Literary Insights

BOOK LINK:

Here is a summary of the key points from the preface:

Treatments for psychological disorders like depression have generally only been effective at providing short-term symptom relief (cosmetic treatments), rather than long-term cures. Effectiveness rates are usually only around 65%.
The focus in psychology/psychiatry has shifted from seeking cures to managing crises and palliating symptoms due to funding/insurance pressures.
Many psychological symptoms stem from highly heritable personality traits, which can be modified but not eliminated. Treatments may only be able to help people function better within their inherent trait range.
The author advocates an approach of learning to deal with and function well in the presence of one’s symptoms, rather than just trying to reduce negative emotions through therapy/drugs.
Examples given of training snipers and pilots focus on building courage and skills to perform under extremely stressful conditions, rather than just reducing stress/anxiety.
For individuals struggling with symptoms, the book can help identify supportive treatments, but lasting changes require courage to understand and manage problems despite inherent limitations. Combining interventions with courage may help exceed typical effectiveness rates.
There are two competing worldviews - that of psychotherapy and self-improvement, which believes people can change anything about themselves through effort, and biological psychiatry, which sees human traits as predetermined by genetics and biology.
The passage argues that both views are incorrect - some traits can be changed through effort, like panic attacks or sexual dysfunction, while others cannot, like dieting success or changing one’s sexual orientation.
The author’s qualifications are outlined - he has spent 30 years researching what he calls “plasticity”, or what can and cannot change. He started by studying learning theory which believed the environment shaped everything, but found biological constraints.
His research focused on problems he believed were “plastic” and could be changed, like learned helplessness, depression, and pessimism. He found these could be both learned and unlearned.
The book aims to provide the first accurate guide to what can and cannot be changed about oneself, since claims from different sides are often untrue or obscured by interests. It will also provide coping skills for what cannot be changed.
The passage introduces the author’s background and biases regarding understanding human psychology and behavior. He used to believe that the environment is entirely responsible for things like depression, anxiety, prejudice, etc. and could be cured by improving the environment.
Now he believes that human evolution and biology also shape our flaws and traits. Both biology and environment interact to influence psychological tendencies.
He aims to evaluate arguments fairly without allegiance to political views. The best evidence comes from outcome studies comparing treatments, not just testimonials.
Self-improvement industries rely more on testimony than rigorous studies. He will consider genetic and environmental causes for traits/behaviors based on evidence. Changeability depends on the issue.
The author then presents a survey to assess views on individual change and the influence of situations vs personality. Respondents are asked to indicate on scales how much various factors influence two scenarios of questionable behavior.

So in summary, the passage introduces the author’s evolved perspective on understanding human psychology and behavior, emphasizing the interplay of biology and environment, as well as the need for evidence-based evaluations over mere testimony. It presents a survey to gauge views on these issues.

Here is a summary of the key points in the passage:

Traditionally, most people in Western history believed that human character is fixed and unchangeable. People do not and cannot improve or advance themselves.
Today, Americans have an almost unprecedented belief in human plasticity - the idea that people can change and improve themselves in many ways through effort and willpower.
This belief in self-improvement underlies the huge modern industry of self-help books, courses, and therapies. Americans spend billions on personal growth and development.
The change from a view of immutable character to one that emphasizes potential for change is recent and represents a major revolution in modern thought. However, this history of how we came to believe so strongly in human malleability has not been fully documented.
The passage questions where exactly this American faith in psychotherapy, self-improvement, and human perfectibility originated from. It notes that exploring the roots of these beliefs would help explain one of the most important shifts in modern thinking.
In summary, the passage establishes that a core American ideology is the ability to change and better oneself, contrasts this with traditional views of fixed traits, and questions the origins of this modern perspective on human plasticity and capacity for growth.

The passage examines how the Bible portrays major events like the Exodus from Egypt and Saul’s conversion as being entirely caused and directed by God, with little to no agency or decision-making from humans. It argues this view of human implasticity, or inability to change, dominated Western civilization for thousands of years.

Three cracks in this view emerged: political liberty like the Magna Carta established individual freedoms; science starting with Francis Bacon showed humans can manipulate nature through experimentation rather than just observe it passively; and debates around free will like Pico della Mirandola’s Oration challenged determinism and asserted humans have free choice. These gradually undermined the dogma that only God’s intervention, not human initiative or change, could improve conditions. Overall, the passage traces how the Bible’s depiction of passive human actors gave way to recognition of individual liberty, science’s power over nature, and free will as forces of change.

Pico della Mirandola argued that humans have free will and can appoint their own nature, raising themselves above all other created beings.
However, the Catholic Church condemned Pico’s views, and he died young still wandering and in poverty.
During the Protestant Reformation, Calvinism argued humans have no free will and their destiny is predestined by God. But Arminianism later claimed humans do have free will and can participate in their own salvation.
John Wesley popularized Arminianism, preaching that humans have free will and can attain salvation through their own efforts using the proper “means.” This view of human ability and agency became widespread.
By the 19th century, the ideas of human plasticity and ability to change were dominant in both America and thinking about criminal rehabilitation, mental healthcare, education and more. Two views emerged - “booters” saw change requiring outside intervention, while “bootstrappers” saw individuals as able to change themselves through willpower and efforts. Both views still influence thinking today.
In the late 19th/early 20th century, there was a widespread epidemic of “general paresis” or severe mental illness and paralysis. This came to be known as the “Italian Pox, French Pox, English Pox”.
There was debate over the cause - some like Griesinger thought it was from loose living/bad cigars, others like Krafft-Ebing thought it was from syphilis.
The debate centered on whether syphilis infection years prior could still cause the illness later on. Scientists did not yet have the ability to directly examine brain tissues of the deceased and look for syphilitic germs.
In 1905, psychiatrist Alois Alzheimer discovered characteristic changes in brain tissue under the microscope. This allowed direct examination and provided evidence that general paresis was indeed caused by long-term syphilitic infection in the brain, resolving the decades-long debate.
This was a landmark discovery as it provided some of the first convincing evidence of a biological/physical cause for mental illness, rather than just attributing it to moral failings or lifestyle factors. It helped establish diseases like syphilis and their long-term effects on the brain and mind.
In the early 1950s, psychosis (severe mental illness involving symptoms like delusions and hallucinations) was seen as largely hopeless and untreatable. Patients were kept in overcrowded psychiatric wards with little improvement.
In 1952, a French psychiatrist, Jean Delay, announced a breakthrough - an antihistamine drug called chlorpromazine was found to dramatically calm psychotic patients and reduce delusions within days or weeks. This started the “drug revolution” in psychiatry.
When a patient named Lester exhibited florid psychosis like thinking he was a worm, doctors at his hospital debated whether to try the new drug or psychotherapy. The drug proponent prevailed and Lester responded extremely well to chlorpromazine, quickly returning to normal functioning.
The success of chlorpromazine rapidly spread this new biological model of understanding mental illness as caused by chemical imbalances treatable with drugs. It reduced overcrowding and improved many long-term patients. However, not all recovered completely.
New antidepressant and anti-anxiety drugs were also discovered serendipitously and widely adopted, helping 65% of depressed patients on average. This established the pharmaceutical industry as a major driver of psychiatric treatment.
Prozac became the top-selling antidepressant in the 1990s due to claims of milder side effects compared to earlier drugs. However, antidepressants only moderately help depression and the effects are not long-lasting if the person stops taking them.
Lithium carbonate was discovered in the 1940s/50s to effectively treat mania, dramatically improving outcomes for those with bipolar disorder. Around 80% see benefits with lithium treatment.
Anti-anxiety drugs like Miltown and later Librium/Valium became widely used starting in the 1950s. While effective at reducing anxiety symptoms, they are prone to misuse/addiction and do not address underlying issues.
Psychiatric drugs have significant downsides and limitations. They mainly provide cosmetic relief of symptoms but do not cure the underlying conditions. Many patients experience relapse of symptoms upon stopping treatment. Drugs often produce severe side effects like tardive dyskinesia. Overall, drugs are portrayed as having more drawbacks than advocates claim.
The essay questions the notion that moods and emotions are solely determined by brain chemistry by highlighting limitations of drug treatments and side effects. A purely biological view of mental illnesses is criticized.
Personality traits being genetic is controversial as it goes against the prevailing view that personality is learned through environment and upbringing.
Biological psychiatry came to believe personality has a genetic basis by studying twins, especially identical twins reared apart. If identical twins raised in separate environments still show similar personalities, it suggests genetics plays a role.
The story of Andy and Steven illustrates the debate between the nature (genetic) vs nurture (learned) explanations of child abuse. Steven was abused as a child and now abuses his son Andy - did he learn this behavior or inherit an aggressive disposition?
Evolution selects for complex traits like aggression, intelligence, beauty that directly impact reproduction, not just genes themselves. So complex traits like personality can be inherited even if specific genes aren’t identified.
Studies of identical twins reared apart provide the best evidence of a genetic basis, as identical twins share 100% of genes but have different upbringings. If they still show similar personalities, it implies genetics plays a role. Numerous personality traits correlating strongly in identical twins supports a genetic influence.
Comparing adopted children to biological vs adoptive parents can also separate genetic and environmental influences, providing further evidence personality has inheritance.
Adoption studies in Denmark provide a natural experiment for untangling the effects of biology vs environment on criminality. They examined criminal records of biological and adoptive fathers as well as their sons.
If neither father had a criminal record, 10.5% of sons became criminals. If just the adoptive father had a record, there was little difference (11.5%). So having a criminal father doesn’t inherently increase risk.
However, if just the biological father had a record, 22% of sons became criminals, doubling risk. Having a criminal biological father significantly increases risk even when raised by a non-criminal adoptive father.
The highest risk was if both fathers had records - in that case 36.2% of sons became criminals, over triple the baseline risk.
This suggests there is a biological predisposition to criminality that is partly heritable. Being raised by a criminal father only increases risk if the biological predisposition is already present.
Other adoption studies support the finding that personality has a genetic component, though it is not completely determined by genes - the degree of heritability is less than 50% for most traits.
While personality is partly heritable, the environment and experiences also play a role, leaving room for therapy and self-improvement to influence the non-genetic influences.
Emotions like anxiety, depression and anger each serve an evolutionary purpose - they warn of danger, mark loss, and signal when something is wrong respectively.
Anxiety in particular acts like a “mental tongue”, constantly scanning for potential threats and problems. It fuels planning and preparation.
Our everyday anxiety, depression, or anger can become irrational, paralyzing or overly intense. When this happens, it has exceeded its useful function and become a burden.
Three signs that negative emotions have become unhelpful are if they are irrational compared to reality, cause paralysis rather than action, or dominate one’s life intensely.
Taking steps to relieve emotions when they cross these lines, like becoming disproportionate, paralyzing or overly intense, can improve quality of life. Tools like CBT can help dispute irrational thoughts and reduce anxiety levels.
Self-analysis questionnaires can help evaluate if one’s general anxiety level is unusually high, indicating it could benefit from reduction through techniques like cognitive behavioral therapy.

