Tagged human nature

One Marshmallow

       “These plans are so unrealistically optimistic that they border on delusional and could lead to outbreaks of Covid-19 among students, faculty and staff.”

       Laurence Steinberg, The New York Times, June 15, 2020, referring to proposed college reopenings

Dear Students,

A few weeks ago, New York Times columnist Paul Krugman (winner of the Nobel Memorial Prize in Economics) wrote a column called “America Fails the Marshmallow Test.” This is a reference to a famous 1960s psychological experiment, in which a marshmallow (or cookie, or piece of candy) is placed in front of a young child, who is told she can eat that marshmallow now, but if she waits 15 minutes, she’ll get two instead of one. Studies stemming from this experiment became a cottage industry, and among the claims made by those involved, being able to postpone gratification for greater gain was a fundamental character trait in the two-marshmallow kids that predicted much about their later success. They were said to have better “executive function,” meaning their frontal lobes were better able to suppress the impulse to get one marshmallow now in order to get two later.

Krugman understood that a 2018 study apparently failed to replicate the marshmallow study, but wanted to use the metaphor for our country’s inability to wait a little longer before lifting social distancing restrictions. Actually, the marshmallow study was not debunked by the 2018 replication, which has been criticized for controlling away some variables (like early cognitive ability) that are intrinsic to what the marshmallow test tries to measure. Also, the replication did find that the test predicted some characteristics of adolescents, just not as much as earlier studies claimed. The critics of the critics—the marshmallow defenders—called their paper “Good Things Come to Those Who Wait,” with the running head, “Delaying Gratification Matters.”

Speaking of delaying gratification, it’s not just five-year-olds who are not good at it. Adolescents are not good at it either.

I know you don’t like to think of yourselves as adolescents, but the fact is that brain development is not complete until age 25 or so, and the main part of the brain that keeps developing is precisely those frontal lobes that are involved in executive functions: planning, reasoning, analyzing, and yes, postponing gratification. This period of extended frontal cortex development has been called youth, pre-adulthood, or emerging adulthood.

Psychologist Laurence Steinberg is the world’s leading authority on brain development in adolescence and beyond, especially in relation to executive functions. He has co-authored papers in law and psychology journals with titles like “Blaming Youth,” “Young Adulthood as a Transitional Legal Category,” and “Less Guilty by Reason of Adolescence.” He has tried to protect young people from the most severe punishments for acts which they literally did not have the brainpower to control.

Now Steinberg has weighed in on a question many of you have asked me about: College reopenings in August, including ours. Steinberg, who has spent his life as a college professor researching the young, wrote an essay two weeks ago called, “Expecting Students to Play It Safe if Colleges Reopen Is a Fantasy.”

Based on his 40 years of research on young people, he writes, “Most types of risky behavior — reckless driving, criminal activity, fighting, unsafe sex and binge drinking, to name just a few — peak during the late teens and early 20s. Moreover, interventions designed to diminish risk-taking in this age group, such as attempts to squelch binge drinking on campus, have an underwhelming track record. There is little reason to think that the approaches proposed to mitigate transmission of the coronavirus among college students will fare any better.”

The evidence on the other side is very strong. Steinberg and his colleagues recently completed “a study of more than 5,000 people between the ages of 10 and 30 from 11 different countries (including both Western and non-Western ones)… Consistent with large-scale epidemiological studies, we found a peak in risk-taking somewhere between age 20 and 24 in virtually every country.” There are three straightforward reasons.

Youth (not just adolescence) is a time of 1. heightened risk taking, and 2. poor self-regulation in all cultures. These two psychological features of young adulthood are in turn explained by 3. easier activation of the brain’s reward circuits, made even worse under conditions of emotional arousal and in the presence of peers.

To Laurence Steinberg, who probably knows more about not only the psychology but the neurobiology of young people than anyone else alive, college reopenings will be a “perfect storm” for viral spread. College reopenings are also being criticized by moral philosophers, college presidents, lawyers, and, of course, some epidemiologists. Dr. Anthony Fauci, our nation’s leading expert on the pandemic, says the matter is “complicated” and will depend on what region of the country you’re talking about.

It’s not always a bad idea to take a reward now even though it may be smaller. That’s why we have the proverb, “A bird in the hand is worth two in the bush.” Young people are designed to take risks for short-term rewards because that is how they test themselves, learn about life, find mates, make friends, and generally position themselves among their peers. Up to a point you have to take risks.

