US Census Bureau Visualizations of Population Aging (2000-2020)

 

(source)

Cheers, 

Colin

Eradicating Diseases?

Nature Medicine has an interesting News feature on disease eradication.  "Wars against disease" must have realistic expectations concerning what constitutes "victory". There are approximately 1,400 species of human pathogens. Plus there are chronic diseases which cause about 71% of all deaths worldwide. Plus there are limited budgets, limited compliance with public health guidelines, etc. etc.

A sample from the story:

...Most scientists have by now conceded that SARS-CoV-2 is here to stay. But as China still hangs on to a ‘zero-COVID’ policy that others abandoned long ago, it is keeping the long-standing debate alive.

“It is not possible to eliminate SARS-CoV-2,” insists Marcel Tanner, president of the Swiss Academy of Sciences and Director Emeritus of the Swiss Tropical and Public Health Institute, who led Switzerland’s now-dissolved COVID-19 Science Task Force. “It’s no longer the time to think of zero COVID, even if you sit on an island.”

....Smallpox is the only human disease to have ever been eradicated, and dominance over a virus that killed 300 million people worldwide in the twentieth century continues to inspire campaigns to vanquish dangerous pathogens. Yet the world is a very different place in the twenty-first century.

....Disputes over the prospect of eradicating diseases might be cast as a battle between optimism and pragmatism, were it not for limited budgets. One criticism of eradication goals is that they drain resources from other health programs. 

Cheers, 

Colin 

Fall term (2022)

The course outlines for my fall teaching term are now ready, I am teaching my regular large (@275 students) lecture course POLS 250 on an introduction to political theory.  This is the first time I get to see these students again in person since March 2020.  So I am really looking forward to that.  I am also teaching a 4th year seminar on "The Politics of Pandemics and Epidemics" and a grad course on "Science and Justice".  Should be a busy but fun and engaging term!

Cheers, 

Colin

Zola on Medicine as an Institution of Social Control

Today I came across the sociologist Irving Zola’s 1972 essay “Medicine as an institution of social control” and I was struck by how relevant it is for many contemporary public health debates, such as the war on drugs, the COVID-19 pandemic and geroscience.  

An excerpt:

Medicine is becoming a major institution of social control, nudging aside, if not incorporating, the more traditional institutions of religion and law. It is becoming the new repository of truth, the place where absolute and often final judgments are made by supposedly morally neutral and objective experts. And these judgments are made not in the name of virtue or legitimacy but in the name of health. Moreover, this is not occurring through the political power physicians hold or can influence, but is largely an insidious and often undramatic phenomenon accomplished by "medicalizing" much of daily living, by making medicine and the labels "healthy" and "ill" relevant to an ever increasing part of human existence.

....….From sex to food, from aspirins to clothes, from driving your car to riding the surf, it seems that under certain conditions, or in combination with certain other substances or activities or if done too much or too little, virtually anything can lead to certain medical problems. In short, I at least have finally been convinced that living is injurious to health. This remark is not meant as facetiously as it may sound. But rather every aspect of our daily life has in it elements of risk to health. 

Cheers, 

Colin

Summer Reading Group 2022 (FLOW, post #4)

 

  This is the fourth and final installment of my book review of Mihaly Csikszentmihalyi’s book FLOW: The Psychology of Optimal Experience. (post #1 is here, post #2 here, post #3 here).

            Chapter 9 of Flow is titled “Cheating Chaos”.  Csikszentmihaly begins the chapter by noting that many people may still (erroneously) believe that it must be easy for people to be happy if they have the good fortune to have money, health and looks.  Many people design their plan of living around this foundational belief.  And for such people talk of “flow” is simply additional icing on the cake of having these other attributes.  Csikszentmihaly notes that the central premise of the book is that such an outlook is spectacularly mistaken.  And that is because this outlook misses the central key to optimal experience- our subjective experience.  “Subjective experience is not just one of the dimensions of life, it is life itself” (192).  Without control over our psychic energy, Csikszentmihaly contends that wealth and health will have little impact on our wellbeing.

