Psychology of Diversity Reflection

psychology exercise and need the explanation and answer to help me learn.

Each Reflection Volume (all three part A, B, C) should be completed in 6-8 pages total
(should incorporate reading materials and lectures PPT)
*The readings files and powerpoint are attached below.
*the subject of an essay “You=tutor(it’s okay if it’s a fictional character or a name”,
Reflection Volume, Part A
Within-person change in Mental Health and Well-being
Sample Core Concepts:
Cultural variation in definitions of well-being, Mental illness versus mental health, Racial Microaggressions, Minority stress framework Individuation
1. From your perspective, what are some of the key indicators of mental health and well-being? Do you think your perspective is shared by other members of your national or racial/ethnic groups or other important social groups? Has your perspective changed over time? Who has shaped your definition of wellbeing? Do others’ perspectives (other people, societal norms, etc.) about what constitutes well-being ever affect you (positively or negatively)?
2. Do you ever find yourself (intentionally or unintentionally) imposing your own definitions of wellbeing on others?
3. If your wellbeing fluctuates a lot day-to-day, why do you think that is? Or if your wellbeing is relatively stable day-to-day, why do you think that is?
You do not need to answer question-by-question. The questions are meant to prompt your thinking.
Reflection Volume, Part B
Perspective-Taking, Neurodiversity & “Normality”
Sample Core Concepts:
Neurodiversity, Thinking Fast and Slow, Adding “Friction”, Empathy, Emotion Regulation
Participate in the Kindness Challenge. Dr. Jamil Zaki has developed a series of 5 kindness challenges that you can use to push yourself and connect better. For an overview see: https://www.warforkindness.com/challenges. Each challenge includes some instructions (as well as a video that includes more details about the challenge) and questions at the end to answer and reflect on. Pick three of the challenges and respond to the reflection questions at the end.
Challenge 1: Reverse the Golden Rule
(https://www.warforkindness.com/challenge-1- reverse-the-golden-rule)
Reflect on this experience. Were you initially harder on yourself than you would be towards someone close to you? Did reversing the golden rule allow you more self-compassion? How could you apply this strategy during hard times in the future?
Challenge 2: Spend Kindly (https://www.warforkindness.com/challenge-2-spend-kindly)
Reflect on your experience. How did you feel after—depleted, refreshed, neither, both? How can you use this knowledge in the future?
Challenge 3: Disagree Better (https://www.warforkindness.com/challenge-3-disagree-better)
Did this approach led to a more productive discussion than you would have had otherwise? Why or why not? Were you surprised by anything you learned?
*** Please note if you select this option—we do not want you to interact with someone who is harmful to you; it is not the responsibility of oppressed people to foster inclusion; this option should be only be applied in situations of disagreement with someone where there is safety and mutual respect
Challenge 4: Kindtech (https://www.warforkindness.com/challenge-4-kindtech)
Did this make your internet time feel different than usual? If so, how, and how could you keep this up?
Challenge 5: Be a Cultural Builder
(https://www.warforkindness.com/challenge-5-be-a-culture- builder)
Reflect on how this goes. Does it feel uncomfortable and intrusive to voice a norm to others, or does it come naturally? Do you think your actions made a difference?
Reflection Volume, Part C
Individual Differences in the Impact of Resources and Resources
Sample Core Concepts:
Risk and Promotive factors, Microsystem, Mesosystem, Exosystem, Macrosystem, Protective factors, Resilience, Differential impact model
1. In class, we looked at the quote “The behaviour of individuals is not solely determined in their mind but is largely influenced by family, community, institutions, media, and political economy.” (Igarashi, 2015). Does that sentiment resonate with you? In what way? Do you think we (as a society) take this idea to heart? In what ways does modern society reflect this idea, and in what ways does modern society fail to live up to this idea?
2. Think about a person who has faced an adversity. This could be a person you know in real life (perhaps a sibling or friend, or even yourself), a person who is well-known in the public domain, or a person from literature or film. How did the person cope with this adversity? What did resilience look like in this example? How does this example inform your understanding of the concept of resilience? What factors supported resilience, if any? What factors interfered? If you are reflecting on a real person, including yourself, you do not need to share the identity of the person in your example. As a reminder, do not share information with your facilitators that might make you feel uncomfortable after you have handed in your reflection volume. If you wish, you may want to create a visualization of the relevant factors and how they have unfolded across different phases of development.
Summary Reflection
➢ Reflecting on the three parts of this volume, has any theme emerged in your thinking?
Thank you so much for your helping:)
Requirements: 6-8pages
First Nations Perspective on Health and Wellness The First Nations Perspective on Health and Wellness aims to visually depict and describe the First Nations Health Authority Vision: Healthy, Self-Determining and Vibrant BC First Nations Children, Families and Communities. This visual depiction of the Perspective on Health and Wellness is a tool for the FNHA and First Nations Communities. It aims to create shared understanding of an holistic vision of wellness. This image is just a snapshot of a fluid concept of wellness: it can be adapted and customized freely and is not confined to remain the same. The original image was created from researching other models; from feedback and ideas gathered from BC First Nations over the past few years and from traditional teachings and approaches shared by First Nations healers and elders at gatherings convened by the FNHA and its predecessor – the First Nations Health Society. This representation was developed by the FNHA with input from our Federal and Provincial government partners to create the Wellness Streams.
Understanding the Perspective on Health and Wellness The Centre Circle represents individual human beings. Wellness starts with individuals taking responsibility for our own health and wellness (whether we are First Nations or not).
The Second Circle illustrates the importance of Mental, Emotional, Spiritual and Physical facets of a healthy, well, and balanced life. It is critically important that there is balance between these aspects of wellness and that they are all nurtured together to create a holistic level of well-being in which all four areas are strong and healthy. The Third Circle represents the overarching values that support and uphold wellness: Respect, Wisdom, Responsibility, and Relationships. All other values are in some way essential to the four below: Respect is about honouring where we come from: our cultures, traditions, and ourselves. Respect is intergenerational. It is passed on through our communities and families. It is the driving force of the community because it impacts all of our life experiences including our relationships, health, and work. It is defined as consideration and appreciation for others, but there is also recognition that respect is so much more in First Nations communities: it entails a much higher standard of care, consideration, appreciation and honour and is fundamental to the health and wellbeing of our people. There is an intuitive aspect to respect, because it involves knowing how to be with oneself and with others. Wisdom includes knowledge of language, traditions, culture, and medicine. Like respect, wisdom is an understanding that is passed on by our ancestors from generation to generation and has existed since time immemorial. It is sacred in nature and difficult to define. Responsibility is something we all have: to ourselves, our families, our communities, and the land. Responsibility extends not just to those with whom we come into contact or relate – but also to the roles we play within our families, our work, and our experiences in the world. Also entailing mutual accountability and reciprocity, responsibility intersects with many areas of our lives, and involves maintaining a healthy, balanced life as well as showing leadership through modelling wellness and healthy behaviours. Relationships sustain us. Relationships and responsibility go hand in hand. Like responsibility, relationships involve mutual accountability and reciprocity. Relationships are about togetherness, team-building, capacity building, nurturing, sharing, strength, and love. Relationships must be maintained both within oneself and with those around us.
The Fourth Circle depicts the people that surround us and the places from which we come: Nations, Family, Community, and Land are all critical components of our healthy experience as human beings. Land is what sustains us physically, emotionally, spiritually and mentally. We use the land for hunting, fishing, and gathering. The land is where we come from and is our identity. It is more than just the earth. It includes the ocean, air, food, medicines, and all of nature. We have a responsibility to care for the land and to share knowledge of the land with our people. Land and health are closely intertwined because land is the ultimate nurturer of people. It provides not only physical but emotional and spiritual sustenance, because it inspires and provides beauty; it nurtures our souls. Community represents the people where we live, where we come from, and where we work. There are many different communities: communities of place, knowledge, interests, experiences, and values. These all have a role in our health. Family is our support base, and is where we come from. There are many different kinds of families that surround us, including our immediate and extended families. For First Nations people, family is often seen as much broader than many Western perspectives. Our immediate and extended families are often interchangeable, so Western descriptions and definitions don’t always apply. Our families may also include who we care for, support systems, and traditional systems in addition to (or instead of) simply blood lines. It is important to recognize the diversity
that exists across British Columbia, that there are different family systems that exist (e.g. matrilineal). Nations include the broader communities outside of our immediate and extended families and communities. In essence, Nation is an inclusive term representing the various Nations that comprise your world. The Fifth Circle depicts the Social, Cultural, Economic and Environmental determinants of our health and well-being. Social determinants such as security, housing, food, prevention, promotion, education, health awareness, and outreach supports, are all critical aspects of our health and well-being. Environmental determinants include the land, air, water, food, housing, and other resources that need to be cared for and considered in order to sustain healthy children, families and communities. Safety and emergency preparedness are critical components. Cultural determinants include language, spirituality, ceremonies, traditional foods and medicines, teachings, and a sense of belonging. Economic determinants include resources which we have a responsibility to manage, share, and sustain for future generations. There is a need to create balance in how we use our resources and a need for good leadership to help us create this balance. The people who make up the Outer Circle represent the FNHA Vision of strong children, families, elders, and people in communities. The people are holding hands to demonstrate togetherness, respect and relationships, which in the words of a respected BC elder can be stated as “one heart, one mind.” Children are included in the drawing because they are the heart of our communities and they connect us to who we are and to our health. The colors of the sunset were chosen specifically to reflect the whole spectrum of sunlight, as well as to depict the sun’s rotation around the earth which governs the cycles of life in BC First Nations communities. Background The First Nations Perspective on Health and Wellness started as a draft visual concept of wellness created by the Traditional Wellness Working Group and staff and advisors from the FNHA. The visual model and description was presented to BC First Nations at Gathering Wisdom V in May 2012. The feedback gathered at Gathering Wisdom V was then incorporated into the current visual model and description. The First Nations Perspective on Health and Wellness is intended to serve as a starting point for discussion by First Nations communities on what they conceptualise as a vision of wellness for themselves and the FNHA. Retrieved from https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-authority/first-nations-perspective-on-wellness
RESEARCHARTICLEOpenAccessLandandnatureassourcesofhealthandresilienceamongIndigenousyouthinanurbanCanadiancontext:aphotovoiceexplorationAndrewR.Hatala1*,ChinyereNjeze1,DarrienMorton1,TamaraPearl2andKelleyBird-Naytowhow1AbstractBackground:PopulationandenvironmentalhealthresearchillustrateapositiverelationshipbetweenaccesstogreenspaceornaturalenvironmentsandpeoplesÕperceivedhealth,mentalhealth,resilience,andoverallwell-being.ThisrelationshipisalsoparticularlystrongamongCanadianIndigenouspopulationsandsocialdeterminantsofhealthresearchwherenotionsofland,health,andnaturecaninvolvebroaderspiritualandculturalmeanings.AmongIndigenousyouthhealthandresiliencescholarship,however,researchtendstoconceptualizelandandnatureasruralphenomenawithoutanyseriousconsiderationontheirimpactswithinurbancityscapes.ThisstudycontributestocurrentliteraturebyexploringIndigenousyouthsÕmeaning-makingprocessesandengagementswithlandandnatureinanurbanCanadiancontext.Methods:ThroughphotovoiceandmodifiedGroundedTheorymethodology,thisstudyexploredurbanIndigenousyouthperspectivesabouthealthandresiliencewithinaninner-cityCanadiancontext.Overthecourseofoneyear,thirty-eightin-depthinterviewswereconductedwithIndigenous(PlainsCreeFirstNationsandMŽtis)youthalongwithphotovoicearts-basedandtalkingcirclemethodologiesthatoccurredonceperseason.TheresearchapproachwasalsoinformedbyEtuaptmumkoraÒtwo-eyedseeingÓframeworkwhereIndigenousandWesternÒwaysofknowingÓ(worldviews)canworkalongsideoneanother.Results:Ourstrength-basedanalysesillustratedthatengagementwithandaconnectiontonature,eitherbywayofbeingpresentinnatureandviewingnatureintheirlocalurbancontext,wasacentralaspectoftheyoungpeoplesÕphotosandtheirstoriesaboutthosephotos.Thisarticlefocusesonthreeofthemainthemesthatemergedfromtheyouthphotosandfollow-upinterviews:(1)natureasacalmingplace;(2)buildingmetaphorsofresilience;and(3)providingasenseofhope.Theselocalprocesseswereshowntohelpyouthcopewithstress,anger,fear,andothergeneraldifficultsituationstheymayencounterandnavigateonaday-to-daybasis.(Continuedonnextpage)©TheAuthor(s).2020OpenAccessThisarticleislicensedunderaCreativeCommonsAttribution4.0InternationalLicense,whichpermitsuse,sharing,adaptation,distributionandreproductioninanymediumorformat,aslongasyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicence,andindicateifchangesweremade.Theimagesorotherthirdpartymaterialinthisarticleareincludedinthearticle’sCreativeCommonslicence,unlessindicatedotherwiseinacreditlinetothematerial.Ifmaterialisnotincludedinthearticle’sCreativeCommonslicenceandyourintendeduseisnotpermittedbystatutoryregulationorexceedsthepermitteduse,youwillneedtoobtainpermissiondirectlyfromthecopyrightholder.Toviewacopyofthislicence,visithttp://creativecommons.org/licenses/by/4.0/.TheCreativeCommonsPublicDomainDedicationwaiver(http://creativecommons.org/publicdomain/zero/1.0/)appliestothedatamadeavailableinthisarticle,unlessotherwisestatedinacreditlinetothedata.*Correspondence:andrew.hatala@umanitoba.ca1DepartmentofCommunityHealthSciences,MaxRadyCollegeofMedicine,UniversityofManitoba,Winnipeg,Manitoba,CanadaFulllistofauthorinformationisavailableattheendofthearticleHatalaetal.BMCPublicHealth (2020) 20:538 https://doi.org/10.1186/s12889-020-08647-z
(Continuedfrompreviouspage)Conclusions:ThisstudycontributestotheliteratureexploringIndigenousyouthsÕmeaning-makingprocessandengagementswithlandandnatureinanurbancontext,andhighlightstheneedforpublichealthandmunicipalagenciestoconsiderdevelopingmoreculturallysafeandmeaningfulnaturalenvironmentsthatcansupportthehealth,resilience,andwell-beingofIndigenousyouthwithininner-citycontexts.Keywords:Health,Resilience,Well-being,Meaning-making,Indigenousyouth,Urban,Land,Nature,CanadaBackgroundAgrowingbodyofevidenceillustratesapositiverela-tionshipbetweenaccesstogreenspaceornaturalenvi-ronmentsandpeoplesÕperceivedhealth,mentalhealth,resilience,andoverallwell-being[1Ð8].Indeed,theas-sertionthatnaturecanhavebeneficialorrestorativehealtheffectsiswellestablished;wherereductionsinstress,increasedfocusandconcentration,improvedgen-eralwell-being,andheightenedvitalityareallpositivelyrelatedtothepresenceofandhumanconnectionswithnature[9Ð12].Researchevidencealsodemonstratesthatsuchconnectionswithnaturecanresultindecreasedanxiety,aggression,anddepression,whileincreasingavarietyofmeasuresofphysicalandmentalhealth,opti-mism,self-esteem,vitality,andresilienceoroneÕsabilitytoovercomestressandobstacles[13Ð17].Theconceptsofnatureorenvironmentwithinthislit-eratureareoftenusedinterchangeablywithavarietyofre-latedterms,suchasthenaturalsetting,greenspace,land,andnaturalenvironment[8].Herenatureisgenerallyde-finedasanenvironmentwheresomeorganicecosystemprocessesarepresent,suchasanimals,trees,gardens,orvegetationinthelandscape,plants,soils,water,rocksorair[13,14].Althoughdefinitionsandoutcomesofwhatconstituteshealthandwell-beingarecomplexanddrawondifferentconceptualmodels,theWorldHealthOrgani-zationÕs(WHO)definitionofhealthofteninformsre-searchinthisareaasastateofphysical,mental,andsocialwell-being,notmerelytheabsenceofdiseaseorinfirmity[5,6].Similarly,thenotionofresilienceisoftendiscussedasanaspectofcoping,whichimpliestheabilitytoÔbounceÕbackduringadversecircumstancestosupporthealthoutcomes[16Ð21].Althoughtheliteratureinthisareaisimportantandwarrantsseriousattention,studiesamonggeneralpopu-lationsoftenadvancenarrowconceptionsofnature,land,orenvironmentsasinanimate,secularspaces,oftenunderthecontrol,ownership,orcareofhumanpopula-tionsandmunicipalgovernments.Tomobilizetheseap-proacheswithinIndigenoushealthcontextsinCanadaparticularly,andglobalhealthmoregenerally,offerslim-itedconceptualandepistemologicalframeworkstounderstandthebroaderspiritualandculturalmeaningsattachedtolandandnature,andcanobscurethehistor-icalprocessesofsettlercolonization,urbanization,andIndigenousknowledgesinfluencingvariousconceptionsofhealth,resilience,andwell-beingamongIndigenouscommunitiesinCanadaandglobally[22,23,24].Indigenousperspectivesofhealth,natureandresilienceUnlikemostnon-Indigenouspeoplesthatmightcon-siderÒlandÓornatureassomethingtheyown,acom-moditytobetraded,oranassettomakeprofitfrom,formanyIndigenouspopulationsperspectivesoflandandnaturearemuchdeeper[23Ð26].Inthesecontexts,maintainingconnectionswithandhavingarelationshiptonatureandtheÒlandÓisnotdependentonaccesstoaliteralmaterialplaceorphysicallocation,butcanofteninvolvesymbolicorsacredrepresentations,andspiritualrelationshipswithbroadermoreuniversalizingnotionsofÒMotherEarthÓ[26Ð30].InherstudyconductedwithAnishinabek(OjibwayandOdawa)livinginoneFirstNationscommunityinnorthernOntario,Canada,forexample,KathleenWilsonexploredthewaysinwhichlandcontributedtophysical,mental,emotionalandspir-itualhealth,andnotedthatIndigenouspeoplesthereoftenreferredtolandasÒMotherEarth,Óaproviderofallthingsnecessarytosustainlife[31].Landfromthisperspective,whichharboursthetrees,animals,andplants,isimportantinatleasttworespects.First,trad-itionallandsaretheÔplaceÕofthenationandareinsepar-ablefromthepeople,theirculture,andtheirspiritualidentity[31].Second,landandresourcesarethefounda-tionsuponwhichIndigenouspeoplesoftenintendtobuildandrebuildtheireconomiesandsoadvanceself-determination,sovereignty,well-being,andthesocio-economiccircumstancesoftheirpeoples[29Ð31].Historically,arelationshipwithnature,landornaturalenvironment,hasbeenasignificantcomponentofmanyIndigenousPeoplesÕlives,identities,andculturesandisseenasanimportantdeterminantofIndigenoushealth[24Ð26,32].HealthfrommanyIndigenousperspectivesisbroaderthanmerelyphysicalhealthortheabsenceofdisease,emphasizingtheimportanceofwell-beingandabalanceinfourelementsoflifeÑthephysical,emotional,mental,andspiritualÑwhichareintricatelywovento-getherandinteracttosupporthealthandwell-being[23Ð25,30,33,34].Indigenousperspectivesofhealthcanalsopointtooraresupportedbystrength-basedprocessesofresiliencethatnotonlyinvolveordrawonHatalaetal.BMCPublicHealth (2020) 20:538 Page2of14
