Archive for the ‘Clinical Psychology’ Category
Obesity is becoming more common in western cultures. Because the genetic component linked to obesity remains the same as it has in the past, there is an increased concern about the cultural and environmental causes of overeating (Lissner, 1997). Affluent western cultures have higher incidences than cultures that have more limited resources. Western cultures also hold more beliefs about individual control over outcomes and value thinness more than non-western cultures (Klaczynski, Goold, & Mudry, 2004). Both of these observations contribute to the increased problem of weight control and overeating in western cultures. Beliefs about individual control are associated with negative affect toward people with obesity and these beliefs are internalized by people who struggle with overeating themselves (Fabricatore & Wadden, 2004). Additionally, the pressures to be thin in western societies contribute to feelings of failure in people battling overeating. In turn, the prejudice and negative attitudes toward obese individuals negatively impacts body esteem subsequently leading to binge eating (Klaczynski, Goold, & Mudry, 2004).
The influence of prejudice and negative attitudes toward people struggling with overeating is widespread. In 2004, Fabricatore and Wadden stated that in the U.S. “ridicule and disparagement of obese individuals seems to remain a socially acceptable form of prejudice” (332). Unfortunately, this prejudice extends from the medical community to the mental health community to the population of overeaters themselves (Fabricatore & Wadden, 2004; Klaczynski, Goold, & Mudry, 2004; Brownell & Puhl, 2003). The scope of this prejudice is so widespread that it does not leave much of a window of opportunity for individuals who are stigmatized by this stereotype to seek the help that they need to overcome their eating problem. Additionally, it increases the risk for low body image, thus enhancing the likelihood for further binge eating. The relationship becomes almost circular in nature.
Another implication of the prejudices that people hold toward overeating and obesity is that it leaves a much smaller window of opportunity for treatment of overeating. Brownell and Puhl (2003) suggest that “negative attitudes in physicians may lead obese persons to avoid seeking health care” (p.16). Additionally, having the belief that overeating and bingeing is due to internal flaws such as laziness also decreases the likelihood that overweight people will seek help or continue with their treatment programs if they fail to see improvement (Brownell & Puhl, 2004).
A study by Klacynski, Goold, and Mudry (2004) investigated people’s attributions of the causes of obesity and found that after stereotypes of obesity were primed, scores that attributed obesity to internal causes increased whereas scores that attributed physical and social causes for obesity remained the same. That is, being thin is an achievement of will and, therefore, being fat (the antithesis) is likely due to lack of will. They also found a negative correlation between self-esteem and anti-fat attitudes and negative stereotypes of the obese. More crucially, this correlation remained significant among participants who’s BMIs were 25 or higher (with 24 being the upper limit in the “normal” weight category). This suggests that the prejudice is so strong that it permeates into the group at which it is targeted.
Body esteem has been linked to obesity such that people with low body esteem who are also exposed to other risk factors are more likely to engage in binge eating (Klacynski, Goold, & Mudry, 2004). Low body esteem is related to negative attitudes about obesity and overeating and is related to the beliefs people hold about obesity (whether it is due to internal or external causes). More specifically, the negative attitudes people hold about obesity mediate the relationship between beliefs about control and body esteem: people who believe that overeating is due to lack of motivation and control over their own eating habits are more likely to hold negative views toward those who overeat, and consequently, negatively influences body esteem (Klacynski, Goold, & Mudry, 2004). Another explanation is that individuals who suffer from the negative stereotypes adopted from beliefs about control and negative attitudes toward obesity are more likely to experience low body esteem which contributes to binge eating. Both explanations are in accordance with the dual-pathway model which shows that low body esteem is negative affect which is a risk factor for binge eating (Van Strien & Ouwens, 2007).