But we are not talking about a torn ligament, a bad hangover, or a brush with gonorrhea. This is a situation that has never before existed in my lifetime, not even during the early years of HIV/AIDS. I have repeatedly emphasized to you that the unknowns in relation to this pandemic are greater than the knowns, and that remains true. Right now cases are on the rise in the nation, in most states, and in almost every major city in the southern half of the country from Los Angeles to Miami.

The entire state university system of California will be 100 percent online. If you were in college in a rural area of Massachusetts or New York, you would probably be safe attending live, but you are not in one of those colleges. The situation in Atlanta is uncertain, but Emory says it is taking precautions that will make reopening safe.

Last week I said that case counts are like lightning, and that I was waiting for the thunder—hospitalizations and deaths. Being no longer young, I am able to wait. Some leaders claim that the only reason we have more cases is that we have more testing. I think this is wrong, but I don’t want to argue about it because I can wait. Others say we really do have more cases but because the age of infection is on average much lower than it was a month or two ago, we will never see the hospitalizations or deaths go up by much.

Lightning is flashing all across the southern United States, and some say it is starting fires that will be impossible to control and that will in the end kill many. State after state in the south are backtracking on their openings. But the states don’t really control behavior, especially the behavior of the young.

The July 4th weekend is coming, and millions of young people will take the one marshmallow. What will you do?

Dr. K

100,000

Dear students,

Before I share a few post-Memorial Day thoughts about the virus and this tragic and needless milestone, I would like to mention two people who have died recently but not from the corona or any virus: George Floyd, a black man who was killed by police in Minneapolis, Minnesota, by strangulation, while handcuffed on the ground begging for his life, and Ahmaud Arbery, a black man shot and killed by vigilantes while jogging, in a modern-day lynching in Brunswick, Georgia. These tragic and needless deaths were part of the same long-standing pattern of structural racism which, as you know, accounts for the huge over-representation of African-Americans in the deaths from COVID-19.

I am frankly confused about where we are in the pandemic right now, both in our country and the world. More Americans have died of COVID-19 than in all the wars since the Korean War, and it is quite possible that before this is over we may be able to include the Korean War in that count. I see what appears to be a wholesale abandonment of the science of public health and medicine by many Americans. I can’t tell you how many, but I am pretty sure it’s enough to keep the U.S. epidemic boiling (not simmering) for months. Maybe we get a rest in September before the second wave. Or will it be the third wave?

I’ve always told you the most important thing you have to know is the limits of what you know. So I’m telling you now. I don’t know. I don’t know. I don’t know.

I don’t know about future cases, hospitalizations, or deaths because the models are shot to hell by the unpredicted and unpredictable behavior of a substantial minority of Americans. I don’t know about progress in vaccines or treatment because every announcement is not a scientific publication but a press release that hugely moves stock prices, especially of the companies involved. Remdesevir and convalescent plasma are in wide use and seem to have some effectiveness, but convincing studies have not been published. I do know something about the anti-malarial drug Whaddayagottalose-oquine. Worldwide randomized controlled trials have been stopped because more people die with it than without it. I took it for years, first to prevent malaria in Africa, then for a minor autoimmune condition. On March 25th in a private email I said that more research was needed but that I would take it if I got COVID-19. Now I wouldn’t. Lesson? Anecdotes, even from smart people, are no substitute for real studies.

This past weekend we commemorated those who gave their lives for our freedom; they died hoping we would use freedom wisely. Yesterday we flew our flags at half-mast to mourn 100,000 dead Americans. Today I want to celebrate the new warriors at the front of the coronavirus wars.

