The Paradox of Control: Gelassenheit, Stoicism, Personal Control and God

1. The Paradox of Control: Gelassenheit, Stoicism, Personal Control and God Thomas V. Merluzzi University of Notre Dame Notre Dame, Indiana USA tmerluzz@nd.edu

2. Thanks to • Steve Fredman for discussions on ancient philosophy and galessenheit • Niels for friendship, colleagueship, and an invitation to Denmark

3. Overview • Historical Perspectives • Psychological Perspectives on Control • Development of Control Beliefs • Primary and Secondary Control • Faith and Control • Types of Religious Problem Solving • Integrating Types and Control Theory

4. Lao Tsu • Tao Te Ching • Wei wu wei • “doing not-doing” • “Less and less do you need to force things, until finally you arrive at non-action.”

5. Lao Tsu Can you coax your mind from its wandering and keep to the original oneness? Can you let your body become supple as a newborn child’s? Can you cleanse your inner vision until you see nothing but the light? Can you love people and lead them without imposing your will? Can you deal with the most vital matters by letting events take their course? Can you step back from your own mind and thus understand all things?

6. Stoicism • Seneca, Epictetus, Marcus Aurelius • Filtered through Pierre Hadot • Happiness consists in the demands of good • Happiness is accessible to all within this life • World view • Fatalism – external causes and fate • However, “what does depend on us is to will to do good and act in conformity with reason.” • Referred to as coherence

7. Stoicism • Coherence sounds paradoxical • Sets stage for detachment from outcomes • Stoics espouse a process model • Do good and detach from externals • Everything outside moral intention is indifferent • Helps us navigate in an uncertain world

8. Stoics • Seneca • “Disaster is virtue’s opportunity.” • Not opposed to goals or confidence • Efficacy in moral intention and behavior with no expectations about the outcomes

9. Meister Eckhart • Late 13th early 14th century Dominican • Wrote many sermons, which are now becoming more popular • Moral liberation is also intellectual liberation • Gelassenheit • Detachment, serenity • from suffering and pain • Teachings are in line with Christian asceticism

10. Martin Heidegger • Secular version of Gelassenheit • A phenomenonological experience that represents a process by which we arrive at “releasement” • “Active waiting” • Was interested in translating the TaoTe Ching but never was able to complete it.

11. Modern Conceptions of Gelassenheit • Mindfulness • Focus on the here and now • Heightened awareness • Used with chronic pain patients • Pain becomes intimately intertwined with “self” and the social context (John Kabat-Zinn) • Transform identity from a “pain patient” to a “person with pain” • Make peace with their pain

12. Niebuhr • Serenity Prayer • God grant me the strength to change the things I can change, accept the things I cannot change and the wisdom to know the difference • 12 step programs – first step is to accept that there is a power greater than mine

13. Personal Control • Buddism • Doing not-doing • Stoicim • Control over our intentions and behavior • Moral imperative • Outcomes not controllable • Gelassenheit • Detachment • Releasement

14. Modern “Western” Perspectives on Psychological Control • Rather pervasive concept in mental and physical health • Self-control • Self-regulation • Self-reliance • Self-efficacy • Agency • All typically associated with positive coping and adjustment to illness

15. Control and Western Concepts of Health • Derived from male sex role characteristics • Definition of health is socially and culturally informed

16. Psychological Control • Opposite of control not valued in our society • Passivity • Withdrawal • Submissiveness • Helplessness • Impulsivity • Behavior Excesses

17. Control: Psychology versus Faith? • Psychological perspective • Emphasis on personal control • Positive outcomes related to degree of personal control • Perceived, “illusory” control (S. Taylor) • Faith perspective • Emphasis on deferring control • Positive outcomes related to the relinquishing of control • Trust in God • “Turn it over to God” • Niebuhr’s serenity prayer • “Thy will be done on earth as it is in heaven”

18. Approaches to Psychological Control in the Context of Illness

19. Psychological Control: Self-Regulation • Self-control • Self-regulation • In children – • emotional self-regulation • ADHD • In adults – • Independence • Problem solving • Dysregulation = addictions • Premise is that our behavior affects the world • ActionsOutcomes (Carver & Scheier, 1998) • Alternative to self-regulation no relation between our actions and outcomes • Stoics, Zen