thesefouraspectsofoneÕsbeing[35,36],butalsoinvolvepositiveadaptationandresistanceinthefaceofcolonization,historicaltraumas,orstructuralviolence,aswellascurrentstresses,challenges,anddemands[37,38].Indeed,researchwithdiverseIndigenousPeoplesatteststhatrelationshipswithnatureandlandsupportallfourel-ementsoflife,andthisinturncan:enhanceoverallhealth,resilience,andwell-being[28,30,31,39];improveself-esteemandself-efficacy[40],increaseconsumptionoftraditionalfoods[41];fosterintergenerationalrelation-ships[38];reducepsychologicaldistress[42];andstrengthenculturalidentityandbelonging[43].ForIndi-genousyouthinCanadaÕsnorth,asanotherexample,be-yondnaturebeingaplacewhereeverythingneededlikeanimalstohunttoedibleplantscanbeaccessed,manyalsolookedtonatureasaplaceforspiritualconnection,healing,andpersonalgrowth[26,35,40,44].Albeitdiversebasedonvariousuniquehistories,cul-tures,andlanguages,Indigenousperspectivesofresili-enceareoftengroundedataculturallevelandarefocusedontherelationshipsthatexistbetweencommu-nity,identity,land,andcultureacrossgenerationsandgeo-graphicalsettings[22,45Ð48].Indeed,notionsofre-siliencehereillustrateastronglinkwithcultureandcommunityandarelargelybasedonprocessesofresist-ancetoahistoryofoppressivecolonialsystems,discrimin-ation,andloss.Forexample,inFirstNationscommunities,resiliencehasbeenapproachedasaprocessoranabilityofanindividualtonavigatetowardresourcesthatfacilitatewellnessandfacilitatepositiveadaptationdespiteadversity[22,36,49Ð51].ForIndigenousyouthwithinCanadiancontexts,therefore,resilienceisnotjustanindividualÕscapacitytocopewithadversity,changeormisfortune,butacommunityÕscapacitytoextendre-sourcestosustainwell-beingandprovidetheseresourcesinculturallyrelevantways[33,49Ð51].Inthisway,youngpeoplesÕviewsofresilienceareoftenreflectiveoflocalcul-tureandcontextinaholisticway,andÒconsistofabal-ancebetweentheabilitytocopewithstressandadversityandtheavailabilityofcommunitysupportÓ([52],p.5).Re-centresearchhasalsoshownthatIndigenousyouthper-spectivesofresiliencedrawonfamilyandlocalenvironmentassupportingfactorsthatcanbesimilaramongcultures[45,53].CurrentresearchobjectivesDespitetheresearchinthisarea,however,conceptualandmethodologicallimitationspersist.First,studiesamonggeneralpopulationstendtoinvolvelimiteddefi-nitionsofhealth,resilience,nature,orgreenspaceswithinurbanenvironments.Tomobilizetheseap-proacheswithinIndigenoushealthcontextscanobscurethebroadermeaningsattachedtoÒlandÓandnatureup-heldbymanyIndigenouscommunities,includingthehistoricalandculturalperspectivesofhealth,resilience,andwell-being[22,23,25,28,30].Second,previousre-searchamongIndigenouscommunitiestendstorestricttheconceptualizationsofÒlandÓornaturetoruralhomecommunities,suchasreservations,northernandremotecommunities,ortraditionalandancestralterritories.Whenlandhasbeensubjectedtohealthresearchinurbanspacesexplicitly,ittypicallyemploysnarrowdefi-nitionsthatviewland-basedculturalpracticesasÒoutofplaceÓornearlyÒinvisibleÓ[45].Lessconsiderations,therefore,aregiventohowdiversegroupsofIndigenousPeoplesÕmaintainconnectionstolandandnaturewithinurbancontextstopromotenotionsofhealth,resilience,andwell-beingtheyuphold[31,43].Whatweexplorehereishowhealth,resilienceandwell-beingforIndigenousyoungpeoplecanbestrengthenedwhenconnectionstonatureorland-basedactivityoccurwithinurbancontexts.WeneedtobetterunderstandthevariouswaysthatgrowingnumbersofIndigenousyouthlivingwithincitiesunderstandtheirrelationshipswithoraccesstonaturalenvironments,andhowthoserelation-shipscansupporttheirlocalperceptionsofhealth,resili-ence,andwell-being.TheresearchpresentedherecriticallyengagestheseissuesthroughaqualitativephotovoicestudyconductedwithurbanIndigenousyouthfromSaskatoon,SaskatchewanincentralCanada.SeveralÒmeaning-makingÓprocessesanimatedbycontext-personinteractionsandas-sociatedwithyouthperceptionsofandday-to-dayengage-mentswithÒlandÓandnatureintheirlocalurbancontextsareexplored[54,55].Insodoing,wechallengecommonapproachestohealthresearchdetailingconnectionswithnaturetoconsiderIndigenousperspectivesofÒland,Óhealth,andresilience,andatthesametimeexaminesomeofthewaysthatcontemporaryIndigenousyouthactivelycon-structmeaningfulrelationshipswithÒlandÓandnatureamidsttheirurbanenvironments.Intheend,weexplorehowconnectionstolandandnaturecouldinformpublichealthinterventionsforcontemporaryIndigenousyoungpeopleexperiencingvarioussocialinequitieswithintheirurbanenvironments.MethodsResearchframeworkTheresearchapproachwasinformedbyEtuaptmumk,aMiÕkmawframeworkforÒtwo-eyedseeingÓwhereIndi-genousandWesternknowledgeorÒwaysofknowingÓ(worldviews)areenvisionedtoworkalongsideonean-other[56].TheÒtwo-eyedseeingÓframeworkproposedbyMiÕkmawEldersAlbertandMurdenaMarshallwasameanstobridgeWesternscienceandresearchwithIn-digenousknowledgeandpractice.Appliedtoourre-searchteamthatwasmadeupofbothIndigenousandnon-Indigenousresearchers,thisapproachmadespaceforopendiscussionsregardingthecrucialrolesofbothHatalaetal.BMCPublicHealth (2020) 20:538 Page3of14
Òwaysofseeing,ÓimprovingourresearchrigourandoverallunderstandingsofurbanIndigenousyouthhealth,resilience,andwell-being[57].Situatedwithinasocialconstructionistepistemologicalperspective,thisresearchusedacommunity-engagedqualitativeapproachbringinganIndigenousmethodo-logicalresearchdesigntogetherwithamodifiedGroundedTheory(GT)methodologyfordatagenerationandanalysis[58,59].AnIndigenousmethodologyin-volvesaparadigmaticapproachwheredecisionscon-cerningthechoiceofmethods,howmethodsareemployed,andhowthedataareanalyzedandinter-pretedareshapedbyIndigenousontologyandepistem-ology[59].Indigenousontologyhasbeendescribedasrelational,placingvalueonnotonlyknowledgeitself,butontherelationshipswesharewithit.RelationalityisalsocentraltoanIndigenousepistemology,whichchar-acteristicallyseesresearchersasconnectedtosubjectsofresearchandplacesvalueonsubjectivity.Consequently,implementingthismodifiedGTwasnecessarytocreatespaceforintegratingaspectsofanIndigenousmethod-ologyandÒtwo-eyedseeingÓthatmightotherwisecon-flictwiththetenetsofclassicGT[58,59].ThemethodofphotovoiceandphotoelicitationwereusedtoexploreyouthsÕperspectivesofÔhowÕandÔwhyÕaconnectiontothelandornatureintheirurbancon-textswasimportanttothem.Photovoiceinvolvesindi-vidualstakingphotographicimagestodocumentandreflectonissuessignificanttothemandhowtheyviewthemselvesandothers[60Ð64].Weusedphotovoicebecauseitisacollaborative,communityengagedprocessthatacknowledgesthesignificanceofgivingvoicetosituatedeventsandperspectivesthroughphotographsandasenseofÒbeingthereÓ[63,64].Asanarts-basedandParticipatoryActionResearch(PAR)method,photovoicewasapositivewayofen-gagingyoungpeopleandenteringtheirworlds,fos-teredrelationalitybetweenyouthandtheresearchteam,andencouragedastoryingofthesacredandcre-ativeaspectsofoneÕsjourney,asÒtheceremonyofarttouchesthedeepestrealmsofthepsycheandthesa-creddimensionoftheartisticcreativeprocessÓ([25],p.46).ByincorporatingphotovoiceandunderstandingthatyouthneedtobeheardinasafeenvironmentÑwhichisnotthecaseformanyyoungpeopleÑwewereabletopromoteknowledgegenerationthatexploredcurrentandpastassumptionsaboutinner-cityIndi-genousyouthandallowedthemtoaskcreativeorcrit-icalquestionsthatmaynothavebeenuncoveredorvoicedotherwise[62,63].ParticipantsandsamplingAcombinationofpurposefulandsnowballsamplingmethodswasusedtorecruityouth,self-identifyingasIndigenous(i.e.,PlainsCreeandMŽtis),throughpartnershipswithlocalyouthorganizationsandaCommunityAdvisoryResearchCommittee(CARC)consistingofparents,Elders,andlocalyouthwhoin-formedthisresearch.Thefocusofsamplingwasplacedlessongeneralizabilityandsamplesize,andmoreonsampleadequacysothatdepthandbreadthofinformationwasachievedasdeterminedbythe-maticdatasaturation[58].Intotal,28youthbetweentheagesof16and25years(12maleand16female)whoself-identifiedasbeingfromPlainsCree(n=21)andMŽtis(n=7)culturalbackgroundsparticipated.Writtenandverbalinformedconsentwasobtainedfromallparticipantsinthisresearch.Consentwasnotobtainedfromtheparents/guardiansofminors(undertheageof18)whoparticipatedinthisre-search.Youth16yearsandolderweredeemedabletoconsenttoparticipateforthemselvesandthiswasap-provedbytheUniversityofSaskatchewanÕsBehavioralResearchEthicsBoard(#14Ð141)andlocallybytheCARC.PhotovoiceproceduresandinterviewprotocolsThisresearchwascarriedoutwithintheinner-cityneighborhoodsofSaskatoon,Saskatchewan,attheCom-munityEngagementOffice,asatellitecenteroftheUni-versityofSaskatchewan.Ourprojecttookplaceoveranentireyearandincludedfoursessionsofcommunity-engagedphototakingdatacollectiontoexplorechangesinandperceptionsofresilienceandwell-beingovertheseasons[57].BasedonconsultationsandengagementswithourCARC,theintentwastocapturediversestoriesofchallengeandresiliencethatcouldassistotheryouthinthecommunitybetternavigatepathstowardwell-being.Atthestartofeachseason,weengagedyouthabouttheirvisionfortheproject,gavethemdigitalcameras,andinvitedopentalkingcirclediscussionsfacilitatedbyourresearchteamandEldersaboutthephotovoiceprocess.Youthweretheninvitedtotakepicturesduringatwo-weekperiodofdifferentobjects,people(withper-mission),oraspectsoftheirlivesthatsupporttheirre-silience,andgeneralhealth,orwell-being.Followingeachphase,talkingcircleinterviewswiththeyouthfacil-itatedbythefirst,fourth,andfifthauthorsoccurredtolearnmoreaboutthemeanings,interpretations,andex-periencesbehindtheyouthsÕphotos.ThisapproachisreferredtoasÒphotoelicitationÓandpurposefullyfo-cusesontheimagesasapointofconversationanddia-logue,ratherthancenteringontheyouththemselves,inordertoallowthemtobemorecomfortableandopen[59].InfollowingtheguidanceofourCARCandaÒtwo-eyedseeingÓapproach,CreeandMŽtisIndigenouswaysoflifeorÒprotocolsÓofsmudgingwereofferedbeforeallHatalaetal.BMCPublicHealth (2020) 20:538 Page4of14
gatheringsorinterviewsandgiftsofnon-commercialto-baccotoyouthwerefollowedinordertorespectthesa-credaspectsandparticipatorynatureoftheresearchprocess[57,59].DataanalysesInaccordancewithamodifiedconstructivistGTap-proach[58],thecorethemesthatemergedfromthefirstinterviews(n=28)influencedthefocusofsubsequentinterviews.Codingmethodsonthefirstroundofinter-viewsfollowedaconstructivistGTapproach[58]andweredonebythefirstauthor.Ascodes,categories,andthemesemerged,theywerecheckedwiththeyouthpar-ticipants,CARC,andtheresearchteam(i.e,authors).Thisinitialroundofanalysisinformedasecondroundofinterviews(n=10)thatwasconductedbytheresearchteamtoclarifythedataandreachdatasaturation[58].Tenyouthwereinvitedtoparticipateinasecondinter-viewbasedonthestrongthemesofandstrategiesforre-siliencethatemergedfromtheirfirstinterviews.SincewefollowedaÒphotoelicitationÓmethod,individualyouthphotoswerenotcoded[65,66].Followingthetworoundsofinterviews,techniquesandmethodsofcon-structivistGTwereagainutilizedbythefirstauthorinsubsequentstagesofdataanalysis,includingdatareduc-tion,datadisplay,andconclusiondrawingorverification[58].Datasummaries,coding,findingthemes,andwrit-ingstoriesoccurredasthedatawerebeingcollected.InitialthemeswerecodedusingDedoosesoftwareVer-sion8.1(2018).Separateanalyticfileswereconstructedbythefirstauthorandcheckedforconsistencybytheresearchteam,participatingyouth,andCARC.Thedatawereexaminedrepeatedlybyallauthorstocaptureandhighlightthemainthemesandtocreateconcisephrasesthatencapsulatedtheessenceofthesection,theme,orconceptbeingexpressedbyyouth[58,59].Toenhancecredibilityandrigor,weemployedpeerdebriefingamongtheresearchteamwheremajorthemeswerevet-tedbytheCARC.ResultsAnalysesofyouthstoriesandphotosrevealedcomplexprocessesofandnavigationsbetweencontextsofdistressandstrategiesofresilienceandwell-being.Thephotosincludedplacesandspacesintheirurbanenvironments(buildings,youthcenters,schools,streetcorners),people(family,friends,partners),andceremonialorculturalob-jects(traditionalmedicinessuchassageandsweetgrass,drums,powwowdresses).Althoughthestoriesandpho-tosthatyouthgeneratedwerediverseandcoveredawiderangeoftopics,acentralthemethatemergedinboththeyouthphotosandstorieswereaspectsofandrelationswithnatureortheÒland.ÓThefindingsex-ploredherefocusonÒmeaning-makingÓandcontext-personengagementswithandconnectionstonature,ei-therbywayofbeingpresentinnatureorbyconnectingwithlandintheirlocalurbancontext,andhowsuchconnectionsfosteredresilienceandwell-beinginvariousways[43,54,55,62].Atthesametime,wehighlighthowtheseconnectionshelpedyoungpeoplecopewithvariousstressorsordifficultsituationstheymayencoun-terandnavigateonaday-to-daybasis.Herewefocusonthreeofthemainthemesandprocessesthatemergedfromtheyouthphotosandfollow-uptalking-circlein-terviews:(1)natureasacalmingplace;(2)buildingmet-aphorsofresilience;and(3)providingasenseofhope.Selectedphotosfromtheyouthparticipants(Figs.1,2,3,4,5,6,7and8)thatcorrespondwithandemphasizetheirthematicexcerptsfromtheinterviewsareinter-spersedthroughout.NatureasacalmingplaceFortheyouthinthisresearch,naturegenerallyinvolvedaspectsoftheirlocalenvironmentunaffectedbyhumanintervention,design,ortechnologyÑthetrees,plants,water,differentseasons,animals,birdsandothernaturalelements.Naturewasprimarilyapositiveforceinthelivesoftheseyoungpeoplethatwasseentodriveawayorprotectthemfromnegativeexperiencesthattheyhadtodealwithatdifferentpointsintheirlives.Whentheyareinthepresenceofnatureorabsorbedbynaturalen-vironmentswithinthecity,theyouthspokeabouthowithelpedthemtoreducestress,bedistractedfrompainordiscomfort,andmadethemfeeladeeperconnectionwiththeirlovedones.Inthisway,thepresenceofnaturebroughtaboutperceptualandemotionalshiftstowardsamorecalmingandpositivestateofbeing.Asoneyouthexpressed,ÒWhenIÕmupset,Ithinkaboutstuff,likethewater.Tome,thiskindofreconnectsme.Andattimes,IletoffsteambygoingforwalksbytheriverÉandhereFig.1YouthÕsphotovoiceimagesignifiedasÒtherivercalmsmedownÓHatalaetal.BMCPublicHealth (2020) 20:538 Page5of14
Ifeelhappy,happywithMotherNature.ÓAsanotheryouthsimilarlyshared,WheneverIÕmlikefeelingreallydownorIjustneedtogetawayfromeveryoneandjustfocusonmyself,Igoforlongwalks.AnditÕsreallynicebecauseIreallyappreciatenatureandeverything.So,itÕsreallycalming.Similarly,whilemanyyoungpeopleprovidedrichde-scriptionsaboutthebeautyandsightofnature,thesoundofnaturewasalsoexpressedascomforting.Asanotheryouthdescribed,WhenIammad,itisnicewhenIjustcomedownherebytheriver,ÔcuzlikeIsaidearlier,likeitcoolsmedownsincemydadleft.AndsometimesIjusttakemyshoesoffandwalkinthewater,andthenjustlistentothewaterÑsplashinitsometimeslikethatÕswhatmydadandIusedtodo.So,itcalmsmedown(Fig.1).Tothisyoungperson,livingwithoutafatherfigureandnothavingaclosefamilystructurewastherootofmuchanger,stress,andworriesinlife.Asakid,hisdadusedFig.2YouthÕsphotovoiceimagesignifiedasÒtheriverprovidesasenseofpeaceandpositivememoryÓFig.3YouthÕsphotovoiceimagesignifiedasÒrestingintheleavesandfeelingatpeaceÓFig.4YouthÕsphotovoiceimagesignifiedasÒspringasametaphorforchangeandgrowthÓFig.5YouthÕsphotovoiceimagesignifiedasÒsurvivingwinterÓHatalaetal.BMCPublicHealth (2020) 20:538 Page6of14
totakehimbytheriverandplaywithhimwhilegoingforlongwalks.Sincehisdadpassedaway,lifehasbeenharderforhim.Thisyouthexpresseddeepstrugglesatschool,withotherfamilymembers,andbeingteasedandbulliedbyotheryouth.Asaresult,heregrettablyattimestakesouthisfrustrationsonthosearoundhim,in-cludingfamilymembers,hisgirlfriend,teachers,orotherstudents.Amidalltheselifestruggles,connectingtona-tureandbeingbytheriver,inparticular,wasdescribedasanimportantcalmingnaturalplacethatprovidedasenseofpeaceandpositivememory.Thissentimentwasnotunique,butwasreflectedinseveralyouthnarrativesandphotos.Asanotheryouthoutlined,IreallylikethatItookpicturesbydowntownandbytheriverlanding,becausethatÕswhereIliketogowhenIÕmstressedoutorjustlikemyalonetime.Ijustreallylikeit.Theskyitselfisreallyblueanditgetslikelighter.ItÕsreallybeautifulandcalming(Fig.2).Theseexperiencesandnarrativesexpressedbytheyoungpeopleweworkedwithrevealdeepconnectionstonat-ureÑrepresentedoftenbythelandandriverÑandtherebyillustratehowpositive,meaningfulrelationshipsbetweentheirinteractionswithnaturalenvironmentsandtheirwell-beingcanoccurwithinurbancontexts.Thefeelingsofcalmingserenitywhichnatureofferscan-notbederivedbyattendingsupportprogramsalone,so-cializingwithfriendsorfamily,orevenparticipatinginculturalactivitiesandschoolinitiatives.Rather,itistheperson-contextinteractionsofyoungpeoplewithnatureandthe”land”intheirurbancontextsthatanimatedmeaning-makingprocessesandemotionalshiftstowardsmorepositiveandcalmingaffectiveexperiences.BuildingmetaphorsofresilienceFortheyouthinthisstudy,natureisalsoseenasaspir-itualforcethatcanguidepeopletodoornotdocertainactionsinlife.Inmostcases,theyouthdescribedsuchimages,stories,orteachingscomingtothemfromna-tureasalivedandembodiedmetaphor[55].ThisnotionisalsoexpressedbyGregoryCajeteasaÒnatureormeta-phoricmind,ÓwhereinhesuggestedthatÒastherationalminddevelops,themetaphoricmindslowlyrecedesintothesubconsciousÓwhereitliesdormantuntilÒitsskillsarecalleduponbythecreativeplayandimaginativerev-erie,orindreamsandstoriesÓ([25],p.28).Interactionswithandconnectionstonatureherethusbecomeonesuchmeaning-makingprocesstoawakentheimaginativestoriesandcreativeinterplaysupportingyouthwell-beingwithintheirinner-cityenvironments.Metaphorthusinvolvesaprocessofdiscoveryorinvention,andisessentiallyacreativemeaning-makingprocessthatcanFig.6YouthÕsphotovoiceimagesignifiedasÒlifelessonsfromnatureÕsanimalsÓFig.7YouthÕsphotovoiceimagesignifiedasÒbranchingoutandavoidingthebumpsinlifeÓFig.8YouthÕsphotovoiceimagesignifiedasÒTurtleIslandasourMotherNatureÓHatalaetal.BMCPublicHealth (2020) 20:538 Page7of14
becomeatoolforworkingwithchallengingexperiences[55].Inthisway,metaphorscanalsobethoughtofasbeingembodiedinsofarastheyprovideidiosyncraticwaysofactingonrepresentationsandofmakingpresen-tationstoothersthatlinkindividualactswithcollectivesense-making[54].Reflectingthisnotionofembodiedmetaphor,oneyouthforexamplefeltthattheseasonoffallÑwiththebrightlycolourleavesfallingfromthetreesÑrepresentednewbeginningsandanopportunitytostartoverorÒre-doÓprevioushardshipsornegativelifeexperiences.Thismetaphor,attimes,offeredpeacetohermind,madeherfeelrested,andgaveheraninnersenseofstrength,des-piteunexpressedangerfromadisturbingchildhood.Assheshared,Inthisphoto,Iwantedtoshowhowtheleaveshavefallenandnowtheyareresting,andIwasjustsit-tingthereandrestingwiththemandfeelingatpeace.BecauseIamsettledhere,kindoflikehowtheleavesaresettled.Ifeelmoreconnectedtomy-self.IdonÕtfeellostandangry,likehowIdidasakid.Seeingthisinnaturehelpedmeseethisinmy-self(Fig.3).Meaningfulperson-contextengagementswithnatureandthedifferenttransformationsoftheseasonsoftheyearwereoftenseenandexpressedaspowerfulmeta-phorsandguidesinformingparticularculturalpracticesandwaysofaction.Whenthetimeofthewintersolsticeappears(oftenatimeofreflectioninCreeculture),forexample,youngpeopleofteninterchangeablyfeltmoreÒclosed,ÓÒdark,ÓandÒcold,Óasthesnowcoverstheiren-vironment.Yet,nomatterhowdarkandcoldthewintermaybe,theyouthoutlinedandrecalledhowÒtherewillalwaysbeaspringtimetofollow.ÓDrawingonthisim-agery,theyouthoftenconnectedhowinlifetheremaybehighpointsandlowpoints,butNaturalLawcon-tinuestoadvanceandÒthingswillworkout,ÓthatÒlifecontinuestomoveforward,ÓandÒchangesandgrows.ÓThespring,then,canoftenembodyandreflectmeta-phoricallythefluxoflifeasexperiencedbyyouth,andhowtoprepareoractwithhopetothefutureamidstsuchaspectsofchangeandtransformation.Inthisspringseason(oftenknownastherenewaltimeofyear),theleavesaregrowingbackonthetreesandthereismorelightandhoursintheday.Inthisway,springcanbeareminderthatanydarknessinoneÕslifeisalwaystemporaryandtobereadyandadjustinsuchawaytoexploreandmaximisethelonghoursofthedayinordertoaccomplishgoal.Asanotheryouthexpressed,Inthespring,whenyouseetheleavesbudding,itÕsthepreparationforchange.Preparationforchange…itjustmeansnewgrowth,newopportunity.So,itÕslikethebeginningofthesegoalsthatwein-tendtodothroughthisstretchoftimewherethesunisclosesttous(Fig.4).Again,forthisyoungperson,seeingthetreeschangewiththeonsetofeachseasonshowsthattheworldaroundhimisregeneratingandresilient.NaturalLawandspiritualinteractionswithnaturethenteacheshimtoberesilientandtoknowthatchangeandrenewalareanaturalcyclicalaspectoflife.Theseembodiedmeta-phorsofseasonalchangehavehelpedthisyouthadapttochangesandÒgowiththeflowÓoftheseasons.Asan-otheryouthsimilarlyelaborated,Seeingthetreeschangeshowschangeinlifebe-causeitidentifiestheseasonsÉAtreechangesordiesoutinthewinterorthesecyclesthatmakelifeevident,andshowsusthatregrowthispossiblebe-causeitcomesbackeveryyearÉJustthatcomfortinknowingthatthenaturearoundmeisresilient,soImustberesilient.Herein,justlikeanElderthatguidesandgivesyouthspiritualteachingsandlessonsinlife,relationshipswithnature,representedbytheseasons,isalsoactingasateacherfortheseyoungpeople.Theteachingslearnedthroughperson-contextcontactwithandmeaning-makingobservationsofnaturewithinanurbanland-scapeareseenasimportantfortheseyoungpeopleÑastheycanguideandsupportyouththatfaceandcopewiththedailystrugglesofinner-citylife.Asmentioned,althoughyouthengagementswithlandandnaturesupportaspectsofresilienceandemotionalwell-being,thereisalsoacomplexityinsuchhuman-naturerelationsthatcanhavenegativeinfluencesaswell.Giventhecyclicalityofseasonsandthechangingpatternsofvulnerabilityoradversityreflectedtherein,manyyoungpeopledescribedthephysicalburdenofcolderCanadianprairieseasonsonthebodyaswellastheemotionalburdenoffamilygriefinthewinter.ÒWin-terisahardtimeformeÓasoneyouthshared,ÒitÕsatimewhereeverythingslowsdown,andwecanbecomeisolatedandlonelysometimesÓ(Fig.5).Orasanotherexpressed,ÒThecoldoutsidesometimesmakesthepeoplecoldinside,lesswillingtostopandsayhi,youknow.ÓDespitetheseexpressions,however,youthagaindescribedacapacitytoactwhenreferringtohowcolderseasonspromptedashiftintoanembodiedÒsurvivalmode.ÓInthisway,youthdisplayedprocessesofÒsurviv-ingÓorresiliencethatcanprotectorsupportthemfromthephysical,emotional,andmetaphoricalburdensorex-periencesofwinter,whilealsoprovidingimageryofim-permanenceinherentwithinlifeÕschallenges.Hatalaetal.BMCPublicHealth (2020) 20:538 Page8of14