Here is a summary of the key points regarding egardless of paralysis and irrationality:

If your anxiety score is at or above the 75th percentile, and anxiety is paralyzing you or seems irrational, you should try to lower your general anxiety level.
If your score is 18 or above, and anxiety is both paralyzing and irrational, you should try to lower your general anxiety level.
Two effective techniques for lowering everyday anxiety are progressive relaxation and meditation. Progressive relaxation involves tensing and relaxing muscle groups to relax the body. Meditation involves focusing on a mantra to block anxious thoughts.
Minor tranquilizers and alcohol can provide quick relief from anxiety but have disadvantages like addiction potential, cognitive impairment, and health risks with long-term use. Progressive relaxation and meditation are safer options.
Intense, unremitting anxiety could indicate an anxiety disorder that requires treatment beyond relaxation techniques. The rest of the text will discuss panic disorder, phobias, and obsessive-compulsive disorder.

So in summary, the key points are around assessing level of anxiety, determining if it is paralyzing or irrational, and using relaxation techniques as a first approach to lowering anxiety levels before considering other treatments.

David Clark, a young psychologist from Oxford, presented an alternative theory that panic disorder is caused by a cognitive process - the catastrophic misinterpretation of normal bodily sensations as signs of impending medical emergencies like heart attacks.
This theory fits well with existing biological evidence for panic disorder. Bodily sensations induced by sodium lactate or inheritability of sensations could lead to misinterpretations, and drugs may work by reducing sensations.
Clark had developed a brief cognitive therapy based on this theory where patients learn to reinterpret sensations as signs of anxiety rather than medical emergencies.
Experiments showed panic patients were faster to interpret sensations catastrophically and could be induced to panic by word associations, supporting the theory.
The therapy resulted in 90-100% remission rates and very low recurrence at one-year follow up, an unprecedented success rate. Controlled studies found it markedly better than drugs or relaxation.
This presented a potentially practice-changing view of panic disorder as a problem of misinterpretation rather than a biological or deeper psychological problem, supported by strong evidence from Clark’s experiments and therapy results.

Here are the key points about how cognitive therapy compares to drugs in treating panic disorder:

Both antidepressants and benzodiazepines like Xanax are effective at markedly reducing panic attacks in most patients when they are taking the drugs. However, once patients stop taking the drugs, panic rebounds for about half of them.
Drugs must be taken indefinitely to continue controlling panic, whereas cognitive therapy aims to teach skills and change maladaptive thoughts so patients no longer need ongoing treatment.
Drugs can have significant side effects like drowsiness, lethargy, pregnancy complications, and risks of addiction/dependence. Cognitive therapy does not involve taking medication so it avoids these risks of side effects.
One study found cognitive therapy was as effective as drug treatment at reducing panic attacks while patients were in treatment. But cognitively treated patients were less likely to have panic rebound once treatment ended, showing cognitive therapy may have a more durable effect.

So in summary, while drugs are generally effective for panic relief, cognitive therapy provides benefits of being equally effective during active treatment, not requiring indefinite medication use, and having a lower risk of dangerous side effects or dependency issues. The cognitive approach potentially produces longer-lasting benefits once treatment is completed.