20. Psychological Control: Learned Helplessness • Learned Helplessness (Seligman, 1975) • Motivational, cognitive, and emotional deficits due to prolonged exposure to non-contingent events • Actions are uncorrelated with outcomes • However, we retain the belief that they should be correlated • Contrast with Stoicism, Gelassenheit • Construct that accounts for depression (Levenson, 1973) • Suspension of means-ends beliefs (E. Skinner et al., 1988) • Premise that certain actions produce desired or prevent undesired outcomes is repeatedly disconfirmed • Can we appreciate the complex relation between actions and outcomes?

21. Psychological Control: Self-Efficacy • Self-efficacy • Beliefs/Expectations about our ability to execute actions (behaviors, thoughts)(Bandura, 1997) Two types of expectancies 1. Behavior (Actions) expectancy (self-efficacy) 2. Outcome expectancy • What is the likelihood of Y if I do X at this level of competence

22. Self-Efficacy • Choose behaviors that will maximize outcomes • Persist in behaviors where the outcome is valued • Cause-effect relation may be illusory • May not reflect actual physical relationships in the world • We “force” correlations between our behavior and desired outcomes • Perceived control paradigm • Seneca and self-efficacy

23. Failures of Control • Type A behavior pattern (Friedman & Rosenman, 1974) • High risk for MI and repeat MI • Anger and cynical hostility • Misattributions about others • antagonistic or threatening • Control to counteract perceived control by others • Unmitigated Agency (Helgeson & Lepore, 1997) • Agency (excessive control) unmitigated by communion (connection with others) not an effective coping strategy

24. Failures of Control • The Bernie Siegel Effect • Attributing the cause of recurrence of cancer to lack of control over negative thoughts • “The prison of positive thinking” (D. Spiegel) • High personal control/ High personal responsibility • Too much control attributed in the face of uncertainty • Self-blame ensues

25. Development of Control Beliefs Not a static concept Changes throughout the lifespan

26. Early Adulthood (22-35) Hyper-Control • “Personal Fable” in adolescence • Belief in complete control • Perceived invulnerability • May actually perceive danger but also willing to take risks • Low incidence of fatal diseases • Dominant factors in life satisfaction • Family life (independence from family) • Standard of living

27. Middle Age (35-44)Career Control • Attainment: Success in career and material world….but also…. • Come to terms with aging (Sheehy, 1995) • Develop/Revisit/Refine value orientation • Dominant factors in life satisfaction • Standard of living • Family life (quality of relationships – spouse, children)

28. Late Middle Age (45-64)Control in Transition • Balance work and relationships • Moral aspects of work and social responsibility • Reflection on the bigger picture • Generativity – helping the formation of the next generation • Experiences losses • Deaths as well as physical stamina • Rapid increase in mortality due to heart disease, cancer, etc. • Caregiving • Men may become more nurturing and accepting of care

29. Late Middle Age (45-64) Con’t Transition • Dominant factors in life satisfaction • Family life • SATISFACTION WITH HEALTH • Standard of living • Cognitive shift in health consciousness • Attempts to maintain, regain, or grieve loss of health (Merluzzi & Nairn, 1999)

30. Late Adulthood (65+)Limits of Control • Come to terms with limitations of control • Much more illness • “Expected” versus “Unexpected” illness • Come to expect more illness with aging • Termination of employment • Loss of independence • Dominant factors in life satisfaction • Family life • Standard of living • SATISFACTION WITH HEALTH

31. Developmental Context of Control Beliefs – Summing Up • Early and middle adulthood • Emphasis on controllability • Unexpected illness more devastating • Older adults • Reconciliation of control beliefs with reality • Does not result in total loss of control • Compensatory strategy (Freund & Baltes, 2002) • Selection, Optimization, Compensation • Relative norming – “compared to others…” • “Reality” changes across the lifespan • “Unexpected” becomes more “expected”

