Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Wednesday, November 30, 2022

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew Wynia
September 15, 2022
N Engl J Med 2022; 387:959-961
DOI: 10.1056/NEJMp2210192

Here is an excerpt:

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?

There are several arguments in favor of professional associations supporting civil disobedience by their members. First, collective civil disobedience by a professional group would avert the most common and powerful criticism leveled against civil disobedience, which is that it could lead to anarchy.

Civil disobedience is a “public, nonviolent, conscientious yet political act contrary to law,” carried out with the aim of bringing about a change in an unjust law.2 But respect for laws is necessary to maintain a civil society. Having each person choose which laws to obey and which to disobey is a recipe for chaos. The most well-known proponents of civil disobedience — Henry David Thoreau, Mahatma Gandhi, Martin Luther King, Jr. — all took seriously the threat of unrestrained disregard of laws under the guise of civil disobedience. In his 1963 Letter from Birmingham Jail, King argued that people must respect just laws, but he also wrote, “law and order exist for the purpose of establishing justice,” and he agreed with St. Augustine that “an unjust law is no law at all.” He described a “moral responsibility to disobey unjust laws” and laid out criteria to help people decide when laws, such as those upholding racial segregation, are sufficiently unjust as to warrant open disobedience. Gandhi was even more worried about chaos and launched hunger strikes to rein in his own supporters when he believed they had gone too far in their disobedience of laws.

But professional civil disobedience poses little threat of anarchy. Unlike a situation in which each person decides whether to obey or disobey a law, a professional group’s deciding together, after frank and rational debate, to support disobedience of an unjust law might eventually reinforce social cohesion, elevate trust in the profession, and help communities avoid tragic errors. Professions, after all, are expected to protect vulnerable people and core social values. Such a decision would still be contentious, however. Civil disobedience is nonviolent, but it elevates and highlights conflict and often leads to violence against people disobeying the law. Professional civil disobedience would undoubtedly require tremendous courage.

Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

Tuesday, November 29, 2022

The Supreme Court has lost its ethical compass. Can it find one fast?

Ruth Marcus
The Washington Post
Originally published 23 Nov 22

The Supreme Court must get its ethics act together, and Chief Justice John G. Roberts Jr. needs to take the lead. After a string of embarrassments, the justices should finally subject themselves to the kind of rules that govern other federal judges and establish a standard for when to step aside from cases — one that is more stringent than simply leaving it up to the individual justice to decide.

Recent episodes are alarming and underscore the need for quick action to help restore confidence in the institution.

Last week, the Supreme Court wisely rebuffed an effort by Arizona GOP chair Kelli Ward to prevent the House Jan. 6 committee — the party in this case — from obtaining her phone records. The court’s brief order noted that Justice Clarence Thomas, along with Justice Samuel A. Alito Jr., would have sided with Ward.

Thomas’s involvement, though it didn’t affect the outcome of the dispute, is nothing short of outrageous. Federal law already requires judges, including Supreme Court justices, to step aside from involvement in any case in which their impartiality “might reasonably be questioned.”

Perhaps back in January, when he was the only justice to disagree when the court refused to grant former president Donald Trump’s bid to stop his records from being turned over to the Jan. 6 committee, Thomas didn’t realize the extent of his wife’s involvement with disputing the election results. (I’m being kind here: Ginni Thomas had signed a letter the previous month calling on House Republicans to expel Reps. Liz Cheney of Wyoming and Adam Kinzinger of Illinois from the House Republican Conference for participating in an “overtly partisan political persecution.”)

But here’s what we know now, and Justice Thomas does, too: The Jan 6. committee has subpoenaed and interviewed his wife. We — and he — know that she contacted 29 Arizona lawmakers, urging them to “fight back against fraud” and choose a “clean slate of electors” after the 2020 election.

Some recusal questions are close. Not this one. Did the chief justice urge Thomas to recuse? He should have. This will sound unthinkable, but if Roberts asked and Thomas refused, maybe it’s time the chief, or other justices, to publicly note their disagreement.


One obvious step is to follow the ethics rules that apply to other federal judges, perhaps adapting them to the particular needs of the high court. That would send an important — and overdue — message that the justices are not a law unto themselves. It’s symbolic, but symbolism matters.

Monday, November 28, 2022

What is behind the rise in girls questioning their gender identity?

Amelia Gentleman
The Guardian
Originally posted 24 Nov 22

Here is an excerpt:

The trend was confirmed by clinicians who spoke to the Guardian.

“In the past few years it has become an explosion. Many of us feel confused by what has happened, and it’s often hard to talk about it to colleagues,” said a London-based psychiatrist working in a child and adolescent mental health unit, who has been a consultant for the past 17 years.

Like all NHS employees interviewed, she asked for anonymity due to the sensitivity of the subject.

“I might have seen one child with gender dysphoria once every two years when I started practising. It was very niche and rare.” Now, somewhere between 10% and 20% of her caseload is made up of adolescents registered as female at birth who identify as non-binary or trans, with just an occasional male-registered teenager who identifies as trans.

Another senior child psychiatrist said girls who wanted to transition made up about 5% of her caseload.

“In the last five to 10 years we’ve seen a huge surge in young women who, at the age of around 12 or 13, want to become boys. They’ve changed their name and they are pressing … to have hormones or puberty blockers”

The psychiatrist added: “Often those girls are children who are going through the normal identity and developmental problems of adolescence and finding a solution for themselves in this way.”

Greater awareness of trans issues is likely to be one common-sense explanation for the rise in requests for referrals.

“Left-handedness increased over time after we stopped punishing left-handed children in schools, because some children are naturally left-handed and were now able to express it,” said Cleo Madeleine, a spokesperson for the trans support group Gendered Intelligence.

“In the same way, increased visibility and acceptance of trans people has led to a gradual increase in young people who feel comfortable expressing their trans identity. The most important thing is to recognise that this is not a problem to be solved or a bad outcome to be avoided.”

The mother of a 17-year-old A-level student (who came out as trans at 13, leaving a handwritten letter for his parents on his bed) agreed: “It’s discussed so much more – on Facebook and on social media. It’s no longer a taboo.”

She is confident this was the right decision for her child. “I think I wondered if this was a phase, but I didn’t look to dissuade him. As he began to socially transition he was a different person. It has made him happier,” she said.

Sunday, November 27, 2022

Towards a Social Psychology of Cynicism

Neumann, E., & Zaki, j. (2022, September 13).


Cynicism is the attitude that people are primarily motivated by self-interest. It tracks numerous negative outcomes, and yet many people are cynical. To understand this “cynicism paradox,” we review and call for more social psychological work on how cynicism spreads, with implications for how we might slow it down.