ProvidingasenseofhopeBuildingontheseideasofanembodiedmetaphorandmeaning-makingprocesses,anotherthemeofnature-personinteractionsthatemergedfromtheyouthphotosandstoriesinvolvedprovidingasenseofhope.Theno-tionofÒhopeÓherewasprimarilyaboutafuturetimeorientationwhereyouthlookedbeyondcurrentchal-lengestohoped-forpositiveopportunities[18].Foroneyouthinparticular,natureintheformofabirdremindsherthatlifeisnotastraightroad,butthatobstaclesandchallengeswillalwaysexist,butcanbeovercome.Assheillustrated,ButwhenIseetheseducksbeinginrelationship,IÕmalllikeoh,theyarelivinglife,beingallcute.Ithinkducksmateforlife,andtheyarejusthappylittleduckshereinthisphotoTheyhavelikethispositivelittlebondofbeingcutelittleducksswimmingalong,justlivinglife(Fig.6).Forthisyouth,shehadbeeninpreviousunhealthyre-lationships,whichconstitutestheprimaryreasonforherupsanddownsinlife.Duringherhighschooldays,shegotintoherfirstrelationshipat17yearsold.Assheex-plained,herboyfriendcontrolledherlife.Shewasabusedmentally,emotionally,andeventuallyitgottotheextentofsexualabuse.Itwasanegativerelationshipwhichmadeherfeelsadandupsetaboutlife,astorynotuncommonamongtheyouthinthisresearch.Asare-sult,shelostconcentrationinschoolandwascompletelyconsumedwithherownissuesandnegativity.Feelingembarrassedandashamed,shekeptthesesituationstoherself,andneverspokeaboutthesechallengeswithfriendsinschoolorfamilymembers.Thiswasoneofherlowesttimesinlife.Despitefacingthesechallenges,however,thethoughtandinteractionswithducksandanimalslivinginnature,gaveherasenseofhopetobe-lievethathealthyrelationshipscanexist.Tothisyouth,naturebecameamodelorteacherforhealthyrelation-ships,whichbroughtanimportantsenseofhopeandpositivityintoherlife.Inasimilarway,otheryouthdescribedasenseofhopethroughtheimageryofatree.Justasthetreegrowsbybranchingoutandexpanding,theseyouthexpressedthattheyshouldnotgiveupinthefaceofdifficultybutlettheirexperienceÒbranchoutÓtoavoidhittingaÒbumpÓintheroadoflife.Asoneyouthexplained,Thetreegrowswithyou.Like,asyouÕregoingalongwithlifeyoumayhitabumpintheroad,andyouÕllgoonewayasaresult.Andthenwhenyoucomeback,likeyouÕllkeepmakingbranchesalongtheway.AndsincethatÕsyourlife,thetreesneedallthosebranchestolive,sothentheygoallthewayupÉSo,youneedallthebadstuffinyourlifetojustbeabletolearnandgothroughÉitÕsneverliketheendbecauseyoustillhavealotmoregrowingpersonally(Fig.7).Forthisyoungpersonandotherslikehim,hehadex-periencedtoughphasesinlifewhichhetermedasÒblockagesÓthatpreventedhimfromseeingthefutureandlivingthelifehewanted.Asayoungteenager,hisone-montholdcousinhadastroke.Duringthisentireperiodofill-health,thecousinwasthefocusofeveryoneinthefamily.Alongwithhismom,theywouldalwaysvisithimbothathomeandatthehospitalmakingsureandprovidingeverythingheneeded.Hewasequallythebabysitterthatwouldtakecareofalltheotherchildrenaroundthehome.ConstantlythinkingaboutthecousinÕssituation,whetherhewasaliveorifthenightbeforewasgoingtobelasttimehewasevergoingtoseehim,helostfocusonschoolandonotheraspectsoflife.Hefeltextremelyupsetatthesituationandeventuallystoppedbuildingfriendshipsorevenhangingaroundfriends.AboutayearafterthecousinÕsbirth,heultimatelypassedon.Thiswasthehardesttime,indeed,trulyaroughandhecticperiodforhim.Asmuchasitwasdiffi-cult,thisexperiencewasseenandinterpretedasanim-portantlifelessonandmeaning-makingprocess.HavingtheknowledgeandimageryofthetreeinmindandhowitgrowsthroughÒbumpsÓandÒstrugglesÓwasreallyim-portantforthisyouth,asitmadehimmoreatpeacewiththenegativeexperience,feelinglessangry,andallowedhimtofocusonhisfuture.Eventhoughhewentthrougharoughpath,hechosenottogiveup,butin-steadÒbranchedoutÓand,likethedifferentbranchesofthetrees,movedoutandgrewindifferentdirections.Alongthesesamelines,anotheryoungpersonillus-tratedhowculturalteachingsofhopeforthefuturereinforcehuman-natureembodiedrelationsthroughasacredturtleshellgiftedtohim.Theturtleshellalsoconnectedthisyouthtoprocessesofgiftgiving,trad-itionaldancing,expressingculturalpride,andlearningmoreabouttheÒlandÓ:ThisismyshieldformyoutfitÐthisturtleshell.ItwasgiventomeasagiftbecauseIdidnÕthaveashieldandaladyrecognizedit.Iuseitalot.ItÕsaverynicegift.Ilikedancing[powwow]withit.Igetalotofgoodcommentsaboutit.Alotofpeopleadmiretheturtlebecause,TurtleIslandrepresentsourmother,youknowlikeMotherNature,andIÕmjustgoingtotakecareofitandkeepitclosebecauseitwasgiventomeforareason(Fig.8).Throughtheseteachings,theyoungpersonÕsrelation-shipwithnatureingeneral,andthesacredturtleshellinHatalaetal.BMCPublicHealth (2020) 20:538 Page9of14
particular,providesÒreasonÓorpurposetowarrantre-newal,growth,thriving,andresilience.Thisyoungper-sondemonstratedhowspiritualconnectionstonatureandÒlandÓbecomeembodiedthroughculturalteachingsthatextendplacetoincludeÒTurtleIsland,Ówhichen-compassesnotonlySaskatoonbuttheentireNorthAmericancontinent.Thisextensionshowshowyouthcanmakeorcreatespaceforculturallyrootedstories,teachings,andconceptionsoflandandnaturetofunc-tionmateriallyandspirituallywithinurbancityscapes,andthusbecomesanimportantstrategyofidentityre-creationandhopeforthefuture[28].DiscussionThisstudycontributestotheliteratureexploringIndi-genousyouthsÕmeaning-makingprocessandengage-mentswithlandandnatureinanurbanCanadiancontext.Throughtheirphotosandstoriesaboutthosephotos,youthinthisresearchrevealedhowlocalen-counterswithnaturewereconstructedthroughday-to-dayaffectiveactivitiesthatchangedandwerefluidovertime,leadingustointerprettheseprocessesthrougheverydayactsofÒmeaning-makingÓ[40,43,54,55].AmovetoanalyzeÒmeaningmakingÓandyouthengage-mentswithnatureinurbancontextsnotonlyconsiderstemporalorientations,butalsoemphasisesconceptionsofsituatedinstancesofÒecologicalresilienceÓthroughmultiple,overlapping,andcontradictoryprocessesofre-newalandgrowth[18Ð20,54].Naturewasseenhereasendowedwithsacredorspiritualmeaningsandembed-dedinrelationsthatservedaspowerfulembodiedmeta-phorsthathelpedyouthtomitigatedistressinglifeexperiences.Thetrees,plants,andanimalswhichinhabittheÒlandÓwerealsohighlypersonalbeingswhichformedpartofyoungpeopleÕssocialandspiritualuni-verse,andtaughtyouthimportantlifelessons[43,44].Theyouthalsolearnedthroughtheseasonsthatchangeisanaturalpartoflife,andtherefore,inthefaceofchangeanddifficulties,theyhavetoadaptandmoveontoaccomplishagoal.Overall,then,thisexplorationbuildsonandcaninformstrengths-basedworkintheareaofurbanIndigenousyouthwell-beingandresilience[67,68].Resilience,Òland,Óandmeaning-makingTheinitialfocusofresilienceonthequalitiesofanindi-vidualhasevolvedinthelasttwodecades[19,20,21,51].Indeed,previousliteratureexploringresilienceamongyouthhasoftenconceptualizedresilienceasastaticoutcomeassociatedwithriskandprotectivefac-tors,andnottypicallyasadynamicandcontextualprocessindialoguewithlocalworldsandenvironments[19,37,51].FromIndigenousperspectives,BurackandcolleagueshavecriticizedwhattheycallÒsimplisticlinearriskmodelsofaspecificpredictortoaspecificoutcomeÓasinadequateforunderstandingreal-lifecomplexitiesforIndigenousyouth([69]p.S18).Populationhealthandre-silienceresearchhasalsobeencriticizedfortheoreticallyplacingtheonusonIndigenousorothermarginalizedyouthtobecomeresilientorhealthywhilenotexplicitlyinterrogatinghistoricalandcontemporaryformsofstruc-turaldisadvantage(i.e.,colonization)thatpermitinequity,marginalization,andexclusion[22,35,44].Inthesecon-texts,therefore,itremainscrucialtounderstandyouthsÕresiliencefromarelationalworldviewthatencompassesthecontext,themental,emotional,physicalandspiritualconnectionswithlandandnature,aswellastheuniqueinteractionsandstructuralimpedimentstowell-beingandresilience[35].Takingtheseissuesintoconsideration,researchnowillus-tratethatmuchofwhatseemstopromoteresilienceamidstadversityoriginatesoutsideoftheindividualÑinthefamily,thecommunity,thesociety,theculture,andtheenviron-ment[18Ð22,35,44].Asaresult,populationandcommunity-basedhealthresearchershaveexploredresili-encepromotingfactorsbeyondtheindividuallevel,tocon-siderfromasocialecologicalperspectivethesedifferentlevelsandyouth-environmentinteractions[22,46Ð49,51,70].Similarly,Indigenous-specificresilienceresearchhavealsoexploredresilience-buildingprocessthatemphasizedtheimportanceofculture,identity,community,family,spir-ituality,andIndigenousworldviewsasintegralfactorsthatenhancesresilience[18,48,67,68].Althoughwedonotdenytheindividualroleoftheseresiliencefactorsinfacilitat-ingbetterhealthandwellbeingofyouth[51],itremainsim-portanttonotonlyunderstandtheintersectingrelationshipsamongtheseindividual,structural,andsocialfactorsin-volvedinresilience,butalsotoexaminetherelativelyunex-ploredareasofIndigenousyouthmeaning-makingconnectionstoÒlandÓornaturewithinurbancontextsandhowtheycanalsoplayaroleinsupportingresilienceandwell-being.DecolonizingurbanenvironmentsDuetolonghistoriesofsettlercolonialism,disposses-sion,oppression,andcontemporaryformsofracism,certainaspectsofurbanenvironments,likecityparksorwalkingtrails,arenotalwayssafespacesforIndigenousyoungpeople.Insuchways,youngpeoplecontinuetofacesubtleandovertformsofdiscrimination,racism,ordonotenjoybasicrightsthatothernon-Indigenousyouthpopulationslivingwithinurbanenvironmentsmaytakeforgrantedorareprivilegedtoassumearenormalized[29,32,71,72].Indeed,manyyoungpeopleinourresearchexpressedhow,intheir18orsoyearsoflife,theystillhavenotcrossedthebridgesacrossSaska-toonÕsriverfromthewesttotheeastsidesofthecity,anddonotfeelliketheybelongincertainparksorgreenHatalaetal.BMCPublicHealth (2020) 20:538 Page10of14
spacesthatareprimarilyassociatedwiththedominantÒWhiteÓpopulationofthecity.Clearly,then,notallna-turespacesareequal.Suchdisparitiesinthebuiltenvir-onmentofacitynotonlyhavedirectimpactsonthesocialdeterminantsofhealthandtheindividualdevelop-mentofyoungpeopleÑincludingeconomiccapacityoropportunityandpsychosocialdomainsofbelongingandsafetyÑbutcanalsoaffectyoungpeoplesÕabilitytoberesilientandsurmountlifestruggles[12,61,64].Whenyouthareabletonavigatewithinandengagewithnatureinculturallyrelevantandmeaningfulways,thenaturalenvironmentcanprovideanempoweringspace,offerasenseofpeaceandhope,positivememories,andfos-teraninnerstrengthtoforgeaheadamidstlifeÕschal-lengesandobstacles[30Ð33,39,43,62].SeveralauthorshavearguedthatIndigenousconnec-tionswithlandandnaturecanrepresentÒdecolonizingÓinitiatives,drawingonaspiritualidentityandculturalhistorytochallengethespatialarrangementsofsettlercoloniallegacies[28Ð31].Whatweobserveinthisre-searchishowyouthareconstructingandbuildingsuchconnectionswithintheirlocalurbanspacesandtherebychallengingassumptionsofIndigenousspace,identity,andnotionsofbelongingthatareonlyrootedinÔances-trallandsÕorruralreservecommunitiesÒoutthereÓbe-yondthecitylimits[43].Indeed,currentÒlandbackÓmovements,localformsoforganizing,protest,anddis-courseburgeoningacrossurbanCanadiancentersoverthelastseveralyearscanbeenseenasexamplesofsuchstrategicdecolonizingactionsthatassertself-determinationandenactresiliencebyoccupyingcollect-ivespacethatwasnothistoricallyÒsafeÓorculturallyrepresentedasÒIndigenous.ÓThisresearchaddstotheseperspectivesbyillustratinghowcontemporaryIndigen-ousyoungpeoplewithininner-citycontextsarebuildingconnectionswithnatureorÒland-makingÓthatcan,invariousways,furthersupporttheirresilienceandwell-being[43].Inthisway,thelocalmodesofmeaning-makingandconnectionswiththelandwehighlightherecanbeseenasapartofthebroadernationalIndigenousrightsactivism,politicalresistance,expressionsofagencyandsovereignty,presence,andself-determinationre-gardingprotectionofthesacredÒlandsÓandtheimport-anceoflandclaimsatnationalandgloballevels[32].Indigenousself-determinationandlandrightsinCanadaandglobally,bothatthemacrolevelsofsettlerstatepol-iticsandthemicrolevelsoftheday-to-daylivesofinner-cityyouth,willonlycontinuetobeofrelevanceasincreasingnumbersofIndigenouspeoplescontinuetomigratetoandfindaÒhomeÓwithinurbancenters[72].Giventhesefindings,provisionsforandaccesstonat-uralspaces,ÒlandÓornature-basedapproachestopopu-lationorcommunityhealtharenotonlyimportantgenerally[3],butcaninformholistichealthapproachestosupportingthehealth,resilience,andwell-beingofIn-digenousyouthwithinurbansettings.Thisisalsoim-portantgiventhat,duetothehistoriesofcolonization,ongoingindustrialization,andincreasingurbanization,severalIndigenousyoungpeoplewithinurbancontextscanhavelimitedexposuretoorculturallymeaningfulwaystoengagewithnatureandtheÒlandÓ[51,52].Lookingforward,inurbansettingsandculturallyÒsafeÓdevelopment,then,thesenaturalspacescanbebetterof-feredthroughaccessibleanddecolonizingcityparks,communitygardens,andyouthculturalspacesthatareco-designedwiththeyoungpeoplethatareintendedtoaccessthem[29,61,71,72].Futureresearchcouldalsoexplorefurtherwhatdecolonizingprocessesinthelocalspacecouldmeanorlooklikeasaformofpopulationlevelstructuralinterventioninordertoensureyoungpeoplewithinthecityareincluded,belong,feelwel-come,andhaveopportunitiestoconstructmeaningandenactresilienceduringpositiveinteractionswithnatureandtheÒlandÓ[31Ð33,39,61,71,72].PhotovoiceandÒtwo-eyedseeingÓTheuseofphotovoicemethodcombinedwithEtuapt-mumkoraÒtwo-eyedseeingÓapproachinthisstudyre-mainsimportantasitallowedyouthtoactivelyengageintheresearchprocessandconnectvisualimageswiththeirlivedexperiencesorsocialrealities[56,57,62Ð64].Youthwerealsoabletosharepersonalknowledgeaboutparticularissuesthatweredifficulttoexpresswithwordsalone[65,66].Additionally,photovoicemethodspre-sentedopportunitiesforyouthtoreflectupontheirin-teractionswithnatureandwaysthroughwhichsuchinteractionscontributetotheirresilience,overallhealthandwell-being.ReflectingbacktotheÒnatureormeta-phoricmindÓthatCajeteoutlines,photovoiceasanarts-basedmethodologycanalsobecomeaspecialÒskillÓoractivitythatinvitesthecreativeplayorimaginativerev-erieandallowsthemetaphoricmindtoflourish[25].ByuncoveringandamplifyingIndigenousyouthperspec-tivesaboutconnectionstonatureanditscontributiontotheirgeneralwell-beingandresiliencethroughphotog-raphy,thismethodnotonlyservedasanempoweringapproachforyouth,butalsoworkedasapowerfultooltovisualizeIndigenousconcernsandfacilitatediscus-sionsonneedsassessmentsofIndigenousyouthinurbansettings[64,71].ThisresearchandaÒtwo-eyedseeingÓmethodologicalapproachcaninformappropriatepopulationhealthinterventionsoractiontoimprovetheresilience,healthandwell-beingofurbanIndigenousyouthintheyearsahead.ConclusionIndigenousyouthconnectionswithlandandnaturemaybeahiddenstrengthorsourceofresilienceandwell-Hatalaetal.BMCPublicHealth (2020) 20:538 Page11of14
beingthathasnotbeenadequatelyexploredorunder-stoodwithinurbancontextsinpreviouspopulationorpublichealthliterature.PerhapsduetoassumptionsthatÒlandÓandnatureforIndigenousyoungpeoplearetobeaccessedÒoutthereÓinruralcontextsandnotÒhereÓinthecity,manyofthepositivehealthassociationsandmeaning-makingprocessesyouthbuildwithnatureinurbanplacesmaybelost[43].Giventhepositiveimpactandbenefitswhichconnectionswithnaturecanoffermanyyouthinurbansettings,publichealthandmunici-palagenciesshouldensurethenaturalenvironmentsareconserved,expanded,andmademoreculturallysafeandmeaningfulsothatIndigenousyouthcaneasilyconnecttonaturewhichguidesandallowsthemtoconstructmeaningintheirlives.Byensuringthatthequalityandhealthofournaturalenvironmentisupheld,andparksandnaturalspacesarewidelyaccessible,naturecouldthereforeservetobeakeycomponentoftheurbanhealthinfrastructurethathasthecapacitytosupportre-silience,thebroadersocialandenvironmentaldetermi-nantsofhealth,andaddressthevarioushealthneedsofIndigenousyouths,othersubgroups,andthebroaderpopulationasawhole[1Ð7].Withthisinmind,how-ever,itisimportanttomaintainanappreciationfordee-permeaningandsignificancewithwhichÒlandÓandnatureareappreciatedwithinmanyIndigenousculturalworldviews[22Ð25].Hence,cautionshouldbetakenwhenengagingcross-culturalcollaborationsduringpub-lichealthresearchandinterventionstomanagetheseparadigmaticorculturaldifferencessensitivelyandrespectfully.AbbreviationsCARC:CommunityAdvisoryResearchCommittee;GT:GroundedTheoryAcknowledgementsWewouldliketoacknowledgealltheyouthresearchersandcollaborators,Elders,CARCmembers,andcommunitypartnerswhoassistedwiththisproject.Wewouldalsoliketothankthereviewersfortheirendorsementofthisresearchandhelpingusimprovethemanuscript.AuthorsÕcontributionsAH,KB,andTPjointlyconceivedthisresearchandcarriedoutalldatacollectionandanalysis.CNandDMcarriedoutaliteraturereviewonthetopicandwroteintroductionanddiscussionsectionsinearlydraftsofthepaper.AHtooktheleadinwritingthefirstdraftofthepaper,withinputfromallotherauthors.Allauthorsreadandapprovedthefinalmanuscript.FundingTheauthor(s)disclosereceiptofthefollowingfinancialsupportfortheresearch,authorship,and/orpublicationofthisarticle:FundingforthisprojectwasprovidedbytheUrbanAboriginalKnowledgeNetworkandSocialSciencesandHumanitiesResearchCouncilPartnershipGrant(895Ð2011-1001),CanadianInstitutesofHealthResearch(FRN130797),SaskatchewanPreventionInstitute,andtheDepartmentofCommunityHealthandEpidemiologyattheUniversityofSaskatchewan.Asidefromtheirfinancialsupport,thefundershadnoroleintheresearchorauthorshipofthisarticle.AvailabilityofdataandmaterialsThedatasetsgeneratedand/oranalysedduringthecurrentstudyarenotpubliclyavailablebecauseofprivacyconcerns;participantsarepotentiallyidentifiableduetothesmallsampleandoverallpopulationsize,andbecauseofthequalitativenatureofmuchofthedata.Thedatasetsarepotentiallyavailablefromthecorrespondingauthoronreasonablerequest.EthicsapprovalandconsenttoparticipateAllaspectsofthisresearchwereapprovedbytheUniversityofSaskatchewanÕsBehaviouralResearchEthicsBoard(#14Ð141)andlocallybytheCommunityAdvisoryResearchCommittee.Writtenandverbalinformedconsentwasobtainedfromallparticipantsinthisresearch.Consentwasnotobtainedfromtheparents/guardiansofminors(undertheageof18)whoparticipatedinthisresearch.Youth16yearsandolderweredeemedabletoconsenttoparticipateforthemselvesandthiswasapprovedbytheUniversityofSaskatchewanÕsBehavioralResearchEthicsBoard.ConsentforpublicationWrittenconsentfromallyouthparticipantswasobtainedfortheuseoftheirphotographsandstories.CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.Thefoundingsponsorshadnoroleinthedesignofthestudy;inthecollection,analyses,orinterpretationofdata;inthewritingofthemanuscript,andinthedecisiontopublishtheresults.Authordetails1DepartmentofCommunityHealthSciences,MaxRadyCollegeofMedicine,UniversityofManitoba,Winnipeg,Manitoba,Canada.2WiyasiwewinMikiwahpNativeLawCentre,CollegeofLaw,UniversityofSaskatchewan,Saskatoon,Canada.Received:11September2019Accepted:2April2020References1.GillT.ThebenefitsofchildrenÕsengagementwithnature:asystematicliteraturereview.ChildrenYouthEnviron.2014;24(2):10Ð34.2.RyanRM,WeinsteinN,BernsteinJ,WarrenBrownK,MistrettaL,GagnŽM.Vitalizingeffectsofbeingoutdoorsandinnature.JofEnvironPsych.2010;30:159Ð68.3.LeeAC,MaheswaranR.Thehealthbenefitsofurbangreenspaces:areviewoftheevidence.JPublicHealth.2011;33(2):212Ð22.4.MallerC,TownsendM,PryorA,BrownP,StLegerL.Healthynaturehealthypeople:contactwithnatureÕasanupstreamhealthpromotioninterventionforpopulations.HealthPromotInt.2006;21(1):45Ð54.5.ShanahanDF,LinBB,BushR,GastonKJ,DeanJH,BarberE,FullerRA.Towardimprovedpublichealthoutcomesfromurbannature.AmJPublicHealth.2015;105(3):470Ð7.6.SeymourV.ThehumanÐnaturerelationshipanditsimpactonhealth:acriticalreview.FrontPublicHealth.2016;4(260):1Ð12.7.WhiteMP,AlcockI,WheelerBW,DepledgeMH.Wouldyoubehappierlivinginagreenerurbanarea?Afixed-effectsanalysisofpaneldata.PsycholSci.2013;24(6):920Ð8.8.WoodL,HooperP,FosterS,BullF.Publicgreens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Change and Stability in WellbeingPSYC 205MARCH 1, 2023
Outline1.Diverse perspectives on mental health well-being2.Individual trajectories of mental health and well-being•Daily diary methods•Minority stress theory•Everyday racism3.The importance of Individuation
Diverse perspectives on mental health and well-being
How do you define “well-being”?
