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Handbook of Positive Psychology C. R. Snyder Shane J. Lopez, Editors OXFORD UNIVERSITY PRESS HANDBOOK OF POSITIVE PSYCHOLOGY This page intentionally left blank HANDBOOK OF POSITIVE PSYCHOLOGY Edited by C. R. Snyder Shane J. Lopez 1 2002 ...

Handbook of Positive Psychology C. R. Snyder Shane J. Lopez, Editors OXFORD UNIVERSITY PRESS HANDBOOK OF POSITIVE PSYCHOLOGY This page intentionally left blank HANDBOOK OF POSITIVE PSYCHOLOGY Edited by C. R. Snyder Shane J. Lopez 1 2002 1 Oxford New York Athens Auckland Bangkok Bogotá Buenos Aires Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris São Paulo Shanghai Singapore Taipei Tokyo Toronto Warsaw and associated companies in Berlin Ibadan Copyright  2002 by Oxford University Press Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Handbook of positive psychology / edited by C. R. Snyder and Shane J. Lopez. p. cm. Includes bibliographical references and indexes. ISBN 0–19–513533–4 1. Psychology. 2. Health. 3. Happiness. 4. Optimism. I. Snyder, C. R. II. Lopez, Shane J. BF121 6.H212 2002 150.19'8—dc21 2001021584 1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper To the positive in all of us... This page intentionally left blank Foreword It gives me great joy to know that so many sci- women who have written chapters for this entists—many of whom have contributed to handbook, as well as countless more inspired by this landmark volume—are striving to inspire their research, are courageously gathering data people to develop a more wholesome focus on and testing hypotheses to help us learn more the positive aspects of life. I am convinced that about an essential question that perhaps serves one day these scientists will be recognized as as the North Star for a positive psychology: visionary leaders, whose research helped to What enables us to override our biological in- identify, elevate, and celebrate the creative po- clinations to be selfish and instead find meaning, tential of the human spirit. purpose, and value in nurturing and upholding Until recently, I had rarely heard about sci- the positive qualities of our human nature? entific research that examined the life- In fact, I am more optimistic than ever that enhancing power of “spiritual principles”—pos- one day soon a group of scientists will publish itive character traits and virtues such as love, findings that will advance humankind’s under- hope, gratitude, forgiveness, joy, future- standing of a spiritual principle that has been at mindedness, humility, courage, and noble pur- the core of my own life’s purpose: agape love. pose. Perhaps my long-standing interest in One of my favorite sayings is, “Love hoarded these spiritual principles and character traits is dwindles, but love given grows.” Love is more best understood by sharing with you the fol- powerful than money; unlike money, the more lowing perspective. My grandfather was a phy- love we give away, the more we have left. Per- sician during the Civil War, and several of my haps, dear reader, you will be the researcher who own children are physicians today. I think we studies a spiritual principle such as agape love would all agree that my children, because of the scientifically or empirically. Wouldn’t all of hu- enormous number of dollars earmarked for mankind benefit from knowing more about this medical research during this past century, know fundamental “law of life,” and many others? a hundred times—perhaps a thousand times— Finally, I am hopeful that as current and fu- more about the human body than my grand- ture researchers catch the vision of a positive father ever did. But I have always wondered: psychology, and as foundations and govern- Why is it that we know so little about the hu- ments initiate programs to support this ground- man spirit? breaking and beneficial work, we will all forge The research highlighted in this volume pro- ahead in a spirit of humility. We know so little, vides overwhelming evidence that many tal- my friends, about the many gifts that God has ented scholars and award-winning researchers given to each and every human being. As the are reclaiming what was once at the core of their truly wise tell us, “How little we know, how discipline: the psyche, the study and under- eager to learn.” standing of the power of the human spirit to Radnor, Pennsylvania Sir John Templeton benefit from life’s challenges. The men and This page intentionally left blank Preface How often does one have the opportunity to remarkable group of authors for their patience edit the first handbook for a new approach to in this process. Their dedication to excel- psychology? We had a “once-in-a-lifetime” lence can be seen in the chapters of this hand- scholarly adventure in preparing this Handbook book. of Positive Psychology. There was never a ques- In order to help readers in gaining a sense of tion in our minds about editing this volume. the topics contained in each chapter, we have We were at the right place at the right time, asked our expert authors to identify sources that and the book simply had to happen. provide excellent overviews of their areas. Fortunately, our superb editors at Oxford Therefore, in the reference section of each chap- University Press, Joan Bossert and Catharine ter, the authors have placed an asterisk in front Carlin, shared our enthusiasm about the neces- of such key readings. We encourage our readers sity of this volume, and they made this huge to use these background sources when more de- editorial undertaking seamless in its unfolding. tailed descriptions of a topic are desired. The authors we invited to write chapters readily Now, before you peruse the contributions of agreed. Much to our delight, this handbook al- the outstanding scholars, consider the following most took on a life of its own. We attribute this... Imagine a planet where the inhabitants are to the vitality of the authors, along with the self-absorbed, hopeless, and filled with psycho- power of their positive psychology ideas and logical problems and weaknesses. Confusion, science. anxiety, fear, and hostility race through their We complemented each other as an editorial minds. These creatures “communicate” with team. Snyder was a stickler for detail and yet each other by lying, faking, torturing, fighting, sought ingenuity in thought and expression. and killing. They hurt each other, and they hurt Lopez saw linkages in ideas, would call upon the themselves. Of course, this imaginary planet is related literatures, and brought unbridled en- not far away—we call it Earth. Although these thusiasm to the editorial process. What this problems do exist, they are made to loom even combination produced was a line-by-line anal- larger because of the propensities of psychology ysis and feedback in every chapter. In short, we and its sister disciplines to focus on the weak- were “hands-on” editors. Given the stature nesses in humankind. Now let us imagine an- of the contributing scholars, with numerous other planet where the inhabitants are caring, awards, distinguished professorships, and hopeful, and boundless in their psychological honorary degrees, they certainly could have strengths. Their thoughts and feelings are clear, balked at such editorial scrutiny. But they did focused, and tranquil. These creatures commu- not. Instead, they used our feedback and revised nicate by spending time talking and listening to their already superb first drafts into stellar each other. They are kind to each other and to subsequent chapters. We are indebted to this themselves. Again, this imaginary, not-so-far- x PREFACE away planet is Earth. These positive descriptions the fate of positive psychology. Although sci- aptly fit many of the people on Earth. In this ence certainly advances on the merits of partic- regard, hardly anyone (including some cynics) ular ideas and facts, it also is true that the suc- quibbles with this latter conclusion. But no sci- cess of a new theory rests, in part, upon its ence, including psychology, looks seriously at ability to gather supporters. On this point, this this positive side of people. It is this latter trou- handbook may enable you to cast a more in- bling void that positive psychology addresses. formed vote as to the enduring viability of pos- As such, this handbook provides an initial sci- itive psychology. entific overview of the positive in humankind. As with any new and promising paradigm, the Lawrence, Kansas C. R. Snyder reactions of people such as you will determine Shane J. Lopez Contents Contributors, xv PART III. EMOTION-FOCUSED APPROACHES 5 Subjective Well-Being: The Science of Happiness and Life Satisfaction, 63 PART I. INTRODUCTORY AND HISTORICAL ed diener OVERVIEW richard e. lucas shigehiro oishi 1 Positive Psychology, Positive Prevention, and Positive Therapy, 3 6 Resilience in Development, 74 martin e. p. seligman ann s. masten marie-gabrielle j. reed 7 The Concept of Flow, 89 jeanne nakamura PART II. IDENTIFYING STRENGTHS mihaly csikszentmihalyi 2 Stopping the “Madness”: Positive 8 Positive Affectivity: The Disposition to Psychology and the Deconstruction of the Experience Pleasurable Emotional Illness Ideology and the DSM, 13 States, 106 james e. maddux david watson 9 Positive Emotions, 120 3 Widening the Diagnostic Focus: A Case barbara l. fredrickson for Including Human Strengths and Environmental Resources, 26 10 The Social Construction of Self- beatrice a. wright Esteem, 135 shane j. lopez john p. hewitt 4 Toward a Science of Mental Health: 11 The Adaptive Potential of Coping Positive Directions in Diagnosis and Through Emotional Approach, 148 Interventions, 45 annette l. stanton corey l. m. keyes anita parsa shane j. lopez jennifer l. austenfeld xii CONTENTS 12 The Positive Psychology of Emotional 23 The Passion to Know: A Developmental Intelligence, 159 Perspective, 313 peter salovey michael schulman john d. mayer david caruso 24 Wisdom: Its Structure and Function in Regulating Successful