The Cynicism Paradox

Out of almost 8,000 respondents from 41 countries, many agree that “powerful people tend to exploit others” or that “kind-hearted people usually suffer losses”. This indicates widespread cynicism, the attitude that people are primarily motivated by self-interest, often accompanied by emotions such as contempt, anger, and distress, and antagonistic interactions with others. What explains such cynicism? Perhaps it reflects a realistic perception of the suffering caused by human self-interest. But workin social psychology regularly demonstrates that attitudes are not always perfect  mirrors of reality.  We will argue  that  people  often  overestimate self-interest,  create  it through their expectations, or overstate their own to not appear naïve. Cynicism rises when people witness self-interest, but social psychology –so far relatively quiet on the topic –can explain why they get trapped in this worldview even when it stops tracking reality.

Cynicism is related, but not reducible to, a lack of trust. Trust is often defined as accepting vulnerability based on positive expectations of others. Generalized trust implies a general tendency to  have  positive  expectations  of  others,  and  shares  with  cynicism  the  tendency  to  judge  the character of a whole group of people. But cynicism is more than reduced positive expectations.It entails a strongly negative view of human nature. The intensity of cynicism’s hostility further differentiates it from mere generalized distrust. Finally, while people can trust and distrust others’ competence,  integrity,  and  predictability,  cynicism  usually  focuses  on  judgments  of  moral character.  This  differentiates  cynicism  from  mere  pessimism,  which  encompasses  any  negative beliefs about the future, moral or non-moral alike. 

Direct applications to psychotherapy.

Saturday, November 26, 2022

Why are scientists growing human brain cells in the lab?

Hannah Flynn
Medical News Today
Originally posted 24 OCT 22

Here is an excerpt:

Ethical boundaries

One of the limitations of using organoids for research is that it is observed in vitro. The way an organ might act in a system, in connection with different organs, or when exposed to metabolites in the blood, for example, could be different from how it behaves when cells are isolated in a single tissue.

More recently, researchers placed an organoid derived from human cells inside the brain of a rat, in a study outlined in Nature.

Using neural organoids that had been allowed to self-organize, these were implanted into the somatosensory cortex — which is in the middle of the brain — of newborn rats. The scientists then found that these cortical organoids had grown axons throughout the rat brain, and were able to contribute to reward-seeking behavior in the rat.

This breakthrough suggested that the lab-created cells are recognizable to other tissues in the body and can influence systems.

Combining the cells of animals and humans is not without some ethical considerations. In fact, this has been the focus of a recent project.

The Brainstorm Organoid Project published its first paper in the form of a comment piece outlining the benefits of the project in Nature Neuroscience on October 18, 2022, the week after the aforementioned study was published.

The Project brought together prominent bioethicists as part of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative of the US National Institutes of Health, which funded the project.

Co-author of the comment piece Dr. Jeantine E Lunshof, head of collaborative ethics at the Wyss Institute for Biologically Inspired Engineering at Harvard University, MA, told Medical News Today in an interview that existing biomedical research and animal welfare guidelines already provide a framework for this type of work to be done ethically.

Pointing to the International Society for Stem Cell Research guidelines published last year, she stated that those do cover the creation of chimeras, where cells of two species are combined.

These hybrids with non-primates are permitted, she explained: “This is very, very strong emphasis on animal welfare in this ISSCR guideline document that also aligns with existing animal welfare and animal research protocols.”

The potential benefits of this research needed to be considered, “though at this moment, we are still at the stage that a lot of fundamental research is necessary. And I think that that really must be emphasized,” she said.

Friday, November 25, 2022

White (but Not Black) Americans Continue to See Racism as a Zero-Sum Game; White Conservatives (but Not Moderates or Liberals) See Themselves as Losing

Rasmussen, R., Levari, D. E.,  et al.
Perspectives on Psychological Science, 0(0).


In a 2011 article in this journal entitled “Whites See Racism as a Zero-Sum Game That They Are Now Losing” (Perspectives on Psychological Science, 6, 215–218), Norton and Sommers assessed Black and White Americans’ perceptions of anti-Black and anti-White bias across the previous 6 decades—from the 1950s to the 2000s. They presented two key findings: White (but not Black) respondents perceived decreases in anti-Black bias to be associated with increases in anti-White bias, signaling the perception that racism is a zero-sum game; White respondents rated anti-White bias as more pronounced than anti-Black bias in the 2000s, signaling the perception that they were losing the zero-sum game. We collected new data to examine whether the key findings would be evident nearly a decade later and whether political ideology would moderate perceptions. Liberal, moderate, and conservative White (but not Black) Americans alike believed that racism is a zero-sum game. Liberal White Americans saw racism as a zero-sum game they were winning by a lot, moderate White Americans saw it as a game they were winning by only a little, and conservative White Americans saw it as a game they were losing. This work has clear implications for public policy and behavioral science and lays the groundwork for future research that examines to what extent racial differences in perceptions of racism by political ideology are changing over time.


Our results suggest that zero-sum thinking about racism pervades the entire political ideological spectrum among White Americans; even liberal White Americans believe that gains for Black people mean losses for White people. However, views of whether and by how much White people are seen as now winning or losing the zero-sum game vary by political ideology. Liberal, moderate, and conservative White Americans agree that White people were winning the zero-sum racism game in the past. They disagree on the outcome more recently; in the most recent decade, liberal White Americans see it as a game they are still winning by a lot, moderate White Americans see it as a game they are still winning but by a little, and conservative White Americans see racism as a zero-sum game they are now losing by a little.

Win or lose, why do White Americans, even liberal White Americans, view racism as a zero-sum game? The zero-sum pattern may be a logical consequence of structural racism, “racial practices that reproduce racial inequality in contemporary America [that] (1) are increasingly covert, (2) are embedded in normal operations of institutions, (3) avoid direct racial terminology, and (4) are invisible to most Whites” (Bonilla-Silva, 1997, p. 476). Racial progress by Black Americans may signal deviation from normal operations of American institutions, which is perceived as a threat to White Americans that motivates them to reassert cultural dominance (Wilkins et al., 2021).

Thursday, November 24, 2022

Powerlessness Also Corrupts: Lower Power Increases Self-Promotional Lying

Li, H.(., Chen, Y., & Hildreth, J.A. (2022).
Organization Science.


The popular maxim holds that power corrupts, and research to date supports the view that power increases self-interested unethical behavior. However, we predict the opposite effect when unethical behavior, specifically lying, helps an individual self-promote: lower rather than higher power increases self-promotional lying. Drawing from compensatory consumption theory, we propose that this effect occurs because lower power people feel less esteemed in their organizations than do higher power people. To compensate for this need to view themselves as esteemed members of their organizations, lower power individuals are more likely to inflate their accomplishments. Evidence from four studies supports our predictions: compared with those with higher power, executives with lower power in their organizations were more likely to lie about their work achievements (Study 1, n = 230); graduate students with lower power in their Ph.D. studies were more likely to lie about their publication records (Study 2, n = 164); and employees with lower power were more likely to lie about having signed a business contract (Studies 3 and 4). Mediation analyses suggest that lower power increased lying because lower power individuals feel lower esteem in their organizations (Study 3, n = 562). Further supporting this mechanism, a self-affirmation intervention reduced the effect of lower power on self-promotional lying (Study 4, n = 536). These converging findings show that, when lies are self-promotional, lower power can be more corruptive than higher power.