Due to the rampant prejudice toward individuals with obesity and the unfortunate consequences of that prejudice, it is not surprising that there is a steady increase in weight related disorders, particularly overeating. Additionally concerning is the notion that people generally hold internal causes of obesity as the strongest influence on overeating with lesser consideration for the physical and social causes. Because these beliefs are associated with prejudice, and subsequently low body imagine and binge eating, it is particularly difficult for those who struggle with binge eating to overcome it. The prevalence of prejudice within the mental health and medical realms is overwhelming. Awareness and training of the known risk factors and maintenance of overeating is called for in these fields, and perhaps more thoroughly with the public in general, to help individuals at risk for overeating.
Brownell, K., & Puhl, R. (2003). Stigma and Discrimination in Weight Management and Obesity. Health Systems, 16-18.
Fabricatore, A.N., & Wadden, T.A. (2004). Psychological Aspects of Obesity. Clinics in Dermatology (22), 332-337.
Klaczynski, P.A., Goold, K.W., & Mudry, J.J. (2004). Culture, Obesity Stereotypes, Self-Esteem, and the “Thin Ideal”: A Social Identity Perspective. Journal of Youth and Adolescence,33, 307-317.
Lissner, L. (1997). Psychosocial aspects of obesity: Individual and societal perspectives. Scandinavian Journal of Nutrition (41), 75-79.
Polivy, J. & Herman, C.P. (2002). Causes of eating disorders. Annual Review of Psychology (53), 187-213.
Van Strien, T., & Ouwens, M.A. (2007). Effects of distress, alexithymia and impulsivity on eating. Eating Behaviors (8), 251-257.
The ability to choose an evidence-based psychotherapy on the base of scientific knowledge has been a negligible factor in the evolution of the human brain. One could argue that empirical science itself fosters a style of thinking that is counter-intuitive for many of us. Personally I believe that the human way of trying to identify causal relations in a chaotic universe is the main reason of the evolution our kind has taken in the last few thousand years. But our susceptibility to see causal relations can also be a big problem. Thus I believe the main reason why fad therapies can book so much success is that the human mind is not made to think empirically. And if people do think the scientific way there are lots of downfalls, because the empirical science we have today is far from perfect and methodological problems lurk around many corners. It is easy to express (warrant) criticism of the scientific method (which currently is strongly connected to positivism) and shake up people’s reality. This can be a good thing, if you want to get people start thinking themselves, but far more often those who condemn the scientific system propose to let go of all empirical science altogether and adopt a system of their own choice. Funny enough these systems often try to build on the credibility of science, but in the end are not provable.
Whereas in the field of medical health, imbalanced can often be cured by the ingestions of medication, the parallel in the mental health would be ingestion of new thoughts in order to resolve psychic imbalance. While the body can react quickly to changes in the system, the plasticity of the neuronal structure is less flexible. Ingestions of new mental processes need to be repeated many times in order to change the underlying biological substrate. While most people understand that the process of loosing weight requires constant attention to food intake and regular exercise, most people do not understand that mental change is comparably slow. When a “quick and easy” fix is offered, people hope to circumvent the long trajectory of psychotherapy.
To sum it up (and two minor new points):
- The human mind is not made to think in a scientific way.
- Problems with the scientific method often lead people to turn to religion/quick’n’easy solutions/fad therapies.
- Normal therapy usually takes time, money and is painful.
People love to fall for the “it’s easy and painless” trick
- Many conditions do not have a real “cure”. Some can not accept that.
- Authority figures support fads and get rich doing so.
Elements of scientific approach violated in fad therapies
If any given theory is considered scientific (within the current paradigm), this usually means that it is objective, testable and replicable. There are different ways in which fads can be non-scientific. Mostly they are scientific in some ways, but not in all. Here are some of the preferred ways of fads for being non-scientific:
- There is no operational definition, no specifications of the processes and how they are related to important constructs and variables.
- There is no theory at all.
- The cause and effect relationship between the characteristics and consequences of environmental events and experiences has not been researched using sound methodology.
- Causal relationships are presumed without any reason or people are made to believe that there is a causal relationship by presenting correlational evidence.
- Alternative explanations are not pursued.
- Effects are generalized without reason to do so.
- Evidence is subject to biases.
- Unwarranted predictions are made.