Monday, July 3, 2017

Power...the mercurial 'drug' under the microscope in The Atlantic

Two pieces in the most recent edition of The Atlantic caught our eyes this week. Both were detailing research on different kinds of POWER.

The first, Power Causes Brain Damage, by Jerry Useem, details newly discovered evidence that people under the influence of power, acted as if they had suffered a traumatic brain injury—“becoming more impulsive, less  risk aware and crucially, less adept at seeing things from other people’s point of view.”* Useem drew such evidence from Dacher Keltner, psychology professor at UC Berkeley.

From Sukhvinder Obhi, a neuroscientist who studies brains at McMaster University in Hamilton, Ontario, Useem learned, that when he “put the heads of the powerful and the no-so-powerful under a transcranial-magnetic-stimulation machine, he found that power…impairs a specifc neural process, ‘mirroring,’ that may be the cornerstone of empathy. Which gives the neurological basis to what Keltner has termed the ‘power paradox’: Once we have power, we lose some of the capacities we needed to gain it in the first place.” (Ibid.)

Useem writes, “Power, the research says, primes our brain to screen out peripheral information. In most situations, this provides a helpful efficiency boost. In social ones, it has the unfortunate side effect of making us more obtuse…As Susan Fiske, a Princeton psychology professor, has persuasively argued, power lessens the need for a nuanced read of power, since it give us command or resources we once had to cajole from others…Less able to make out people’s individuating traits, they rely more heavily on stereotype. And the less they’re able to see, other research suggests, they rely on a personal ‘vision’ for navigation. (CEO of Wells Fargo) John Stumpf saw a Wells Fargo where every customer had eight separate accounts,” as justification for what he calls ‘Cross-selling, as short-hand for deepening relationships’.” (Ibid, p.25)

Drawing from Lord David Owen, Useem notes Owen’s book, In Sickness and in Power, in which Owen documents the various illnesses of British and American leaders. Owen, with co-author Jonathan Davidson, wrote an article published in Brain, in which they defined the “hubris syndrome”…

·      A disorder of the possession of power, particularly power which has been associated with overwhelming success, held for a period of years and with minimal constraints on the leader.”
Useem lists some of the the 14 clinical features of Hubris Syndrome:
1.    Manifest contempt for others
2.    Loss of contact with reality
3.    Restless or reckless actions
4.    Displays of incompetence (Ibid, p.26)

To combat the hubris syndrome, Owen tells Useem a few strategies:
·      Thinking back on hubris-dispelling episodes from the past
·      Watching documentaries about ordinary people
·      Making a habit of reading constituents’ letters

What really upset both Useem and Owen, and should upset most of us, is that businesses have shown no appetite for research on hubris and business schools were not much better.

The second piece in The Atlantic, “The Smartphone Psychiatrist, written by David Dobbs, details the story of one American psychiatrist, Tom Insel, who wants psychiatry to better and more quickly diagnose and more quickly treat mental illness through the apps currently available and yet-to-be-researched for smartphones.

The debate in psychiatry has vacillated between the very difficult to measure, talk therapy that focused heavily on the environmental forces behind mental illness and the biocentric, pharmaceutical interventions that emerge from  biologically based research.
 While that debate continues to rumble underneath the emerging developments in digital technology, Insel has most recently joined a new “two-pizza” firm small enough in his view to change and adapt, to improvise and to satisfy his impatience, called Mindstrong.

Persisting for much of his earlier career in “brain” studies of rodents called voles, Insel now wants to mine and develop software based on an “objective textured picture of people’s lives collected continuously, not merely in weekly visits to the psychiatrist.” 
Dobbs writes:

With inputs like these, a phone could sense the beginning of a crisis and trigger an appropriate response. Because the response could come earlier, it could be more measured, less jarring, and less medication-heavy. ‘The earlier you intervene, the better the outcomes,’ Insel says. ‘Instead of detect and treat, it’s predict and pre-empt.’**
When asked how his new Mindstrong company might work, Insel points to a couple of already operating examples. A new company called 7-Cups “provides text-based peer-counselling and support for people with depression or anxiety or a long list of other conditions….7Cups gives everyone who register the change to take a standardized screening test for depression, anxiety and stress called DASS-21. A second model is an app called PRIME (Personalized Real-time Intervention for Motivation Enhancement) inspired by research showing that social connection and peer support can reduce the severity of depression and schizophrenia. The mobile app connects members to both a circle of peers and professional clinicians who can assist as needed…..The app has three real functions:

·      One is connecting people so they can turn to one another for help, perspective and affirmation
·      Another is providing a set of motivational essays, talks, and interactive modules that help with decisions and dilemmas common among the membership
·      The third is quickly spotting emerging crises and responding ith peer, social-service and clinician support.**

Clearly, Insel is probably guessing correctly that there is no way in the near or medium-future to be able to reach all people who suffer from mild and/or serious mental illness and debilitation with individual appointments with a psychiatrist. And we applaud the mounting research toward alleviating such a social and cultural dilemma.
Simultaneously, we also applaud the discovery of a hubris syndrome among leaders, with some minimal yet effective approaches to alleviating its damage.

Some other observations emerge from the collision of these two pieces. One is that most, if not all, people who serve in leadership are unlikely to welcome any attempt to mollify a hubris syndrome or even to acknowledge its existence. Pointing it out, and bringing it into the public discourse, as The Atlantic has done, is a commendable public service. Let’s watch and listen to see how long it takes the respective deans of the many business schools to open their minds and then their departments to acknowledge their perhaps unconscious aiding and abetting the  hubris syndrome. We know that departments of political science will take even longer to move in that same direction.

It is with the second piece, the digitizing of conventional human behaviour, forming like-“minded” groups around a cluster of mental illnesses, to satisfy what is really a personal ambition of several professional clinicians to “provide” service and support, for what is undoubtedly an interminable repeating fee that throws red flags up. These flags are not the kind that celebrate a sesquicentennial birthday of a nation. They are, rather, the kind that, while purporting to replace pharma-therapy with “app” therapy could gobble so much human private information, provide it to a group of “leaders” in their respective field without the appropriate and necessary oversight that must protect the “consumer/patient” in this equation.

Both talk therapy, and environmentally-focused analysis of mental illness, while currently out of vogue, continue to have a respected and needed place in the quiver of arrows available to all of us, whether or not we have been diagnosed with a specific mental illness. In fact, the opportunity to sit with, in the presence of a human being, face-to-face, in a situation in which body language, voice inflection and atmospheric dynamics of both melody and rhythm all can, and frequently do, lead to the establishment of trust and the possibility of being heard, maybe for the first time in one’s life has much to commend it.

Instant “analysis” of the kind that attends sport network broadcasting, without the benefit of that “private” period between weekly or monthly appointments, could reasonably be expected to replace what up to now is essentially the patients’ deep and profound reflections on his/her situation, in light of the most recent conversation.

We have to be especially careful, cautious and circumspect in both our private lives and in the evaluation of our leaders, in public institutions and in private for-profit corporations. Individual choice and decision-making, without the conscious awareness of human insight, intuition and “how-it-feels” to be in a room with another sentient human, caring, compassionate, yet truthful professional can easily fall off the rails.

One of the prime expectations of the Hippocratic Oath is “do no harm” and there is no way to guestimate that these new “approaches” to mental illness will observe that dictum.

*Jerry Useem, Power Causes Bain Damage, The Atlantic, July/August 2017, p. 24

**David Dobbs, The Smartphone Psychiatrist, The Atlantic, July/August 217, p.85

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