The popular maxim that power corrupts has long held sway over the public imagination, but recently, scholarly research has challenged the universality of this maxim and added an important modifier: power corrupts when corruption is selfish in nature. In the current research, we drive another nail into this maxim’s coffin, finding that lower rather than higher power can increase certain self-interested unethical behaviors.  Specifically, we find that lower power increases self-promotional lying because it triggers the aversive feeling of low esteem. Therefore, the effects of power on corruption depend critically on the motivations underlying a particular unethical behavior. Even when corruption is self-interested in nature, power need not always corrupt.

Wednesday, November 23, 2022

You Can't Win at Morality

Kurt Gray, Will Blakey, and Carlos Rebollar
Moral Understanding Substack
Originally posted 26 OCT 22

Here is an excerpt:

Moral Ideals

Most of us want to do good in the world, and follow a set of moral guidelines, or “ideals.” But the word “ideals” has dangerous roots. The etymology of the very word “ideal” implies perfection, which we authors believe is bad.

 In 1796, Immanuel Kant used the word “ideal” to describe a hypothetically perfect person, thing, or state. It may have been easy for Kant to fetishize the perfect moral person, but it’s not clear that he is the best role model for us modern people (or anyone else). Kant was a weird guy. He once likened sex to sucking dry a lemon (scholars think he died a virgin), he thought you had to tell the truth even if it meant the slaughter of an innocent family, and he thought it was a good idea to get a portrait taken that highlighted his giant bald forehead and left most of his face in darkness (see picture).

Despite Kant’s questionable judgment, an ideal-driven ethics is widely promoted. Christianity’s most popular role model is Jesus, and they say he was perfect. Tony Robbins, self-help guru, says that we should become the best version of ourselves. The reasoning goes, “if our ideals are unachievable, that’s the whole point! They’re supposed to make you shoot for the moon.” This is why Kant’s idealism is so seductive. We think it’ll make us never stop improving ourselves. When it comes to role models, we don’t search for pretty good people, we search for moral perfection and emulate it to the best of our abilities.

As advocates for increasing moral understanding in the world, we are not arguing that people should stop striving to do good. But we do think that the quest for moral perfection can lead us astray. “The perfect is the enemy of the good” is a quote that’s useful in a lot of cases, but it’s especially useful when it comes to morality.

We argue that striving for moral perfection or “trying to win at morality,” has at least two main drawbacks: First, it can contribute to unhealthy thinking, and second, it can deter us from taking steps in the right direction. Instead, we propose that striving for more moral good (not the most) and practicing moral humility can help us do good in the world around us.

Anxiety is the Dizziness of Freedom… When Your Goal is Perfection

Achieving moral perfection is tricky because, as we saw with Janet, answers to the “most moral good” are uncertain. And this is a problem because uncertainty about big questions doesn’t feel good.

Take these big questions: Is God real? Are we living in a simulation? Why are we here and what is the meaning of life? For many, the uncertainty inherent in these questions is a background feature of life. But for others, including me (Will), it is too often an anxiety-provoking challenge. I struggle with “existential OCD,” a psychological disorder involving anxiety resulting from intrusive thoughts and discomfort about these big life questions. Not knowing why we’re all here or where we’re all going often stresses me out. But I’ve largely been able to combat this stress through therapy and renegotiating a better relationship with uncertainty.

Tuesday, November 22, 2022

America Is Pursuing Happiness in All the Wrong Places

Arthur Brooks
The Atlantic
Originally posted 16 NOV 22

Here are two excerpt:

As a social scientist, I believe that happiness should be understood as a combination of three phenomena: enjoyment, satisfaction, and meaning. Enjoyment is pleasure consciously and purposefully experienced, so it can create a positive memory. Satisfaction is the joy of an achievement, the reward for a job well done.

And then, there’s meaning. You can make do without enjoyment for a while, and even without a lot of satisfaction. But without meaning, you will be utterly lost. That is the psychiatrist and Holocaust survivor Viktor Frankl’s argument in his classic book Man’s Search for Meaning. Without a sense of meaning—a sense of the why of our existence–our lives cannot be endured.

Here is a quick diagnostic tool I sometimes use to find out if someone has a good sense of their life’s meaning. I ask them two questions:
  1. Why do you exist?
  2. For what would you be willing to die?
There is no greater joy than seeing someone you love find their answers. I remember this in the case of my son Carlos. He struggled in high school, like so many adolescents, to find a sense of his life’s meaning.  After high school, he joined the military. Today, at 22, he is Corporal Carlos Brooks, Scout Sniper, Third Battalion, Fifth Marine Regiment, Weapons Company.


But my goal is not just to tell you our troubles. It is to suggest solutions. Let me propose three that we all can undertake.

First, share your secrets of meaning. When I explained the importance of faith, family, friendship, and work, perhaps you said to yourself, I practice those things! That’s great. But it’s not enough to practice these things in our own lives—we need to celebrate them openly and recommend them to others. We all need to preach what we practice. To keep quiet about your sources of meaning because you are worried about looking judgmental is an act of selfishness.

Second, go out of your way to reject identity politics, and tell our shared story as Americans instead. If we want to find our way back as a nation, we must repudiate the poison of grievance and victimization and work instead to reestablish a healthy sense of meaning by constructing a narrative for our country that includes all of us.

Please don’t dismiss this as impossibly idealistic. On the contrary, some of our most successful presidents, from Washington to Lincoln to Franklin D. Roosevelt, did exactly this in times of crisis and trouble—they told a shared story to unite Americans against a common threat rather than balkanizing our people against one another.

Monday, November 21, 2022

AI Isn’t Ready to Make Unsupervised Decisions

Joe McKendrick and Andy Thurai
Harvard Business Review
Originally published September 15, 2022

Artificial intelligence is designed to assist with decision-making when the data, parameters, and variables involved are beyond human comprehension. For the most part, AI systems make the right decisions given the constraints. However, AI notoriously fails in capturing or responding to intangible human factors that go into real-life decision-making — the ethical, moral, and other human considerations that guide the course of business, life, and society at large.

Consider the “trolley problem” — a hypothetical social scenario, formulated long before AI came into being, in which a decision has to be made whether to alter the route of an out-of-control streetcar heading towards a disaster zone. The decision that needs to be made — in a split second — is whether to switch from the original track where the streetcar may kill several people tied to the track, to an alternative track where, presumably, a single person would die.