Life Span 13 Emotional Creativity: Toward Development, 327 “Spiritualizing the Passions”, 172 paul b. baltes james r. averill judith glück ute kunzmann PART IV. COGNITIVE-FOCUSED APPROACHES PART V. SELF-BASED APPROACHES 14 Creativity, 189 25 Reality Negotiation, 351 dean keith simonton raymond l. higgins 26 The Truth About Illusions: Authenticity 15 The Role of Personal Control in Adaptive and Positivity in Social Functioning, 202 Relationships, 366 suzanne c. thompson william b. swann brett w. pelham 16 Well-Being: Mindfulness Versus Positive Evaluation, 214 27 Authenticity, 382 ellen langer susan harter 17 Optimism, 231 28 Uniqueness Seeking, 395 charles s. carver michael lynn michael f. scheier c. r. snyder 29 Humility, 411 18 Optimistic Explanatory Style, 244 june price tangney christopher peterson tracy a. steen PART VI. INTERPERSONAL APPROACHES 19 Hope Theory: A Member of the Positive Psychology Family, 257 30 Relationship Connection: The Role of c. r. snyder Minding in the Enhancement of kevin l. rand Closeness, 423 david r. sigmon john h. harvey brian g. pauwels 20 Self-Efficacy: The Power of Believing You susan zickmund Can, 277 james e. maddux 31 Compassion, 434 eric j. cassell 21 Problem-Solving Appraisal and 32 The Psychology of Forgiveness, 446 Psychological Adjustment, 288 michael e. mccullough p. paul heppner charlotte vanoyen witvliet doug-gwi lee 33 Gratitude and the Science of Positive 22 Setting Goals for Life and Psychology, 459 Happiness, 299 robert a. emmons edwin a. locke charles m. shelton CONTENTS xiii 34 Love, 472 43 Positive Responses to Loss: Perceiving susan hendrick Benefits and Growth, 598 clyde hendrick susan nolen-hoeksema christopher g. davis 35 Empathy and Altruism, 485 c. daniel batson 44 The Pursuit of Meaningfulness in nadia ahmad Life, 608 david a. lishner roy f. baumeister jo-ann tsang kathleen d. vohs 36 How We Become Moral: The Sources of 45 Humor, 619 Moral Motivation, 499 herbert m. lefcourt michael schulman 46 Meditation and Positive Psychology, 632 shauna l. shapiro gary e. r. schwartz PART VII. BIOLOGICAL APPROACHES craig santerre 37 Toughness, 515 47 Spirituality: Discovering and Conserving richard a. dienstbier the Sacred, 646 lisa m. pytlik zillig kenneth i. pargament annette mahoney 38 A Role for Neuropsychology in Understanding the Facilitating Influence of Positive Affect on Social Behavior and PART IX. SPECIAL POPULATIONS AND Cognitive Processes, 528 SETTINGS alice m. isen 48 Positive Psychology for Children: 39 From Social Structure to Biology: Development, Prevention, and Integrative Science in Pursuit of Human Promotion, 663 Health and Well-Being, 541 michael c. roberts carol d. ryff keri j. brown burton singer rebecca j. johnson janette reinke 40 Toward a Biology of Social Support, 556 shelley e. taylor 49 Aging Well: Outlook for the 21st sally s. dickerson Century, 676 laura cousino klein gail m. williamson 50 Positive Growth Following Acquired PART VIII. SPECIFIC COPING APPROACHES Physical Disability, 687 timothy r. elliott monica kurylo 41 Sharing One’s Story: On the Benefits of patricia rivera Writing or Talking About Emotional Experience, 573 51 Putting Positive Psychology in a kate g. niederhoffer Multicultural Context, 700 james w. pennebaker shane j. lopez ellie c. prosser 42 Benefit-Finding and Benefit- lisa m. edwards Reminding, 584 jeana l. magyar-moe howard tennen jason e. neufeld glenn affleck heather n. rasmussen xiv CONTENTS 52 Positive Psychology at Work, 715 55 The Future of Positive Psychology: A nick turner Declaration of Independence, 751 julian barling c. r. snyder anthea zacharatos shane j. lopez with contributions from Lisa Aspinwall PART X. THE FUTURE OF THE FIELD Barbara L. Fredrickson Jon Haidt Dacher Keltner 53 Positive Ethics, 731 Christine Robitschek mitchell m. handelsman Michael Wehmeyer samuel knapp Amy Wrzesniewski michael c. gottlieb 54 Constructivism and Positive Author Index, 769 Psychology, 745 michael j. mahoney Subject Index, 793 Contributors GLENN AFFLECK , Professor, Department of ogy and Human Development and Family Psychiatry, University of Connecticut Life, University of Kansas Health Center DAVID CARUSO , President, Work-Life Strate- NADIA AHMAD , Doctoral Student, Social gies, New Canaan, Connecticut Psychology Program, Department of Psy- chology, University of Kansas CHARLES S. CARVER , Professor, Department of Psychology, University of Miami LISA ASPINWALL , Associate Professor, De- partment of Psychology, University of Utah ERIC J. CASSELL , Clinical Professor of Public Health, Weill Medical College of Cornell JENNIFER L. AUSTENFELD , Doctoral Student, University Clinical Psychology Program, Department of Psychology, University of Kansas MIHALY CSIKSZENTMIHALYI , C. S. and C. J. Davidson Professor of Psychology, Peter JAMES R. AVERILL , Professor, Department of Drucker School of Management, Claremont Psychology, University of Massachusetts, Graduate University Amherst CHRISTOPHER G. DAVIS , Associate Profes- PAUL B. BALTES ,Director, Center for Life- sor, Department of Psychology, St. Francis span Psychology, Max Planck Institute for Xavier University Human Development, Berlin, Germany SALLY S. DICKERSON , Master’s Student, De- JULIAN BARLING , Associate Dean, Research and Graduate Programs, School of Business, partment of Psychology, University of Cali- Queen’s University, Kingston, Ontario, fornia, Los Angeles Canada ED DIENER , Distinguished Professor, Depart- C. DANIEL BATSON , Professor, Social Psy- ment of Psychology, University of Illinois chology Program, Department of Psychol- at Champaign-Urbana ogy, University of Kansas RICHARD A. DIENSTBIER , Professor, Depart- ROY F. BAUMEISTER , Elsie B. Smith Chair ment of Psychology, University of Ne- in Liberal Arts, and Professor, Department braska, Lincoln of Psychology, Case Western Reserve Uni- LISA M. EDWARDS , Doctoral Student, Coun- versity seling Psychology Program, Department of KERI G. BROWN , Doctoral Student, Clinical Psychology and Research in Education, Uni- Child Psychology, Departments of Psychol- versity of Kansas xv xvi CONTRIBUTORS TIMOTHY R. ELLIOTT , Associate Professor Psychology and Human Development and and Psychologist, Department of Physical Family Life, University of Kansas Medicine and Rehabilitation, University of DACHER KELTNER , Associate Professor, De- Alabama–Birmingham Medical School partment of Psychology, University of Cali- ROBERT A. EMMONS , Professor, Department fornia, Berkeley of Psychology, University of California, Da- COREY L. M. KEYES , Assistant Professor, vis Department of Sociology and the Rollins BARBARA L. FREDRICKSON , Associate Pro- School of Public Health, Emory University fessor, Department of Psychology, Univer- LAURA COUSINO KLEIN , Department of sity of Michigan Biobehavioral Health, Pennsylvania State JUDITH GLECK ,Max Planck Institute for Hu- University man Development, Berlin, Germany SAMUEL KNAPP , Director of Professional Af- MICHAEL C. GOTTLIEB , Private Practice, fairs, Pennsylvania Psychological Associa- Dallas, Texas tion JON HAIDT , Assistant Professor, Department UTE KUNZMANN , Max Planck Institute for of Psychology, University of Virginia, Char- Human Development, Berlin, Germany lottesville MONICA KURYLO , Rehabilitation Psycholo- MITCHELL M. HANDELSMAN , Professor of gist, Department of Physical Medicine and Psychology and Colorado University Presi- Rehabilitation, University of Alabama– dent’s Teaching Scholar, Department of Birmingham Medical School Psychology, University of Colorado ELLEN LANGER , Professor, Department of Psychology, Harvard University SUSAN HARTER , Professor, Department of Psychology, University of Denver DOUG - GWI LEE , Doctoral Student, Counsel- ing Psychology Program, Department of Ed- JOHN H. HARVEY , Professor, Department of ucational and Counseling Psychology, Uni- Psychology, University of Iowa versity of Missouri–Columbia CLYDE HENDRICK , Paul Whitfield Horn Pro- HERBERT M. LEFCOURT , Distinguished Pro- fessor of Psychology, Department of Psy- fessor Emeritus, Department of Psychology, chology, Texas Tech University University of Waterloo SUSAN HENDRICK , Associate Dean, College DAVID A. LISHNER , Doctoral Student, Social of Arts and Sciences, and Professor, Depart- Psychology Program, Department of Psy- ment of Psychology, Texas Tech University chology, University of Kansas P. PAUL HEPPNER , Professor, Department of EDWIN A. LOCKE , Dean’s Professor Emeritus Educational and Counseling Psychology, of Leadership and Motivation, R. H. Smith University of Missouri–Columbia School of Business, University of Maryland, JOHN P. HEWITT , Professor, Department of College Park Sociology, University of Massachusetts, SHANE J. LOPEZ , Assistant Professor, Coun- Amherst seling Psychology Program, Department of RAYMOND L. HIGGINS , Professor, Clinical Psychology and Research in Education, Uni- Psychology Program, Department of Psy- versity of Kansas chology, University of Kansas RICHARD E. LUCAS , Assistant Professor, De- ALICE M. ISEN , Samuel Curtis Johnson Pro- partment of Psychology, Michigan State fessor of Marketing and Professor of Behav- University ioral Science, Johnson Graduate School of MICHAEL LYNN , Professor, School of Hotel Management and Department of Psychol- Administration, Cornell University ogy, Cornell University JAMES E. MADDUX , Professor and Associate REBECCA J. JOHNSON , Doctoral Student, Chair for Graduate Studies, Department of Clinical Child Psychology, Departments of Psychology, George Mason University CONTRIBUTORS xvii JEANA L. MAGYAR - MOE , Doctoral Student, JAMES W. PENNEBAKER , Professor, Depart- Counseling Psychology Program, Depart- ment of Psychology, University of Texas ment of Psychology and Research in Educa- CHRISTOPHER PETERSON , Professor of Psy- tion, University of Kansas chology and Arthur F. Thurnau Professor, ANNETTE MAHONEY , Associate Professor, Clinical Psychology Program, University of Department of Psychology, Bowling Green Michigan State University ELLIE