Csikszentmihaly focuses on a number of moving examples of people who, faced with severe disadvantages, were able to enjoy optimal experience because they were able to control their consciousness.  The examples include a young man (Lucio) who became paraplegic in a motorcycle accident, but then went on to become a regional champion in archery.  Lucio remarked, after his accident “It was like being born again.  I had to learn from scratch everything I used to know, but in a different way…. As far as the future is concerned, I hope to keep improving, to keep breaking through the limitations of my handicap… (194)”. 

There is a similar story for Franco, another person with paraplegia.  Before his accident, he worked as an electrician and enjoyed acrobatic dancing.  After the accident Franco became an counselor for other paraplegics, and said the most important goal in his life, after the accident, was “to feel that I can be of use to others, to help recent victims to accept their situation” (104). 

Other examples mentioned include a group of blind people.  Paolo, who lost his vision when he was 24 (and is now 30), didn’t consider his blindness a positive influence in his life.  However, he did see 4 positive outcomes of this tragedy:  (i) while he accepted his limits, he was always going to try to overcome them, (ii) he always strives to change situations he doesn’t like (iii) he is very careful not to repeat mistakes and (iv) he now has no illusions, but tries to be tolerant towards himself, so he can be more tolerant towards others (195).

Csikszentmihaly also discusses some examples of homeless people, like Reyad, who described most of his life as being in the state of flow, as a spiritual quest.  Despite living in material conditions most people would find unbearable, Reyad was able to find meaning and joy.

Csikszentmihaly then turns to the issue of coping with stress.  Even if one has the good fortune to avoid the circumstances described above, such as a debilitating injury or extreme poverty, we will all experience stress.  And how we cope with that stress will have a profound impact on our happiness and wellbeing.  Csikszentmihaly notes there are 3 different kinds of resources (p. 198-99) that people can have for coping with stress:

(1)   Social support network (friends and family)

(2)   One’s psychological resources- such as intelligence, education and relevant personality factors

(3)   Coping strategies that one uses to comfort themselves when stress arises.

Csikszentmihaly focuses on (3), though I was puzzled a bit by this.  I didn’t think he provided a compelling justification for this.  He asserts (199) that external supports are not, by themselves, that effective in mitigating stress.  But I felt more needed to be said about (1) and (2). 

            He argues that there are two main ways people respond to stress:  (1) MATURE DEFENCE, and (2) NEUROTIC DEFENCE “or regressive coping”.  To illustrate the difference between these two ways of dealing with stress he gives the example of Jim, an analyst who loses his job.  If he withdraws, sleeps in, denies what happened, turn his anger to friends and family, get drunk, etc….. these are the negative strategies of neurotic defence.  By contrast, he can keep his cool, analyze the problem logically and reassess his priorities in life.  Csikszentmihaly notes most people do not rely exclusively on one strategy, but rather we may start with some negative coping strategies, getting drunk the first night of being fired, getting into an argument with family, etc.  Then after a day or week we shift to the more mature defence approach.  What separates people’s ability to deal with stress is their ability to eventually transition from the negative to positive approach.  People who are capable of transforming adversity into something positive or good are rare individuals.  But how do such people do this?  This is what Csikszentmihaly focuses on next.

One’s sense of self seems to be the central determinate of one’s coping skills (and opportunity to realize flow).  A person with a strong self of self will have personally selected goals (vs simply following goals they have been told to pursue from others) and thus they are protected from the sense of serious erosion of the self that might arise from external disappointment.  By contrast if your sense of worth comes from parental or societal approval, you will suffer when they signal disappointment with your decisions or accomplishments.

            The ability to transform adversity into growth and positivity stems, argues Csikszentmihaly, from 3 transformative steps:

(1)   Unconscious self-assurance :  believing that your destiny is in your hands.  You don’t see yourself in opposition to the environment, but rather are in harmony with it.  Confidence plus humility (not arrogance).  His example involves a person who has to get to work on time but the car won’t start.  The person who tries, over and over again, to get their car started, flooding the engine and getting angry and wasting time vs the person who calmly enacts plan  B- take a taxi to work today!  The central goal for the day is to get to work on time, a person with unconscious self-assurance has the flexibility to shift the means to achieve that goal from driving there to taking a taxi vs the person who gets stuck in the frustration of the sub-goal of driving themself to work.