While there are many other analogies that can be made about difficult decisions, the trolley problem is regarded to be the pinnacle exhibition of ethical and moral decision making. Can this be applied to AI systems to measure whether AI is ready for the real world, in which machines can think independently, and make the same ethical and moral decisions, that are justifiable, that humans would make?

Trolley problems in AI come in all shapes and sizes, and decisions don’t necessarily need to be so deadly — though the decisions AI renders could mean trouble for a business, individual, or even society at large. One of the co-authors of this article recently encountered his own AI “trolley moment,” during a stay in an Airbnb-rented house in upstate New Hampshire. Despite amazing preview pictures and positive reviews, the place was poorly maintained and a dump with condemned adjacent houses. The author was going to give the place a low one-star rating and a negative review, to warn others considering a stay.

However, on the second morning of the stay, the host of the house, a sweet and caring elderly woman, knocked on the door, inquiring if the author and his family were comfortable and if they had everything they needed. During the conversation, the host offered to pick up some fresh fruits from a nearby farmers market. She also said she doesn’t have a car, she would walk a mile to a friend’s place, who would then drive her to the market. She also described her hardships over the past two years, as rentals slumped due to Covid and that she is caring for someone sick full time.

Upon learning this, the author elected not to post the negative review. While the initial decision — to write a negative review — was based on facts, the decision not to post the review was purely a subjective human decision. In this case, the trolley problem was concern for the welfare of the elderly homeowner superseding consideration for the comfort of other potential guests.

How would an AI program have handled this situation? Likely not as sympathetically for the homeowner. It would have delivered a fact-based decision without empathy for the human lives involved.

Sunday, November 20, 2022

Telehealth is here to stay. Psychologists should equip themselves to offer it.

Hannah Calkins
The Monitor On Psychology
Vol. 53 No. 7, Print version: page 30

Telehealth continues to play a significant role in the health care industry. However, psychologists who offer both in-person and virtual services are poised to meet increased demand for flexible, accessible mental health care.

In 2020, psychologists responded to the onset of the COVID-19 pandemic by making a nearly universal pivot to telehealth. This rapid and widespread adoption was largely enabled by the federal government’s declaration of a public health emergency (PHE), which prompted several significant policy changes that made telehealth more feasible for both patients and providers.

Yet in the following year, an APA survey found that 50% of psychologists had moved to offering both in-person and virtual services to their patients, up from 30% in 2020. Additionally, Pew Research Center data showed that 25% of adults with ­low incomes do not own smartphones, and 40% of this group do not have broadband internet or computers at home, signaling significant concerns about telehealth equity.

This means that psychologists should prepare for a hybrid future in which they deliver services via both modalities.

“Telehealth is here to stay. In-person isn’t going away,” said Robin McLeod, PhD, a licensed psychologist and president and chief business development officer at Natalis Psychology in St. Paul, Minnesota. “I believe it is vital for most psychologists to be able and willing to provide both options for patients. It just makes good business sense.”

Meeting demand for telehealth

Like many other providers, those at McLeod’s large practice made a quick pivot to virtual care during the pandemic and now offer hybrid options.

“[Our] providers have returned to providing in-person care, which many of our patients welcomed,” said McLeod. “However, most every provider in our organization continues to provide telehealth services for those clients who prefer that.”

Similarly, Zixuan Wang, PsyD, of Encounter Psychotherapy in Gaithersburg, Maryland, also has a robust hybrid practice. However, prior to spring 2020, she had never seriously considered offering telehealth.

“I am so appreciative that technology has enabled us to provide telehealth services, as they have been proven to be effective and beneficial for so many people who need care,” she said.

Wang and McLeod’s stories are scaled-down versions of the broader narrative of telehealth during the pandemic: Rapid and sustained implementation out of necessity has led to a permanent change.

Saturday, November 19, 2022

Human mini-brains were transplanted into rats. Is this ethical?

Julian Savulescu
Originally posted 22 OCT 22

Here is an excerpt:

Are 'Humanized Rats' just rats?

In a world-first, scientists have transplanted human brain cells into the brains of baby rats, offering immense possibilities to study and develop treatment for neurological and psychiatric conditions.

The human brain tissue, known as brain organoids or “mini-organs”, are independent nerve structures grown in a lab from a person’s cells, such as their skin cells, using stem cell technology. Although they can’t yet replicate a full brain, they resemble features or parts of an embryonic human brain.

The study, published in the journal Nature on Oct 12, showed that the human organoids integrated into the rat brain and function, and were even capable of affecting the behaviour of the rats.

A few months later, up to one-sixth of the rat cortex was human. In terms of their biology, they were “humanised rats”.

This is an exciting discovery for science. It will allow brain organoids to grow bigger than they have in a lab, and opens up many possibilities of understanding how early human neurons develop and form the brain, and what goes wrong in disease. It also raises the possibility of organoids being used to treat brain injury.

Indeed, the rat models showed the neuronal defects related to one rare severe disease called Timothy Syndrome, a genetic condition that affects brain development and causes severe autism.

This is one step further along the long road to making progress in brain disease, which has proved so intransigent so far.

The research must go ahead. But at the same time, it calls for new standards to be set for future research. At present, the research raises no significant new ethical issues. However, it opens the door to more elaborate or ambitious research that could raise significant ethical issues.

Moral Status of Animals with Human Tissue

The human tissue transplanted into the rats’ brains were in a region that processes sensory information such as touch and pain.

These organoids did not increase the capacities of the rats. But as larger organoids are introduced, or organoids are introduced affecting more key areas of the brain, the rat brain may acquire more advanced consciousness, including higher rational capacities or self-consciousness.

This would raise issues of how such “enhanced” rats ought to be treated. It would be important to not treat them as rats, just because they look like rats, if their brains are significantly enhanced.

This requires discussion and boundaries set around what kinds of organoids can be implanted and what key sites would be targets for enhancement of capacities that matter to moral status.

Friday, November 18, 2022

When Patients Become Colleagues

Charles C. Dike
Psychiatric News
Published Online:27 Oct 2022

Dr. Jones, a psychiatrist in private practice, described to me a conundrum she was trying to resolve. A patient she has been treating for eight years with psychotherapy and medication was recently certified as a therapist. The patient intends to terminate treatment with her and set up a private practice in the same district as the psychiatrist. The new therapist is asking for a collaborative relationship with the psychiatrist in which he would refer patients to the psychiatrist for medication management. The psychiatrist is not comfortable with the proposal and worries that her deep knowledge of her ex-patient’s flaws would negatively influence her view of the patient as a therapist. Most importantly, however, she is concerned about the risks of boundary violations and a breach in confidentiality, for example, when patients ask about the relationship between the psychiatrist and their referring therapist, as often happens.