C. PROSSER , Doctoral Student, Coun- MICHAEL J. MAHONEY , Professor, Clinical seling Psychology Program, Department of Psychology Program, Department of Psy- Psychology and Research in Education, Uni- chology, University of North Texas versity of Kansas ANN S. MASTEN , Director, Institute of Child KEVIN L. RAND , Doctoral Student, Clinical Development, and Emma M. Birkmaier Pro- Psychology Program, Department of Psy- fessor in Educational Leadership, University chology, University of Kansas of Minnesota HEATHER N. RASMUSSEN , Doctoral Student, JOHN D. MAYER , Professor of Psychology, Counseling Psychology Program, Depart- Department of Psychology, University of ment of Psychology and Research in Educa- New Hampshire tion, University of Kansas MICHAEL E. MCCULLOUGH , Associate Pro- MARIE - GABRIELLE J. REED , Research Assis- fessor, Department of Psychology, Southern tant, Institute of Child Development, Uni- Methodist University versity of Minnesota JEANNE NAKAMURA , Research Director, Quality of Life Research Center, Claremont JANNETTE REINKE , Doctoral Student, Clinical Graduate University Child Psychology, Departments of Psychol- ogy and Human Development and Family JASON E. NEUFELD , Doctoral Student, Coun- Life, University of Kansas seling Psychology Program, Department of Psychology and Research in Education, Uni- PATRICIA RIVERA , Postdoctoral Fellow, De- versity of Kansas partment of Physical Medicine and Rehabili- tation, University of Alabama–Birmingham KATE G. NIEDERHOFFER , Doctoral Student, Medical School Social Psychology Program, Department of Psychology, University of Texas MICHAEL C. ROBERTS , Professor and Direc- tor, Clinical Child Psychology Program, SUSAN NOLEN - HOEKSEMA , Professor, De- University of Kansas partment of Psychology, University of Michigan CHRISTINE ROBITSCHEK , Associate Profes- sor, Counseling Psychology Program, De- SHIGEHIRO OISHI , Assistant Professor, De- partment of Psychology, Texas Tech Uni- partment of Psychology, University of Min- versity nesota CAROL D. RYFF , Director, Institute on Aging KENNETH I. PARGAMENT , Professor, De- partment of Psychology, Bowling Green and Professor of Psychology, Department of State University Psychology, University of Wisconsin, Madi- son ANITA PARSA , Doctoral Student, Clinical Psychology Program, Department of Psy- PETER SALOVEY , Professor of Psychology chology, University of Kansas and of Epidemiology and Public Health, De- partment of Psychology, Yale University BRIAN G. PAUWELS , Doctoral Student, Per- sonality and Social Psychology, Department CRAIG SANTERRE , Doctoral Student, Clinical of Psychology, University of Iowa Psychology Program, Department of Psy- chology, University of Arizona BRETT W. PELHAM , Associate Professor, De- partment of Psychology, State University of MICHAEL F. SCHEIER , Professor, Department New York at Buffalo of Psychology, Carnegie-Mellon University xviii CONTRIBUTORS MICHAEL SCHULMAN , Clinical Department, SIR JOHN TEMPLETON , Founder of Temple- Leake and Watts Services, Bronx, New York ton Foundation, Radnor Pennsylvania GARY E. R. SCHWARTZ , Professor of Psy- HOWARD TENNEN , Professor, Department of chology, Neurology, Psychiatry, and Medi- Psychiatry, University of Connecticut cine, Director, Human Energy Systems Lab, Health Center Department of Psychology, University of Arizona SUZANNE C. THOMPSON , Professor, Depart- ment of Psychology, Pomona College MARTIN E. P. SELIGMAN , Fox Leadership Professor of Psychology, Department of JO - ANN TSANG , Postdoctoral Fellow, Depart- Psychology, University of Pennsylvania ment of Psychology, Southern Methodist University SHAUNA L. SHAPIRO , Doctoral Student, Clinical Psychology Program, Department of NICK TURNER , Doctoral Student, Institute of Psychology, University of Arizona Work Psychology, The University of Shef- CHARLES M. SHELTON , Professor of Psy- field chology, Department of Psychology, Regis KATHLEEN D. VOHS , Postdoctoral Fellow, University Department of Psychology, Case Western DAVID R. SIGMON , Doctoral Student, Clini- Reserve University cal Psychology Program, Department of DAVID WATSON , Professor, Department of Psychology, University of Kansas Psychology, University of Iowa DEAN KEITH SIMONTON , Professor, Depart- ment of Psychology, University of Califor- MICHAEL WEHMEYER , Courtesy Associate nia, Davis Professor, Special Education Department, University of Kansas BURTON SINGER , Professor of Demography and Public Affairs and the Charles and Ma- GAIL M. WILLIAMSON , Professor and Chair, rie Robertson Professor of Public and Inter- Life-Span Developmental Psychology, De- national Affairs, Office of Population Re- partment of Psychology, University of search, Princeton University Georgia C. R. SNYDER ,M. Erik Wright Distinguished CHARLOTTE VANOYEN WITVLIET , Associate Professor of Clinical Psychology, Depart- Professor, Department of Psychology, Hope ment of Psychology, University of Kansas College ANNETTE L. STANTON , Professor, Clinical BEATRICE A. WRIGHT , Professor Emerita, Psychology Program, Department of Psy- University of Kansas chology, University of Kansas AMY WRZESNIEWSKI , Assistant Professor, TRACY A. STEEN , Doctoral Student, Clinical Department of Management and Organiza- Psychology Program, Department of Psy- tional Behavior, New York University chology, University of Michigan ANTHEA ZACHARATOS , Doctoral Student, WILLIAM B. SWANN , William Howard Beas- ley Professor, Department of Psychology, School of Business, Queen’s University, University of Texas Kingston, Ontario, Canada JUNE PRICE TANGNEY , Professor, Depart- SUSAN ZICKMUND , Assistant Professor, De- ment of Psychology, James Madison Uni- partment of Internal Medicine, University versity of Iowa College of Medicine SHELLEY E. TAYLOR , Professor, Department LISA M. PYTLIK ZILLIG , Doctoral Student, of Psychology, University of California, Los Clinical Psychology Program, Department of Angeles Psychology, University of Nebraska I Introductory and Historical Overview This page intentionally left blank 1 Positive Psychology, Positive Prevention, and Positive Therapy Martin E. P. Seligman Positive Psychology mindedness, high talent, and wisdom. At the group level it is about the civic virtues and the Psychology after World War II became a science institutions that move individuals toward better largely devoted to healing. It concentrated on citizenship: responsibility, nurturance, altruism, repairing damage using a disease model of hu- civility, moderation, tolerance, and work ethic man functioning. This almost exclusive atten- (Gillham & Seligman, 1999; Seligman & Csik- tion to pathology neglected the idea of a fulfilled szentmihalyi, 2000). individual and a thriving community, and it ne- The notion of a positive psychology move- glected the possibility that building strength is ment began at a moment in time a few months the most potent weapon in the arsenal of ther- after I had been elected president of the Amer- apy. The aim of positive psychology is to cata- ican Psychological Association. It took place in lyze a change in psychology from a preoccu- my garden while I was weeding with my 5- pation only with repairing the worst things in year-old daughter, Nikki. I have to confess that life to also building the best qualities in life. To even though I write books about children, I’m redress the previous imbalance, we must bring really not all that good with them. I am goal- the building of strength to the forefront in the oriented and time-urgent, and when I am weed- treatment and prevention of mental illness. ing in the garden, I am actually trying to get The field of positive psychology at the sub- the weeding done. Nikki, however, was throw- jective level is about positive subjective ex- ing weeds into the air and dancing around. I perience: well-being and satisfaction (past); yelled at her. She walked away, came back, and flow, joy, the sensual pleasures, and happiness said, “Daddy, I want to talk to you.” (present); and constructive cognitions about the “Yes, Nikki?” future—optimism, hope, and faith. At the in- “Daddy, do you remember before my fifth dividual level it is about positive personal birthday? From the time I was three to the time traits—the capacity for love and vocation, cour- I was five, I was a whiner. I whined every day. age, interpersonal skill, aesthetic sensibility, When I turned five, I decided not to whine any- perseverance, forgiveness, originality, future- more. That was the hardest thing I’ve ever 3 4 PART I. INTRODUCTORY AND HISTORICAL OVERVIEW done. And if I can stop whining, you can stop making the lives of all people better and nur- being such a grouch.” turing genius—were all but forgotten. It was This was for me an epiphany, nothing less. I not only the subject matter that altered with learned something about Nikki, something funding but also the currency of the theories about raising kids, something about myself, and underpinning how we viewed ourselves. Psy- a great deal about my profession. First, I real- chology came to see itself as a mere subfield of ized that raising Nikki was not about correcting the health professions, and it became a victim- whining. Nikki did that herself. Rather, I real- ology. We saw human beings as passive foci: ized that raising Nikki was about taking this stimuli came on and elicited responses (what an marvelous skill—I call it “seeing into the extraordinarily passive word). External rein- soul”—and amplifying it, nurturing it, helping forcements weakened or strengthened re- her to lead her life around it to buffer against sponses, or drives, tissue needs, or instincts. her weaknesses and the storms of life. Raising Conflicts from childhood pushed each of us children, I realized, is more than fixing what is around. wrong with them. It is about identifying and Psychology’s empirical focus then shifted to nurturing their strongest qualities, what they assessing and curing individual suffering. There own and are best at, and helping them find