Culturally-embedded health and well-being beliefsWestern cultureHaving high self-esteem is a valued goal.You are what you have achieved –you create your own worth rather than receiving it by virtue of birth, position, seniority, or longevity. Your self-esteem comes from what you have done to earn self-esteem.Being happy is a valued goal.Because we are ultimately in control of our lives and destiny, we have no excuse for unhappiness. If you are suffering or unhappy, then just do whatever it takes to be happy again. How might these contrast with other cultures?Peace Corp
Cultural perspectives
Indigenous views on health and well-beingInterview and photovoiceproject with urban Indigenous youth -engagement with and a connection to nature as central to well-being
First Nations Health AuthorityVision: Healthy, Self-Determining and Vibrant BC First Nations Children, Families and CommunitiesHolistic vision of wellnessFirst circle: individual responsibility for health and wellnessSecond circle: facets of a healthy, well, and balancedlifeThird Circle: overarching values that support and uphold wellnessFourth Circle: the people that surround us and the places from which we come are critical components of healthy experienceFifth Circle: social+ determinants of our health and well-beingOuter circle: strong communities –togetherness, respect, relationshipshttps://www.fnha.ca/wellness/wellness-for-first-nations/our-history-our-health
Mental HealthWorld Health Organization Mental health = “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
Mental Health Continuum ModelR2MR modelIt is okay to react to stressful situations
Mental health and Mental illnessyTwo independent dimensionsyMental illness dimensionyMental health dimensionsyThe absence of illness does not necessarily indicate health (growth, satisfaction, etc.) Low mental illnessHigh mental illnessHigh mental healthLow mental health
https://www.utsc.utoronto.ca/projects/flourish/about/New York Times article by Adam Grant in April 2021
Mental Health: Flourishing and Languishing Emotional well-beingHow oftenin the past month did you feel …1. happy?2. interested in life?3. satisfied with your life? Positive functioningHow often during the past month did you feel …4. that you had something important to contribute to society? (social contribution)5. that you belonged to a community (like a social group, your neighbourhood, your city, your school)? (social integration)6. that our society is becoming a better place for people like you? (social growth)7. that people are basically good? (social acceptance)8. that the way our society works makes sense to you? (social coherence)9. that you liked most parts of your personality? (self-acceptance)10. good at managing the responsibilities of your daily life? (environmental mastery)11. that you had warm and trusting relationships with others? (positive relationship with others)12. that you had experiences that challenged you to grow and become a better person? (personal growth)13. confident to think or express your own ideas and opinions? (autonomy)14. that your life has a sense of direction or meaning to it? (purpose in life)Keyes, 2002
Positive psychology What allows people and communities to thrive and live meaningful and fulfilling lives•Martin Seligman5 C’s of positive youth development (Richard Lerner)CaringCompetenceCharacterConnection Confidence AutonomyRelatedness CompetenceSelf-Determination Theory (Deciand Ryan)
Definitions of Well-being
Diverse perspectives neededWe need diverse psychologies -Indigenous psychologies, psychologies from the perspectives of non-Western cultures, racialized individuals, people with disabilities, sexual minorities, etc.Understanding subjectivitiesVariation in what is considered to indicate “well-being”¾Reclaim holistic perspectives that include emphasis on land, spiritual beliefs, cultural practices, language, and communityDifferentiation –that shared understanding of differences
Diverse perspectives neededThe qualities that are considered normal, valued, desirable are relative; They are constructed within each society; Nothing in psychology is value-neutralWho gets to decide what is “healthy”? oIn Western societies, qualities that are valued tend towards majority members (e.g., white, middle class, heterosexual men…)oNegative impact on those who don’t belong to the majority
Diverse perspectives needed¾Sometimes values about well-being are imposed on others ¾Leads to judgments, assumptions, etc.¾Negatively affects the well-being of others ¾Diagnosis as a tool for social control and management of individuals’ conduct (Foucault, 1976)¾Psychology’s history is to “pathologize” difference; deficit models
Stella Young “I am not your inspiration”Social model of disability Example of how otherpeople’s constructions and assumptions about what it is like to live with a disability –even when it’s a pseudo-positive construction –is detrimental to well-being
Intra-individual trajectories of mental health and well-being
Trajectories of mental health and well-beingDynamic not static How much variation is there withina person over time?What explains fluctuations in well-being?Is variation in one area related to variation in another?◦e.g., sleep and mood◦e.g., discrimination and well-being
Intra-individual variability Daily diary methodology also referred to as experiencesamplingmethod (ESM) or ecological momentary assessment (EMA)
Daily diary study of support received from partner for chronic painDaily Well beingpositive affectnegative affectrelational conflictssatisfaction with received helpDaily Need Satisfaction/FrustrationIn relationship with my partner today…I could freely take decisionsI was confident that I could do things rightI felt that partner cared about me…I felt like a failure by the mistakes I madeDaily autonomous versus controlled motivations for helping8 reasons for supporting partner that day -for example:-Because my partner demanded it of me-Because I would feel guilty if I didn’t help-Because I think it’s important to help my partner-Because I enjoy helping my partnerN = 70 couples in the NetherlandsAverage age ~55 years oldCompleted daily diaries every evening for 14 daysLong-term relationships Kindtet al., 2016
Daily diary study of support received from partner for chronic painPartners’ daily helping motivation related to changes in ICP well-beingDaily variations in autonomous help motivations (P)Daily psychological well-being (ICP)Changes in daily Need Satisfaction (ICP)Daily Well beingIncreased positive affectIncreased satisfaction with received helpDecreased negative affectDecreased relational conflictsKindtet al., 2016“support effectiveness may depend on the extent to which it nurtures or thwarts universal psychological needs for autonomy, competence, and relatedness”
Daily exposure to negative campaign messages and same-sex couples’ well-beingDaily exposure to campaign messages against same-sex marriage (e.g., commercials, billboards, yard signs, social media posts, etc.)Daily psychological and relational well-being of couples (affect, conflict)Frost & Fingerhut, 201610 daily diary reports during the month before an electionFour U.S. states that had same-sex marriage voter initiatives in the 2012 general electionDevaluing social discourse the precedes policy decisions can be damagingRights of minority groups subjected to referendums-immigrant rights in Europe-voter rights acts -the availability of cultural studies programs in schools, CRT curriculum -Affirming care for trans youth
Minority Stress FrameworkGreater exposure to social stress due to stigmatized social status as explanation for health disparities (higher rate of mental and physical health problems among sexual minorities compared to heterosexual peers)Minority Stressors◦Expectations of rejection◦Concealment of stigmatized identity◦Internalization of negative social beliefs◦Experiences of rejection, discrimination (e.g., ban on same-sex marriage)Stressors are unique, chronic, and socially-based (social processes, institutions and structures) Frost & Fingerhut, 2016Hostile everyday environment
Cissexism and daily stress for transgender and gender diverse peoplePuckett et al., 2021Application of the Minority Stress Framework to Transgender and Gender Diverse (TGD) peopleN = 181 TGD people reported on stressors they encountered on a daily basis for 56 days88 trans men34 trans women17 genderqueer individuals42 non-binary individuals Ages 16 –40 (average = 25.6)85% whiteMarginalization stress –centres the marginalization that minorities experience rather than simply having a minority identity(consider parallels with social model of disability)
Cissexism and daily stress for transgender and gender diverse peoplePuckett et al., 2021Application of the Minority Stress Framework (Marginalization Stress) to Transgender and Gender Diverse (TGD) peopleChecklist of 15 marginalization stressors (Table 2) such asVerbally insulted or threatenedSomeone asked you invasive questions Someone stereotyped or made assumptions about youOther people acted as if they were uncomfortable with youOthers minimized that transphobia exists“Were there any other experiences where you felt like you were treated differently or where you felt like you encountered stigma related to being trans or gender nonconforming?”
Cissexism and daily stress for transgender and gender diverse peoplePuckett et al., 2021Structural and Cultural Stigma•Political oppression•Enforcement of gender binary (e.g., forms)Enacted stigma •Violence and harassment•Rejection•Negative experiences in medical care•Non-affirmation (e.g., misgendered) Felt Stigma•Vicarious stress (e.g., media portrayals of oppressive experiences)•Bodily vigilance (e.g., alertness for how others are perceiving gender)Infrequent themes•Minimization of transphobia•Personal discomfort with one’s body•Invasive questionsExamples of themes
Everyday Racism –Racial MicroaggressionsMicro-aggressions (Williams, 2020)¾Covert form of racism based in pathological stereotypes about groups¾Linked to medical and psychological problems¾Often invisible to others (similar to the stressors in the Minority Stress Framework)¾Being questioned/disbelieved adds further injury to already damaging experience ¾Any individual microaggressionis but one piece in a larger pattern of oppression¾Need to educate oneself about racial microaggressions, not rely on IBPOC to teach
Everyday Racism –Racial MicroaggressionsAdapted from: Wing et al., (2007). Racial Microaggressionsin Everyday Life: Implications for Clinical Practice. American Psychologist, 62, 4, 271-286 …“microaggressionsare context dependent (Sue et al., 2007), and so they cannot be defined simply on the basis of the exact behavior performed or the precise words in a given sentence” (Williams, 2020)
Everyday Racism –Racial MicroaggressionsAdapted from: Wing et al., (2007). Racial Microaggressionsin Everyday Life: Implications for Clinical Practice. American Psychologist, 62, 4, 271-286
Living in a diverse world
Living in a diverse worldIndividuation –seeing beyond labels◦How can we better see others as individuals, independent of social categories (race/ethnicity, gender, ability, size, age, etc.)Need to better understand the experiences people go through that are not visible to others from the outside◦How can we develop a better understanding of the experiences of people whose lives are different from our own?◦the ways in which society marginalizes, objectifies, or “others” difference◦the everyday stressors experienced, which may be less visible to others
Importance of relationships, curiosity, openness •Self-reflectionLearn about self•Perspective takingLearn about othersMore able to recognize implicit biases, stereotypesIndividuation “Visibility is key… Familiarity is the gateway drug to empathy”iOTillettWright
ON NEURODIVERSITY: OR, HOW TO HELP PEOPLE WITHOUT CALLING THEM BROKEN Patrick Dwyer, August 18, 2018, Autistic Scholar Blog. The Pathology Paradigm Most of us have a basic idea of how psychological interventions work. The ÒdisorderedÓ person has a deficit, a deficiency. We intervene to eliminate or reduce the deficit, improving the ÒdisorderedÓ personÕs ability to function in the world. Ultimately, we want to eliminate the ÒdisorderÓ entirely if possible. ItÕs neat and logical. We can refer to this set of ideas and assumptions as the pathology paradigm (see Walker, 2013). ThereÕs also a number of serious problems with this paradigm. For example, we know that many autistic people are already experiencing terrible mental health challenges: depression, anxiety, eating disorders, and more. We also know that autism is a pervasive type of neurodevelopment, shaping multiple aspects of the person. Where does the person end and where does their autism begin? ItÕs not clear that we can separate the two. This pervasiveness is precisely why we used to refer to autism as Òpervasive developmental disorder.Ó So, to recap, we have three facts. One: autistic people can have mental health challenges. Two: autism is a fundamental and pervasive part of a person. Three: in the pathology paradigm, autism is also considered a deficit that needs to be corrected. Thus, in the traditional pathology paradigm, weÕre effectively going around telling a population of people with poor self-esteem and a high risk of depression that thereÕs something fundamentally wrong with them. Implying that
someone is fundamentally flawed as a person, and behaving accordingly, is not necessarily a good way of protecting their self-esteem. This is one of the many reasons why many autistic people have raised serious concerns about the pathology paradigm and the project of normalizing autistic people. For example, Damian Milton (2012) seems to be expressing this fear in the statement that Òattempts to normalise people through behaviourist means or any other, would send them into disequilibrium and a state of personal anomie and possibly rather than leading someone away from mental ill-health, be actually leading someone toward it.Ó Indeed, in the foundational essay ÒDonÕt Mourn for UsÓ by Jim Sinclair (1993), which arguably started the autistic advocacy movement, we hear deep concern about the impact of the drive for normalization on the well-being of the autistic person: ÒYou didnÕt lose a child to autism. You lost a child because the child you waited for never came into existence. That isnÕt the fault of the autistic child who does exist, and it shouldnÕt be our burden. We need and deserve families who can see us and value us for ourselves, not families whose vision of us is obscured by the ghosts of children who never lived. Grieve if you must, for your own lost dreams. But donÕt mourn for us. We are alive. We are real. And weÕre here waiting for you.Ó Now, if you are someone who has been trained and taught within the assumptions and practices of the pathology paradigm, you might not see where weÕre going with this. Yes, you can probably accept the idea that calling someone disordered and deficient could be bad for mental health, but you might be confused about what we are supposed to do instead. Are we really supposed to just stop trying to intervene to change people? Are we supposed to simply ignore the fact that autistic people often do lack important skills? Are we supposed to do nothing to teach these skills? Of course not! ThatÕs not the point at all, and IÕll get to that later. But first, let us consider what the pathology paradigm tells us to do.
LetÕs take a simple example. LetÕs put ourselves into the role of a clinician or professional. An autistic teen Ð letÕs say that theyÕre a she, and that her name is Sally Ð has been struggling with the social dynamics of her school. SheÕs extremely interested in science fiction and biology, but her attempts to engage classmates in discussion of these topics have failed. Sally has been unable to make friends, and some of her peers bully her. SheÕs extremely lonely, and her mental health is slipping. Now, letÕs take the pathology paradigm to its logical conclusion. Sally has a deficit in her social skills. Sally must be fixed Ð she must be made normal. We must get rid of SallyÕs unusual interests, for they impair her social functioning. We must teach her better social skills. We must make her into a copy of her peers, allowing her to gain social acceptance by giving up that which makes her unique Ð that which makes her ÒSally.Ó Hopefully youÕre cringing by now. You might also be calling, ÒStraw man!Ó You might be saying that IÕm not actually representing the position of most adherents of the pathology paradigm. ThatÕs technically true, but I have accurately represented the pathology paradigm itself. Paradigm Shift Yet it is true that most advocates of the pathology paradigm wonÕt really go to these extremes. Those with any critical thinking skills Ð or even common sense Ð will recognize that the situation is much more complex than the pathology paradigm dictates. SallyÕs unusual interests might be sources of strength someday Ð and more to the point, she enjoys them. If the professional or clinician knows their stuff, theyÕll try to find a venue where Sally can find others interested in the same topics Ð a school club, or a group she could attend outside of school. Furthermore, the school could implement a peer-mediated intervention to encourage SallyÕs peers to accept her for who she is, and the school could punish SallyÕs classmates when they bully her. A competent clinician or professional might still want to work to protect SallyÕs
mental health and might want to work to teach Sally some skills she could use to help navigate social situations and protect herself from bullying, and but thatÕs it. Yet nothing in the pathology paradigm provides for the idea of a peer-mediated intervention, where we actually intervene on the ÒnormativeÓ neurotypical children and train them to be more accepting of the ÒdeficientÓ children. The idea that an unusual interest that impairs Sally in one context could be a source of strength in another context also sits uneasily within the pathology paradigm. So what happened to the pathology paradigm? Do its own adherents no longer believe in it? Well, letÕs consider how paradigms work. The term ÒparadigmÓ as IÕm using it here comes from the work of Kuhn (1962/2012), a philosopher of the ÒhardÓ sciences. He noticed how scientists would often spend ages stuck with one set of fundamental assumptions and ideas that they used to understand the world. We can refer to these assumptions and ideas as a paradigm. Scientists would base their entire work on these fundamental assumptions, but over time, ÒanomaliesÓ would pile up Ð problems that the paradigm couldnÕt explain away properly. One classic example of this is the Copernican Revolution and the shift from a geocentric paradigm of the solar system (with Earth at the centre of the universe) to a heliocentric paradigm (with the sun at the centre). From the perspective of an observer on Earth, the planets sometimes seem to slow down or even travel backwards. ThatÕs because the planets donÕt orbit the Earth; both Earth and the other planets orbit the sun. This Òretrograde motionÓ was a serious anomaly for the geocentric paradigm. To explain away the anomaly, astronomers added little sub-orbits called epicycles, so that the planets were rotating in little circles (sometimes taking them backwards) even as they circled around the Earth in a big circle. As astronomers made more and more precise observations of the sky, they just had to keep adding more and more epicycles to cope. Finally, as the geocentric system became increasingly complex and untenable, the anomalies built up to the point
that the paradigm was in crisis. Then Copernicus came along and suggested that maybe the Earth wasnÕt at the centre of the universe after all. Instead, he proposed the heliocentric paradigm. This wasnÕt an entirely new idea, but because the geocentric paradigm was now in crisis, astronomers eventually switched over to the new system and changed their fundamental assumptions about the nature of reality.[1] This was a paradigm shift. In the field of neurodevelopment today, weÕre already in the middle of a paradigm shift. The pathology paradigm is now being used in an inconsistent, illogical way as clinicians, professionals, and researchers try desperately to paper over the anomalies that run deeply through it. For example: ¥ While clinicians still cling to the stigmatizing language which grounds all ÒdeficitÓ and ÒdisorderÓ within the atypical individual and not their context, many or most nevertheless recognize that it sometimes makes as much or more sense to intervene to change the context as it does to change the autistic child. ¥ While many researchers still pursue biomedical research into the causes of autism, hoping that their discoveries will allow for the ÒcuringÓ of the ÒdisorderÓ, most researchers recognize that many cases of autism are idiopathic, lacking in a clear causal origin, and that ÒcuringÓ or eliminating these cases will be impossible. ¥ While many clinicians try to treat their autistic clients, they might struggle to balance the pathology paradigmÕs demand for elimination of the autistic personÕs atypical behaviour with the cliniciansÕ need to protect their clientsÕ mental health and well-being by showing them positive regard. If we cared to, we could easily identify many other examples. The pathology paradigm is in crisis: it is collapsing as we speak. The paradigm is ridden with anomalies, and the behaviour of those who still try to embrace it is filled with contradictions. As many people have pointed out, nobodyÕs normal. Furthermore, the thought of living in a world where everyone is precisely normal is actually rather horrifying.