The APA Ethics Committee has received questions about similar situations. One such question involved a patient who had received psychiatric treatment at an institution for years and was now applying to work as a clinician at the same institution a decade later. In this case, the Ethics Committee affirmed the need for psychiatrists “to support the concept that treatment matters and that people can recover and live full lives by addressing the challenges of mental illness. Psychiatrists should model that seeking treatment is a healthful and positive behavior and not a stigmatized act that will forever preclude a person, once a patient, from joining a team of respected mental health professionals. A history of mental health treatment should not be used to ban employment; a history of appropriate qualifications and pursuit of necessary medical treatment should be positive indicators for employment.”

Nonetheless, every such situation requires deep reflection to avoid potential ethics breaches. In some cases, the guidance is clear. For example, it is unethical for a psychiatrist in a solo private practice to employ a former patient because the pre-existing doctor-patient relationship is likely to influence the working relationship on both sides with potential negative consequences. In Dr. Jones’s case, however, the situation has ethics considerations that need to be addressed. Here is the advice that I gave to Dr. Jones: After celebrating her patient’s success, she should schedule a private meeting to discuss the contours of their new professional relationship. She should clarify that it would be a challenge to be his psychiatrist in the future should he suffer a relapse and need care. Further, Dr. Jones should point out that a personal relationship with a former patient could be unethical, especially if intimate, and therefore, all social interactions should be avoided as much as possible. When it is not possible to avoid them, they should carefully manage their interactions, social or professional, making sure boundaries are not breached. Dr. Jones should also discuss possible circumstances that could insinuate to others that she and the therapist had a prior treatment relationship as any such acknowledgment on her part would be a breach of her patient’s confidentiality. The fact that her former patient discloses their relationship to others does not absolve the psychiatrist of this ethical injunction. Such a discussion would prevent future problems and set the stage for the next chapter of their relationship.

Thursday, November 17, 2022

The Scientific Study of Consciousness Cannot and Should Not Be Morally Neutral

Mazor, M., Brown, S., Ciaunica, A., et al. (2022)
Perspectives on Psychological Science, 0(0).


A target question for the scientific study of consciousness is how dimensions of consciousness, such as the ability to feel pain and pleasure or reflect on one’s own experience, vary in different states and animal species. Considering the tight link between consciousness and moral status, answers to these questions have implications for law and ethics. Here we point out that given this link, the scientific community studying consciousness may face implicit pressure to carry out certain research programs or interpret results in ways that justify current norms rather than challenge them. We show that because consciousness largely determines moral status, the use of nonhuman animals in the scientific study of consciousness introduces a direct conflict between scientific relevance and ethics—the more scientifically valuable an animal model is for studying consciousness, the more difficult it becomes to ethically justify compromises to its well-being for consciousness research. Finally, in light of these considerations, we call for a discussion of the immediate ethical corollaries of the body of knowledge that has accumulated and for a more explicit consideration of the role of ideology and ethics in the scientific study of consciousness.


The animal-models-of-consciousness paradox

An instance in which the scientific community has failed to acknowledge the intimate link between consciousness and ethics is in the use of animal models of consciousness. Our focus here is on the use of animals that are assumed to be conscious as an opportunity to probe the underlying mechanisms of consciousness in ways that would not be ethically acceptable with human subjects. In such studies, animals are often captive and deprived of basic needs and undergo invasive procedures. At the same time, for these animals to be appropriate models for the study of consciousness, it has to be assumed that they are conscious. Because conscious capacities play a pivotal role in the attribution of moral status to animals, in these experiments, scientific validity and moral justification are in direct conflict. This conflict is particularly acute in the study of consciousness and subjective experience: That an animal is an adequate model for the study of consciousness makes it more likely to be capable of experiencing rich phenomenal states, self-awareness, or suffering and to have its life considered to be deserving of appropriate protection much more than being an appropriate model for the study of the immune system does.

In a recent study of the neural correlates of consciousness, researchers contrasted brain activation in awake, sleeping, and anesthetized macaque monkeys (Redinbaugh et al., 2020). For this study, two monkeys were kept in captivity, implanted with brain electrodes, and immobilized by sticking rods in a head implant during electrophysiological recordings. In another study from 2021, a behavioral measure of conscious awareness was reported in four caged rhesus monkeys (Ben-Haim et al., 2021). Scientists surgically implanted subjects with a metal extension to their skull for the purpose of restraining movement during experimental sessions and restricted subjects’ access to water at testing so that they were motivated to participate in the task for juice droplets. In a study from 2019 on the neural basis of introspection, researchers abolished parts of the prefrontal cortex of six caged macaque monkeys, which were killed at the end of the study (Kwok et al., 2019). In another study published in Science in 2020 (Nieder et al., 2020), a neural correlate of sensory consciousness was demonstrated in the brains of two male crows by implanting electrodes in their brains. These are mere examples of typical research practice in the field of invasive electrophysiology that conform with current ethical guidelines in place at a national level and are commonplace in many fields of study. Yet common to these studies is that their scientific relevance rests on the animal being conscious, whereas their ethical justification rests on the animal not deserving the same protection from suffering as a human subject.

Wednesday, November 16, 2022

‘What if Yale finds out?’

William Wan
The Washington Post
Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.
Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.


In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

Tuesday, November 15, 2022

Psychiatry wars: the lawsuit that put psychoanalysis on trial

Rachel Aviv
The Guardian
Originally posted 11 OCT 22

Here is an excerpt:

In the lawsuit, the 20th century’s two dominant explanations for mental distress collided. No psychiatric malpractice lawsuit has attracted more prominent expert witnesses than Ray’s, according to Alan Stone, the former president of the APA. The case became “the organising nidus” around which leading biological psychiatrists “pushed their agenda”, he told me.

At a hearing before an arbitration panel, which would determine whether the case could proceed to trial, the Lodge presented Ray’s attempt to medicalise his depression as an abdication of responsibility. In a written report, one of the Lodge’s expert witnesses, Thomas Gutheil, a professor of psychiatry at Harvard, observed that the language of the lawsuit, much of which Ray had drafted himself, exemplified Ray’s struggle with “‘externalisation’ – that is, the tendency to blame one’s problems on others”. Gutheil concluded that Ray’s “insistence on the biological nature of his problem is not only disproportionate but seems to me to be yet another attempt to move the problem away from himself: it is not I, it’s my biology.”

The Lodge’s experts attributed Ray’s recovery at Silver Hill at least in part to his romantic entanglement with a female patient, which gave him a jolt of self-esteem.

“It’s a demeaning comment,” Ray responded when he testified. “And it just speaks to the whole total disbelief in the legitimacy of the symptomatology and the disease.”

The Lodge lawyers tried to chip away at Ray’s description of depression, arguing that he had shown moments of pleasure at the Lodge, such as when he had played piano.

