I’m a psychology expert in Finland, the No. 1 happiest country in the world—here are 3 things we never do

Frank Martela

CNBC.com

Originally posted 5 Jan 23

For five years in a row, Finland has ranked No. 1 as the happiest country in the world, according to the World Happiness Report. 

In 2022′s report, people in 156 countries were asked to “value their lives today on a 0 to 10 scale, with the worst possible life as a 0.” It also looks at factors that contribute to social support, life expectancy, generosity and absence of corruption.

As a Finnish philosopher and psychology researcher who studies the fundamentals of happiness, I’m often asked: What exactly makes people in Finland so exceptionally satisfied with their lives?

To maintain a high quality of life, here are three things we never do:

1. We don’t compare ourselves to our neighbors.

Focus more on what makes you happy and less on looking successful. The first step to true happiness is to set your own standards, instead of comparing yourself to others.

2. We don’t overlook the benefits of nature.

Spending time in nature increases our vitality, well-being and a gives us a sense of personal growth. Find ways to add some greenery to your life, even if it’s just buying a few plants for your home.

3. We don’t break the community circle of trust.

Think about how you can show up for your community. How can you create more trust? How can you support policies that build upon that trust? Small acts like opening doors for strangers or giving up a seat on the train makes a difference, too.

The details of the principles are here.

What makes Voldemort tick? Children's and adults' reasoning about the nature of villains

V.A. Umscheid, C.E. Smith, et al.

Cognition

Volume 233, April 2023, 105357

Abstract

How do children make sense of antisocial acts committed by evil-doers? We addressed this question in three studies with 434 children (4–12 years) and 277 adults, focused on participants' judgments of both familiar and novel fictional villains and heroes. Study 1 established that children viewed villains' actions and emotions as overwhelmingly negative, suggesting that children's well-documented positivity bias does not prevent their appreciation of extreme forms of villainy. Studies 2 and 3 assessed children's and adults' beliefs regarding heroes' and villains' moral character and true selves, using an array of converging evidence, including: how a character felt inside, whether a character's actions reflected their true self, whether a character's true self could change over time, and how an omniscient machine would judge a character's true self. Across these measures, both children and adults consistently evaluated villains' true selves to be more negative than heroes'. Importantly, at the same time, we also detected an asymmetry in the judgments, wherein villains were more likely than heroes to have a true self that differed from their outward behavior. More specifically, across the ages studied participants more often reported that villains were inwardly good, than that heroes were inwardly bad. Implications, limitations, and directions for future research are discussed in light of our expanding understanding of the development of true self beliefs.

General discussion

What do young children understand about the nature of antisocial individuals, and how does this understanding change with development? We examined this question in three studies, asking children aged

4–10 to predict how villains—and in comparison, heroes—behave when given a chance to engage in a range of anti- and prosocial behaviors (in Study 1) and to think about their deeper underlying villainy in terms of characters’ moral character and true selves (in Studies 2 and 3). The present research is distinctive in its focus on what children understand about truly wicked familiar individuals, notably well-known villains in children’s films, and distinctive in asking about not only their behaviors, but also asking about their inner emotional responses and underlying goodness/badness. Moreover, we examined the limits of villains’ antisociality, via the scenarios involving the pets and ‘kindred spirits’ of villains in Study 1, and via scenarios involving omniscient true-self machines and magic pills in Study 3. The research also provides new, strong, and consistent evidence by examining a broad range of theoretically grounded evil behaviors and beliefs, and in charting these beliefs across early to middle childhood.

Taken together, findings from all three studies show that children ages 4–10 firmly understand that villainous individuals are prone to callous and antisocial behavior, have deeply mean personalities, and are

less likely than heroes to engage in prosocial behavior. At the same time, although they grasp the essential villainy of villains, children tend to be somewhat more positive about villains than adults. Three additional

findings are worthy of emphasis. First, children demonstrated a nuanced view of villains; many who consistently predicted cruel behavior in villains also expected that villains would treat those in their inner circle (pets and fellow villains) with less cruelty. Second, even young children went beyond noting behavioral tendencies, indicating that villains were deeply mean individuals in their underlying true selves and emotional responses, not just their behaviors. And third, there was an asymmetry in participants’ (both children’s and adults’) judgments regarding individuals’ true selves, wherein villains were more often viewed as having a good true self, than heroes were judged as having a bad true self. For children, villains’ true selves were less mean than might be expected from their mean behaviors and villainous identities, but rarely shaded into niceness itself. For adults this was also often true, but consistent with the literature on adults’ true self beliefs (De Freitas et al., 2017;Newman et al., 2014; Strohminger et al., 2017), adults often indicted a belief that even villains might be deep-down nice in certain circumstance. 

