A Psychological Exploration of Zoom Fatigue

Jena Lee
Psychiatric Times
Originally published 27 July 20

Here is an excerpt:

This neuropathophysiology may explain other proposed reasons for Zoom fatigue. For example, if the audio delays inherent in Zoom technology are associated with more negative perceptions and distrust between people, there is likely decreased reward perceived when those people are videoconferencing with each other. Another example is direct mutual gaze. There is robust evidence on how eye contact improves connection—faster responses, more memorization of faces, and increased likeability and attractiveness. These tools of social bonding that make interactions organically rewarding are all compromised over video. On video, gaze must be directed at the camera to appear as if you are making eye contact with an observer, and during conferences with 3 or more people, it can be impossible to distinguish mutual gaze between any 2 people.

Not only are rewards lessened via these social disconnections during videoconferencing compared to in-person interactions, but there are also elevated costs in the form of cognitive effort. Much of communication is actually unconscious and nonverbal, as emotional content is rapidly processed through social cues like touch, joint attention, and body posture. These nonverbal cues are not only used to acquire information about others, but are also directly used to prepare an adaptive response and engage in reciprocal communication, all in a matter of milliseconds. However, on video, most of these cues are difficult to visualize, since the same environment is not shared (limiting joint attention) and both subtle facial expressions and full bodily gestures may not be captured. Without the help of these unconscious cues on which we have relied since infancy to socioemotionally assess each other and bond, compensatory cognitive and emotional effort is required. In addition, this increased cost competes for people’s attention with acutely elevated distractions such as multitasking, the home environment (eg, family, lack of privacy), and their mirror image on the screen. Simply put, videoconferences can be associated with low reward and high cost.

The info is here.

When a Patient Regrets Having Undergone a Carefully and Jointly Considered Treatment Plan, How Should Her Physician Respond?

L. V. Selby and others
AMA J Ethics. 2020;22(5):E352-357.
doi: 10.1001/amajethics.2020.352.

Abstract

Shared decision making is best utilized when a decision is preference sensitive. However, a consequence of choosing between one of several reasonable options is decisional regret: wishing a different decision had been made. In this vignette, a patient chooses mastectomy to avoid radiotherapy. However, postoperatively, she regrets the more disfiguring operation and wishes she had picked the other option: lumpectomy and radiation. Although the physician might view decisional regret as a failure of shared decision making, the physician should reflect on the process by which the decision was made. If the patient’s wishes and values were explored and the decision was made in keeping with those values, decisional regret should be viewed as a consequence of decision making, not necessarily as a failure of shared decision making.

(cut)

Commentary

This case vignette highlights decisional regret, which is one of the possible consequences of the patient decision-making process when there are multiple treatment options available. Although the process of shared decision making, which appears to have been carried out in this case, is utilized to help guide the patient and the physician to come to a mutually acceptable and optimal health care decision, it clearly does not always obviate the risk of a patient’s regretting that decision after treatment. Ironically, the patient might end up experiencing more regret after participating in a decision-making process in which more rather than fewer options are presented and in which the patient perceives the process as collaborative rather than paternalistic. For example, among men with prostate cancer, those with lower levels of decisional involvement had lower levels of decisional regret. We argue that decisional regret does not mean that shared decision making is not best practice, even though it can result in patients being reminded of their role in the decision and associated personal regret with that decision.

The info is here.

Americans want ‘moral, ethical’ president more than a religious one

Mark Wingfield
Baptist Global News
Originally published 31 July 20

Here is an excerpt:

Democrats were more likely than Republicans to say the personal morality and ethical behavior of a president matters. Among Democrats, 71% said this is “very important,” compared to 53% of Republicans.

However, Republicans were nearly three times more likely than Democrats to say it is important that a president share their own religious beliefs.

White evangelical Christians top the chart on seeing Trump as at least “somewhat religious,” a view held by 64% of this group, compared to only 35% of all Americans. Within that group, only 12% of white evangelicals believe Trump is “very religious.”

Pew Center research also discovered that while white evangelical Protestants may not see Trump as “moral and ethical,” they believe their own views of the world are “winning” with Trump’s leadership.

In this latest survey, 83% of white evangelicals identified with the Republican Party, which could be one factor in believing their side is winning. Other polling indicates that Trump’s policies — such as restrictions on immigration and attempts to preserve Confederate monuments — play a role in this assessment too.

The info is here.