(2)   Focusing attention on the world.  If one’s psychic energy is mostly focused inwards towards one’s ego (vs the environment) they will struggle to transform stress into enjoyable challenges.  Telic individuals do not spend all their time trying to satisfy what they believe are their needs.  Instead the focus is on processing info from the environment.  This enables one to adapt, to still pursue one’s goals but do so in a fashion informed/shaped by the constraints and challenges they encounter. When the car doesn’t start in the morning your mind needs to transcend the fixation on what will happen if you are late or the car itself, so you can think of an alternative way to get to work.  Csikszentmihaly shares a rather morbid example of a parachuter who, having been told he was given a left-handed parachute during an exercise because they didn’t have enough right-handed parachutes, fatally died when he failed to pull it with his other hand.  When they examined his body they found evidence he pulled so hard with the other side, pulling his flesh off.  He was unable to tell himself to pull with his left hand (the environment was signally this was needed!) and instead sadly repeated his trained habits, costing him his life.

(3)   The discovering of new solutions.  Two strategies are identified for dealing with situations of psychic entropy.  The first is to focus on the obstacles that obstruct the realization of your goal, and to work on removing those obstacles.  The second strategy is to assess the whole situation, including oneself, and thus the possibility that different goals (and thus solutions) might be advisable. 

 

The chapter concludes with a summary of the 4 core elements of the autotelic personality.  These are:

(a)   Setting goals.

(b)  Becoming immersed in an activity.

(c)   Paying attention to what is happening.

(d)  Learning to enjoy immediate experience.

 

Group exercise:  Some topics for discussion and debate from chapter 9:

In terms of some specifics we might focus on this issue, perhaps think of how you have coped (or failed to cope) with stressful events in your own life.  Did you react to these challenges with mature or neurotic defence?  Did you gain any valuable insights into your own personality when grappling with adversity?  Think of ongoing challenges you continue to face, are there different ways of looking at problems or solutions that might help you make progress on dealing with specific challenges?

Reflecting on your own personal experiences and observations, how important do you think the 3 resources identified in this chapter are?

(1)   Social support network (friends and family)

(2)   One’s psychological resources- such as intelligence, education and relevant personality factors

(3)   Coping strategies that one uses to comfort themselves when stress arises.

The last chapter of Flow is titled “The Making of Meaning” and it addresses what I think is the most critical part of the central message behind the book- how does flow contribute, overall, to our living a good life.  One may experience optimal flow in one specific aspect of life- say at work, or in a hobby, or a relationship- but that does not mean we realize meaning and fulfilment overall.  Csikszentmihaly provides the examples of Picasso and Bobby Fisher as individuals who were deeply committed to painting and chess and explored flow in those activities but, when outside of these activities, were unpleasant or unhappy people.  What flow really needs is a meta-account of the good life, one that transcends a focus on one specific aspect of our lives.  And this is a critical message to convey, otherwise people might mistakenly think that cultivating the autotelic personality in one specific arena of life- such work or a hobby- is the road to personal fulfilment.  Csikszentmihaly argues that one last step of control in consciousness is needed- turning all life into a unified flow experience (10).  This is necessary because the specific contributors to our flow experience- family relationships, work, hobbies, etc.- are fleeting and subject to change over time.  So if your meaning in life is tied to just parenting or work you will really struggle as your kids get older or you retire.  What we need, contends Csikszentmihaly, is to find meaning (traditionally this was provided by belief in a deity).

He acknowledges that meaning is a difficult concept to define.  He identifies 3 ways the concept is often utilized:

(1)   Refers to an end or ultimate goal (purpose):  “what is the meaning of life?”   

(2)   Refers to a person’s intentions (resolution).   Our purposes are revealed in action. 

(3)   Refers to ordering information such as the relationship between events, establishing some order between apparently unrelated or conflicting information (harmony).

Csikszentmihaly’s account of meaning is thus “the bringing order to the contents of mind by integrating one’s actions into a unified flow experience” (216) and this involves all three of the types of meaning he identifies.