Garcia’s experiments with rats showed conditioning could occur across long delays between the conditioned stimulus (taste) and unconditioned stimulus (illness), unlike typical Pavlovian conditioning which requires a short delay.
Rats developed an aversion to saccharin after just one pairing with radiation sickness, unlike typical conditioning which requires multiple pairings.
The conditioning was irrational - knowledge that the taste didn’t cause illness didn’t eliminate the tasted aversion, unlike typical conditioning which extinguishes with expectations.
The aversion lasted a long time and was very resistant to change, unlike typical conditioning which extinguishes easily.
These discrepancies could be explained if conditioning was shaped by evolution over millions of years to help organisms avoid toxic foods or illnesses through taste aversions.
Quick one-trial learning of taste-illness pairs that lasts a long time increases an organism’s chance of survival, passing these learning abilities on genetically.
Garcia’s findings challenged behaviorism’s view that learning is governed by universal laws shaped only by the environment, not genetics. This caused major controversy.
Phobias are often acquired through a traumatic childhood incident and involve an irrational, long-lasting fear disproportionate to the actual danger. About half of phobias begin this way.
The woman, Susan, developed a severe phobia of cats as a child after witnessing an injured rabbit. Her aversion to cats intensified over time.
By age 31, her cat phobia had reached its peak. She was afraid to leave her house for fear of encountering a cat outside and being attacked. Any unexpected noise or movement in her house startled her, worrying it may be a cat.
Traditional talk therapies like psychoanalysis were unsuccessful in treating phobias. Behavioral therapies like systematic desensitization and flooding that use extinction techniques, by exposing patients to the feared object without negative consequences, reliably cure phobias about 70% of the time.
Phobias appear to be a result of ordinary Pavlovian conditioning, where a neutral stimulus like a cat becomes associated with a traumatic event and elicits a fear response. Behavioral therapies succeed by breaking this association through repeated exposures without triggering the trauma response.
However, phobias also show selectivity towards objects that were evolutionarily dangerous, unlike ordinary conditioning. This and other inconsistencies suggest phobias may have origins in evolution beyond simple classical conditioning. Behavioral therapies are still the most effective treatment available.
Garcia conducted an experiment on human fear conditioning using pictures of spiders (an evolutionarily prepared stimulus) and houses (an unprepared stimulus). Participants conditioned much more strongly to the spider image after just one pairing with electric shock, showing spiders elicit a stronger innate fear response.
Phobias do not always follow classic Pavlovian conditioning principles which require a close timing between stimulus and response. Some phobias form without explicit trauma or even after a delayed experience. Social learning also plays a role in phobia formation.
Experiments by Ohman found prepared threats like pictures of scorpions or snakes could elicit fear responses without explicit conditioning, just by observing another person’s distress. This showed prepared fears are intrinsic and irrational.
Phobias are deeply irrational but resistant to reason, reflecting an unconscious evolutionary adaptation. They require flooding or desensitization to extinguish, not just cognitive therapy. Phobias represent a persistent primitive fear response rooted in our ancestral past that modern knowledge cannot easily override.
Our evolutionary heritage shapes not just fears but many psychological tendencies, from sexual preferences to aggression to prejudices. While not excusing problematic behaviors, recognizing this biological influence is important for understanding why change is difficult in these domains. Reason alone often cannot produce lasting change for such deep-rooted tendencies.
Obsessive-compulsive disorder (OCD) is characterized by unwanted and intrusive thoughts (obsessions) and repetitive behaviors performed to neutralize the thoughts (compulsions).
Common obsessions include dirt/contamination, checking for dangers, and doubts. Compulsions typically involve cleaning/washing rituals or checking behaviors.
The biological viewpoint considers OCD a brain disease, citing occasional onset after brain trauma, genetics, and brain scan studies showing increased activity in filtering and perseveration areas.
Content of obsessions and compulsions (germs, violence, washing, checking) seem evolutionarily adaptive behaviors rather than random themes.
Treatment involves both biological approaches like drugs and behavioral therapy aiming to reduce rituals and decrease anxiety aroused by obsessions.
Diagnoses are made clinically based on intrusive/unwanted nature of thoughts, lack of stimuli, and difficulty dismissing thoughts, as validated by questionnaires like the Maudsley Obsessive-Compulsive Inventory. Severe scores indicate need for professional help.
Obsessive-compulsive disorder (OCD) may have biological roots related to ancient primate behaviors of grooming and checking that have gone awry. The brain areas involved in these behaviors may be responsible for OCD symptoms.
Effective treatment for OCD involves medication (Anafranil/clomipramine) and behavioral therapy techniques like exposure and response prevention. Medication alone is not fully effective for many patients and symptoms often return after stopping treatment.
Behavioral theories view OCD as stemming from an inability to dismiss disturbing thoughts and images. Rituals and compulsions provide temporary anxiety relief and become reinforced, leading to a vicious cycle. Exposure therapy aims to extinguish this cycle.
Both biological and behavioral factors likely play a role in OCD. The most effective treatment combines medication and behavior therapy. While treatment can significantly improve symptoms, OCD thoughts often persist after treatment to some degree.
Depression has become more common in modern times compared to past eras. It is the dominant emotion of our current age, reflecting themes of uncontrollability and helplessness. The CES-D test measures common symptoms of depressive mood and behaviors.
The questionnaire measures symptoms of depression across 4 clusters - negative thoughts, negative mood, behavior changes, and physical/somatic symptoms.
A high score does not necessarily mean clinical depression, but suggests elevated depressive symptoms. Scores above certain thresholds recommend seeking professional help.
Depression involves negative Cognitive styles, low mood, passivity, indecisiveness, suicide ideation, and physical symptoms like appetite changes and sleep issues.
Unipolar depression involves episodes of depression without mania. Bipolar depression involves both depressive and manic episodes.
Bipolar depression is highly heritable and responds well to lithium treatment, suggesting it has biochemical/medical underpinnings. Manic-depression is considered a body disorder.
Therapists are generally not liable for malpractice if they misdiagnose unipolar vs bipolar depression initially, as bipolar can be difficult to identify, but continued failure to properly diagnose could potentially create liability.
Studies in the late 1970s found significantly higher rates of depression than expected, indicating a potential “epidemic” of depression. Lifetime prevalence of depression had increased over 10 times for those born in the mid-20th century compared to the early 20th century.
Depression also started striking victims much earlier in life for those born later in the 20th century. For example, the average age of a first depressive episode decreased from 30-35 years old to 20-25 years old.
Depression affects women at about twice the rate of men. This difference does not appear to be explained by factors like willingness to seek treatment, economic status, biological differences, or genetics. The extra demands placed on modern women from both traditional and professional roles may contribute to higher rates of depression compared to men.
In summary, studies found clear evidence that rates of depression, especially severe depression, had increased dramatically over the 20th century. This suggests an “epidemic” of depression, particularly among women. Earlier onset and higher prevalence of depression remained puzzling and unexplained by typical contributing factors.
There are three plausible explanations for why women experience depression more than men: learned helplessness, rumination, and the pursuit of thinness.
Learned helplessness refers to women receiving more experiences of helplessness throughout their lives due to societal factors like parenting styles, achievement recognition, and roles/expectations.
Rumination means women tend to think about and analyze problems more, like the cause of their depression, which can make depression worse. Men are more likely to act or distract themselves.
The pursuit of thinness sets women up for failure and constant reminders about weight, leading to depression. Dieting and discontent with body image particularly impact girls during puberty.
Effective treatments for depression include drugs, electroconvulsive therapy (ECT), cognitive therapy, and interpersonal therapy. Drugs and ECT provide acute relief for 65-75% of people but side effects are a risk and depression often returns without continued treatment.
Cognitive therapy aims to change negative thought patterns by recognizing automatic thoughts, disputing them with evidence, making new explanations, distracting from rumination, and questioning assumptions related to depression. It provides relief for around 70% of people.
Cognitive therapy (CT) aims to change depressive thinking patterns through brief, weekly sessions over a few months. It teaches skills to disrupt negative thoughts that can be used in the future to prevent relapse.
While CT reduces future risk more than drugs, it does not eliminate the risk of recurrence completely. It may work better for moderate than severe depression. More research is needed on its effectiveness for less educated populations.
Interpersonal therapy (IPT) focuses on current social/interpersonal problems rather than past issues. Sessions are 12-16 weeks. It addresses issues like grief, conflicts, role transitions and social skills.
IPT has been shown to be as effective as antidepressants and CT in clinical trials. However, it is not widely available outside of major cities due to lack of practitioners and research on its active ingredients.
Both therapies provide alternatives to medication with fewer side effects. More research is still needed on their long-term effectiveness, especially for severe depression. Relapse prevention remains an ongoing challenge.
Anger has three components - a thought of being trespassed against, bodily reaction (increased heart rate, blood pressure, etc.), and an attack response to end the trespass.
Anger helps defend one’s territory, aiming for justice and righting wrongs. It has an evolutionary benefit for survival.
There is a debate around whether suppressing anger is unhealthy, leading to increased risk of cancer, heart disease, depression, etc. due to bottling it up. Or if expressing anger dissipates it and has no long term health effects.
Evidence linking suppressed anger specifically to higher cancer and heart disease is weak. Type C and Type A personality traits confound other factors like hopelessness/helplessness that may be the real risks.
Whether expressing anger is seen as virtuous depends on cultural/social norms. The modern view sees it as healthy to vent anger, but other cultures value controlling emotional expression.
In summary, while anger has evolutionary benefits, claims that suppressed anger causes severe health risks are questionable and not well supported by evidence according to this analysis. Cultural views on emotional expression also vary.
Hostility, overt anger, is likely the real culprit that increases risk of heart disease in Type A personalities, not competitiveness or time urgency. Studies have shown angry individuals have higher rates of heart disease decades later.
Expressing anger does not lower blood pressure for women and may actually raise it. For men, bottling up anger lowers blood pressure only against superiors, not peers.
A simple theory is that emotions like anger and fear that increase heart rate and blood pressure use up the heart’s life allotment of beats faster, leading to earlier heart disease. Venting anger regularly uses up this allotment.
Depression is not simply anger turned inward, as Freud theorized. Encouraging depressed people to get angry can actually worsen their depression in some cases.
While anger may feel honest, it does not provide an accurate or truthful view of events due to its biased perception. It also does not guarantee justice or effectiveness in resolving conflicts in many situations.
Serious turmoil and fighting between parents is very psychologically damaging for children to witness and can lead to depression. A society that encourages unrestrained anger expression tends to be more violent.
Research shows that children of parents who fight or divorce are more depressed than children from intact families with non-fighting parents. This depression persisted even 3 years later.
Exposure to parental fighting causes children to develop a negative, pessimistic worldview that lasts into adulthood. They see bad events as permanent and pervasive, and blame themselves.
However, not all children are negatively affected - some recover over time or do not become depressed or pessimistic. Divorce/fighting increases the likelihood but does not doom children.
Children of parental turmoil experience more negative life events like failing courses, hospitalization of parent/child, death of friends, etc. which contributes to high depression rates.
Parental fighting may cause lasting harm because 1) the conflict directly disturbs the child or 2) the child is aware of parental unhappiness, though the evidence leans toward the direct disturbance being more impactful.
Marital counseling or refraining from separation/fighting may help children, depending on what future research finds as the root cause of harm - overt conflict or awareness of parental unhappiness.
Expressing anger through fighting damages relationships in the long-run and does not relieve anger as the “catharsis theory” claims. Maintaining an anger diary and learning anger management techniques can help those with frequent anger issues.
Hector and Jodi’s 14-year-old son Tommy was killed in a car accident driven by his 17-year-old cousin Norma Sue.
In the 5 years since, both Hector and Jodi have suffered tremendously from post-traumatic stress disorder (PTSD) as a result of this tragedy.
Jodi has been severely depressed, waking up from nightmares about Tommy pleading for help. She relives that day constantly and lost motivation for life.
Hector barely functions at his job and dreads weekends when he used to spend time with Tommy. He can’t talk about Tommy without hurting.
Their suffering from PTSD includes constantly reliving the trauma in dreams/flashbacks, avoidance of anything related to it, anxiety, sleep issues, inability to concentrate, and being easily startled.
The trauma was so devastating and long-lasting that it has permanently damaged their lives, mental health, and relationship, culminating in their recent divorce.
PTSD is the clinical term for the universal and persistent psychological distress experienced after extraordinary loss or trauma beyond ordinary human experiences.

