved by developing a paralyzed hand. This is not done consciously, of course, and the person is not aware of the origin or meaning of the physical symptom. Freud also thought that the reduction in anxiety and intrapsychic conflict was the “primary gain” that maintained the condition, but he noted that patients often had many sources of “secondary gain” as well, such as receiving sympathy and attention from loved ones. Authors of DSM-5 had many suggestions for changing the name of this disorder (e.g., to psychogenic, functional, and dissociative). In the end, a conservative approach was taken and the term conversion disorder was retained, although this is now followed in parentheses by “Functional neurological symptom disorder” (Stone et al., 2011).

PRECIPITATING CIRCUMSTANCES, ESCAPE, AND SECONDARY GAINS

Freud’s theory that conversion symptoms are caused by the conversion of sexual conflicts or other psychological problems into physical symptoms is no longer accepted outside psychodynamic circles. However, many of Freud’s astute clinical observations about primary and secondary gain are still incorporated into contemporary views of conversion disorder. Although the condition is still called a conversion disorder, the physical symptoms are usually seen as serving the rather obvious function of providing a plausible bodily “excuse” enabling an individual to escape or avoid an intolerably stressful situation without having to take responsibility for doing so. Typically, it is thought that the person first experiences a traumatic event that motivates the desire to escape the unpleasant situation, but literal escape may not be feasible or socially acceptable. Moreover, although becoming sick or disabled is more socially acceptable, this is true only if the person’s motivation to do so is unconscious.

Thus, in contemporary terms, the primary gain for conversion symptoms is continued escape or avoidance of a stressful situation. Because this is all unconscious (i.e., the person sees no relation between the symptoms and the stressful situation), the symptoms go away only if the stressful situation has been removed or resolved. Relatedly, the term secondary gain , which originally referred to advantages that the symptom(s) bestow beyond the “primary gain” of neutralizing intrapsychic conflict, has also been retained. Generally, it is used to refer to any “external” circumstance, such as attention from loved ones or financial compensation, that would tend to reinforce the maintenance of disability.

DSM-5 criteria for: Conversion Disorder

· A. One or more symptoms of altered voluntary motor or sensory function.

· B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.

· C. The symptom or deficit is not better explained by another medical or mental disorder.

· D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Given the important role often attributed to stressful life events in precipitating the onset of conversion disorder, it is unfortunate that little is actually known about the exact nature and timing of these psychological stress factors (Roelofs et al., 2005 ). However, one study compared the frequency of stressful life events in the recent past in patients with conversion disorder and depressed controls and did not find a difference in frequency between them. Moreover, the greater the negative impact of the preceding life events, the greater the severity of the conversion disorder symptoms (Roelofs et al., 2005 ). Another study compared levels of a neurobiological marker of stress (lower levels of brain-derived neurotropic factor) in individuals with conversion disorder versus major depression versus no disorder. Both those with depression and those with conversion disorder showed reduced levels of this marker relative to the nondisordered controls (Deveci et al., 2007 ). This also provides support for the link between stress and the onset of conversion disorder.

DECREASING PREVALENCE AND DEMOGRAPHIC CHARACTERISTICS

Conversion disorders were once relatively common in civilian and (especially) military life. In World War I, conversion disorder was the most frequently diagnosed psychiatric syndrome among soldiers; it was also relatively common during World War II. Conversion disorder typically occurred under highly stressful combat conditions and involved men who would ordinarily be considered stable. Here, conversion symptoms—such as paralysis of the legs—enabled a soldier to avoid an anxiety-arousing combat situation without being labeled a coward or being subject to court-martial.

Conversion disorders are found in approximately 50 percent of people referred for treatment at neurology clinics. The prevalence in the general population is unknown, but even the highest estimates have been around only 0.005 percent (APA, 2013 ). Interestingly, this decreased prevalence seems to be closely related to our growing sophistication about medical and psychological disorders: A conversion disorder apparently loses its defensive function if it can be readily shown to lack a medical basis. When it does occur today, it is most likely to occur in rural people from lower socioeconomic circles who are medically unsophisticated. For example, a highly unusual “outbreak” of cases of severe conversion disorder involving serious motor weakness and wasting symptoms was reported in five 9- to 13-year-old girls living in a small, poor, rural Amish community. Each of these girls had experienced substantial psychosocial stressors including behavioral problems, dys-functional family dynamics, and significant community stress from a serious local church crisis (see Cassady et al., 2005 ). Fortunately, after the caregivers of these girls were educated regarding the psychological nature of the symptoms and given advice to stick with one doctor, minimize stress, and avoid reinforcement of the “sick role,” four of the five girls showed significant improvement over the next 3 months. In the fifth case, the family refused to acknowledge the psychological component of the illness, holding to the belief that the symptoms were caused by parasites.

Conversion disorders were fairly common during World War I and World War II. The disorder typically occurred in otherwise “normal” men during stressful combat conditions. The symptoms of conversion disorder (e.g., paralysis of the legs) enabled a soldier to avoid high-anxiety combat situations without being labeled a coward or being court-martialed.

Conversion disorder occurs two to three times more often in women than in men (APA 2013 ). It can develop at any age but most commonly occurs between early adolescence and early adulthood (Maldonado & Spiegel, 2001 ). It generally has a rapid onset after a significant stressor and often resolves within 2 weeks if the stressor is removed, although it commonly recurs. In many other cases, however, it has a more chronic course. Like most other somatic symptom disorders, conversion disorder frequently occurs along with other disorders, especially major depression, anxiety disorders, and other forms of somatic symptom or dissociative conditions.

RANGE OF CONVERSION DISORDER SYMPTOMS

The range of symptoms for conversion disorder is practically as diverse as it is for physically based ailments. In describing the clinical picture in conversion disorder, it is useful to think in terms of four categories of symptoms: (1) sensory, (2) motor, (3) seizures, and (4) a mixed presentation of the first three categories (APA, 2013 ).

Sensory Symptoms or Deficits Conversion disorder can involve almost any sensory modality, and it can often be diagnosed as a conversion disorder because symptoms in the affected area are inconsistent with how known anatomical sensory pathways operate. Today the sensory symptoms or deficits are most often in the visual system (especially blindness and tunnel vision), in the auditory system (especially deafness), or in the sensitivity to feeling (especially the anesthesias). In the anesthesias, the person loses her or his sense of feeling in a part of the body. One of the most common is glove anesthesia, in which the person cannot feel anything on the hand in the area where gloves are worn, although the loss of sensation usually makes no anatomical sense.

With conversion blindness, the person reports that he or she cannot see and yet can often navigate about a room without bumping into furniture or other objects. With conversion deafness, the person reports not being able to hear and yet orients appropriately upon “hearing” his or her own name. Such observations lead to obvious questions: In conversion blindness (and deafness), can affected people actually not see (or hear), or is the sensory information received but screened from consciousness? In general, the evidence supports the idea that the sensory input is registered but is somehow screened from explicit conscious recognition (explicit perception).

Motor Symptoms or Deficits Motor conversion reactions also cover a wide range of symptoms (e.g., Maldonado & Spiegel, 2001 ; see also Stone et al., 2010). For example, conversion paralysis is usually confined to a single limb such as an arm or a leg, and the loss of function is usually selective for certain functions. For example, a person may not be able to write but may be able to use the same muscles for scratching, or a person may not be able to walk most of the time but may be able to walk in an emergency such as a fire where escape is important. The most common speech-related conversion disturbance is aphonia, in which a person is able to talk only in a whisper although he or she can usually cough in a normal manner. (In true, organic laryngeal paralysis, both the cough and the voice are affected.) Another common motor symptom, called globus hystericus, is difficulty swallowing or the sensation of a lump in the throat (Finkenbine & Miele, 2004 ).

Seizures Conversion seizures, another relatively common form of conversion symptom, involve pseudoseizures, which resemble epileptic seizures in some ways but can usually be fairly well differentiated via modern medical technology (Bowman & Markand, 2005 ; Stonnington et al., 2006 ). For example, patients with pseudoseizures do not show any EEG abnormalities and do not show confusion and loss of memory afterward, as patients with true epileptic seizures do. Moreover, patients with conversion seizures often show excessive thrashing about and writhing not seen with true seizures, and they rarely injure themselves in falls or lose control over their bowels or bladder, as patients with true seizures frequently do.

The following case of conversion disorder clearly shows how “functional” a conversion disorder may be in the overall life circumstances of a patient despite its exacting a certain cost in illness or disability.

A Wife with “Fits” Mrs. Chatterjee, a 26-year-old patient, attends a clinic in New Delhi, India, with complaints of “fits” for the last 4 years. The “fits” are always sudden in onset and usually last 30 to 60 minutes. A few minutes before a fit begins, she knows that it is imminent, and she usually goes to bed. During the fits she becomes unresponsive and rigid throughout her body, with bizarre and thrashing movements of the extremities. Her eyes close and her jaw is clenched, and she froths at the mouth. She frequently cries and sometimes shouts abuses. She is never incontinent of urine or feces, nor does she bite her tongue. After a “fit” she claims to have no memory of it. These episodes recur about once or twice a month. She functions well between the episodes.

Both the patient and her family believe that her “fits” are evidence of a physical illness and are not under her control. However, they recognize that the fits often occur following some stressor such as arguments with family members or friends …. She is described by her family as being somewhat immature but “quite social” and good company. She is self-centered, she craves attention from others, and she often reacts with irritability and anger if her wishes are not immediately fulfilled. On physical examination, Mrs. Chatterjee was found to have mild anemia but was otherwise healthy. A mental status examination did not reveal any abnormality … and her memory was normal. An electroencephalogram showed no seizure activity.

Source: Adapted with permission from DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (pp. 469–70). Washington, DC. (Copyright © 2002). American Psychiatric Association.

IMPORTANT ISSUES IN DIAGNOSING CONVERSION DISORDER

Because the symptoms in conversion disorder can simulate a variety of medical conditions, accurate diagnosis can be extremely difficult. It is crucial that a person with suspected conversion symptoms receive a thorough medical and neurological examination. Unfortunately, however, misdiag-noses can still occur. Nevertheless, as medical tests (especially brain imaging) have become increasingly sophisticated, the rate of misdiagnoses has declined substantially from in the past, with estimates of misdiagnoses in the 1990s at only 4 percent down from nearly 30 percent in the 1950s (e.g., Stone et al., 2005 ).

Several other criteria are also commonly used for distinguishing between conversion disorders and true neurological disturbances:

· • The frequent failure of the dysfunction to conform clearly to the symptoms of the particular disease or disorder simulated. For example, little or no wasting away or atrophy of a “paralyzed” limb occurs in conversion paralyses, except in rare and long-standing cases.

Virtually all the symptoms of conversion disorder can be temporarily reduced or reproduced by hypnotic suggestion.

· • The selective nature of the dysfunction. As already noted, in conversion blindness the affected individual does not usually bump into people or objects, and “paralyzed” muscles can be used for some activities but not others.

· • Under hypnosis or narcosis (a sleeplike state induced by drugs), the symptoms can usually be removed, shifted, or re-induced at the suggestion of the therapist. Similarly, a person abruptly awakened from a sound sleep may suddenly be able to use a “paralyzed” limb.

TREATMENT OF CONVERSION DISORDER

Our knowledge of how best to treat conversion disorder is very limited because few well-controlled studies have yet been conducted (e.g., Bowman & Markand, 2005 ; Looper & Kirmayer, 2002 ). However, it is known that some hospitalized patients with motor conversion symptoms have been successfully treated with a behavioral approach in which specific exercises are prescribed in order to increase movement or walking, and then reinforcements (e.g., praise and gaining privileges) are provided when patients show improvements. Any reinforcements of abnormal motor behaviors are removed in order to eliminate any sources of secondary gain. In one small study using this kind of treatment for 10 patients, all had regained their ability to move or walk in an average of 12 days, and for seven of the nine patients available at approximately 2-year follow-up, the improvements had been maintained (Speed, 1996 ). At least one study has also used cognitive-behavior therapy to successfully treat psychogenic seizures (LaFrance et al., 2009 ). Some studies have used hypnosis combined with other problem-solving therapies, and there are some suggestions that hypnosis, or adding hypnosis to other therapeutic techniques, can be useful (Looper & Kirmayer, 2002 ; Moene et al., 2003 ).

Distinguishing Somatization, Pain, and Conversion Disorders from Malingering and Factitious Disorder

DSM-5 criteria for: Factitious Disorder

Factitious Disorder Imposed on Self

· A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.

· B. The individual presents himself or herself to others as ill, impaired, or injured.

· C. The deceptive behavior is evident even in the absence of obvious external rewards.

· D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.

Earlier we mentioned that the DSM distinguishes between malingering and factitious disorder on the basis of the feigning person’s apparent goals. Malingering is diagnosed if the person is intentionally producing or grossly exaggerating physical symptoms and is motivated by external incentives such as avoiding work or obtaining financial compensation. Factitious disorder is diagnosed if the person intentionally produces psychological or physical symptoms, the person’s goal being simply to obtain and maintain the personal benefits that playing the “sick role” (even undergoing repeated hospitalizations) may provide, including the attention and concern of family and medical personnel. In factitious disorder, frequently these patients surreptitiously alter their own physiology—for example, by taking drugs—in order to simulate various real illnesses. Indeed, they may be at risk for serious injury or death and may even need to be committed to an institution for their own protection. The World Around Us box above describes a particularly pathological variation on this theme. In the past, severe and chronic forms of factitious disorder with physical symptoms were called “Munchausen’s syndrome,” where the general idea was that the person had some kind of “hospital addiction” or a “professional patient” syndrome.

the WORLD around us: Factitious Disorder Imposed on Another (Munchausen’s Syndrome by Proxy)

In a somewhat bizarre variant of factitious disorder called factitious disorder imposed on another (or Munchausen’s syndrome by proxy), the person seeking medical help or consulting a mental health professional has intentionally produced a medical or psychiatric illness (or appearance of an illness) in another person who is under his or her care (usually a child; e.g., Pankratz, 2006 ). In a typical instance, a mother presents her own child for treatment of a medical condition she has deliberately caused, disclaiming any knowledge of its origin. Of course, the health of such victims is often seriously endangered by this repeated abuse, and the intervention of social service agencies or law enforcement is sometimes necessary. In as many as 10 percent of cases, this atypical form of child abuse may lead to a child’s death (Hall et al., 2000 ).

Over a period of 20 months, Jennifer, 8, shown here with her mother, Kathy Bush, was taken to the hospital more than 130 times, underwent 40 surgeries, and amassed over $3 million in medical expenses. Doctors and nurses testified that Jennifer’s condition always worsened after her mother visited her daughter at the hospital behind closed doors. In addition, Jennifer’s health had significantly improved since being removed from her mother’s care. The jury was convinced that Kathy Bush was responsible for causing Jennifer’s illnesses. Bush was arrested and diagnosed with Munchausen’s syndrome by proxy.

This disorder may be indicated when the victim’s clinical presentation is atypical, when lab results are inconsistent with each other or with recognized diseases, or when there are unduly frequent returns or increasingly urgent visits to the same hospital or clinic. The perpetrators (who often have extensive medical knowledge) tend to be highly resistant to admitting the truth (McCann, 1999 ), and it has been estimated that the average length of time to confirm the diagnosis is 14 months (Rogers, 2004 ). If the perpetrator senses that the medical staff is suspicious, he or she may abruptly terminate contact with that facility, only to show up at another one to begin the entire process anew. Compounding the problem of detection is the fact that health care professionals who realize they have been duped may be reluctant to acknowledge their fallibility for fear of legal action. Misdiagnosing the disorder when the parent is in fact innocent can also lead to legal difficulties for the health care professionals (McNicholas et al., 2000 ; Pankratz, 2006 ). One technique that has been used with considerable success is covert video surveillance of the mother and child during hospitalizations. In one study, 23 of 41 suspected cases were finally determined to have factitious disorder by proxy, and in 56 percent of those cases video surveillance was essential to the diagnosis (Hall et al., 2000 ).

It is sometimes possible to distinguish between a conversion (or other somatic symptom) disorder and malingering, or factitiously “sick-role-playing,” with a fair degree of confidence, but in other cases it is more difficult to make the correct diagnosis. Persons engaged in malingering (for which there are no formal diagnostic criteria) and those who have factitious disorder are consciously perpetrating frauds by faking the symptoms of diseases or disabilities, and this fact is often reflected in their demeanor. In contrast, individuals with conversion disorders (as well as with other somatic symptom disorders) are not consciously producing their symptoms, feel themselves to be the “victims of their symptoms,” and are very willing to discuss them, often in excruciating detail (Maldonado & Spiegel, 2001 , p. 109). When inconsistencies in their behaviors are pointed out, they are usually unperturbed. Any secondary gains they experience are byproducts of the conversion symptoms themselves and are not involved in motivating the symptoms. On the other hand, persons who are feigning symptoms are inclined to be defensive, evasive, and suspicious when asked about them; they are usually reluctant to be examined and slow to talk about their symptoms lest the pretense be discovered. Should inconsistencies in their behaviors be pointed out, deliberate deceivers as a rule immediately become more defensive. Thus conversion disorder and deliberate faking of illness are considered distinct patterns.

in review

· ● What are the primary characteristics of hypochondriasis, and how does the cognitive-behavioral viewpoint explain their occurrence?

· ● What are the symptoms of somatization disorder and of pain disorder?

· ● What are sources of primary and secondary gains involved in conversion disorders, and how is conversion disorder distinguished from malingering and from factitious disorder?

Dissociative Disorders

Dissociative disorders are a group of conditions involving disruptions in a person’s normally integrated functions of consciousness, memory, identity, or perception (APA, 2013 ; Spiegel et al., 2013 ). Included here are some of the more dramatic phenomena in the entire domain of psychopathology: people who cannot recall who they are or where they may have come from, and people who have two or more distinct identities or personality states that alternately take control of the individual’s behavior.

The term dissociation refers to the human mind’s capacity to engage in complex mental activity in channels split off from, or independent of, conscious awareness (Kihlstrom, 1994 , 2001 , 2005 ). The concept of dissociation was first promoted over a century ago by the French neurologist Pierre Janet (1859–1947). We all dissociate to a degree some of the time. Mild dissociative symptoms occur when we daydream or lose track of what is going on around us, when we drive miles beyond our destination without realizing how we got there, or when we miss part of a conversation we are engaged in. As these everyday examples suggest, there is nothing inherently pathological about dissociation itself. Dissociation only becomes pathological when the dissociative symptoms are “perceived as disruptive, invoking a loss of needed information, as producing discontinuity of experience” or as “recurrent, jarring involuntary intrusions into executive functioning and sense of self” (Spiegel et al., 2011, p. E19).

Much of the mental life of all human beings involves automatic nonconscious processes that are to a large extent autonomous with respect to deliberate, self-aware direction and monitoring. Such unaware processing extends to the areas of implicit memory and implicit perception, where it can be demonstrated that all persons routinely show indirect evidence of remembering things they cannot consciously recall ( implicit memory ) and respond to sights or sounds as if they had perceived them (as in conversion blindness or deafness) even though they cannot report that they have seen or heard them ( implicit perception ; Kihlstrom, 2001 , 2005 ; Kihlstrom et al., 1993 ). As we learned in Chapter 3 , the general idea of unconscious mental processes has been embraced by psychodynamically oriented clinicians for many years. But only in the past 30 years has it also become a major research area in the field of cognitive psychology (though without any of the psychodynamic implications for why so much of our mental activity is unconscious).

In people with dissociative disorders, however, this normally integrated and well-coordinated multichannel quality of human cognition becomes much less coordinated and integrated. When this happens, the affected person may be unable to access information that is normally in the forefront of consciousness, such as his or her own personal identity or details of an important period of time in the recent past. That is, the normally useful capacity of maintaining ongoing mental activity outside of awareness appears to be subverted, sometimes for the purpose of managing severe psychological threat. When that happens, we observe the pathological dissociative symptoms that are the cardinal characteristic of dissociative disorders. Like somatic symptom disorders, dissociative disorders appear mainly to be ways of avoiding anxiety and stress and of managing life problems that threaten to overwhelm the person’s usual coping resources. Both types of disorders also enable the individual to deny personal responsibility for his or her “unacceptable” wishes or behavior. In the case of DSM-defined dissociative disorders, the person avoids the stress by pathologically dissociating—in essence, by escaping from his or her own autobiographical memory or personal identity. The DSM-5 recognizes several types of pathological dissociation. These include depersonalization/derealization disorder, dissociative amnesia, dissociative fugue (a subtype of dissociative amnesia) and dissociative identity disorder.

Depersonalization/Derealization Disorder

Two of the more common kinds of dissociative symptoms are derealization and depersonalization. We mentioned these in Chapter 6 because they sometimes occur during panic attacks. In derealization one’s sense of the reality of the outside world is temporarily lost, and in depersonalization one’s sense of one’s own self and one’s own reality is temporarily lost. As many as 50-74 percent of us have such experiences in mild form at least once in our lives, usually during or after periods of severe stress, sleep deprivation, or sensory deprivation (e.g., Khazaal et al., 2005 ; Reutens et al., 2010 ). But when episodes of depersonalization or derealization become persistent and recurrent and interfere with normal functioning, depersonalization / derealization disorder may be diagnosed.

In this disorder, people have persistent or recurrent experiences of feeling detached from (and like an outside observer of) their own bodies and mental processes. They may even feel they are, for a time, floating above their physical bodies, which may suddenly feel very different—as if drastically changed or unreal. During periods of depersonalization, unlike during psychotic states, reality testing remains intact. The related experience of derealization, in which the external world is perceived as strange and new in various ways, may also occur. As one leader in the field described it, in both states “the feeling puzzles the experiencers: the changed condition is perceived as unreal, and as discontinuous with his or her previous ego-states. The object of the experience, self (in depersonalization) or world (in derealization), is commonly described as isolated, lifeless, strange, and unfamiliar; oneself and others are perceived as ‘automatons,’ behaving mechanically, without initiative or self-control” (Kihlstrom, 2001 , p. 267). Often people also report feeling as though they are living in a dream or movie (Maldonado et al., 2002 ). In keeping with such reports, research has shown that emotional experiences are attenuated or reduced during depersonalization—both at the subjective level and at the level of neural and autonomic activity that normally accompanies emotional responses to threatening or unpleasant emotional stimuli (Lemche et al., 2007 ; Phillips & Sierra, 2003 ; Stein & Simeon, 2009 ). After viewing an emotional video clip, participants with depersonalization disorder showed higher levels of subjective and objective memory fragmentation than controls (Giesbrecht et al., 2010 ). Memory fragmentation is marked by difficulties forming an accurate or coherent narrative sequence of events, which is consistent with earlier research suggesting that time distortion is a key element of the experience of depersonalization (Simeon et al., 2008 ).

DSM-5 criteria for: Depersonalization/Derealization Disorder

· A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both:

· 1. Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).

· 2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

· B. During the depersonalization or derealization experiences, reality testing remains intact.

· C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

· D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).

· E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

Dissociative Disorders And Trauma Assignment help

People with derealization symptoms experience the world as hazy and indistinct.

A number of researchers have noted elevated rates of comorbid anxiety and mood disorders as well as avoidant, borderline, and obsessive-compulsive personality disorders (e.g., Hunter et al., 2003 ; Mula et al., 2007 ; Reutens et al., 2010 ). Another study of over 200 cases found that the disorder had an average age of onset of 23. Moreover, in nearly 80 percent of cases, the disorder has a fairly chronic course (with little or no fluctuation in intensity; Baker, Hunter, et al., 2003 ).

The case of the foggy student below is fairly typical.

A Foggy Student A 20-year-old male college student sought psychiatric consultation because he was worried that he might be going insane. For the past 2 years he had experienced increasingly frequent episodes of feeling “outside” himself. These episodes were accompanied by a sense of deadness in his body. In addition, during these periods he was uncertain of his balance and frequently stumbled into furniture; this was more apt to occur in public, especially if he was somewhat anxious. During these episodes he felt a lack of easy, natural control of his body, and his thoughts seemed “foggy” as well ….

The patient’s subjective sense of lack of control was especially troublesome, and he would fight it by shaking his head and saying “stop” to himself. This would momentarily clear his mind and restore his sense of autonomy, but only temporarily, as the feelings of deadness and of being outside himself would return. Gradually, over a period of several hours, the unpleasant experiences would fade …. At the time the patient came for treatment, he was experiencing these symptoms about twice a week, and each incident lasted from 3 to 4 hours. On several occasions the episodes had occurred while he was driving his car and was alone; worried that he might have an accident, he had stopped driving unless someone accompanied him.

Source: Adapted with permission from DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (pp. 270–71). Washington, DC. (Copyright © 2002). American Psychiatric Association.

The lifetime prevalence of depersonalization/derealization disorder is unknown but has been estimated at 1 to 2 percent of the population (Reutens et al., 2010 ). Moreover, occasional depersonalization/derealization symptoms are not uncommon in a variety of other disorders such as schizophrenia, borderline personality disorder, panic disorder, acute stress disorder, and posttraumatic stress disorder (PTSD) (Hunter et al., 2003 ). Although severe depersonalization/derealization symptoms can be quite frightening and may make the victim fear imminent mental collapse, such fears are usually unfounded. Sometimes, however, feelings of depersonalization are clearly early manifestations of impending decompensation and the development of psychotic states ( Chapter 13 ). In either case, professional assistance in dealing with the precipitating stressors and in reducing anxiety may be helpful. Unfortunately, however, as of yet there are no clearly effective treatments—either through medication or psychotherapy.

Dissociative Amnesia and Dissociative Fugue

Retrograde amnesia is the partial or total inability to recall or identify previously acquired information or past experiences; by contrast, anterograde amnesia is the partial or total inability to retain new information (Gilboa et al., 2006 ; Kapur, 1999 ). Persistent amnesia may occur in several disorders, such as dissociative amnesia and dissociative fugue. It may also result from traumatic brain injury or diseases of the central nervous system. If the amnesia is caused by brain pathology, it most often involves failure to retain new information and experiences (anterograde amnesia). That is, the information contained in experience is not registered and does not enter memory storage (Kapur, 1999 ).

On the other hand, dissociative amnesia is usually limited to a failure to recall previously stored personal information (retrograde amnesia) when that failure cannot be accounted for by ordinary forgetting. The gaps in memory most often occur following intolerably stressful circumstances—wartime combat conditions, for example, or catastrophic events such as serious car accidents, suicide attempts, or violent outbursts (Maldonado & Spiegel, 2007 ; Spiegel et al., 2011). In this disorder, apparently forgotten personal information is still there beneath the level of consciousness, as sometimes becomes apparent in interviews conducted under hypnosis or narcosis (induced by sodium amytal, or so-called truth serum) and in cases where the amnesia spontaneously clears up. Watch the Video Sharon: Dissociative Amnesia on MyPsychLab

Amnesic episodes usually last between a few days and a few years. Although many people experience only one such episode, some people have multiple episodes in their lifetimes (Maldonado & Spiegel, 2007 ; Staniloiu & Markowitsch, 2010 ). In typical dissociative amnesic reactions, individuals cannot remember certain aspects of their personal life history or important facts about their identity. Yet their basic habit patterns—such as their abilities to read, talk, perform skilled work, and so on—remain intact, and they seem normal aside from the memory deficit (Kihlstrom, 2005 ; Kihlstrom & Schacter, 2000 ). Thus the only type of memory that is affected is episodic (pertaining to events experienced) or autobiographical memory (pertaining to personal events experienced). The other recognized forms of memory—semantic (pertaining to language and concepts), procedural (how to do things), and short-term storage—seem usually to remain intact, although there is very little research on this topic (Kihlstrom, 2005 ; Kihl-strom & Schacter, 2000 ). Usually there is no difficulty encoding new information (Maldonado & Spiegel, 2007 ).

DSM-5 criteria for: Dissociative Amnesia

· A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.

· B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

· C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition).

· D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.

In rare cases a person may retreat still further from real-life problems by going into an amnesic state called a dissociative fugue , which, as the term implies (the French word fugue means “flight”), is a defense by actual flight—a person is not only amnesic for some or all aspects of his or her past but also departs from home surroundings. This is accompanied by confusion about personal identity or even the assumption of a new identity (although the identities do not alternate as they do in dissociative identity disorder). During the fugue, such individuals are unaware of memory loss for prior stages of their life, but their memory for what happens during the fugue state itself is intact (Kihlstrom, 2005 ; Kihlstrom & Schacter, 2000 ). Their behavior during the fugue state is usually quite normal and unlikely to arouse suspicion that something is wrong. However, behavior during the fugue state often reflects a rather different lifestyle from the previous one (the rejection of which is sometimes fairly obvious). Days, weeks, or sometimes even years later, such people may suddenly emerge from the fugue state and find themselves in a strange place, working in a new occupation, with no idea how they got there. In other cases, recovery from the fugue state occurs only after repeated questioning and reminders of who they are. In either case, as the fugue state remits, their initial amnesia remits—but a new, apparently complete amnesia for their fugue period occurs. In DSM-5 dissociative fugue is considered to be a subtype of dissociative amnesia rather than a separate disorder as it was in DSM-IV.

The pattern in dissociative amnesia and dissociative fugue is essentially similar to that in conversion symptoms, except that instead of avoiding some unpleasant situation by becoming physically dysfunctional, a person unconsciously avoids thoughts about the situation or, in the extreme, leaves the scene (Maldonado & Spiegel, 2007 ; Maldonado et al., 2002 ). Thus people experiencing dissociative amnesia and fugue are typically faced with extremely unpleasant situations from which they see no acceptable way to escape. Eventually the stress becomes so intolerable that large segments of their personalities and all memory of the stressful situations are suppressed.

Several of these aspects of dissociative fugue are illustrated in the following case.

A Middle Manager Transformed into a Short-Order Cook Burt Tate, a 42-year-old short-order cook in a small-town diner, was brought to the attention of local police following a heated altercation with another man at the diner. He gave his name as Burt Tate and indicated that he had arrived in town several weeks earlier. However, he could produce no official identification and could not tell the officers where he had previously lived and worked. Burt was asked to accompany the officers to the emergency room of a local hospital so that he might be examined ….

Burt’s physical examination was negative for evidence of recent head trauma or any other medical abnormality …. He was oriented as to current time and place, but manifested no recall of his personal history prior to his arrival in town. He did not seem especially concerned about his total lack of a remembered past ….

Meanwhile, the police … discovered that Burt matched the description of one Gene Saunders, a resident of a city some 200 miles away who had disappeared a month earlier. The wife of Mr. Saunders … confirmed the real identity of Burt, who … stated that he did not recognize Mrs. Saunders.

Prior to his disappearance, Gene Saunders, a middle-level manager in a large manufacturing firm, had been experiencing considerable difficulties at work and at home. A number of stressful work problems, including failure to get an expected promotion, the loss of some of his key staff, failure of his section to meet production goals, and increased criticism from his superior—all occurring within a brief time frame—had upset his normal equanimity. He had become morose and withdrawn at home and had been critical of his wife and children. Two days before he had left, he had had a violent argument with his 18-year-old son, who had declared his father a failure and had stormed out of the house to go live with friends.

Source: Adapted with permission from DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (pp. 254–55). Washington, DC. (Copyright © 2002). American Psychiatric Association.

MEMORY AND INTELLECTUAL DEFICITS IN DISSOCIATIVE AMNESIA AND FUGUE

Unfortunately, very little systematic research has been conducted on individuals with dissociative amnesia and fugue. What is known comes largely from intensive studies of the memory and intellectual functioning of isolated cases with these disorders, so any conclusions should be considered tentative pending further study of larger samples with appropriate control groups. What can be gathered from a handful of such case studies is that these individuals’ semantic knowledge (assessed via the vocabulary subtest of an IQ test) seems to be generally intact. The primary deficit these individuals exhibit is their compromised episodic or autobiographical memory (Kihlstrom, 2005 ; Kihlstrom & Schacter, 2000 ). Indeed, several studies using brain-imaging techniques have confirmed that when people with dissociative amnesia are presented with autobiographical memory tasks, they show reduced activation in their right frontal and temporal brain areas relative to normal controls doing the same kinds of tasks (Kihlstrom, 2005 ; Markowitsch, 1999 ). In a recent review of nine cases of dissociative amnesia for which brain imaging data were available, the authors concluded there was evidence of significant changes in the brains of these patients, mostly centered on subtle loss of function in the right anterior hemisphere—changes similar to those seen in the brains of patients with organic memory loss (Staniloiu & Markowitsch, 2010 ).