Good News

  1. Dr. Richard Levitan, 59, a leading expert on teaching intubation, left safe Northern New Hampshire to volunteer for ten days at New York’s dangerous Bellevue hospital. After his first exhausting shift he went to his brother’s apartment, where he was staying, and was kicked out by the building’s other residents. He found some kind of lodging, completed his ten days, and wrote an article teaching others throughout the world how to deal with COVID-19 pneumonia.
  2. If you click on one link in this message, make it Dr. Sharon Duclos, a Family Medicine specialist in Cedar Valley, Iowa, and watch the video, recorded on May 6th, the day before the local Tyson meatpacking plant, the source of the cases that overwhelmed Dr. Duclos and her colleagues, reopened under government orders. She appeared calm today (May 28) at a press conference with other local medical leaders; she is at around minute 14:30 in this new video. She implored people to keep taking precautions, “as we go through the little lulls and valleys, and the peaks that will occur with this, for months to come.” More on this below.
  3. Sylvia Leroy, 35, was a labor and delivery nurse at Brookdale Hospital in Brooklyn, where patients she cared for were positive for the virus. She got it. She was 28 weeks pregnant with her second child. Her own hospital did not take proper care of her. She was transferred to Mount Sinai where she got better care but went into cardiac arrest for some four to eight minutes; the doctor who called Sylvia’s sister was crying herself. They delivered her baby, Esther, by C-section. The baby needed oxygen but was “pink and healthy.” As of May 20, Sylvia was very slowly recovering from brain damage; Baby Esther was doing well. See their GoFundMe page here. Her sister once asked her why she didn’t go into private practice. “And she said to me, ‘This is an underserved community. Who is going to help them if I don’t help them?’”
  4. Dr. Ryan Padgett, 45, who played football for Northwestern in the Rose Bowl, was one of the first U.S. doctors to get the virus. It was still February, and nobody knew anything, but he was taking care of a string of patients from one nursing home in Kirkland, Washington. He was in great shape, hardly ever missed a day of work, but in March he was near death. He recovered, but still had more recovery ahead of him, when he said, “As an emergency physician, you walk into every single room and take care of whatever is there. Going back, I don’t think that will change. I hope not.”
  5. Dr. Theresa Greene, an emergency physician in Miami, temporarily lost custody of her 4-year-old daughter because she takes care of COVID-19 patients. She said, “I think it’s not fair. It’s cruel to ask me to choose between my child and the oath I took as a physician. I won’t abandon my team at work or the patients who will increasingly look to me to save their lives in the coming weeks, but it’s torture.” She and her husband have amicably shared custody since their divorce two years ago. Why is this under “Good News”? Nobody’s sick. Nobody died. However unfair it may be, mother and daughter will live to put this separation behind them.

Bad News

  1. Madhvi Aya, 61, was a doctor in India but a senior physician assistant in the U.S. She worked at a hospital in one of the poorest sections of Brooklyn; it was overflowing with coronavirus patients, and she was there until she got sick herself. At the end, in a different hospital, she was alone after texting with her husband, mother, and daughter, whom she had been very afraid of infecting. She often said, “We have to take care of our patients first.”
  2. A nurse who must keep her identity secret for her own protection was on a bus in Chicago, coming home in her scrubs from a difficult shift, coughed into the crook of her elbow, with a mask, and was punched in the face by a man who accused her of trying to give him the virus. He gave her a black eye. Attacks on coronavirus heroes in all frontline professions have been happening all over the world. “It’s not going to stop me from coming to work every single day and taking care of the people I take care of,” she said.
  3. Immigrant Celia Marcos, 61, worked as a nurse at Hollywood Presbyterian Medical Center for 16 years until her death in April from COVID-19, which she almost certainly contracted from a patient. Her family and colleagues state that she was not provided with proper PPE, which the hospital denied. Her son Donald said, “when the call of duty came, she will do the best that she could.” He also said she “coded seven times” before she died. In their last conversation he said, “when you get out of that hospital, you will retire immediately.” She barely was able to say yes. Both were crying.
  4. Jason Hargrove, 50, a bus driver in Detroit, loved his job and did it faithfully, carrying essential workers and others to their own jobs. A passenger openly coughed near him without covering her mouth, and he recorded a Facebook video about the incident. He was worried about the other passengers and himself. He said, “I feel violated.” He died of the virus 11 days later. He left home by 5am and disinfected his bus every day. He would tell his wife, “Baby, when you get off work, make sure you grab me some more Lysol… I gotta make sure that my people are protected.”
  5. Dr. Lorna Breen, 49, head of the emergency medicine department at NY Columbia-Presbyterian Hospital, contracted the virus while heroically trying to save others. She recovered, but the hospital told her to stay home. She moved from NY to her parents home in Charlottesville. There, with no history of mental illness, she took her own life. Her father said, “Make sure she’s praised as a hero.”

Under the Russian Tsars, young men were drafted into the army for 25 years. As a child I knew an old man who had chopped off the first joint of his own trigger finger to avoid that fate. And why do I mention this? Because many, maybe even most of you, have told me you want to become nurses, physician assistants, or physicians. You are signing up for roughly twice the length of service that the Tsars demanded of young people. There will be another pandemic like this in your career. You will be called on. Even medical students have been called on in this crisis. You will not say no when you are asked to put your own life, and that of your loved ones, in danger, because that is your oath. Even when you think or know that you are risking your life for stupid people who put their own lives in danger, you will serve. Know what you are signing up for.