The key message is that extraordinary loss or trauma, like the sudden death of a child, can profoundly and permanently damage people’s lives through post-traumatic stress disorder. Hector and Jodi’s story serves as a tragic example of how PTSD manifests and destroys lives after such a tragedy.

Numbness and detachment from people are common reactions after trauma or loss. Jodi and Hector experienced this after their marriage fell apart.
The death of a child is one of the worst tragedies and is a leading cause of death in the US each year. Unexpected death of a spouse is also extremely difficult to cope with.
Contrary to common beliefs, grieving a major loss like a spouse or child does not necessarily heal with time. Studies have found bereaved parents and spouses are still depressed, less optimistic, and in poorer health 4-7 years later.
Experiences like surviving the Holocaust or being a prisoner of war can clearly cause lifelong PTSD symptoms. Dora, a Holocaust survivor, still struggles with intrusive memories and symptoms over 45 years later. Many WWII POWs also still had PTSD symptoms 40 years later.
However, PTSD is more widespread than traditionally thought and can be triggered by more commonplace losses or events. The death of a child or experience of rape can cause the same symptoms as clearly traumatic events.
Rape victims commonly experience PTSD symptoms like reliving the event, sleep issues, fear, detachment from relationships and sexuality. While most report recovering after a few years, about 25% say they never fully recover even after 4-6 years.
Severity of injury alone does not predict who gets PTSD - it is more about the level of psychological distress felt after the event. Having a prior mental health history increases vulnerability to developing long-term PTSD after trauma.

Here are the key points summarized from the passage:

People who experienced more trauma before an event were less likely to develop chronic PTSD from the event. Factors like high neuroticism and a family history of mental illness were better predictors than the level of physical trauma experienced.
Israeli combat veterans whose parents were Holocaust survivors had higher PTSD rates than other veterans after the Lebanon war.
Israeli combat veterans who developed PTSD after a second war were more likely to have experienced combat stress reactions during their first war.
Previous good psychological health does not always protect against PTSD if the traumatic event is severe enough. However, people who are psychologically healthier beforehand are generally at lower risk.
Both drugs and cognitive behavioral therapies have shown some success in reducing PTSD symptoms, but treatment success has been modest so far with many patients still experiencing symptoms after treatment. Combining exposure therapy and stress inoculation has shown the most success in some studies but more research is still needed.

The passage discusses human sexuality in terms of five layers:

Sexual identity and transsexuality. This layer determines whether one identifies as male or female, which is very deeply ingrained from early fetal development. Transsexuality involves identifying with the opposite gender and is nearly impossible to change.
Sexual orientation. This layer involves whether one is attracted to men, women, or both. Sexual orientation strongly resists change once established.
Sexual preferences. Specific turn-ons or fetishes fall into this layer. Preferences can change to some degree once acquired.
Sex roles. This involves adopting typical “masculine” or “feminine” behaviors and roles. Sex roles are somewhat flexible and shaped by socialization and personal choice.
Sexual performance. This surface layer involves the ability to become aroused and experience orgasm during intimate encounters. Performance issues like impotence or frigidity can sometimes be addressed.

The passage also explores the origins of sexual identity in fetal development and hormone exposure, and how transsexuality likely results from a disconnect between biological sex and innate psychological gender identity established very early in development.

Here are the key points:

The theory proposes there are two phases of sexual development - psychological sex and physical sex organs. For some transsexuals, only one phase goes awry.
Adrenogenital syndrome (AGS) and androgen insensitivity syndrome (AIS) are genetic conditions that cause atypical sexual development. They provide parallels to the two types of transsexualism.
AGS feminizes an XX fetus physically but not psychologically. AGS individuals raised as male identify as male. Their experience parallels female-to-male transsexuals.
AIS masculinizes an XY fetus physically but not psychologically. AIS individuals raised as female identify as female. Their experience parallels male-to-female transsexuals.
The theory suggests sexual orientation develops separately from identity and physical sex. Different levels of hormonal influence in utero could result in transsexualism, homosexuality or neither.
Studies find genetic and prenatal hormonal factors influence sexual orientation. Identical twins show higher concordance for homosexuality than fraternal twins.

So in summary, the theory proposes a multi-phase model of sexual development influenced by both genetics and prenatal hormones to explain different sexual outcomes. Conditions like AGS and AIS provide biological parallels for understanding transsexualism.

Sexual preferences are often wrapped in an initial “inhibitory wrapping” of disgust or aversion that is later overcome through social pressure, curiosity, or other experiences. Once someone indulges in an activity, they often come to enjoy and crave it.
Early sexual experiences during childhood and adolescence, such as dreams, play, and fantasies, are formative in shaping someone’s long-term sexual preferences. Events during this period can cause preferences for certain acts, objects, or scenarios to develop.
Case studies are presented of two men (Leopold and Sammy) whose earliest sexual experiences involved feet/shoes and buttocks, respectively. They developed long-term preferences and needs centered around those initial objects/acts of arousal.
Sexual preferences formed in this way, like phobias, become deeply ingrained and resistant to change. Early sexual experiences essentially “condition” what a person finds arousing for the rest of their life.

So in summary, the passage argues that sexual preferences are significantly shaped by inhibitory experiences that are overcome during adolescence and childhood sexual development.

Male sexual preferences are usually oriented towards specific female body parts or acts related to intercourse, such as breasts, feet, hair, etc. Truly bizarre fetishes like attraction to dead bodies are rare and often indicate psychopathology.
According to the “prepared conditioning” view, evolution has made certain stimuli like buttocks or feet more likely to become targets of sexual arousal and conditioning during childhood sex play and fantasizing. Repeated pairing of these stimuli with masturbation leads the preferences to endure lifelong.
Masturbation serves to reinforce sexual fantasies and preferences through repeated conditioning trials throughout adolescence and adulthood. Evolution may have selected for this to strongly instill males with the sexual practices of their culture.
In contrast, female sexual preferences tend to be oriented towards more subtle relationship dynamics and scenarios rather than specific physical objects. Fetishism is also much rarer in women.
While sexual preferences endure naturally, explicit therapeutic techniques like aversion conditioning or orgasmic reconditioning have had some success in altering maladaptive preferences like exhibitionism, though reported subjective changes may not reflect full behavior modification.
The passage discusses ways to potentially curb sex offending behavior, including therapy and chemical or surgical castration. It notes that castration has shown much lower recidivism rates (around 3% versus 70% without) in European studies.
However, castration is currently not allowed in the U.S. as it is considered “cruel and unusual punishment.” The author argues castration may be less cruel than typical prison sentences given recidivism risks and dangers for sex offenders in prison.
Overall the passage weighs the pros and cons of different approaches to limiting harmful sexual behaviors, with castration presenting strong evidence of effectiveness but also humanitarian concerns about cruel treatment. It does not take a definitive stance, simply presenting facts about various options.
Sexual performance issues like impotence, premature ejaculation, lack of arousal, and failure to orgasm are common sexual dysfunctions that were historically difficult to treat but are now often curable.
Adequate sexual performance involves two phases - arousal and orgasm - which function similarly biologically in men and women. Dysfunctions can occur in either phase.
Anxiety, anger, depression and “spectatoring” (watching oneself have sex from the outside) can interfere with arousal and orgasm and make dysfunctions worse by heightening anxiety in a vicious circle.
In the late 1960s, Masters and Johnson pioneered direct sexual therapy which treats problems as local issues for the couple rather than labeling individuals as neurotic. The couple practices sex together under the guidance of a therapist using their techniques.
Direct sex therapy has proven highly effective for treating sexual dysfunctions and can now be accessed through therapists in most major population centers using the Masters and Johnson approach.
Cindy and Bob were experiencing issues in their marriage and sex life. They sought counseling at the Marriage Council in Philadelphia.
Over multiple therapy sessions, Cindy was taught how to masturbate with a vibrator and have her first orgasm. This built her confidence.
Bob was then gradually involved, starting by just watching and then lightly touching Cindy.
They progressed to reciprocal caresses (sensate focus) and eventually non-demanding intercourse where there was no pressure for Cindy to orgasm.
During therapy, Cindy was able to have orgasms during intercourse for the first time.
Six years later, Cindy almost always achieves orgasm during intercourse with Bob.
The therapy employed graduated steps and emphasized giving/receiving to help Cindy overcome anxieties and fully participate sexually. It was highly successful in resolving their sexual dysfunction issues.
Direct sexual therapy like this can have high success rates of 70-95% in treating most major sexual dysfunctions, except for retarded ejaculation in men. Successful treatment results in little relapse.