However, several cases (some nearly a century old) have suggested that implicit memory is generally intact. For example, Jones (1909, as cited in Kihlstrom & Schacter, 2000 ) studied a patient with dense amnesia and found that although he could not remember his wife’s or daughter’s names, when asked to guess what names might fit them, he produced their names correctly. In a more contemporary case (Lyon, 1985, as cited in Kihlstrom & Schacter, 2000 ), a patient who could not retrieve any autobiographical information was asked to dial numbers on a phone randomly. Without realizing what he was doing, he dialed his mother’s phone number, which then led to her identifying him. In one particularly fascinating contemporary case of dissociative fugue, Glisky and colleagues ( 2004 ) describe a German man who had come to work in the United States several months before he had experienced a traumatic incident in which he had been robbed and shot. After the trauma, he wandered along unfamiliar streets for an unknown period of time. Finally, he stopped at a motel and asked if the police could be called because he did not know who he was (and had no ID because he’d been robbed) and could not recall any personal details of his life. He spoke English (with a German accent) but could not speak German and did not respond to instructions in German (which he denied that he spoke). In spite of his extensive loss of autobiographical memory (and the German language), when given a variety of memory tasks, he showed intact implicit memory. Especially striking was his ability to learn German–English word pairs, which he learned much faster than did normal controls, suggesting implicit knowledge of German even though he had no conscious knowledge of it.

Some of these memory deficits in dissociative amnesia and fugue have been compared to related deficits in explicit perception that occur in conversion disorders. This has convinced many people that conversion disorder should be classified with dissociative disorders rather than with somatic symptom disorders. This issue is discussed in more detail in the Thinking Critically About DSM-5 box below.

Dissociative Identity Disorder (Did)

DSM-5 THINKING CRITICALLY about DSM-5: Where Does Conversion Disorder Belong?

Starting with Freud and Janet, and for a large portion of the twentieth century prior to the publication of DSM-III in 1980, conversion disorders were classified together with dissociative disorders as subtypes of hysteria. When it was determined that DSM-III would rely heavily on overt behavioral symptoms rather than on presumed underlying etiology (namely, repressed anxiety) for classifying disorders, the decision was made to include conversion disorder with the other somatic symptom disorders. This was because its symptoms were physical ones with no demonstrable medical basis. However, as Kihlstrom ( 1994 , 2001 , 2005 ) and others have pointed out, this ignores some very important differences between conversion disorders and other somatic symptom disorders. The most important overall difference is that conversion symptoms (but not those of the other somatoform disorders) are nearly always pseudoneurological in nature (blindness, paralysis, anesthesias, deafness, seizures, etc.), mimicking some true neurological syndromes, just as most of the dissociative disorders do.

The disorders we currently classify as dissociative disorders (such as dissociative amnesia and DID) involve disruptions in explicit memory for events that have occurred, or who or what one’s identity is, or both. However, it is clear that events occurring during a period of amnesia or in the presence of one identity are indeed registered in the nervous system because they influence behavior indirectly even when the person cannot consciously recollect them (i.e., implicit memory remains at least partially intact in dissociative disorders). Similarly, Kihlstrom and others have argued that the conversion disorders involve disruptions in explicit perception and action. That is, people with conversion disorders have no conscious recognition that they can see or hear or feel, or no conscious knowledge that they can walk or talk or feel. However, patients with conversion disorder can see, hear, feel, or move when tricked into doing so or when indirect physiological or behavioral measures are used (see Janet, 1901 , 1907 ; Kihlstrom, 1994 , 2001 , 2005 ). Thus Kihlstrom ( 1994 , 2001 , 2005 ) and others made a compelling argument that in future editions, the term conversion disorder should be dropped and the sensory and motor types of the syndrome should be reclassified as forms of dissociative disorders. This way, the central feature of all dissociative disorders would be a disruption of the normally integrated functions of consciousness (memory, perception, and action). Such a proposal is also consistent with observations that dissociative symptoms and disorders are quite common in patients with conversion disorder (e.g., Sar et al., 2004 ). This proposal was seriously considered and heavily debated by the DSM-5 task force. In the end, the proponents for moving conversion disorder into the dissociative disorders category did not succeed and in DSM-5 conversion disorder (at least for now) is still listed as a somatic symptom disorder.

Dissociative identity disorder (DID) , formerly known as multiple personality disorder is a dramatic dissociative disorder in which a patient manifests two or more distinct identities that alternate in some way in taking control of behavior. There is also an inability to recall important personal information that cannot be explained by ordinary forgetting. Each identity may appear to have a different personal history, self-image, and name, although there are some identities that are only partially distinct and independent from other identities. In most cases the one identity that is most frequently encountered and carries the person’s real name is the host identity . Also in most cases, the host is not the original identity, and it may or may not be the best-adjusted identity. The alter identities may differ in striking ways involving gender, age, handedness, handwriting, sexual orientation, prescription for eyeglasses, predominant affect, foreign languages spoken, and general knowledge. For example, one alter may be carefree, fun-loving, and sexually provocative, and another alter quiet, studious, serious, and prudish. Needs and behaviors inhibited in the primary or host identity are usually liberally displayed by one or more alter identities. Certain roles such as a child and someone of the opposite sex are extremely common.

Much of the reason for abandoning the older diagnostic term multiple personality disorder in favor of DID was the growing recognition that it had misleading connotations, suggesting multiple occupancy of space, time, and people’s bodies by differing, but fully organized and coherent, “personalities.” In fact, alters are not in any meaningful sense personalities but rather reflect a failure to integrate various aspects of a person’s identity, consciousness, and memory (Spiegel, 2006). The term DID better captures this. Indeed Spiegel (one prominent theorist in this area) has argued that “the problem is not having more than one personality, it is having less than one” (Spiegel, 2006, p. 567).

Chris Sizemore was the inspiration for the book and movie Three Faces of Eve, which explore her multiple personality disorder (now known as DID). After her recovery, Sizemore worked as an advocate for the mentally ill.

DSM-5 criteria for: Dissociative Identity Disorder

· A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

· B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

· C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

· D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.

Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

· E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Alter identities take control at different points in time, and the switches typically occur very quickly (in a matter of seconds), although more gradual switches can also occur. When switches occur in people with DID, it is often easy to observe the gaps in memories for things that have happened—often for things that have happened to other identities. But this amnesia is not always symmetrical; that is, some identities may know more about certain alters than do other identities. Sometimes one submerged identity gains control by producing hallucinations (such as a voice inside the head giving instructions). In sum, DID is a condition in which normally integrated aspects of memory, identity, and consciousness are no longer integrated. Additional symptoms of DID include depression, self-mutilation, frequent suicidal ideation and attempts, erratic behavior, headaches, hallucinations, posttraumatic symptoms, and other amnesic and fugue symptoms (APA, 2013 ; Maldonado et al., 2002 ). Depressive disorders, PTSD, substance-use disorders, and borderline personality disorder are the most common comorbid diagnoses (Maldonado & Spiegel, 2007 ). One recent study found that among patients with diagnoses of DID, the average number of comorbid diagnoses (based on structured diagnostic interviews) was five, with PTSD being the most common (Rodewald et al., 2011 ).

DID usually starts in childhood, although most patients are in their teens, 20s, or 30s at the time of diagnosis (Maldonado & Spiegel, 2007 ). Approximately three to nine times more females than males are diagnosed as having the disorder, and females tend to have a larger number of alters than do males (Maldonado & Spiegel, 2007 ). Some believe that this pronounced gender discrepancy is due to the much greater proportion of childhood sexual abuse among females than among males (see Chapter 12 ), but this is a highly controversial point.

Many of these features are illustrated in the case of Mary Kendall below.

the WORLD around us: DID, Schizophrenia, and Split Personality: Clearing Up the Confusion

The general public has long been confused by the distinction between DID and schizophrenia. It is not uncommon for people diagnosed with schizophrenia to be referred to as having a “split personality.” We have even heard people say such things as, “I’m a bit schizophrenic on this issue” to mean that they have more than one opinion about it!

Although this misuse of the term split personality actually began among psychiatric professionals, today it reflects the public’s general misunderstanding of schizophrenia, which does not involve a “split” or “Jekyll and Hyde” personality at all. The original confusion may have stemmed from the term schizophrenia, which was first coined by a Swiss psychiatrist named Bleuler. Schizien is German for “split,” and phren is the Greek root for “mind.” The notion that schizophrenia is characterized by a split mind or personality may have arisen this way (see McNally, 2007 , for a historical review of how this confusion arose).

However, this is not at all what Bleuler intended the word schizophrenia to mean. Rather, Bleuler was referring to the splitting of the normally integrated associative threads of the mind—links between words, thoughts, emotions, and behavior. Splits of this kind result in thinking that is not goal-directed or efficient, which in turn leads to the host of other difficulties known to be associated with schizophrenia.

It is very important to remember that people diagnosed with schizophrenia do not have multiple distinct identities that alternately take control over their mind and behavior. They may have a delusion and believe they are someone else, but they do not show the changes in identity accompanied by changes in tone of voice, vocabulary, and physical appearance that are often seen when identities “switch” in DID. Furthermore, people with DID (who are probably closer to the general public’s notion of “split personality”) do not exhibit such characteristics of schizophrenia as disorganized behavior, hallucinations coming from outside the head, and delusions, or incoherent and loose associations (e.g., Kluft, 2005 ).

Mary and Marian Mary, a 35-year-old divorced social worker, had … in her right forearm and hand … chronic pain. Medical management of this pain had proved problematic, and it was decided to teach her self-hypnosis as a means whereby she might control it. She proved an excellent hypnotic subject and quickly learned effective pain control techniques.

Her hypnotist/trainer, a psychiatrist, describes Mary’s life in rather unappealing terms. She is said to be competent professionally but has an “arid” personal and social life …. She spends most of her free time doing volunteer work in a hospice ….

In the course of the hypnotic training, Mary’s psychiatrist discovered that she seemed to have substantial gaps in her memory. One phenomenon in particular was very puzzling: She reported that she could not account for what seemed an extraordinary depletion of the gasoline in her car’s tank. She would arrive home from work with a nearly full tank, and by the following morning as she began her trip to work would notice that the tank was now only half-full. When it was advised that she keep track of her odometer readings, she discovered that on many nights on which she insisted she’d remained at home the odometer showed significant accumulations of up to 100 miles. The psychiatrist, by now strongly suspecting that Mary had a dissociative disorder, also established that there were large gaps in her memories of childhood. He shifted his focus to exploring the apparently widespread dissociative difficulties.

In the course of one of the continuing hypnotic sessions, the psychiatrist again asked about “lost time,” and was greeted with a response in a wholly different voice tone that said, “It’s about time you knew about me.” Marian, an apparently well-established alter identity, went on to describe the trips she was fond of taking at night … Marian was an extraordinarily abrupt and hostile “person,” the epitome in these respects of everything the compliant and self-sacrificing Mary was not. Marian regarded Mary with unmitigated contempt, and asserted that “worrying about anyone but yourself is a waste of time.”

In due course some six other alter identities emerged …. There was notable competition among the alters for time spent “out,” and Marian was often so provocative as to frighten some of the more timid others, which included a 6-year-old child ….

Mary’s history, as gradually pieced together, included memories of physical and sexual abuse by her father as well as others during her childhood …. Her mother was described … as having abdicated to a large extent the maternal role, forcing Mary from a young age to assume these duties in the family.

Four years of subsequent psychotherapy resulted in only modest success in achieving a true “integration” of these diverse trends in Mary Kendall’s selfhood.

The number of alter identities in DID varies tremendously and has increased over time (Maldonado & Spiegel, 2007 ). One early review of 76 classic cases reported that two-thirds of these cases had only two personalities and most of the rest had three (Taylor & Martin, 1944 ). More recent estimates are that about 50 percent now show over 10 identities with some respondents claiming as many as a hundred. This historical trend of increasing multiplicity suggests the operation of social factors, perhaps through the encouragement of therapists, as we discuss below (e.g., Kihlstrom, 2005 ; Lilienfeld et al., 1999 ; Piper & Merskey, 2004a , 2004b ). Another recent trend is that many of the reported cases of DID now include more unusual and even bizarre identities than in the past (such as being an animal) and more highly implausible backgrounds (e.g., ritualized satanic abuse in childhood).

PREVALENCE—WHY HAS DID BEEN INCREASING?

Owing to their dramatic nature, cases of DID receive a great deal of attention and publicity in fiction, television, and motion pictures. But in fact, until relatively recently, DID was extremely rare—or at least rarely diagnosed—in clinical practice. Prior to 1979, only about 200 cases could be found in the entire psychological and psychiatric literature worldwide. By 1999, however, over 30,000 cases had been reported in North America alone (Ross, 1999 ), although as we will discuss later, many researchers believe that this is a gross overestimate (e.g., Piper & Merskey, 2004b ). Because their diagnosed occurrence in both clinical settings and in the general population increased enormously in recent years, prevalence estimates in the general population vary. One study of 658 people in upstate New York estimated a 1.5 percent prevalence (Johnson et al., 2006 ), but it is possible that no such estimates are valid, given how hard it is to make this diagnosis reliably. (For example, recall that Mary’s DID was uncovered only in the course of hypnotic sessions for pain management.)

Many factors probably have contributed to the drastic increase in the reported prevalence of DID (although in an absolute sense it is still very rare, and most practicing psychotherapists never see a person with DID in their entire careers). For example, the number of cases began to rise in the 1970s after the publication of Flora Rhea Schreiber’s Sybil ( 1973 ) This increased public awareness of the condition. (Ironically, however, the case has now been thoroughly discredited (see Borch-Jacobsen, 1997 ; Paris, 2012 ; Rieber, 1999 ). At about the same time, the diagnostic criteria for DID (then called multiple personality disorder) were clearly specified for the first time with the publication of DSM-III in 1980. This seems to have led to increased acceptance of the diagnosis by clinicians, which may have encouraged reporting of it in the literature. Clinicians were traditionally (and often still are today) somewhat skeptical of the astonishing behavior these patients often display.

Another reason why the diagnosis was made more frequently after 1980 is that the diagnostic criteria for schizophrenia were tightened in DSM-III. People who had perhaps been inappropriately diagnosed with schizophrenia could now receive the more appropriate diagnosis of multiple personality disorder. In addition, beginning in about 1980, prior scattered reports of instances of childhood abuse in the histories of adult patients began building into what would become a crescendo. As we will see later, many controversies arose regarding how to interpret such findings, but it is definitely true that these reports of abuse in patients with DID drew a great deal of attention to this disorder, which in turn may have increased the rate at which it was being diagnosed.

Finally, it is almost certain that some of the increase in the prevalence of DID is artifactual and has occurred because some therapists looking for evidence of DID in certain patients may suggest the existence of alter identities (especially when the person is under hypnosis and very suggestible; e.g., Kihlstrom, 2005 ; Piper & Merskey, 2004b ). The therapist may also subtly reinforce the emergence of new identities by showing great interest in these new identities. Nevertheless, such factors cannot account for all cases of diagnosed DID, which has been observed in most parts of the world, even where there is virtually no personal or professional knowledge of DID, including rural Turkey (Akyuz et al., 1999 ; see also Maldonado & Spiegel, 2007 ) and Shanghai, China (Xiao et al., 2006 ).

EXPERIMENTAL STUDIES OF DID

Much of what is known about DID comes from patients’ self-reports and from therapists’ or researchers’ clinical observations. Indeed, only a small number of experimental studies of people with DID have been conducted to corroborate clinical observations. Moreover, most of these studies have been conducted on only one or a few cases, although very recently a few larger studies have been done that include appropriate control groups (e.g., Dorahy et al., 2005 ; Huntjens et al., 2003 , 2007 ). In spite of such shortcomings, most of the findings from these studies are generally consistent with one another and reveal some very interesting features of DID.

The primary focus of these studies has been to determine the nature of the amnesia that exists between different identities. As we have already noted, most people with DID have at least some identities that seem completely unaware of the existence and experiences of certain alter identities, although other identities may be only partially amnesic of some alters (e.g., Elzinga et al., 2003 ; Huntjens et al., 2003 ). This feature of DID has been corroborated by studies showing that when one identity (Identity 1) is asked to learn a list of word pairs, and an alter identity (Identity 2) is later asked to recall the second word in each pair using the first word as a cue, there seems to be no transfer to Identity 2 of what was learned by Identity 1. This interpersonality amnesia with regard to conscious recall of the activities and experiences of at least some other identities has generally been considered a fundamental characteristic of DID (Kihlstrom, 2001 , 2005 ; Kihlstrom & Schacter, 2000 ). Nevertheless, several interesting recent studies, each with about 20 DID patients, have challenged any idea that this interpersonality amnesia is complete, instead sometimes finding partial transfer of explicit memory across identities in certain tasks (Huntjens et al., 2003 , 2007 , 2012; see also Dorahy & Huntjens, 2007 , for a review).

As noted earlier, there are kinds of memory other than simply what can be brought to awareness (explicit memory). As with dissociative amnesia and fugue, there is evidence that Identity 2 has some implicit memory of things that Identity 1 learned. That is, although Identity 2 may not be able to recall consciously the things learned by Identity 1, these apparently forgotten events may influence Identity 2’s experiences, thoughts, and behaviors unconsciously (Kihlstrom, 2001 , 2005 ). This might be reflected in a test asking Identity 2 to learn the list of words previously learned by Identity 1. Even though Identity 2 could not consciously recall the list of words, Identity 2 would learn that list more rapidly than a brand-new list of words, an outcome that suggests the operation of implicit memory (e.g., Eich et al., 1997 ; Elzinga et al., 2003 ; see Kihlstrom, 2001 , 2005 , for reviews).

Related studies on implicit transfer of memories have shown that emotional reactions learned by one identity often transfer across identities, too. Thus, even though Identity 2 may not be able to recall an emotional event that happened to Identity 1, a visual or auditory reminder of the event (a conditioned stimulus) administered to Identity 2 may elicit an emotional reaction even though Identity 2 has no knowledge of why it did so (e.g., Ludwig et al., 1972 ; Prince, 1910 ). Moreover, one study by Huntjens and colleagues ( 2005 ) had 22 DID patients in Identity 1 learn to reevaluate a neutral word in a positive or negative manner through a simple evaluative conditioning procedure in which neutral words are simply paired with positive or negative words; the neutral words then come to take on positive or negative connotations. When Identity 2 was later asked to emerge, he or she also categorized the formerly neutral word in the same positive or negative manner as learned by Identity 1, showing implicit memory for the reevaluation of the word learned by Identity 1 (although complete subjective amnesia was reported by Identity 2). Nevertheless, other sophisticated studies have made it clear that implicit memory transfer across personalities does not always occur, particularly with certain kinds of implicit memory tasks where memory performance may be strongly influenced by the identity currently being tested (e.g., Dorahy, 2001 ; Eich et al., 1997 ; Nissen et al., 1988 ). However, the results that do show implicit memory transfer are very important because they demonstrate that explicit amnesia across identities cannot occur simply because one identity is trying actively to suppress any evidence of memory transfer. If this were possible, there would be no leakage of implicit memories across identities (Dorahy, 2001 ; Eich et al., 1997 ).

An even smaller number of experimental studies have examined differences in brain activity when individuals with DID are tested with different identities at the forefront of consciousness. For example, in an early classic study, Putnam ( 1984 ) investigated EEG activity in 11 DID patients during different identities, and in 10 control subjects who were simulating different personality states, in order to determine whether there were different patterns of brain wave activity during different identities (real or simulated), as would be found if separate individuals were assessed. The study found that there were indeed differences in brain wave activity when the patients with DID were in different personality states and that these differences were greater than those found in the simulating subjects (see Kihlstrom et al., 1993 ; Putnam, 1997 ).

One particularly interesting study by Reinders and colleagues ( 2006 ) examined subjective and cardiovascular activation patterns to both neutral and traumatic memories in 11 people diagnosed with DID. Each patient had one alter with a neutral identity such as the one active when they were functioning in everyday life, and each had another alter with a traumatic identity who had access to traumatic memories. As expected, when exposed to a script of neutral personal memories neither identity displayed much subjective or cardiovascular reactivity. However, when exposed to a script of personal memories of traumatizing events, responding differed in the two identity states. Specifically, the traumatic identity state (but not the neutral identity state) showed subjective and cardiovascular reactivity reflecting emotional distress to the personal traumatic memory. Such results could be seen as providing support for the idea that one function of certain alters is to protect the person from traumatic memories that a traumatic identity state has access to.

CAUSAL FACTORS AND CONTROVERSIES ABOUT DID

There are at least four serious, interrelated controversies surrounding DID and how it develops. First, some have been concerned with whether DID is a real disorder or is faked, and whether, even if it is real, it can be faked. The second major controversy is about how DID develops. Specifically, is DID caused by early childhood trauma, or does the development of DID involve some kind of social enactment of multiple different roles that have been inadvertently encouraged by careless clinicians? Third, those who maintain that DID is caused by childhood trauma cite mounting evidence that the vast majority of individuals diagnosed with DID report memories of an early history of abuse. But are these memories of early abuse real or false? Finally, if abuse has occurred in most individuals with DID, did the abuse play a causal role, or was something else correlated with the abuse actually the cause?

DID: Real or Faked? The issue of possible factitious or malingering origins of DID has dogged the diagnosis of DID for at least a century. One obvious situation in which this issue becomes critical is when it has been used by defendants and their attorneys to try to escape punishment for crimes (“My other personality did it”). For example, this defense was used, ultimately unsuccessfully, in the famous case of the Hillside Strangler, Kenneth Bianchi (Orne et al., 1984 ), but it has probably been used successfully in other cases that we are unaware of (unaware because the person is not sent to prison but rather to a mental hospital in most cases). Bianchi was accused of brutally raping and murdering 10 young women in the Los Angeles area. Although there was a great deal of evidence that he had committed these crimes, he steadfastly denied it, and some lawyers thought perhaps he had DID. He was subsequently interviewed by a clinical psychologist, and under hypnosis a second personality, “Steve,” emerged. Steve confessed to the crimes, thereby creating the basis for a plea of “not guilty by reason of insanity” (see Chapter 17 ). However, Bianchi was later examined even more closely by a renowned psychologist and psychiatrist specializing in this area, the late Martin Orne. Upon closer examination, Orne determined that Bianchi was faking the condition. Orne drew this conclusion in part because when he suggested to Bianchi that most people with DID have more than two identities, Bianchi suddenly produced a third (Orne et al., 1984 ). Moreover, there was no evidence of multiple identities existing prior to the trial. When Bianchi’s faking the disorder was discovered, he was convicted of the murders. In other words, some cases of DID may involve complete fabrication orchestrated by criminal or other unscrupulous persons seeking unfair advantages, and not all prosecutors have as clever and knowledgeable an expert witness as Martin Orne to help detect this. Nevertheless, most researchers think that factitious and malingering cases of DID (such as the Bianchi case or cases in which the person has a need to be a patient) are relatively rare.

FIGURE 8.1 Reported childhood abuse in five separate studies of DID patients (Total n = 843).

If DID Is Not Faked, How Does It Develop: Posttraumatic Theory or Sociocognitive Theory? Many professionals acknowledge that, in most cases, DID is a real syndrome (not consciously faked), but there is marked disagreement about how it develops and how it is maintained. In the contemporary literature, the original major theory of how DID develops is posttraumatic theory (Gleaves, 1996 ; Maldonado & Spiegel, 2007 ; Ross, 1997 , 1999 ). The vast majority of patients with DID (over 95 percent by some estimates) report memories of severe and horrific abuse as children (see Figure 8.1 below). According to this view, DID starts from the child’s attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse. Lacking other resources or routes of escape, the child may dissociate and escape into a fantasy, becoming someone else. This escape may occur through a process like self-hypnosis (Butler et al., 1996 ), and if it helps to alleviate some of the pain caused by the abuse it will be reinforced and occur again in the future. This notion is consistent with recent evidence that inducing a dissociative state in research participants can lead to decreased pain sensitivity (Ludascher et al., 2009 ). Sometimes the child simply imagines the abuse is happening to someone else. If the child is fantasy prone, and continues to stay fantasy prone over time, the child may unknowingly create different selves at different points in time, possibly laying the foundation for multiple dissociated identities.

Kenneth Bianchi, known as the “Hillside Strangler,” brutally raped and murdered 10 women in the Los Angeles area. Hoping to create a plea of “not guilty by reason of insanity,” Bianchi fabricated a second personality—“Steve”—who “emerged” while Kenneth was under hypnosis. A psychologist and psychiatrist specializing in DID determined he was faking the diagnosis, and Bianchi was subsequently convicted of the murders.

But only a subset of children who undergo traumatic experiences are prone to fantasy or self-hypnosis, which leads to the idea that a diathesis-stress model may be appropriate here. That is, children who are prone to fantasy and those who are easily hypnotizable may have a diathesis for developing DID (or other dissociative disorders) when severe abuse occurs (e.g., Butler et al., 1996 ; Kihlstrom et al., 1993 ). However, it should also be emphasized that there is nothing inherently pathological about being prone to fantasy or readily hypnotizable (Kihlstrom et al., 1994 ).

Increasingly, those who view childhood abuse as playing a critical role in the development of DID are beginning to see DID as perhaps a complex and chronic variant of posttraumatic stress disorder, which by definition is caused by exposure to some kind of highly traumatic event(s), including abuse (e.g., Brown, 1994 ; Maldonado & Spiegel, 2007 ; Maldonado et al., 2002 ). Anxiety symptoms are more prominent in PTSD than in DID, and dissociative symptoms are more prominent in DID than in PTSD. Nevertheless, both kinds of symptoms are present in both disorders (Putnam, 1997 ). Moreover, some (but not all) investigators have estimated that a very high percentage of individuals diagnosed with DID have a comorbid diagnosis of PTSD, suggesting the likelihood of some important common causal factors (Vermetten et al., 2006; see also Rodewald et al., 2011 ).

At the other extreme from posttraumatic theory is sociocognitive theory , which claims that DID develops when a highly suggestible person learns to adopt and enact the roles of multiple identities, mostly because clinicians have inadvertently suggested, legitimized, and reinforced them and because these different identities are geared to the individual’s own personal goals (Lilienfeld & Lynn, 2003 ; Lilienfeld et al., 1999 ; Spanos, 1994 , 1996 ). It is important to realize that at the present time, the sociocognitive perspective maintains that this is not done intentionally or consciously by the afflicted individual but, rather, occurs spontaneously with little or no awareness (Lilienfeld et al., 1999 ). The suspicion is that overzealous clinicians, through fascination with the clinical phenomenon of DID and unwise use of such techniques as hypnosis, are themselves largely responsible for eliciting this disorder in highly suggestible, fantasy-prone patients (e.g., Giesbrecht et al., 2008 ; Piper, Merskey, 2004a , 2004b ; Spanos, 1996 ).

Consistent with the sociocognitive hypothesis, Spanos et al. ( 1985 ) demonstrated that normal college students can be induced by suggestion under hypnosis to exhibit some of the phenomena seen in DID, including the adoption of a second identity with a different name that shows a different profile on a personality inventory. Thus people can enact a second identity when situational forces encourage it. Related situational forces that may affect the individual outside the therapist’s office include memories of one’s past behavior (e.g., as a child), observations of other people’s behavior (e.g., others being assertive and independent, or sexy and flirtatious), and media portrayals of DID (Lilienfeld et al., 1999 ; Piper & Merskey, 2004b ; Spanos, 1994 ).

Sociocognitive theory is also consistent with evidence that most DID patients do not show unambiguous signs of the disorder before they enter therapy and with evidence that the number of alter identities often increases (sometimes dramatically) with time spent in therapy (Piper & Merskey, 2004b ). It is also consistent with the increased prevalence of DID since the 1970s, when the first popular accounts of DID reached the general public, and since 1980, when therapist awareness of the condition increased as well (Lilienfeld et al., 1999 ; Piper & Merskey, 2004a ).

However, there are also many criticisms of sociocognitive theory. For example, Spanos and colleagues’ demonstration of role-playing in hypnotized college students is interesting, but it does not show that this is the way DID is actually caused in real life. For example, someone might be able to give a convincing portrayal of a person with a broken leg, but this would not establish how legs are usually broken. Moreover, the hypnotized participants in this and other experiments showed only a few of the most obvious symptoms of DID (such as more than one identity) and showed them only under short-lived, contrived laboratory conditions. No studies have shown that other symptoms such as depersonalization, memory lapses for prolonged periods, or auditory hallucinations can occur under similar laboratory conditions. Thus, although some of the symptoms of DID could be created by social enactment, there is no evidence that the disorder can be created this way (e.g., Gleaves, 1996 ).

Former Georgia football star Herschel Walker has written a book, Breaking Free: My Life with Dissociative Identity Disorder (2008), in which he tells about his struggle with this disorder.

Are Recovered Memories of Abuse in DID Real or False? Case reports of the cruelty and torture that some DID patients suffered as children are gut-wrenching to read or hear. However, the accuracy and trustworthiness of these reports of widespread sexual and other forms of childhood abuse in DID have become a matter of major controversy. Critics (who are often proponents of sociocognitive theory) argue that many of these reports of DID patients, which generally come up in the course of therapy, may be the result of false memories, which are in turn a product of highly leading questions and suggestive techniques applied by well-meaning but inadequately skilled and careless psychotherapists (Lilienfeld et al., 1999 ; Loftus & Davis, 2006 ; Yapko, 1994 ). It seems quite clear to many investigators that this sort of thing has happened, often with tragic consequences. Innocent family members have been falsely accused by DID patients and have sometimes been convicted and imprisoned. But it is also true that brutal abuse of children occurs far too often and that it can have very adverse effects on development, perhaps encouraging pathological dissociation (e.g., Maldonado & Spiegel, 2007 ; Nash et al., 1993 ). In such cases, prosecution of the perpetrators of the abuse is indeed appropriate. Of course, the real difficulty here is in determining when the recovered memories of abuse are real and when they are false (or some combination of the two). This bitter controversy about the issue of false memory is more extensively considered in the Unresolved Issues section at the end of this chapter.

One way to document that particular recovered memories are real might be if some reliable physiological test could be developed to distinguish between them. Thus, some researchers are currently trying to determine whether there are different neural correlates of real and false memories that could be used to make this determination reliably. Another somewhat easier way to document whether a particular recovered memory is real would be to have independent verification that the abuse had actually occurred, such as through physician, hospital, and police records. A number of studies have indeed reported that they have confirmed the reported cases of abuse, but critics have shown that the criteria used for corroborating evidence are almost invariably very loose and suspect as to their validity. For example, Chu and colleagues ( 1999 ) simply asked their subjects, “Have you had anyone confirm these events?” (p. 751) but did not specify what constituted confirmation and had no way of determining if subjects were exaggerating or distorting the information they provided as confirming evidence (Loftus & Davis, 2006 ; Piper & Merskey, 2004a ). In another example of a flawed study, Lewis and colleagues ( 1997 ) studied 12 convicted murderers and then confirmed through medical, social service, and prison records that all 12 had been severely abused as children. Unfortunately, this study did not include a control group of otherwise comparable murderers who did not exhibit DID symptoms. Hence we cannot be certain that the childhood abuse of these subjects is not as much (or more) associated with violence or conviction for murder as with the development of DID specifically. Moreover, Lewis and colleagues should have carefully assessed for the possibility that some of the murderers might have been malingering (i.e., faking DID; Lilienfeld et al., 1999 ). Thus, although this study may have been one of the most impressive attempts yet to document abuse independently in people with DID, it was significantly flawed and therefore highly inconclusive.

If Abuse Has Occurred, Does It Play a Causal Role in DID? Let us put the previous controversy about the reality of recovered memories of abuse aside for a moment and assume that severe abuse has occurred in the early childhood backgrounds of many people with DID. How can we determine whether this abuse has played a critical causal role in the development of DID (e.g., Piper & Merskey, 2004a )? Unfortunately, many difficulties arise in answering this question. For example, child abuse usually happens in family environments plagued by many other sources of adversity and trauma (e.g., various forms of psychopathology and extreme neglect and poverty). One or more of these other, correlated sources of adversity could actually be playing the causal role (e.g., Lilienfeld et al., 1999 ; Nash et al., 1993 ). Another difficulty of determining the role of abuse is that people who have experienced child abuse as well as symptoms of DID may be more likely to seek treatment than people with symptoms of DID who did not experience abuse. Thus the individuals in most studies on the prevalence of child abuse in DID may not be representative of the population of all people who suffer from DID. Finally, childhood abuse has been claimed by some to lead to many different forms of psychopathology including depression, PTSD, eating disorders, somatic symptom disorders, and borderline personality disorder, to name just a few. Perhaps the most we will ever be able to say is that childhood abuse may play a nonspecific role for many disorders, with other, more specific factors determining which disorder develops (see Chapters 10 and 12 ).