“The sheer mechanical banging of ragtime rhythms on that dilapidated old piano on the ward was almost an act of agitation rather than a creative pleasurable act,” Ray responded. “Just because I played ping-pong, or had a piece of pizza, or smiled, or may have made a joke, or made googly eyes at a good-looking girl, it did not mean that I was capable of truly sustaining pleasurable feelings.” He went on, “I would say to myself: ‘I am living, but I am not alive.’”

Manuel Ross, Ray’s analyst from the Lodge, testified for more than eight hours. He had read a draft of Ray’s memoir and he rejected the possibility that Ray had been cured by antidepressants. He was not a recovered man, because he was still holding on to the past. (“That’s what I call melancholia as used in the 1917 article,” he said, referring to Freud’s essay Mourning and Melancholia.)

Ross said that he had hoped Ray would develop insight at the Lodge. “That’s the true support,” he said, “if one understands what is going on in one’s life.” He wanted Ray to let go of his need to be a star doctor, the richest and most powerful in his field, and to accept a life in which he was one of the “ordinary mortals who labour in the medical vineyard”.

Ray’s lawyer, Philip Hirschkop, one of the most prominent civil rights attorneys in the country, asked Ross: “As an analyst, do you have to sometimes look inside yourself to make sure you’re not reacting to your own feelings about someone?”

“Oh yes,” Ross said. “Oh yes.”

“You who’ve locked yourself into one position for 19 years with no advancement in position other than salary, might you be a little resentful of this man who makes so much more money, and now he’s here as your patient?” Hirschkop asked.

Monday, November 14, 2022

Your Land Acknowledgment Is Not Enough

Joseph Pierce
Originally posted 12 OCT 22

Here is an excerpt:

Museums that once stole Indigenous bones now celebrate Indigenous Peoples’ Day. Organizations that have never hired an Indigenous person now admit the impact of Indigenous genocide through social media. Land-grant universities scramble to draft statements about their historical ties to fraudulent treaties and pilfered graves. Indeed, these are challenging times for institutions trying to do right by Indigenous peoples.

Some institutions will seek the input of an Indigenous scholar or perhaps a community. They will feel contented and “diverse” because of this input. They want a decolonial to-do list. But what we have are questions: What changes when an institution publishes a land acknowledgment? What material, tangible changes are enacted?

Without action, without structural change, acknowledging stolen land is what Eve Tuck and K. Wayne Yang call a “settler move to innocence.” Institutions are not innocent. Settlers are not innocent.

The problem with land acknowledgments is that they are almost never followed by meaningful action. Acknowledgment without action is an empty gesture, exculpatory and self-serving. What is more, such gestures shift the onus of action back onto Indigenous people, who neither asked for an apology nor have the ability to forgive on behalf of the land that has been stolen and desecrated. It is not my place to forgive on behalf of the land.

A land acknowledgment is not enough.

This is what settler institutions do not understand: Land does not require that you confirm it exists, but that you reciprocate the care it has given you. Land is not asking for acknowledgment. It is asking to be returned to itself. It is asking to be heard and cared for and attended to. It is asking to be free.

Land is not an object, not a thing. Land does not require recognition. It requires care. It requires presence.

Land is a gift, a relative, a body that sustains other bodies. And if the land is our relative, then we cannot simply acknowledge it as land. We must understand what our responsibilities are to the land as our kin. We must engage in a reciprocal relationship with the land. Land is — in its animate multiplicities — an ongoing enactment of reciprocity.

A land acknowledgment is not enough.

Sunday, November 13, 2022

Cross-cultural variation in cooperation: A meta-analysis

Spadaro, G., Graf, C., et al.
JPSP, 123(5), 1024–1088.


Impersonal cooperation among strangers enables societies to create valuable public goods, such as infrastructure, public services, and democracy. Several factors have been proposed to explain variation in impersonal cooperation across societies, referring to institutions (e.g., rule of law), religion (e.g., belief in God as a third-party punisher), cultural beliefs (e.g., trust) and values (e.g., collectivism), and ecology (e.g., relational mobility). We tested 17 preregistered hypotheses in a meta-analysis of 1,506 studies of impersonal cooperation in social dilemmas (e.g., the Public Goods Game) conducted across 70 societies (k = 2,271), where people make costly decisions to cooperate among strangers. After controlling for 10 study characteristics that can affect the outcome of studies, we found very little cross-societal variation in impersonal cooperation. Categorizing societies into cultural groups explained no variance in cooperation. Similarly, cultural, ancestral, and linguistic distance between societies explained little variance in cooperation. None of the cross-societal factors hypothesized to relate to impersonal cooperation explained variance in cooperation across societies. We replicated these conclusions when meta-analyzing 514 studies across 41 states and nine regions in the United States (k = 783). Thus, we observed that impersonal cooperation occurred in all societies-and to a similar degree across societies-suggesting that prior research may have overemphasized the magnitude of differences between modern societies in impersonal cooperation. We discuss the discrepancy between theory, past empirical research and the meta-analysis, address a limitation of experimental research on cooperation to study culture, and raise possible directions for future research. 


Humans cooperate within multiple domains in daily life, such as sharing common pool resources and producing large-scale public goods. Cooperation can be expressed in many ways, including strategies to favor kin (Hamilton, 1964), allies and coalitional members (Balliet et al., 2014; Yamagishi et al., 1999), and it can even occur in interactions among strangers with no known future interactions (Delton et al., 2011; Macy & Skvoretz, 1998).  Here, we focused on this later kind of impersonal cooperation, in which people interact for the first time, they have no knowledge of their partner’s reputation, and no known possibilities of future interaction outside the experiment. Impersonal cooperation can enable societies to  develop, expand, and compete, impacting wealth and prosperity. Although impersonal cooperation occurs in all modern, industrialized, market-based societies, prior research has documented cross-societal variation in impersonal cooperation (Henrich, Ensminger, et al., 2010; Hermann et al., 2008; Romano et al., 2021). To date, several perspectives have been advanced to explain why and how impersonal cooperation varies across societies. 

Saturday, November 12, 2022

Loss aversion, the endowment effect, and gain-loss framing shape preferences for noninstrumental information

Litovsky, Y. Loewenstein, G. et al.
PNAS, Vol. 119 | No. 34
August 23, 2022


We often talk about interacting with information as we would with a physical good (e.g., “consuming content”) and describe our attachment to personal beliefs in the same way as our attachment to personal belongings (e.g., “holding on to” or “letting go of” our beliefs). But do we in fact value information the way we do objects? The valuation of money and material goods has been extensively researched, but surprisingly few insights from this literature have been applied to the study of information valuation. This paper demonstrates that two fundamental features of how we value money and material goods embodied in Prospect Theory—loss aversion and different risk preferences for gains versus losses—also hold true for information, even when it has no material value. Study 1 establishes loss aversion for noninstrumental information by showing that people are less likely to choose a gamble when the same outcome is framed as a loss (rather than gain) of information. Study 2 shows that people exhibit the endowment effect for noninstrumental information, and so value information more, simply by virtue of “owning” it. Study 3 provides a conceptual replication of the classic “Asian Disease” gain-loss pattern of risk preferences, but with facts instead of human lives, thereby also documenting a gain-loss framing effect for noninstrumental information. These findings represent a critical step in building a theoretical analogy between information and objects, and provide a useful perspective on why we often resist changing (or losing) our beliefs.