has been an explosion in research on psycho- niches in which they can best live out these pos- logical disorders and the negative effects of en- itive qualities. vironmental stressors such as parental divorce, As for my own life, Nikki hit the nail right death, and physical and sexual abuse. Practi- on the head. I was a grouch. I had spent 50 tioners went about treating mental illness years mostly enduring wet weather in my soul, within the disease-patient framework of repair- and the last 10 years being a nimbus cloud in a ing damage: damaged habits, damaged drives, household of sunshine. Any good fortune I had damaged childhood, and damaged brains. was probably not due to my grouchiness but in The message of the positive psychology spite of it. In that moment, I resolved to change. movement is to remind our field that it has been But the broadest implication of Nikki’s lesson deformed. Psychology is not just the study of was about the science and practice of psychol- disease, weakness, and damage; it also is the ogy. Before World War II, psychology had study of strength and virtue. Treatment is not three distinct missions: curing mental illness, just fixing what is wrong; it also is building making the lives of all people more productive what is right. Psychology is not just about ill- and fulfilling, and identifying and nurturing ness or health; it also is about work, education, high talent. Right after the war, two events— insight, love, growth, and play. And in this both economic—changed the face of psychol- quest for what is best, positive psychology does ogy. In 1946, the Veterans Administration was not rely on wishful thinking, self-deception, or founded, and thousands of psychologists found hand waving; instead, it tries to adapt what is out that they could make a living treating men- best in the scientific method to the unique prob- tal illness. At that time the profession of clinical lems that human behavior presents in all its psychologist came into its own. In 1947, the Na- complexity. tional Institute of Mental Health (which was based on the American Psychiatric Association’s disease model and is better described as the Na- Positive Prevention tional Institute of Mental Illness) was founded, and academics found out that they could get What foregrounds this approach is the issue of grants if their research was described as being prevention. In the last decade psychologists about pathology. have become concerned with prevention, and This arrangement brought many substantial this was the theme of the 1998 American Psy- benefits. There have been huge strides in the chological Association meeting in San Francisco. understanding of and therapy for mental illness: How can we prevent problems like depression At least 14 disorders, previously intractable, or substance abuse or schizophrenia in young have yielded their secrets to science and can people who are genetically vulnerable or who now be either cured or considerably relieved live in worlds that nurture these problems? (Seligman, 1994). But the downside was that the How can we prevent murderous schoolyard vi- other two fundamental missions of psychology— olence in children who have poor parental su- CHAPTER 1. POSITIVE PREVENTION AND POSITIVE THERAPY 5 pervision, a mean streak, and access to weapons? strengths that these teens already have. A teen- What we have learned over 50 years is that the ager who is future-minded, who is interperson- disease model does not move us closer to the ally skilled, who derives flow from sports, is not prevention of these serious problems. Indeed, at risk for substance abuse. If we wish to pre- the major strides in prevention have largely vent schizophrenia in a young person at genetic come from a perspective focused on systemati- risk, I would propose that the repairing of dam- cally building competency, not correcting weak- age is not going to work. Rather, I suggest that ness. a young person who learns effective interper- We have discovered that there are human sonal skills, who has a strong work ethic, and strengths that act as buffers against mental ill- who has learned persistence under adversity is ness: courage, future-mindedness, optimism, in- at lessened risk for schizophrenia. terpersonal skill, faith, work ethic, hope, hon- This, then, is the general stance of positive esty, perseverance, the capacity for flow and psychology toward prevention. It claims that insight, to name several. Much of the task of there is a set of buffers against psychopathol- prevention in this new century will be to create ogy: the positive human traits. The Nikki prin- a science of human strength whose mission will ciple holds that by identifying, amplifying, and be to understand and learn how to foster these concentrating on these strengths in people at virtues in young people. risk, we will do effective prevention. Working My own work in prevention takes this ap- exclusively on personal weakness and on dam- proach and amplifies a skill that all individuals aged brains, and deifying the Diagnostic and possess but usually deploy in the wrong place. Statistical Manual (DSM), in contrast, has ren- The skill is called disputing (Beck, Rush, Shaw, dered science poorly equipped to do effective & Emery, 1979), and its use is at the heart of prevention. We now need to call for massive “learned optimism.” If an external person, who research on human strength and virtue. We is a rival for your job, accuses you falsely of need to develop a nosology of human strength— failing at your job and not deserving your po- the “UNDSM-I”, the opposite of DSM-IV. We sition, you will dispute him. You will marshal need to measure reliably and validly these all the evidence that you do your job very well. strengths. We need to do the appropriate lon- You will grind the accusations into dust. But if gitudinal studies and experiments to understand you accuse yourself falsely of not deserving how these strengths grow (or are stunted; Vail- your job, which is just the content of the au- lant, 2000). We need to develop and test inter- tomatic thoughts of pessimists, you will not dis- ventions to build these strengths. pute it. If it issues from inside, we tend to be- We need to ask practitioners to recognize that lieve it. So in “learned optimism” training much of the best work they already do in the programs, we teach both children and adults to consulting room is to amplify their clients’ recognize their own catastrophic thinking and strengths rather than repair their weaknesses. to become skilled disputers (Peterson, 2000; Se- We need to emphasize that psychologists work- ligman, Reivich, Jaycox, & Gillham, 1995; Se- ing with families, schools, religious communi- ligman, Schulman, DeRubeis, & Hollon, 1999). ties, and corporations develop climates that fos- This training works, and once you learn it, it ter these strengths. The major psychological is a skill that is self-reinforcing. We have shown theories now undergird a new science of that learning optimism prevents depression and strength and resilience. No longer do the dom- anxiety in children and adults, roughly halving inant theories view the individual as a passive their incidence over the next 2 years. I mention vessel “responding” to “stimuli”; rather, indi- this work only in passing, however. It is in- viduals now are seen as decision makers, with tended to illustrate the Nikki principle: that choices, preferences, and the possibility of be- building a strength, in this case, optimism, and coming masterful, efficacious, or, in malignant teaching people when to use it, rather than re- circumstances, helpless and hopeless. Science pairing damage, effectively prevents depression and practice that relies on the positive psychol- and anxiety. Similarly, I believe that if we wish ogy worldview may have the direct effect of to prevent drug abuse in teenagers who grow preventing many of the major emotional dis- up in a neighborhood that puts them at risk, the orders. It also may have two side effects: mak- effective prevention is not remedial. Rather, it ing the lives of our clients physically healthier, consists of identifying and amplifying the given all we are learning about the effects of 6 PART I. INTRODUCTORY AND HISTORICAL OVERVIEW mental well-being on the body; and reorienting exceptions mentioned previously) shows big, psychology to its two neglected missions, mak- specific effects when it is compared with another ing normal people stronger and more produc- form of psychotherapy or drug, adequately ad- tive, as well as making high human potential ministered. Finally, add the seriously large “pla- actual. cebo” effect found in almost all studies of psy- chotherapy and of drugs. In the depression literature, a typical example, around 50% of pa- Positive Therapy tients will respond well to placebo drugs or therapies. Effective specific drugs or therapies I am going to venture a radical proposition usually add another 15% to this, and 75% of about why psychotherapy works as well as it the effects of antidepressant drugs can be ac- does. I am going to suggest that positive psy- counted for by their placebo nature (Kirsch & chology, albeit intuitive and inchoate, is a major Sapirstein, 1998). effective ingredient in therapy as it is now done; So why is psychotherapy so robustly effec- if it is recognized and honed, it will become an tive? Why is there so little specificity of psy- even more effective approach to psychotherapy. chotherapy techniques or specific drugs? Why But before doing so, it is necessary to say what is there such a huge placebo effect? I believe about “specific” ingredients in therapy. Let me speculate on this pattern of questions. I believe there are some clear specifics in psy- Many of the relevant ideas have been put for- chotherapy. Among them are ward under the derogatory misnomer nonspe- cifics. I am going to rename two classes of non- Applied tension for blood and injury phobia specifics as tactics and deep