Английский язык учебник

521

The context of wisdom

Not only is the complex makeup of the traits and stales of the individual who is presumed to be wise of relevance to decisions, but the context must be judged as well. Naturally occurring emergencies and crises may dictate time limits within which a solution has to be made. In addition to what the individual brings to the situation, there is also a matter of surveying what is required. Thus, although there may be elements in common between a wise general, soldier, judge, trial lawyer, teacher, and policeman, the complex set of si multaneous equations needed to be solved has different parameters. The multiple regression equation, which expresses the qualities of the individual, has to be weighted differently depending upon the context of the problem and the time constraints.

The approval of President Harry Truman to use the atomic bomb in a military operation over Japan was a weighted decision in terms of the consequences, but it had to be arrived at in a particular period of time. Whether one regards it as a wise or unwise decision de pends upon the outcomes or products of the decision and the values of the persons viewing the decision. Whereas many persons may judge Truman’s act to be wise and appropriate, there will be many others who regard it as being unwise and not in the best interest of humankind.

The foregoing example of President Truman’s de cision implies that longstanding values surround and color our evaluations of what wisdom is and who is wise. For example, we are perhaps least likely to at tribute wisdom to persons of an opposite political par ty. Decisions to deregulate society will be thought wise by laissez faire opponents but be ridiculed by oppo nents of strong governments. Particularly in a contem porary context, it is rare for persons to be termed “wise” if they are from different value orientations.

522

These thoughts give rise to the fact that the area of value research should be coupled with that of wisdom.

In this regard, time again plays a role. One may struggle for the best long range solution in which con sequences may flow many years to the future or one may concentrate on a contemporary solution. General ly, wise persons are thought to project the consequen ces of their solutions far into the future: “I will plant seeds to grow in springs I will not see.” Thus, what is good for the greatest number of people for the long run is presumably the most wise decision. The demand on the decision maker is to have an orientation in time that examines the past for relevant knowledge, experi ence, and precedent; that examines the present context of the problem to be solved; and that projects into the future the long range effects.

It is here perhaps that we consider the products of decisions as another avenue to the study of wisdom. One may compare the products of wise judges with those of the decisions of unwise judges. This gives rise to the research question of what distinguishes or cha racterizes the products of wise decisions, providing that one can agree upon a class of individuals who are regarded as possessing the quality of wisdom.

J.L. Birren & L.M. Fisher “Wisdom”, Ch. 14, pp. 319–322

SOME EXAMPLES OF MENTAL ILLNESS

Schizophrenia

It is hard to imagine any adult who has not heard of schizophrenia, and yet it is an illness which is often woe fully misunderstood. First, it is important to state that the term does not mean “split personality”. This arises from a twofold misunderstanding. First, ‘schizophrenia’ means ‘cloven mind’; it is easy to see how this might be

523

misinterpreted as ‘split mind’, but the term is intended to mean a broken or fragmented mind. Second, there are in stances of patients with ‘split personalities’ (or more accu rately, multiple personality disorder) who at different times can assume radically different personas, each often unaware of the others.8 Such cases are an obvious gift to Hollywood scriptwriters and actors wishing to show their range of skills,9 but real cases of multiple personality dis order are extremely rare and usually less florid than fic tion would have one believe.10 In addition, they are not re lated to schizophrenia.

A further point is that schizophrenia is usually seen as synonymous with violence. Whilst it is true that some of the more distressing crimes by mentally ill people have been by patients suffering from schizophrenia, the illness takes many different forms, and the majority of patients offer no threat to other people.

There is no single snappy definition of schizophrenia. Broadly speaking, it is “a psychosis characterised by pro found disorders of thought and language (though without signs of mental retardation), loss of perception of reality, and concomitant changes in emotions and behaviour”. The DSM requires that the symptoms must be present for a minimum of 6 months to be classified as schizophrenia (briefer episodes with similar symptoms are classified un der such headings as schizophreniform disorder and brief re active psychosis). We are thus considering a serious long term break down of reality and the attendant misery which this brings. Most patients are unaware that their belief systems are illogical, although they may be aware that they are considered ill. The said beliefs are varied, but nearly always unpleasant. A frequent, but not uni versal element, for example, is a feeling of persecution. Others include the belief that other beings (either human, spiritual, or extraterrestrial) are controlling the pa tient’s thoughts and deeds. This is a familiar phenomenon from newspaper reports, since it is often cited as the mo tive in crimes committed by schizophrenic patients;

524

namely, that they were not in rational control and were ordered to do their acts by voices in the head. It is small wonder that it is now often argued that cases of supposed demonic possession throughout history may have been cases of schizophrenia rather than the actions of Satan. By the same token, the religious visions and actions of some holy men and women may also have been the by pro ducts of a schizophrenic disturbance. However, once again it must be stressed that such behaviour is rarely very florid. Relatively few schizophrenics are prompted to act violently to others, or for that matter, see visions of the Heavenly Host. For many, the experience is of having a nasty peevish voice in the head which will never leave one alone or let one enjoy life.