ItÕs time to find a new paradigm. WeÕll discuss that in Part II. Footnotes [1] If we want to be really technical, CopernicusÕ system didnÕt actually eliminate epicycles, at least not at first. ThatÕs because he wanted the planets to have perfectly circular orbits, but they really have slightly ovoid or elliptical orbits. It was another guy Ð Kepler Ð who said that the orbits are elliptical. That was what really showed that the heliocentric system made more sense than the anomaly-ridden geocentric model. References Kuhn, T. S. (2012). The structure of scientific revolutions (50th anniv. ed.). Chicago: The University of Chicago Press. [Original work published 1962] Milton, D. E. M., & Moon, L. (2012). The normalisation agenda and the psycho-emotional disablement of autistic people. Autonomy, the Critical Journal of Interdisciplinary Autism Studies, 1: 1. Retrieved from http://www.larry-arnold.net/Autonomy/index.php/autonomy/article/view/9 Sinclair, J. (1993). DonÕt mourn for us. Retrieved from http://www.autreat.com/dont_mourn.html Walker, N. (2013, August 16). Throw away the masterÕs tools: Liberating ourselves from the pathology paradigm [Blog post]. Neurocosmopolitanism: Nick WalkerÕs notes on neurodiversity, autism, and cognitive liberation. Retrieved from http://neurocosmopolitanism.com/throw-away-the-masters-tools-liberating-ourselves-from-the-pathology-paradigm/ The Neurodiversity Paradigm
In Part I of this post, we discussed how the pathology paradigm (Walker, 2013) is failing under the weight of the anomalies that beset it. We concluded that it was time to find a new paradigm. The emerging rival to the pathology paradigm is the neurodiversity paradigm. Judy Singer (1998/2016), who is generally accepted to have coined the term Òneurodiversity,Ó asked: ÒWhy not appropriate metaphors based on biodiversity, for instance, to advance the causes of people with disabilities? Why not propose that just as biodiversity is essential for system stability, so neurodiversity may be essential for cultural stability? Why not strategically argue that the nurturing of neurodiversity gives society a repository of types who may come into their own under unforseeable circumstancesÉÓ Thus, the term ÒneurodiversityÓ itself refers to the diversity of human brains and minds, while the paradigm of neurodiversity starts with the assumption that there is value in this human neurodiversity. Deviation from what is ÒnormalÓ or ÒnormativeÓ is not bad, but good. For further details on this terminology, I would refer to Nick WalkerÕs blog post on the subject. Many people in the autism field still resist the neurodiversity paradigm. Why? Well, there are several reasons. Partly, itÕs simply because of tradition and custom. Believe it or not, academics can be absurdly conservative at times, at least in the more scientific fields. We have dogmatic stylistic guidelines, inflexible peer-review processes, and rigid customs and conventions. In scientific fields, something as simple as a minor change of terminology, let alone a change of paradigm, can be a big deal! However, thereÕs also a lack of clarity about what, exactly, the neurodiversity paradigm is. ItÕs a new way of looking at the world, and it means different things to different people.[1]
ThereÕs a lot of fear about the paradigm as well. LetÕs imagine a child Ð weÕll call him James, say Ð who displays a severe self-injurious behaviour: banging his head into the wall. James parentsÕ could easily look at the pathology paradigm and hear, ÒWe will change James so that he stops injuring himself.Ó Then, if they looked at the neurodiversity paradigm, they might hear, ÒJames is valuable just as he is, and doesnÕt need to change.Ó Naturally, theyÕd be horrified by the implication that he should go on banging his head undisturbed. Indeed, if we took the neurodiversity paradigm to a ridiculous extreme Ð if we said that all human neurodiversity was both good and sacrosanct Ð then I admit we would be in quite a mess. Perhaps an even worse mess than if we followed the pathology paradigm to its extremes. LetÕs think back to Sally, trying to cope with peer rejection and victimization in her school. If we said that all mental variation was sacrosanct, not only would we be unable to ever do any sort of intervention to teach Sally skills that could help her protect herself from bullies, but we would arguably be unable to restrain the behaviour of SallyÕs bullies, because that would be changing the bullies. For that matter, we wouldnÕt even be able to teach Sally or her peers in school at all, because teaching them subjects like math and English would technically be changing their minds! Clearly, when we say that neurodiversity is valuable, that the diversity of brains and minds is valuable, we have something very different in mind. Now, we could instead say that the neurodiversity paradigm is about fostering and respecting the diversity of brains and minds that make it possible to run a complex, interconnected society like our own Ð thus excluding any variation deemed valueless to society (like bullying, poor English, or poor math). However, this takes us too far in the opposite direction. Before, our problem was that we couldnÕt change any human mental variation. But if we were to adopt the proposal that the neurodiversity paradigm is about fostering only the neurodiversity that is valuable due to its social contribution, we could find ourselves dealing with the same sorts of problems as the pathology paradigm. If and when we encounter neurodiversity that
does not contribute to society, or appear likely to contribute in the future, it would not be protected, and thus we would risk causing mental health damage to anyone whose neurodivergence we deem valueless. So what is the neurodiversity paradigm, really? (Or rather, what shouldthe neurodiversity paradigm be?) Well, itÕs certainly a rejection of one idea fundamental to the pathology paradigm: that the individual is a problem if they ever fail to live up to some normative ideal. ItÕs a rejection of the idea that peopleÕs differences are always at fault. Instead, the neurodiversity paradigm directs us to consider the individual in their whole context. It invites us to consider interactions between the individual and other individuals around them, or between the individual and the physical spaces around them. It reminds us that sometimes itÕs appropriate to modify those contexts in order to protect the individual. We can teach SallyÕs peers about prosocial behaviour and encourage them to accept her. We can build physical spaces in such a way that they donÕt inflict sensory distress on autistic people. We can conduct functional behaviour assessments to identify and eliminate the environmental causes of challenging behaviours. All of these interventions are fundamentally grounded in the logic of the neurodiversity paradigm, not the pathology paradigm. But how do we modify the individual? There are clearly cases when it is necessary Ð just think of the parents struggling to keep James from banging his head on the wall. Or consider SallyÕs mental health challenges Ð we donÕt want her to be miserable! Well, the neurodiversity paradigm just reminds us that human variation has value. We want a variety of types of people in our society, because that variety enriches society as a whole. But we also donÕt want to make people feel bad for being who they are. This last statement Ð Òfor being who they areÓ Ð is crucial. Some
forms of human variation reflect variation in peopleÕs basic personalities. TheyÕre variation in the things that fundamentally make up a person, that make them who they are. We can rarely change someoneÕs basic personality, and if we try, then remember what we discussed earlier: we risk telling the person that thereÕs something fundamentally wrong with them. Neurodiversity of personality is especially precious to us. ThereÕs also variation in things that are less core to our personalities. Depression, for example, we might imagine as a layer of miserableness grafted on top of someoneÕs fundamental personality. ItÕs definitely okay to try to get rid of depression if we can do it without rejecting the personÕs personality![2] Social skills are skills, and it is okay to try to teach someone skills if we can do it effectively and in a way that doesnÕt demean them.[3] IÕm not sure exactly what self-injurious behaviours are Ð (problematic) coping mechanisms, maybe? Ð but IÕm pretty sure theyÕre not a core part of personality either. So, we have a distinction between two types of neurodiversity Ð personality and non-personality diversity Ð and personality variation generally has much, much more value than non-personality variation. This distinction, though, doesnÕt yet cover everything. Sexual orientation is probably not really a core part of personality, but itÕs something that exists naturally and which canÕt really be altered (not that there is, of course, any reason to attempt to alter it, or any justification for attempting to alter it). Attempting to alter sexual orientation will simply risk causing damage to individualsÕ mental health. Thus, we can distinguish variation that is plastic from variation that is largely static and largely unalterable. More-or-less unalterable mental variation is precious, because interventions to destroy or change it would be futile and harmful. ThereÕs also another dimension, identity, that becomes relevant here. In the modern world, sexual orientation has emerged as part of individual identity, and an assault on identity is perhaps comparable to an assault on personality. Thus, neurodiversity that is a positive part of anyoneÕs identity is precious as well.
Moreover, we have to consider whether mental variation is innate or acquired. If something about a person is present very early in development, thatÕs obviously a very different situation than if it emerges much later on. Schizophrenia, for example, is generally acquired in early adulthood. If a major neurodivergence is acquired late in development, intervening to eliminate it can, in a sense, be said to preserve the individualÕs original personality and identity, to preserve natural human neurodiversity rather than destroy it. Thus, if and when a major, personality-level change is acquired later in life, it shouldnÕt automatically have the protection that we ordinarily give to personality variation, unless the individual accepts the change and absorbs it as a positive part of their identity. But none of this means that all plastic, non-personality, non-identity neurodiversity is worthless. On the contrary. If someone has a unique or special skill, something in which they can take pride, then that obviously has value. There is also a potential for psychological damage if we refuse to accept something about a person that distinguishes them from others, even if itÕs a plastic characteristic thatÕs not a core part of personality or identity. When someone feels unequal to others in some area of skill, continued remedial instruction will most likely highlight this perceived insufficiency, even if the individual does learn the skill in the end. While I said earlier that teaching social skills is okay, done properly, and while I stand by that statement, there can be costs to weigh against the benefits, especially if stigmatizing language is used. Furthermore, it might sometimes be unclear whether some mental characteristic qualifies as plastic or static, personality or non-personality, or identity or non-identity. Consider anxiety: anxiety can sometimes be a response to a negative experience, and it can sometimes be grafted on top of a personÕs underlying personality, but thereÕs also a genuine sense in which some people have more anxious temperaments than others. Therefore, while the distinctions we can draw between personality and non-personality diversity, between identity and non-identity diversity, and between
plastic and static diversity are useful, and while they help us to protect people from being told the essence of who they are is wrong, they are not by themselves sufficient for case-by-case decisions about whether we want to intervene with the goal of changing a person. How do we decide whether or not, in any given case, we should intervene with the intention of changing something about a person? Well, hereÕs one very important thing to keep in mind: the neurodiversity paradigm says that mental variation is valuable. ThatÕs not exactly the same thing as saying that mental variation is sacrosanct. Ultimately, we want people to be happy. We want to protect their mental well-being. This is fundamental. If anything is sacrosanct, it is the principle that we always want to improve mental well-being. The neurodiversity paradigm provides us with an ontology Ð a system of meaning in which to understand the world. It tells us that each individual has a mind, and it tells us that that mind has value. It also tells us that the individual is surrounded by an environment, a context, which includes both physical structures and other individuals with their own minds Ð and all of those minds have value too. It tells us that some things about these minds have great value, because they are core to personality, or identity, or because they arenÕt changeable, while others have less value. Now, what if someone is not mentally well? What if someone is suffering, or if someone is likely to be suffering in the future if nothing is done?[4] What if someone is encountering a barrier that will cause distress, or if they are likely to encounter such a barrier in the future?[5] Our core goal, remember, is to protect mental well-being. What do we do? Well, we have to consider the whole system. We arenÕt in the pathology paradigm Ð the knee-jerk attempt to fix the individual is not always the correct response.
¥ Sometimes, the best course of action will be to modify the physical environment, or to modify other individuals around the individual whose mental well-being is at risk. All else being equal, at least when one is dealing with innate rather than acquired mental variation, environmental modification is preferable to an intervention aimed at changing the person, because this environmental modification carries with it much less risk of conveying the message that a specific individual is somehow deficient, somehow to blame for their own distress and the barriers that afflict them. ¥ But sometimes, the best course of action will be to modify the individual themselves: to change plastic aspects of the individual that are not central to the personality and identity, such as by teaching a skill.[6] Any potential negative impact on well-being from the intervention can be balanced against the potential positive impact after the individual learns the skill (a positive impact which could include both the direct benefit of the skill and the indirect benefit, to mental health and self-confidence, of knowing that one has the skill). Thus, the neurodiversity paradigm is still fully compatible with interventions aimed at changing the person. Crucially, there is no need to mention ÒdisorderÓ or ÒdeficitÓ in this process. We can still identify groups of people like autistics, ADHD people,[7] and neurotypical people.[8] Individuals exhibit behaviours. Some of these behaviours can be described as Òautistic.Ó The neurotype we might call ÒAutistic Spectrum DevelopmentÓ does not need to be described any differently than ÒTypical DevelopmentÓ or any other pattern of development. We can use language that places all of us on a footing of equality, thereby helping us to confront the stigma that, today, threatens those most vulnerable among us. We should never use harmful or demeaning language. At the same time, we can recognize that some of these neurotypes are disabilities that are likely to be associated with barriers within many contexts. We donÕt blame the neurotype and we donÕt blame the context, but we acknowledge the poor fit that creates the barriers and disables the individuals. This justifies giving people with these neurotypes Ð autistic people, ADHD people, etc. Ð access to particular services and supports that they may need.
Other neurotypes might not be associated with barriers, but they might still be associated with distress, and this too will require eligibility for some sort of services. We intervene to improve the fit of the environment and the person, and our intervention can target the environment or the person. ThereÕs no need to label the individual ÒdeficientÓ in the process. We simply say that the individual and their environment donÕt fit well together. This approach not only helps to protect mental health and self-esteem, but it also allows for greater precision in intervention decisions. It helps us hone in on whatever strategy will be most effective in promoting well-being, where today we still have the knee-jerk response of intervening on individual Òdeficits.Ó Yes, the pathology paradigm is in crisis, and yes, people often ignore it, but we usually donÕt start ignoring it until its failure in some given area has become blatantly obvious. We probably still devote too many resources towards intervening to change individuals and not enough towards changing environments. I recently saw a review paper (Scott et al., 2018) reporting that lots of the published research on employment interventions for autistic people is about skills training, not things like job coaching or help with the job search process. Actual employment status wasnÕt even an outcome in the majority of studies Ð most of them examined changes in vocational skills. This is a case where the pathology paradigm has guided the research agenda towards intervening on the individual with the aim of reducing individual Òdeficits,Ó even though the most effective strategy in the circumstances will probably be something like job coaching. (At a trend level, job skills training in high school actually predicts lower odds of employment; Carter et al., 2012.) The neurodiversity paradigm would direct us away from the knee-jerk attempt to correct deficits and towards considering the interaction of the prospective employee and the surrounding social contexts of the job search and the workplace, which would guide us towards more effective interventions like job coaching. Beyond the Clinic
So far, weÕve mainly considered how the neurodiversity paradigm applies to clinicians: how it applies to diagnosis, intervention, etc. However, another advantage of the neurodiversity paradigm is that it allows us to look at neurotypes as something more than pathologies. Traditionally, research has tended to be about characterizing the ÒdeficitsÓ of people with a given neurotype, or judging whether a given intervention can reduce these Òdeficits.Ó This type of research is still possible within the neurodiversity paradigm (albeit with a modified, less stigmatizing jargon): we can characterize the behaviours or biology associated with a given neurotype, and of course we want to know as much as possible about the relative effectiveness of different interventions. But with the neurodiversity paradigm, we can also ask many other questions. Nick WalkerÕs definition of the neurodiversity paradigm includes three principles, two of which weÕve already covered: (1) that human neurodiversity is valuable, and (2) that there is no normative or ÒrightÓ style of neurocognitive functioning. We discussed how human neurodiversity is valuable and weÕve discussed how itÕs inappropriate to make some a priori judgement that somebodyÕs neurotype is better than somebody elseÕs. However, we havenÕt talked about the third principle, which is: ÒThe social dynamics that manifest in regard to neurodiversity are similar to the social dynamics that manifest in regard to other forms of human diversity (e.g., diversity of ethnicity, gender, or culture). These dynamics include the dynamics of social power inequalities, and also the dynamics by which diversity, when embraced, acts as a source of creative potential.Ó When we study ethnicity, gender, and culture, we can ask a bunch of interesting questions. How has a given ethnicity, gender, or culture oppressed another? What are the negative effects of inequality between genders and ethnicities? What sort of biases might people of one ethnicity or gender have against another? How do cultures construct gender and ethnicity? How do different cultures permit different views of the world? And so forth.
We can ask similar questions about human neurodiversity. How have people of different neurotypes interacted with one another, and how have some neurotypes been subjected to oppression? What are the effects of inequality between neurotypes? What sort of biases do we have against certain neurotypes, and what are the effects of this ableism? How does culture construct neurotypes and neurodiversity? How do different neurotypes permit different views of the world? And so forth. Thus, instead of solely permitting the use of the clinical lens to investigate mental and brain variation, the neurodiversity paradigm moves human neurodiversity into the social sciences: we can apply the clinical lens, in modified form, but we can also do much more. Neurodiversity Applies to Everyone Many people (e.g., Jaarsma & Wellin, 2012) have suggested that the neurodiversity paradigm only makes sense when applied to so-called Òhigh-functioningÓ autistics: those with average or superior cognitive abilities. This response would preserve the pathology paradigm for all dealings with Òlow-functioningÓ autistics. However, the neurodiversity paradigm as I have defined it here is a paradigm in the truest sense of the word. It is intended as a bedrock on which we can construct an approach to human variation: not only to autistic variation, but all human mental variation, all human neurodiversity. It is certainly not intended as an approach which is only to be applied to one group of autistics Ð those with IQs over 70 Ð and not to others. Earlier, we discussed the case of James, an autistic child engaging in a severe self-injurious behaviour: banging his head on the wall. In the neurodiversity paradigm IÕve laid out, thereÕs nothing stopping JamesÕ parents from working to put a stop to this behaviour in the most effective way possible, regardless of whether that happens to involve intervening to change James or his environment or both,
because the self-injurious behaviour is undoubtedly detrimental to JamesÕ well-being. We could also imagine that James doesnÕt have spoken language. Again, thereÕs nothing in the neurodiversity paradigm to stop people from teaching James language. Speaking language is a skill, and a very useful one. Everyone who knows a language learns it at some point; some people just need more help than others. I think someoneÕs lack of language will rarely be part of their identity, let alone their personality. However, if one intervened to teach spoken language to James, thereÕs a need to be sensitive and not cause distress to James by sending the message that he is deficient without spoken language. Systematically engaging a child in fun interactions is an excellent way to teach spoken language: we might not have to make a big production of it. Furthermore, itÕs possible that James will do better with augmentative & alternative communication (AAC) than with an outright attempt to teach speech. Again, the neurodiversity paradigm copes very well with this: use of AAC is not exactly ÒnormativeÓ behaviour (and it thus sits uneasily with the pathology paradigm), but it would promote JamesÕ mental well-being by helping him to communicate his wants and needs. On the other hand, our application of the neurodiversity paradigm can warn us when we shouldnÕt be intervening to change James. LetÕs imagine that a functional behaviour assessment shows that JamesÕ self-injurious behaviours are related to something in his environmental context. Well, in that case, the path forwards is clear: we change the environment, not James. Similarly, letÕs imagine that James stims, but without injuring himself. Well, if we apply the pathology paradigm, stimming is abnormal and deviant and it probably impairs something-or-other, so we have to get rid of it. If we apply the neurodiversity paradigm, weÕll probably see that it enhances JamesÕ mental well-being, and at the very least isnÕt harmful, so weÕll know to leave it alone.[9]
Thus, there is no sense in which the neurodiversity paradigm Ð at least as IÕve described it here Ð can be said to apply to only one group. ItÕs not a crude, inflexible dictum that we can never intervene to change any form of mental variation. ItÕs a paradigm and an ontology, which does nothing more than give us an organizing framework that helps us protect peopleÕs well-being in a way that the crude pathology paradigm does not. ItÕs a way of moving us away from the stigmatizing language of ÒdeficitÓ and Òdisorder,Ó a way of forcing us to avoid judging some people inferior and to instead see the value inherent in our neurodiversity, and a way of forcing us to carefully consider and choose the best ways of intervening when we must protect peopleÕs well-being. Footnotes [1] If you think back to the footnote in Part I, our current uncertainty about the neurodiversity paradigmÕs meaning is sort of like how the nature of the heliocentric model was unclear before Kepler came along and said that orbits were elliptical. Indeed, the paradigm shift between when Copernicus revived the heliocentric model and when Kepler showed that orbits were elliptical was an extremely messy and confusing time. There were strange hybrid systems and everything. [2] And, as discussed earlier at some length, it can be rather self-defeating to try to get rid of someoneÕs depression by rejecting them as a person. [3] As a quick aside, I feel the need to remind everyone that teaching social skills effectively requires real-world practice, not just worksheets and role-play. [4] Note that we can accommodate things like severe antisocial conduct within this paradigm, because even if the individual behaving antisocially does not suffer (which is disputable in many cases), distress can be inflicted on other people around them. This is not intended solely as a framework for autism: the intention is that antisocial conduct, and anything else, should be accommodated within it.