strategies. Among Penile squeeze for premature ejaculation the tactics of good therapy are Cognitive therapy for panic Relaxation for phobia Attention Exposure for obsessive-compulsive disorder Authority figure Behavior therapy for enuresis Rapport Paying for services (My book What You Can Change and What Trust You Can’t documents the specifics and Opening up reviews the relevant literature.) But specificity Naming the problem of technique to disorder is far from the whole Tricks of the trade (e.g., “Let’s pause here,” story. rather than “Let’s stop here”) There are three serious anomalies on which present specificity theories of the effectiveness The deep strategies are not mysteries. Good of psychotherapy stub their toes. First, effect- therapists almost always use them, but they do iveness studies (field studies of real-world deliv- not have names, they are not studied, and, ery), as opposed to laboratory efficacy studies of locked into the disease model, we do not train psychotherapy, show a substantially larger ben- our students to use them to better advantage. I efit of psychotherapy. In the Consumer Reports believe that the deep strategies are all tech- study, for example, over 90% of respondents niques of positive psychology and that they can reported substantial benefits, as opposed to be the subject of large-scale science and of the about 65% in efficacy studies of specific psy- invention of new techniques that maximize chotherapies (Seligman, 1995, 1996). Second, them. One major strategy is instilling hope when one active treatment is compared with an- (Snyder, Ilardi, Michael, & Cheavens, 2000). other active treatment, specificity tends to dis- But I am not going to discuss this one now, as appear or becomes quite a small effect. Lester it is often discussed elsewhere in the literature Luborsky’s corpus and the National Collabora- on placebo, on explanatory style and hopeless- tive Study of Depression are examples. The lack ness, and on demoralization (Seligman, 1994). of robust specificity also is apparent in much of Another is the “building of buffering the drug literature. Methodologists argue end- strengths,” or the Nikki principle. I believe that lessly over flaws in such outcome studies, but it is a common strategy among almost all com- they cannot hatchet away the general lack of petent psychotherapists to first identify and specificity. The fact is that almost no psycho- then help their patients build a large variety of therapy technique that I can think of (with the strengths, rather than just to deliver specific CHAPTER 1. POSITIVE PREVENTION AND POSITIVE THERAPY 7 damage-healing techniques. Among the we have lost our birthright as psychologists, a strengths built in psychotherapy are birthright that embraces both healing what is weak and nurturing what is strong. Courage Interpersonal skill Rationality Conclusions Insight Optimism Let me end this introduction to the Handbook Honesty of Positive Psychology with a prediction about Perseverance the science and practice of psychology in the Realism 21st century. I believe that a psychology of pos- Capacity for pleasure itive human functioning will arise that achieves Putting troubles into perspective a scientific understanding and effective inter- Future-mindedness ventions to build thriving individuals, families, Finding purpose and communities. You may think that it is pure fantasy, that Assume for a moment that the buffering effects psychology will never look beyond the victim, of strength-building strategies have a larger ef- the underdog, and the remedial. But I want to fect than the specific “healing” ingredients that suggest that the time is finally right. I well rec- have been discovered. If this is true, the rela- ognize that positive psychology is not a new tively small specificity found when different ac- idea. It has many distinguished ancestors (e.g., tive therapies and different drugs are compared Allport, 1961; Maslow, 1971). But they some- and the massive placebo effects both follow. how failed to attract a cumulative and empirical One illustrative deep strategy is “narration.” body of research to ground their ideas. I believe that telling the stories of our lives, Why did they not? And why has psychology making sense of what otherwise seems chaotic, been so focused on the negative? Why has it distilling and discovering a trajectory in our adopted the premise—without a shred of evi- lives, and viewing our lives with a sense of dence—that negative motivations are authentic agency rather than victimhood are all power- and positive emotions are derivative? There are fully positive (Csikszentmihalyi, 1993). I be- several possible explanations. Negative emo- lieve that all competent psychotherapy forces tions and experiences may be more urgent and such narration, and this buffers against mental therefore override positive ones. This would disorder in just the same way hope does. Notice, make evolutionary sense. Because negative however, that narration is not a primary subject emotions often reflect immediate problems or of research on therapy process, that we do not objective dangers, they should be powerful have categories of narration, that we do not enough to force us to stop, increase vigilance, train our students to better facilitate narration, reflect on our behavior, and change our actions that we do not reimburse practitioners for it. if necessary. (Of course, in some dangerous sit- The use of positive psychology in psycho- uations, it will be most adaptive to respond therapy exposes a fundamental blind spot in without taking a great deal of time to reflect.) outcome research: The search for empirically In contrast, when we are adapting well to the validated therapies (EVTs) has in its present world, no such alarm is needed. Experiences form handcuffed us by focusing only on vali- that promote happiness often seem to pass ef- dating the specific techniques that repair dam- fortlessly. So, on one level, psychology’s focus age and that map uniquely into DSM-IV cate- on the negative may reflect differences in the gories. The parallel emphasis in managed care survival value of negative versus positive emo- organizations on delivering only brief treat- tions. ments directed solely at healing damage may But perhaps we are oblivious to the survival rob patients of the very best weapons in the value of positive emotions precisely because arsenal of therapy—making our patients they are so important. Like the fish that is un- stronger human beings. That by working in the aware of the water in which it swims, we take medical model and looking solely for the salves for granted a certain amount of hope, love, en- to heal the wounds, we have misplaced much of joyment, and trust because these are the very our science and much of our training. That by conditions that allow us to go on living (Myers, embracing the disease model of psychotherapy, 2000). They are the fundamental conditions of 8 PART I. INTRODUCTORY AND HISTORICAL OVERVIEW existence, and if they are present, any amount and depression. They have developed sophisti- of objective obstacles can be faced with equa- cated methods—both experimental and longi- nimity, and even joy. Camus wrote that the tudinal—for understanding the causal pathways foremost question of philosophy is why one that lead to such undesirable outcomes. Most should not commit suicide. One cannot answer important, they have developed pharmacological that question just by curing depression; there and psychological interventions that have must be positive reasons for living as well. moved many of the mental disorders from “un- There also are historical reasons for psychol- treatable” to “highly treatable” and, in a couple ogy’s negative focus. When cultures face mili- of cases, “curable.” These same methods, and tary threat, shortages of goods, poverty, or in- in many cases the same laboratories and the stability, they may most naturally be concerned next two generations of scientists, with a slight with defense and damage control. Cultures may shift of emphasis and funding, will be used to turn their attention to creativity, virtue, and the measure, understand, and build those char- highest qualities in life only when they are sta- acteristics that make life most worth living. ble, prosperous, and at peace. Athens during the As a side effect of studying positive human 5th century b.c., Florence of the 15th century, traits, science will learn how to better treat and and England in the Victorian era are examples prevent mental, as well as some physical, ill- of cultures that focused on positive qualities. nesses. As a main effect, we will learn how to Athenian philosophy focused on the human vir- build the qualities that help individuals and tues: What is good action and good character? communities not just endure and survive but What makes life most worthwhile? Democracy also flourish. was born during this era. Florence chose not to become the most important military power in Europe but to invest its surplus in beauty. Vic- Acknowledgment This research was sup- torian England affirmed honor, discipline, and ported by grants MH19604 and MH52270 duty as important human virtues. from the National Institute of Mental Health. I am not suggesting that our culture should Please send reprint requests to Dr. M. E. P Se- now erect an aesthetic monument. Rather, I be- ligman, Department of Psychology, University lieve that our nation—wealthy, at peace, and of Pennsylvania, 3815 Walnut Street, Phila- stable—provides a similar world historical op- delphia, PA 19104, or e-mail (seligman@psych. portunity. We can choose to create a scientific upenn.edu). This chapter draws heavily on Se- monument—a science that takes as its primary ligman and Csikszentmihalyi (2000). task the understanding of what makes life worth living. Such an endeavor will move the whole of social science away from its negative bias. The prevailing social sciences tend to view the References authentic forces governing human behavior as self-interest, aggressiveness, territoriality, class Allport, G. W. (1961). Pattern and growth in per- conflict, and the like. Such a science, even at its sonality. New York: Holt, Rinehart, & Winston. best, is by necessity incomplete. Even if utopi- Beck, A., Rush, J., Shaw, B., & Emery, G. (1979). anly successful, it would then have to proceed Cognitive therapy. New York: Guilford. to ask how humanity can achieve what is best Csikszentmihalyi, M. (1993). The evolving self. New York: HarperCollins. in life. Gillham, J. E., & Seligman, M. E. P. (1999). Foot- I predict that in this new century positive steps on the road to positive psychology. Be- psychology will come to understand and build haviour Research and Therapy, 37, S163–S173. those factors that allow individuals, communi- Kirsch, I., & Sapirstein, G. (1998). Listening to ties, and societies to flourish. Such a science will Prozac but hearing placebo: A meta-analysis of not need to start afresh. It requires for the most antidepressant medication. Prevention & Treat- part just a refocusing of scientific energy. In the ment, 1, Article 0002a, posted June 26, 1998. 