So in summary, the passage describes how Cindy and Bob received counseling that used masturbation, mutual caresses and sensate focus exercises to help Cindy overcome anxiety and fully experience sex and orgasms, saving their marriage.

The common advice to diet down to an “ideal” weight in order to live longer is a myth that is not backed by proper scientific studies. There is no evidence dieting leads to longer life.
Dieting can actually damage health in ways that may shorten life, such as through repeated use of hair dye chemicals during weight loss efforts.
Some other myths about overweight people include that they overeat more than others, have an “overweight personality,” and that weight is simply a matter of willpower. Research does not support these claims.
America has become obsessed with thinness. Billions are spent each year on dieting and weight loss products. However, long term studies show that almost all dieters regain the lost weight within a few years. Very few people are able to maintain significant weight loss long-term through dieting alone.
The “Oprah effect” demonstrated how a celebrity like Oprah was able to lose dramatic amounts of weight on a liquid diet but eventually regained most of it. Scientific studies have consistently shown similar patterns of initial weight loss but almost complete regain over time through dieting.

The passage discusses yo-yo dieting and its effects on metabolism and weight regain. Repeated cycles of dieting and weight regain cause lasting changes to how the body stores and conserves energy. This makes long-term weight maintenance very difficult.

It introduces the concept of natural weight, which is determined in part by genetics. The body defends its natural weight range through slowed metabolism and other mechanisms. Dieting can trigger bulimia as the body rebels against self-imposed starvation. Bulimia is seen as the body’s defense of its natural weight in the face of dieting and an unattainable thin ideal.

Treatment of bulimia focuses on getting patients to stop dieting and accept their natural weight. Studies show bulimic episodes stop when patients adopt a nutritionally adequate diet rather than undereating. Cognitive-behavioral therapies that emphasize accepting natural weight over being extremely thin have shown success in reducing bulimic behaviors and preventing relapse compared to drug treatments alone. Dieting is identified as a key cause and trigger of bulimia.

Depression may worsen bulimia by making it easier to give in to temptation to binge and purge.
Dieting on its own may just be another symptom of bulimia rather than a cause. Other underlying factors are likely involved.
Speculatively, being below one’s natural weight is likely a necessary condition for bulimia, and returning to one’s natural weight through accepting it could cure bulimia.
There is a push to add “binge eating disorder” to the DSM-4, where people binge but don’t purge. However, many of these cases could just be people inappropriately dieting below their natural weight.
“Dieting disorder” could be a new category, defined as being within 20% of one’s “ideal” weight but ruining health through dieting.
Artificial sweeteners may not lead to long-term weight loss as the body compensates by eating more elsewhere to make up the lost calories.
Diet pills suppress appetite but rarely lead to long-term weight loss as weight returns after stopping. Side effects can be serious. Newer drugs like fenfluramine and phentermine show more promise but research is still needed.
Moderate overweight may carry little health risk while underweight and weight cycling from dieting likely carry greater risks. Dieting itself may present a health risk through weight cycling.
Gradually gaining weight in middle age may carry less risk than staying thin through dieting.
Depression is a risk of dieting due to the failure and helplessness of the yo-yo effect of losing and regaining weight. Cultures with thin ideals have higher rates of both eating disorders and depression in women.
The thin ideal promoted in many cultures can lead women to feel more depressed than men, as they feel pressure to conform to an unrealistic body type. This effect starts around puberty.
Dieting is linked to higher rates of eating disorders and may increase the risk of becoming clinically depressed over time. Constantly feeling like a failure compared to thin ideals can damage mental health.
For those who are overweight, regular exercise is more important for health and lowering mortality risk than dieting alone. Modest exercise like brisk walking can significantly improve health outcomes.
Modifying diet composition by reducing fat and alcohol intake may improve health whether weight is lost or not. However, overeating is a bigger problem than weight itself. Learning to only eat in response to hunger is important.
For those who are severely obese, bariatric surgery may be necessary to achieve long term weight loss, though it carries risks itself. Addressing the psychological drivers of overeating is also important.
There are commonly believed statements about alcoholism and addiction, such as it being a progressive disease and the belief in an “addictive personality”. However, many of these statements are controversial and not clearly proven to be true.
While not proven, these beliefs can be useful for alcohol abusers seeking help and for those trying to help them, as in Alcoholics Anonymous which is built on these principles.
The tactics that help with recovery, like believing in alcoholism as a disease, may differ from the objective truth about alcoholism and addiction. Relieving the problem through certain beliefs does not necessarily mean those beliefs accurately reflect reality.
Determining if someone has a drinking problem and where to draw the lines between abuse, dependence, and normal use is not clear cut. Having more symptoms from lists of problems does not prove alcoholism but suggests a higher risk of problems.
Self-diagnosis of alcoholism is difficult and controversial. Objective measures do not clearly differentiate social drinking from abuse or dependence for most people. Professional diagnosis may be needed.
There are open questions around alcoholism as a disease or addiction versus a habit or behavior issue. The author will discuss but not resolve these controversies, only providing their opinion rather than proven facts.
The passage discusses whether alcoholism should be considered a disease. There are good arguments on both sides of this debate.
Calling it a disease emphasizes that alcoholics lose control over their drinking in later stages, even if choices mattered at the beginning. However, others argue it is a failure of will and personal choice, not a true physical disease.
Ultimately, whether it is classified as a disease or not is less important than how it affects treatment and outcomes.
Explaining problems as due to a disease (temporary, specific, impersonal) leads to better outcomes than a vice or character flaw (permanent, global, personal). It encourages optimism about change rather than helplessness.
Alcoholics who see their condition as an illness are less depressed, have higher self-esteem, and try harder to change than those who see it as a moral failure or vice.
So while the scientific definition is disputed, viewing it as a treatable disease is more useful tactically for helping alcoholics make positive changes in their lives. The label impacts mindset and likelihood of recovery efforts.
The disease label of alcoholism is seen as more hopeful than alternatives like calling it a vice or sin, as it frames it as something that can potentially be treated or changed. Seeing oneself as ill opens the possibility of recovery through treatment.
AA gets partial credit, as calling it a disease promotes change, but the concept of powerlessness can undermine that and lead to passivity rather than active change. Later alternatives like “habit disorder” or “behavioral problem” imply it’s something that can be changed through one’s own efforts.
Landmark longitudinal studies found no evidence of an “addictive personality” - traits like anxiety, depression, etc. were results not causes of alcoholism, and disappeared after recovery. The only predictive factors were family history and genetics.
Alcoholism is usually progressive, getting worse over time without intervention like AA or abstinence. But it tends to level off or improve in middle age for those who survive that long. About 1/3 recover fully, 1/3 die or remain severely impacted, and 1/3 continue struggling with recovery. Those on the progressive course had worse initial symptoms and spent more years feeling “out of control” of their drinking.