We build on Abelson and Prentice’s conjecture that beliefs are not merely valued as guides to interacting with the world, but as cherished possessions. Extending this idea to information, we show that three key phenomena which characterize the valuation of money and material goods—loss aversion, the endowment effect, and the gain-loss framing effect—also apply to noninstrumental information. We discuss, more generally, how the analogy between noninstrumental information and material goods can help make sense of the complex ways in which people deal with the huge expansion of available information in the digital age.

From the Discussion

Economists have traditionally treated the value of information as derivative of its consequences for decision-making. While prior research on noninstrumental information has shown that this narrow view of information may be incomplete, only a few accounts have attempted to explain intrinsic preferences for information. One such account argues that people seek (or avoid) information inasmuch as doing so helps them maintain their cherished beliefs. Another proposes that people choose which information to seek or avoid by considering how it will impact their actions, affect, and cognition. Yet, outside of the curiosity literature, no existing account of information valuation considers preferences for information that has neither instrumental nor (concrete) hedonic value. By showing that key features of Prospect Theory’s value function also apply to individuals’ valuation of (even noninstrumental) information, the current paper suggests that we may also value information in some of the same fundamental ways that we value physical goods.

Friday, November 11, 2022

Moral disciplining: The cognitive and evolutionary foundations of puritanical morality

Fitouchi, L., André, J., & Baumard, N. (2022).
Behavioral and Brain Sciences, 1-71.


Why do many societies moralize apparently harmless pleasures, such as lust, gluttony, alcohol, drugs, and even music and dance? Why do they erect temperance, asceticism, sobriety, modesty, and piety as cardinal moral virtues? According to existing theories, this puritanical morality cannot be reduced to concerns for harm and fairness: it must emerge from cognitive systems that did not evolve for cooperation (e.g., disgust-based “Purity” concerns). Here, we argue that, despite appearances, puritanical morality is no exception to the cooperative function of moral cognition. It emerges in response to a key feature of cooperation, namely that cooperation is (ultimately) a long-term strategy, requiring (proximately) the self-control of appetites for immediate gratification. Puritanical moralizations condemn behaviors which, although inherently harmless, are perceived as indirectly facilitating uncooperative behaviors, by impairing the self-control required to refrain from cheating. Drinking, drugs, immodest clothing, and unruly music and dance, are condemned as stimulating short-term impulses, thus facilitating uncooperative behaviors (e.g., violence, adultery, free-riding). Overindulgence in harmless bodily pleasures (e.g., masturbation, gluttony) is perceived as making people slave to their urges, thus altering abilities to resist future antisocial temptations. Daily self-discipline, ascetic temperance, and pious ritual observance are perceived as cultivating the self-control required to honor prosocial obligations. We review psychological, historical, and ethnographic evidence supporting this account. We use this theory to explain the fall of puritanism in WEIRD societies, and discuss the cultural evolution of puritanical norms. Explaining puritanical norms does not require adding mechanisms unrelated to cooperation in our models of the moral mind.


Many societies develop apparently unnecessarily austere norms, depriving people from the harmless pleasures of life. In face of the apparent disconnect of puritanical values from cooperation, the latter have either been ignored by cooperation-centered theories of morality, or been explained by mechanisms orthogonal to cooperative challenges, such as concerns for the purity of the soul, rooted in disgust intuitions. We have argued for a theoretical reintegration of puritanical morality in the otherwise theoretically grounded and empirically supported perspective of morality as cooperation. For deep evolutionary reasons, cooperation as a long-term strategy requires resisting impulses for immediate pleasures. To protect cooperative interactions from the threat of temptation, many societies develop preemptive moralizations aimed at facilitating moral self-control. This may explain why, aside from values of fairness, reciprocity, solidarity or loyalty, many societies develop hedonically restrictive standards of sobriety, asceticism, temperance, modesty, piety, and self-discipline.

Thursday, November 10, 2022

Institutional betrayal, institutional courage and the church

Susan Shaw
Baptist News Global
Originally published 26 JUL 22

Betrayal by trusted people, like pastors, teachers, supervisors and coaches can inflict devastating consequences on victims. According to psychologists who study trauma, betrayal trauma affects the brain differently than any other trauma, particularly when the victim depends upon the perpetrator. Betrayal trauma threatens the very sense of self of the victim, who often cannot easily escape because of physical, psychological or spiritual dependence.

Institutional betrayal

When institutions don’t address perpetrators but rather meet survivors with denial, harassment and attack, they engage in institutional betrayal. Institutional betrayal occurs “when an institution causes harm to people who depend on it.”

Betrayal blindness describes ignoring, overlooking, “not-knowing” and forgetting betrayal. People, including victims themselves as well as perpetrators and witnesses, exhibit betrayal blindness to “preserve relationships, institutions and social systems upon which they depend.”

We don’t have to think very long to name a depressing list of instances of institutional betrayal by the church: segregation, clergy sex abuse, conversion therapy, exclusion of women from church leadership and ordained ministry, purity culture, the Magdalene laundries, witch hunts, Indian schools, on and on.

In recent days, we’ve seen institutional betrayal at work in megachurches like Hillsong and Highpoint, where popular pastors engaged in abusive conduct and their churches enabled them. The clergy abuse scandals in the Catholic Church and Southern Baptist Convention are textbook examples of institutional betrayal — institutions that chose to protect themselves rather than address the harm done to members.

Rather than challenging itself to create welcome, repair harm and do justice, the church often has chosen to preserve itself, to overlook harmful behavior by leaders and to demonize and ostracize those who speak out against abuse

Findley Edge, who taught religious education at Southern Baptist Theological Seminary, wrote about the process of institutionalization. Edge explained people developed great and exciting ideas, and these ideas lead to innovations and movements. As time goes along, these innovations and movements develop structure to continue to facilitate their growth. Eventually, the first generation that formed the great and exciting idea dies out, and soon people only know the institution and not the idea that sparked it. Their goal then becomes preservation of the institution, not the idea.

Uncritical dedication to the preservation of an institution can easily lead to institutional betrayal, especially when people depend upon organizations like the church, work or family.