Comments on a Few of These Controversies About DID As we have seen, numerous studies indicate that the separate identities harbored by DID patients are somewhat physiologically and cognitively distinct. For example, EEG activity of various alters may be quite different. Because such differences cannot in any obvious way be simulated (e.g., Eich et al., 1997 ), it seems that DID must, in at least some cases, involve more than simply the social enactment of roles. Moreover, this should not be too surprising, given the widespread evidence of separate (dissociated) memory subsystems and nonconscious active mental processing, which indicates that much highly organized mental activity is normally carried on in all of us in the background, outside of awareness (e.g., Kihlstrom, 2005 ). Moreover, some people seem to be especially prone to pathological variants of these dissociative processes (Waller et al., 1996 ; Waller & Ross, 1997 ).

We should also note that each of these controversies has usually been stated in a dichotomous way: Is DID real or faked? What causes DID—spontaneous social enactment of roles or repeated childhood trauma? Are recovered memories of abuse real or false? If abuse occurs, does it play a primary causal role? Unfortunately, however, such dichotomously stated questions encourage oversimplified answers. The human mind does not seem to operate in these dichotomous ways, and we need to address the complex and multifaceted nature of the dissociated mental processes that these often miserable and severely stressed patients are experiencing. Fortunately, theorists on both sides have begun to soften their positions a little, acknowledging that multiple different causal pathways are likely to be involved. For example, Ross ( 1997 , 1999 ), a long-time advocate for a strong version of posttraumatic theory, later acknowledged that some cases are faked and that some may be inadvertently caused by unskilled therapists in the course of treatment. In addition, other advocates of posttraumatic theory have recently acknowledged that both real and false memories do occur in these patients, noting that it is critical that a method for determining which is which be developed (e.g., Gleaves & Williams, 2005 ; Gleaves et al., 2004 ). From the other side, Lilienfeld et al., 1999 , who have been vocal advocates for Spanos’ sociocognitive theory since his death in 1994 , have acknowledged that some people with DID may have undergone real abuse, although they believe it occurs far less often, and is less likely to play a real causal role, than the trauma theorists maintain (see also Kihlstrom, 2005 ).

Sociocultural Factors in Dissociative Disorders

There seems little doubt that the prevalence of dissociative disorders, especially their more dramatic forms such as DID, is influenced by the degree to which such phenomena are accepted or tolerated either as normal or as legitimate mental disorders by the surrounding cultural context. Indeed, in our own society, the acceptance and tolerance of DID as a legitimate disorder have varied tremendously over time. Compared to relatively high reported rates of DID in Western cultures, a recent study of 893 patients diagnosed with some type of dissociative disorder over 10 years at a psychiatric hospital in India found no cases of DID (Chaturvedi et al., 2010 ). Nevertheless, although its prevalence varies, DID has now been identified in all racial groups, socioeconomic classes, and cultures where it has been studied. For example, outside North America it has been found in countries ranging from Nigeria and Ethiopia to Turkey, India, China, Australia, and the Caribbean, to name a few (Maldonado et al., 2002 ; Xiao et al., 2006 ).

Many seemingly related phenomena, such as spirit possession and dissociative trances, occur very frequently in many different parts of the world where the local culture sanctions them (Krippner, 1994 ; Spiegel et al., 2011). When entered into voluntarily, trance and possession states are not considered pathological and should not be construed as mental disorders. But some people who enter into these states voluntarily because of cultural norms develop distress and impairment. In DSM-5, the diagnostic criteria for DID have been modified to that they now include certain phenomena associated with possession. A trance is said to occur when someone experiences a temporary marked alteration in state of consciousness or identity (but with no replacement by an alternative identity). It is usually associated with either a narrowing of awareness of the immediate surroundings, or stereotyped behaviors or movements that are experienced as beyond one’s control. A possession trance is similar except that the alteration of consciousness or identity is replaced by a new identity that is attributed to the influence of a spirit, deity, or other power. In both cases there is typically amnesia for the trance state. One study of 58 individuals from Singapore with this diagnosis, as well as 58 individuals with a diagnosis of major depression, found that conflicts over religious or cultural issues, prior exposure to trance states, and being a spiritual healer or healer’s helper were most predictive of who had dissociative trance disorder relative to major depression (Ng & Chan, 2004 ). A recent review of 402 cases of dissociative trance and possession disorders indicates that migration and struggles with acculturation are associated with these disorders (During et al., 2011 ).

There are also cross-cultural variants on dissociative disorders, such as Amok, which is often thought of as a rage disorder. Amok occurs when a dissociative episode leads to violent, aggressive, or homicidal behavior directed at other people and objects. It occurs mostly in men and is often precipitated by a perceived slight or insult. The person often has ideas of persecution, anger, and amnesia, often followed by a period of exhaustion and depression. Amok is found in places such as Malaysia, Laos, the Philippines, Papua New Guinea, and Puerto Rico and among Navajo Indians.

Treatment and Outcomes in Dissociative Disorders

Unfortunately, virtually no systematic, controlled research has been conducted on treatment of depersonalization disorder, dissociative amnesia, and dissociative fugue, and so very little is known about how to treat them successfully. Numerous case histories, sometimes presented in small sets of cases, are available, but without control groups who are assessed at the same time or who receive nonspecific treatments it is impossible to know the effectiveness of the varied treatments that have been attempted (Kihlstrom, 2005 ).

As noted earlier depersonalization/derealization disorder is generally thought to be resistant to treatment (e.g., Simeon et al., 1997 ), although treatment may be useful for associated psycho-pathology such as anxiety and depressive disorders. Some think that hypnosis, including training in self-hypnosis techniques, may be useful because patients with depersonalization disorder can learn to dissociate and then “reassociate,” thereby gaining some sense of control over their depersonalization and derealization experiences (Maldonado & Spiegel, 2007 ; Maldonado et al., 2002 ). Many types of antidepressant, antianxiety, and antipsychotic drugs have also been tried and sometimes have modest effects. However, one randomized controlled study showed no difference between treatment with Prozac versus with placebo (Simeon et al., 2004 ). One recent treatment showing some promise for the treatment of dissociative disorders involves administering rTMS (repetitive transcranial magnetic stimulation) to the temporo-parietal junction, an area of the brain highly involved in the experience of a unified self and body (Mantovani et al., 2011 ). After three weeks of treatment, half of the subjects showed significant reductions in depersonalization, with nonresponders showing symptom reduction after an additional three weeks of treatment. In dissociative amnesia and fugue, it is important for the person to be in a safe environment, and simply removing her or him from what he or she perceives as a threatening situation sometimes allows for spontaneous recovery of memory. Hypnosis, as well as drugs such as benzodiazepines, barbiturates, sodium pentobarbital, and sodium amobarbital, is often used to facilitate recall of repressed and dissociated memories (Maldonado & Spiegel, 2007 ; Maldonado et al., 2002 ). After memories are recalled, it is important for the patient to work through the memories with the therapist so that the experiences can be reframed in new ways. However, unless the memories can be independently corroborated, they should not be taken at their face value (Kihlstrom, 2005 ).

For DID patients, most current therapeutic approaches are based on the assumption of posttraumatic theory that the disorder was caused by abuse (Kihlstrom, 2005 ). Most therapists set integration of the previously separate alters, together with their collective merging into the host personality, as the ultimate goal of treatment (e.g., Maldonado & Spiegel, 2007 ). There is often considerable resistance to this process by the DID patients, who often consider dissociation as a protective device (e.g., “I knew my father could get some of me, but he couldn’t get all of me”; Maldonado & Spiegel, 2007 , p. 781). If successful integration occurs, the patient eventually develops a unified personality, although it is not uncommon for only partial integration to be achieved. But it is also very important to assess whether improvement in other symptoms of DID and associated disorders has occurred. Indeed, it seems that treatment is more likely to produce symptom improvement, as well as associated improvements in functioning, than to achieve full and stable integration of the different alter identities (Maldonado & Spiegel, 2007 ; Maldonado et al., 2002 ).

Typically the treatment for DID is psychodynamic and insight-oriented, focused on uncovering and working through the trauma and other conflicts that are thought to have led to the disorder (Kihlstrom, 2005 ). One of the primary techniques used in most treatments of DID is hypnosis (e.g., Kluft, 1993 ; Maldonado & Spiegel, 2007 ; Maldonado et al., 2002 ). Most DID patients are hypnotizable and when hypnotized are often able to recover past unconscious and frequently traumatic memories, often from childhood. Then these memories can be processed, and the patient can become aware that the dangers once present are no longer there. (One problem here is that such patients are suggestible under hypnosis, so much of what is recalled may not be accurate; see Kihlstrom, 2005 ; Loftus & Davis, 2006 ). Through the use of hypnosis, therapists are often able to make contact with different identities and reestablish connections between distinct, seemingly separate identity states. An important goal is to integrate the personalities into one identity that is better able to cope with current stressors. Clearly, successful negotiation of this critical phase of treatment requires therapeutic skills of the highest order; that is, the therapist must be strongly committed as well as professionally competent. Regrettably, not all therapists are.

Most reports in the literature are treatment summaries of single cases, and reports of successful cases should always be considered with caution, especially given the large bias in favor of publishing positive rather than negative results. Treatment outcome data for large groups of DID patients have been reported in only four studies we are aware of, and none of these included a control group, although it is clear that DID does not spontaneously remit simply with the passage of time, nor if a therapist chooses to ignore DID-related issues (Kluft, 1999 ; Maldonado et al., 2002 ). For example, Ellason and Ross ( 1997 ) reported on a 2-year postdischarge follow-up of DID patients originally treated in a specialized inpatient unit. Of the original 135 such patients, 54 were located and systematically assessed. All these patients, and especially those who had achieved full integration, generally showed marked improvements in various aspects of their lives. However, only 12 of the 54 had achieved full integration of their identities. Such results are promising, but we must wonder about the clinical status of the 81 “lost” patients who may likely have done less well. Another 10-year follow-up study reported similar results in a smaller sample of 25 treated DID patients. Only 12 were located 10 years later; of these, six had achieved full integration, but two of those had partially relapsed (Coons & Bowman, 2001 ). In general it has been found that (1) for treatment to be successful, it must be prolonged, often lasting many years, and (2) the more severe the case, the longer that treatment is needed (Maldonado & Spiegel, 2007 ; Maldonado et al., 2002 ).

in review

· ● Describe the symptoms known as depersonalization and derealization, and indicate which disorder is primarily characterized by their appearance.

· ● Describe dissociative amnesia and dissociative fugue, and indicate what aspects of memory are affected.

· ● What are the primary symptoms of dissociative identity disorder (DID), and why is its prevalence thought to have increased?

· ● Review the four major controversies surrounding DID that were discussed in this chapter.

UNRESOLVED issues: DID and the Reality of “Recovered Memories”

As we have seen in this chapter, many controversies surround the nature and origins of DID. None have been more bitter than those related to the truth value of “recovered” memories of childhood abuse, particularly sexual abuse, which posttraumatic theorists assert is the major causal factor in the development of DID. Indeed, a virtual chasm has developed between the “believers” (mostly but not exclusively private practitioners who treat people with DID) and the “dis-believers” (mostly but not exclusively the more academic and science-oriented mental health professionals). The disbelievers are very sympathetic to people suffering DID symptoms, but they have tended to doubt that the disorder is usually caused by childhood abuse and have challenged the validity or accuracy of recovered memories of abuse (see Loftus & Davis, 2006 , for a review of the recovered memory debate).

For 20 years, these controversies have moved beyond professional debate and have become major public issues, leading to countless legal proceedings. DID patients who recover memories of abuse (often in therapy) have often sued their parents for having inflicted abuse. But ironically, therapists and institutions have also been sued for implanting memories of abuse that they later came to believe had not actually occurred. Some parents, asserting they had been falsely accused, formed an international support organization—the False Memory Syndrome Foundation—and have sometimes sued therapists for damages, alleging that the therapists induced false memories of parental abuse in their child. Many families have been torn apart in the fallout from this remarkable climate of suspicion, accusation, litigation, and unrelenting hostility.

Whether DID originates in childhood abuse and whether recovered memories of abuse are accurate are basically separate issues, but they have tended to become fused in the course of the debate. Hence those who doubt the validity of memories of abuse are also likely to regard the phenomenon of DID as stemming from the social enactment of roles encouraged or induced—like the memories of abuse themselves—by misguided therapy (e.g., see Bjorklund, 2000 ; Lilienfeld et al., 1999 ; Lynn et al., 2004 ; Piper & Merskey, 2004a , 2004b ). Believers, on the other hand, have usually taken both DID and the idea that abuse is its cause to be established beyond doubt (e.g., see Gleaves, 1996 ; Gleaves et al., 2001 ; Ross, 1997 , 1999 ).

Much of the controversy about the validity of recovered memories is rooted in disagreements about the nature, reliability, and malleability of human autobiographical memory. With some exceptions, evidence for childhood abuse as a cause of DID is restricted to the “recovered memories” (memories not originally accessible) of adults being treated for dissociative experiences. Believers argue that before treatment such memories had been “repressed” because of their traumatic nature or had been available only to certain alter identities that the host identity was generally not aware of. Treatment, according to this view of believers, dismantles the repressive defense and thus makes available to awareness an essentially accurate memory recording of the past abuse.

Disbelievers counter with several scientifically well-supported arguments. For example, scientific evidence in support of the repression concept is quite weak (e.g., Kihlstrom, 2005 ; Loftus & Davis, 2006 ; Piper, 1998 ). In many alleged cases of repression, the event may have been lost to memory in the course of ordinary forgetting rather than repression, or it may have occurred in the first 3 to 4 years of life, before memories can be recorded for retrieval in adulthood. In many other cases, evidence for repression has been claimed in studies where people may simply have failed to report a previously remembered event, often because they were never asked or were reluctant to disclose such very personal information (Kihlstrom, 2005 ; Loftus & Davis, 2006 ; Pope et al., 1998 ).

Even if memories can be repressed, there are very serious questions about the accuracy of recovered memories. Human memory of past events does not operate in a computer-like manner, retrieving with perfect accuracy an unadulterated record of information previously stored and then repressed. Rather, human memory is malleable, constructive, and very much subject to modification on the basis of events happening after any original memory trace is established (Loftus & Bernstein, 2005 ; Loftus & Davis, 2006 ; Schacter et al., 2000 ).

Indeed, there is now good evidence that in certain circumstances, people are sometimes very prone to the development of false memories (see Wade et al., 2007 , for a review). For example, a number of studies have now shown that when normal adult subjects are asked to imagine repeatedly events that they are quite sure had not happened to them before age 10, they later increase their estimate of the likelihood that these events actually had happened to them (Tsai et al., 2000 ). Moreover, even in a relatively short time frame, adult subjects sometimes come to believe they have performed somewhat bizarre acts (e.g., kissing a magnifying glass), as well as common acts (e.g., flipping a coin), after simply having imagined they had engaged in these acts several times 2 weeks earlier (Thomas & Loftus, 2002 ). These and other studies clearly show that repeated imagining of certain events (even somewhat bizarre events) can lead people to have false memories of events that never happened (Loftus & Bernstein, 2005 ; Loftus & Davis, 2006 ). In addition, an experimental study by McNally and colleagues ( 2005 ) looked at individuals who reported either repressed or recovered memories of childhood sexual abuse and found some evidence that they had greater difficulty on at least some measures than normal controls in distinguishing between words that they had seen versus words that they had only imagined. This suggests that people with repressed or recovered memories of abuse may have greater difficulty distinguishing between what has actually happened to them and what they have imagined happened to them. However, a different study found that those who report recovered memories of childhood sexual abuse did not show increased difficulty retrieving non-abuse-related autobiographic memories compared to those who reported continuous memories of childhood sexual abuse or a control group reporting no childhood sexual abuse (Raymaekers et al., 2010 ).

One fascinating study compared a group of people who had continuous memories of childhood abuse with two groups who had recovered memories of abuse. In one of the latter groups the memories had been recovered during therapy and in the other the memories had been recovered out of therapy. The researchers then attempted to corroborate these recovered memories, and found corroborative evidence for over half of those who had recovered memories outside of therapy and for none in the group who recovered their memories during therapy (Geraerts et al., 2007 ).

Recently, McNally and Geraerts ( 2009 ) offered a different perspective on recovered memories, one that attempts to bridge the gap between the conviction that repression underlies recovered memories and the alternate conviction that all recovered memories are false. Their third perspective suggests that some recovered memories are genuine but were never actually repressed. Instead, some abuse victims may simply not have thought about their abuse for a long period of time, have been deliberately attempting to forget the abuse (suppression rather than repression), or may have forgotten prior instances when they did recall the abuse, resulting in the false impression that a recently surfaced memory had been repressed for years.

8 summary

· 8.1 What are somatic symptom disorders?

· • Somatic symptom disorders lie at the interface of abnormal psychology and medicine. These are disorders in which psychological problems are manifested in physical symptoms. In response to the symptoms the person also experiences abnormal thoughts, feelings, and behaviors.

· • Somatic symptom disorder occurs in individuals who have had multiple somatic complaints lasting at least 6 months. Even if the symptoms do not seem to have a medical explanation, the person’s suffering is regarded as authentic.

· 8.2 What is illness anxiety disorder?

· • Illness anxiety occurs in individuals who are very anxious about having an illness even though there are no apparent symptoms.

· 8.3 What is conversion disorder (functional neurological symptom disorder)?

· • Conversion disorder involves patterns of symptoms or deficits affecting sensory or voluntary motor functions leading one to think there is a medical or neurological condition, even though medical examination reveals no physical basis for the symptoms.

· 8.4 What is the difference between a factitious disorder and malingering?

· • Individuals with factitious disorder intentionally produce medical or psychological symptoms (or both). They do this in the absence of external rewards in order to take on an illness role.

· • Malingering involves the intentional production of symptoms or the exaggeration of symptoms. This is motivated by external factors such as a wish to claim insurance money, avoid work or military service, or to get leniency in a criminal prosecution.

· 8.5 What are the primary features of dissociative disorders?

· • Dissociative disorders occur when the processes that normally regulate awareness and the multichannel capacities of the mind apparently become disorganized, leading to various anomalies of consciousness and personal identity.

· 8.6 What is depersonalization/derealization disorder?

· • Depersonalization/derealization disorder occurs in people who experience persistent and recurrent episodes of derealization (losing one’s sense of reality of the outside world) and/or depersonalization (losing one’s sense of oneself and one’s own reality).

· 8.7 What is dissociative amnesia?

· • Dissociative amnesia involves an inability to recall previously stored information that cannot be accounted for by ordinary forgetting and seems to be a common initial reaction to highly stressful circumstances. The memory loss is primarily for episodic or autobiographical memory.

· 8.8 What is dissociative identity disorder?

· • In dissociative identity disorder, the person manifests at least two or more distinct identities that alternate in some way in taking control of behavior. Alter identities may differ in many ways from the host identity.

key terms

· alter identities 281

· conversion disorder 270

· depersonalization 276

· depersonalization/derealization disorder 276

· derealization 276

· dissociation 276

· dissociative amnesia 278

· dissociative disorders 276

· dissociative fugue 278

· dissociative identity disorder (DiD) 280

· factitious disorder 264

· factitious disorder imposed on another 275

· host identity 281

· hypochondriasis 265

· hysteria 271

· implicit memory 276

· implicit perception 276

· malingering 264

· pain disorder 269

· posttraumatic theory (of DID) 285

· primary gain 271

· secondary gain 271

· sociocognitive theory (of DID) 286

· soma 264

· somatic symptom disorders 264

· somatization disorder 268

· somatoform disorders 264

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“Love” By Leo Buscaglia – ESSAY

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

“Love” By Leo Buscaglia – ESSAY

LO\/E

Leo Buscaglia, Ph. D.

G.K. HALL & CO. Boston, Massachusetts

1989

See.p. 169, which is an extension of this page.

Library of Congress Cataloging in Publication Data

Buscaglia, Leo F. Love / Leo Buscaglia. _ p. cm.—(G.K. Hall large print book series) Reprint. Originally published: Thorofare, N.J. : Slack, c1972. Includes bibliographical references. ISBN 0-8161-4511-3 (lg. print) 1. Love. 2. Large type books. I. Title. [BF575.L8B842 1989] l58’.2—dc19 88-25170

This book is dedicated to Tulio and Rosa Buscaglia, my father and mother who were my best teachers of love, because they never taught me, they showed me. This book is also dedicated to all those who have helped me to continue to grow in love, and those who will help me tomorrow.

Leo Buscaglia

“To cheat oneself out of love is the most terrible deception; it is an eternal loss for which there is no reparation, either in time or in eternity.”

—Kierkegaard

Contents

Introduction

Forward to Love

Love As A Learned Phenomenon

Man Needs To Love And Be Loved

A Question of Definition

Love Knows No Age

Love Has Many Deterrents

To Love Others You Must First Love Yourself

To Love You Must Free Yourself Of Labels

Love Involves Responsibility

Love Recognizes Needs

Love Requires One To Be Strong

Love Offers No Apology

Introduction

In the winter of 1969, an intelligent, sensitive female student of mine committed suicide. She was from a seemingly fine upper middle class family. Her grades were excellent. She was popular and sought after. On the particular day in January she drove her car along the cliffs of Pacific Palisades in Los Angeles, left the motor running, walked to the edge of a deep cliff overlooking the sea and leaped to her death on the rocks below. She left no note, not a word of explanation. She was only twenty.

I have never been able to forget her eyes; alert, alive, responsive, full of promise. I can even recall her papers and examinations which I always read with interest. I wrote on one of her papers which she never received, “A very fine paper. Perceptive, intelligent and sensitive. It indicates your ability to apply what you have learned to your ‘real’ life. Nice work!” What did I know about her “real” life?

I often wonder what I would read in her eyes or her papers if I could see them now. But, as with so many people and situations in our life, we superficially experience them, they pass and can never again be experienced in the same manner.

I was not blaming myself for her death. I simply wondered what I might have done; if I could have, even momentarily, helped.

It was this question, more than anything else, that led me, in that year, to start an experimental class. It was to be an informal group with voluntary attendance, where any student could be present or drop out at any time, if he so desired. It was to be dedicated to personal growth. I did not want it to become problem-centered or group psychotherapy nor an encounter group. I was an educator, not a psychotherapist. I wanted this class to be a unique experience in learning. I wanted it to have a definite, yet loose, framework and be of broad interest and import to the student. I wanted it to be related to his immediate experience. Students with whom I was relating were, more than ever, concerned with life, living, sex, growth, responsibility, death, hope, the future. It was obvious that the only subject which encompassed, and was at the core of all these concerns and more, was love.

I called the class, “Love Class.”

I knew beforehand that I could not “teach”—in the formal sense—such a class. It would be presumptuous. I too was limited in my knowledge and experience of the subject. I was as actively engaged as any of my students in discovering what the real meanings of the word were. I would only be able to act as a facilitator to the students as we guided each other closer to an understanding of the delicate phenomenon of human love.

My determination to start such a class was met with no resistance as long as it was taught free of salary and on my own time without load credit. Of course, a few eyebrows were raised by those who didn’t consider love a scholarly subject nor a serious part of a university curriculum.

I was highly amused in the ensuing weeks by the odd looks I received from some colleagues. One professor, in discussing my plans over lunch in the Faculty Center, called love—and anyone who purported to teach it—“irrelevant!” Others asked mockingly and with a wild leer, if the class had a lab requirement and was I going to be the primary investigator.

Nevertheless, student attendance at the class kept growing until we had to close enrollment with 100 students per year. The students were of all ages, from freshmen to graduates, obviously of varying degrees of experience and sophistication. All were unique and, as such, had individual approaches to the subject and some special knowledge to share.

This book is an outgrowth of “Love Class.” It is, as such, in no way intended to be a scholarly, deeply philosophical or definitive work on love. It’s rather a sharing of some of the practical and vital ideas, feelings and observations which emerged from the group that seemed to me relevant to the human condition. It might be said that the classes and I wrote this book together. The book may be said to have over 400 authors.

We never attempted nor in three years were able to define love. We felt as we grew in love, that to define it would be to delimit it and love seemed infinite. As one student stated, “I find love much like a mirror. When I love another, he becomes my mirror and I become his, and reflecting in each other’s love we see infinity!”

Forward to Love

(An excerpt from a speech delivered in Texas 1970— and since.)

If we are going to be “loving” together, it’s important that you know who I am and where I’m “at.” My name is B-U-S-C-A-G-L-I-A, and it’s pronounced like everything in the world. I always start by telling this story because I think it’s delightful. Recently I placed a long distance call, the line was busy, and the operator said she’d call me back. I gave her my name, waited a while, and then the phone rang. When I picked it up, she said. “Would you please tell Dr. Boxcar that his telephone call is through?” I said, “Could that be Buscaglia?” She giggled and said, “Sir, it could be damn near anything!”

I have a wonderful time with my name because not only is it Buscaglia, but if you’ll look at it you’ll see that it’s also Leo F. Well, it’s really Leonardo, the middle initial is F, but that’s really the first name, and it’s Felice, that means happiness. Isn’t that fantastic? Felice Leonardo Buscaglia! Recently I wanted to visit the Communist-block countries, and I needed a visa. I was in a large room in Los Angeles and filled out a very official form which I turned in. After which, I was asked to sit down and wait for my name to be called. When the time came, this poor man stood at his counter for a moment and looked at the form and I knew it was me he was going to call. He did sort of a double take, took a deep breath, looked up, and said, “Phyllis?” And I swear I’ll answer to anything, but Phyllis.

Yes, I am in a “love bag,” and I’m not ashamed of it. I have one single message, and I can give you that now. Then you can lay the book aside, go for a walk and hold hands with someone or what you will.

We are in a time in our society when we’re really beginning to look at what life is all about, what is learning, and what are the processes of change. We’re becoming acquainted with a new nomenclature. We’re looking at “conditioning,” we’re looking at “behavior shaping and modification,”

reinforcement, that it is necessary to reinforce, that what is reinforced will probably effect behavior. We are using all kinds of things to reinforce. We’re using money, we’re using bells, we’re using electric shocks. We’re even using candy. M M’s have become the big thing, and when somebody gives the correct response, we pop an M M into his mouth. My message to you today is simply that the best M M in the world is a warm, pulsating, non-melting human being—YOU! Real love is a very human phenomenon.

About five years ago I started a love class at the University. I am—-I’m teaching a class in love, and we are probably the only University in the country that does have such a class. It meets on Tuesday nights. We sit on the floor and relate, and I’m sure the vibrations are felt all over the world. I don’t teach love, of course, I simply facilitate growth in love.

Love is a learned phenomenon, and I think the sociologists, the anthropologists, the psychologists, will tell us this with no hesitation. What worries me is that maybe many of us are not happy with the way we’ve learned it. As experienced human beings we must certainly believe in one thing more than anything else—we believe in change. And so, if you don’t like where you’re at in terms of love, you can change it, you can create a new scene. You can only give away what you have. That’s the miracle. If you have love, you can give it. If you don’t have it, you don’t have it to give. Actually it’s not really even a matter of giving, is it? It’s a matter of sharing. Whatever I have I can share with you. I don’t lose it because I still have it. For example, I could teach every reader everything I know. I would still know everything I know. It is possible for me—and not unreasonable—to love everyone with equal intensity and still have all the love energy I have ever had. There are a lot of miracles to being a human being, but this is one of the greatest miracles.

Only recently has it become at all defensible to even mention the word “love.” Every time I go to speak somewhere, someone asks, “Will you talk about love?” I reply, “Sure,” and they say, “What’s your title?” I reply, “Let’s just call it ‘Love.’ ” There’s a brief hesitation, and then they say, “Well, you know, this is a professional meeting, and it may not be understood. What will the press say?” So I suggest “Affect as a Behavior Modifier,” and they agree that sounds more acceptable and scientific and everyone is happy.

Love has really been ignored by the scientists. It’s amazing. My students and I did a study. We went through books in psychology. We went through books in sociology. We went through books in anthropology, and we were hard pressed to find even a reference to the word “love.” This is shocking because it is something we all know we need, something we’re all continually looking for, and yet there’s no class in it. It’s just assumed that it comes to us by and through some mysterious life force.

One of Pitirim Sorokin’s last books was called The Ways and Power of Love. It’s full of wonderful studies of affect in which this man engaged because he was really worried about the fact that everybody seemed to be going in opposite directions. Dr. Albert Schweitzer said, “We are all so much together, but we are all dying of loneliness.” I feel this, you know this, and Dr. Sorokin thought it was true, too. In his book he is trying to share some of the things that might bring us together again.

If we’ve ever needed it, we need it now. In his book’s introduction, he says this: “The sensate mind emphatically disbelieves in the power of love. It appears to us something illusionary. We call it self- deception, the opiate of the people’s mind, unscientific bosh and unscientific delusion.” Some of you were brought up in Econ I class with a textbook by Samuelson. Remember that dreary book? Yet in his latest edition after five editions—can you imagine five editions of the same book?—there is a chapter that’s going to freak you, called “Love and Economics.” It’s a beautiful chapter. In his introduction, he says, “I know my colleagues at Harvard are going to say I have lost my mind, but I want them to know that I have just found it.”

Sorokin also says, “We are biased against all theories that try to prove the power of love in determining human behavior and personality, in influencing the course of biological, social, mental and moral evolution, in affecting the direction of historical events and in shaping social institutions and culture. In the sensate milieu they appear to be unconvincing, certainly unscientific, prejudiced, and superstitious.” And I think that’s really where we are. Love is prejudicial, superstitious, unscientific bosh.

I’d like to relate with you about some of the ways in which I think we can be reinforcing, non-melting, gorgeous, tender, loving human persons. First of all the loving individual has to care about himself. This is number one. I don t mean an ego trip. I’m talking about somebody who really cares about himself, who says, “Everything is filtered through me, and so the greater I am, the more I have to give. The greater knowledge I have, the more I’m going to have to give. The greater understanding I have, the greater is my ability to teach others and to make myself the most fantastic, the most beautiful, the most wondrous, the most tender human being in the world.”

Some exciting work has been going on in California by some great humanist psychologists like Rogers, Maslow, and Herbert Otto. These men and others are saying that only a small portion of what we are, are we, and that there is an enormous potential in the human being, that it isn’t outlandish to say that if we really desired to fly, we could fly! We could have the ability to feel that would be so spectacular that we could feel color! We could have the ability to see better than an eagle, the ability to smell better than a birddog, and a mind that could be so big, it would constantly be full of exciting dreams. Yet we are perfectly happy to be only a small portion of what we are. A London psychiatrist, R.D. Laing, in his book, The Politics of Experience, suggests something very provoking—something alien and rather frightening, yet a wondrous challenge. He says, “What we think is less than what we know: What we know is less than what we love: What we love is so much less than what there is; and to this precise extent, we are much less than what we are.” Isn’t that a mind blower?

Knowing this, we should have a tremendous desire to become. If all of life is directed toward the process of becoming, of growing, of seeing, of feeling, of touching, of smelling, there won’t be a boring second. I scream at my students, “Think of what you are and all the fantastic potential of you.”

It seems to me that in the past we have not sufficiently celebrated the wonderful uniqueness of every

individual. I would agree that personality is the sum total of all the experiences that we have known since the moment of conception to this point in our life along with heredity. But what is often ignored is an X factor. Something within the you of you that is different from every single human being, that will determine how you will project in this world, how you will see this world, how you will become a special human being. That uniqueness is what Worries me because it seems to me that we’re dropping it; we’re losing it. We’re not stressing it; we’re not persuading people to discover it and develop it.

Education should be the process of helping everyone to discover his uniqueness, to teach him how to develop that uniqueness, and then to show him how to share it because that’s the only reason for having anything. Imagine what this world would be like if all along the way you had people say to you, “It’s good that you’re unique; it’s good that you’re different. Show me your differences so that maybe I can learn from them.” But we still see the processes again and again of trying to make everyone like everybody else.