Here is a summary of the key points about whether AA (Alcoholics Anonymous) works:

It is very difficult to definitively say whether any alcohol treatment works, as high-quality outcome studies comparing treatment groups to control groups are rare. This lack of evidence is a problem.
In the natural course of events, about one in five severe alcoholics will recover completely long-term (over 18 months), while about half will remain alcohol-dependent or die prematurely.
Factors like being married, having a stable job/home, hitting “rock bottom”, finding religion/spiritual support, and developing new relationships can help the recovery process.
Elaborate inpatient treatment programs sometimes show good short-term (6 months) outcomes, but long-term controlled studies comparing them to no treatment are rare and have not clearly shown they work better.
One study found compulsory AA attendance for a year worked better than no treatment or brief hospitalization alone, with higher abstinence rates after 2 years.
In summary, the evidence is mixed as to whether AA or formal treatment meaningfully improves outcomes beyond the natural recovery rate due to lack of quality long-term control studies. More research is still needed.
Inpatient treatment for alcoholism is expensive and there is limited evidence that it is more effective than natural recovery. Outpatient psychotherapy like talk therapy has not been shown to help alcoholics stop drinking.
Antabuse (disulphram) is a medication that causes nausea if alcohol is consumed while taking it. Studies show implanted Antabuse is no more effective than a placebo at stopping drinking long-term. Other aversion therapies like electrical shock or chemical induction of nausea have also not shown clear effects.
Naltrexone, a drug that blocks opioid receptors, may be promising based on two studies showing it reduced relapse rates. However, long-term effects need more research.
Evaluating Alcoholics Anonymous is difficult due to lack of controlled studies and its ubiquitous nature. While some observational studies found AA attendance correlated with abstinence, causation cannot be determined. AA may help certain subgroups but is not effective or acceptable for all.
Total abstinence appears to be the only goal that works for the most severe alcoholics. While a small percentage may resume social drinking, promoting this as a general goal could undermine recovery efforts for many. More research is still needed on treatment approaches and goals for alcoholism.
There are two major seasons in life - a season of expansion and a season of contraction.
The season of expansion begins at birth and focuses on fitting into the outside world by getting an education, finding a partner, having a family, embracing societal values, and establishing a career. It is an extrinsic season driven by external demands.
Most readers are around 30-45 years old and entering the transition between the first and second seasons. This marks the “height of their powers” and the halfway point of life.
The second season is defined more by internal realities than external demands. It involves pursuing the activities, objects, and people you discovered you truly love during the first season but may have postponed.
The transition from the first to second season is usually driven not by a sense of total success or completion, but can be prompted by things like failure, frustration with existing paths, children gaining independence, or “topping out” in a career.
The second season allows postponing exploration of your inner world no longer. It is a time to rearrange your life around what you have discovered about yourself.

So in summary, it outlines two major life seasons and discusses the internal transition most adults face around mid-life to shift focus from external to internal demands and truly living according to their discovered passions and self.

The passage discusses and critiques the popular “inner child” philosophy and recovery movement view that adult problems are caused by childhood mistreatment or trauma. It argues that this view appeals to people on both factual and moral levels, but is questionable.

Factually, childhood events alone cannot fully explain adult outcomes, as genetics also play an important role. The evidence for childhood influences is often confounded. Morally, the inner child view provides consolation by allowing people to see problems as outside their control, caused by others. It builds on philosophies like Freudianism that emphasize plasticity over genetics.

After WWII, genetic explanations fell out of favor due to associations with Nazis and racism. Emphasizing childhood and environment fits better with democratic ideals of equality. Similarly, movements like Alcoholics Anonymous and the Civil Rights movement softened failures by redefining them as diseases or due to discrimination, not personal faults.

Overall, the passage questions the common assumptions that childhood alone shapes adults and reliving trauma can undo effects, though it aims to have a constructive discussion about what really enables positive changes throughout life.

This passage discusses some complex issues around the influence of childhood experiences on adult personality and development. Some key points:

Large studies have found that specific childhood events like parental death, divorce, abuse, etc. have minor or barely detectable effects on adult outcomes. Genetic factors seem to have a stronger influence.
Adopted children resemble their biological parents more as adults than their adoptive parents, further suggesting genetic influence.
Childhood sexual abuse is singled out as potentially having long-lasting impacts. However, studies of “adult survivors” are methodologically flawed as they don’t adequately control for genetic and family environmental factors.
The families and individuals who perpetrate abuse often have broader mental health and family dysfunction issues, both genetic and environmental, that could contribute to outcomes along with the abuse itself.
While childhood trauma likely does have lasting effects, there is no clear evidence it has more impact than similar traumas experienced as an adult. Natural healing processes may mitigate impacts over time.

Overall it questions some assumptions about the determinative influence of childhood experiences, argues for more consideration of genetic factors, and calls for better controlled research on impacts of childhood trauma like sexual abuse.

Several follow-up studies have found that more than half of sexually abused children improve markedly within 1-2 years, and the number with severe problems diminishes. However, a few do get worse.
The objective severity of child sexual abuse ranges from brutal rape to erotic fondling. In PTSD, objective severity alone does not determine symptom duration or intensity. Some are severely affected while others are unchanged, or even strengthened. This also applies to children - a quarter to a third show no symptoms.
Therapists and parents can help contain the damage by muting the trauma in the child’s mind. Reliving the experience repeatedly may retard natural healing. Prolonged criminal cases are linked to worse outcomes for children.
Turning down the volume quickly, without interrogating the child or forcing reliving of trauma, promotes better recovery, as seen in the author’s own experience of childhood abuse.
Most childhood events have little documented influence on adult personality. Only the most brutal abuse may have effects. Children generally heal better than adults from trauma. Claims of “toxic shame” and guilt from childhood abuse influencing adults later are not well supported by data.
Personality differences within families are about as great as between families once genetics are accounted for. Small differences in childhood can snowball into large personality divergences by adulthood. We are not prisoners of our past and free to change.
The passage discusses two key premises of the recovery movement - that childhood experiences determine adult personality, and that coming to grips with childhood abuse through catharsis can cure adult problems.
It argues there is no evidence to support these premises. Specifically, there is no documentation that cathartic techniques lasting help chronic emotional problems or alter adult personality. Follow-ups have not been done to assess the long-term effects.
While taking on a victim label through the recovery movement can raise self-esteem by lowering guilt, it also increases helplessness, hopelessness and passivity. This hinders effective treatment approaches.
Labeling oneself a victim looks to the past rather than taking responsibility and being forward-looking, which are key to successful therapy. An excessive focus on the past does not improve ability to cope in the present.
The passage worries the recovery movement capitalizes on the epidemic of depression in young people by providing only temporary relief and increased perception of victimhood rather than effective treatment.
However, it does endorse the idea that exploring patterns from childhood can provide insight, just not the premises that childhood determines personality or that catharsis alone can cure problems. The goal of change is good but the methods lack evidence.
The depth of a psychological issue determines how easy or difficult it is to change. Deeper issues are more resistant to change than superficial issues.
Biological factors contribute to depth - problems that are evolutionarily prepared or genetically heritable are deeper and harder to change.
Evidentiary factors also determine depth. Issues whose underlying beliefs are easy to continuously confirm through evidence gathering and difficult to disconfirm are deeper.
The power of the underlying belief also impacts depth. Broad, general beliefs that explain much of one’s experiences are deeper than narrow, isolated beliefs.
Problems with significant biological/genetic, evidentiary, and belief power factors are the deepest and most resistant to change through therapy or other means. More superficial issues with fewer of these depth factors are easier to alter or remedy.
This theory of depth proposes it can help explain the varying degrees of change seen across different psychological issues and problems in response to treatment interventions. Deeper problems tend to show less change than superficial ones.

The passage discusses different problems and how deeply rooted and resistant to change they are based on three criteria: how biologically based they are, how easy it is to confirm the underlying beliefs, and how much power or influence those underlying beliefs have.

Problems that are seen as most deeply rooted and resistant to change include transsexualism, sexual orientation, and post-traumatic stress disorder. Alcoholism, everyday anxiety, and pervasive anger are also hard to change due to biological and behavioral factors that confirm and give power to the underlying beliefs.

Mid-depth problems include sexual preferences/paraphilias, obsessive-compulsive disorder, sex roles, and depression - they can be influenced to some degree by therapy but not fully cured.

Nearer the surface are social phobia, agoraphobia, sexual performance issues, and specific phobias. These problems are influenced by evolution but not heritable, the beliefs can be disconfirmed, and they have limited influence, so they are easier to change with the right therapy.

Panic is considered the most superficial problem as it is based on mistaken beliefs that can be easily disconfirmed through education about anxiety symptoms.