50 years since psychology and psychiatry be- http://journals.apa.org/prevention/volume1. came healing disciplines, they have developed a Maslow, A. (1971). The farthest reaches of human highly useful and transferable science of mental nature. New York: Viking. illness. They have developed a taxonomy, as Myers, D. G. (2000). The funds, friends, and faith well as reliable and valid ways of measuring of happy people. American Psychologist, 55, 56– such fuzzy concepts as schizophrenia, anger, 67. CHAPTER 1. POSITIVE PREVENTION AND POSITIVE THERAPY 9 Peterson, C. (2000). The future of optimism. Seligman, M. E. P., Reivich, K., Jaycox, L., & Gill- American Psychologist, 55, 44–55. ham, J. (1995). The optimistic child. New York: Schwartz, B. (2000). Self-determination: The tyr- Houghton Mifflin. anny of freedom. American Psychologist, 55, Seligman, M. E. P., Schulman, P., DeRubeis, R. J., 79–88. & Hollon, S. D. (1999). The prevention of de- Seligman, M. (1991). Learned optimism. NY: pression and anxiety. Prevention and Treat- Knopf. ment, 2. http://journals.apa.org/prevention/ Seligman, M. (1994). What you can change and Snyder, C., Ilardi, S., Michael, S., & Cheavens, J. what you can’t. New York: Knopf. (2000). Hope theory: Updating a common pro- Seligman, M. E. P. (1995). The effectiveness of cess for psychological change. In C. R. Snyder psychotherapy: The Consumer Reports study. & R. E. Ingram (Eds.), Handbook of psycholog- American Psychologist, 50, 965–974. ical change: Psychotherapy processes and prac- Seligman, M. E. P. (1996). Science as an ally of tices for the 21st century (pp. 128–153). New practice. American Psychologist, 51, 1072–1079. York: Wiley. Seligman, M., & Csikszentmihalyi, M. (2000). Pos- Vaillant, G. (2000). The mature defenses: Ante- itive psychology: An introduction. American cedents of joy. American Psychologist, 55, 89– Psychologist, 55, 5–14. 98. This page intentionally left blank II Identifying Strengths This page intentionally left blank 2 Stopping the “Madness” Positive Psychology and the Deconstruction of the Illness Ideology and the DSM James E. Maddux The ancient roots of the term clinical psychol- come easily. The field began with the founding ogy continue to influence our thinking about of the first “psychological clinic” in 1896 at the the discipline long after these roots have been University of Pennsylvania by Lightner Witmer forgotten. Clinic derives from the Greek kli- (Reisman, 1991). Witmer and the other early nike, or “medical practice at the sickbed,” and clinical psychologists worked primarily with psychology derives from the Greek psyche, children who had learning or school problems— meaning “soul” or “mind” (Webster’s Seventh not with “patients” with “mental disorders” New Collegiate Dictionary, 1976). How little (Reisman, 1991; Routh, 2000). Thus, they were things have changed since the time of Hippoc- influenced more by psychometric theory and its rates. Although few clinical psychologists today attendant emphasis on careful measurement literally practice at the bedsides of their pa- than by psychoanalytic theory and its emphasis tients, too many of its practitioners (“clini- on psychopathology. Following Freud’s visit to cians”) and most of the public still view clinical Clark University in 1909, however, psycho- psychology as a kind of “medical practice” for analysis and its derivatives soon came to dom- people with “sick souls” or “sick minds.” It is inate not only psychiatry but also clinical psy- time to change clinical psychology’s view of it- chology (Barone, Maddux, & Snyder, 1997; self and the way it is viewed by the public. Korchin, 1976). Positive psychology, as represented in this Several other factors encouraged clinical psy- handbook, provides a long-overdue opportunity chologists to devote their attention to psycho- for making this change. pathology and to view people through the lens of the disease model. First, although clinical psychologists’ academic training took place in How Clinical Psychology universities, their practitioner training occurred Became “Pathological” primarily in psychiatric hospitals and clinics (Morrow, 1946, cited in Routh, 2000). In these The short history of clinical psychology sug- settings, clinical psychologists worked primarily gests, however, that any such change will not as psychodiagnosticians under the direction of 13 14 PART II. IDENTIFYING STRENGTHS psychiatrists trained in medicine and psycho- psychology and psychological health described analysis. Second, after World War II (1946), the previously continue to serve as implicit guides Veterans Administration (VA) was founded and to clinical psychologists’ activities. In addition, soon joined the American Psychological Asso- the language of clinical psychology remains the ciation in developing training centers and stan- language of medicine and pathology—what dards for clinical psychologists. Because these may be called the language of the illness ide- early centers were located in VA hospitals, the ology. Terms such as symptom, disorder, pa- training of clinical psychologists continued to thology, illness, diagnosis, treatment, doctor, occur primarily in psychiatric settings. Third, patient, clinic, clinical, and clinician are all con- the National Institute of Mental Health was sistent with the four assumptions noted previ- founded in 1947, and “thousands of psycholo- ously. These terms emphasize abnormality over gists found out that they could make a living normality, maladjustment over adjustment, and treating mental illness” (Seligman & Csik- sickness over health. They promote the dichot- szentmihalyi, 2000, p. 6). omy between normal and abnormal behaviors, By the 1950s, therefore, clinical psychologists clinical and nonclinical problems, and clinical had come “to see themselves as part of a mere and nonclinical populations. They situate the lo- subfield of the health professions” (Seligman & cus of human adjustment and maladjustment Csikszentmihalyi, 2000, p. 6). By this time, the inside the person rather than in the person’s practice of clinical psychology was characterized interactions with the environment or in socio- by four basic assumptions about its scope and cultural values and sociocultural forces such as about the nature of psychological adjustment prejudice and oppression. Finally, these terms and maladjustment (Barone, Maddux, & Sny- portray the people who are seeking help as pas- der, 1997). First, clinical psychology is con- sive victims of intrapsychic and biological forces cerned with psychopathology—deviant, abnor- beyond their direct control who therefore mal, and maladaptive behavioral and emotional should be the passive recipients of an expert’s conditions. Second, psychopathology, clinical “care and cure.” This illness ideology and its problems, and clinical populations differ in kind, medicalizing and pathologizing language are in- not just in degree, from normal problems in liv- consistent with positive psychology’s view that ing, nonclinical problems and nonclinical pop- “psychology is not just a branch of medicine ulations. Third, psychological disorders are concerned with illness or health; it is much analogous to biological or medical diseases and larger. It is about work, education, insight, love, reside somewhere inside the individual. Fourth, growth, and play” (Seligman & Csikszentmi- the clinician’s task is to identify (diagnose) the halyi, 2000, p. 7). disorder (disease) inside the person (patient) and This pathology-oriented and medically ori- to prescribe an intervention (treatment) that ented clinical psychology has outlived its use- will eliminate (cure) the internal disorder (dis- fulness. Decades ago the field of medicine began ease). to shift its emphasis from the treatment of ill- ness to the prevention of illness and later from the prevention of illness to the enhancement of Clinical Psychology Today: health (Snyder, Feldman, Taylor, Schroeder, & The Illness Ideology and the DSM Adams, 2000). Health psychologists acknowl- edged this shift over two decades ago (e.g., Once clinical psychology became “pathologi- Stone, Cohen, & Adler, 1979) and have been zed,” there was no turning back. Albee (2000) influential ever since in facilitating it. Clinical suggests that “the uncritical acceptance of the psychology needs to make a similar shift, or it medical model, the organic explanation of men- will soon find itself struggling for identity and tal disorders, with psychiatric hegemony, med- purpose, much as psychiatry has for the last two ical concepts, and language” (p. 247), was the or three decades (Wilson, 1993). The way to “fatal flaw” of the standards for clinical psy- modernize is not to move even closer to chology training that were established at the pathology-focused psychiatry but to move 1950 Boulder