A few years ago with some of my student teachers at the University, I went back into classrooms and was astounded to find the same things going on that had been going on when I was in school—a million years ago. For example, the art teacher would come in. Remember how we always anticipated and got ready for the art teacher? You put your papers down and you got your Crayolas out and you waited and finally in would walk this harried person. I really feel sorry for an itinerant art teacher. She comes racing in from another class and has time only to nod to the teacher, turn around and say, “Boys and girls, today we are going to draw a tree.” She goes to the blackboard, and she draws her tree which is a great big green ball with a little brown base. Remember those lollipop trees? I never saw a tree that looked like that in my life, but she puts it up there, and she says, “All right, boys and girls, draw.” Everybody gets busy and draws.

If you have any sense, even at that early age, you realize that what she really wanted was for you to draw her tree, because the closer you got to her tree, the better your grade. If you already realized this in grade one, then you handed in a little lollipop, and she said, “Oh, that’s divine.” But here’s Junior who really knows a tree as this little woman has never seen a tree in her life. He’s climbed a tree, he’s hugged a tree, he’s fallen out of a tree, he’s listened to the breeze blow through the branches. He really knows a tree, and he knows that a tree isn’t a lollipop! So he takes purple and yellow and orange and green and magenta crayons and he draws this beautiful freaky thing and hands it in. She takes one look and shrieks, “Brain damaged!”

There’s a wonderful story in education that always amuses me. It’s called The Animal School. I always love to tell it because it’s so wild, yet it s true. Educators have been laughing at it for years, but nobody does anything about it. The animals got together in the forest one day and decided to start a school. There was a rabbit, a bird, a squirrel, a fish and an eel, and they formed a Board of Education. The rabbit insisted that running be in the curriculum. The bird insisted that flying be in the curriculum. The fish insisted that swimming be in the curriculum, and the squirrel insisted that perpendicular tree climbing be in the curriculum. They put all of these things together and wrote a

Curriculum Guide. Then they insisted that all of the animals take all of the subjects. Although the rabbit was getting an A in running, perpendicular tree climbing was a real problem for him; he kept falling over backwards. Pretty soon he got to be sort of brain damaged, and he couldn’t run any more. He found that instead of making an A in running, he was making a C and, of course, he always made an F in perpendicular climbing. The bird was really beautiful at flying, but when it came to burrowing in the ground, he couldn’t do so well. He kept breaking his beak and wings. Pretty soon he was making a C in flying as well as an F in burrowing, and he had a hellava time with perpendicular tree climbing. The moral of the story is that the person who was valedictorian of the class was a mentally retarded eel who did everything in a half-way fashion. But the educators were all happy because everybody was taking all of the subjects, and it was called a broad-based education. We laugh at this, but that’s what it is. It’s what you did. We really are trying to make everybody the same as everybody else, and one soon learns that the ability to conform governs success in the educational scene.

Conformity continues right on into the university. We in higher education are as guilty as everyone else. We don’t say to people, “Fly! Think for yourselves.” We give them our old knowledge, and we say to them, “Now this is what is essential. This is what is important.” I know professors who teach nothing but one best “way,” they don’t say, “Here are a lot of tools, now go create your own. Go into abstract thinking. Go into dreaming. Dream a while. Find something new.” Could it not be that among their students there are greater dreamers than themselves? So, it all starts with you. You can only give what you have to give. Don’t give up your tree. Hold onto your tree. You are the only you—the only magical combination of forces that will be and ever has been that can create such a tree. You are the best you. You will always be the second best anyone else. ‘

We are living in a culture where a person is not measured by who he is or what he is but rather by what he has. If he has a lot, he must be a great man. If he has little, he must be insignificant. About seven years ago I decided that I was going to do something really weird, at least at that time it was considered weird. I was going to sell everything I had, my car, my life insurance policy, my house, all the “important” things, and I was going to take off for a couple of years. I was going to look for me. I spent most of my time in Asia because I knew less about Asia than any other part of the world. The countries of Asia are underdeveloped countries. They have very little and, therefore, they must be terribly insignificant. Well, I found out very differently. Those of you who have been there or have delved into Asian culture will agree how wrong this Western concept is. I learned many, many things in Asia that I brought back with me which have really put me on a different path. Where it is leading I don’t know and I don’t care, but it’s different and exciting and wondrous.

I found a very interesting thing in Cambodia. The country is made up mostly of a great lake called the Tonle Sap. Many people live and work around it. When tourists go to Cambodia, they go directly to Angkor Wat, as they should; it’s fantastic. The Buddhist ruins being devoured by forests of great trees with monkeys swinging through them are unbelievable. It’s beyond your wildest dreams. While I was there, I met a French woman who loved the country so much she stayed on after the French left Cambodia, even though she was a secondary citizen. She really loved the people and the country, and she was willing to put up with whatever it meant. She said to me, “You know, Leo, if you really want to find these people, you won’t find them in the ruins. You’ll find them in their villages. Take my

bicycle and go to the Tonle Sap and see what’s happening now.”

Nature in Cambodia is very severe. Every year the monsoons come and wash everything into the rivers and streams and lakes. So you don’t build great permanent mansions because nature has told you that it will only be washed away. You build little huts. Tourists look and say, “Aren’t they quaint but poor people! living in such squalor.” It’s not squalor. It’s how you perceive it. They love their houses which are comfortable and exactly right for their climate and culture. So I went to the lake. I found the people in the process of getting together and preparing for the monsoons. This meant that they were constructing big communal rafts. When the monsoons come and wash away their houses, several families get on a raft and live together about six months of the year. Wouldn’t it be beautiful to live with your neighbors? Just think if we could make a raft together and live together for six months of the year! What would probably happen to us? All of a sudden we would again realize how important it is to have a neighbor—that I need you because today you may catch the fish that we will eat or I like you because I can sit down and ta1l with you if I’m lonely and learn from you and understand another world. After the rains are over, the families once again live as independent units.

I wanted to help them move so I walked in and offered myself in sign language. But they had nothing to move. A few pots and pans, a couple of mats, a few articles of clothing. I thought, “What would you do if tomorrow there were a monsoon in Los Angeles? What would you take? Your TV set? Your automobile? The vase that Aunt Catherine brought from Rome? Think about that. This was dramatically portrayed to us during the Los Angeles fires. A couple of pictures appeared in the Los Angeles Times that really freaked me. One was of a woman running down the streets of Malibu with a great pile of books, her house in the background being consumed by flames. I thought, “Wow, I would like to know this woman. I would like to know what are those books that she considered to be so valuable.” I brought the picture to a graduate seminar of supposedly really beautiful students. I asked, “What do you think those books were?” You know what they said? “Her income tax reports!” That’s where we are in the U.S.A. I even heard of one woman who fled with her blue chip stamps! She said, “I don’t know why I did it,” which shows you how silly it all is. But you know what she did have? She still had herself! That’s what it’s all about. In the end, you have only you.

Then I think this loving person rids himself of labels. You know, we are really marvelous. Being human is the greatest thing in the world, but we’re also funny, and we have to learn to laugh again. After all, we do funny things. We created time, for instance, and then became the slave of time. Like now—you may be thinking in the back of your mind that you have only ten minutes before you must do this or that. You may be somewhere where something really incredible is happening, but it’s 10:07, time to leave, and so you’ve got to move on. We have bells which ring. Bells! Every time we hear a bell, we respond. It tells us that we must be here or we must be there. We created time, and now we have become the slave of time.

The same thing is true with words. When you read books like Hayakawa’s The Use and Misuse of Language or Wendell ]ohnson’s book, People in Quandries, you see how tremendously powerful language is. A word is just a few phonetic meaningless symbols side by side. You give it meaning,

and then it sticks with you. You give it a cognitive meaning, and you give it an emotional meaning, and then you live with it. Dr. Timothy Leary did some fantastic work on the mind when he was at Harvard. He said, “Words are a freezing of reality.” Once you learn a word and get the intellectual and emotional meaning of that word, you are stuck with that word the rest of your life. So, your world of words is built. Everything that happens is filtered through this stuck, frozen system, and that keeps us from growing. We say things like “He’s a Communist.” Pow! We turn him off. We stop listening. Some people say, “He’s a Jew.” Pow! we turn him off. We’ve ceased respecting him. “He’s a Dago.” Pow! Labels, labels, labels! How many kids have not been educated just because someone pinned a label on them somewhere along the line? Stupid, dumb, emotionally disturbed. I have never known a stupid child. Never! Never! I’ve only known children and never two alike. Labels are distancing phenomena. They push us away from each other. Black man. What’s a black man? I’ve never known two alike. Does he love? Does he care? What about his kids? Has he cried? Is he lonely? Is he beautiful? Is he happy? Is he giving something to someone? These are the important things. Not the fact that he is a black man or Jew or Dago or Communist or Democrat or Republican.

I had a very unique experience in my childhood. You can look in the annals because it’s all recorded. I was born in Los Angeles, and my parents were Italian immigrants. A big family. Mama and Papa were obviously great lovers! They came from a tiny village at the base of the Italian Swiss Alps where everyone knew everyone. Everyone knew the names of the dogs, and the village priest came out and danced in the streets at the fiestas and got as drunk as everybody else. It was the most beautiful scene in the world and a pleasure to be raised by these people in this old way. But when I was taken, at five, to a public school, tested by some very official-looking person, the next thing I knew I was in a class for the mentally retarded! It didn’t matter that I was able to speak Italian and an Italian dialect. I also spoke some French and Spanish—but I didn’t speak English too well and so I was mentally retarded. I think the term now is “culturally disadvantaged.” I was put into this class for the mentally retarded, and I never had a more exciting educational experience in my life! Talk about a warm, pulsating, loving, teacher. Her name was Miss Hunt, and I’m sure she was the only one in the school who would teach those “dumb” kids. She was a great bulbous woman. She liked me even if I smelled of garlic. I remember when she used to come and lean over me, how I used to cuddle! I did all kinds of learning for this woman because I really loved her. Then one day I made a tremendous mistake. I wrote a newspaper as if I were a Roman. I described how the gladiators would perform and so on. The next thing I knew I was being retested and was transferred to a regular classroom after which I was bored for the rest of my educational career.

This was a traumatic time for me. People went around calling me a Dago and a Wop, very popular expressions at that time. I didn’t understand it. I remember talking to Papa, who was a big—still is— patriarchal type of guy. I asked, “What is a Dago? What is a Wop?” And he replied, “Oh, never mind, Felice, people always call names. It doesn’t mean anything. They don’t know anything about you by calling you names. Don’t let it bother you.” But it did! It did because it distanced me. It put me aside. It gave me a label. I felt a little sorry, too, because it meant that these people didn’t know any- thing about me, although they thought they did, by calling me a Dago. That categorized me. That made them comfortable. They didn’t know, for instance, that my mother was a singer and that my dad was a waiter when he first came to this country. He used to work most of the night, and Mama was a little

bit lonely. And so she would gather all eleven of us around and play Aida or La Boheme, how we’d fight over the roles! I remember I was the best Butterfly in the family. I still am, and when the Metropolitan Opera discovers me, they’l1 have their definitive performance. By the time we were ten or eleven, we knew these operas by heart and could play all the roles. People missed all this by a narrow label.

They also didn’t know, for instance, that Mama thought that no diseases would come if you had garlic around your neck. She’d rub garlic and tie it up in a hanky and put it around our necks and send us off to school. And I’ll tell you a small secret: I had perfect health. I was never sick a day. I have my theories about this—-I don’t think anyone ever got close enough to me to pass any germs. Now, having become sophisticated and having given up my garlic, I get a cold a year. They didn’t know this by calling me a Wop and a Dago. And they didn’t know about Papa’s rule that before we left the table, we had to tell him something new that we had learned that day. We thought this was really horrible— what a crazy thing to do! While my sisters and I were washing our hands and fighting over the soap, I’d say, “Well, we’d better learn something,” and we’d dash to the encyclopedia and flip to something like “The population of Iran is one million . . .” and we’d mutter to our- selves “The population of Iran is. . . .” We’d sit down and after a dinner of great big dishes of spaghetti and mounds of veal so high you couldn’t even see across the table, Papa would sit back and take out his little black cigar and say, “Felice, what did you learn new today?” And I’d drone, “The population of Iran is. . . .” Nothing was insignificant to this man. He’d turn to my mother and say, “Rosa, did you know that?” She’d reply, impressed, “No.” We’d think, “Gee, these people are crazy.” But I’ll tell you a secret. Even now going to bed at night, as exhausted as I often am, I still lie back and say to myself, “Felice, old boy, what did you learn new today?” And if I can’t think of anything, I’ve got to get a book and flip to something before I can get to sleep. Maybe this is what learning is all about. But they didn’t know that when they called me a Dago. Labels are distancing phenomena—stop using them! And when people use them around you, have the gumption and the guts to say, “What and who are you talking about be- cause I don’t know any such thing.” If each and every one of you stop it, it’s going to stop. There is no word vast enough to begin to describe even the simplest of man. But only you can stop it. A loving person won’t stand for it. There are too many beautiful things about each human being to call him a name and then put him aside.

Then this loving person must be one who recognizes responsibility. There is no greater responsibility in the world than being a human being, and you’d better believe it.

This loving person is a person who abhors waste—waste of time, waste of human potential. How much time we waste. As if we were going to live forever. I have to tell you this story because it is one of my greatest experiences. We had a young lady in our School of Education that I thought perhaps had the possibilities of being one of the greatest teachers of all time. She was absolutely psychedelic, and she loved kids. She was so turned on that it was impossible to hold her down—“I want to get with them, I want to get with them.” She went through school, was graduated and was hired, of course, because she was so beautiful—spiritually, mentally, every way. She was assigned to a first grade class. I remember the whole process because I was let in on it, step by step, in great moments of wonderment on her part.

When she got in her classroom she looked at the Curriculum Guide which said-—and you know we are still doing this—the first unit would be “The Store”—the S-T-O-R-E. She looked at it, and she said, “That’s not possible. This is 1970, U.S.A. These kids were raised in stores. They were wheeled around in little baskets in stores. They knocked over Campbell Soup cans and they spilled milk. They know what a store is. What are we doing studying a store?” Nevertheless this was what it said in the Curriculum Guide, and so she thought, “Well, maybe there is some merit and I can have a really exciting unit on the store. I’ll really try.” On that first day she sat down with the kids on the rug, and she said, very enthusiastically, “Boys and girls, how would you like to study the store?” They said, “Rotten!”

Kids are not as stupid nowadays as they used to be. McLuhan has shown that most children have seen 5,000 hours of TV before they reach kindergarten. They have seen murders and rapes, they have seen love affairs, they have heard music, they have been to Paris, to Rome. On their TV set they have seen real people die violently. Then we bring them to school, and we teach them about stores. Or we give them a book that says, “Tom said, ‘Oh, Oh.’ Mary said ‘Oh, Oh.’ Grandma said, ‘Oh, Oh.’ Spot said, ‘Oh, Oh.’ ” Well, damn Spot! It’s about time that we started realizing that we are educating children, not things. We must say, “Who is the new child we are educating and what are his needs?” How else can he survive tomorrow?”

And so this little girl, because she was a real teacher, said, “Okay, what do you want to study?” One little kid’s eyes opened real wide, and he said, “You know, my father works at ]et Propulsion Labs, and he can get us a rocket ship, and we could put up a rocket ship and learn all about it and fly to the moon!” All the kids said, “Groovy! That’s great!” So she said, “Okay, let’s do it.” The next day the father came and set up a rocket ship. He sat down on the rug with the kids, and he told them about flying to the moon and how a rocket ship works. You should have seen what was happening in that classroom. They were talking about science astronomy, complex theories of math. They had a vocabulary not of “oh, oh,” but of parts of a rocket ship, galaxies, space; a meaningful vocabulary.

Then one day in the middle of all of this fantastic learning, in walked the supervisor. She looked around and said, “Mrs. W, where is your store?” Some day I’m going to write this story for The New Yorker, and I’m going to call it “Mrs. W, Where Is Your Store?” The young teacher took the supervisor aside, saying, “You know, we talked about the store, but the kids wanted to fly to the moon. Look at our vocabulary lists and look at the books they are making. Next we are going to have a man from Jet Propulsion who is going to do a demonstration. . . .” The supervisor said, “Nevertheless, Mrs. W, the Curriculum Guide says you will have a store, and you will have a store”—(tight smile)—“Won’t you, dear?”

She came to me and said, “What’s this bit you have been feeding me about creativity in education, getting me blown up and excited, and then I begin teaching, and I have to make clay bananas!” You ate a banana, you slipped on a banana peel, you got sick on bananas—then you spent a six-week unit making artificial clay bananas for the store. Time’s awasting! And so do you know what she did? She

sat down with her kids, and she said, “Kids, do you want Mrs. W to be here next year?” And they said, “Oh, yes!” “Well, then, we’ve got to make a store.” And they said, “Okay, let’s do it, but let’s do it fast!” In two days they did a six-week unit. They made those damn clay bananas, and they pounded boxes together and put everything in them. She also told them that when the supervisor came, it would be necessary to show her that they could function in a store. When the supervisor came, she was very happy because there was the store, and the little kids would say, “Would you like to buy some bananas today?” And as soon as she left, they flew to the moon! Hypocrisy! And waste, waste, waste!

It isn’t enough to live and learn for today. We have to dream about what the world is going to be like in fifty years and educate for a hundred years hence and a dream world of a thousand years hence. The world today for the first grader is not going to be his world in thirty years. Look at how our world has changed. No wonder we are confused and up tight and anxious — we were not prepared to deal with the world we are living in. And it’s moving so fast! There isn’t time for “Grandma said, ‘Oh, Oh.’ ”

Then I think this loving individual is a person who is spontaneous. This is something that I feel really, really strongly about because I think that we have lost our ability to be spontaneous. We are all marking time, and we are all regimented. We have forgotten what it is to laugh and to feel good laughing. We are taught that a young sophisticated lady does not laugh boisterously—she titters. Who said? Emily Post? She’s sick! Why should we listen to somebody else tell us how to live our existence? Yet every day we see in the papers “Dear Miss Post, My daughter is being married in February. What kind of flowers should she carry?” If your daughter wants to carry radishes, let her carry them. “Dear Interior Decorator, I have puce curtains in my living room. What color should my rug be?” I can just see this little cat sitting in his office saying, “Heh, heh, heh.” And he replies, “Purple.” So you run out and buy thousands of dollars worth of purple rugs with puce curtains, and you’re stuck with them, and you deserve it! We don’t trust our own feelings any more. Men don’t cry. Who said? If you feel like crying, you cry. I cry all the time. I cry when I’m happy, I cry when I’m sad, I cry when a student says something beautiful, I cry when I read poetry.

If you feel something, let people know that you feel it. Don’t you get tired of these stoic faces that don’t show anything? If you feel like laughing, laugh. If you like what somebody says, go up and give them a hug. If it is right, it will be right. Spontaneity again, living again, knowing what it is like to tingle. Sometimes I get up in the morning, and I feel so freaky and good, I can’t stand it. I remember once driving to work, and I was singing Butterfly, the love duet, both roles, best performance I’d ever given, and a policeman stuck his head in the window, he had a great big grin on his face, and he said, “This is going to be the funniest ticket I’ve ever given.” I said, “How’s that, Officer?” He said, “I was chasing someone for speeding, and you passed us both up.” I love that. I hadn’t even seen him. I was in my own beautiful world.

We are constantly moving away from ourselves and others. The scene seems to be how far away you can get from another person, not how close you can get to them. I’m all for going back to the old- fashioned thing of touching people. My hand always goes out because when I touch somebody, I know

they are alive. We really need that affirmation. The existentialist says that we all think we are invisible and that sometimes we have to commit suicide to affirm the fact that we have lived at all. Well, I don’t want to do that. There are better, less drastic ways of affirming it. If somebody hugs you, you know you must be there or they’ll go through you. I hug everybody—just come close to me, you’re more than likely to get hugged, certainly touched.

We need not be afraid to touch, to feel, to show emotion. The easiest thing in the world to be is what you are, what you feel. The hardest thing to be is what other people want you to be, but that’s the scene we are living in. Are you really you or are you what people have told you you are? And are you interested in really knowing who you are because if you are, it is the happiest trip of your life.

And this loving person is also one who sees the continual wonder and joy of being alive. I am sure that contrary to the media, we were meant to be happy because there are so many beautiful things in our world—-trees and birds and faces. There are no two things alike and things are always changing. How can we get bored? There has never been the same sunset twice. Look at everybody’s face. Each face is different. Everybody has his own beauty. There have never been two flowers alike. Nature abhors sameness. Even two blades of grass are different. The Buddhists taught me a fantastic thing. They believe in the here and the now. They say that the only reality is what is here, what is happening between you and me right now. If you live for tomorrow, which is only a dream, then all you are going to have is an unrealized dream. And the past is no longer real. It has value because it made you what you are now, but that is all the value it has. So don’t live in the past. Live now. When you are eating, eat. When you are loving, love. When you are talking with someone, talk. When you are looking at a flower, look. Catch the beauty of the moment!

The loving person has no need to be perfect, only human. The idea of perfection frightens me. We’re almost afraid to do anything anymore because we can’t do it perfectly. Maslow says there are marvelous peak experiences that we all should be experiencing, like creating a pot in ceramics or painting a picture and putting it over here and saying, “That’s an extension of me.” There’s another existentialist theory that says, “I must be because I have done something. I have created something – therefore, I am.” Yet we don’t want to do this because we’re afraid it isn’t going to be good, it isn’t going to be approved of. If you feel like smearing ink on a wall, you do it. Say, “That came out of me, it’s my creation, I did it, and it is good.” But we’re afraid because we want things to be perfect. We want our children to be perfect.

Drawing from personal experiences, I remember my physical education classes in junior and senior high school. If there are any physical education teachers reading this, I hope they hear me loud and clear. I remember the striving for perfection. Physical education should be a place where we all should have an equal opportunity, where our only competition should be with ourselves. If we can’t throw a ball, then we learn to throw a ball the best we can. But that wasn’t it—they were always rewarding perfection. There were always the big muscular guys standing up there. They were the stars. And there I was—skin and bones with my little bag of garlic around my neck, and shorts that didn’t fit and always hung way down my little skinny legs. I’d stand there in line while we were being

chosen in games, and I used to die every single day of my life. You remember! We all lined up, and there were the athletes standing there with their big chests out, and they’d say, “I choose you” and “I choose you” and you saw the line dwindling away, and there you were, still standing there. Finally it got down to two people, one other little skinny guy and you. And then they’d say, “Okay, I’ll take Buscaglia” or “I’ll take the Wop” and you’d step out of line dying because you were not the image of the athlete, you were not the image of perfection they were striving for. I have a student in class who is a gymnast. He almost made the Olympics last year. He has a club foot. In every other way in this world he is as perfect as you can imagine, a body that would be the envy of anyone, a beautiful mind, fantastic crop of hair, sparkling, alert eyes. But he isn’t a beautiful boy in his perception—-he’s a club foot. Somewhere along the line somebody missed the boat, and all he hears when he walks down the street is the clump of a foot even though no one else is aware of it any longer. But if he sees it, then that’s what he is. So this idea of perfection really turns me off.

But man is always capable of growth and change, and if you don’t believe this, you are in the process of dying. Every day you should be seeing the world in a new personal way. The tree outside your house is no longer the same—so look at it! Your husband, wife, child, mother, father all are changing daily so look at them. Everything is in the process of change, including you. The other day I was on a beach with some of my students, and one of them picked up an old, dried-out starfish, and with great care he put it back in the water. He said, “Oh, it’s just dried out but when it gets moisture again, it’s going to come back to life.” And then he thought for a minute, and he turned to me, and he said, “You know, maybe that’s the whole process of becoming, maybe we get to the point from time to time where we sort of dry out, and all we need is a little more moisture to get us started again.” Maybe this is what it’s all about.

In fact, an investment in life is an investment in change to the end, and we can’t be concerned with dying because we must be too damned busy living! Let dying take care of itself. And don’t ever believe that your life is ever going to be peaceful—life is not like that. With change taking place all around you, you’ve got to continue adjusting which means that you are going to constantly be becoming, there is no stopping. We’re all on a fantastic journey! Every day is new. Every experience is new. Every person is new. Everything is new, every morning of your life. Stop seeing it as a drag! In Japan, the running of water is a ceremony. We used to sit in a little hut when the tea ceremony took place, and our host would pick up a scoop of water and pour it into the teapot, and everybody would listen. The sound of the falling water would be almost overpoweringly exciting. I think of how many people run showers and water in their sinks every single day and have never heard it. When was the last time you listened to rain drops?

Herbert Otto says, “Change and growth take place when a person has risked himself and dares to become involved with experimenting with his own life.” Isn’t that fantastic? A person has risked himself and dared to become involved with experimenting with his own life, trusting himself. To do this, to experiment with your own life, is very exhilarating, full of joy, full of happiness, full of wonder, and yet it’s also frightening. Frightening because you are dealing with the unknown, and you are shaking complacency.

I have a very strong feeling that the opposite of love is not hate—it’s apathy. It’s not giving a damn. If somebody hates me, they must “feel” something about me or they couldn’t possibly hate. Therefore, there’s some way in which I can get to them. If you don’t like the scene you’re in, if you’re unhappy, if you’re lonely, if you don’t feel that things are happening, change your scene. Paint a new backdrop. Surround yourself with new actors. Write a new play. And if it’s not a good play, get the hell off the stage and write another one. There are millions of plays—as many as there are people. Nikos Kazantzakis says, “You have your brush and colors, paint paradise, and in you go.”

A loving person recognizes needs. He needs people who care, someone who cares at least about him, who truly sees and hears him. Again, perhaps just one person but someone who cares deeply. Sometimes it takes only one finger to mend a dike.

I don’t know how many of you have ever seen the play Our Town but one of its most poignant scenes is when little Emily dies, and she goes into the graveyard, and the gods tell her that she can come back to life for one day. She chooses to go back and relive her twelfth birthday. She comes down the stairs in her birthday dress, her curls bouncing, so happy because she is the birthday girl. And Mama is so busy making a cake for her that she doesn’t look up to see her. Papa comes in, and he is so busy with his books and his papers and making his money, that he walks right by, doesn’t even see her. Her brother is in his own scene, and he’s not bothering to look either. Emily finally ends up in the center of the stage alone, in her little birthday dress. She says, “Please, somebody, look at me.” She goes to her mother once again, and she says, “Mama, please, just for a minute, look at me.” But nobody does, and she turns to the gods, if you remember, and her line is something like, “Take me away. I forgot how difficult it was to be a human being. Nobody looks at anybody anymore.”

It’s also about time we started listening to each other. We need to be heard. I used to love the idea of “share and tell” in the classroom. I thought this was a time when people would listen. But, you see, someone told the teachers that they had to have their enrollment slips in by 9:05 so they used this time for share and tell. Little kids went up and said, “Last night my daddy hit my mommy with the rolling pin and knocked out two front teeth, and the ambulance came and took her away, and she’s in the hospital.” And the teacher looked up and said, “All right, who’s next?” Or the little kid came up and showed teacher a rock, “I found a rock on the way to school today.” She said, “Fine, Johnny, put it on the science table.” I wonder what would happen if she picked the rock up and said, “Let me see the rock. Look at that. Kids, look at the color of that rock. Feel it. Who made a rock? Where does a rock come from? What’s a rock? What kind of a rock is this?” I can see how everything could stop all day long, and you could just groove on learning about a rock. But “Put it on the science table.”

And man needs a feeling of achievement. We all do. We’ve got to be able to be recognized for doing something well. And somebody’s got to point it out to us. Somebody has got to come up occasionally and pat us on the shoulder and say, “Wow! That’s good. I really like that.” It would be a miracle if we could let people know what was right rather than always pointing out what is wrong.

And then, the lover, to learn and to change and to become, also needs freedom. Thoreau said a wonderful thing: “Birds never sing in caves.” And neither do people. You’ve got to be free in order to learn. You’ve got to have people who are interested in your tree, not the lollipop tree, and you’ve got to be interested in their tree. “Show me your tree. Show me who you are, and then I’ll know where I can begin.” But birds never sing in caves. We need to be free to create.

I had an incredible experience recently. I talked to a bunch of gifted kids in a California school district. I ranted and raved in my usual fashion, and they sat there just sort of glued—the vibrations between us were incredible. After the morning session, the faculty took me to lunch. When I came back, the kids met me and said, “Oh, Dr. B., a terrible thing has happened. Remember the boy who was sitting right in front of you there?” And I said, “Oh, yes, I’ll never forget him, he was so with it.” “Well, he’s been thrown out of school for two weeks.” I said, “Why?” It seems that in my lecture I had been talking about the way that you know something, really know it, is to experience it fully. And I said, “If you really want to know a tree, for instance, you’ve got to climb in the tree, you’ve got to feel the tree, sit in the branches, listen to the wind blow through the leaves. Then you’ll be able to say, ‘I know that tree’.” And the boy had said, “Yeh, man, I’ll remember that. That’s where it’s at.” So during lunch time, this kid saw a tree and climbed up in it. The boys’ vice principal passed by, saw him up there, dragged him down, and kicked him out of school.

I said, “Oh, there must be a mistake; there was a misunderstanding. I’ll go talk to the boys’ vice principal.” I don’t know why it is but boys’ vice principals are always ex- P.E. teachers. I went to the office where he was sitting with his bulging muscles, and I said, “I’m Dr. Buscaglia.” He looked up at me furious. He said, “You’re the man who comes onto this campus and tells kids to climb trees? You’re a menace!” And I said, “Well, you didn’t understand. I think there was a little mis . . .” He shouted, “You’re a menace! Telling kids to climb trees! What if they fell out? They’re problems enough!” Well, I never got to him, it was impossible, I couldn’t deal with him. So I went to the house of this boy who now had two free weeks to climb trees, I sat down with him, and he said, “I think the thing I’ve learned from this is when to climb trees and when not to do it. I guess I just used bad judgment, didn’t I?” He had listened, and he’ll have to adjust to this man in the front office—but he’s still climbing trees. There are ways to meet the needs of society, and still do your own thing. It’s knowing where and when and how.

Everybody has his own way and must be allowed the freedom to pursue it. There are a thousand paths to loving. Everyone will find his own way if he listens to himself. Don’t let anybody impose their way on you. There’s a wonderful book called Teachings According to Don Juan written by an anthropologist named Carlos Castaneda. It’s all about the Yaqui Indians whom he studied. In it there is a man called Don Juan, who says, “Each path is only one of a million paths. Therefore, you must always keep in mind that a path is only a path. If you feel that you must now follow it, you need not stay with it under any circumstances. Any path is only a path. There is no affront to yourself or others in dropping it if that is what your heart tells you to do. But your decision to keep on the path or to leave it must be free of fear and ambition. I warn you: Look at every path closely and deliberately. Try it as many times as you think necessary. Then ask yourself and yourself alone one question. It is this: Does this path have a heart? All paths are the same. They lead nowhere. They are paths going

through the brush or into the brush or under the brush. Does this path have a heart is the only question. If it does, then the path is good. If it doesn’t, it is of no use.” If your path is love the goal is unimportant, the process will have heart.

You can only be “real” on your path. The hardest thing in the world is to be something you’re not. By straying from yourself you must get closer and closer and closer to what you are. You’ll find it’s an easy way to be. The easiest thing to be in the world is you. The most difficult thing to be is what other people want you to be. Don’t let them put you in that position. Find “you,” who you are, be as you are. Then you can live simply. You can use all of the energy that it takes to “hold back the spooks,” as Alpert calls it. You won’t have any spooks to hold back anymore. You won’t be playing games anymore. Clear them all away and say, “Here’s me. Take me for what I am with all my frailties, all my stupidity, and so on. And if you can’t, leave me be.”