The author presents a theory of personality and change that rejects the assumptions that early learning is profoundly influential and emotional traits are inherently difficult to change.
The theory argues that the depth of problems/personality traits depends on their biological basis, supporting evidence, and power/influence, not when they were acquired or whether they involve trauma. Both early learning and traumatic learning are quite flexible.
The notion of “depth” is key - traits that are deeply ingrained require major effort like intensive therapy or medications to alter, while more superficial traits can change readily.
Childhood/trauma are not given privileged status in explaining unchangeability. Resistant traits result from biology, evidence/framework they provide, or power gained over time, not early acquisition.
The goal is to instill a warranted optimism about what individuals can realistically change, focusing efforts on achievable goals rather than unrealistic hopes for self-improvement. Deep understanding of what can and cannot change allows for acceptance of limits.
The passage thanks numerous people who provided feedback and support during the writing process of the book, including the author’s wife Mandy McCarthy Seligman.
It also thanks his two-year-old daughter Nicole Seligman, noting that the writing began around the time of her conception and the first draft was finished when she took her first steps. The author says her “buoyancy and sunshine” made the writing easier.
The endnotes section provides references and sources for claims made in the book. It elaborates on some of the topics discussed in the first three chapters, such as learned helplessness, biological boundaries of learning, and the history of concepts like free will, grace, and human agency.
It discusses thinkers and movements that contributed to changing views of human potential and agency over time, from the Bible and ancient philosophers to more modern figures like Pelagius, Luther, Erasmus, Wesley, Jackson, Freud, and Watson.
In summarizing the book so far and sources for chapters 1-3, the notes aim to provide deeper context and scholarly references for ideas presented accessibly in the main text.

Here is a summary of the key points from the provided references:

Berger (1977) provides a useful general review of antidepressant medications and the treatment of depression. Different classes of antidepressants like tricyclics and SSRIs have different rates of effectiveness.
White et al. (1990) found that the SSRI fluvoxamine was effective in treating depression that was resistant to tricyclic antidepressants.
Hall (1988) conducted a study showing the dose-dependent efficacy of the SSRI fluoxetine against placebo in treating depression.
Cade (1949, referenced in Ayd and Blackwell) discovered the antidepressant effects of lithium through his research with uric acid. Lithium is more effective for managing manic episodes in bipolar disorder than depression.
Sack and De Fraites (1977) discuss the use of lithium in treating mania. Problems include non-compliance since manic patients may not want medication.
Berger (1977) and Cohen (1977, referenced in Ayd and Blackwell) provide overviews of the discovery and history of benzodiazepines as minor tranquilizers for treating anxiety.
Chandler and Winokur (1989) estimated that antipsychotics were fully effective in eradicating symptoms in 22.5% of schizophrenia patients and partially effective in 60%.
Bouchard et al.’s (1990) classic Minnesota twins study showed that 75% of IQ variance is genetic based on identical twins reared apart. Environment also plays a role through gene-environment covariance.

Here is a summary of the key sources referenced:

Min, R. Corley, J. DeFries, and D. Fulker, “Individual Differences in Television Viewing in Early Childhood: Nature as Well as Nurture,” Psychological Science 1 (1990): 371–77. This study looks at the genetic and environmental influences on television viewing habits in early childhood.
N. Waller, B. Kojetin, T. Bouchard, D. Lykken, and A. Tellegen, “Genetic and Environmental Influences on Religious Interests, Attitudes, and Values,” Psychological Science 1 (1990): 138–42. This study examines the heritability of religious beliefs and attitudes.
Bouchard and McGue’s analysis of the California Personality Inventory in “Genetic and Rearing Environmental Influences on Adult Personality: An Analysis of Adopted Twins Reared Apart,” Journal of Personality 58 (1990): 263–92. This study analyzes genetic and environmental influences on personality using adopted twins reared apart.
N. Pedersen, G. McClearn, R. Plomin, et al. “The Swedish Adoption/Twin Study of Aging: An Update,” Acta Geneticae Medicae et Gemellologiae 40 (1991): 7–20. This is an update to the long-running Swedish Adoption/Twin Study examining genetic and environmental influences on aging.
B. Hutchings and S. Mednick, “Criminality in Adoptees and Their Adoptive and Biological Parents: A Pilot Study,” in Biosocial Bases of Criminal Behavior (1977). This pilot study looks at criminality among adoptees and their biological/adoptive parents.
M. McGue and D. Lykken, “Genetic Influence on Risk of Divorce,” Psychological Science 3 (1992): 368–73. This study examines heritability of divorce and reasons why.

Here are the summaries of the articles as requested:

“Lactate Provocation of Panic Attacks” (Archives of General Psychiatry 41 (1984): 764–70) - This study found that intravenous administration of lactic acid triggered panic attacks in patients diagnosed with panic disorder, but not in control subjects. This provided evidence that biological and physiological factors may play a role in panic attacks.
“Lactate Infusions in Obsessive-Compulsive Disorder” (American Journal of Psychiatry 142 (1985): 864–66) - This study found that intravenous lactate did not provoke anxiety symptoms in patients with obsessive-compulsive disorder, unlike in patients with panic disorder. This suggested a distinction between the psychobiology of OCD and panic disorder.
Regarding genetic factors in anxiety disorders, see “Genetic Factors in Anxiety Disorders” (Archives of General Psychiatry 40 (1983): 1085–89) and “Panic Disorder: Genetic Considerations” (Journal of Psychiatric Research 24 (1990): 129–34).
Regarding biological factors, see “Abnormal Regulation of Noradrenergic Function in Panic Disorders” (Archives of General Psychiatry 43 (1986): 1042–54) and “The Application of Positron Emission Tomography to the Study of Panic Disorder” (American Journal of Psychiatry 143 (1986): 469–77).

Here is a summary of the key points across the three articles:

Several studies showed 60-75% improvement levels with drug treatment (MAO inhibitors particularly effective) for social phobia/social anxiety. However, most did not report outcomes after drug discontinuation.
Those that did report post-discontinuation outcomes found very high relapse rates, over 50%, after drugs were stopped.
A review by Noyes et al. concluded that drugs have a “cosmetic effect” on social anxiety due to the high dropout rates with drug treatment and high relapse rates after discontinuation.
Alone, both antidepressants and exposure therapy have some lasting benefits for 5 years after treatment ends, but around 50% of patients relapse or are not fully recovered.
The combination of exposure therapy and antidepressant drugs seems to be the most effective treatment, with improvement rates as high as 90% reported in some studies comparing drug alone, exposure alone, and the combination.
There is still debate around the relative benefits of antidepressants alone vs. exposure alone vs. the combination for treating phobias/social anxiety, but the combination approach has shown benefits in well-executed studies.

Here are the key points summarized from the passages:

The biological viewpoint sees OCD as having biological/genetic underpinnings including irregularities in serotonin levels in the brain. Specific studies and reviews are cited to support this.
The woodworking-film experiment showed that exposing participants to uncontrollable and aversive events led to later intrusive and repetitive thoughts, similar to OCD symptoms.
A case study is described that showed using exposure therapy (in vivo exposure) was effective for treating chronic OCD.
Reviews are cited showing behavior therapy involving exposure and response prevention is an effective treatment for OCD, based on over a dozen outcome studies.
Trait anger is measured using questions from Spielberger’s trait anger scale.
Territoriality is discussed as a factor in anger based on Ardrey’s work.
Studies link hostility, frustration and anger to negative health consequences like higher risk of heart disease.
Some research links suppression of anger or lack of fighting spirit to higher rates of breast cancer; but the studies have statistical limitations and helplessness may be a more important factor than direct expression of anger.

This section discusses anger and hostility, and suggests that expressing or suppressing anger does not improve health outcomes. Several studies are cited showing no benefits to anger catharsis or suppression. Managing anger through awareness and not reacting angrily is proposed to be healthier. Controlling hostility through cognitive techniques like reframing stressful events appears more effective than complete suppression of anger. Regular exercise is said to lower long-term heart rate even if individual workouts raise it, due to reducing total annual heartbeats. Witnessing parental conflicts and divorce is linked to increased depression in children. Overall the importance of managing anger through awareness and cognitive techniques rather than suppression or catharsis is emphasized.

This passage summarizes and cites several studies relating to gender identity and sexual orientation:

It discusses John Money’s introduction of the concept of “gender” to distinguish it from biological sex.
It references studies on attempts to change gender identity/sexual orientation through psychotherapy/behavioral therapy, finding limited success.
It discusses research on outcomes of sex reassignment surgery for transsexual individuals.
It proposes alternative theories to explain variations in sexual identity, including one involving masculinization and defeminization processes influenced by genes, hormones, environment.
It cites twin and familial studies pointing to biological/genetic influences on sexual orientation.
It speculates on potential prenatal hormonal mechanisms influencing later sexual identity and orientation.
It distinguishes sexual orientation as deeper/less flexible than sexual preferences.
It discusses limitations and need for more research to understand influences on bisexuality.

The passage summarizes a number of academic sources on the topics of gender identity, sexual orientation and potential biological influences, while also proposing some alternative theoretical perspectives.