Conference. He argues that this closer to mainstream psychology, with its focus fatal flaw “has distorted and damaged the de- on understanding human behavior in the velopment of clinical psychology ever since” broader sense, and to join the positive psychol- (p. 247). Indeed, things have changed little since ogy movement to build a more positive clinical 1950. These basic assumptions about clinical psychology. Clinical psychologists always have CHAPTER 2. DECONSTRUCTION OF THE ILLNESS IDEOLOGY AND THE DSM 15 been “more heavily invested in intricate theo- programs (including mine), students are re- ries of failure than in theories of success” (Ban- quired to memorize parts of it line by line, as dura, 1998, p. 3). They need to acknowledge if it were a book of mathematical formulae or a that “much of the best work that they already sacred text. do in the counseling room is to amplify The DSM’s categorizing and pathologizing of strengths rather than repair the weaknesses of human experience is the antithesis of positive their clients” (Seligman & Csikszentmihalyi, psychology. Although most of the previously 2000). noted assumptions of the illness ideology are Building a more positive clinical psychology explicitly disavowed in the DSM-IV’s introduc- will be impossible without abandoning the lan- tion (APA, 1994), practically every word guage of the illness ideology and adopting a lan- thereafter is inconsistent with this disavowal. guage from positive psychology that offers a For example, in the DSM-IV (APA, 1994), new way of thinking about human behavior. In “mental disorder” is defined as “a clinically sig- this new language, ineffective patterns of be- nificant behavioral or psychological syndrome haviors, cognitions, and emotions are problems or pattern that occurs in an individual” (p. xxi, in living, not disorders or diseases. These prob- emphasis added), and numerous common prob- lems in living are located not inside individuals lems in living are viewed as “mental disorders.” but in the interactions between the individual So steeped in the illness ideology is the DSM- and other people, including the culture at large. IV that affiliation, anticipation, altruism, and People seeking assistance in enhancing the qual- humor are described as “defense mechanisms” ity of their lives are clients or students, not (p. 752). patients. Professionals who specialize in facili- As long as clinical psychology worships at tating psychological health are teachers, coun- this icon of the illness ideology, change toward selors, consultants, coaches, or even social activ- an ideology emphasizing human strengths will ists, not clinicians or doctors. Strategies and be impossible. What is needed, therefore, is a techniques for enhancing the quality of lives are kind of iconoclasm, and the icon in need of shat- educational, relational, social, and political in- tering is the DSM. This iconoclasm would be terventions, not medical treatments. Finally, the figurative, not literal. Its goal is not DSM’s de- facilities to which people will go for assistance struction but its deconstruction—an examina- with problems in living are centers, schools, or tion of the social forces that serve as its power resorts, not clinics or hospitals. Such assistance base and of the implicit intellectual assumptions might even take place in community centers, that provide it with a pseudoscientific legiti- public and private schools, churches, and peo- macy. This deconstruction will be the first stage ple’s homes rather than in specialized facilities. of a reconstruction of our view of human be- Efforts to change our language and our ide- havior and problems in living. ology will meet with resistance. Perhaps the pri- mary barrier to abandoning the language of the illness ideology and adopting the language of The Social Deconstruction of the DSM positive psychology is that the illness ideology is enshrined in the most powerful book in psy- As with all icons, powerful sociocultural, polit- chiatry and clinical psychology—the Diagnostic ical, professional, and economic forces built the and Statistical Manual of Mental Disorders, or, illness ideology and the DSM and continue to more simply, the DSM. First published in the sustain them. Thus, to begin this iconoclasm, early 1950s (American Psychiatric Association we must realize that our conceptions of psycho- [APA], 1952) and now in either its fourth or logical normality and abnormality, along with sixth edition (APA, 2000) (depending on our specific diagnostic labels and categories, are whether or not one counts the revisions of the not facts about people but social constructions— third and fourth editions as “editions”), the abstract concepts that were developed collabor- DSM provides the organizational structure for atively by the members of society (individuals virtually every textbook and course on abnor- and institutions) over time and that represent a mal psychology and psychopathology for un- shared view of the world. As Widiger and Trull dergraduate and graduate students, as well as (1991) have said, the DSM “is not a scientific almost every professional book on the assess- document.... It is a social document” (p. 111, ment and treatment of psychological problems. emphasis added). The illness ideology and the So revered is the DSM that in many clinical conception of mental disorder that have guided 16 PART II. IDENTIFYING STRENGTHS the evolution of the DSM were constructed abstractions and struggles for the personal, po- through the implicit and explicit collaborations litical, and economic power that derives from of theorists, researchers, professionals, their cli- the authority to define these abstractions and ents, and the culture in which all are embedded. thus to determine what and whom society views For this reason, “mental disorder” and the nu- as normal and abnormal. merous diagnostic categories of the DSM were Medical philosopher Lawrie Resnek (1987) not “discovered” in the same manner that an has demonstrated that even our definition of archaeologist discovers a buried artifact or a physical disease “is a normative or evaluative medical researcher discovers a virus. Instead, concept” (p. 211) because to call a condition a they were invented. By describing mental dis- disease “is to judge that the person with that orders as inventions, however, I do not mean condition is less able to lead a good or worth- that they are “myths” (Szasz, 1974) or that the while life” (p. 211). If this is true of physical distress of people who are labeled as mentally disease, it is certainly also true of psychological disordered is not real. Instead, I mean that these “disease.” Because they are social constructions disorders do not “exist” and “have properties” that serve sociocultural goals and values, our in the same manner that artifacts and viruses notions of psychological normality-abnormality do. For these reasons, a taxonomy of mental and health-illness are linked to our assumptions disorders such as the DSM “does not simply about how people should live their lives and describe and classify characteristics of groups of about what makes life worth living. This truth individuals, but... actively constructs a version is illustrated clearly in the American Psychiatric of both normal and abnormal... which is then Association’s 1952 decision to include homosex- applied to individuals who end up being classi- uality in the first edition of the DSM and its fied as normal or abnormal” (Parker, Georgaca, 1973 decision to revoke homosexuality’s disease Harper, McLaughlin, & Stowell-Smith, 1995, status (Kutchins & Kirk, 1997; Shorter, 1997). p. 93). As stated by psychiatrist Mitchell Wilson The illness ideology’s conception of “mental (1993), “The homosexuality controversy disorder” and the various specific DSM catego- seemed to show that psychiatric diagnoses were ries of mental disorders are not reflections and clearly wrapped up in social constructions of de- mappings of psychological facts about people. viance” (p. 404). This issue also was in the fore- Instead, they are social artifacts that serve the front of the controversies over post-traumatic same sociocultural goals as our constructions of stress disorder, paraphilic rapism, and maso- race, gender, social class, and sexual orienta- chistic personality disorder (Kutchins & Kirk, tion—that of maintaining and expanding the 1997), as well as caffeine dependence, sexual power of certain individuals and institutions and compulsivity, low-intensity orgasm, sibling ri- maintaining social order, as defined by those in valry, self-defeating personality, jet lag, patho- power (Beall, 1993; Parker et al., 1995; Rosen- logical spending, and impaired sleep-related blum & Travis, 1996). Like these other social painful erections, all of which were proposed for constructions, our concepts of psychological inclusion in DSM-IV (Widiger & Trull, 1991). normality and abnormality are tied ultimately Others have argued convincingly that “schizo- to social values—in particular, the values of so- phrenia” (Gilman, 1988), “addiction” (Peele, ciety’s most powerful individuals, groups, and 1995), and “personality disorder” (Alarcon, institutions—and the contextual rules for be- Foulks, & Vakkur, 1998) also are socially con- havior derived from these values (Becker, 1963; structed categories rather than disease entities. Parker et al., 1995; Rosenblum & Travis, 1996). Therefore, Widiger and Sankis (2000) missed As McNamee and Gergen (1992) state: “The the mark when they stated that “social and po- mental health profession is not politically, mor- litical concerns might be hindering a recognition ally, or valuationally neutral. Their practices of a more realistic and accurate estimate of the typically operate to sustain certain values, po- true rate of psychopathology” (p. 379, emphasis litical arrangements, and hierarchies or privi- added). A “true rate” of psychopathology does lege” (p. 2). Thus, the debate over the definition