Now we are ready to share a trip into love. This trip is not meant to be a path. It’s a sharing. Take what is right for you. But first, I’d like to offer a wondrous bit of philosophy. It’s written by a man named Zinker, who is at the Gestalt Institute in Cleveland. He wrote this as the end of a paper which he called On Public Knowledge and Personal Revelation. He said, “If a man in the street were to pursue his self, what kind of guiding thoughts would he come up with about changing his existence? He would perhaps discover that his brain is not yet dead, that his body is not dried up, and that no matter where he is right now, he is still the creator of his own destiny. He can change this destiny by taking his one decision to change seriously, by fighting his petty resistances against change and fear, by learning more about his mind, by trying out behavior which fills his real need, by carrying out concrete acts rather than conceptualizing about them”—(I feel strongly about that— let’s stop talking and start doing)-—“by practicing to see and hear and touch and feel as he has never before used these senses, by creating something with his own hands without demanding perfection, by thinking out ways in which he behaves in a self-defeating manner, by listening to the words that he utters to his wife, his kids, and his friends, by listening to himself, by listening to the words and looking into the eyes of those who speak to him, by learning to respect the process of his own creative encounters and by having faith that they will get him somewhere soon. We must remind ourselves, however, that no change takes place without working hard and without getting your hands dirty. There are no formulae and no books to memorize on becoming. I only know this: I exist, I am, I am here, I am becoming, I make my life and no one else makes it for me. I must face my own shortcomings, mistakes, transgressions. No one can suffer my non-being as I do, but tomorrow is another day, and I must decide to leave my bed and live again. And if I fail, I don’t have the comfort of blaming you or life or God.”

“We are all functioning at a small fraction of our capacity to live fuller in its total meaning of loving, caring, creating and adventuring. Consequently, the actualizing of our potential can become the most exciting adventure of our lifetime.”

—Herbert Otto

Love As A Learned Phenomenon

At the turn of the century a child was found in the forests of a small village in France. The child had been abandoned for dead by his parents. By some miracle he did not die in the forest. He survived, not as a child, even though he was physically a human being, but rather as an animal. He walked on all fours, made his home in a hole in the ground, had no meaningful language above an animal cry, knew no close relationships, cared about no one or no thing except survival.

Cases such as this—that of Kumala, the Indian girl, for instance—-have been reported from the beginning of time. They have in common the fact that if man is raised as an animal he will behave as an animal, for man “learns” to be human. Just as man learns to be a human being, so he learns to feel as a human being, to love as a human being.

Each man lives love in his limited fashion and does not seem to relate the resultant confusion and loneliness to his lack of knowledge about love.

Psychologists, psychiatrists, sociologists, anthropologists and educators have suggested in countless studies and numerous research papers that love is a “learned response, a learned emotion.” How man learns to love seems to be directly related to his ability to learn, those in his environment who will teach him, as well as the type, extent and sophistication of his culture. Family structure, courtship practices, marriage laws, sex taboos, for instance, all vary according to where one lives. The mores and folkways involved in love, sex, marriage and the family are different, for instance, in Bali than they are in New York City. In Bali, for instance, the family structure is close; in Manhattan, it is loose and less structured. In Bali, marriage is polygamous in Manhattan, at least for legal purposes, monogamous.

These facts concerning the effects of learning upon behavior appear self-evident when stated. Yet, they seem to have little, if any, effect upon the majority of people when applied to love. Most of us continue to behave as though love is not learned but lies dormant in each human being and simply awaits some mystical age of awareness to emerge in full bloom. Many wait for this age forever. We seem to refuse to face the obvious fact that most of us spend our lives trying to find love, trying to live in it, and dying without ever truly discovering it.

There are those who will dismiss love as a naive and romantic construct of our culture. Others will wax poetic and tell you that “love is all,” “love is the bird call and the glint in a young girl’s eyes on a summer night.” Some will be dogmatic and tell you emphatically that “God is Love.” And some, according to their own unique experience, will tell us, “Love is a strong, emotional attachment to another . . .” etc. In some cases you will find that people have never thought of questioning love, much less defining it, and object violently even to the suggestion that they think about it. To them love is not to be pondered, it is simply to be experienced. It is true that to some degree all of these statements are correct, but to assume that any one is best or all there is to love, is rather simple. So each man lives love in his limited fashion and does not seem to relate the resultant confusion and loneliness to this lack of knowledge about love.

If he desired to know about automobiles, he would, without question, study diligently about automobiles. If his wife desired to be a gourmet cook, she’d certainly study the art of cooking, perhaps even attend a cooking class. Yet, it never seems as obvious to him that if he wants to live in love, he must spend at least as much time as the auto mechanic or the gourmet in studying love. No mechanic or cook would ever believe that by “willing” the knowledge in his field, he’d ever become an expert in it.

In discussing love, it would be well to consider the following premises:

One cannot give what he does not possess. To give love you must possess love.

One cannot teach what he does not understand. To teach love you must comprehend love.

One cannot know what he does not study. To study love you must live in love.

One cannot appreciate what he does not recognize. To recognize love you must be receptive to love.

One cannot have doubt about that which he wishes to trust. To trust love you must be convinced of love.

One cannot admit what he does not yield to. To yield to love you must be vulnerable to love.

One cannot live what he does not dedicate himself to. To dedicate yourself to love you must be forever growing in love.

A human child, newly born, knows nothing of love. He is totally helpless, mostly ignorant, dependent and vulnerable. If left alone, uncared for for any time before he is six or seven years of age, he will most likely die. He will take longer to learn independence than any living creature. And, it seems that, as societies become more complicated and sophisticated, the time before independence is attained is extended to the point to which the individual remains dependent, if not economically, emotionally, until his death.

As the human child grows, the world which surrounds him, the people interacting in his world, will teach him what love means. At first, it may mean that when he is hungry, lonely, in pain or discomfort, he cries out. His cry may bring a response, usually someone who will feed him so he’ll no longer feel hunger pains; hold him so he’ll no longer feel lonely; remove or eliminate the source of his pain so he’ll again feel comfort. These will be the first interactions which will teach him to identify with another being. He is still not able to relate this source of comfort to a human role, like mother, father, servant, female, governess, grandmother. It is likely that if a wolf-which has been known to serve this purpose for a child-were to fulfill his basic needs, he would form an attachment of need to the wolf. But it’s not yet love, simply a need attachment. No matter. It is this first reaction-interaction, one- sided and simple though it may seem, that eventually will lead to the complicated, multifaceted phenomenon, love.

At this point, the attitude of the object upon whom the child depends and reacts plays an important role. The object, too, has needs. According to his needs, so will he respond to the child. The reinforcement for a mother’s rising in the night and caring for the child or doing the thousand different chores required of the 20th century mother, for example, may be simply the feeling of fulfillment in having created life or the smile of the child or the warmth of the child against her body. But, nevertheless, she’ll need the reinforcement or she will abandon the child. According to how these

acts meet her needs, so she will respond in kind. It has been noted that in mothers of autistic, totally nonresponsive infants, the mothers tend to pull away, to hold the child less, fondle and caress him less, and generally respond to him less.

As the child grows, so does his world and so do his attachments. His world of love is still limited, usually to his family; his father, his brothers, his sisters, but mostly his mother. Each family member in his turn will play a role in teaching the child something of love. He will do this by how he handles the child, how he plays or speaks with him, how he reacts to him. Certainly, no family member has ever set out deliberately to “teach” love to a child. Love is an emotion, that is true. But it is also a “response” to an emotion and, therefore, an “active” expression of what is felt. Love is not learned by osmosis. It is actually acted out and acted upon.

In turn, each family member can teach only what he knows of love. The child will more and more act out what he’s learning. Those positive elements he expresses which are approved and reinforced according to the family’s feelings and beliefs will be adopted as part of his behavior. Those elements of his expressed behavior of which his family disapproves and which are not reinforced, which may even be punished, will not become a part of his behavioral repertory. For example, if the family is a demonstrative group where affection is outwardly expressed, the child will be reinforced by a positive response when he expresses this. The child leaps into his father’s arms and plants a kiss on his mouth, full and juicy. The father returns this in kind, joyfully, verbally, tenderly, smilingly, approvingly. He is teaching the child that this outward expression of love is a good one. On the other hand, a child may spontaneously leap upon his father who may be equally loving, but whose expression of love does not include demonstrative acting out of affection. This father may tenderly hold the child away from him and smilingly say, “Big men don’t hug and kiss each other.” This father has taught his child that it is well to love, but that an outward show of love is not approved in his environment. The French philosopher, ]ean-Paul Sartre, has said, “Long before birth, even before we are conceived, our parents have decided who we shall be.”

Aside from the immediate family, there are other influences which teach love. The effect of these influences can be strong. One of these is the individual’s culture. It is this culture which, in many cases, has taught the family its responses to love. So it will serve to further reinforce the child’s actions.

A French child, for example, born and raised in a Chinese society by Chinese parents, will grow up as a Chinese child with the Chinese child’s games, his responses, his manners, his reactions, his likes and dislikes, his language, his aspirations and dreams.

On the other hand, this same French child raised in a Chinese culture by French parents will become a French child in a Chinese society-holding on to those aspects of the French culture he is being taught by his parents and adapting them as he grows up in order to live in a Chinese society. He will then develop those French characteristics common to French children, but will have, also, to adjust them

to the Chinese culture.

No person can be totally free of cultural pressures and influences. To become a “socially approved” person, one must always give up some of himself. A Robinson Crusoe can be totally free on his island, but he pays for his freedom with isolation. When Friday, a second person, appears, he has a choice. He can either co-habit with him and make him one like himself which would involve changing his habits and participating in a democratic interchange, or he can make Friday his slave. This decision will require little or no change of Crusoe’s personality and life except that he keep a continual, forceful, watchful eye on Friday, his slave.

In the fall of 1970, I had an interesting experience in social living. I enjoy fall leaves, the colors, the sound of the leaves as you walk on them. For this reason, I allow them freely to collect on my path and on the walk that runs before my home. They become like a crackling, multi-colored sound carpet under my feet. One day, I was at home with some students and responded to a knock on the front door. It was a group of neighbors who had come to complain about the accumulation of what they saw as a neighborhood “eyesore.” They asked if I would clean up the leaves and they also politely offered to do it for me. I quickly agreed to comply with their request, much to the disillusionment of the students who felt that I had “copped out” and should have told them to which layer of Dante’s Hell they might go. I explained that we could reach a mutually satisfactory solution if they’d help me to rake the leaves into the baskets. They complied questioningly and begrudgingly, cursing the “hung-up” culture that would infringe upon an individual’s rights. The leaves finally collected, I gathered up the baskets and poured the leaves over my living room floor. Now the neighbors would have a more acceptable scene to gaze upon and I would have my wondrous fall color world to crackle beneath my feet to my heart’s content. (It was such a simple thing to sweep and vacuum when I so desired.) I had yielded to the culture, for I enjoy and need neighbors, but I also met my own needs. I enjoy and need fall leaves. It is possible that when we choose to give up one freedom of a lower order, we achieve a freedom of a still higher order. (By sweeping the leaves I still have neighbors who care. A man never knows when he will need a cup of flour.) The culture and society has the power, then, if we choose to be a member of it, to affect our thoughts, limit our choices, mold our behavior, teach us its definition of adjustment and show us what it means by love.

How you learn love, then, will be somewhat determined by the culture in which you grow.

The unique family and the individual’s culture may, at times, come into conflict. My parents and family, a large, warm, demonstrative, highly emotional Italian one, with strong personal ties and attachments, taught me an outward expression of love. But going to school and hugging and kissing the children and teachers was soon taught out of me as immature, effeminate and, to say the least, disruptive. I can recall the confusion in my mind when one of my classmates’ mothers came to my home and explained to my confused parents that I was not a suitable playmate for their children, that I was too “physical.” But it no longer became a conflict when it was explained, and I was able to understand, that when I was in our home and homes like ours there was a correct way of expressing our affection but in other homes it might be different. I was to observe and respond accordingly, using

my own judgment. By this time of course I was convinced that a handshake or even a warm smile could never mean as much pleasure for me as a warm embrace or a tender kiss. (I still believe it’s true.)

The child, so far, is continually at the mercy of his teachers —the environment in which he lives and those individuals (human persons) with which he’ll come into contact. They are responsible for teaching him to love. His parents, of course, will be his foremost teachers. They will have the strongest impact upon him and will teach him only the kind of love they’ve learned and only to the degree to which they’ve learned it. For they, too, have been at the mercy of their teachers and their culture. Teachers can only teach what they have learned. If the love they’ve learned is immature, confused, possessive, destructive, exclusive, then that is what they’ll pass on and teach to their young. If, on the other hand, they know a love that is growing, free, mature, they’ll teach this to their children. The child cannot resist his teachers. He has little or no power to do so. In order to exist at some level of comfort, he must accept what is offered, often without question. In fact, he has few questions for he has little knowledge and nothing to compare it to. He is spoon-fed his world, handed the tools to meet its requirements and the symbols with which to organize it. He is even taught what things are significant, what sounds to listen for and what they mean, and what is valueless. In other words, he is taught to be a particular type of human lover. To be loved in return, he need but listen, see and respond as others do. It is a simple matter but the cost to his individuality is great.

Language is the main means by which we transfer knowledge, attitudes, prejudices, feelings and those aspects which make personality and culture unique. Language is taught and learned in and through the family and society. Any normal child has the biological, mental and physical equipment to learn any of the world’s languages. He can execute, as an infant, all the sounds of the Universal Phonetic Alphabet. Although he will never be formally taught, by the time he is three or four years of age, he will be speaking, intelligibly, the language of his culture. He’ll learn the system of the language and the color and tone of that language. The words he’ll use and what they mean will be decided by those in his immediate world who will be teaching him. He’s unable to read, of course, and therefore he’ll learn his language orally. He is unaware that the language he learns will determine who he is, how he will see the world, how he will organize the world and how he will present his world to others.

All words have an intellectual content. We could have little difficulty defining, for instance, a “table” or a “home.” But each word also has an emotional content. It becomes a very different thing when you are asked to define a “home” as opposed to telling about the “first home” you can remember. We all know the superficial meaning of the word “free.” But if we were to try to define freedom in terms of ourselves in our present milieu, we would be hardpressed.

Timothy Leary, when he was doing his interesting work in language and awareness, called words: “The imprint (the freezing) of external awareness.” He explained that each time a parent or society teaches a child a new symbol he is given both an intellectual and an emotional content for the symbol. The content is limited by the attitudes and feelings of his parents and society. This process begins too early for the child to have much to say about what words will mean for him. Once “frozen,” the

attitudes and feelings toward the objects or persons to which the words refer become very stable, in many cases irreversible. Through words, then, the child is given not only content but attitude. His attitudes of love are so formed. A sort of map is set up, Leary continues, which is static and upon which all subsequent learning of attitudes and awareness take place. The child’s “map” will be determined by how closely the symbols resemble the facts and how they are taken in, assimilated, analyzed and reinforced through experience. The important language for establishing behavior, relationships, action, attitudes, empathy, responsibility, trust, caring, joy, response—the language of love, in other words, will thus be set.

From this point the child is still at the mercy of his teachers. He has been coerced, due to lack of experience and through his dependence, to trust his teachers and to accepting the love world they offer him as reality.

At about this time he goes to school. Great hope lies in education. Through education he’s offered his first possible escape—broad, new worlds to discover, full of different, exceptional and exciting attitudes and definitions of life and love. But he’s soon disillusioned. In place of freeing him to pursue his own world, he is now in a new environment often even less flexible than his home. Charles Reich makes this point dramatically in The Greening of America: “While the school’s authority is lawless, school is nevertheless an experience made compulsory by the full power of the law, including criminal penalties. (The option to go to private school does exist for families that can afford it, but this is not the students’ own option, and it is obviously available only to a few.) School has no prison bars, or locked doors like an insane asylum, but the student is no more free to leave it than a prisoner is free to leave the penitentiary.”

With the child thus imprisoned, formal education assumes as its major task the process of passing on the “accumulated knowledge of the past,” usually at the expense of the present and the future. It is a “feeding in” rather than a “leading out.” Everything is taught but seemingly what is necessary for the growing individual’s knowledge of self, of the relationship of his self to others. He finds many of his teachers lifeless individuals, devoid of enthusiasm, hope or joy. Erich Fromm said, “Living is the process of continuous rebirth. The tragedy in the life of most of us is that we die before we are fully born.” Modem education does little to guide the child from death to rebirth.

Neither the love of self—what educators call self-respect—nor love of others—responsibility and love for his fellow man—can ever be taught in our present educational system. Teachers are too busy “managing” to be “creating.” As Albert Einstein said, “It is nothing short of a miracle that instruction today has not strangled the holy curiosity of inquiry. For this delicate little plant lies mostly in need of freedom without which it will fall into rack and ruin and die without fail.”

So the individual, now fully grown, leaves our schools confused, lonely, alienated, lost, angry, but with a mind full of isolated, meaningless facts which together are laughingly called an education. He knows neither who he is, where he is, or how he got there. He has no concept of where he’s going,

how to arrive there nor what he’ll do when he gets there. He has no idea what he has, what he wants, nor how to develop it. In essence, he’s a type of robot—old before his time, living in the past, confused by the present, frightened by the future, much like the teachers who made him.

Nowhere along the way has he been directly exposed to love as a learned phenomenon. What he has learned of love he has come upon indirectly, by chance or by trial and error. His greatest exposure and often his only teaching has been through the commercial mass media which has always exploited love for its own ends. Frustrated poets with the aid of Metro-Goldwyn-Mayer and 20th Century Fox created Romantic Love for the world market. Their concept of love usually goes no deeper than boy meets girl, girl hassles boy (or vice-versa), boy loses girl, girl and boy gain insight through some magical stroke of fate, boy gets girl, and they live “happily ever after.” All this with variation.

A classic case in point was the success of Rock Hudson-Doris Day films. Rock meets Doris. Rock woos Doris with attention; gifts, flowers, kind words, wild chases and special manners. Doris keeps running from Rock’s advances for six reels. At last, Doris can resist no longer, she yields and gives herself to Rock. Rock carries Doris across the threshold. Fade out.

What would be most interesting would be to see what happens after the fade. Most certainly, any girl such as the character Doris portrays, who has run from a man for six reels, is frigid and any man who has put up with that kind of nonsense is impotent. They deserve each other.

Still, it’s this example and countless others that create for us the notion of what love is.

Deodorant ads, cigarette commercials, cosmetic companies play an additional role in strengthening this insane notion of love. You are assured that love means running together through a meadow, lighting two cigarettes in the dark or applying a deodorant daily. You are given the idea that love just “happens,” and usually at first sight. You don’t have to work at love—love requires no teacher—you just fall into love-—if you follow the right rules, and play the “game” correctly.

I would not want to form a partnership with an architect who has only a little knowledge of building or a broker who has a limited knowledge of the stock market. Still, we form what we hope to be permanent relationships in love with people who have hardly any knowledge of what love is. They equate love with sex, attraction, need, security, romance, attention and a thousand similar things. Certainly, love is all of these and yet no one of these things. Someone in love class once said, “I wish she could love me more and need me less.”

So most of us never learn to love at all. We play at love, imitate lovers, treat love as a game. Is it any wonder so many of us are dying of loneliness, feel anxious and unfulfilled, even in seemingly close relationships, and are always looking elsewhere for something more which we feel must certainly be there? “Is that all there is?” the song asks.

There is something else. It’s simply this-— the limitless potential of love within each person eager to be recognized, waiting to be developed, yearning to grow.

It’s never too late to learn anything for which you have a potential. If you want to learn to love, then you must start the process of finding out what it is, what qualities make up a loving person and how these are developed. Each person has the potential for love. But potential is never realized without work. This does not mean pain. Love, especially, is learned best in wonder, in joy, in peace, in living.

“Scientists are discovering at this very moment that to live as if to live and love were one is the only way of life for human beings, because, indeed, this is the way of life which the innate nature of man demands.”

—Ashley Montagu.

Man Needs To Love And Be Loved

It is true that in the last analysis each man stands alone. No matter how many people surround him or how famous he may be, in the most significant moments of his life he’l1 most likely find himself alone. The moment of birth is an “alone” world, as is the moment of death. In between these most significant moments there is the aloneness of the moments of tears, moments of struggle for change, moments of decision. These are times when man is faced only with himself, for no one else can ever truly understand his tears, his striving, or the complex motivations behind his decisions. Most men remain essentially strangers, even to those who love them. Orestes was alone when he decided to kill Clytemnestra, his mother, the act that freed him. Hamlet was alone when he made the decision to avenge his father’s death, the act that destroyed him and virtually all those about him. John Kennedy was alone when he made the famous Bay of Pigs decision, a decision which might have brought another great war upon the world. Most of us will never know the weight of such momentous aloneness, but each time we, too, make a decision, insignificant though it may seem, we are just as truly alone.

The concept of aloneness becomes even more devastating when we equate “aloneness” with

“loneliness.” These, of course, are two radically different things. One can be alone and never feel loneliness and, conversely, one can be lonely even when he is among people. We have all experienced degrees of aloneness. They have not always been frightening. At times, we’ve found aloneness not only necessary but challenging, enlightening, even joyful. We’ve needed to be alone with ourselves to become reacquainted with ourselves in the deepest sense. We’ve needed time to reflect, to tie loose ends together, to make meaning of confusion or simply to revel in dreams. We have found that we often do these things best alone. Albert Schweitzer stressed this poignantly in his comment that modern man is so much a part of a crowd that he is dying of a personal loneliness.

Most men seem able to contend with the knowledge of being alone as a unique challenge. But they do not choose aloneness as a permanent state. Man is by nature a social being. He finds that he feels more comfortable in his aloneness to the degree to which he can volitionally be involved with others. He discovers that with each deep relationship he’s brought closer to himself, that others help him to gain personal strength and this strength, in turn, makes it more possible for him to face his aloneness. So man strives consciously to reach out to others and bring them closer to himself. He does this to the degree to which he is able and to which he is accepted. The more he can ally himself to all things, even to death, the less fearful of isolation he becomes. For these reasons man created marriage, the family, communities, and most recently, communes, and some contend, even God.

There seems to be accumulating evidence that there is actually an inborn need for this togetherness, this human interaction, this love. It seems that without these close ties with other human beings, a newborn infant, for example, can regress, developmentally, lose consciousness, fall into idiocy and die. He may do this even if he has a perfect physical environment, a superb diet, and hospital-type hygiene. These do not seem to be enough for his continued physical and mental development. The infant mortality rate in well-equipped but understaffed institutions in the past decade has been appalling. In the previous two decades, before an understanding of the import of human response on child development was accepted, the statistics of infant mortality in institutions were even more horrible. In 1915, for example, at a meeting of the American Pediatric Society, Dr. Henry Chapin reported a study of ten institutions for infants in the United States where every child under two years of age died! Other reports at the time were similar.

Dr. Griffith Banning, in a study of 800 Canadian children, reported that in a situation where children whose parents were divorced, dead or separated, and where a feeling of love and affection were lacking, this knowledge did far more damage to growth than caused by disease and was more serious than all other factors combined. Skeels, a noted psychologist and educator, reported recently on his most dramatic long-term study conducted on orphaned children where the only variable was human love and nurturing. One group of 12 children remained housed in an orphanage. Each of 12 children, in a second group, was brought daily to be cared for and loved by an adolescent, retarded girl in an institution nearby. His findings have become classic in the literature. After over twenty years of study he has found that of those in Group I who remained in the institution, without personal love, all were at present, if not dead, either in institutions for the mentally retarded or in institutions for the mentally ill. Of those in Group II, who received love and attention, all were self-supporting, most had graduated high school and all were happily married, with only one divorce. Startling statistics,

indeed!

In New York City, Dr. Rene Spitz, in the past decade, studied children who lived in two different but physically adequate institutions. The institutions differed mainly in their approach to their charges in the amount of physical contact, and nurturing which the children received. In one institution the child was in contact with a human person, usually his mother, daily. In the second institution, there was a single nurse in charge of from eight to twelve children. Dr. Spitz studied each child in terms of factors of his development, medically and psychologically. He concerned himself with the child’s Developmental Quotient which included such important aspects of personality as intelligence, perception, memory, imitative ability and so on. All else being comparatively equal in the children who had the nurturing, the caring human contact, the Developmental Quotient rose from 101.5 to 105 and showed a continued rising trend.

Love is like a mirror. When you love another you become his mirror and he becomes yours. . . . And reflecting each other’s love you see infinity.

Those children deprived of nurturing started with an average Developmental Quotient of 124 and by the second year of study the Developmental Quotient had fallen to a startling 45!

There are several other studies by Drs. Fritz Ridel, David Wineman, and Karl Memiinger, all of which indicate a positive correlation between human concern and togetherness, and human growth and development. A very interesting and more thorough report on these studies and many of a similar nature can be found in a fascinating article by Ashley Montagu in the Phi Delta Kappan, May 1970.

So it seems the infant does not know or understand the subtle dynamics of love but already has such a strong need for it that the lack of it can affect his growth and development and even bring on his death. This need does not change with adulthood. In many cases, the need for togetherness and love becomes the major drive and goal of an individual’s life. It is known that a lack of love is the major cause of severe neuroses and even psychoses in adulthood.

A few years back, I spent Sunday evenings on a rap-rock radio station ir1 Los Angeles. It was an open line to the city. There were just two of us in a small, glass booth full of electrical equipment and outside, a sole telephone operator who managed six working lines. From 7:00 P.M. until 10:00 P.M. we talked to strange voices out of the city. The lines were never free, always one speaking, five waiting. The subject was love. It was interesting that the majority of calls concerned themselves with loneliness, inability to love others, confusion in interpersonal relationships, the fear of loving for fear of being hurt. Every one of the hundreds whose calls were received each evening wanted to love but found that they did not know how. One young man said, “I’m all alone in a small apartment on Melrose Avenue. There are all kinds of people like me on this street, everyone in his own apartment, all of us wanting to be with someone, none of us knowing how to break down the walls. What’s the matter with us, anyway?”

In fact, the fear of aloneness and lack of love is so great in most of us that it’s possible we can become a slave of this fear. If so we’re ready to part with even our true self, anything, to meet others’ needs and in this way hope to gain intimate companionship for ourselves.

There is a popular Broadway musical called Company which suggests that the only reason for love and marriage is so that one can have company, for better or for worse. It suggests that anything is better than nothing. In Wild Palms, William Faulkner has said, “If I were to choose between pain and nothing, I would choose pain.” So do most men.

The child will comply to unreasonable rearing habits for the love of his parents. The adolescent will lose his identity, will part with his self, to be accepted as one of a group. He’ll dress like his peers, wear his hair like them, listen to the same music, dance the same dances and take on the same attitudes. In adulthood, we find that the easiest way of being accepted is to be like those by whom we

wish to be accepted. So we conform. We take up bridge, we read the same bestsellers, we give similar cocktail parties, construct like houses, dress properly according to group standards, so that we can feel the sense of community and security. During courtship and the period of romantic love, we’ll change ourselves most radically for the approval and acceptance of the one we love, to the extent of the lyrics, “He likes curly hair and I never cared for curly, but he likes curly hair, so that’s my weakness now.”

In old age, we either will it or are forced to move into artificial environments for the aged to escape from a youthful world where we seem to be no longer useful or wanted, into a world where we can continue to feel one with the group.

No matter how much we deny it, we find that at every stage of life we move toward others—to parents when we are a child, to peers when we are adolescents, to possible sexual partners when young adults, to appropriate communities when adults, and to retirement communities when we are older on to our death.

We need others. We need others to love and we need to be loved by them. There is no doubt that without it, we too, like the infant left alone, would cease to grow, cease to develop, choose madness and even death.

“Love is patient and kind; love is not jealous, or conceited, or proud; love is not ill-mannered, or selfish, or irritable; love does not keep a record of wrongs: love is not happy with evil, but is happy with the truth. Love never gives up: its faith, hope and patience never fail. Love is eternal . . . There are faith, hope and love, these three; but the greatest of these is love”

-I Corinthians 13

A Question of Definition

To a great extent, the job of dealing with love is left to poets, philosophers and holy men. Scientists seem to avoid the subject. Abraham Maslow has stated: “It is amazing how little the empirical sciences have to offer on the subject of love. Particularly strange is the silence of the psychologists. Sometimes it is merely sad or irritating, as in the case of the textbooks of psychology and sociology, ‘particularly none of which recognizes the subject.”

Pitirim Sorokin, the famed Harvard sociologist, in his book, The Ways and Power of Love, explains why he feels the scientist has long avoided the discussion of love. He states: “The sensate minds emphatically disbelieve in the power of love. It appears to us something illusionary. We call it self- deception, the opiate of people’s minds, idealistic bosh, unscientific delusion. We are biased against all theories that try to prove the power of love and other positive forces in determining human behavior and personality; in influencing the course of biological, social, mental and moral evolution; in affecting the direction of historical events; in shaping social institutions and culture. In the sensate milieu they appear to be unconvincing, unscientific, prejudiced and superstitious.”

So, science and scientists remain silent on the subject. Some recognize it as a reality while others see it only as a fantasized construct to give a meaningless life meaning. Some condemn it as out-and-out pathological.

There is no doubt that love is not any easy subject with which to deal. Perhaps to be concerned with it is to “walk in where angels fear to tread.” But for such a powerful life force to remain ignored, uninvestigated, condemned by the social scientists, is ludicrous.

Perhaps the fears are founded in a semantic base. There is perhaps no word more misused than love. Francois Villon, the French Romantic poet, decried the fact that we constantly “beggar the poor love word to base kitchen usages and work-a-day desires.” A person may “love” God and “love” apple pie or the Dodgers. He may see “love” as sacrifice or dependency. He may think of “love” only in a male-female relationship; as a referent to sexual “love”; or he may see it only in saintly purity.

We are obliged as individuals to arrive at some understanding of love before we can deal with it. This, as we indicated earlier, is not an easy task and we’re often satisfied with giving it but small consideration. The task may even seem to us impossible and limiting of so broad a concept. For the scientist, therefore, it seems better to ignore it altogether.

It has, then, fallen into the hands of the saint who defines it in terms of a state of ecstasy; the poet who sees it in an exaggerated state of joy or disillusionment; the philosopher who attempts to analyze it in his rational, point-by-point, often obscure fashion. Love, it seems, fits perfectly into no one of these molds, for it may be all at once; a state of ecstasy, a state of joy, a state of disillusionment, a rational state or an irrational state.

Love is many things, perhaps too many things to be definitive about it. So, one who attempts a definition runs the danger of ending up being vague or nebulous and arriving nowhere.

One does not fall ‘in’ or ‘out’ of love. One grows in love.

We have already said that each man has learned and continues to learn love in a most individual and unique fashion. To expect him to understand the word when used by another, in anything but a general sense, is to expect the miraculous. If one says to another, “I love apple pie,” there would be little doubt what the person meant. Namely, that apple pie appealed to his gastronomic tastes. But, if the same person were to say to the other, “I love you,” this would be another matter. We would have a tendency to question: “What does he mean by that? Does he love my body? My mind? Does he love me at this moment? Forever?” And so on. A student in love class stated this precisely when she said, “The difference between saying, ‘I love you’ to a friend or a lover is that if you said ‘I love you’ to a friend, the friend would know exactly what you meant.”

It’s certainly clear to the reader who has come this far, that to define love presents monumental problems because one grows in love, so his definition changes, and enlarges. But there are certain things which can be said about love, certain common elements which can be examined and which may help in clarifying the subject for discussion. Sharing some ideas regarding these aspects of love is my purpose in writing this book.

Love is a learned, emotional reaction. It is a response to a learned group of stimuli and behaviors. Like all learned behavior, it is affected by the interaction of the learner with his environment, the person’s learning ability, and the type and strength of the reinforcers present; that is, which people respond, how they respond and to what degree they respond to his expressed love.

Love is a dynamic interaction, lived every second of our lives, all of our lives. Therefore, it is everywhere at every time. For this reason, I am put off by the phrase, “to fall in love.” I do not believe that one falls in or out of love. One learns to react in a particular way to a certain degree to a specific stimulus. That reaction will be the visible index of his love. He possesses no more love to “fall into” or “out of” than what he has and acts out at any precise moment of his life. It seems more accurate to say one grows in love. The more he learns, the more his opportunities to change his behavioral responses and thus expand his ability to love. Man is either constantly growing in love, or dying. Therefore, his actions as well as his interactions will change throughout his life.

If one wishes to know love, one must live love, in action. To think or read about love or carry on profound discourses on love is all very well, but in the last analysis, will offer few if any real answers. Thoughts, readings and discourses on love are of value only as they present questions to be acted upon. One will learn love only with fresh insight, with each new bit of knowledge, which he acts out, and which is reacted to, or his knowledge is valueless. As Rilke states so accurately, he must simply “love along someday into the answer.” One, in other words, lives the questions. But in order to live the questions, it is logical that one will have to pose them.

In living the questions he will learn many truths about love, among them that love is not a thing. It’s not a commodity that can be bartered for or bought or sold, nor can it be forced upon or from

someone. It can only voluntarily be given away. If an individual chooses to share it with all men alike, he’s free to do so. If he chooses to reserve it for a unique few, he may do this, also. His love is his to give.