The article is paywalled here.

Contraceptive Coverage Expanded: No More ‘Moral’ Exemptions for Employers

Ari Blaff

Yahoo News

Originally posted 30 JAN 23

Here is an excerpt:

The proposed new rule released today by the Departments of Health and Human Services (HHS), Labor, and Treasury would remove the ability of employers to opt out for “moral” reasons, but it would retain the existing protections on “religious” grounds.

For employees covered by insurers with religious exemptions, the new policy will create an “independent pathway” that permits them to access contraceptives through a third-party provider free of charge.

“We had to really think through how to do this in the right way to satisfy both sides, but we think we found that way,” a senior HHS official told CNN.

Planned Parenthood applauded the announcement. “Employers and universities should not be able to dictate personal health-care decisions and impose their views on their employees or students,” the organization’s chief, Alexis McGill Johnson, told CNN. “The ACA mandates that health insurance plans cover all forms of birth control without out-of-pocket costs. Now, more than ever, we must protect this fundamental freedom.”

In 2018, the Trump administration sought to carve out an exception, based on “sincerely held religious beliefs,” to the ACA’s contraceptive mandate. The move triggered a Pennsylvania district court judge to issue a nationwide injunction in 2019, blocking the implementation of the change. However, in 2020, in Little Sisters of the Poor v. Pennsylvania, the Supreme Court, in a 7–2 ruling, defended the legality of the original Trump policy.

The Supreme Court’s overturning of Roe v. Wade in June 2022, in its Dobbs ruling, played a role in HHS’s decision to release the new proposal. Guaranteeing access to contraceptions at no cost to the individual “is a national public health imperative,” HHS said in the proposal. And the Dobbs ruling “has placed a heightened importance on access to contraceptive services nationwide.”

The info is here.

Yale Changes Mental Health Policies for Students in Crisis

William Wan

The Washington Post

Originally posted 18 JAN 23

Here are some excerpts:

In interviews with The Post, several students — who relied on Yale’s health insurance — described losing access to therapy and health care at the moment they needed it most.

The policy changes announced Wednesday reversed many of those practices.

By allowing students in mental crisis to take a leave of absence rather than withdraw, they will continue to have access to health insurance through Yale, university officials said. They can continue to work as a student employee, meet with career advisers, have access to campus and use library resources.

Finding a way to allow students to retain health insurance required overcoming significant logistical and financial hurdles, Lewis said, since New Haven and Connecticut are where most health providers in Yale’s system are located. But under the new policies, students on leave can switch to “affiliate coverage,” which would cover out-of-network care in other states.

In recent weeks, students and mental advocates questioned why Yale would not allow students struggling with mental health issues to take fewer classes. The new policies will now allow students to drop their course load to as low as two classes under special circumstances. But students can do so only if they require significant time for treatment and if their petition is approved.

In the past, withdrawn students had to submit an application for reinstatement, which included letters of recommendation, and proof they had remained “constructively occupied” during their time away. Under new policies, students returning from a medical leave of absence will submit a “simplified reinstatement request” that includes a letter from their clinician and a personal statement explaining why they left, the treatment they received and why they feel ready to return.

<cut>

In their updated online policies, the university made clear it still retained the right to impose an involuntary medical leave on students in cases of “a significant risk to the student’s health or safety, or to the health or safety of others.”

The changes were announced one day before Yale officials were scheduled to meet for settlement talks with the group of current and former students who filed a proposed class-action lawsuit against the university, demanding policy changes. 

<cut>

In a statement, one of the plaintiffs — a nonprofit group called Elis for Rachael, led by former Yale students — said they are still pushing for more to be done: “We remain in negotiations. We thank Yale for this first step. But if Yale were to receive a grade for its work on mental health, it would be an incomplete at best.”

But after decades of mental health advocacy with little change at the university, some students said they were surprised at the changes Yale has made already.