The Role of Cognitive Dissonance in the Pandemic

Elliot Aronson and Carol Tavris
The Atlantic
Originally published 12 July 20

Here is an excerpt:

Because of the intense polarization in our country, a great many Americans now see the life-and-death decisions of the coronavirus as political choices rather than medical ones. In the absence of a unifying narrative and competent national leadership, Americans have to choose whom to believe as they make decisions about how to live: the scientists and the public-health experts, whose advice will necessarily change as they learn more about the virus, treatment, and risks? Or President Donald Trump and his acolytes, who suggest that masks and social distancing are unnecessary or “optional”?

The cognition I want to go back to work or I want to go to my favorite bar to hang out with my friends is dissonant with any information that suggests these actions might be dangerous—if not to individuals themselves, then to others with whom they interact.

How to resolve this dissonance? People could avoid the crowds, parties, and bars and wear a mask. Or they could jump back into their former ways. But to preserve their belief that they are smart and competent and would never do anything foolish to risk their lives, they will need some self-justifications: Claim that masks impair their breathing, deny that the pandemic is serious, or protest that their “freedom” to do what they want is paramount. “You’re removing our freedoms and stomping on our constitutional rights by these Communist-dictatorship orders,” a woman at a Palm Beach County commissioners’ hearing said. “Masks are literally killing people,” said another. South Dakota Governor Kristi Noem, referring to masks and any other government interventions, said, “More freedom, not more government, is the answer.” Vice President Mike Pence added his own justification for encouraging people to gather in unsafe crowds for a Trump rally: “The right to peacefully assemble is enshrined in the First Amendment of the Constitution.”

The info is here.

Why Do Social Identities Matter?

Linda Martín Alcoff
thephilosopher1923.0rg
Originally published

Here is an excerpt:

What has come to be known as identity politics gives a negative answer to these questions. If social identities continue to structure social interactions in debilitating ways, progress on this front requires showing varied identities in leadership, among other things, so that prejudices can be reformed. But the use of identities in this way can of course be manipulated. Certain experiences and interests might be implied when in reality there are no good grounds for either. For example, when President Donald Trump chose Ben Carson, an African American, to head up the federal department overseeing low-income, public housing, it appeared to be a choice of someone with an inside experience who would know first-hand the effects of government policies. Carson was not a housing expert, nor did he have any experience in housing administration, but his identity seemed like it might be helpful. When the appointment was announced, many applauded it, assuming that Carson must have lived in public housing, and neglected to investigate any further. Arkansas Governor Mike Huckabee claimed that Carson was the first Housing and Urban Development Secretary to have lived in public housing, and called Congresswoman Nancy Pelosi a racist for criticizing Carson’s credentials. Carson’s appointment helped to make President Trump appear to be making appointments with an eye toward an insider’s perspective, unless one checked the subsequent news outlets that explained Carson’s actual background. In fact, Carson never lived in public housing. As a neurosurgeon, it is far from clear what in Carson’s background prepared him for a role leading the federal housing department other than the superficial feature of his racial background.

Clearly, social identities are not always misleading in this way, but they can be purposefully used to misdirect. They can also be used to manufacture or heighten conflict. Allowing housing discrimination to continue to flourish has created significant differences in real estate values across neighbourhoods with different ethnic and racial constitutions, causing the most substantial part of the differences in wealth between groups. These differences, and the related differences of interest that result, are not a natural outcome of racial differences, but the product of real estate policies and practices that segregated neighbourhoods and orchestrated economic disparities that would cross multiple generations. It is important to understand the conflicts of interest that result from such differences as produced by political policy, rather than being reflective of natural or pre-political conflicts. While our shared identities can signal true commonalities, we need to ask: what is the true source of these commonalities?

The info is here.

How to Fix Science's Diversity Problem

Benjamin Deen
Scientific American
Originally posted 11 July 20

Here is an excerpt:

As bothered as I was by my own behavior, I’m inspired by the simplicity of the fix: just flag the importance of representation when making decisions about who exists and is heard in academia. Scientists at all levels make these decisions. As trainees, we decide whom to cite in our manuscripts, whose research to read and engage with. Later, we begin choosing people to invite to talks, and students to mentor. Ultimately, as senior scientists, we have an even more direct gatekeeping role, deciding whom to hire and, thus, who constitutes the scientific enterprise. These choices are all levers that can be used to nudge the system away from its default, white male–heavy state.

We tend to think about racism as a personality trait: someone can be racist, nonracist or antiracist. But this simple model that we use to understand other people belies an incredibly complex underlying reality. We contain multitudes. We can be aware of the problems, read Baldwin and Coates, and still have patterns of thinking and behavior that perpetuate racial discrimination.

I’m not sure if we can convince the rest of the country to make concrete behavioral changes, to focus their effort on this issue and face the uncomfortable need to change. But I have more hope for science, which is largely composed of liberal and thoughtful people.