When we weigh the well-being of different individuals against one another, I would suggest something sounding a little like John RawlsÕ ÒDifference PrincipleÓ be used: we want the least mentally well among us to be as mentally well as possible. We particularly want to minimize the distress of the most distressed. We donÕt just want to minimize average distress. [5] Note that I am not convinced that including ÒimpairmentÓ as a justification for intervention in itself is appropriate: it seems to me that an ÒimpairmentÓ is only a problem if it is inflicting distress now or can reasonably be expected to inflict distress in the future. Furthermore, I do not believe it is appropriate to judge that an ÒimpairmentÓ exists within the individual: I prefer to consider that there is a ÒbarrierÓ created when the interaction between the characteristics of the individual and their context frustrates the individualÕs attempts to achieve goals. This barrier, it can be presumed, will lead to distress. Thus, we can identify neurodivergences like autism, but not as impairments: as forms of development and neurodiversity that are likely to lead to barriers within many contemporary contexts, and which therefore count as disabilities. [6] I suppose there could be some cases when attempting to alter an individualÕs fundamental personality and identity may be the best way of protecting their well-being, but I donÕt imagine those circumstances being common. [7] Except that ADHD stands for ÒAttention-Deficit/Hyperactivity Disorder,Ó which is a stigmatizing deficit-language term. ADHD may well be associated with barriers in most contexts, but remember, we are going to decide whether or not to intervene to alter the person by considering the best way of promoting well-being. We can still prescribe Ritalin if it promotes well-being, but we donÕt make the a priori judgement that the correct course of action is always normalizing the ÒdisorderedÓ person. Thus, instead of using the deficit-language term ÒADHDÓ, we could use a neutral phrase like ÒAtypical Attention-Regulation Development.Ó
[8] ItÕs a little-known but important fact that the concept of a ÒneurotypicalÓ person was invented by autistic advocates. Before, we hadnÕt really considered ÒneurotypicalÓ people to be a neurotype in their own right. Traditional research just compared diagnosed people with ÒdeficitsÓ to ÒnormalÓ or ÒhealthyÓ controls. [9] ThereÕs always subtleties, though. While a stimming individual with a very visible disability might not experience too many negative reactions from strangers, a stimming individual with a more invisible disability might get negative reactions more often, and it might not be immediately practically feasible to ensure that every person who might ever encounter a stimming autistic would immediately and unjudgementally accept the stimming behaviour. Thus, some people may wish to substitute a more socially acceptable behaviour, like squeezing a stress ball, in some public contexts. References Carter, E. W., Austin, D., & Trainor, A. A. (2012). Predictors of postschool employment outcomes for young adults with severe disabilities. Journal of Disability Policy Studies, 23(1), 50Ð63. https://doi.org/10.1177/1044207311414680 Jaarsma, P., & Welin, S. (2012). Autism as a natural human variation: Reflections on the claims of the neurodiversity movement. Health Care Analysis, 20(1), 20Ð30. https://doi.org/10.1007/s10728-011-0169-9 Singer, J. (2016). NeuroDiversity: The birth of an idea. Kindle edition. Original work published 1998 Scott, M., Milbourn, B., Falkmer, M., Black, M., Bӧlte, S., Halladay, A., É Girdler, S. (2018). Factors impacting employment for people with autism spectrum disorder: A scoping review. Autism. Advance online publication. https://doi.org/10.1177/1362361318787789
Walker, N. (2013, August 16). Throw away the masterÕs tools: Liberating ourselves from the pathology paradigm [Blog post]. Neurocosmopolitanism: Nick WalkerÕs notes on neurodiversity, autism, and cognitive liberation. Retrieved from http://neurocosmopolitanism.com/throw-away-the-masters-tools-liberating-ourselves-from-the-pathology-paradigm/ Walker, N. (2014, September 27). Neurodiversity: Some basic terms and definitions [Blog post]. Neurocosmopolitanism: Nick WalkerÕs notes on neurodiversity, autism, and cognitive liberation. Retrieved from http://neurocosmopolitanism.com/neurodiversity-some-basic-terms-definitions/
GreaterEmotionalEmpathyandProsocialBehaviorinLateLifeJocelynA.SzeUniversityofCalifornia,BerkeleyAnettGyurakStanfordUniversityMadeleineS.GoodkindandRobertW.LevensonUniversityofCalifornia,BerkeleyEmotionalempathyandprosocialbehaviorwereassessedinolder,middle-aged,andyoungadults.Participantswatchedtwofilmsdepictingindividualsinneed,oneupliftingandtheotherdistressing.Physiologicalresponsesweremonitoredduringthefilms,andparticipantsratedtheirlevelsofemotionalempathyfollowingeachfilm.Asameasureofprosocialbehavior,participantsweregivenanadditionalpaymenttheycouldcontributetocharitiessupportingtheindividualsinthefilms.Age-relatedlinearincreaseswerefoundforbothemotionalempathy(self-reportedempathicconcernandcardiacandelectrodermalresponding)andprosocialbehavior(sizeofcontribution)acrossbothfilmsandinself-reportedpersonaldistresstothedistressingfilm.Empathicconcernandcardiacreactivitytobothfilms,alongwithpersonaldistresstothedistressingfilmonly,wereassociatedwithgreaterprosocialbehavior.Empathicconcernpartiallymediatedtheage-relateddifferencesinprosocialbehavior.Resultsarediscussedintermsofourunderstandingbothofadultdevelopmentandofthenatureofthesevitalaspectsofhumanemotion.Keywords:emotionalempathy,prosocialbehavior,emotion,physiologicalresponses,agingOurcapacitytorespondtoothersinneedisanimportantaspectofthehumancondition,helpingusformsocialbonds,facilitatingharmoniousgrouprelations,andenhancingtheÒgreatergoodÓ(Eisenberg&Fabes,1998;Hoffman,2000).Researchershavefocusedprimarilyontworesponsestoothersinneed:emotionalempathy(i.e.,havinganemotionalreactiontotheotherÕsplight)andprosocialbehavior(i.e.,actingtohelpthoseinneed).Emo-tionalempathyandprosocialbehaviorarelinkedconceptuallyandempirically,inthatemotionalempathyisthoughttobeamotivat-ingfactorforsubsequenthelpingbehavior(Batson,1990;Eisen-bergetal.,1989;Krebs,1975;Stocks,Lishner,&Decker,2009).Thesecapacitiesincreaseinearlydevelopment.Ameta-analysisof179studiesconcludedthatolderchildrenexhibitmoreemo-tionalempathyandmoreprosocialbehaviorinresponsetoneedyothersthandoyoungerchildren(Eisenberg&Fabes,1998).How-ever,empiricalstudiesofchangesinemotionalempathyandprosocialbehaviorinadultdevelopmentarerare.Instead,mostresearchhasfocusedoneitherofthefollowing:(a)agedifferencesincognitiveempathy(i.e.,theabilitytorecognizeandinterprettheemotionsofothers),forwhichtherearewell-documenteddeclineswithage(Ruffman,Henry,Livingstone,&Phillips,2008),or(b)agedifferencesintraitempathy,forwhichthereareindicationsofmilddeclinesincognitiveaspectsandrelativestabilityinemo-tionalaspects(Bailey,Henry,&vonHippel,2008;Gru¬hn,Rebu-cal,Diehl,Lumley,&Labouvie-Vief,2008;Schieman&VanGundy,2000).Toaddressthisgap,inthepresentstudyweexaminedemotionalempathyandprosocialbehaviorinasamplerangingfromyoungtoolderadulthood.EmotionalEmpathyEmotionalempathyhasbeendefinedasanemotionalresponseproducedbywitnessinganotherpersoninneedandisthoughttoinvolvebothsubjectiveandphysiologicalcomponents.Thesub-jectivecomponentsincludeempathicconcern,orfeelingsofwarmthandconcerntowardtheother,andpersonaldistress,orfeelingsofdistressanddiscomfort(Batson,Darley,&Coke,1978;Eisenbergetal.,1988).EmpathicconcernandpersonaldistressaresimilarinthattheyarebothmanifestationsofthevicariouslyinducedarousalgeneratedfromapprehensionoftheotherÕsemo-tionalstateorgeneralsituation(Eisenberg&Miller,1987).Theydifferinthatempathicconcernisthoughttorelyonhigher-levelcognitiveprocessessuchasperspectivetaking,whereaspersonaldistressisthoughttorelyonlower-levelprocessessuchasemo-tionalreactivityandcontagion(Eisenberg,2000;Lamm,Batson,&Decety,2007).Alongwithproducingsubjectivearousal,thereisevidencethatwitnessingothersinneedisphysiologicallyactivating.Moststud-ieshavefocusedonelectrodermalandcardiovascularmeasuresasphysiologicalindicesofemotionalempathy(Eisenberg&Fabes,1990;Krebs,1975;Zahn-Waxler,Cole,Welsh,&Fox,1995).Apositiveassociationhasconsistentlybeenfoundbetweenemo-ThisarticlewaspublishedOnlineFirstAugust22,2011.JocelynA.Sze,MadeleineS.Goodkind,andRobertW.Levenson,DepartmentofPsychology,UniversityofCalifornia,Berkeley;AnettGyurak,DepartmentofPsychology,StanfordUniversity.WethankSandyLwiforherhelpindatacollection.ThisresearchwassupportedbyagrantfromtheNationalInstituteofAging(R37-AG017766).CorrespondenceconcerningthisarticleshouldbeaddressedtoRobertW.Levenson,InstituteofPersonalityandSocialResearch,DepartmentofPsychology,UniversityofCalifornia,4143TolmanHall,MC5050,Berke-ley,CA94720-5050.E-mail:boblev@socrates.berkeley.eduEmotion©2011AmericanPsychologicalAssociation2012,Vol.12,No.5,1129Ð11401528-3542/11/$12.00DOI:10.1037/a00250111129
tionalempathyandskinconductance(Blair,1999;Craig&Low-ery,1969;Lanzetta&Englis,1989).Theassociationbetweenemotionalempathyandcardiacactivationhasbeenlessconsistent,withsomestudiesreportingapositiveassociation(Craig&Low-ery,1969;Hastings,Zahn-Waxler,Robinson,Usher,&Bridges,2000;Krebs,1975)andothersreportinganegativeassociation(e.g.,Eisenbergetal.,1989;seeEisenberg&Fabes,1990).Toresolvetheseinconsistencies,researchershaveproposedacurvi-linearrelationshipbetweencardiacactivationandemotionalem-pathy,withheartratedecelerationsoccurringinmildlydistressingsituationscharacterizedbyother-orientedemotionsandheartrateaccelerationsoccurringinhighlydistressingsituations(Eisenberg&Fabes,1990).ProsocialBehaviorProsocialbehaviorhasbeendefinedasvoluntary,intentionalbehaviorthatresultsinbenefitsforanotherindividualorgroup(Eisenberg,1982;Staub,1979).Inlaboratorystudies,prosocialbehavioristypicallymeasuredbybehavioralindicatorsofhelpingorself-reportedintenttohelp(Batson,Fultz,&Schoenrade,1994;Eisenbergetal.,1989;Zahn-Waxleretal.,1995).Prosocialbe-haviorcanbemotivatedbyanumberoffactorsincludingsocialdesirability,taxincentives,andself-enhancement(Eisenbergetal.,1989;Kahneman&Knetsch,1992)aswellasbyemotionalempathy.EmotionalEmpathyandProsocialBehaviorResearchhashighlightedthespecialrolethatemotionalempa-thycanplayinmotivatingprosocialbehavior(Batson,1987;Coke,Batson,&McDavis,1978;Eisenberg,2003;Eisenbergetal.,1989;Eisenberg,Fabes,Nyman,Bernzweig,&Pinuelas,1994;Eisenberg&Miller,1987;Toi&Batson,1982).Oneexplanationofthismotivationemphasizesemotionregulation;actingonbehalfofaneedyotherreducesthearousalinducedbyexperiencingthatpersoninneed(Schaller&Cialdini,1988).Anotherviewempha-sizescalibration,withpeopleusingtheirlevelofemotionalem-pathytoinfertheseverityoftheotherpersonÕssituationandthedegreetowhichtheyvaluethatpersonÕswelfare,whichinturninfluencestheirdecisionastowhetherornottohelp(Batsonetal.,1989;Baumann,Cialdini,&Kenrick,1985;Krebs,1975;Toi&Batson,1982).EmotionalDevelopmentinAdulthoodSeveralprominenttheoriesofadultdevelopmentproposethatdespiteage-relateddeclinesincognitivedomains,age-relatedgainsmaybeseeninsocioemotionaldomainssuchasemotionalresponding(Izard,1977;Magai,2008)andprioritizingsocialandgenerativegoals(Carstensen,Fung,&Charles,2003;Erikson,1982).Forexample,Magai(2008)arguesthatagingenhancestheinterconnectionsamongemotional,cognitive,andbehavioralsub-systems,facilitatingthedevelopmentofmorecomplexemotionsandgreaterempathytotheemotionalneedsofothers.Socioemo-tionalselectivitytheoryproposesthatasagingindividualsperceivetheirtimeleftinlifeasincreasinglylimited,theyshifttheirmotivationsawayfromfuture-orientedgoalsandtowardsocialandemotionallymeaningfulones(Carstensenetal.,2003).AccordingtoErikson(1982),generativity(i.e.,expandingthefocusofcon-cernbeyondoneself)isapredominantdevelopmentalchallengeofmiddletolateadulthood.Evolutionaryperspectivessuggestthatbecauseyoungpeopleinforagingsocietiesconsumemorethantheyproduce,cooperationbetweengenerationsiscriticalforsur-vival.Inthiscontext,thereisaparticularneedforolderadultstoprovideemotionalsupportandmediateconflicts(Gurven&Ka-plan,2009).AgeDifferencesinEmotionandEmotionalEmpathyEmpiricalstudieshavefoundage-relateddifferencesinemo-tionalrespondingthatareconsistentwiththesetheoreticalac-counts.Studiesofagedifferencesinemotionalreactivityhavegenerallyfoundage-relatedincreasesinsubjective,behavioral,andphysiologicalreactivityinsituationsthatsignaltheneedforhelpingorreparation,suchascontextsinvolvingloss(Kunzmann&Gruhn,2005;Seider,Shiota,Whalen,&Levenson,2010),suffering(Kliegel,Ja¬ger,&Phillips,2007),andinjustice(Charles,2005;Phillips,Henry,Hosie,&Milne,2008).Thereisalsoevidencethatagingisassociatedwithashifttowardmoreaffiliativeemotions,whichmayalsorelatetogreaterconcernforothers.Forexample,whenwatchingavideoofemo-tionallyambiguousbehavior,olderadultsweremorelikelytoreporttheprotagonistasfeelingsad,whileyoungeradultsweremorelikelytoreporttheprotagonistasfeelingangry(Charles,Carstensen,&McFall,2001).Similarly,whendiscussingaprob-lematicareaintheirmarriage,oldercouplesexhibitedrelativelymoreaffection(anaffiliativeemotion)andrelativelylessdisgustandanger(bothnonaffiliativeemotions)thanmiddle-agedcouples(Carstensen,Gottman,&Levenson,1995).AgeDifferencesinProsocialBehaviorStudiessuggestthatgenerativityisakeycomponenttosuccess-fulaging(Antonovsky&Sagy,1990;Erikson,1982;Fisher,1995).Consistentwiththis,olderadultshavebeenfoundtoendorsemoregenerativegoals(e.g.,helpingothersandmakinganimpact)andother-focusedproblemsolving(e.g.,strategiesdi-rectedatmaintainingrelationshipsandtakingotherÕneedsintoaccount)thandoyoungeradults(Hoppmann,Coats,&Blanchard-Fields,2007).WeinerandGraham(1989)foundthatself-reportedlevelsofpityandwillingnesstohelpcharactersinhypotheticalsituationsincreasedwithage.Additionally,inrecallingautobio-graphicalinformation,middle-agedandolderadultsemphasizedmorethemesofgenerativitythandidyoungeradults(McAdams,St.Aubin,&Logan,1993).ThePresentStudyBasedonthesetheoreticalandempiricalliteratures,wehypoth-esizedthatbothemotionalempathyandprosocialbehaviorinresponsetoindividualsinneedwouldincreasewithage.Giventhelinkbetweenemotionalempathyandprosocialbehavior,wealsohypothesizedthatdifferencesinemotionalempathywouldaccountatleastinpartforage-relatedincreasesinprosocialbehavior.Totestthesehypotheses,weshowedolder,middle-aged,andyoungparticipantstwofilms,onedepictinganupliftingthemeandonedepictingadistressingtheme.Usingfilmswithdifferentthemes1130SZE,GYURAK,GOODKIND,ANDLEVENSON
providedanopportunitytoassessgeneralizability.Weassessedemotionalempathybydeterminingthemagnitudeofsubjectiveandphysiologicalresponsestothefilms.Afterviewingthefilms,participantsweregiventheopportunitytodonatetotwodifferentcharitiesrelatedtothefilms.Weassessedprosocialbehaviorbydeterminingthesizeofthedonations.Becausedifferencesbetweenagedifferencesinprosocialbehaviormightbeexplainedbyfactorsotherthanagedifferencesinemotionalempathy,weincludedanumberofadditionalmeasures(income,socialdesirability,per-ceptionsofcharities,pastdonationbehavior,andtraitempathy)thatenabledustoevaluatealternativeexplanations.MethodParticipantsSeventyolderparticipants(agerange,60Ð80years,M66.43,SD5.40),72middle-agedparticipants(agerange,40Ð50years,M44.58,SD2.90),and71youngparticipants(agerange,20Ð30years,M23.07,SD2.65)wererecruitedusingflyersandonlinepostingsinthelocalcommunityandfromaresearchparticipantdatabaseadministeredbytheUniversityofCalifornia,Berkeley.Participantshadtobeingoodhealthandsufficientlymobiletotraveltothelaboratory.Therecruitmentwasdesignedtoensurethatgenderandethnicitywerestratifiedevenlyacrossthethreeagegroups.Intermsofgender,67%oftheparticipantswerewomenand33%weremen.Intermsofethnicity,thesamplewas68%percentCaucasianAmerican,12%AsianAmerican,8%AfricanAmerican,4%LatinoAmerican,and6%other.Partici-pantsreportedtheirannualhouseholdincomeusingthefollowingincomebrackets(1$10,000;2$10,000Ð$19,999;3$20,000Ð$29,999;4$30,000Ð49,999;5$50,000Ð74,999;6$50,000Ð74,999;7$100,000Ð200,000;8over$200,000).Aswouldbeexpected,thegroupsdifferedinincome,witholderandmiddle-agedparticipantsreportinghigherincomesthanyoungparticipants.Descriptivestatisticsandpairwisecom-parisonsamongagegroupsforincomearepresentedinTable1.Participantswerepaid$50forcompletingaquestionnairepack-ageandparticipatingina2.5-hrlaboratorysession.Unbeknownsttothem,theywouldalsoreceiveanadditional$10attheendoftheexperiment,withtheoptionofkeepingthemoneyordonatingsomeorallofittotwodifferentcharities(seeProcedure).ApparatusAudiovisual.ApartiallyconcealedvideocamerafocusedontheparticipantÕsupperbodyandface.Theoutputofthecamerawasroutedthroughvideotime-codegeneratorsthataddedvisibleandinvisiblecomputer-readabletiminginformationonthesignalbeforeitwasrecordedinDVDandVHSformats.Asisourpracticeinallstudies,participantswereinformedbeforethestartofthesessionaboutthevideorecordingandthenaskedforconsentforvaryinglevelsofusage(e.g.,researchonly,publicshowings)attheendoftheexperiment.Physiology.Continuousrecordingsofsevenphysiologicalmeasurementsofautonomicnervoussystemactivityweremea-suredusingasystemconsistingofeitheraGrassModel7poly-graphoraBIOPACpolygraphandacomputerequippedforprocessingmultiplechannelsofanaloginformation(130partici-pantswereassessedusingtheGrassModel7polygraph,and83participantswereassessedusingtheBIOPACpolygraph).Physi-ologywasmonitoredandaveragedonasecond-by-secondbasisforeachofthefollowingmeasuresusingcomputerprogramswrittenbyoneoftheauthors(Levenson):(a)heartrate(Beck-manminiatureelectrodeswithReduxpasteorVermedSilveR-estEKGpregelledelectrodeswereplacedinabipolarconfig-urationonoppositesidesoftheparticipantÕschest;theinterbeatintervalwascalculatedastheinterval,inmilliseconds,betweensuccessiveRwaves),(b)fingerpulseamplitude(aUFIphoto-plethysmographattachedtothesecondfingerofthenondomi-nanthandrecordedthevolumeofbloodinthefinger,andthetrough-to-peakamplitudeofthefingerpulsewasmeasured),(c)fingerpulsetransmissiontime[thetimeintervalinmillisecondswasmeasuredbetweentheRwaveoftheelectrocardiogramTable1GroupMeansandStandardDeviationsforDemographicVariablesandCovariatesMean(SD)AgeeffectYoungMiddle-agedOlderFpvalue2Income(1Ð8)2.17a(2.04)2.99b(1.90)3.29b(1.83)5.11.01.05Confidenceindonations4.49(.90)4.64(.85)4.66(.79)1.37.26.01CharityperceptionsSurferscharity3.70(.73)4.11(.75)3.96(.80)2.54.08.02Darfurcharity3.66(.83)3.83(.84)3.64(.93)Pastdonation($)92.36a(146.68)815.67b(2056.76)1628.40b(3002.31)8.34.01.08TraitempathyEC3.76a(.70)4.02(.67)4.07b(.55)3.61.05.03PD2.58a(.72)2.21b(.69)2.23(.69)4.03.05.04PT3.66(.67)3.68(.75)3.67(.70)1.98.00Socialdesirability4.64(2.28)4.99(2.02)4.86(2.11)1.77.00Baselineempathicconcern1.70a(.73)2.14b(.93)2.27b(.97)6.80.01.06Baselinepersonaldistress1.28(.49)1.23(.52)1.181.01.37.01Note.EC,PD,PTEmpathicConcern,PersonalDistress,andPerspectiveTakingsubscalesoftheInterpersonalReactivityIndex.Withineachrow,differentsubscriptsdenotesignificantlydifferentmeansatp.05.1131EMPATHYANDPROSOCIALBEHAVIORINLATELIFE