Love is always open arms. If you close your arms about love you will find that you are left holding only yourself.

There are people available for purchase, body and mind, in the name of love. But it’s only a self- deceiver who believes that love can truly be bought. He may buy another’s body, his time, his earthly possessions, but he will never buy his love. One may choose to pretend love for a price. This is a dramatic art which has been perfected by many to the extent to which it is impossible for anyone to discern the deceit. But this game of playing love is not easy. The cost is great and never worth the price.

Love cannot be captured or tied to a wall. Love only slips through the chains. If love wills to take another course, it goes; and all the prisons, guards, chains or obstructions in the world aren’t strong enough to detain it for a second. If one human being ceases to will to grow in love with another, the other may play several parts to hold him. He may become a villain and threaten him; he may become generous and offer him gifts; he may become the schemer and make him feel guilty; he may become crafty and trick him into remaining, or he may change his own “self” to meet the other’s needs. But whatever he does the other’s love is gone and he will receive, for all of his energies, only an empty body, devoid of love—all but dead. So the prize for his efforts will be to live out his life holding on desperately and giving his love to a lifeless, loveless human frame. This, though it may seem revolting, is common practice, often performed for security, fame or fortune. The dynamics become even more grotesque when one considers that this dead-ended relationship forfeits all possibilities of a lover’s continued growth. Love is always open arms. With arms open you allow love to come and go as it wills, freely, for it’ll do so anyway. If you close your arms about love you’ll find you are left only holding yourself.

Love, of some type and degree, is present in all civilized men. A base for love and the potential for growth in love is also present in each man. Love is then a process of “building upon” what is already there. Love is never complete in any person. There is always room for growth. At each point in a person’s life, his love is at a different level of development as well as in the process of becoming. It is foolish to feel that one’s love is ever completely realized or actualized. Perfect love is rare indeed. It is to be wondered if any man has ever achieved it. This does not mean that it may not be possible, nor a goal devoutly to be strived for. In fact, it is our greatest challenge, for love and the self are one and the discovery of either is the realization of both.

He will perceive also that there are not “kinds” of love. Love is only of one kind. Love is love. One knows and expresses and acts out what he knows of love. He does this at each stage of growth. It’s like the child. When he’s born he knows little of love and all objects are loved equally. As he grows

in love, he differentiates with the growing knowledge he has and chooses responsive objects upon which to test his love. He loves his Pablum; he also loves his mother. His mother is more responsive and satisfying than his Pablum, it is hoped. So he grows more deeply in love with his mother. There are degrees of love, but there’s only one kind of love.

He will discover that love is trusting. Experience seems to convince us that only fools trust, that only fools believe and accept all things. If this is true, then love is most foolish, for if it is not founded on trust, belief and acceptance, it’s not love. Erich Fromm has said, “Love means to commit oneself without guarantee, to give oneself completely in the hope that our love will produce love in the loved person. Love is an act of faith, and whoever is of little faith is also of little love.” The perfect love would be one that gives all and expects nothing. It would, of course, be willing and delighted to take anything it was offered; the more the better. But it would ask for nothing. For if one expects nothing and asks nothing, he can never be deceived or disappointed. It is only when love demands that it brings on pain.

This statement sounds very basic and simple, but in practice, it’s difficult, indeed. There are few of us so strong, so totally permissive, so trusting, as to give without expectation. It is not surprising, since we are taught from infanthood to anticipate a reward for any effort expended. If we work, we demand a proper wage or we will quit. If we cultivate plants and trees, we expect flowers and fruits or we will chop them down. If we invest time in a task, we await some satisfaction or praise or we refuse to do it again. In fact, a demonstrated reward is often the sole motivation for learning.

But love isn’t like that. It’s only love when given without expectation. For instance, you can’t insist that someone you love, love you back. Even the thought is comical. Yet, unconsciously, it’s the manner in which most people live. If you love truly, then you have no choice but to believe, trust, accept and hope that your love will be returned. But there can never be any assurance, never any guarantee. If one waits to love only until he is certain of receiving equal love in return, he may wait forever. Indeed, if he loves with any expectation at all, he will surely be disappointed eventually, for it’s not likely that most people can meet all of his needs even if their love for him is great.

One loves because he wills it, because it gives him joy, because he knows that growth and discovery of oneself depend upon it. He knows that the only assurance he has lies within himself. If he trusts and believes in himself, he will trust and believe others. He’s eager to accept all they are able to give, but he can be certain of and depend upon nothing except himself.

The Buddhist says that you are well on your way to enlightenment when you “cease desiring.” Perhaps we can never reach this enviable state of peace, but to the extent to which we can live without demanding or expecting (except from ourselves), so can we be free from disillusionment and disappointment. To expect something from another because it’s our right, is to court unhappiness. Others can and will only give what they are able, not what you desire they give. When you cease placing conditions on your love you have taken a giant step toward learning to love.

Love offers itself as a continual feast to be nourished upon.

The human seeking love will find that love is patient. The lover knows that each person can enhance his knowledge of love and bring him closer to himself. He knows that experience and the knowledge people have of love differs. He’s excited by the idea that a relationship is a sharing, a mutual revealing of one’s knowledge of love. He knows that each man has an endless capacity to love, but that capacity will be realized differently in every man. Each person will grow at his own rate, in his own manner, at his own time, by way of his unique self. Therefore, it’s helpless to berate, judge, predict, demand or assume. Love must be patient. Love waits. This doesn’t mean that love sits passively forever, if necessary, for the person to grow. Love is active, not passive. It is continually engaged in the process of opening new doors and windows so that fresh ideas and questions can be admitted. It shares in knowledge and offers a proving ground for trying out what’s learned. It sets an appetizing, attractive, gourmet table, but it cannot force anyone to eat. It allows each the freedom to select and reject according to his taste. Love offers itself as a continual feast to be nourished upon, knowing that the more one samples, the more one ingests and digests, the greater become his energies. One can’t overeat. He will only have more to offer when others come to his feast. Love’s potential is limitless.

Love has a different manner of revealing itself through each man. To expect others to love as you do at the moment is unrealistic. Only you are you and can therefore respond to love, give love and feel love as you do. The adventure lies in the discovery of love in yourself and others. In watching love in others revealing itself, the soft, wondrous disclosure; the gentle, guarded unfolding.

Love isn’t afraid to feel and cries for expression. Cultures vary in their attitudes about emotional demonstrativeness. In some cultures the cries of the family at a funeral are expected. Friends would be surprised and shocked if it were otherwise. In other cultures, a calm, austere approach to death is highly approved and the show of emotion would be surely frowned upon. In America, for instance, most children are taught to “control” their emotions, to internalize their feelings. To be demonstrative, to laugh uproariously or weep bitterly are signs of immaturity. Only babies cry.

It isn’t surprising then that the adult finds it difficult to express strong feelings such as love. It’s difficult for him to verbalize what he feels; he doesn’t have the words or the practice. Latin lovers, for instance, have the reputation of being able to wax poetic appropriately to each new love. This is often revealed in the richness of emotionally-laden words to be found in their languages. French, Italian, Spanish are examples of such “romance” languages. To his words he often adds animation and gesticulation which enhance their emotional content. One can often understand such a person merely by observation, without a single word being understood.

Strong emotions are present in all people. Without feeling, we would not be human. It’s unnatural for man to hide what he’s feeling, though if taught to do so, he can learn. Love teaches a man to show what he is feeling. Love never presupposes that it can be discerned or felt without expression. Each time I return to my relatives in Italy, there’s no doubt about their love so sweetly and warmly

expressed. I instantaneously feel their excitement, and joy at my presence. I am caught up in their cries of happiness, exclamations of love, hugs, kisses, fondling, all affirmations of their feelings. I find this refreshing and delightful. I was raised in such an environment. My family always showed what they felt, openly expressed it. But it’s understandable that for those who are unaccustomed to such a shower of feelings, this experience can be an overwhelmingly frightening and even a depressing one.

Tears are all but disappearing in our culture. Certainly, a man doesn’t cry and even a woman is considered “emotional” if she weeps. So we must all cry alone or risk the title of “neurotic” or “odd.”

Recently, while viewing Man From La Mancha, the musical based upon Don Quixote, the novel of Cervantes, I found myself caught up in the trials of the poor misunderstood, ill-treated knight. It wasn’t difficult to relate to his need for recelebration of the beautiful, the romantic and the good in a world, where these were no longer considered of value. During his death scene, surrounded by those he loved, Quixote rose up, grabbed his lance, and was again ready to charge windmills for the love of his Dulcinea. The scene affected me greatly and tears flowed freely down my cheeks. A woman seated next to me poked her husband and whispered in wonder, “Look, Honey, that man’s crying!” Hearing this, I took out my handkerchief and loudly blew my nose as I continued to sob. She was so full of disbelief that a grown man could cry that I feel certain, to this day, she has no idea how the show ended. Love isn’t afraid to feel.

As human persons, we’re even more separated, physically. All over Europe and Asia, women and men alike kiss, embrace and walk hand-in-hand, arm-in-arm. There are certain cities in the United States where these acts would be considered a misdemeanor and such men and women would be jailed. Touching is still permitted among women, but strictly prohibited, from childhood, among males. Yet this touching offers a form of communication often far greater than words and expression. To put your arm about another or on his shoulder is a way of saying, “I see you,” “I feel with you,” “I care.” I have seen persons cry while others look on in uneasy embarrassment. Someone may offer a handkerchief, but seldom an embrace.

Babies and dogs are common visitors to love class. One young lady made the ‘observation, “It’s funny, but no one hesitates touching a baby and patting or hugging a strange dog. And here I sit sometimes dying to have someone touch me and no one does.”

Love has meaning only as it is experienced in the now.

At this, she passed among the students on all fours and, needless to say, her request was fulfilled. She concluded that perhaps it was necessary, though it seemed a shame, for the human being to let his needs be known. “I guess,” she said “that we don’t trust letting people know the fact that we all like to be touched because we’re afraid that people will misinterpret. So we sit back in loneliness and physical isolation.” Love has a need to be expressed physically.

Love lives the moment. Most people are either living in yesterday or busily working for tomorrow. They look back to “the good old days” with fondness and try to find in the present the security of the past. They soon discover that they are standing still and don’t realize that in our fast-moving world, to stand still is to move backward, and to move backward, is to die. The past is dead, it is unreal. It has value only as it effects the moment.

Other people live for tomorrow. They amass fortunes and store them away. They deny themselves daily to buy large insurance policies. They direct their entire process of life to some nebulous future or to death itself. They are so concerned with tomorrow that they have lost the purpose of life. They forget that there are no permanent goals. When they have a goal and reach it, they only find another to take its place. The Tomorrow they plan for never comes. Tomorrow only comes with death. Life. is not the goal, it is the process. It is the “getting there, not the arrival.” Thoreau said, “Oh God, to have reached the point of death only to find that you have never lived at all.” So it is for him who lives only in unreality that the past is dead or the future never comes.

There is only the moment. The now. Only what you are experiencing at this second is real. This does not mean, live for the moment. It means you live the moment. A very different thing. There’s value in the past. After all, it brought you to where you are. There’s value in the future, but it lies in the dream, for who can predict tomorrow? Only the moment has true value, for it’s here. Love knows this—it doesn’t look back-—it experiences the past and takes the best from it. It doesn’t look forward. It knows that tomorrow’s dream remains waiting and may never come. Love is now! It is only in the “now” that love is reality. Love has meaning only as it is experienced in the now. If one is looking at a flower, he is one with the flower; if one is reading, he is totally absorbed; if one is listening to music, he goes with the sound; if one is talking or listening to another, he is the other.

There’s an old Buddhist koan which relates the story of a monk who’s running from a hungry bear. He runs to a cliff and is required to jump or be eaten. As he falls, he grabs hold of a small clump of wood extending from the wall of the cliff. He looks down to find a starving tiger awaiting his fall. At that moment from the side of the cliff, come two hungry gophers who start at once to gnaw at the clump of wood from which he is suspended. There he is, hungry bear above, starving tiger below, and gophers to the side. Looking beyond the gophers, he sees a bush of wild strawberries and a giant, red, ripe, juicy one facing him, ready to be eaten. He plucks it and puts it in his mouth and eats it, exclaiming, “How delicious! Love revels in and grows in the moment and the joy of the moment.

So we find love is many things, though we know it’s not a thing in the sense that it cannot be bought or sold or weighed or measured. Love can only be given, expressed freely. It can’t be captured or held, for it’s neither there to tie nor to hold. It’s in everyone and everything in varying degrees and awaits actualization. It’s not apart from the self. Love and the self are one. There are not kinds of love, love is love; there are only degrees of love. Love is trusting, accepting and believing, without guarantee. Love is patient and waits, but it’s an active waiting, not a passive one. For it is continually offering itself in a mutual revealing, a mutual sharing. Love is spontaneous and craves expression through joy, through beauty, through truth, even through tears. Love lives the moment; it’s neither lost in yesterday nor does it crave for tomorrow. Love is Now!

“Who has drunk will drink, who has dreamed will dream. He will not gioe up that alluring abyss, that sound of the fathomless, that entrance into the forbidden, that effort to handle the impalpable and to see the invisible; he returns to it, bends over it, he takes one step forward, then two; and thus it is that one penetrates into the impenetrable and there it is that one finds the boundless release of infinite meditation.”

—Victor Hugo.

“There is no love where there is no will.”

——Gandhi.

Love Knows No Age

Man can learn, relearn or unlearn to the point of death. There is always more to discover. No matter how much knowledge he has, man can never know everything about anything. For this reason, the semanticist says all sentences should end with, “and, etc.”

Change is the end result of all true learning. Change involves three things: First, a dissatisfaction with self—a felt void or need; 5 second, a decision to change—to fill the void or need, and; third, a conscious dedication to the process of growth and change-the willful act of making the change, doing something.

Man is forever expressing his loneliness, his despair, his frustration, his loss of hope. In his day-to- day living he finds it difficult to share, to understand and to relate with others. He feels that he must cope with an inordinate amount of envy, fear, anxiety and hate. He’s constantly finding reasons for his

unhappiness in those about him and in his extemal enviromnent: “The political system is corrupt and will always be so.” “Wars are inevitable.” “Man is essentially evil and cannot change.” “Justice, peace and security is only for the wealthy; the common man is just a dupe of the system.” “Education is meaningless for the future, frozen into its own irrelevance.” “Existence is a dead-end street where death stands holding a bloody knife. There are no detours, no escapes.”

He sees himself as helpless in a situation that is hopeless. He appears intent upon looking for gloom. He seems more willing to accept the negative than the positive, always more prepared to doubt than trust. He is continually living in worry about the future and disillusionment regarding the past. He seldom finds himself at the source of his unhappiness. He scoffs at the idea that he can also elect happiness. In fact, man may be the only living creature with sufficient will and intelligence to choose happiness. How sad that he so often chooses despair. An optimist is seen as a fool. A lover is seen as a helpless romantic. If one enjoys life he’s called a “ne’er-do-well.” Man gets the feeling that if he’s joyful, he is certain to be punished for it tomorrow. The old adage that says, “All that’s good in the world is either illegal, 1 immoral or fattening,” is a case in point. The Christian ethic that convinces man that he is not on earth to know joy and satisfaction but rather to work and suffer his way to etemal peace with God, is another illustration. Man seldom questions the fact that ugliness and evil are to be found in the world. But he’s never as ready to accept that life also offers unlimited beauty and potential for joy as well as endless opportunities for pleasure.

Man becomes dissatisfied with himself and placing the blame on the unalterable aspects of a hostile world, he feels comfort in his self-created hopelessness. In this way, he relieves himself of all responsibility.

I am not suggesting that there is no evil in the world, nothing to fear, no corruption, no hatred, no malice, no animosity. One need only pick up any newspaper, watch any television screen, read any modem novel, or follow the world political scene to find all the unpleasantness and injustice he needs to reinforce a negative attitude.

But most men fail to consider that there are at least two major forces at work upon him in the complicated process of his adjustment. Certainly he must contend with the external forces, the natural forces. An earthquake, flood or bolt of lightning may destroy him or those he loves. An accident may permanently cripple him. But how he responds, reacts and lives with the handicap or through the earthquake or ?ood is another matter. This he can regulate. This he has some management over. Man has will and thus to a large measure guides his life. The devastating effects of external forces are not often experienced in a lifetime. So he is free to use his internal powers to make his own life. He can write his own dialogue, surround himself with the actors of his choice, paint his backdrop and arrange his background music. Then, if he doesn’t like the play he has created for himself, he has only himself to blame. But even then he has choice. He can get off the stage and produce a new play. A free man is free even in the darkest prison. Most people in despair have little knowledge and less will with which to make things better for themselves. They are convinced that things are unalterable and will remain that way forever. As long as man has will he will have some degree of control over his

reactions, responses and conclusions. To this extent he can assume responsibility for his own life. He is not totally at the mercy of forces greater than himself for he himself becomes a powerful force.

In order to change, then, man must trust that he is capable of change. If he is dissatisfied with his ability to live in love, for example, then he must face this fact but be convinced that he is able to do something about it.

Knowing that one is always capable of change, the second step lies in making the decision to change. Change does not occur by merely willing it anymore than behavior changes simply through insight. One can know that something is evil, painful or dangerous and still pursue it relentlessly. One can only move toward change when he willfully arrives at a proposal to do so. The obese gentleman who wants desperately to be slim and handsome in his bathing suit cannot do it by desire alone. He must plan a proper diet, stay on his diet, and engage in the right exercise. Otherwise, his wish will never become reality. He has the insight about how to achieve his goal, but until the moment of action all of his insight goes for naught. “To be is to do,” says the existentialist. “One only becomes real (human) at the point of action.” If one wants to love, it is apparent that he must move to love.

A total immersion in life offers the best classroom for learning to love.

The third step in change is perhaps the most difficult. It involves the actual processes of the relearning. All learning involves searching, finding, analyzing, evaluating, experiencing, accepting, rejecting, practice and reinforcement. It is often said that “love is its own reward.” If this means that by being a loving human being, one gets all the reinforcement he needs, it is only partially true. It means, also, that since society and man are often less than perfect, one is going to have, at times, to reinforce himself in order to continue to learn. The lover must often say, “I love because I must, because I will it. I love for myself, not for others. I love for the joy it gives me—and incidentally, only for that joy it gives to others. If they reinforce me it will be good. If they do not, it will be good, for I will to love.”

As in learning all things, man must be constantly alert, watchful, patient, observant, trusting, open- minded and not easily discouraged. He must be willing to experiment and be constantly evaluating and flexible. Life, and experiencing through the total immersions in living, offers the best classroom for learning to love. Even the greatest guru cannot give you love. He can only help by guiding you, by offering insights, suggestions and encouragement. You will not learn either by watching others live love; you will only learn as an active participant in love.

If one is dissatisfied, then, with his ability to live in love, it is good, for it may be the first step in finding the love he craves. But this is only a beginning. He must also will to change and move to change. Learning is a complicated life-long process. To learn to love is to be in constant change. The process is endless, for man’s potential to love is infinite.

“Just because the message may never be received does not mean it is not worth sending.”

—Segaki.

Trans. David Stackton.

Love Has Many Deterrents

Loving is never easy and the man who has decided to live in love is liable to find many barriers to his growing in love. But if he analyzes them carefully and astutely, he will be likely to discover that they are all artificial obstacles and mostly of his own making. In reality, they do not exist. They are, for the most part, simply excuses for not accepting the challenge of love. The man who falls a dupe to these deterrents condemns himself forever to remain much less than a total human being.

There is ample reason for man to blame his inability to love on factors apart from himself. He can insist, for example, that others are basically corrupt, depraved and unable to change. Therefore, would he not be foolish to try to influence them in any way? He can accuse man of being hostile by nature. Then isn’t his decision to avoid contact with others well formulated, unless he is a fool, seeking to be hurt? He can point up that the endless obstructions which lie in the way of love are insurmountable and historically have always been. Would not his trying to remove these barriers be like an insect trying to change the course of a giant river? A waste of time and energy! Or he may sit back comfortably in the assurance that he is already a lover, satisfied with his ability to love and be loved. Would he not be foolish, then, to gamble his present security for a doubtful future?

Man often hides comfortably behind these easily reinforced rationalizations for his entire life. He never sees their relationship to his inability to form serious, meaningful relationships or feel peak experiences.

If he creates an image of man as basically hostile and evil, for example, he is wise to be hesitant to reveal himself, much less reveal his love for him, for in doing so, he becomes susceptible to hurt. It’s easier and safer for him to sit alone, even if he feels a natural urge to relate to others, than run the risk of being shunned. His first assumption, of course, is that others will reject him. He seldom considers the fact that he runs an equal chance of being accepted. It does not seem possible to him that the person at the next table or across the room may have as great a need for him as he has for them. He selects to remain silent, alone and lonely and states as his basic defense, “What if I approach him and he turns away?” He seldom asks, “What if I extend my hand to another and he reciprocates with, ‘Yes, please join me.’ ”

I recall an evening in a bar in San Francisco. I was with several good friends. The conversation was animated. We were all sharing reactions to a wondrous day’s diversions. I saw a gentleman at a nearby table, sitting alone, staring at his half-filled cocktail glass. “Why don’t we ask him to join us? He seems so alone,” I said. “I know what it means to be alone in a room full of people.”

“Leave him be,” was the consensus of the others. “Perhaps he wants to be alone.”

“That’s fine, but if I ask him, he’ll have a choice.”

I approached the gentleman and questioned whether he would like to join us or if he would prefer being alone. His eyes lit up with surprise. He accepted happily. He was a visitor from Germany. As he joined our table, he told us that he had traveled the entire length of the United States without speaking to anyone except hotel receptionists, tour guides and waiters. Our invitation was a most welcome change.

Of course, it must be admitted that some of the fault rested with the German gentleman, for part of the responsibility lies with each of us to reach out. If we take the risk, it is true that we may be rejected, but we must also remember that all men are also prospective friends and lovers.

We tend to suspect man of evil more readily than of good. The evil about him makes the news media, the good seldom does. Considering the world’s population, there are relatively few murders, robberies, rapes or major crimes. But when a crime does occur, we are certain to hear of it. Not simply because it’s news, but rather because it sells newspapers. People seem to enjoy the sensational and find some pleasure in revulsion. But, in reality, the greater number of men are like ourselves. They do not voluntarily hurt another human being, steal from him or kill him. They can usually be trusted, are concerned and are friendly. Most live their lives without having to deal with

police, courts of law or lawyers. This fact is taken, rather, as what is to be expected of man. The evil he does, on the other hand, is magnified. It is of interest for it is the deviation. But we act, often, as if the deviation is the rule. Perhaps the greatest tribute to the good in man was paid by the young Anne Frank, a Iewess who literally spent most of her short life hiding from the Nazis in a small apartment in Amsterdam and finally met her death at their hands. She was still able to write in her diary shortly before her murder: “No matter. I still believe that at heart man is good.”

Man learns evil in the same manner in which he learns good. If he believes in a world of evil he will respond suspiciously, fearfully and be constantly searching for and assuredly finding the evil he seeks. If, on the other hand, he believes in a world of good, he will remain confident, trusting, vuh1erable and hopeful. To discern only the evil in the world and live willingly in its shadow, is to set up another obstacle to love.

Another deterrent to love is the rationalization that there are too many forces prohibiting a sane person to love. Though man, by nature, is a creator, he creates life and builds upon knowledge. He is often taught from an early age that his very survival depends upon his ability to destroy. He is pictured as being constantly at the mercy of a series of possible destructive forces. In fact, it is made to seem as if destroyers are those who actually thrive in the culture. It is understandable, then, that he has little incentive to use his creative strength to battle the forces of destruction. It seems so hopeless. Man is happiest when he is creating. In fact, the highest state of which man is capable lies in the creative act. Love always creates, it never destroys. In this lies man’s only promise.

Real love always creates, it never destroys. In this lies man’s only promise.

Thornton Wilder ends his amazing little philosophical novel, The Bridge of San Luis Rey, with the following statement: “There is a land of the living and a land of the dead. The bridge is love, the only truth, the only survival.”

If man looks at the unloving and unloved in the world, the problem seems so overwhelming it often causes him to completely give up hope. If he studies the past, he finds that selfishness, greed, Wretchedness and affliction have existed since the beginning of history. He is convinced that men have always, assumes therefore, will always, covet more and different things and flight among themselves to acquire them; Catholic against Protestant against Jew, Communists against Socialists against Capitalists, rich against poor against middle class, black against white against yellow, genius against intelligent against ignorant. His proof and support rests in the argument that it has always been, so it always will be and he as an individual is helpless to change it. It’s true that the problems of poverty, starvation, wars, ignorance, prejudice, fears, and antipathy are with us in abundance. There are few individuals who have the power to stop prejudice, universal poverty or world wars, but this is not the question. The only question we can justly ask of ourselves is, “What can I do?” The answer is usually simple and answerable, especially if we truly care and are willing to assume the responsibility.

I met a young Chinese refugee in Hong Kong. He was one of a family of eleven, all of whom were on the point of starvation. Though he had some knowledge of English, he wanted desperately to learn so as to be able to secure a well-paying position in the city. By my contributing a few dollars for books and enrolling him in the English Speaking Society, he was able to find the means of bringing his family back to a well functioning unit. He was determined to repay me upon graduation. I refused and asked him to find another youth, like himself, and offer him a similar chance. To date, we have sent three young men through school. I have not in this way solved the refugee problem in Hong Kong, but I have helped three families to survive. If each person were to assume a small responsibility, things could be made better. Helping through large charity systems is fine, but it has lost its personal value, its joy and satisfaction in perceiving and experiencing the results. Things can be changed. Nothing is irreversible. Perhaps I personally cannot do much about the infant mortality rate or the problems of the aged, but I may give some of my time to making a child’s day or an elderly person’s remaining days on earth more pleasant.

A little knowledge of love and the satisfaction therewith is also a deterrent to growth in love. If man finds that he has the love of a few in his life and if he is able to love them in return, he assumes that is all he needs to know of love or can expect to find. What else can there be? He does not suspect that love is illimitable, deep, infinite and that the potential for greater security, joy and growth is his. He does not think about the possibility that at another place, at that moment, there is someone in need of his love. It often takes a severe emotional shock to awaken man from his lethargic state. Let’s say he now has a wife whom he loves and who loves him; they have a fair sex life; two children who are growing in his image; a home with thick walls and large locks to protect him from the outside world; a good job, and some money in the bank to secure his future. He has everything. But what happens, as

in the story of Job, if one thing after the other falls about him? His children drop out and join a hippy commune; his wife finds a lover; he loses his position, his walls tumble; the bank crumbles; or his locks are picked? He has several choices. He may endeavor to find the same life again, which is impossible. One can never relive anything, for it remains always, at best, only a poor copy of the original. He may go mad or take his life. He may become bitter and live without trust, hope or concem. Or, he has the choice to learn from his encounter, grow from the experience and start afresh, with new knowledge, hope, possibilities and alternatives.

When change confronts man he often uses the excuse that he’s too old to change, too old to learn. He says, “You can’t teach an old dog new tricks.” This analogy when directed to man is as condescending as it is untrue. Even an “old dog” can learn new tricks. The real issue is that he lacks motivation or is simply too lazy. Man’s ability to learn will always be greater than that of the “old dog” and to compare them, is to degrade the very strength that keeps a dog a dog but makes man human.

Each day we are offered new means for learning and growing in love. Each day in which we become more observant, more flexible, more knowledgeable, more aware, we grow in love. Even the seemingly most insignificant thing can bring us closer to ourselves and therefore to others. If, at each moment, we listen and learn—-the seagulls’ cry on a deserted, windy beach will tell us as much about life, living and death, as the tragedy which destroys our home and loved ones. As the Japanese haiku says, “My barn having burned to the ground, I can now see the moon.” There is insight, knowledge and discovery in the barn as well as the moon. Now the farmer knows both.

One must never be satisfied with his ability to love. No matter where he is, it is always just a beginning.

Finally, a great deterrent to love is found in anyone who fears change, for as suggested above, growing, learning, experiencing is change. Change is inevitable. There is only one thing of which you can be certain and that is change. To deny change is to deny the only single reality. Attitudes change, feelings change, desires change, especially love changes. There is no stopping it, no holding it back; there is only going with it. There is a Hindu tale about a man in a small boat rowing up a fast-flowing river against the current. After a great battle, he finally discovers that the effort is futile, so he gives up, raises his oars and begins to sing. The moment teaches him a new way of life; only when he goes with the changing river is man truly free.

Deterrents to love are man-made. Love will not be deterred. Love flows like the river; always itself, yet ever changing, recognizing no obstacle.

“We are one, after all, you and I, together we suffer, together exist, And forever will recreate each other.

—Teilhard de Chardin

To Love Others You Must First Love Yourself

To love others you must love yourself. We have already stated several times that you can only give to others what you have yourself. This is especially true of love. You cannot give what you have not learned and experienced. Since love is not a thing, it is not lost when given. You can offer your love completely to hundreds of people and still retain the same love you had originally. It is like knowledge. The wise man can teach all he knows and when he’s through he’ll still know all that he has taught. But first he must have the knowledge. It would better be said that man “shares” love, as he “shares” knowledge but he can only share what he possesses.

Loving oneself does not imply an ego centered reality like the old witch in Snow White who reveled in the process of gazing into her mirror and asking, “Mirror, mirror on the wall, who is the fairest one of all.” Loving oneself does mean a genuine interest, caring, concern and respect for oneself. To care about oneself is basic to love. Man loves himself when he sees himself with accuracy, genuinely appreciates what he sees, but is especially excited and challenged with the prospect of what he can become.

Each man is unique. Nature abhors sameness. Each flower in the field is different, each blade of

grass. Have you ever seen two roses alike, even among the same variety? No two faces are exactly alike, even in identical twins. Our fingerprints are so singularly ours that we can be positively identified by them. But man is a strange creature. Diversity frightens him. Instead of accepting the challenge, the joy, the wonder of variation, he usually is frightened of it. He either moves away from or endeavors to twist uniqueness into sameness. Only then does he feel secure.

Each child born is an unmarked creation, a new combination of wonder. In general, his human anatomy is similar to others, but on a subtle level even how his anatomy functions will vary with each individual. His personality development seems to have common elements which affect it; heredity, environment, chance. But there is surely an additional element, not yet scientifically identifiable, which can be called the “X” factor of personality, that special combination of forces which act upon the individual so that he will react, respond, perceive as himself, alone. The child is exceptional but most learning which he will receive from birth will not afford him the freedom to discover and develop this uniqueness.

As we have indicated previously, the true function of a child’s education should be the process of helping him to discover his uniqueness, aiding him toward its development, and teaching him how to share it with others. Rather, education is an “imposition” of what is called “reality” upon the child. Society, on the other hand, should be the agent through which his uniqueness is shared, for it is in dire need of fresh, new approaches to individual and group living. But society has the idea that what has been for centuries, even if it has not proven true, is the best way. This fallacy, if adhered to, leads individuality to its doom.

Each child offers a new hope for the world. But this thought apparently frightens most people. What would society be like made up of all “individuals?” Would it not be unruly and lead to anarchy? We recoil in horror at this thought. We feel more comfortable with a “silent majority.” We distrust and suspect “oddballs.” The family must make the child “?t” into the societal scheme of things. Education is afforded a similar role. It is most successful when it maintains the status quo, when it makes what we call “good citizens.” The definition of a “good citizen” is usually one who “thinks, behaves and responds like everyone else.” Educators also feel that there is an essential body of knowledge which it is their duty to implant in each child. Their defense of this is that they are teaching “the wisdom of the ages.”

To love oneself is to struggle to rediscover and maintain your uniqueness. It is understanding and appreciating the idea that you will be the only you to ever live upon this earth, that when you die so will all of your fantastic possibilities. It is the realization that even you are not totally aware of the wonders which lie dormant within yourself. Herbert Otto says only about 5 percent of our human potential is realized in our lifetime. Margaret Mead has hypothesized that 4 percent is discovered. What of the other 95 percent?

The psychiatrist, R.D. Laing, has written: “We think much less than what we know, we know much

less than what we love, we love much less than what there is, and to this precise extent we are much less than what we are!”

There is a you, lying dormant. A potential within you to be realized. It does not matter whether you have an intelligence quotient of 60 or 160, there is more of you than what you are presently aware of. Perhaps the only peace and joy in life lies in the pursuit of and the development of this potential. It’s doubtful that one will realize all of his “self” in a lifetime even if his every moment were dedicated to it.