“I really didn’t think it would happen during my time here,” said Akweley Mazarae Lartey, a senior at Yale who has advocated for mental rights throughout his time at the school. 

“I started thinking of all the situations that I and people I care for have ended up in and how much we could have used these policies sooner.”

The info is here.

Ethics Consult: Keep Patient Alive Due to Spiritual Beliefs?

Jacob M. Appel

MedPageToday

Originally posted 28 Jan 23

Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel's 2019 book, Who Says You're Dead? Medical & Ethical Dilemmas for the Curious & Concerned.

Alexander is a 49-year-old man who comes to a prominent teaching hospital for a heart transplant. While awaiting the transplant, he is placed on a machine called a BIVAD, or biventricular assist device -- basically, an artificial heart the size of a small refrigerator to tide him over until a donor heart becomes available. While awaiting a heart, he suffers a severe stroke.

The doctors tell his wife, Katie, that no patient who has suffered such a severe stroke has ever regained consciousness and that Alexander is no longer a candidate for transplant. They would like to turn off the BIVAD and allow nature to take its course.

Not lost on these doctors is that Alexander occupies a desperately needed ICU bed, which could benefit other patients, and that his care costs the healthcare system upwards of $10,000 a day. The doctors are also aware than Alexander could survive for years on the BIVAD and the other machines that are now helping to keep him alive: a ventilator and a dialysis machine.

Katie refuses to yield to the request. "I realize he has no chance of recovery," she says. "But Alexander believed deeply in reincarnation. What mattered most to him was that he die at the right moment -- so that his soul could return to Earth in the body for which it was destined. To him, that would have meant keeping him on the machines until all brain function ceases, even if it means decades. I feel obligated to honor those wishes."

The page and voting is here.

Why VIP Services Are Ethically Indefensible in Health Care

Denisse Rojas Marquez and Hazel Lever

AMA J Ethics. 2023;25(1):E66-71.

doi: 10.1001/amajethics.2023.66.

Abstract

Many health care centers make so-called VIP services available to “very important persons” who have the ability to pay. This article discusses common services (eg, concierge primary care, boutique hotel-style hospital stays) offered to VIPs in health care centers and interrogates “trickle down” economic effects, including the exacerbation of inequity in access to health services and the maldistribution of resources in vulnerable communities. This article also illuminates how VIP care contributes to multitiered health service delivery streams that constitute de facto racial segregation and influence clinicians’ conceptions of what patients deserve from them in health care settings.

Insurance and Influence

It is common practice for health care centers to make “very important person” (VIP) services available to patients because of their status, wealth, or influence. Some delivery models justify the practice of VIP health care as a means to help offset the cost of less profitable sectors of care, which often involve patients who have low income, are uninsured, and are from historically marginalized communities.1 In this article, we explore the justification of VIP health care as helping finance services for patients with low income and consider if this “trickle down” rationale is valid and whether it should be regarded as acceptable. We then discuss clinicians’ ethical responsibilities when taking part in this system of care.

We use the term VIP health care to refer to services that exceed those offered or available to a general patient population through typical health insurance. These services can include concierge primary care (also called boutique or retainer-based medicine) available to those who pay out of pocket, stays on exclusive hospital floors with luxury accommodations, or other premium-level health care services.1 Take the example of a patient who receives treatment on the “VIP floor” of a hospital, where she receives a private room, chef-prepared food, and attending physician-only services. In the outpatient setting, the hallmarks of VIP service are short waiting times, prompt referrals, and round-the-clock staffing.

While this model of “paying for more” is well accepted in other industries, health care is a unique commodity, with different distributional consequences than markets for other goods (eg, accessing it can be a matter of life or death and it is deemed a human right under the Alma-Ata Declaration2). The existence of VIP health care creates several dilemmas: (1) the reinforcement of existing social inequities, particularly racism and classism, through unequal tiers of care; (2) the maldistribution of resources in a resource-limited setting; (3) the fallacy of financing care of the underserved with care of the overserved in a profit-motivated system.