not exist apart from the social and political con- of “mental disorder,” the struggle over who cerns involved in the construction of the defi- gets to define it, and the continual revisions of nition of psychopathology in general and spe- the DSM are not searches for truth. Rather, cific psychopathologies in particular. Lopez and they are debates over the definition of a set of Guarnaccia (2000) got closer to the truth by CHAPTER 2. DECONSTRUCTION OF THE ILLNESS IDEOLOGY AND THE DSM 17 stating that “psychopathology is as much pa- panied by distress is female sexual arousal dis- thology of the social world as pathology of the order. Excessive masturbation used to be con- mind or body” (p. 578). sidered a sign of a mental disorder (Gilman, With each revision, the DSM has had more 1988). Perhaps in DSM-V not masturbating at to say about how people should live their lives all, if accompanied by “marked distress or in- and about what makes life worth living. The terpersonal difficulty,” will become a mental number of pages has increased from 86 in 1952 disorder (“autoerotic aversion disorder”). to almost 900 in 1994, and the number of men- Most recently we have been inundated with tal disorders has increased from 106 to 297. As media reports of epidemics of Internet addiction, the boundaries of “mental disorder” have ex- road rage, and pathological stockmarket day panded with each DSM revision, life has become trading. Discussions of these new disorders have increasingly pathologized, and the sheer num- turned up at scientific meetings and are likely bers of people with diagnosable mental disor- to find a home in the DSM-V if the media and ders has continued to grow. Moreover, we men- mental health professions continue to collabo- tal health professionals have not been content rate in their construction, and if treating them to label only obviously and blatantly dysfunc- and writing books about them becomes lucra- tional patterns of behaving, thinking, and feel- tive. ing as “mental disorders.” Instead, we gradually The trend is clear. First we see a pattern of have been pathologizing almost every conceiv- behaving, thinking, feeling, or desiring that de- able human problem in living. viates from some fictional social norm or ideal; Consider some of the “mental disorders” or we identify a common complaint that, as found in the DSM-IV. Premenstrual emotional expected, is displayed with greater frequency change is now premenstrual dysphoric disorder. or severity by some people than others; or Cigarette smokers have nicotine dependence. If we decide that a certain behavior is undesir- you drink large quantities of coffee, you may able, inconvenient, or disruptive. We then develop caffeine intoxication or caffeine-induced give the pattern a medical-sounding name, pref- sleep disorder. Being drunk is alcohol intoxica- erably of Greek or Latin origin. Eventually, tion. If you have “a preoccupation with a defect the new term may be reduced to an acronym, in appearance” that causes “significant distress such as OCD (obsessive-compulsive disorder), or impairment in... functioning” (p. 466), you ADHD (attention-deficit/hyperactive disorder), have a body dysmorphic disorder. A child and BDD (body dysmorphic disorder). The new whose academic achievement is “substantially disorder then takes on a life of its own and be- below that expected for age, schooling, and level comes a diseaselike entity. As news about “it” of intelligence” (p. 46) has a learning disorder. spreads, people begin thinking they have “it”; Toddlers who throw tantrums have oppositional medical and mental health professionals begin defiant disorder. Even sibling relational prob- diagnosing and treating “it”; and clinicians and lems, the bane of parents everywhere, have clients begin demanding that health insurance found a place in DSM-IV, although not yet as policies cover the “treatment” of “it.” an official mental disorder. Over the years, my university has con- Human sexual behavior comes in such vari- structed something called a “foreign-language ety that determining what is “normal” and learning disability.” Our training clinic gets five “adaptive” is a daunting task. Nonetheless, sex- or six requests each year for evaluations of this ual behavior has been ripe for pathologization “disorder,” usually from seniors seeking an ex- in the DSM-IV. Not wanting sex often enough emption from the university’s foreign-language is hypoactive sexual desire disorder. Not want- requirement. These referrals are usually ing sex at all is sexual aversion disorder. Having prompted by a well-meaning foreign-language sex but not having orgasms or having them too instructor and our center for student disability late or too soon is considered an orgasmic dis- services. Of course, our psychology program order. Failure (for men) to maintain “an ade- has assisted in the construction of this “disor- quate erection... that causes marked distress or der” by the mere act of accepting these referrals interpersonal difficulty” (p. 504) is a male erec- and, on occasion, finding “evidence” for this so- tile disorder. Failure (for women) to attain or called disorder. Alan Ross (1980) referred to this maintain “an adequate lubrication or swelling process as the reification of the disorder. In light response of sexual excitement” (p. 502) accom- of the awe with which mental health profes- 18 PART II. IDENTIFYING STRENGTHS sionals view their diagnostic terms and the answered by saying that it depends on whether power that such terms exert over both profes- you are a furrier or a butcher. How you choose sional and client, a better term for this process to classify rabbits depends on what you want to may be the deification of the disorder. do with them. Neither classification system is We are fast approaching the point at which more valid or “true” than the other. We can say everything that human beings think, feel, do, the same of all classification systems. They are and desire that is not perfectly logical, adaptive, not “valid” (true) or “invalid” (false). Instead, or efficient will be labeled a mental disorder. they are social constructions that are only more Not only does each new category of mental dis- or less useful. Thus, we can evaluate the “valid- order trivialize the suffering of people with se- ity” of a system of representing reality only by vere psychological difficulties, but each new cat- evaluating its utility, and its utility can be eval- egory also becomes an opportunity for in- uated only in reference to a set of chosen goals, dividuals to evade moral and legal responsibility which in turn are based on values. Therefore, for their behavior (Resnek, 1997). It is time to instead of asking, “How true is this system of stop the “madness.” classification?” we have to ask, “What do we value? What goals do we want to accomplish? How well does this system help us accomplish The Intellectual Deconstruction them?” Thus, we cannot talk about “diagnostic of the DSM: An Examination of validity and utility” (Nathan & Langenbucher, Faulty Assumptions 1999, p. 88, emphasis added) as if they are dif- ferent constructs. They are one and the same. The DSM and the illness ideology it represents Most proponents of traditional classification remain powerful because they serve certain so- of psychological disorders justify their efforts cial, political, and professional interests. Yet the with the assumption that “classification is the DSM also has an intellectual foundation, albeit heart of any science” (Barlow, 1991, p. 243). an erroneous one, that warrants our examina- Categorical thinking is not the only means, tion. The developers of the DSM have made a however, for making sense of the world, al- number of assumptions about human behavior though it is a characteristically Western means and how to understand it that do not hold up for doing so. Western thinkers always have ex- very well to logical scrutiny. pended considerable energy and ingenuity di- viding the world into sets of separate “things,” dissecting reality into discrete categories and Faulty Assumption I: constructing either-or and black-or-white di- Categories Are Facts About the World chotomies. Westerners seem to believe that the The basic assumption of the DSM is that a sys- world is held together by the categories of hu- tem of socially constructed categories is a set of man thought (Watts, 1951) and that “making facts about the world. At issue here is not the sense out of life is impossible unless the flow of reliability of classifications in general or of the events can somehow be fitted into a framework DSM in particular—that is, the degree to which of rigid forms” (Watts, 1951, pp. 43–44). Un- we can define categories in a way that leads to fortunately, once we construct our categories, consensus in the assignment of things to cate- we see them as representing “things,” and we gories. Instead, the issue is the validity of such confuse them with the real world. We come to categories. As noted previously, the validity of believe that, as Gregory Kimble (1995) said, “If a classification system refers not to the extent there is a word for it, there must be a corre- to which it provides an accurate “map” of re- sponding item of reality. If there are two words, ality but, instead, to the extent to which it there must be two realities and they must be serves the goals of those who developed it. For different” (p. 70). What we fail to realize is that, this reason, all systems of classification are ar- as the philosopher Alan Watts (1966) said, bitrary. This is not to say that all classifications “However much we divide, count, sort, or clas- are capricious or thoughtless but that, as noted sify [the world] into particular things and earlier, they are constructed to serve the goals events, this is no more than a way of thinking of those who develop them. Alan Watts (1951) about the world. It is never actually divid

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