Goethe has Faust discover this when he says, “If on this earth one moment of peace could I find, then unto that moment would I say, ‘Linger awhile, so fair thou art.’ ” If he rests from his searches even for a brief moment, he is courting the devil, for there can be no peace in man’s struggle to become. The Gospel of St. John tells us that our house has many rooms, each with its own wonders to disclose. How can we be content to let spiders, rats, decay and death take over our house?

Love and the self are one and the discovery of either is the realization of both.

What may be is always potential for discovery. It’s never too late. This knowledge should give man his greatest challenge—the pursuit of self—his own personal Odyssey; discovering his rooms and putting them in order. It should challenge him not only to be a good person, a loving person, a feeling person, an intelligent person, but the best, most loving, feeling, intelligent person he is capable of. His search is not in competition with anyone else’s. He becomes his own personal challenge.

So loving yourself involves the discovery of the true wonder of you; not only the present you, but the many possibilities of you. It involves the continual realization that you are unique, like no other person in the world, that life is, or should be, the discovery, the development and the sharing of this uniqueness. The process is not always easy, for one is bound to find those who will feel threatened by a changing, growing you. But it will always be exciting, always be fresh and like all things new and changing, never be dull. The trip into oneself is the grandest, most enjoyable and longest lasting. The fare is cheap; it merely involves continual experiencing, evaluating, educating, trying out of new behavior. Only you can be the final judge in determining what is right for you.

When man has love he is no longer at the mercy of forces greater than himself, for he, himself, becomes the powerful force.

The Western culture has been a culture of competitors. The worth of a man has always been measured by how much more he has than other men. If he has a larger home, a more powerful car, a more impressive formal education, he must be a better man. But these are not universal values. There are cultures whose highest adulation goes to the holy man, the teacher, who has spent his lifetime in self- discovery and has nothing of monetary value to show for it. There are cultures who value joy and peace of mind over property and busyness. They hypothesize that since all men must die, whether poor or rich, the only real goal of life is the present joy and the realization of self in joy, not the collection of material things. There are areas where nature has taught and continues to teach this lesson with a vengeance. What good is accumulating objects or building large villas at the base of Mt. Etna? What is the purpose of permanent housing where monsoons come annually and wash away all but the people and the land?

The Thirties in the United States caused many to take a deep look at values. After the Market crash, men who had put their store in “things” went under with them, even to suicide. Other men, who had put their hope in themselves, sighed, “I did it once. I can do it again,” and went out to create anew. Loving yourself involves appreciating the value of you above all things.

Loving yourself also involves the knowledge that only you can be you. If you try to be like anyone else, you may come very close, but you will always be second best. But, you are the best you. It is the easiest, most practical, most rewarding thing to be. Then it makes sense that you can only be to others what you are to yourself.

If you know, accept and appreciate yourself and your uniqueness, you will permit others to do so. If you value and appreciate the discovery of yourself, you will encourage others to engage in self- discovery. If you recognize your need to be free to discover who you are, you will allow others their freedom to do so, also. When you realize you are the best you, you will accept the fact that others are the best they. But it follows that it all starts with you. To the extent to which you know yourself, and we are all more alike than different, you can know others. When you love yourself, you will love others. And to the depth and extent to which you can love yourself, only to that depth and extent will you be able to love others.

“Man has a pretty static picture of the world, accidentally or forcibly imprinted upon him by means of chains of conditioned associations. Man believes his imprint board is reality.”

—Timothy Leary

To Love You Must Free Yourself Of Labels

In a previous section we discussed the import of words in the process of learning to love. We mentioned that words caused a permanent imprint, a freezing of reality, through which all future learning and perception would then be filtered. This filtering is a great hindrance to love. If your learning has caused an avoidance reaction to black men or Jews or the Mexican, or those with different manners from yours, a different dress, then your possibilities of loving these human beings will be minimized.

Man created words to free himself. He created language so that he could communicate himself to others and allow them to do the same. He intended words to help organize and record the wisdom of the past and dreams of the future. He found that words helped him in organizing his environment. But most of all, he used words to think with and to create. He developed language to free himself, never imagining that he would become a slave to language. He found that the very same labels he originated to merely stand for something soon had the power to become the thing itself. Man began to act as if the word was the thing. With names in hand, man assumed he had the ‘thing’ in hand. He inferred, therefore, that he could communicate it to others simply by using the label. When he discussed a Frenchman, he supposed that all people had the same static picture of a Frenchman as he. This, of course, was not so and thus his ability to communicate began to break down. The label tricked man

into becoming its slave and distanced him from other human beings. He never stopped to ask what he or others actually understood about another individual when he labeled him “Communist,” “Catholic,” “Republican,” “]ew.” He did not bother to ask if the “communist” was also a good father, a gentle man, a dedicated teacher, a good human being, a warm lover, a pacifist, a dreamer or a creator. The negative stimuli produced by the word, “communist,’ were enough to convince him he could “hate” the individual. So it went.

When I was a child, it was popular to call Italians “Dagos” and “Wops.” We moved into a neighborhood which had never had an Italian family living among them. Immediately the label went to work. “Dagos are all members of the Mafia.” “A Dago in the neighborhood will cause property values to go down.” “The peace of the neighborhood is gone. Dagos are such boisterous, emotional people.”

For months we were ignored, though we tried to break down the barriers. We had been pushed aside, categorized. The connotation toward ‘Dagos’ caused our neighbors to believe they knew us and be comfortable in rejecting us.

What they didn’t know about us was far greater and more significant than what they did know. They didn’t know that mama was a singer and our house was always full of music.

Mama, too, had great secret medical knowledge and while she was our physician none of the family was ever sick. Her treatments consisted mainly of two major remedies; “garlic,” which was a general cure-all for daily use, and “polenta,” which was a scalding hot, thick mixture of com flour and water, placed steaming hot on our chests when all else failed. The garlic was tied, rubbed and raw, in a small handkerchief around our necks each morning before school. Strangely enough, we were never ill. (I have developed a theory about this. With raw garlic on us, no one ever got close enough to pass on germs.) The polenta worked miracles, too, though I’ve never been able to figure out what pharmaceutical value it had. Perhaps it was the realization of the fact that whatever illness was present was minor compared to the second degree bums left by the steaming hot com meal on our skin. These were already reason enough for neighbors not to exclude us. What better medical remedies could have been shared? What arias and operas will they never again have the opportunity to hear so superbly performed?

Papa made wine which was fit for a Papal altar. He also demanded continual growth in the education of all of us. His favorite question, asked of each of us after every meal, was “Well, what new thing did you learn today?” He was always eager to learn and continually concerned about his own education. We thought the wine superb. In fact, I was weaned on it. The practice of sharing new knowledge was not as appealing. When he was with us for dinner, the family was busy going through the encyclopedia looking for something new to teach papa, while he sat back, curled his moustache and sipped his wine. Our exclusive neighbors were missing this intellectual exchange and above all, the palatal delights of home-made “vino rosso.”

To be able to love one must control his linguistic environment, “defrost” all preconceived notions brought on by old word traps. Buckminster Fuller is said to have been so concerned with his being controlled by words that he spent two years, mostly alone, studying what words meant specifically to him. Only after a two-year period did he feel sufficiently free from language traps to use language as an agent for bringing things closer rather than pushing them away, for making language his tool.

The effect of language on personality is now the science of psycholinguistics. The psycholinguist is “repeatedly showing how language affects behavior. There are those who have created a positive linguistic environment. Their words are joyful, pleasant, reflective of the beautiful, reinforcing of the good. Others are controlled by negative words. Their lives are made up of callous words, caustic, lifeless, dreary, tedious, depressing Words, devoid of joy, unpleasant, reinforcing of the negative.

If one wishes to be a lover he must start by saying ‘YES’ to love.

Perhaps the most positive word in the English language and that most conducive to continued growth in love is “Yes.” “Yes” is the best ‘defroster’ of frozen symbols and ideas. A lover says “Yes” to life, “Yes” to joy, “Yes” to knowledge, “Yes” to people, “Yes” to differences. He realizes that all things and people have something to offer him, that all things are in all things. If “Yes” is too threatening, he tries “Maybe.”

To say “No” to something, is to exclude it; to exclude it is to close it out, perhaps forever.

James Joyce, in his masterpiece, Ulysses, ends the book with the greatest affirmation in literature when he has Molly sigh several pages of “Yesses.” “Yes. Yes. Yes. Yes!”

Dag Hammarskjold wrote in his fantastically personal Markings, “I don’t know who—or what—put the question, I don’t know when it was put. I don’t even remember answering. But at some moment I did answer “Yes” to Someone or something. And from that hour I was certain that existence is meaningful and that, therefore, my life, in self-surrender, had a goal.”

If one wishes to be a lover, he must start by saying “Yes” to love. He can do this by looking carefully and coolly at the words he uses when he talks to his wife and children, to his boss and co-workers, to his neighbors and close friends, to his salesgirl and the gas station attendant.

For the words you use will tell you what you are, what you have seen, what*you have learned and how you have learned it. For you are your words and they can be a long and important step on the road to discovery of love.

“Only when it is a duty to love, only then is love eternally and happily secured against despair.

—Kierkegaard

Love Involves Responsibility

Before man can love all men or any man, his first responsibility in love is, and always will be, to himself. The Gospel statement, “You shall love your neighbor as yourself,” presupposes self-love and suggests that man “shall” love others to the extent to which he loves himself. We have already discussed this love of self in a previous section, so we shall not belabor the fact. Suffice it to say that only to the depth and the extent to which one feels responsibility to grow in self-love, so can he feel this toward helping others to do so. All men are related to a greater or smaller extent, interconnected, and each man who comes closer to himself in any way comes closer to others.

Albert Schweitzer said repeatedly that as long as there was a man in the world who was hungry, sick, lonely or living in fear, he was his responsibility. He affirmed this by living a life in this belief; a life of the loftiest order, the highest fulfillment, the greatest joy, the most elevated dignity and, therefore, the most towering love.

Society has not produced many Schweitzers, but all of us know and accept some level of responsibility to ourselves and to others. The fact is, to be human is to be responsible.

Many men find it difficult to assume full responsibility for even themselves, let alone for another individual, or a group of individuals. Therefore, the idea of being accountable for a “family of man” seems to them inconceivable, unrealistic, idealistic nonsense.

When love is truly responsible, it is one’s duty to love all men. Man has no choice but to accept this duty, for when he does not, he finds his alternatives lie in loneliness, destruction and despair. To assume this responsibility is for him to become involved in delight in mystery and in growth. It is to dedicate himself to the process of helping others to realize their love through him. Simply speaking, to be responsible in love is to help other men to love. To be helped toward realizing your love is to be loved by other men.

Men have been known to approach this responsibility to love from different means, but the ends are always the same, universal love. Some begin with a deep personal involvement with another individual. From this, they learn that love cannot be exclusive. They learn that if love is to grow, it will need diverse minds, innumerable individuals, and the exploration of varied paths. No one human being can afford him all of these things, so he must enlarge his love to include all mankind in his love. The more all encompassing his love, the greater his growth. The love of humanity is the natural outgrowth of love for a single individual. From one man to all men.

Herbert Otto states: “Only in a continuing relationship is there a possibility for love to become deeper and fuller so that it envelops all of our life and extends into the community.” For only a deep relationship offers “the adventure of uncovering the depth of our love, the height of our humanity. It means risking ourselves physically and emotionally; leaving old habit patterns and developing new ones; being able to express our desires fully, while sensitive to the needs of the other; being aware that each changes at his own rate, and unafraid to ask for help when needed.”

Others have felt that anything less than love of all men is not love at all. They argue that who does not love all men sincerely cannot love even a single person deeply, since all men are one. Loving all men is the same as loving each man.

Kierkegaard is one of the chief proponents of this idea. He says, “It is, in fact, Christian love which discovers and knows that one’s neighbor exists and that . . . it is one and the same thing . . . everyone is one’s neighbor. If it were not a duty to love, then, there would be no concept of neighbor at all. But only when one loves his neighbor, only then is the selfishness of preferential love rooted out and the equality of the eternal preserved.”

In dedicating himself to humanity, Schweitzer, on the one hand, finds it to be only an extension of the love he felt for each living thing. Through loving a single person, Herbert Otto feels that one acquires enough strength to assume the responsibility for the community of man. No matter which way it is approached, one finds that love is not selfish and exclusive, but selfless and inclusive. The fact remains that the world still finds it difficult to accept universal truth. If one loves only himself, he’s

labeled egocentric, self-centered and selfish. If he loves himself and a small community, including a wife and family in his love, society will call him a true lover and praise him as a sound man. But, if he loves all men in an extremely high-minded manner, he’s often ridiculed by the world as naive, fanciful and foolish.

The third responsibility love implies lies in the continued assurance that it will always be directed in growth, personal growth as well as the growth of selves and those whom we love.

Antoine Saint-Exupery has defined love as “the process of my leading you back to yourself.” In this statement, he is confirming his faith in man’s ability to guide another to love. He suggests that a growing Self brings with it a growing love.

Love abhors waste, especially waste of human potential.

At a recent wedding ceremony where two young people were permitted to write their own marriage vows, they repeated, “I will love you as long as I can help you to grow in love.” This, it seems to me, is the essence of loving another, to assure them that we are dedicated to their growth, to the actualization of their limitless potential. This couple was determined to use their united energies in helping each other through the endless process of discovering who they really are, then revel forever in this continually changing knowledge and discovery. It is only in this way that human love can flourish. As soon as the love relationship does not lead me to me, as soon as I in a love relationship do not lead another person to himself, this love, even if it seems to be the most secure and ecstatic attachment I have ever experienced, is not true love. For real love is dedicated to a continual becoming. When, for any reason, this process ceases, love becomes tedious, listless and is doomed to fade. It decays. It destroys itself. So, what may seem like a beginning is, in actuality, only the beginning of an end.

As soon as the love relationship does not lead me to me, as soon as I, in a love relationship, do not lead the other person to himself, this love, even if it seems to be the most secure and ecstatic attachment I have ever experienced, is not true love.

Responsibility of any kind can seem intimidating and for this reason man may often be afraid of truly deep relationships with other human beings. A relationship suggests to him the most extreme of responsibilities. It implies a burden, a restriction to his freedom, seldom the converse. A student in love class, for instance, commented, “I’ve always been afraid of a deep relationship because of the responsibility it seemed to impose. I was afraid of the demands it would make of me and I worried that I wouldn’t be able to meet those demands. I was amazed to find that when I did get the courage to form a relationship, I actually became stronger. I acquired two minds instead of one, four hands, four

arms, four legs and another’s world. In joining forces with someone, I got twice the strength to grow, with twice as many alternatives. Now, it’s easier for me to love others. I am stronger and I am less afraid.” He had discovered an important insight.

Another responsibility of love is to create joy. Joy is always an integral part of loving. There is joy in every act of life, no matter how menial or repetitive. To work in love is to work in joy. To live in love is to live in joy. You may not have before you the most creative and satisfying day to live, but you know that live it you must. You can make the day a chore; dull, nerve-wracking, frustrating, a waste of time. Or the same day can be taken on with energy, enthusiasm and a determination to make it one of the best days of your life, for yourself and those about you. To live each moment as if, as the popular saying goes, “it is the last day of your life.” It is the same day, requiring the same energy and hours. The difference is that you can choose to live it with joy or live it in misery. Why not choose joy?

In one of my classes I ask my students to write on the subject, “If I were to die tomorrow, how would I live tonight?” Answering this question always brings great insight. In working on this exercise students find that in so many ways they are wasting time, precious time. That though, in their youth, death is far off, even for the longest lived of all, time of life is limited. Why not live it in joy?

Responsible love needs expression. Love is communication. As man must assume the responsibility for expressing his joy, in like manner he is responsible for letting his sorrow and loneliness be known. In reality, it seems the more devastated one becomes, the more he builds defenses, rationalizations, and creates walls behind which to grumble. He is misunderstood. He is unloved. He is abused. He is exploited. In other words, the more he seems to need loving understanding, the more he moves away from any possibility of receiving it. The “pouting syndrome” is the perfect example of this. If one needs, one must let others know of his need or it can never be met. Even lovers are not mind readers. Oftentimes, when people have allowed themselves to express a need, they are surprised at the response they have received. For example, “I had no idea you were lonely.” “You always seemed so self-sufficient, so composed, so fulfilled. I’m really pleased to know you’re human.” As one shows others he loves them, so must he reveal to them his need for love. You cannot assume that people, even those most close to you, will know and understand your unexpressed needs and feelings. If you want people to know you, you are responsible for communicating yourself to them.

Responsible love is accepting and understanding. Love grows at different rates and in different directions in all individuals. Love in marriage, or any close relationship, for example, is the process of growing hand in hand, but separately. Separately, because it’s impossible to expect that two individuals, even in love, will grow at the same rate and in the same direction. This means that one may not always totally understand or appreciate another’s growth or its resultant behavior. But love helps us to accept the fact that the other individual is behaving only as he is able to behave at the moment. To ask that he act otherwise is to ask the impossible.

Responsible love is empathic. The word, empathy, though perhaps overused, is still a great word. It means to “feel” with. It does not imply “total understanding.” We know that we can never really understand another person, but since in love we have so many positive and common elements, there is hope. If behavior is contradictory to our expectations or annoying or a disappointment to us, it must be seen as merely a passing phase. Love is always changing and always learning. Love offers the greatest flexibility. It asks only that we accept behavior as it is expressed in the knowledge that this behavior is not permanent. It is not a matter of forgiving. Forgiving, in a sense, is condescending. It is a matter of accepting the person unconditionally for what he is at the moment, realizing that what he is today is not what he will be tomorrow. A lover is, then, constantly watching, listening, waiting, feeling, adjusting, readjusting and changing.

If two people grow apart in love, it is usually due to the fact that one or the other refuses to grow or change. In this case, a lover can either decide to adjust to the behavior, ignore it or, after all else seems useless, move away from it, and leave. You may ask the question, “But is ‘moving away’ really love?” Indeed, it is. For if a lover stands in the way of another then he is no longer loving.

Man has no choice but to love. For when he does not, he finds his alternatives lie in loneliness, destruction and despair.

Responsible love has at its universal core man’s humanity. In the deepest sense, we all have a core of humanness. The greatest thing a man can be is a human being with the strengths and the frailties implied in the meaning. The world’s greatest figures have often been the most “human” and have been the least reticent to reveal it. On earth, ]esus wept, felt loneliness, disappointment, pain and despair. Only in this way could he understand what it was to be a man. Buddha knew the most basic human characteristics; confusion, egocentricity, pride, envy, even indigestion. Gandhi felt humility, exhaustion, physical deprivation, illness, frailty, torture, and suffered from what he called the “temporal accident of his own personality.” In varying degrees we have all felt what great men such as Jesus, Buddha, and Gandhi felt. To that degree we have empathy with them— a common tie.

We have often heard or said to ourselves, “It’s only human.” We say this because we know that perfection is a concept that for most of us is far off. In the meantime, we must make do with what we have. But it is simple to understand that it is no more easy for the father in India to stand by and watch his family starve than it would be for a father anywhere in the world. The Africans are just as capable of happiness as are the Peruvians. The wealthy are just as susceptible to tears as are the poor. The wise are just as capable of being confused as the retarded. In other words, it is the humanity of man that gives us the common base from which we can have empathy in love.

It’s this empathy that makes us responsible in love to all men. With each man who dies in the world, each of us dies a little. With each person who suffers, we, too, suffer a little. With each child bom in the world, we all become richer in possibilities. We’re all unconditionally like the other; it is just that we are in diverse lands, playing different roles in a variety of robes before dissimilar backdrops on various stages before foreign audiences. It would be interesting if we could often change robes and stand on many stages in our lifetime. It would give us great insight into man’s universality. We exist for each individual as each individual exists for us all.

If all men were naked and we were asked to shut our eyes and feel, the flower girl could be confused with the queen, the jester could pass as king, and the president could be taken as the migrant worker or the angry militant. There is perhaps no greater knowledge than this, that each person in the world, no matter how lowly or how princely, is basically a human being. To turn anyone out will be to lose all the possibilities offered through the intimacy of knowing deeply and feeling sincerely with another.

Responsible love shares. In actuality, no man possesses anything but himself. The saying that “you can’t take it with you,” though overused, is singularly a true one. One can hold on to nothing or no one. Love shares with others. What purpose of knowledge if it isn’t offered to students? What meaning has beauty that isn’t presented for all to experience? What good is love that isn’t freely given? Love is always an active sharing. If one has love to give, he may impart it to all in the world and he will still have the same love he started with. We never lose anything by sharing it, for nothing is ever solely ours to start with. In fact, love acquires meaning only as it’s shared.

An interesting experiment was performed in a sociology class at an eastern American college. The professor was discussing the process of giving and how it relates to responsibility. He asked the class to give ten cents to any of the following three needy situations. First, there was a very severe drought in Southern India for which money was needed. Women and children were dying; men were despondent. By giving they would be helping in a battle for life itself. Secondly, they could offer their ten cents toward a college fund being organized to help an excellent black student. The student was being forced to leave school due to an insurmountable family misfortune which could only be remedied with instant cash. Thirdly, they could contribute to a fund being started to purchase a new Xerox machine for student use. This machine would most assuredly make their academic life much easier. The results of the lesson will not be a surprise to many and a great shock to a few. Over 85 percent of the students, by secret ballot, donated their ten cents toward the purchase of the Xerox machine for their own immediate use. The next larger amount, about 12 percent, was given for the black student to remain in school. Only 3 percent of the students gave to the most urgent need, to maintain life in India.

The further away the problem the less was the responsibility to share felt. The need or the urgency of the need did not seem to matter. It was not the selfless “I” but the selfish “I” that lost the opportunity to give life to the Indian or education to the black man. It was the selfish “I” who ignored the fact that in the end he had gained little. Do all the Xerox machines in the world have the worth of a single life? To not realize this is to place value upon empty “things,” which when death pays its inevitable call, will only have to be surrendered at its door.

Lastly, responsible love rises even beyond hope. The ability to hope, certainly, is one of the greatest lifesaving phenomena of man. In hope, man shows a deep respect and faith in man’s ability to change, a belief in “the integrity of the universe,” in new beginnings, in exciting tomorrows. Hope is essential to man, for man is not yet brave enough to exist without it. To live without hope would be devastating for him. Man has not yet learned to work for the joy of work, learn for the sake of growth, create for the expression and the exaltation in the act, or to love simply for the pleasure of loving: he still requires a reward. Until man learns to do these things, hope will have to be his basic motivating force. In work, he’ll require more wages and better titles; in knowledge, he’ll require degrees and diplomas; in creativity, he’ll require recognition; in love, he’ll require assurance. Until. he appreciates that each of these are their own reward, he’ll need hope as his crutch. There is nothing wrong with hope in love; it is simply the second best thing.

In the meantime, hope is admittedly a powerful creative force. For, as Norman Cousins has put it, “Hope is the beginning of plans. It gives men a destination, a sense of direction for getting there, and the energy to get started. It enlarges sensitivities. It gives proper values to feelings as well as to facts.” His hope involves “a rekindling of human imagination—about life as man might like it; about the full use of his intelligence to bring sanity and sensitivity to his world and to his art; about the importance of the individual; about his capacity for creating new institutions, discovering new approaches, sensing new possibilities.”

Certainly, all this is true. But love goes beyond hope. Hope is a beginning. Love is forever.

“A mind not to be changed by place or time, the mind is its own place, and in itself can make a Heaven of Hell, a Hell of Heaven.”

—John Milton

Love Recognizes Needs

Man has both physical and emotional needs. His physical needs, though he spends most of his time — indeed, most of his life— meeting them, are the simplest to satisfy. Man requires but a small quantity of food —most of us eat far too much— some shelter from the elements —we hardly need the large homes we live in — clothing in winter — many still use only a fig leaf in parts of the world- and, of course, nurturing and water. Everything beyond this is luxury, fine to have, of course, for comfort’s sake, but not necessary for his survival. Two-thirds of today’s world attest to this.

But man has other needs as well: emotional needs. These, too, are few, but every bit as important as his physical requirements, yet not so simple. If they aren’t met, they can be as devastating as physical hunger, as uncomfortable as lack of shelter, as incapacitating as thirst. The frustration, isolation and anxiety brought about by umnet emotional needs can, like physical privation, produce death or a degree of living death—neur0sis and psychosis.

Still, aware of this, man continues to spend only a small portion of his time in the activities involved in meeting his emotional needs and in the process of aiding others toward the satisfaction of their needs. Certainly, there are few people who would consider their emotional needs important enough to Warrant the equal time spent earning the wages with which their physical necessities are satisfied.

Man’s basic psychological needs are these. He requires to be seen, recognized, appreciated, heard, fondled, sexually satisfied. He must be allowed the freedom to choose his own way, to grow at his own rate and to make his own mistakes, to learn. He needs to accept himself and other human beings and be accepted by them. He desires to be an “I” as well as a “we.” He strives to grow into the unique individual he is.

Love recognizes all these needs or it isn’t love. If any are umnet, the individual can never be totally realized and will remain hidden, in part, even from himself. It is much like a tree, certain branches of which have been kept from the sun while the remainder of the tree grows; the parts which have been deprived of sunshine will never develop in the normal way.

The bank president, for example, may be a highly efficient, intelligent, accepted, respected, contributing member of the community. In all ways, it seems, he’s like the strong growing tree. But his wife knows that when it comes to eating habits he has the limited tastes of a child, and in the bedroom, he is as impotent as one. Somewhere along in his emotional growth, he needed. The needs were unmet. In order to continue to grow, he put the need aside—psychologically speaking—and his eating and sexual habits remained at a childish level while the rest of him went on toward maturity. Of course, this is an oversimplification of the dynamics involved, which are far more complex and subtle. But the main point I wish to make here is the fact that man will suffer for unmet needs.

Man has a need to be seen, heard and fondled. Love recognizes these needs. Each individual seems to be far too busy these days to stop and look at or listen to anyone, even his own family. This, I call the “invisible man” syndrome. One is directly before you each day, at meals, in the living room, even in bed. You know he’s there, but you don’t see him, you don’t look at him.

If you love someone, you’ll look at him carefully. He is changing each day through a beautiful, gradual process which you will surely miss if you do not learn to watch. When is the last time you looked at your wife or husband’s face, your child’s face, your mother’s face? For that matter, how long has it been since you looked deeply at yourself, not while shaving or washing or putting on eye shadow, but at a moment of peace, just looking?

The American black man has known this feeling of being invisible for years. So much so that he has called himself the “Invisible Man.” The existentialist has formed a whole philosophy around the idea of the futility of man’s personal struggle for recognition, for his search for affirmation of his real existence and the meaning of that existence. A lover recognizes the need of others to be seen. He looks.

Man needs just as surely to be heard. I refer to the lack of this as the “cocktail party” syndrome. Here there are great mobs of people all gaily chatting at one another, exchanging what has been called “small talk.” Much is spoken, but little is heard or listened to. It might be said that it is merely the setting of air into vibration—vibration does not become sound until it’s picked up by the ear and the

vibrations are translated and interpreted into symbols by the brain. The brain plays little part at the usual cocktail party except as an organ to be numbed.

Even when one person does listen to another, he often hears what he wishes to hear. He has a capacity to choose or screen out what is uncomfortable for him.

In an interesting book by Alexandra David-Neel and Lama Yongden, The Secret Oral Teachings in Tibetan Buddhist Sects, the author tells how she approached a learned Tibetan regarding her plan to write the book. The wise man’s answer is both amusing and illustrative of the point I am trying to make. He says: “Waste of time. The great majority of readers and hearers are the same all over the world. I have no doubt that the people of your country are like those I have met in China and India, and these latter were just like Tibetans. If you speak to them of profound truths they yawn, and, if they dare, they leave you but if you tell them absurd fables they are all eyes and ears. They wish the doctrines preached to them, whether religious, philosophic, or social, to be agreeable, to be consistent with their conceptions, to satisfy their inclinations, in fact, that they find themselves in them, and that they feel themselves approved by them.”

To add to the confusion, words often mean different things to different people. This sometimes produces a rather strange phenomenon which Timothy Leary has referred to as “my Checkerboard trying to communicate with your Monopoly game.” This scene has been beautifully portrayed by Edward Albee in The American Dream, which opens with such a conversation between a man and his wife; she discussing in minute detail a shopping episode, he a thousand miles away in his own thoughts. Her only punctuation marks are when she stops long enough to ask him to repeat what she has said. She wants to be certain he has heard. To be sure, he has not “heard” a word, but he repeats it perfectly. The audiences find this scene hilarious. Strange that it doesn’t weep, since most of us find ourselves in this play each day of our lives. Perhaps if we listened to another person, truly listened, we could hear his joy or his cry. Love listens. Love hears.

Love touches, fondles. Physical love is necessary for happiness, growth and development. We have mentioned earlier that the infant needs to be fondled or he will die even if all his biological needs are met. Freud’s statement that at the base of all mental illness is the lack of sensual gratification has had many and varied interpretations, even to labeling him a “dirty old man.” What he meant by sensual gratification extended from the mother nursing her child and changing his diapers to the most passionate of sexual experiences, and all physical gradations in between. Even a handshake may be classified as sensual gratification. No matter the degree, and we will hope that all men will take the opportunity to experience the entire gamut of experience, man needs to be touched. The power of the sexual drive attests to this. In some people it becomes so powerful that it directs their entire lives. Kingdoms have been known to rise and fall, wars have been declared, murders have been committed just so that someone could have that moment of sexual union; often without love in the real sense, strictly in passion.

In love, each man is his own personal challenge.

Love is not sex, though sensual gratification in varying degrees is always a part of love. To attempt to write a book on love without the consideration of the import of sex would be absurd. It is impossible to realize a situation where one loves deeply and sincerely without a desire for some form of sensual gratification. ()ur mores against the most superficial human contact are so great, even to laws which prohibit it, that many have moved almost completely away from any fonn of physical love except on a purely animalistic level. Even the choice of shaking hands, man with woman, is, according to Emily Post, at the discretion of the woman. If she extends her hand, the male accepts it. But she is also “right” not to extend it. And so we distance ourselves from each other, through manners as well as laws. There is no doubt that someone is real when you touch them, when you feel their flesh on yours, even for a brief moment. I continually breach etiquette in that I always extend my hand to men and women alike; I cause looks of horror when I hold their hand longer than is accepted and cover it warmly with my free hand. It frightens some—who look at me quizzically wondering, “What is he after?”—-but it mostly affirms to us both that we are two human beings relating on a very real level. It might present a new philosophical statement: “We touch, therefore we are.” Surely there are few people who do not find being touched or touching others pleasurable. There are some, of course, who find it, in a pathological way, unpleasant. I have known occasions when people have said, “Please don’t touch me. I prefer not being touched.” Of course, it is their right, which must be respected. Nevertheless, love is physical, it touches.

Love needs freedom. We discussed earlier that, in every sense, love is always free. It is both given and received freely, but it also needs freedom in order to grow. Each man growing in love will find his own way, his own path to love. We cannot force others into our way; we can only encourage them to find their own. Carlos Castaneda in his startlingly interesting book on the Yaqui Indians, The Teaching of Don Juan, quotes Don ]uan’s wisdom: “You must always keep in mind that a path is only a path; if you feel you must not follow it, you must not stay with it under any circumstances . . . any path is only a path, there is no affront to yourself or others in dropping it if that is what your head tells you to do. But your decision to keep on the path or to leave it must be free of fear or ambition. I warm you! Look at every path closely and deliberately. Try it as many times as you think necessary. Then ask yourself, and you alone, one question. . . It is this . . . Does this path have a heart? All paths are the same; they lead nowhere. They are paths going through the brush, or into the brush. Does this path have a heart is the question. If it does, then the path is good; if it doesn’t, it is of no use. Both paths lead nowhere, but one has heart and the other doesn’t. One makes for a joyful journey; as long as you follow it you will be one with it. The other will make you curse your life. One makes you strong, the other weakens you.”

Each individual can judge for himself alone which path has heart for him. Where paths cross there is union; where they run parallel there is peace, provided that each path loves and honors the other.