Individuals who have meaning in their lives thus have a goal that consumes their physic energies- to win a game, make friends, etc.  This is purpose, and achieving this goal is actually of secondary importance as the really important thing is focusing one’s physic energy on pursuing the goal (not actually achieving it).  This relates to (2) as purpose results in striving, effort, or resolution (217).  Our energy is invested in trying to achieve this goal vs wasted somewhere else (e.g. on things that distract us from flow and meaning).  This second sense of meaning is critical as having a goal, but not the concerted effort to engage in the activity needed to realize that goal, will undermine meaning in our lives.  Many people are great at setting goals for themselves, but lack the skills needed to pursue and attain them- they give up at the first challenge or disappointment, mistakenly thinking it is the realization of the goal (vs the intention and striving) that really matters.

Csikszentmihaly contends that (1) and (2) thus lead to (3), which is a harmony in one’s consciousness.  “When an important goal is pursued with resolution, all one’s varied activities fit together into a unified flow experience, the result is that harmony is brough to consciousness” (217).   Bringing these points together we thus get a concise account of the central conclusion of this chapter:  PURPOSE, RESOLUTION AND HARMONY UNIFY LIFE AND GIVE IT MEANING BY TRANSFORMING IT INTO A SEAMLESS FLOW EXPERIENCE (217-8).  But how can we attain this?  That is the next topic Csikszentmihaly addresses in the chapter.

When discussing the setting of goals, Csikszentmihaly invokes a gradient of complexity with respect to individual development.  This coheres very closely with Kegan’s distinction between the socialized mind, the self-authoring mind and transformative mind.  (According to Kegan, the former  (approximately 58% of the population) just internalize the values and roles socially prescribed to them.  But the latter two conceptions of the mind, achieved by only a minority of adults, 35% and 1% respectively, can stand back and critically assess societal norms and roles).  Csikszentmihaly notes 4 stages of individual development with respect to purpose/meaning, that involve an oscillatation between the self and Other.  In the first stage we equate our purpose with our survival needs- our energy is invested in getting survival, comfort and pleasure.  Once this is achieved we equate meaning with group values- religion, patriotism, etc.  Then, having achieved a sense of belonging to a larger collectivity, we oscillate back to the self in the next stage, where enjoyment (rather than pleasure) becomes our focus.  We become “a seeker”, faced with a mid-life crisis, career change, etc.  And then, finally, “having discovered what one can, and cannot, do alone, the ultimate goal merges with a system larger than the person- a cause, an idea, a transcendental reality” (222). Like Kegan’s account, Csikszentmihaly notes that not everyone goes through all these stages of development.  Some, because their basic needs are at risk, never go beyond the first stage.  And Csikszentmihaly contends that the majority of people never go beyond the second stage, where the country, family, community, etc. is the source of meaning.

With respect to resolution, Csikszentmihaly notes the importance of the interdependence of action and reflection:

Activity and reflection should ideally complement and support each other.  Action by itself is blind, reflection impotent.  Before investing great amounts of energy in a goal, it pays to raise the fundamental questions:  is this something I really want to do? Is it something I enjoy doing?  Am I likely to enjoy it in the foreseeable future?  Is the price that I- and others- will pay worth it?  Will I be able to life with myself if I accomplish it? (226)

Harmony, the third feature of meaning Csikszentmihaly identifies, thus involves a harmony between reason and choice.  “When a person’s psychic energy coalesces into a life theme, consciousness achieves harmony” (230).  But can this harmony transcend the traditional narratives of religious culture?  I believe this is the real challenge for positive psychology.  Csikszentmihaly argues:

If a new faith is to capture our imagination, it must be one that will account rationally for the things we know, the things we feel, the things we hope for, and the ones we dread.  It must be a system of beliefs that will marshal our psychic energy toward meaningful goals, a system that provides rules for a way of life that can provide flow (239).  

 

Group Exercise:  A few things we might consider from chapter 10 include:

(1)   When you reflect on purpose, intention and harmony in your own life, what is the relation between the self and Other?

(2)   What obstacles have you faced when it comes to finding purpose or action in your own life?  How have did you overcome some of these constraints (if you have)?

(3)   Do you think science can replace religion in terms of providing us with a life of meaning? 

Lots of interesting topics to discuss in these two final chapters from the book!  Looking forward to the discussion.

Cheers,

Colin