Here is a summary of the key points from the specified sources:

J. Polivy and P. Herman’s 1983 book Breaking the Diet Habit argued that dieting is ineffective and potentially dangerous in the long run. They were ahead of their time in recognizing this.
D. Garner and S. Wooley’s 1991 article “Confronting the Failure of Behavioral and Dietary Treatments for Obesity” in Clinical Psychology Review also showed dieting to be largely ineffective and questioned its prevalent use. These two sources identify real issues with dieting.
The June 1993 issue of Consumer Reports had an excellent article titled “Diets: What Works—What Doesn’t” that evaluated different diets.
Two major works critique assumptions about ideal weights and dieting. Polivy and Herman’s book and the 1991 Garner and Wooley review argue dieting is generally not effective and can be unhealthy. They provide important warnings about prevailing views on weight control.
Alternative explanations for weight gain need attention beyond just eating more and exerting less. Psychological and genetic factors likely also contribute to obesity. More nuanced understanding is needed around weight regulation.

In summary, these sources raise significant doubts about common assumptions promoting dieting as effective and healthy for weight control. They suggest dieting is often ineffectual long-term and may carry health risks, warranting reevaluation of dominant weight-focused approaches. A more sophisticated, evidence-based perspective is still emerging on this complex issue.

Here is a summary of the key sources referenced in the provided text:

The text references several studies that examine cultural expectations of thinness, the prevalence of dieting among men and women, and long-term outcomes of various weight loss methods like low-calorie diets, behavior therapy, fasting, etc. It provides details on sample sizes, follow-up periods, and results of these studies.
J. LaRosa’s book “Dieter Beware” is mentioned as an unselective but useful compendium of facts about the weight loss industry.
The text highlights the NIH conference proceedings and accompanying 1,119-item bibliography called “Methods for Voluntary Weight Loss and Control” as the most complete source on this topic.
It analyzes perspectives from Brownell and Wadden who remain optimistic about dieting, despite poor long-term results, versus the author who is skeptical that improvements can be made.
Animal and human studies on “yo-yo dieting” and its physiological effects are discussed, noting some mixed findings that require more research.
Epidemiological data on eating disorders like prevalence of bulimia nervosa is referenced.
Effectiveness of antidepressants for bulimia is summarized based on reduction in symptoms and high relapse rates.
The text endorses theories from Polivy and Herman, Garner and Wooley, Wardle, and Slade linking dieting behaviors to disordered eating and the etiology of bulimia.

In summary, it integrates evidence from a wide range of academic and medical sources on the weight loss industry, methods of dieting, physiological impacts, eating disorders, and theoretical perspectives on their relationships.

Here is a summary of the key points from the passages:

Dieters are at least 8 times more likely to develop an eating disorder like bulimia than non-dieters.
One study showed that a dietary approach can be effective for treating bulimia, but this paper has remained obscure.
Cognitive-behavioral therapy and antidepressant drugs have both been shown to be effective treatments for bulimia based on multiple outcome studies.
Binge eating increases with increasing weight/adiposity. Dieting may be necessary but not sufficient to treat bulimia.
“Binge eating disorder” was proposed as a new diagnosis based on a 1992 study.
Studies on artificial sweeteners and weight gain in humans have been inconclusive so far. A long-term study is still needed.
Behavior therapy, pharmacotherapy, and multimodal interventions have all shown potential for treating obesity based on various studies from the 1980s and 1990s.
The risk of health issues from overweight varies based on the degree of overweight. Being 30% or more overweight appears to clearly increase health risks, while being under 10-30% overweight may be marginally associated with increased risk. Underweight also increases mortality risk.
The studies suggest there is a genetic risk factor for alcoholism, based on numerous heritability studies showing a substantial genetic component.
Some argue alcoholism should be viewed as a medical disease, similar to how diabetes or heart disease have genetic and behavioral components. Others see it more as a habit disorder stemming from biopsychosocial factors.
Twelve-step programs and the disease concept may imply it is a chronic, relapsing condition. Alternative models propose it could be addressed as breaking unhealthy habits, with a less pessimistic long-term outlook for some.
Overall, the evidence points to both genetic and environmental influences, with ongoing debate around the most useful conceptual framework - whether a medical disease model or alternative models emphasizing biopsychosocial influences and habit change are most appropriate and helpful. More educated populations may respond better to non-disease approaches.
All major studies of the natural history of alcoholism have only examined men, and there is a need for knowledge about the course of recovery among women as well.
Several studies are cited that examined the effects of exposure to parental alcoholism in childhood and outcomes in adulthood.
Several studies find that physical addiction to alcohol may have a biological component as prolonged alcohol exposure can change brain cell functioning over time. However, the physical aspect of addiction remains hypothetical.
Progression of alcoholism symptoms over time has been outlined based on retrospective data. New data and theories are emerging from ongoing research.
Relapse is common in recovery from alcoholism, and the prospects and causes of relapse over the long term are discussed.
Controlled long-term studies of existing elaborate and expensive treatments for alcoholism, such as hospitalization programs, are lacking but overdue given the costs of alcoholism. Existing reviews find mixed effectiveness of different treatments.
Psychiatric drugs have generally not proven effective in the treatment of alcoholism according to controlled studies, despite some initial promising findings.
The literature on aversion therapies is discussed, with mixed findings from controlled studies.

Here is a summary of the paper “Shock Alcohol Aversion Therapy: Six-and Twelve-Month Follow-up,” Journal of Consulting and Clinical Psychology 49 (1981): 360–68:

The paper presents a 6-month and 12-month follow-up study of patients who underwent shock alcohol aversion therapy for alcoholism treatment.
At intake, patients were alcoholic males between ages 22-45, all drinking heavily. They underwent a therapy involving pairing alcohol consumption with electric shocks.
At 6 months post-treatment, 46% were abstinent or moderate drinkers. However, relapse rates increased over time - at 12 months follow up, only 27% were abstinent or moderate drinkers.
Those who relapsed tended to do so earlier in the follow-up period. Relapse was associated with intrapersonal/social difficulties and resumption of old drinking habits/contexts.
The researchers note the therapy was effective for many patients in the short-term, but long-term outcomes were more variable. Continued treatment/support may be needed to sustain effects over time.
In conclusion, shock aversion therapy showed some initial success in reducing alcohol consumption, but high relapse rates occurred especially beyond 6 months, calling into question the therapy’s long-term effectiveness without additional interventions.

Here are summaries of the key studies:

Stattin and Klackenberg-Larsson (1990): Studied the relationship between maternal attributes in a child’s early life and their future criminal behavior. Suggested a link between poor maternal parenting and increased criminal behavior later on.
van der Kolk, Perry, and Herman (1991): Examined childhood origins of self-destructive behavior. Argued that childhood trauma can lead to self-destructive behaviors later in life.
Browne and Finkelohr (1986), Alter-Reid et al. (1986): Provided reviews of the research on the impact of child sexual abuse, including long-term psychological and psychiatric effects.
Herman, Russell, and Trocki (1986): Longitudinal study finding long-term effects of incestuous abuse in childhood, including increased rates of depression, PTSD, and dissociation.
Nash et al. (1993): Study finding that when controlling for family pathology, no long-term effects of childhood sexual abuse alone could be found. Suggested family environment was a bigger factor.
Finkelhor (1990): Review article summarizing early and long-term effects of child sexual abuse.

The summaries focused on key findings and topics discussed in the cited studies, without excessive detail, in line with an editorial summary. Please

Here are summaries of the key papers:

“Constructive Criticism: The Relative Efficacy of Four Interventions” (1990) - Studied the effectiveness of four different types of constructive criticism interventions. Found that some were more effective than others in improving performance.
“Test Anxiety: Past Performance and Coping Strategies” (1986) - Examined the relationship between past performance, test anxiety, and different coping strategies. Found that past performance and coping strategies influenced levels of test anxiety.
“Outcome of Brief Cathartic Psychotherapy” (1974) - Looked at the effects of brief cathartic psychotherapy. Found that patients generally rated catharsis highly in terms of liking it, but it did not fare as well on objective measures of improvement.
“Effects of Varying Session Length and Frequency in Brief Emotive Psychotherapy” (1976) - Studied the impact of session length and frequency on outcomes of brief emotive psychotherapy. Found that varying these factors influenced results.

Overall, the author notes that while catharsis is popular among patients, research does not consistently show its effectiveness. Disclosure of trauma may be beneficial to health, but catharsis alone is under-researched and its effects remain unclear. More research is still needed.

#book-summary

What You Can Change _. and What You Can't - Martin E. Seligman