(cut)

Conclusion

VIP health care, while potentially more profitable than traditional health care delivery, has not been shown to produce better health outcomes and may distribute resources away from patients with low incomes and patients of color. A system in which wealthy patients are perceived to be the financial engine for the care of patients with low incomes can fuel distorted ideas of who deserves care, who will provide care, and how expeditiously care will be provided. To allow VIP health care to exist condones the notion that some people—namely, wealthy White people—deserve more care sooner and that their well-being matters more. When health institutions allow VIP care to flourish, they go against the ideal of providing equitable care to all, a value often named in organizational mission statements.22 At a time when pervasive distrust in the medical system has fueled negative consequences for communities of color, it is our responsibility as practitioners to restore and build trust with the most vulnerable in our health care system. When evaluating how VIP care fits into our health care system, we should let health equity be a moral compass for creating a more ethical system.

The info is here.

Abortion Access Tied to Suicide Rates Among Young Women

Michael DePeau-Wilson

MedPage Today

Originally posted 28 DEC 22

Restrictions on access to reproductive care were associated with suicide rates among women of reproductive age, researchers found.

In a longitudinal ecologic study using state-based data from 1974 to 2016, enforcement of Targeted Regulation of Abortion Providers (TRAP) laws was associated with higher suicide rates among reproductive-age women (β=0.17, 95% CI 0.03-0.32, P=0.02) but not among women of post-reproductive age, according to Ran Barzilay, MD, PhD, of the University of Pennsylvania in Philadelphia, and colleagues.

Nor was enforcement of TRAP laws associated with deaths due to motor vehicle crashes, they reported in JAMA Psychiatry in a new tab or window.

Additionally, enforcement of a TRAP law was associated with a 5.81% higher annual rate of suicide than in pre-enforcement years, the researchers found.

"Taken together, the results suggest that the association between restricting access to abortion and suicide rates is specific to the women who are most affected by this restriction, which are young women," Barzilay told MedPage Today.

Barzilay said their study "can inform, number one, clinicians working with young women to be aware that this is a macro-level suicide risk factor in this population. And number two, that it informs policymakers as they allocate resources for suicide prevention. And number three, that it informs the ethical, divisive debate regarding access to abortion."

In an accompanying editorial, Tyler VanderWeele, PhD, of Harvard T.H. Chan School of Public Health in Boston, wrote that while analyses of this type are always subject to the possibility of changes in trends being attributable to some third factor, Barzilay and colleagues did "control for a number of reasonable candidates and conducted sensitivity analyses indicating that these associations were observed for reproductive-aged women but not for a control group of older women of post-reproductive age."

VanderWeele wrote the findings do suggest that a "not inconsiderable" number of women might be dying by suicide in part because of a lack of access to abortion services, and that "the increase is cause for clinical concern."

But while more research "might contribute more to our understanding," VanderWeele wrote, its role in the legal debates around abortion "seems less clear. Regardless of whether one is looking at potential adverse effects of access restrictions or of abortion, the abortion and mental health research literature will not resolve the more fundamental and disputed moral questions."

"Debates over abortion access are likely to remain contentious in this country and others," he wrote. "However, further steps can nevertheless be taken in finding common ground to promote women's mental health and healthcare."

For their "difference-in-differences" analysis, Barzilay and co-authors relied on data from the TRAP laws index to measure abortion access, and assessed suicide data from CDC's WONDER database in a new tab or window database.

The info is here.

UCSF Issues Report, Apologizes for Unethical 1960-70’s Prison Research

Restorative Justice Calls for Continued Examination of the Past

Laura Kurtzman

Press Release

Originally posted 20 DEC 22

Recognizing that justice, healing and transformation require an acknowledgment of past harms, UCSF has created the Program for Historical Reconciliation (PHR). The program is housed under the Office of the Executive Vice Chancellor and Provost, and was started by current Executive Vice Chancellor and Provost, Dan Lowenstein, MD.

The program’s first report, released this month, investigates experiments from the 1960s and 1970s involving incarcerated men at the California Medical Facility (CMF) in Vacaville. Many of these men were being assessed or treated for psychiatric diagnoses.

The research reviewed in the report was performed by Howard Maibach, MD, and William Epstein, MD, both faculty in UCSF’s Department of Dermatology. Epstein was a former chair of the department who died in 2006. The committee was asked to focus on the work of Maibach, who remains an active member of the department.

Some of the experiments exposed research subjects to pesticides and herbicides or administered medications with side effects. In all, some 2,600 incarcerated men were experimented on.