Love never gives direction, for it knows that to lead a man off his path is to give him our path which will never be truly right for him and is certain to “weaken” him. He must be free to go his own way, in his chosen manner and at his special rate. He must be free to make his own mistakes and learn from

them what he can. Our love is there to give him sustenance, the strength to continue his seeking securely, in joy, and offer him the day-by-day encouragement he will require. Any aid we give is only directed in helping him to find the self which he has long since been seeking. Love is his guide, not his leader. Each man is his own leader. Love never reflects the giver. For if there is any detection of our aid, then we have kept the loved one from truly traveling his own path and he has not been really free. He has his path and love encourages him on his way, even if his path does not intersect with our desired path. To hold him to what we believe to be the right path for him is to lead him into darkness and as Thoreau says, “Birds never sing in caves.”

Love listens to its own needs. Society is replete with rules, regulations and guidelines to finding love and social acceptance. Often, man is so taken up with what others believe or will think or say, that he stops listening to what he believes, thinks or says. Society will tell him that he must live in a certain type of house. He, on the other hand, has always wanted to live in a modified igloo. If he builds an igloo, “people” will think him mad, so he builds a ranch-style house which drives “him” mad. He likes his walls a warm color, orange perhaps. He has always loved orange, even as a child. But the interior decorator tells him that “no one paints walls orange,” that avocado green is delightful and very “in.” So, he has his walls painted green and takes the decorator’s advice to add purple drapes —“very smart”—and a puce rug— “the latest thing.” So he has green walls, purple curtains and a puce rug. Each time he walks into the room he becomes physically ill, but the neighbors and “Better Homes Gardens” approve, so it must be right. Homes are built for contractors, clothes are designed by sadistic couturiers, beauty is defined by Hollywood and Cinecitta and the individual is lost. He becomes all the things others dictate, sometimes without being consciously aware of it.

We are caught up in trivia, all of which we are told certainly will bring us love. Each day it becomes more and more impossible for us to emerge from the bathroom. We rise; we exercise for twenty minutes; then, we shower, dry ourselves, use powders or creams for our skin, brush our teeth using a mouthwash to be ‘doubly sure,’ brush our hair two hundred times after we have shampooed it, conditioned it, dried it, set it and combed it. We deodorize ourselves, bind ourselves into clothes, push our feet into shoes, make our bed, grab a cup of coffee and we are ready for the day. With some, the same routine is repeated before bed each night, only in reverse. As a result, We no longer know what a human being smells like and are repelled by natural human odors. We are so clean that we have little or no resistance against germs when we travel outside our own country. We are so involved in what must be done that we have no time to do what we will to do. I am not advocating a return to poor hygiene, the mass murder of all those who write books of etiquette that so complicate our lives, or the exile of all clothes designers and interior decorators and advertisers. I am simply suggesting that man must listen to his own “drummer” or he will be marched right out of himself.

Love listens to its own needs and appreciates its own uniqueness. It abhors the fact that men are becoming more and more the same, so that it will not be long before the only way he will be identifiable as an individual will be through his social security number.

Love, then, recognizes needs, physical and emotional. It sees as well as looks, listens as well as

hears. Love touches, fondles and revels in sensual gratification. Love is free and cannot be realized unless it is left free. Love fmds its own path, sets its own pace and travels in its own way. Love recognizes and appreciates its uniqueness. Love needs no recognition, for if its effect is recognizable, it is not true love at all.

“It is the weak who are cruel. Gentleness can only be expected from the strong.

—Leo Rosten

Love Requires One To Be Strong

To live in love is life’s greatest challenge. It requires more subtlety, flexibility, sensitivity, understanding, acceptance, tolerance, knowledge and strength than any other human endeavor or emotion, for love and the actual world make up what seem like two great contradictory forces. On the one hand, man may know that only by being vuh1erable can he truly offer and accept love. At the same time, he knows that if he reveals this vulnerability in daily life he often runs the risk of being misused, taken advantage of. He senses that if he holds a part of himself in reserve to protect this vulnerability, he will always receive in return only the partial love he gives. So, the only chance he has for a depth of love is to give all that he has. Yet, he discovers that when he gives all that he has, he is often left with little or nothing in return.

He knows he must trust and believe in love, for it’s the only approach to love. Yet, if he expresses his trust and belief, society doesn’t hesitate to abuse him and take him for a fool. If he has hope in love and knows that it’s only with this hope that he can make the dream of an all-loving humanity a reality, society ridicules him as an idealistic dreamer. If he doesn’t seek love frantically, he’s suspected of being impotent and an “odd-ball.” Yet, he knows that love isn’t to be sought after, it’s everywhere, and to search is self-deception, a charade. If he decides to spend each moment of his life, living in love, in the knowledge that he is most real and human when he is living love, society labels him a weak-minded romantic. Love and the practices of the real world seem at odds, miles apart. It is no wonder so many people do not have the courage to attempt to bridge the gap, for in practice, the gap seems unbridgeable. Man has, on the one hand, the understanding and drives for growing in love, but society makes this knowledge difficult in practice. Society’s reality differs from love’s reality. The strength to believe in love when you are pitted against a nonreinforcing proving ground is more than most people can accept. So they find it easier to put love aside, to reserve it for special people on unique occasions and join forces with society in questioning its supposed reality.

To be open to love, to trust and believe in love, to be hopeful in love and live in love, you need the greatest strength. This condition is so seldom experienced in real life that people don’t know how to cope with it, even when they discover it. They crucify a Jesus, shoot a Gandhi, behead a Thomas More and poison a Socrates. Society has little place for honesty, tenderness, goodness or concern. These get in the way of the “way of the world.” This phenomenon has been the basis for great works of literature from Plato’s Republic and Dostoevsky’s The Idiot, to Kazantzakis’ The Greek Passion and Luis Bunuel’s The Nazarene. It’s almost like a game. People seek a figure to exalt. They select him carefully, spend some time at his feet in adulation, then get great satisfaction in the slaughter. It’s as if they cannot handle perfection, as if it causes them to reflect upon themselves, to move them to change, the thought of which is perhaps too uncomfortable and painful. It’s easier not to see or concern themselves with perfection. Then they can be content with their own imperfection.

It’s a fact that man does not move in a world of lovers. If he deals in the world of men, he’s more likely to come upon selfishness, cruelty, deception, manipulation and like parasitic actions. If he depends upon the real world outside of himself for reinforcement, he’ll be disillusioned and soon discovers that society and men are far less than perfect. For his society was created by less than perfect men. To cope with what he finds and to still live in love, he must have strength. He’ll only survive if this strength lies within himself. He must not put his love upon the world and if it is rejected blame the world for its insensitivity. If he finds no love, he can blame only the fact that he has no love. He must have love securely in himself. He must dedicate himself to love, be resolute in his love and unwavering in his love. He must not be as Voltaire’s foolish Candide and recognize only goodness even where evil exists. He must also know evil, hate and bigotry as real phenomena, but he must see love as the greater force. He must not doubt this even for a moment or he is lost. His only salvation is to dedicate himself to love, in the same fashion as Gandhi did to militant nonviolence, as Socrates did to truth, as ]esus did to love and as More did to integrity. Only then will he have the strength to combat the forces of doubt, confusion and contradiction. He can depend upon no one or no thing for reinforcement and assurance but himself. This may be a lonely path, but it’s less lonely if he will understand the following:

His main function is to help unfold his true Self.

Equal to this function is helping others to become strong, and perfect themselves as unique individuals.

He will do this best by affording all persons the opportunity to show their feelings, express their aspirations and share their dreams.

He must see the forces labeled “evil” as emanating from suffering people who, like himself, are “human” and in the process of attempting to perfect their “beings.”

He must combat these forces of evil through an active love which is deeply concemed and interested

in each person’s free quest for self-discovery.

He must believe that it is not the world that is ugly, bitter and destructive, but it is what man has done to the world that makes it appear so.

To live in love is life’s greatest challenge.

He must be a model. Not a model of perfection, a state not often reached by man, but a model human being. For being a good human being is the greatest thing he can be.

He must be able to forgive himself for being less than perfect.

He must understand that change is inevitable, and that when it is directed in love and self-realization, it is always good.

He must be convinced that behavior, to be learned, must be tried out. “To be is to do.”

He must learn that he cannot be loved by all men. That is the ideal. In the world of men, it is not often found. He can be the finest plum in the world, ripe, juicy, sweet, succulent and offer himself to all. But he must remember that there will be men who do not like plums.

He must understand that if he is the world’s finest plum and someone he loves does not like plums, he has the choice of becoming a banana. But he must be warned that if he chooses to become a banana, he will be a second rate banana. But he can always be the best plum.

He must realize that if he chooses to be a second rate banana, he runs the risk of the loved one finding him second best and, wanting only the best, discarding him. He can then spend his life trying to become the best banana—which is impossible if he is a plum -or he can seek again to be the best plum.

He must endeavor to love all men even if he isn’t loved by them. He doesn’t love to be loved; he loves to love.

He must reject no man, for he realizes that he is a part of every man and to reject even one man, is to reject himself.

He must know that if he loves all men and is rejected by one, he must not pull away in fear, pain, disappointment or anger. It is not the other man’s fault. He was not ready for what was offered. Love was not offered him with conditions. He gave love because he was fortunate enough to have it to give, because he felt joy in the giving, not for what he would receive in return.

He must understand that, if he is rejected in one love, there are hundreds of others awaiting love. The idea that there is but one right love is deception. There are many right loves.

These ideas will aid in giving you the strength to be a lover, for to be a lover will require that you continually have the subtlety of the very wise, the flexibility of the child, the sensitivity of the artist, the understanding of the philosopher, the acceptance of the saint, the tolerance of the dedicated, the knowledge of the scholar, and the fortitude of the certain. A tall order! All of these qualities will grow in him who chooses love for these are already a part of his potential and will be realized through loving. It becomes, then, a matter of loving your way to love.

“If I am level with the lowest, I am nothing; and if I did not know for a certainty that the craziest sot in the village is my equal, and were not proud to have him walk with me as my friend, I would not write another word — for this is my strength.”

—Edward Carpenter

Love Offers No Apology

This short book has been no more than what was promised, hardly a deep philosophical or definitive work on love, nor a scholarly exploration of the phenomenon. This responsibility will have to be assumed by a man or woman far wiser, experienced, poetic and knowledgeable than I.

Rather, this work is and was intended to be a sharing. It is, in this sense, a work of love. If the message is received or not, it has been worth the effort, for in the writing a book on love, I have intentionally exposed myself to praise or ridicule, acceptance or rejection; I have made myself totally vuh1erable. Vulnerability is always at the heart of love.

Father William Du Bay stated it far better than I, when he said, “The most human thing we have to do in life is to learn to speak our honest convictions and feelings and live with the consequences. This is the first requirement of love, and it makes us vulnerable to other people who may ridicule us. But our vulnerability is the only thing we can give to other people.”

Yes . . . !

“. . . and we ourselves shall be loved for a while and forgotten. But the love will have been enough; all those impulses of love return to the love that made them. Even memory is not necessary for love. There is a land of the living and a land of the dead, and the brulge is love, the only survival, the only meaning.”

—Thornton Wilder

Acknowledgments

We are pleased to acknowledge permission to reprint brief quotations from the following works.

Carlos Castaneda, The Teachings of Don ]uan: A Yaqui Way of Knowledge. Berkeley: University of California Press, 1968. The excerpt quoted from this book is reprinted by permission of The Regents of the University of California.

Alexandra David-Neel and Lama Yongdon, The Secret Oral Teachings in Tibetan Buddhist Sects. San Francisco: City Lights Books, 1907. Reprinted by permission of City Lights Books.

Charles Reich, The Greening of America: How the Youth Revolution is Trying to Make America Livable. New York: Random House, Inc. , 1970.

Pitirim A. Sorokin, The Ways and Power of Love. Chicago: Henry Regnery Company, 1967.

Introduction

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Ethical, Legal And Professional Standards In Assessment

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

Ethical, Legal And Professional Standards In Assessment

In this Assignment, you will consider the ACA’s Code of Ethics and how these practices impact assessment. This professional code identifies your responsibilities and the practices you must adhere to for the benefit of your clients, your colleagues, and your community.

To Prepare:

· Review ACA’s Code of Ethics website found in the Learning Resources and consider how they apply to your professional development.

· Review and use the Corey, Corey, Corey, and Callanan Ethical Decision-Making Model from the course text on p. 28 to process the cases on p. 37 by including each step.

· Review Exercise 2.2 Making Ethical Decisions (p. 37), choose two to review and process through the Model, answering each question.

Assignment:

· Review the five cases (Below)

· Select two of the situations in Exercise 2.2 in the text to discuss. Complete the eight steps provided in the course text from the Ethical Decision-Making Model on p. 28 (Copied Below) for both of the situations you chose. You do not need to answer the questions at the end of each submission in Exercise 2.2. Take the point of view of what YOU need to do as an ethical counselor, and consider ALL perspectives in the situation, not just one person’s perspective.

· In one page each, identify the cases you selected and include your responses to the steps of the model on p. 28 (Copied Below) for each situation (Note: Two pages not including title or reference page).

· On page 3, add a summary paragraph or two that shares your personal challenges with addressing the ethical issues in the assignment.

· Use proper APA formatting and citations.

CASES and Ethical Decision-Making Model

Making Ethical Decisions

Because ethical codes can be limiting in their ability to guide a practitioner who is faced with a thorny ethical dilemma, it is important that other avenues are available to aid in ethical decision-making. For instance, some practitioners might use moral models in guiding their ethical decision-making process. One moral model, described by Kitchener ( 1984 , 1986 ; Urofsky, Engels, & Engebretson, 2008 ), suggests that there are six critical moral principles one should consider when making difficult ethical decisions. They include autonomy, which has to do with protecting the independence, self-determination, and freedom of choice of clients; nonmaleficense is the concept of “do no harm” when working with clients; beneficence is related to promoting the good of society, which can be at least partially accomplished by promoting the client’s well-being; justice refers to providing equal and fair treatment to all clients; fidelity is related to maintaining trust (e.g., keeping conversations confidential) in the counseling relationship and being committed to the client within that relationship; and veracity has to do with being truthful and genuine with the client, within the context of the counseling relationship. Consider these principles if you had just assessed a client and had determined that she potentially might cause harm to her children. How might each of these moral principles play into the decisions you make regarding your client. For instance, after considering each of the principles, how and to whom would you communicate your results? To make things a bit more complicated, Remley and Herlihy (2014) go on to note that the culture of the client might impact your understanding of your results and how you apply the principles. Autonomy, for individuals from some cultures, may have to do with individual behaviors whereas individuals from other cultures might view autonomy within the context of their extended family or community. As you can see, ethical decision-making can be a complex and difficult process.

Moral model

Consider moral principles involved in ethical decision-making

In addition to the moral model just noted, a number of other ethical decision-making models exist ( Neukrug, 2012 ). One hands-on, practical, problem-solving model espoused by Corey, Corey, Corey, and Callanan ( 2015 ) suggests that the practitioner go through the following eight steps when making complex ethical decisions:

· 1. Identify the problem or dilemma

· 2. Identify the potential issues involved

· 3. Review the relevant ethical guidelines

· 4. Know the applicable laws and regulations

· 5. Obtain consultation

· 6. Consider possible and probable courses of action

· 7. Enumerate the consequences of various decisions

· 8. Decide on what appears to be the best course of action

Exercise 2.2 Making Ethical Decisions

Review the situations below, and then using the moral principles identified in the chapter, Corey’s models of ethical decision-making, and your knowledge of legal and professional issues decide on your probable course of action. Share your answers with the rest of the class.

Situation 1: A graduate-level mental health professional with no training in career development is giving interest inventories as she counsels individuals for career issues. Can she do this? is this ethical? Professional? Legal? If this professional happened to be a colleague of yours, what, if anything, would you do?

Situation 2: During the taking of some routine tests for promotion, a company learns that there is a high probability that one of the employees is abusing drugs and is a pathological liar. The firm decides not to promote him and instead fires him. He comes to see you for counseling because he is depressed. Has the company acted ethically? Legally? What responsibility do you have toward this client?

Situation 3: An African-American mother is concerned that her child may have an attention deficit problem. She goes to the teacher, who supports her concerns, and they go to the assistant principal requesting testing for a possible learning disorder. The mother asks if the child could be given an individual intelligence test that can screen for such problems, and the assistant principal states, “Those tests have been banned for minority students because of concerns about cross-cultural bias.” The mother states that she will give her permission for such testing, but the assistant principal says, “I’m sorry, we’ll have to make do with some other tests and with observation.” is this ethical? Professional? Legal? If you were a school counselor or school psychologist and this mother came to see you, what would you tell her?

Situation 4: A test that has not been researched to show that it is predictive of success for all potential graduate students in social work is used as part of the program’s admission process. When challenged on this by a potential student, the head of the program states that the test has not been shown to be biased and the program uses other, additional criteria for admission. You are a member of the faculty at this program. Is this ethical? Professional? Legal? What is your responsibility in this situation?

Situation 5: An individual who is physically challenged and wheelchair bound applies for a job at a national fast-food chain. When he goes in to take the test for a mid-level job at this company, he is told that he cannot be given this test because it has not been assessed for its predictive ability for individuals with his disability. You are hired by the company to do the testing. What is your responsibility, if any, to this individual and to the company?

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homework help for Racism and Privilege

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

homework help for Racism and Privilege

Discussion1 : Racism and Privilege

In many societies certain groups possess more resources and hold more power than other groups. In some of these societies, racial discrimination and racial tension also exist. While members of the societies may openly acknowledge that unequal distribution of power and racism are present in their society, many fail to examine the complex relationships between privilege and racism. Social workers must understand this complex relationship so they can educate and empower their clients. Empowerment is the cornerstone of social work practice.

In the book Black Empowerment, the author,Barbara Solomon, writes, “Empowerment refers to a process whereby persons who belong to a stigmatized social category throughout their lives can be assisted to develop and increase skills in the exercise of interpersonal influence and the performance of valued social roles” (p. 6).

Empowerment practice is based on a collaborative relationship between worker and client, initiated to promote the client’s power through self-actualization, self-determination, and the fulfillment of personal goals (Gutierrez, Parsons, & Cox, 1998). Further, this process includes increasing your clients’ awareness of the structural oppression that exists and its impact on them. It is the role of social workers to empower clients and to bring about awareness of the inequalities that exist in society. This is done two fold—through work with clients on the micro and mezzo levels and on a macro level through work in organizations and communities.

Social workers cannot effectively empower clients without first understanding the mechanisms of oppression and how they impact their day-to-day work. Then social workers can recognize the impact on their clients’ lives and apply the appropriate skills.

To prepare: Review the case study “Working With Individuals: The Case of Mary.”

· Post an explanation of the relationship between racism and privilege.

·      Furthermore, explain how the concepts of racism and privilege relate to “Working With Individuals: The Case of Mary.”

·      Explain the impact of racism and privilege on social work practice.

·      Provide recommendations for how you as a social worker might use an empowerment perspective when responding to Mary.

· Be specific and provide examples from the case. Also, identify specific skills social workers might employ.

References (use at least 2)

Adams, M., Blumenfeld, W. J., Castaneda, C., Hackman, H. W., Peters, M. L., & Zuniga, X. (Eds.). (2013). Readings for diversity and social justice. (3rd ed.). New York, NY: Routledge Press.

Chapter 11, (pp. 77–86)

Chapter 12, (pp. 86–92)

Chapter 14, (pp. 96–101)

Chapter 15, (pp. 102–109)

National Association of Social Workers. (2007). Institutional racism & the social work profession: A call to action. Retrieved from http://www.socialworkers.org/diversity/InstitutionalRacism.pdf

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Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

Working With Individuals: The Case of Mary”

Working With Individuals: The Case of Mary

Mary is a 47-year-old, single, heterosexual Caucasian female. She lives with her 52-year-old sister and 87-year-old father in the home in which she was raised. She also has a 45-year-old sister who lives 10 minutes away and a 23-year-old daughter living on her own. Mary and her family members do not maintain friendships outside the family. Mary has been unable to work for the past 3 years because she says she has felt too frightened to go too far from her home. As a result, she has been financially reliant on her family members for these last few years. Prior to this lapse in employment, she had been a school bus driver and an administrative assistant at a warehouse distribution center. Mary has no history of drug or alcohol abuse. She is well groomed and physically fit with a diagnosis of hypoactive thyroid, for which she is treated with Synthroid^®. Mary was diagnosed with post-traumatic stress disorder (PTSD) and adjustment disorder, not otherwise specified (NOS) by the clinic psychiatrist.

Before meeting with me, Mary saw a social worker in a private practice for 2 years. She entered treatment with that clinician because she said she was traumatized by a romantic relationship with a married African American man she had met at work. Her trauma symptoms began 6 months after she ended the yearlong romantic relationship. Mary said the romance occurred because he had “brainwashed” her, as there could be no other reason she would have slept with him. Mary believes that bad people are capable of “brainwashing” good people to perform bad deeds. Mary was raised in a home that espoused racism, and she and her family members believe that African Americans and other people of color are untrustworthy and bad. She said, “I take after my father, and he thinks black people are just evil.” Mary said she understands her feelings about race are not right.

Mary considered her initial attempt at treatment unsuccessful for two reasons. First, she felt the therapist (a Caucasian woman) judged her and her family harshly for their racial beliefs and this got in the way of the two of them building a trusting working relationship. Second, she did not feel relief from her PTSD symptoms. Mary ended the relationship with that social worker 6 months ago. Mary then approached her primary care physician about her symptoms, and the doctor prescribed an antidepressant. When, after 3 months, Mary asked to have her dosage increased, the doctor suggested that she get a psychiatric evaluation and consider returning to therapy. Mary’s insurance company suggested our agency for the psychiatric evaluation and approved 10 sessions.

Mary said she felt sad, frightened, and anxious most of the time. She had no appetite, slept most of the day, had no interest in dressing, and rarely left the house. When she did go out, she felt the need to be accompanied by of one of her sisters.

Mary presented as angry during our initial sessions. She requested that one of her sisters attend the sessions with her, to which I agreed. My intent in agreeing to have her sister in the room was to help Mary feel safe and create a strong rapport. During the early sessions, most of what Mary said began as half sentences that she asked her sister to complete. Mary referred to her sisters as her “caretakers and minders” who “know me better than I know myself so you should talk to them.” Mary said that if she talked for herself she would get “it wrong.” The “it” and the “wrong” remained elusive in meaning when I asked her what that meant.

Mary agreed, after two sessions, to meet with me alone. We used our first individual session to establish Mary’s goals for therapy. Among her goals was developing ways she could feel safer about going outside alone. Over the next eight sessions, I used cognitive behavioral therapy interventions to help Mary build coping strategies for recognizing triggers to frightening thoughts and to help her manage her anxiety symptoms. I also used psychoeducational interventions to help Mary develop routines for proper sleep hygiene, healthy eating, and regular exercise.

After several sessions, Mary shared insight into her feelings about dating an African American man. Mary said that being attracted to an African American man frightened her and that there was no future for her relationship with this man because he was married. Mary believed that she had jeopardized her secure position in the family because being with an African American man challenged the family’s ideas about race and their view of themselves as separate and unique from non-family members. Once the family discovered Mary’s relationship with this man, she believed her only way back into their lives was to accept the role of a “crazy sister” in need of protection and whose judgment about people was faulty. By forming a relationship with an African American man, Mary had shown her judgment to be outside of the norm in the conventions of her family.

In our final two sessions, Mary said that she no longer felt like she was the “crazy woman in the family” and she felt safe going to the grocery store alone. It was my impression that Mary may have been the identified patient in her family but exploring this idea would require family therapy.

Discussion 2 : Values Consistent With Social Work Practice

While counseling clients, it can be tempting for social workers to rely on their own set of values and ethical principles. Although the intention here is a good one, social workers must remember that, when working, their values need to be consistent with those of social work practice. The video case study featuring Eboni is a good example of what kinds of consequences can arise when a social worker is led by a personal set of ethics and values. For this Discussion, watch the video about Eboni and consider how you would respond to her during this particularly difficult time in her life. Be sure to include what kinds of supports are available for a pregnant teen.

Post your answer to the following questions:

· After watching the video about Eboni, describe her response to the situation in terms of her developmental stage. How would you, as a social worker, respond?

· What do you think are the most important messages for Eboni to understand at this point in her life span?

· Also, explain which concepts/values, consistent with social work practice, you would try to reinforce.

· Be sure to include what kinds of supports are available for a pregnant teen.

References (use at least 2)

Caputo, R. K. (2009). Adolescent sexual debut: A multisystem perspective of ethnic and racial differences. Journal of Human Behavior in the Social Environment, 9(4), 330–358.

Laureate Education (Producer). (2013). Logan family (Episode 3) [Video file]. In Sessions.

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed.). Boston, MA: Cengage Learning.

Chapter 6 (pp. 295-332)

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Statistics In Psychologist homework help

February 1, 2024/in Assignment Help, Homework Help /by Daniel Jennings

Statistics In Psychologist homework help

1. A method for testing a claim or hypothesis about a parameter in a population, using data measured in a sample, is called

random sampling

level of significance

hypothesis testing

guessing

2. The one-sample z test is a hypothesis test used to test hypotheses

concerning a single population with a known variance

concerning at least one population

concerning the variance in a population

all of the above

3. Given the following values: μ = 6.0, M = 7.6, n = 36, σ = 6, conduct a one-sample z test at a 0.05 level of significance. For a one-tailed test, upper-tail critical, what is the decision?

to reject the null hypothesis

to retain the null hypothesis

There is not enough information since the sample size is not given.

4. ________ allows researchers to describe (1) how far mean scores have shifted in the population, or (2) the percentage of variance that can be explained by a given variable.

significance

probability

power

effect size

5. The ________ is an inferential statistic used to determine the number of standard deviations in a t distribution that a sample means deviates from the mean value or mean difference stated in the null hypothesis.

t distribution

t statistic

standard error

degrees of freedom

6. State the critical value(s) for the following two-tailed t test at a 0.05 level of significance: t(∞).

±1.645

±1.96

the same as for a two-tailed z test at a 0.05 level of significance

both ±1.96 and the same as for a two-tailed z test at a 0.05 level of significance

7. A researcher reports that the mean time it takes to complete an experimental task is 1.4 ± 8.0 (M ± SD) seconds. If the null hypothesis was that the mean equals 1.0, then what is the effect size for this test using estimated Cohen’s d?

d = 0.05; small effect size

d = 0.50; medium effect size

d = 1.05; large effect size

There is not enough information to answer this question.

8. Computing a two-independent sample t test is appropriate when

different participants are assigned to each group

the population variance is unknown

participants are observed one time

all of the above

9. A researcher has participants rate the likability of a sexually promiscuous person described in a vignette as being male (n = 20) or female (n = 12). The mean likability ratings in each group were 4.0. If the null hypothesis is that there is no difference in likability ratings, then do likability ratings differ at a 0.05 level of significance?

Yes, this result is significant, p < 0.05.

No, this result is not significant, t(30) = 0.

No, this result is not significant, t(30) = 1.00.

There is not enough information to answer this question, because the variance in each sample is not given.

10. A type of related samples design in which participants are observed more than once is called a

repeated measures design

matched pairs design

matched samples design

both matched pairs design and matched samples design

11. A researcher records the level of attention among 18 students during an interactive and lecture portion of a single class. If she computes a related samples t test at a 0.05 level of significance (two-tailed test), then what is the critical value for this test?

±1.734

±1.740

±2.110

±2.101

12. A researcher computes the mean difference in locomotion in a sample of 12 rats before and 30 minutes after an injection of amphetamine. Rats were placed in a box with infrared beams. The number of times rats crossed the beams was used as a measure of locomotion. The mean difference in locomotion was 6.2 ± 8.4 (MD ± SD), and this difference was significant. What is the effect size for this result using estimated Cohen’s d?

d = 0.74 (medium effect)

d = 1.36 (medium effect)

d = 0.74 (large effect)

d = 1.36 (large effect)

13. A researcher reports with 90% confidence that 31% to 37% of Americans believe in ghosts. What is the point estimate for this interval?

31%

34%

37%

31% to 37%

14. In a sample of 20 participants, a researcher estimates the 95% CI for a sample with a mean of M = 5.4 and an estimated standard error (SM) of 1.6. What is the upper confidence limit for this interval?

2.1

3.8

7.0

8.8

15. There is no difference between a point estimate and an interval estimate.

True

False

16. Using a between-subjects ANOVA design,

n · k participants are each observed one time

n participants are observed k times

data are not analyzed between groups

the same participants are observed in each group

17. A researcher measures attractiveness ratings of a male confederate among 30 women who were told the confederate was either single, dating, or married (n = 10 per group). What are the degrees of freedom for error for the one-way between-subjects ANOVA?

18. A researcher measures differences in romantic feelings among adolescent and adult males. If different participants were in each group, then what type of statistical design is appropriate for this study?

a two-independent sample t test

a one-way between-subjects ANOVA

a two-way between-subjects ANOVA

both a two-independent sample t test and a one-way between-subjects ANOVA

19. Which of the following post hoc tests is associated with the greatest power to detect an effect?

Schaffé test

Tukey’s HSD test

Bonferroni test

Fisher’s LSD test

20. A researcher computes a one-way within-subjects ANOVA in which k = 4 and n = 20.

What are the degrees of freedom error for this test?

There is not enough information to answer this question.

21. A researcher computes the following one-way within-subjects ANOVA table for a study in which k = 3 and n = 12.

State the decision at a 0.05 level of significance.

Source of Variation	SS	df	MS	Fobt
Between groups	450
Between persons			20
Within groups (error)
Total	1030

Reject the null hypothesis.

Retain the null hypothesis.

There is not enough information to answer this question.

22. There are ____ factors in a 2 × 3 ANOVA design.

23. A researcher conducts a 2 × 4 between-subjects ANOVA in which 12 participants were observed in each group. If SSB = 18 and SSE = 264 for this study, then what is the decision for Factor B at a 0.05 level of significance?

Reject the null hypothesis.

Retain the null hypothesis.

There is not enough information to answer this question.

24. A statistical procedure used to describe the strength and direction of the linear relationship between two factors is called

effect size

power

a correlation

coincidence

25. A researcher measures the following correlation: r = −0.21. What is the value of the coefficient of determination?

0.04

−0.04

0.42

−0.42

26. A researcher measures the correlation between the frequency of self-esteem (high, low) and health status (lean/healthy, overweight/obese). Based on the frequencies for each nominal category given below, what is the value of the phi correlation coefficient?

		Health Status
		Overweight/Obese	Lean/Healthy
Self-Esteem	Low	32	18
	High	18	32

0.08

0.28

0.52

0.56

27. Linear regression describes the extent to which _______ predicts ________.

X; Y

the predictor variable; the criterion variable

the known variable; the to-be-predicted variable

all of the above

28. A researcher reports the following equation for a best-fitting straight line to a set of data points: Y hat = −1.01X + 3.24.Which value is the y-intercept?

Y hat

ñ1.01

3.24

29. If the coefficient of determination is 0.12 and SSY = 225, then what is the sum of squares regression for an analysis of regression?

198

225

There is not enough information to answer this question.

30. A chi-square goodness-of-fit test shows that the frequencies observed fit well with those that were expected. Hence, the decision was to

reject the null hypothesis

retain the null hypothesis

no decision was made

31. A researcher asks participants to taste each of three meals and to choose the one they like best. The same foods are in each meal, however the calorie total of each meal is different. One is low in calories, one is moderate in calories and one is high in calories. Based on the observed frequencies given below, what is an appropriate conclusion for this test at a .05 level of significance?

	Type of Meal
	Low Calorie	Moderate Calorie	High Calorie
fo	6	7	17
fe	10	10	10

Participants liked the high calorie meal more than the low calorie meal.

Participants liked the low calorie meal less than the moderate calorie meal.

Participants liked the high calorie meal more than was expected.

all of the above

32. Each of the following is an appropriate test for ordinal data, except

the Mann-Whitney U test

the chi-square goodness-of-fit test

the one-sample sign test

the Friedman test

33. A professor ranks the grades of students in each of three sections of a statistics course. He computes H = 6.83 for the Kruskal-Wallis H test to test for differences between the sections. What is the decision for this test?

Retain the null hypothesis.

Reject the null hypothesis.

There is not enough information to answer this question.

RC_3117073_0_0

{}

RC_3116863_1_0

{}

Psych 635 Shaping And Chaining, Reinforcement Schedules And One-Trial Learning Week 3

HEALTH AND SPORTS PSYCHOLOGY REVIEW

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