Jennifer Freyd, the psychologist who coined “institutional betrayal,” says people protect institutions by participating in what she calls DARVO — Deny, Attack and Reverse Victim and Offender.

Wednesday, November 9, 2022

Functional neural changes associated with psychotherapy in anxiety disorders - A meta-analysis of longitudinal fMRI studies

Schrammen E, Roesmann K, Rosenbaum D, et al.
Neuroscience and Biobehavioral Reviews. 2022 


Successful psychotherapy for anxiety disorders is thought to be linked to functional neural changes in prefrontal control areas and fear-related limbic regions. Thus, discovering such therapy-associated neural changes might point to relevant mechanisms of action. Using AES-SDM, we conducted a coordinate-based meta-analysis of 22 whole-brain datasets (n = 419 anxiety patients) from 18 studies identified by our systematic literature search following PRISMA criteria (preregistration available at OSF: https://osf.io/dgc4p). In these studies, fMRI data was collected in response to negative stimuli during cognitive-emotional tasks before and after psychotherapy. Post-psychotherapy, activation decreased in the right insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex; no region had increased activation. A subgroup analysis for CBT revealed additional decrease in the supplementary motor area. Reduced activation in limbic and frontal regions might indicate therapy-associated normalization regarding the perception of internal and external threat, subsequent allocation of cognitive resources, and changes in cognitive control. Due to the integration of diverse treatments and experimental tasks, these changes presumably reflect global effects of successful psychotherapy.


• We conducted a coordinate-based meta-analysis of studies assessing fMRI pre- and post-therapy in anxiety disorders.

• Our results are based on whole-brain findings and include more than 50% original statistical maps.

• From pre to post, activation decreased in the insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex.

• Subgroup-analysis for CBT and exposure revealed an additional cluster of activation decrease in the supplementary motor area.

Tuesday, November 8, 2022

Fetal frontolimbic connectivity prospectively associates with aggression in toddlers

Hendrix, C. L., Ji, L.,  et al. (2022).
Biological Psychiatry Global Open Science. 

Aggression is a major public health concern that emerges early in development and lacks optimized treatment, highlighting need for improved mechanistic understanding of aggression etiology. The present study leverages fetal resting-state functional MRI (rsfMRI) to identify candidate neurocircuitry for the onset of aggressive behaviors, prior to symptom emergence.

Pregnant mothers were recruited during the third trimester of pregnancy to complete a fetal rsfMRI scan. Mothers subsequently completed the Child Behavior Checklist to assess child aggression at 3 years postpartum (N=79). Independent component analysis was used to define frontal and limbic regions of interest.

Child aggression was not related to within network connectivity of subcortical limbic regions or within medial prefrontal network connectivity in fetuses. However, weaker functional coupling between the subcortical limbic network and medial prefrontal network in fetuses was prospectively associated with greater maternal-rated child aggression at 3 years of age even after controlling for maternal emotion dysregulation and toddler language ability. We observed similar, but weaker, associations between fetal frontolimbic FC and toddler internalizing symptoms.

Neural correlates of aggressive behavior may be detectable in utero, well before the onset of aggression symptomatology. These preliminary results highlight frontolimbic connections as potential candidate neurocircuitry that should be further investigated in relation to the unfolding of child behavior and psychiatric risk.


In a prospective study of 79 mother-child dyads, we found that lower intrinsic functional coupling between medial prefrontal and limbic regions prior to birth was associated with greater maternal report of aggressive behavior when children reached 3 years of age. This association was specific to between network coactivation, as neither within-network connectivity of the mPFC nor within-network connectivity of the limbic network was associated with subsequent child aggression. Our results are consistent with extant fMRI studies showing links between aggressive behavior and altered frontolimbic circuitry in childhood, adolescence, and adulthood, and extend these findings to demonstrate prospective associations with frontolimbic connections measured prior to the onset of symptomatology and prior to birth.

Not quite Minority Report, but stunning nonetheless.

Monday, November 7, 2022

Neural processes in antecedent anxiety modulate risk-taking behavior

Nash, K., Leota, J., & Tran, A. (2021). 
Scientific Reports, 11.


Though real-world decisions are often made in the shadow of economic uncertainties, work problems, relationship troubles, existential angst, etc., the neural processes involved in this common experience remain poorly understood. Here, we randomly assigned participants (N = 97) to either a poignant experience of forecasted economic anxiety or a no-anxiety control condition. Using electroencephalography (EEG), we then examined how source-localized, anxiety-specific neural activation modulated risky decision making and strategic behavior in the Balloon Analogue Risk Task (BART). Previous research demonstrates opposing effects of anxiety on risk-taking, leading to contrasting predictions. On the one hand, activity in the dorsomedial PFC/anterior cingulate cortex (ACC) and anterior insula, brain regions linked with anxiety and sensitivity to risk, should mediate the effect of economic anxiety on increased risk-averse decision-making. On the other hand, activation in the ventromedial PFC, a brain region important in emotion regulation and subjective valuation in decision-making, should mediate the effect of economic anxiety on increased risky decision-making. Results revealed evidence related to both predictions. Additionally, anxiety-specific activation in the dmPFC/ACC and the anterior insula were associated with disrupted learning across the task. These results shed light on the neurobiology of antecedent anxiety and risk-taking and provide potential insight into understanding how real-world anxieties can impact decision-making processes. 


Rarely, in everyday life, must we make a series of decisions as anxious events fit in and out of awareness. Rather, we often face looming anxieties that spill over into the decisions we make. Here, we experimentally induced this real-world experience, in which we examined how antecedent anxiety and the accompanying neural processes modulated decision-making in a risk-taking task. Based on past research demonstrating that anxiety can have diverging effects on risk-taking, we formulated contrasting predictions. An anxious experience should modulate dmPFC/dACC and anterior insula activity, brain regions tightly linked with anxious worry, and this anxiety-specific activation should predict more risk-averse decisions in the BART. Alternatively, anxiety should modulate activation in the vmPFC, a brain region important in emotion regulation and decision-making and this anxiety-specific activation should then predict more risk-seeking decisions in the BART, through disrupted cognitive control or heightened sensitivity to reward.

We found evidence related to both predictions. On the one hand, right anterior insula activation specific to
antecedent anxiety predicted decreased risk-taking. This finding is consistent with considerable research on the neural mechanisms of risk and the limited prior research on incidental anxiety and decision-making. For example, the threat of shock during a decision-making task increased the anterior insula’s coding of negative evaluations and this activation predicted increased rejection rate of risky lottery decisions. For the first time, we extend these prior results to antecedent anxiety. The experience of economic anxiety is a poignant and difficult to regulate event. Presumably, right anterior insula activation caused by the economic anxiety manipulation sustained a more cautious approach to negative outcomes that trickled-down to risk-averse decision-making.