The men volunteered for the studies and were paid for participating. But the report raises ethical concerns over how the research was conducted. In many cases there was no record of informed consent. The subjects also did not have any of the medical conditions that any of the experiments could have potentially treated or ameliorated.

Such practices were common in the U.S. at the time and were increasingly being criticized both by experts and in the lay press. The research continued until 1977, when the state of California halted all human subject research in state prisons, a year after the federal government did the same.

The report acknowledges that Maibach was working during a time when the governance of human subjects research was evolving, both at UCSF and at institutions across the country. Over a six-month period, the committee gathered some 7,000 archival documents, medical journal articles, interviews, documentaries and books, much of which has yet to be analyzed. UCSF has acknowledged that it may issue a follow-up report.

The report found that “Maibach practiced questionable research methods. Archival records and published articles have failed to show any protocols that were adopted regarding informed consent and communicating research risks to participants who were incarcerated.”

In a review of publications between 1960 and 1980, the committee found virtually all of Maibach’s studies lacked documentation of informed consent despite a requirement for formal consent instituted in 1966 by the newly formed Committee on Human Welfare and Experimentation. Only one article, published in 1975, indicated the researchers had obtained informed consent as well as approval from UCSF’s Committee for Human Research (CHR), which began in 1974 as a result of new federal requirements.

The pressor is here.

The pervasive impact of ignorance

Kirfel, L., & Phillips, J.

Cognition

Volume 231, February 2023, 105316

Abstract

Norm violations have been demonstrated to impact a wide range of seemingly non-normative judgments. Among other things, when agents' actions violate prescriptive norms they tend to be seen as having done those actions more freely, as having acted more intentionally, as being more of a cause of subsequent outcomes, and even as being less happy. The explanation of this effect continue to be debated, with some researchers appealing to features of actions that violate norms, and other researcher emphasizing the importance of agents' mental states when acting. Here, we report the results of two large-scale experiments that replicate and extend twelve of the studies that originally demonstrated the pervasive impact of norm violations. In each case, we build on the pre-existing experimental paradigms to additionally manipulate whether the agents knew that they were violating a norm while holding fixed the action done. We find evidence for a pervasive impact of ignorance: the impact of norm violations on non-normative judgments depends largely on the agent knowing that they were violating a norm when acting. Moreover, we find evidence that the reduction in the impact of normality is underpinned by people's counterfactual reasoning: people are less likely to consider an alternative to the agent's action if the agent is ignorant. We situate our findings in the wider debate around the role or normality in people's reasoning.

General discussion

Studies show that norm violations influence a wide range of domains, including judgments of causation, freedom, happiness, doing vs. allowing, mental state ascriptions, and modal claims. A continuing debate centers on why normality has such a pervasive impact, and whether one should attempt to offer a unified explanation of these various effects (Hindriks, 2014). In this study, we found evidence that the epistemic state of norm-violating agents plays a fundamental role in the impact of norms on non-normative judgments. Across a wide range of intuitive judgments and highly different manipulations of an agents' knowledge, we found that the impact of normality on non-normative judgments was diminished when the agent did not know that they were violating a norm. More precisely, the agent's knowledge of the norm violation determined the extent to which abnormal actions increased judgments of causation, decreased attribution of force, increased attributions of intentional action, and so on. In other words, the impact of ignorance appears to be as pervasive as the impact of normality itself. In addition, our study showed that the agent's epistemic state also influenced to what extent people engage in reasoning about alternatives to the agent's action. If the agent was ignorant when they violated a norm, people were less inclined to consider what the agent could have done differently.

At the broadest level, the current results provide evidence that the pervasive impact of normality likely warrants a unified explanation at some level: we considered a specific feature that had been shown to moderate the impact of normality in one domain (causation) and demonstrated that this same feature of the impact of normality can be found across a wide range of other domains. This finding suggests that the impact of norms arises from a shared underlying mechanism that is recruited across domains. Specific accounts may, of course, seek to incorporate agents' epistemic states into their respective theory of how normality influences judgments in one particular domain. However, such an approach will miss out on a generalization and will necessarily be less parsimonious. Accordingly, we turn now to considering two broad approaches to offering a unified account of the pervasive impact of ignorance.

A pdf of the research is here.