Another relatively common problem is that the pa tient becomes convinced that their thoughts are being read by other people, and that (entirely innocent) remarks by others are directed at the patient (ideas of reference). This illustrates the point that mental illness can be seen as a continuum. Most people have at some time misinterpret ed other people’s behaviour as being directed at oneself. This commonly occurs when someone has done something embarrassing and is convinced that everybody else knows. In everyday life, this is little more than a guilty con science, and in time will pass. The difference in schizo phrenia is one of degree – the belief is more strongly held and does not go away. Added to these problems, there are of ten delusions (false beliefs about the world and people around the patient) and hallucinations (a misperception of sensory information, such as seeing people with gross ly distorted faces).

Given such a mental world, it is not surprising that the schizophrenic patient often behaves and talks in an un usual manner. For example, responses to questions may of ten be classed as “surreal”, either because they appear at best to be only tangentially connected with the question, or because the answers, whilst obeying the rules of conversa tion, are magnificently false (e.g. “where are we?” –

525

“Egypt in 54 BC”). This can make communication diffi cult, but it may be worsened by a tendency to produce made up words (neologisms) and clang association (producing strings of real words and neologisms whose only link is that they sound similar). Since a clinician cannot readily un derstand the language, it makes understanding the pa tients’ problems and “getting through” to them all the more difficult. Alternatively, language may be severely impoverished, with a limited vocabulary, or statements which “tail off” before they are completed. This is not helped by the fact that in most cases, emotional expres sion is usually either limited, or otherwise may be inappro priate for the situation. Given this catalogue of problems, it is small wonder that many schizophrenic patients are also depressed.

There are many types of schizophrenia, which are clas sified according to the most prevalent symptom (though symptoms found in other forms of the illness may also be present in a less pronounced fashion). The following are amongst the most often encountered.

Catatonic schizophrenia is characterised by extremes of motor activity – the patient alternates between high activi ty and periods of extraordinary immobility, “freezing” into postures which are maintained for several hours. Dis organised schizophrenia is characterised by a disorgani sation of thought, inconsistent and extreme moods, and a general lack of control (e.g. of personal hygiene). In cas es of paranoid schizophrenia, the patient has delusions of persecution and/or of self importance, and/or has delu sional jealousy (an extreme and illogical delusion of one’s partner’s infidelity). Ideas of reference are also often present. Residual schizophrenia describes a state in which the patient has suffered from schizophrenia in the past, who now could not be described as suffering from the illness in its full blown form, but who nonetheless continues to exhibit some symptoms. Undifferentiated schizophrenia is a rather nebulously defined condition, in which the patient possesses symptoms characteristic of more than one of the

526

other types of schizophrenia. The illness can also be sub categorised according to rate of onset. Process schizophre nia has a very slow and gradual onset, whilst reactive schizo phrenia has a sudden and dramatic onset (and may be trig gered by a stressful or otherwise distressing event). Re covery is less good from the former condition.

The debate about the causes of schizophrenia is a lengthy one. It is worth noting that the illness is common er than many people believe, and studies usually find an incidence between 1 and 2 percent. Generally, propor tions increase the lower the socio economic group being considered, and also tend to be higher amongst ethnic mi norities (though this can be confounded with socio eco nomic status). The explanations for these figures vary, but all are essentially permutations of the nature–nurture de bate. It is possible, for example, that people are born pre destined to become schizophrenic, and that peculiarities in their behaviour before the illness becomes apparent en sure that they remain unemployed or can only find low status jobs. Hence, their schizophrenic minds have in effect lowered their social status. The converse of this argument is that people in poor living conditions are made schizo phrenic by the stress they receive from the environment. This is exacerbated by a tendency of a predominantly white middle class medical profession to regard working class and racial minority behaviour with less tolerance, and thus be more prepared to slap a label of “mentally ill” upon it.