(EKG)andtheupstrokeoftheperipheralpulseatthefingersite,recordedfromthedistalphalanxoftheringfingerofthenondominanthand]withthephotoplethysmograph,(d)earpulsetransmissiontime(aUFIphotoplethysmographattachedtotherightearloberecordedthevolumeofbloodintheear,andthetimeintervalinmillisecondswasmeasuredbetweentheRwaveoftheEKGandtheupstrokeofperipheralpulseattheearsite),(e)systolicbloodpressureand(f)diastolicbloodpressure(anoccludingcuffwasplacedonmiddlephalangeofthemiddlefingerofthenondominanthandandbloodpressurewasmea-suredoneachheartbeatusinganOhmedaFinapress2300),and(g)skinconductance[aconstant-voltagedevicewasusedtopassasmallvoltagebetweentwoBeckmanorBIOPACelec-trodes(filledwithanelectrolyteofsodiumchlorideinUnibase)attachedtothepalmarsurfaceofthemiddlephalangesoftheringandindexfingersofthenondominanthand].Severalotherphysiologicalresponseswerealsomonitored(fin-gertemperature,respirationperiod,andgeneralsomaticactivity),butcardiacandelectrodermalmeasureswerechosenasthefocusofthepresentstudybecauseofthelonghistoryofusingthesemeasuresinresearchonprosocialandempathicresponding(Eisenberg&Fabes,1990;Eisenbergetal.,1989;Krebs,1975;Zahn-Waxleretal.,1995).Donationboxes.Twolockeddonationboxes(1586cm,withslotslargeenoughtoinsertdollarbills)wereplacedonacabinetatthefar-endoftheroomacrossfromtheparticipant.TheboxeswerelabeledwithÒSurfersHealingÓandÒDarfur.ÓPartici-pantswerenotinformedaboutthedonationprocedureuntiltheendoftheexperiment;noparticipantaskedaboutorcommentedontheboxes.MeasuresSelf-reportedemotionalexperience.Uponarrivingatthelaboratoryandimmediatelyaftereachfilm(seebelow),partici-pantsusedafive-pointLikert-typescale(1notatall;5extremely)toindicatethedegreetowhichtheywerefeelingeachof18emotionitems(afraid,amused,angry,ashamed,calm,com-passionate,disgusted,disturbed,embarrassed,enthusiastic,inter-ested,moved,proud,sad,sympathetic,surprised,upset,andwor-ried).Basedonpreviousresearch(Batson,1987;Eisenbergetal.,1988),threeoftheitemsmeasuringempathicconcern(Òsympa-thetic,ÓÒmoved,ÓÒcompassionateÓ)andthreemeasuringpersonaldistress(Òdisturbed,ÓÒupset,ÓÒworriedÓ)wereaveragedtocom-putemeanscoresforeach.Reliabilitiesamongtheempathiccon-cernandpersonaldistressitemswerehighforbothofthefilmsused(alphasforupliftingfilm:empathicconcern.85,personaldistress.87;fordistressingfilm:empathicconcern.92,personaldistress.89).AnÒupliftingÓscorewasderivedfromtwoitems(enthusiastic,proud)andwasusedasamanipulationcheck(seebelow)ofpresumeddifferencesbetweentheupliftinganddistressingfilms.Reliabilitiesamongtheupliftingitemswereadequateforbothfilms(alphasforupliftingfilm.72;fordistressingfilm.57).Theremainingnineemotionitemswerenotincludedintheanalysis.Physiology.Usingthesecond-by-seconddataobtainedforeachphysiologicalmeasure,meansforeachfilmandforeachparticipantwerecalculated.Asnotedearlier,inthecurrentre-searchwefocusedoncardiacandelectrodermalmeasures.Wecomputedacompositemeasureofautonomicactivationbyaver-agingthestandardizedmeansofthefollowingvariables:cardiacinterbeatinterval,fingerpulseamplitude,pulsetransmissiontimetothefinger,pulsetransmissiontimetotheear(thestandardizedscoresofthesemeasuresweremultipliedby1sothathighernumberswouldindicategreateractivation),systolicbloodpres-sure,diastolicbloodpressure,andskinconductance.Reactivityscoreswerecomputedbysubtractingtheaveragelevelfortheprefilmbaselineperiod(the30secondsbeforethewarningthatthefilmwasabouttostart)fromtheaveragelevelduringthefilm.Wehaveusedthesekindsofphysiologicalreactivitycompositesinourpreviouswork(e.g.,Gross&Levenson,1997;Maussetal.,2005;Sturmetal.,2006;Werneretal.,2007).Compositesofthissortreducethenumberofphysiologicaldependentvariables,thushelpingcontrolforTypeIerror.However,toensurethattheuseoftheautonomiccompositedidnotdistortthefindings,wealsoconductedfollow-upanalysesatthelevelofindividualphysiolog-icalvariables.Tobeconsistentwithpreviousresearchonempathy,whichlargelyusedcardiacinterbeatinterval/heartrateasitsphys-iologicaldependentmeasure,wehighlightedanalysesusingonlycardiacinterbeatinterval.Prosocialbehavior.Thetotaldollaramounts(from$0Ð$10)donatedbyeachparticipanttoeachofthetwocharitableorgani-zationsassociatedwiththefilms(seebelowfordescriptionofthisprocedure)providedindicesofprosocialbehavior.Beliefsaboutdonationandperceptionsofcharities.Attheendoftheexperiment,participantswereaskedtorate(1notatall;5extremely)thefollowing:(a)asingleitemthataskedtheextenttowhichtheybelievedthatmoneyplacedinthedonationboxeswouldactuallybedonatedtothecharities(thisservedasamanipulationcheckforthedonationtask);and(b)twosetsoffouritemsthataskedtheextenttowhicheachcharitywaswell-managedandunderfundedandtheextenttowhichtheircauseswerehopefulandhelpful(thisservedasameasureofperceptionstowardthecharities).Thefourcharity-relateditemswerecom-binedtocreateasingleindexofcharityperceptions.Reliabilitiesamongthefouritemswereadequateforbothfilms(forupliftingfilm:.68;fordistressingfilm:.66).Self-reportedpastdonationbehavior.Toprovideanindexofpastdonationbehavior,participantsreportedthetotaldollaramountofdonationstheyhadgiventocharitiesinthepast12months.Traitempathy.Traitempathywasassessedusingthreesub-scalesoftheInterpersonalReactivityIndex(Davis,1980):em-pathicconcern(e.g.,ÒWhenIseesomeonebeingtakenadvantageof,IfeelkindofprotectivetowardthemÓ),personaldistress(e.g.,ÒBeinginatenseemotionalsituationscaresmeÓ),andperspectivetaking(e.g.,ÒItrytolookateverybodyÕssideofadisagreementbeforeImakeadecisionÓ).Internalconsistencieswereadequateforallthreesubscales(alphas:empathicconcern.80,personaldistress.78,perspectivetaking.82).Socialdesirability.Socialdesirabilitywasassessedusingthe10-itemversionoftheMarlowe-CrowneSocialDesirabilityScale(Crowne&Marlowe,1960).Socialdesirabilitycandirectlyinflu-enceprosocialbehavior;thus,itwasimportanttocontrolforitinouranalyses.Internalconsistencyforthisversionwasadequate(.64).1132SZE,GYURAK,GOODKIND,ANDLEVENSON
ProcedureThreetosevendaysbeforetheirlaboratoryvisit,participantswereaskedtocompleteaquestionnairepacketincludingmeasuresofpersonalityandemotionalexperience.Onarrivaltothelabora-tory,participantsweregreetedbyafemaleexperimenterandseatedinachairina36mexperimentalroom.Participantswereinformedthattheywereparticipatinginastudyofemotion,duringwhichtheirphysiologicalreactionswouldbemonitoredandbe-havioralreactionswouldbevideotaped.Aftersigningtheconsentformandhavingthephysiologicalsensorsattached,participantscompletedthebaselineself-reportedemotionalexperienceques-tionnaire.Theexperimentalprotocolthatfollowedconsistedofaseriesoftasksdesignedtoassessanumberofaspectsofemotionalandempathicfunctioning.Forthepresentstudy,wearefocusingonthetaskadministeredattheendoftheprotocol,inwhichparticipantsviewedthetwofilmsportrayingindividualsinneed(toassessemotionalempathy)andsubsequentlyhadanopportu-nitytocontributetotworelatedcharities(toassessprosocialbehavior).Empathyfilms.EachparticipantviewedanÒupliftingÓandaÒdistressingÓfilm,bothofwhichportrayedindividualsinneed,andbothofwhichweredesignedtoelicitemotionalempathy.TheupliftingfilmbeganwithabriefintroductiontochildhoodautismfollowedbyimagesofchildrenwithautismlearninghowtosurfatanonprofitcampcalledSurfersHealing(116sinlength).Thefilmdepictedtheempowermentandjoyexperiencedbythechildrenwithautismwhilesurfing.ThedistressingfilmbeganwithabriefintroductiontotheDarfurcrisisfollowedbyimagesofmen,women,andchildrenwhoarewoundedandemaciatedreceivingaidfromreliefworkers(117sinlength).ThefilmdepictsthehorrorandinhumaneconditionsbeingexperiencedbythepeopleofDarfur.Thetwofilmswereshownincounterbalancedorder.Eachfilmwasprecededbya1-minrestingperiod,duringwhichparticipantswereaskedtocleartheirmind,relax,andfocusonanXinthecenterofthevideoscreen.Fifty-threesecondsintotherestingperiod,awrittenmessageappearedabovetheXindicatingthatthefilmwasabouttostart.Immediatelyaftereachfilm,participantscompletedtheself-reportedemotionalexperiencequestionnairedescribedabove.Prosocialbehavior.Afterparticipantsfinishedviewingthetwofilms,theassistantandtheexperimenterenteredtheroom.Theassistantremovedthephysiologicalsensorsandtheexperimentergavetheparticipanta$50checkthatconstitutedtheagreed-uponpaymentforthestudyandaconsentformtocompleteregardinguseofthevideorecording.Participantswerealsogiven10one-dollarbillsandaninformationsheetabouttwoactualcharitableorganizationsassociatedwiththeindividualsportrayedinthetwofilms(SurfersHealing,whichprovidessurfingcampsforchildrenwithautism,andNotOnOurWatch,whichprovidesaidtoDarfur).Theexperimenterexplained:ÒAsanaddedthankyou,weareofferingyouanextra$10incompensation,ontopofyouroriginal$50compensation.Youcanchoosetokeepalloftheextra$10,ordonatesomeorallofthe$10toeitherorbothofthecharitiesdescribedonthissheet,relatedtothetwofilmsyoujustsaw.WewanttoemphasizethatwhetheryoudonateisentirelyanonymousandvoluntaryÑwearenolongervideotaping,andifyoudodecidetodonate,pleasedosoonceweareoutsideoftheroomÑthedonationboxesareinthebackoftheroom[experimenterpointstotheboxes].Donationssubmittedthroughthisstudyareperiodicallysenttothetwocharitiesdescribedonthissheet.AfteryouÕreallsetinhere,pleasemeetmeoutsidefortwowrap-upquestionnaires.ÓToreducepressuresofsocialdesirability,theexperimenterandassistantthenexitedtheroom,leavingtheparticipantalonetomakethedonationdecisionprivately.Aftertheparticipantexited,theexperimenteradministeredthequestionnaireassessingbeliefsaboutthedonationandthecharities.Participantswerethende-briefedandthanked.Aftertheparticipantleft,theexperimenterunlockedandopenedthedonationboxesandloggedtheamountdonatedtoeachcharity.Consistentwithwhatparticipantsweretold,allcontributionsweredonatedanonymouslytothetwochar-ities.ResultsOverallAnalyticStrategyAninitialseriesofdataanalyseswereconductedtoevaluatetheeffectsofthecounterbalancedorderingsoffilms.Theseanalysesrevealednosignificantmaineffectsorinteractionsinvolvingorderforanyofourdependentvariables.Thus,wecollapsedacrossfilmorderandconductedouranalysesusing322(AgeSexFilm/Charity)ANOVAsandANCOVAswithageandgendertreatedasbetween-subjectsfactorsandfilm/charitytreatedasawithin-subjectfactor.Whencontinuouscovariateswereused,theywerecenteredonthegrandmeanasrecommendedbyAikenandWest(1991).Foreaseofinterpretation,estimatedmarginalmeans(correctedforanycovariates)arereportedforallANCOVAanal-yses.WhenasignificantmaineffectwasfoundforagewithnosignificantAgeFilm/Charityinteraction,weconductedapoly-nomialtrendanalysisandtestedwhetheralinearorquadraticpatternbestcapturedtheeffectofage.Becausepolynomialtrendanalysescaptureonlyoverallpatternsofgroupdifferencesinadependentvariable,wealsoconductedBonferroni-adjustedposthocteststoidentifyspecificdifferencesbetweengroups.WhenasignificantinteractioneffectofAgeFilm/Charitywasfound,weconductedanalysestoexaminetheeffectsofageseparatelyforeachFilm/Charity.Thep.05rejectionlevelwasusedforallstatisticaltests.1EmotionalEmpathyOuranalysesofemotionalempathywerederivedfromself-reportedemotionalreactivityandautonomicreactivitytothetwo1Therewerenomaineffectsforgender(Fsrangedfrom.06to2.44)orsignificantinteractionsofgenderwithageandcharityorageandfilm(Fsrangedfrom.14to1.91)forthemajorityofourparticipantcharacteristicsorforanyofourlaboratorymeasures.TheonlygendereffectobservedwasforthetraitempathicconcernsubscaleoftheIRI,withwomenreportinggreaterempathicconcernthanmen,F(1,207)5.87,p.05.Inameta-analysisofsexdifferencesinempathy,EisenbergandLennon(1983)foundthatgreaterempathyinwomenthaninmenhasbeenreliablydemonstratedinstudiesusingself-reporttraitmeasuresbutnotincon-trolledlaboratorystudiesusingmeasuressuchassubjective,facial,andphysiologicalresponding.1133EMPATHYANDPROSOCIALBEHAVIORINLATELIFE
films.Analysesofself-reportdatawereconductedusingbaselinelevelsofself-reportedemotionasacovariate.Asnotedearlier,analysesofphysiologicaldatawereconductedusingreactivityscores(changefromprefilmbaseline).Means,SDs,effectsizes,andpairwisecomparisonsamongagegroupsforemotionalempa-thyarepresentedinTable2.ManipulationCheckConfirmingouraprioridesignationsofthetwofilmsasÒup-liftingÓandÒdistressing,Ósimplettestsrevealedahigherupliftingscore(enthusiastic,proud)fortheupliftingfilm(M2.88SD1.23)comparedwiththedistressingfilm(M1.15,SD.47),t(211)20.53,p.01.Additionally,morepersonaldistresswasreportedduringthedistressingfilm(M3.59,SD1.19)thanduringtheupliftingfilm(M1.28SD.70),t(211)25.31,p.01.AgeDifferencesinEmotionalEmpathyEmpathicconcern.Therewasasignificantmaineffectofage,F(2,202)15.06,p.01.Aspredicted,resultsindicatedasignificantage-relatedlinearrelationship,contrastestimate.57,p.01.Specifically,olderparticipantsreportedthegreatestempathicconcern,middle-agedparticipantsreportedintermediatelevels,andyoungparticipantsreportedlowestlevels.Thequa-dratictermofagewasnotsignificant,contrastestimate.09,p.39.Therewasalsoasignificantmaineffectoffilm,F(1,202)100.37,p.01,resultingfromhigherreportsofempathicconcernduringthedistressingfilmthantheupliftingfilm;how-ever,theAgeFilm/Charityinteractionwasnotsignificant,F(2,202)2.95,p.06.Personaldistress.TherewasasignificantAgeFilm/Charityinteraction,F(2,202)5.36,p.01.Analyzingtheresultsseparatelyforeachfilm,fortheupliftingfilm,therewasnomaineffectofage,F(2,208)1.Forthedistressingfilm,therewasasignificantmaineffectofage,F(2,208)5.52,p.01,andasignificantage-relatedlinearrelationship,contrastesti-mate.63,p.01.Specifically,olderparticipantsreportedthegreatestpersonaldistress,middle-agedparticipantsreportedinter-mediatelevels,andyoungparticipantsreportedthelowestlevels.Thequadratictermofagewasnotsignificant,contrastestimate.05,p.75.Thus,forpersonaldistress,age-relatedincreasesinreactivitywerespecifictothedistressingfilm.Physiologicalreactivity.Therewasamaineffectofage,F(2,206)3.89,p.05,andasignificantage-relatedlinearrelation-ship,contrastestimate.11,p.01.Specifically,olderadultsexhibitedgreaterautonomicactivationthanyoungeradults,withmiddle-agedadultsnotdifferingfromeitheragegroup.Thequa-dratictermofagewasnotsignificant,contrastestimate.06,p.52.Therewasnomaineffectoffilm,indicatingsimilarlevelsofautonomicactivationtobothfilms,andnoAgeFilm/Charityinteraction,Fs1.Exploratoryanalysesconductedontheindividualphysiologicalmeasuresweregenerallyconsistentwiththeoverallage-relatedlinearincreaseinautonomicreactivityfoundforthecompositevariable.Reactivityininterbeatinterval(themeasurepredomi-nantlyusedinresearchonempathy),alongwiththreeothermea-sures(fingerpulsetransmissiontime,skinconductance,andsys-tolicbloodpressure),showedsignificantage-relatedlinearincreasesacrossbothfilms(ps.05).Fortheotherthreemea-sures(fingerpulseamplitude,earpulsetransmissiontime,anddiastolicbloodpressure),agedifferencesdidnotreachsignifi-cance.GroupmeansofphysiologicalrespondinginindividualmeasuresarereportedinTable3.Summary.Theresultsforemotionalempathyindicatedage-relatedincreases,witholderparticipantsexhibitingthehighestTable2MeansandStandardDeviationsbyGroupandFilmforMeasuresofEmotionalEmpathyandProsocialBehaviorMean(SD)EffectsizeaPairwisecomparisons(p)YoungMiddle-agedOlderFilmAgeFAYoungvs.Middle-agedOldervs.Middle-agedOldervs.YoungEmpathicConcernUpliftingfilm2.84(.93)3.56(.95)4.10(.86).33.13.03.004ns.001Distressingfilm3.74(1.07)4.22(1.02)4.51(.84)PersonalDistressUpliftingfilm1.22(.73)1.23(.64)1.35(.65).74.08.05ÑÑÑDistressingfilm3.20(1.22)3.50(1.18)4.03(1.04)ns.045.00PhysiologicalActivationUpliftingfilm.10(.39).02(.41).05(.42).00.00.04nsns.022Distressingfilm.09(.38).01(.47).07(.50)ProsocialBehaviorUpliftingfilm1.46(2.09)1.69(2.31)1.74(2.91).12.04.00ns.078.013Distressingfilm2.63(2.63)3.04(3.04)3.84(3.81)Note.Empathicconcernandpersonaldistressresultsarereportedaftercontrollingforbaselinelevelsofempathicconcernandpersonaldistress,respectively.Physiologicalactivationscoresreflectz-scoredmeandifferencesfrombaselineandarecompositesofsevenphysiologicalresponses:inter-beatinterval,fingerpulseamplitude,fingerpulsetransmissiontime,earpulsetransmissiontime,systolicbloodpressure,diastolicbloodpressure,andskinconductance.Prosocialbehaviorisreportedindollarsdonated.WheretheAgeFilm/Charityinteractionwassignificant,pairwisecomparisonsreflectagecomparisonsseparatelybyfilm.Dashes(Ñ)indicatethatanalyseswerenotconductedbecauseofalackofsignificantageeffects.aEffectsizesarepartialetasquares(2).p.05.p.01.1134SZE,GYURAK,GOODKIND,ANDLEVENSON