The info is here.

Antipsychotics for Children With ADHD Should Be a Last Resort

Jeannette Y. Wick
pharmacytimes.com
Originally published 20 Feb 20

Here is an excerpt:

ANTIPSYCHOTICS: NOT FIRST LINE

A freestanding diagnosis of ADHD is not an indication for antipsychotic medications. Although no studies have determined which children who get an ADHD diagnosis are most likely to receive antipsychotic medications, mental health comorbidity is a possible factor.

ADHD often occurs in conjunction with other mental health conditions. Common comorbidities include conduct disorder (depression, or oppositional defiant disorder), and prescribers may use antipsychotic drugs to augment other approaches. The evidence does not support using antipsychotic medication for depression in youths, but some data support a risperidone trial for conduct disorder or oppositional defiant disorder in stimulant-resistant youths with ADHD.

A second concern is aggression. Aggression that stems from poor impulse control is common in youths who have ADHD, and it frequently occurs in children who have comorbidities. This behavior is often associated with a need for assessment, hospitalization, or urgent care and requires careful follow-up and cautious risk assessment. ADHD may not respond to stimulant medications, so prescribers may use antipsychotic drugs off-label in an effort to reduce aggressive outbursts. Research shows that antipsychotic-treated youths with ADHD often have clinical characteristics associated with aggression. However, few youths with ADHD who were treated with antipsychotics received the evidence-indicated trial doses of 2 stimulants before an antipsychotic.

The info is here.

Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge

Jonathan M. Metzl and Dorothy E. Roberts
Virtual Mentor. 2014;16(9):674-690.
doi: 10.1001/virtualmentor.2014.16.9.spec1-1409.

Here is an excerpt:

The Clinical Implications of Addressing Race from a Structural Perspective

These brief case examples illustrate the complex ways that seemingly clinically relevant “cultural” characteristics and attitudes also reflect structural inequities, medical politics, legal codes, invisible discrimination, and socioeconomic disparities. Black men who appeared schizophrenic to medical practitioners did so in part because of the framing of new diagnostic codes. Lower-income persons who “refused” to eat well or exercise lived in neighborhoods without grocery stores or sidewalks. Black women who seemed to be uniquely harming their children by using crack cocaine while pregnant were victims of racial stereotyping, as well as of a selection bias in which decisions about which patients were reported to law enforcement depended on the racial and economic segregation of prenatal care. In this sense, approaches that attempt to address issues—such as the misdiagnosis of schizophrenia in black men, perceived diet “noncompliance” in minority populations, or the punishment of “crack mothers”—through a heuristic aimed solely at enhancing cross-cultural communication between doctors and patients, though surely well intentioned, will overlook the potentially pathologizing impact of structural factors set in motion long before patients or doctors enter exam rooms.

Structural factors impact majority populations as well as minority ones, and structures of privilege or opulence also influence expressions of illness and health. For instance, in the United States, research suggests that pediatricians disproportionately overdiagnose ADHD in white school-aged children. Until recently, medical researchers in many global locales assumed, wrongly, that eating disorders afflicted only affluent persons.

Yet of late, medicine and medical education have struggled most with addressing ways that structural forces impact and disadvantage communities of color. As sociologist Hannah Bradby rightly explains it, hypothesizing mechanisms that include the micro-processes of interactions between patients and professionals and the macro-processes of population-level inequalities is a missing step in our reasoning at present…. [A]s long as we see the solution to racism lying only in educating the individual, we fail to address the complexity of racism and risk alienating patients and physicians alike.

The info is here.

Survival of the Friendliest: Homo sapiens Evolved via Selection for Prosociality

Brian Hare
Annu. Rev. Psychol. 2017.68:155-186.

Abstract

The challenge of studying human cognitive evolution is identifying unique features of our intelligence while explaining the processes by which they arose. Comparisons with nonhuman apes point to our early-emerging cooperative-communicative abilities as crucial to the evolution of all forms of human cultural cognition, including language. The human self-domestication hypothesis proposes that these early-emerging social skills evolved when natural selection favored increased in-group prosociality over aggression in late human evolution. As a by-product of this selection, humans are predicted to show traits of the domestication syndrome observed in other domestic animals. In reviewing comparative, developmental, neurobiological, and paleoanthropological research, compelling evidence emerges for the predicted relationship between unique human mentalizing abilities, tolerance, and the domestication syndrome in humans. This synthesis includes a review of the first a priori test of the self-domestication hypothesis as well as predictions for future tests.

A pdf can be downloaded from here.