It was very interesting for me to watch today’s press conference on local television in Black Hawk County, Iowa. This is the cutting edge of the U.S. pandemic going forward. The local Tyson meatpacking plant reopened because the governor and the president said so, and because it was in their financial interest. Three leading local physicians and county health officials spoke. They stated that they did not know what was going on at the Tyson plant and would not be getting that information. They said they could not do contact tracing of confirmed cases. A county health official laughed at the idea of testing health care workers in nursing homes, because they don’t have the resources to do it.

Don’t think about New York any more. Think about Black Hawk County. Times ten. Or maybe times 100.

Stay safe,

Dr. K

Triumph of the (Teenage) Human Spirit

Resilience is sometimes astounding, and we need to acknowledge it.

school-group-wearing-red-c-uA boy, in flames, is running, screaming, across the parking lot of his school on an otherwise ordinary morning. The image evokes Vietnam or Bosnia, but it is Charleston, South Carolina, Wednesday, December 8. The school happens to be the number-one ranked Academic Magnet High School in the United States, and it shares a campus with a highly regarded School of the Arts. The burning boy is running toward the magnet school’s front doors. Read more

Psychological States As Ancient Adaptations

Depressed? Anxious? Happy? Resilient? Thank a hunter-gatherer in your past.

women-at-mongongo-groves-copy3I’ve considered here the high probability that obesity and diabetes are diseases of civilization and the possibility that ADHD may in part be as well. But what about other psychological symptoms and disorders? Randolph Nesse , a distinguished psychiatrist at the University of Michigan, has long been thinking about depression and anxiety in evolutionary perspective, and so have I and others.
Depression is a kind of withdrawal. Although it can be severe or long enough to hurt your reproductive options and even endanger your life, it is sometimes a symptom that gets you out of harm’s way. Read more

The Happiness Summit: Four Religious Leaders Talk

Religious summit finds happiness in relationships and even in suffering.

dalai-lama-emoryLast month at Emory (my university), the Dalai Lama was the center of a conversation-a “summit,” according to the press-on happiness. Also included were a Presiding Episcopal Bishop, the Chief Rabbi of Britain and the Commonwealth, and a famed Islamic scholar. None of them said anything about mood, and several denied that happiness has much to do with pleasure. Read more

The Social Network, 10,000 BP

Do 21st-century networks hark back to the distant past?

Picture a fire in an otherwise pitch-dark cave, or outside on a still plain on a moonless, starry night. Drop the temperature a bit, perhaps, and add the distant wail of a coyote or some wild dogs. Now add the most important ingredient: four or seven or ten people sitting around the fire talking, Read more

Epidemic Obesity: Adaptation Gone Wild

Obesity is unnatural, but it’s natural to try for it.

titian_venus_mirrorThis morning I sat on a panel for medical students; the subject was obesity. Nationally, as anyone who hasn’t been hiding under a rock knows, the picture is not pretty-in fact it’s pretty ugly. By the standard definition, obesity means a Body Mass Index (BMI; weight in kilos over height in meters squared) above 30, and in about 15 years starting in 1990 we went from 22 percent to 33 percent obese.

Now, I don’t care what you call it or Read more

Human Nature in High Places

Statesmen understand human nature. Why not psychologists and social scientists?

apg_obama_nobel_091009_mn1Most psychologists don’t like human nature, or at least not the idea of it. Clinicians, life coaches, and corporate motivators dislike it because it implies unchangeability. Anyone who took college psychology knows how to modify behavior, from direct instruction to manipulative advertising.

And then, what fool surveying the huge variety of human personalities, needs, and tastes would dream of trying to characterize all that as one thing? Well, some fool might, but not the philosophers, evolutionists, historians and political leaders who have long used the phrase. They’ve always meant something complex, varied, and big-but not limitless.

 Barack Obama, for instance. Read more

Barack Obama on War and Human Nature

Is Barack Obama an evolutionary psychologist?

Since I criticized President Obama’s speech last year in Cairo (and even “rewrote” it) and later pointed out the names and deeds of those who did not get the Nobel Peace Prize because he did, I think it’s only fair that I resume this blog after a long hiatus by writing about his Nobel Prize acceptance speech in December.

I have to say that it stunned me. Read more