levelsofreportedempathicconcernandphysiological(inbothcardiacandelectrodermalvariables)activation,middle-agedpar-ticipantsexhibitingintermediarylevels,andyoungparticipantsexhibitinglowestlevelsacrosstheupliftinganddistressingfilms.Thesamepatternemergedforpersonaldistressbutwaslimitedtothedistressingfilmonly.ProsocialBehaviorManipulationCheckDonationtask.AscanbeseeninTable1,participantswereveryconfidentthatthedonationswouldbegiventothecharities.Therewerenoagedifferencesintheseratings,F(2,206)1.37,p.26.Charityperceptions.AscanbeseeninTable1,participantsgenerallyhadmoderatelypositiveperceptionsaboutthecharities.Therewerenosignificantagedifferencesintheseratings,F(2,206)2.54,p.08,andtherewasnoAgeFilm/Charityinteraction,F(2,206)2.62,p.08.Therewasasignificantmaineffectforcharity,F(1,206)16.38,p.01,suchthatallgroupsratedtheSurfersHealingcharitymorepositivelythantheDarfurcharity,consistentwiththeupliftinganddistressingthemesoftheirassociatedfilms.AgeDifferencesinProsocialBehaviorProsocialbehavior.Therewasasignificantmaineffectofage,F(2,207)4.59,p.05.Aspredicted,resultsindicatedasignificantlineartrendamongthethreeagegroups,contrastesti-mate.78,p.01.Specifically,olderparticipantsexhibitedthegreatestprosocialbehavior,middle-agedparticipantswereinter-mediate,andyoungparticipantsshowedthelowestlevels.Thequadratictermofagewasnotsignificant,contrastestimate.24,p.36.Therewasalsoasignificantmaineffectofcharity,F(1,207)28.17,p.01,resultingfromlowerdonationstotheSurfersHealingcharity(associatedwiththeupliftingfilm)thantotheDarfurcharity(associatedwiththedistressingfilm);however,theAgeFilm/Charityinteractionwasnotsignificant,F(2,207)1.Means,SDs,effectsizes,andpairwisecomparisonsamongagegroupsforprosocialbehaviorarepresentedinTable2.Age-RelatedIncreasesinProsocialBehavior:ExplanatoryVariablesResultsindicatedagedifferencesinprosocialbehaviorthatlargelyparalleledthosefoundforemotionalempathy,witholderadultsexhibitingthehighestlevels,middle-agedadultsintermedi-arylevels,andyoungadultslowestlevels.ToexaminepossibleTable3GroupMeansofPhysiologicalRespondinginIndividualChannels(CorrectedforPre-FilmBaselineLevels)MeasureYoungMiddle-agedOlderMeanSEMeanSEMeanSECardiacinter-beatinterval(ms)Upliftingfilm888.354.67874.914.62876.944.75Distressingfilm894.395.22880.59134.51877.905.29Fingerpulseamplitude(A/Uunits)Upliftingfilm13.08.5612.56.5513.52.58Distressingfilm12.92.7212.56.7213.58.74Fingerpulsetransittime(ms)Upliftingfilm281.531.30281.151.30278.761.36Distressingfilm282.571.43281.441.43280.741.47Earpulsetransittime(ms)Upliftingfilm219.261.42222.731.43221.781.45Distressingfilm220.181.30220.241.30222.071.31Systolicbloodpressure(mm|Hg)Upliftingfilm152.631.06154.041.01155.741.01Distressingfilm153.71.89153.18.86155.36.87Diastolicbloodpressure(mm|Hg)Upliftingfilm91.73.6592.97.6592.39.64Distressingfilm92.40.4892.34.4892.59.48Skinconductance(mhos)Upliftingfilm2.93.042.91.032.92.04Distressingfilm3.00.042.95.042.97.04Temperature(¡Fahrenheit)*Upliftingfilm81.23.0381.36.0381.26.03Distressingfilm81.08.0481.17.0481.12.04Respirationperiod(sec)*Upliftingfilm3.84.113.95.113.82.11Distressingfilm3.76.104.19.104.08.10Somaticactivity(A/Dunits)*Upliftingfilm.80.05.74.05.77.05Distressingfilm.77.05.65.05.68.05Note.Asterisksindicatemeasuresthatwerenotincludedinthecardiovascularandelectrodermalphysiologicalcomposite.1135EMPATHYANDPROSOCIALBEHAVIORINLATELIFE
factorscontributingtotheseagedifferences,weconductedtwomultipleregressionmodelsexaminingtwodifferentkindsofvari-ables:emotionalempathytothefilmsandgeneralparticipantcharacteristics.BecausetherewasnoAgeFilm/Charityinter-actionforprosocialbehavior,wecollapsedacrosstheFilm/Charityfactorbyusingthetotalamountdonatedtobothcharities.Doesemotionalempathyexplainagedifferencesinprosocialbehavior?Giventhelinkbetweenemotionalempathyandproso-cialbehaviorfoundinpreviousresearch(e.g.,Batson,1990;Eisenbergetal.,1989;Krebs,1975;Stocks,Lishner,&Decker,2009),wesoughttoevaluatewhetheragedifferencesinemotionalempathycontributedtoagedifferencesinprosocialbehavior.First,weexaminedzero-orderandpartial-ordercorrelationsbetweensubjectiveaspectsofemotionalempathy,physiologicalaspectsofemotionalempathy(overallphysiologicalcompositeandinterbeatinterval),andprosocialbehavior(i.e.,totaldonation).AsTable4indicates,prosocialbehaviorwasassociatedwithhigherlevelsofemotionalempathyinself-reportedempathicconcern(forbothfilms)andinpersonaldistress(forthedistressingfilmonly),alongwithgreaterinterbeatintervalreactivity(forbothfilms).Prosocialbehaviorwasnotassociatedwiththeoverallphysiologicalcom-posite.Thus,weconstructedamultipleregressionanalysisofprosocialbehavior(totaldonation)inwhichbaselineempathicconcernandpersonaldistresswereenteredintothefirststep,thesignificantemotionalempathypredictors(describedabove)en-teredinthesecondstep,andageenteredinthethirdstep.Inthefinalmodel,empathicconcerntothedistressingfilm,interbeatintervalreactivitytotheupliftingfilm,andageweresignificantpredictorsofprosocialbehavior(seeTable5).Becausebothempathicconcernandinterbeatintervalwereassociatedwithageandwithprosocialbehavior,weconductedSobeltests(1982)toevaluatewhethertheyweresignificantme-diatorsoftheassociationbetweenageandprosocialbehavior.Thesetestsrevealedthatempathicconcernwasasignificantme-diatorofagedifferencesinprosocialbehavior(z2.79,p.01),butinterbeatintervalwasnot(z.64,ns).DoparticipantsÕcharacteristicsexplainagedifferencesinprosocialbehavior?Inaddition,weexaminedanumberofpar-ticipantcharacteristicsthatcouldhaveinfluencedprosocialbehav-ior:income,socialdesirability,traitempathy,2charityperceptions,andpastdonationbehavior.Thelogicbehindselectingthesevariableswasthatparticipantsmighthavecontributedmoreifthey(a)hadmorediscretionaryincome,(b)believeditwasthesociallydesirablethingtodo,(c)hadhigherlevelsoftraitempathy,(d)hadmorepositiveviewstowardthecharities,and/or(e)haddonatedmoretocharitiesinthepast.Totestthesealternativeexplanations,weconductedamultipleregressionanalysisofprosocialbehavior(totaldonation)inwhichalltheseparticipantcharacteristicswereenteredinthefirststepinadditiontobaselineempathicconcernandpersonaldistress,theemotionalempathypredictorsenteredinthesecondstep,andageenteredinthethirdstep.AsTable5indicates,inthefullmodel,traitempathicconcernandpastdona-tionbehaviorweresignificantpredictorsofprosocialbehavior.Controllingfortheseparticipantcharacteristics,empathicconcerntothedistressingfilm,interbeatintervalreactivitytotheupliftingfilm,andageremainedsignificantpredictorsofprosocialbehav-ior.Insummary,differencesinseveralparticipantcharacteristicswereclearlyimportantbutdidnotfullyaccountforage-relatedincreasesinprosocialbehavior.DiscussionUsingasampleofolder,middle-aged,andyoungadultswhoviewedtwokindsoffilmsportrayingindividualsinneed,wefoundsupportforourhypothesesthat(a)emotionalempathyincreasedwithage,(b)prosocialbehaviorincreasedwithage,and(c)aspectsofemotionalempathy(empathicconcern)partiallyaccountforage-relatedincreasesinprosocialbehavior.Intermsofthefirsthypothesis,wefoundevidenceinbothself-reportedandphysio-logicaldomainsforage-relatedincreasesinemotionalempathy.Muchofthisevidencegeneralizedacrossboththeupliftinganddistressingfilms;however,theage-relatedincreasesinself-reportedpersonaldistresswereonlyfoundinresponsetothedistressingfilms.Intermsofthesecondhypothesis,wefoundevidenceforage-relatedincreasesinprosocialbehaviorintheformofgreatercharitablegiving.Thisevidencegeneralizedacrossboththeupliftinganddistressingfilms.Intermsofthethirdhypothesis,wefoundevidencethatage-relateddifferencesinempathicconcernpartiallyaccountedforage-relateddifferencesinprosocialbehavior.Finally,weexaminedanumberofparticipantcharacteristicsthatmighthaveaccountedforfoundagediffer-2Agedifferencesintraitempathywerenotaprimaryfocusofthepresentstudy;however,thesemeasuresarehelpfulincharacterizingoursample.AscanbeseeninTable1,resultsrevealedsignificantagediffer-encesinthetraitempathicconcernsubscaleoftheIRI.Pairwisecompar-isonsamongthethreeagegroupsrevealedthatolderadultsreportedmoretraitempathicconcernthanyoungadults(p.05),withmiddle-agedadultsnotdifferingsignificantlyfromeithergroup.Thisisincontrasttoarecentcross-sectionalstudythatfoundnoagedifferencesintraitaffectiveempathy(Baileyetal.,2008).Inaddition,thereweresignificantagedifferencesinthetraitpersonaldistresssubscale,withyoungeradultsreportinggreatertraitlevelsofpersonaldistressthanmiddle-agedadults,andolderadultsnotdifferingsignificantlyfromeithergroup.Finally,therewerenoagedifferencesinthetraitperspectivetakingsubscale.Table4Zero-OrderandPartial-OrderCorrelationsofProsocialBehaviortoLaboratoryMeasuresofProsocialBehavioroftheTotalSampleLaboratorymeasuresProsocialbehaviorEmpathicconcernUpliftingfilm.16Distressingfilm.30PersonaldistressUpliftingfilm.11Distressingfilm.24PhysiologicalactivationUpliftingfilm.08Distressingfilm.04Inter-beatintervalUpliftingfilm.14Distressingfilm.16Note.Correlationswithempathicconcernandpersonaldistresstothefilmsarepartialcorrelations,controllingforbaselineempathicconcernandbaselinepersonaldistress,respectively.Correlationswithphysiologicalactivationarezero-ordercorrelations.p.05.p.01.1136SZE,GYURAK,GOODKIND,ANDLEVENSON
ences.Traitempathyandpastdonationhistoryweresignificantpredictorsofprosocialbehavior,butevenaftercontrollingforthesefactors,age-relatedincreasesremainedsignificant.Ourevidenceforage-relatedincreasesinemotionalempathyandprosocialbehaviorwasquiterobust,generalizingacrossemo-tionaldomains(i.e.,bothself-reportandphysiology),physiologi-calsystems(bothcardiovascularandelectrodermal),andcontexts(bothinthelaboratoryandinreportedrecentcharitablecontribu-tionsoutsidethelaboratory).Althoughmostage-relatedincreasesinemotionalempathyandprosocialbehaviorwereexhibitedacrossbothfilms,thereweresomefindingsthatwerespecificastofilm.Age-relatedincreasesinpersonaldistresswereonlyfoundforthedistressingfilm.Thebasisforthisspecificitymaybefoundinthenatureofthetwofilms.WhereastheSurfersHealingfilmdepictsindividualsafflictedbyaparticularformofpsychopathol-ogy,theindividualsinthefilmareclearlyshownhavingfunandovercomingtheirlimitations.TheDarfurfilmisquitedifferent,depictingindividualsindistresswhoareclearlysufferingandseemquitehelpless.Distressisapowerfulstimulusforempathicandprosocialresponding(Hoffman,1975;Zahn-Waxler,Fried-man,&Cummings,1983).Webelievethatsensitivitytothecombinationofdistressandneed(asembodiedintheDarfurfilm)isparticularlyintensifiedwithage.Thiswouldbeconsistentwithpriorfindingsofheightenedsensitivityamongolderadultstosituationscharacterizedbylossthatengendersadnessandpity(Kunzmann&Gruhn,2005;Palmore,1974;Seider,Shiota,Whalen,&Levenson;Weiner&Graham,1989).EmotionalEmpathyandProsocialBehaviorContemporarytheoriesofempathyoftenaffordimportancetoprocessesofemotionalactivationwithintheobserver.Thisacti-vationcanbefairlyautomatic,representingaformofmimicry(Preston&deWaal,2003)orresultfrommorecomplexprocess-ing(Eisenberg&Miller,1987;Singer,2006).Thisactivationcanplayanimportantroleinmotivatingsubsequentbehaviors,includ-ingprosocialactsthatmayhavebenefitsforboththeobserver(e.g.,reducingarousal)andforthepersoninneed.Empathicconcernandcardiacreactivitytobothfilms,alongwithpersonaldistresstothedistressingfilmonly,wereallassociatedwithgreaterprosocialbehavior.Whereasearlierstudieshavedemon-stratedthatsimilarconnectionsexistinearlydevelopment(Eisen-berg&Miller,1987),thepresentstudyindicatesthattheyalsoexistinlate-lifeadultdevelopment.Moreover,thepartialmedia-Table5StandardizedRegressionCoefficientsPredictingProsocialBehavior(TotalLaboratoryDonations)VariableAgeonlymodelEmotionalempathymodelParticipantcharacteristicsmodelParticipantcharacteristics:IncomeÑÑ.02SocialdesirabilityÑÑ.05CharityperceptionsÑÑ.01PastdonationÑÑ.15TraitECÑÑ.20TraitPDÑÑ.10TraitPTÑÑ.06Emotionalempathycovariates:BaselineECÑ.03.06BaselinePDÑ.02.05Emotionalempathypredictors:FilmECÑupliftingÑ.06.10FilmECÑdistressingÑ.27.26FilmPDÑdistressingÑ.08.07IBIÑupliftingÑ.14.15IBIÑdistressingÑ.04.03R2incrementÑ.12.078FincrementÑ5.313.46DfÑ200189FÑ3.842.31Age:Ovs.YandM.21.20.20Yvs.MandO.05.02.00R2incrementwithAge.057.040FincrementwithAge6.304.153.49Df210198187F6.304.012.51Note.O,M,andYOlder,Middle-aged,andYoungparticipants,respectively.TraitEC,PD,andPTEmpathicConcern,PersonalDistress,andPerspectiveTakingsubscalesoftheIRI.BaselineandFilmECandPDEmpathicConcernandPersonalDistressatbaselineandtothefilms.Dashes(Ñ)indicatethatvariableswerenotenteredintothemodel.PredictorvariableswerecenteredonthegrandmeanasrecommendedbyAiken&West(1991).p.05.p.01.1137EMPATHYANDPROSOCIALBEHAVIORINLATELIFE
tionofagedifferencesindonationsbyaspectsofself-reportedempathicconcernsuggeststhatsomeaspectsofthisrelationshipmayactuallystrengthenasweage.AgingandEmpathyOurfindingsofage-relatedincreasesinemotionalempathyandprosocialbehaviorrepresentaquitedifferenttrajectoryfromtheage-relateddeclinesthathavebeenfoundincognitiveempathy(Ruffmanetal.,2008),traitempathy(Eisenberg&Miller,1987),aswellasinmanyareasofgeneralcognitive(Salthouse,2004)andphysical(Liu&Lapane,2009)functioning.Attheveryleast,age-relatedincreasesinemotionalempathyandprosocialbehaviorargueagainstreducingagingtosimplyaprocessofloss.Increasedemotionalempathyandprosocialbehaviorwithagemayreflectanumberofotherchangesthatarethoughttocomewithage,includingthefollowing:(a)increasedemotionalreactivitytosit-uationssignalingtheneedforhelpingorreparation(Charles,2005;Kliegeletal.,2007;Kunzmann&Gruhn,2005;Phillipsetal.,2008;Seideretal.);(b)increasedsalienceofloss(Palmore,1974);(c)shiftsawayfromself-andfuture-orientedgoalstosocialandemotionallymeaningfulones(Carstensenetal.,2003;Erikson,1982;Fisher,1995;Vaillant,2003);and(d)anevolutionarilyadaptive(Gurven&Kaplan,2009)anddevelopmentallyappropri-ate(Erikson,1982;Fisher,1995;Vaillant,2003)emphasisonsocialcontributionandgenerativityinlaterlife.Viewedinthislight,ourfindingsarefarfromisolated,butratherlendempiricalsupporttoadiversesetoftheoriesaboutthenatureofemotional-ity,motivation,andlate-lifedevelopment.LimitationsandStrengthsOneimportantlimitationofthepresentstudyincludedouruseofacross-sectionaldesign,whichmakesfoundagedifferencesinemotionalempathyandprosocialbehaviorvulnerabletocohortandsurvivorshipeffects.Forexample,membersofouroldercohortgrewupduringthepost-WWIIera,andtheirexperienceswithsufferinganddistressmighthaveledtotheirhavingagreatercapacityforemotionalempathyandprosocialbehaviortoothersinneed.Otherlimitationsincludethefollowing:(a)ourmeasureofincome(wehadnomeasureofsatisfactionwithincome,whichcanshowagedifferences;Francoeur,2002);and(b)ourlimitedmea-suresofprosocialbehavior(onlymonetarygivinginsideandoutsidethelaboratory).Intherealmofstrengths,toourknowledgethisisthefirststudyofagedifferencesinemotionalempathyandprosocialbehaviorthathascombinedthefollowing:(a)examiningthreeagegroups;(b)assessingbothsubjectiveandphysiologicalaspectsofemo-tionalempathy;(c)utilizingobjectivebehavioralmeasuresofprosocialbehavior;(d)includingfilmsofpeopleinneedwithmultiplethemes;(e)evaluatingthecontributionofemotionalem-pathytoagedifferencesinprosocialbehaviorintheseagegroups;and(f)evaluatinganumberofviablealternativeexplanationsforfoundagedifferences.AConcludingThoughtUnderstandingthetrajectoriesofchangeinemotionalempathyandprosocialbehaviorinnormalaginggreatlyenrichesourun-derstandingbothofadultdevelopmentandofthenatureofthesevitalaspectsofhumanemotion.Characterizingthekindsofage-relatedincreasesinemotionalempathyandprosocialbehaviorthatwerefoundinthisstudyasÒgoodÓmayseemsimpleandobvious.Afterall,emotionalempathyandprosocialbehaviorarewidelyviewedasconstitutinganimportantpartofthesocialgluethatenablesustoformandmaintainlastinginterpersonalbonds(Schonert-Reichl,1993),actintheinterestofthegreatergood,andpromotepositivefeelingsinself(Dunn,Aknin,&Norton,2008;Molletal.,2006)andothers.However,aswithmostthingsemotional,thereisanotherside.Age-relatedincreasesinemo-tionalempathyandprosocialbehaviortowardothersinneedcancontributetoolderadultsÕgreatersusceptibilitytodeceptionandfraud(Tueth,2000).Thus,therecipeforsuccessfulaginginthisparticulardomainofemotionalfunctioningwillrequiremaximiz-ingthoseaspectsofempathyandprosocialbehaviorthatcontrib-utetothegreatersocialgoodandminimizingthosethatdonot.ReferencesAiken,L.S.,&West,S.G.(1991).Multipleregression:Testingandinterpretinginteractions.NewburyPark,CA:SagePublications.Antonovsky,A.,&Sagy,S.(1990).Confrontingdevelopmentaltasksintheretirementtransition.Gerontologist,30,362Ð368.doi:10.1093/geront/30.3.362Bailey,P.,Henry,J.D.,&vonHippel,W.(2008).Empathyandsocialfunctioninginlateadulthood.AgingandMentalHealth,12,499Ð503.doi:10.1080/13607860802224243Batson,C.D.(1987).Prosocialmotivation:Isitevertrulyaltruistic?InL.Berkowitz,(Ed.),Advancesinexperimentalsocialpsychology,20(pp.65Ð122).SanDiego,CA:AcademicPress.doi:10.1016/S0065-2601(08)60412-8Batson,C.D.(1990).Howsocialananimal?Thehumancapacityforcaring.AmericanPsychologist,45,336Ð346.doi:10.1037/0003-066X.45.3.336Batson,C.D.,Batson,C.D.,Griffitt,C.A.,Barrientos,S.,Brandt,J.R.,Sprengelmeyer,P.,&Bayly,M.J.(1989).Negative-statereliefandtheempathyÐaltruismhypothesis.JournalofPersonalityandSocialPsy-chology,56,922Ð933.Batson,C.D.,Darley,J.M.,&Coke,J.(1978).Altruismandhumankindness:Internalandexternaldeterminantsofhelpingbehavior.InL.A.PervinandM.Lewis(Eds.),Perspectivesininteractionalpsychol-ogy(111Ð140).NewYork,NY:PlenumPress.Batson,C.D.,Fultz,J.,&Schoenrade,P.A.(1994).Distressandempathy:Twoqualitativelydistinctvicariousemotionswithdifferentmotivationalconsequences.InB.Puka(Ed.),Reachingout:Caring,altruismandprosocialbehavior(57Ð75).NewYork,NY:Garland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