There is some justification for both these viewpoints. Let us first consider the case for environmental factors. It must be stressed that there are no truly objective measures of schizophrenia — there is no blood test or body scan, for example, which will unambiguously prove a diagnosis. This means that, ultimately, the judgement on who is sane and who is insane is down to the clinician, and this judgement can be very fallible indeed. In a classic study by Rosenhan (1973) a group of eight sane individuals (many of them psychiatric professionals) applied for admission as pa

527

tients to mental hospitals complaining of hearing “voices in the head”. Once admitted, they claimed the symptoms had stopped, and behaved in all ways as “normal” individu als. In all cases, the pretence of the pseudopatients was un detected by the staff (though interestingly, an appreciable proportion of fellow patients detected the deception). All but one was diagnosed as “schizophrenic” and took an ave rage of 19 days to be released from hospital “care” with a typical diagnosis of “schizophrenia in remission” (i.e. it might return). What this study demonstrates is that it is very easy to label a person as schizophrenic on inade quate evidence. If we follow this argument to its logical con clusion, it only requires a relatively mild bias against peo ple from working class or ethnic minority backgrounds for a disproportionate number to be diagnosed as schizo phrenic. It should be stressed that this bias need not be derived from snobbery or racism. A simple incompre hension of different attitudes and behaviours, which may be appropriate in one social setting but not anoth er, could be a large contributory factor. For example, studies have found a higher probability of being diag nosed by UK clinicians as being mentally ill if one is of Afro Caribbean descent (e.g. Harrison et al., 1988), which may imply a racist element. However, one of the first studies of this subject found a similarly higher rate of mental illness amongst Norwegian emigrants to the United States.

Another aspect of the environmental argument is to consider the potential causes of schizophrenia. It has long been argued, for example, that schizophrenic pa tients tend to come from rather emotionally “cold” and domineering families (the term refrigerator parent was for a time in vogue). A manifestation of this is the double bind, in which family members express emotions ambiguously. Thus, expressions of love might be coupled with warn ings of not to misbehave or the love will be withdrawn. Falloon et al. (1985) found that if the whole household in which a schizophrenic patient lived was treated in thera

528

peutic sessions, then the level of remission amongst the schizophrenic patients was significantly lower. There fore, the familial background is an important contributo ry factor. However, taken by itself such a statement might be interpreted as a stigma on families of schizo phrenic patients. It must be stressed that not all families with a schizophrenic member are dysfunctional, nor is there evidence that families of schizophrenic patients are any different from non schizophrenic families in their belief that they are doing their best. Any dysfunction is thus not deliberate.

However, none of the above arguments presents an overwhelming case for the environmental viewpoint. First, consider the evidence on misdiagnosis. Although clinicians are capable of bad judgement, it must be stressed that the pseudopatients in Rosenhan’s study were deliberately trying to get admitted to hospital. In normal circumstances, a person is only considered for hospitalisa tion if their everyday behaviour has given cause for con cern. In other words, if there are genuine grounds for con cern. It is also worth noting that whilst it is right and proper that there should be concern that over racial and so cial bias may be marring diagnosis, it is also highly divisive to assume that it is “natural” that particular social and ra cial groups contain higher proportions of people behaving in an aberrant manner. If poor living conditions are caus ing some groups to have a higher level of mental illness, then this is cause for concern, but that is a rather differ ent argument. Again, evidence that familial factors often play an important role in schizophrenia cannot be denied but, equally, there may be a strong genetic role. For exam ple, parents of schizophrenic patients may have provided a dysfunctional environment, but they also share genes in common with the patient. Is the dysfunctional house hold simply a product of dysfunctional genes? The total evidence points to there being strong environmental con tributory factors, but in themselves they are not necessari ly the sole causes.

530

sciousness. Traditionally, meditation has been a reli gious practice aimed at achieving a mystical union with God or the universe. All major religions, includ ing Buddhism, Christianity, Hinduism, Islam, Juda ism, and Taoism, have centuries old formal meditative practices. In the past two decades meditation has also gained popularity as a means of promoting physical and psychological well being by reducing stress and in ducing relaxation.

Common Meditative Practices

The popular forms of meditation share techniques aimed at producing physical relaxation and mental concentration. If you decided to meditate, you would seek a peaceful setting, maintain a comfortable seated position, focus on a sound, image, or object, and calmly withdraw your attention from any intruding images, feelings, or sensations. Though some forms of medita tion promote emptying the mind of all content, most are concentrative and involve focusing on one thing.

Meditation was popularized in the West in the late 1960s by Maharishi Mahesh Yogi, an Indian guru, through the influence of his most famous disciples, the Beatles. They promoted a Westernized form of medita tion called transcendental meditation. In TM, you con centrate on repeating a sound called a mantra, (a San skrit word such as Om) for two 20 minute periods a day. The alternation of Om and silence is presumed to represent fulfillment. In the early 1970s, cardiologist Herbert Benson introduced the relaxation response, a form of meditation that is identical to TM except that the meditator may mentally repeat a sound other than a mantra, such as the number one or a favorite brief prayer. Benson believes the relaxation response is marked by reduced sympathetic nervous system arousal, decreased muscle tension, and mental quieting. But a