32. Two Forms of Control • Primary Control • Change the environment • Secondary Control • Change ourselves

33. Primary and Secondary Control • Primary Control • Bringing the environment in line with our wishes • Imposing control • Oriented to outcomes • Early Adulthood and Middle Age • Higher demand for control in young adulthood • Secondary Control • Bringing ourselves in line with environmental forces • Coming to terms with the limits of control • Outcomes are not controllable OR • Outcomes are internal • Late adulthood

34. Secondary Control • Types of Secondary Control • Attributions of outcomes to • Severe limited ability (negative outcomes) • Luck or chance (positive or negative outcomes) • Secondary control that may be faith-based • Powerful others – forces beyond our control (positive or negative outcomes) • God referenced control • Interpretive control – seek to understand and derive meaning from uncontrollable events (transform negative to positive) • Meaning referenced control

35. Faith and Control • Faith Perspectives on Control (Pargament, 1997) • Self-Directing (Primary Control) • God gives people freedom to direct their own lives • I have control • Collaborative (Primary and Secondary Control) • Problem solving process held jointly by the individual and God • Shared control with God • Deferring (Secondary Control) • God is the source of all solutions • God has control

36. Research on the Structure of Religious Control • Healthy group of church members (Hathaway & Pargament, 1990) • Found 3 distinct control styles • Collaborative, Deferring, Self-directing • Although Collaborative and Deferring somewhat correlated • Persons with cancer (Nairn & Merluzzi, 2003) • Found that the Collaborative & Deferring styles are very highly correlated • Thus, just two control styles found • Collaborative/Deferring and Self-Directing • highly negatively correlated

37. Comparison of Collaborative/Deferring and Self-Directing Collaborative/ Self-Directing Deferring Self-Directing (-) 7.52* 11.86* Self-Directing (+) 21.70 20.64 Attend Religious Services 4.28* 3.40* Pray, how often 7.24* 4.25* How religious 4.10* 3.00* SP Well Being (Faith) 13.21* 9.35* SP Coping Efficacy 76.31* 62.28*

38. Comparing C/D and SD Collaborative/ Self-Directing Deferring SP Well Being (Meaning) 34.24 34.27 Coping Self-efficacy 97.38 102.53 Quality of Life (FACT) Physical 12.87 12.04 Social/Family 28.23 29.00 Emotional 11.65 10.40 Functional 27.12 29.09 Mindfulness 64.79* 69.32*

39. Three Types Of People 30 20 10 Collaborative/ Deferring (CD) Collaborative Deferring H H L Self-Directing 30 20 10 Self-Directing (SD) L L H 30 20 10 Paradox-ers CD + SD H H H

40. Differences in the Three Types • Paradox-ers highest on all scales of the Cancer Behavior Inventory (agentic coping) • Maintaining Activity and Independence : P>C/D=SD • Coping with Side Effects P>C/D=SD • Positive Attitude P>CD>SD • Seeking Medical Information P>C/D=SD • Emotional Regulation P>C/D=SD • Seeking Support P>C/D>SD • Religiousness P = CD > SD • Trends • Social Support CD>SD>P • Adjustment P=CD>SD

41. Contextualizing of Control • Optimizing Health • For a well population in terms of esteem and adjustment • Self-Directing and Collaborative • for prevention of illness and promotion of health • For those coping with serious illness • Self-Directing less effective • Collaborative and Deferring correlated and more effective • Paradox-ers approach most effective? Most flexible? • Able to “live” with the seemingly opposing strategies

42. Continuum of Control Primary Control Secondary Control Engagement Detachment Health/ Acute Illness Chronic Illness Self-Directed Deferring Prevention Acceptance Younger Older Paradox-er is able to move along this continuum depending upon the context of coping

43. Integrating Types and Control Theory • Self-Directing Type • Control over Behavior and Outcome expectancy • High correlation of behavior (action) and outcome expectancies • High expectations for certain outcomes • Works for prevention • Cause – Effect attribution • Rigid perspective of God as uninvolved

44. Integrating Types and Control Theory • Collaborative/Deferring Type • Increasing recognition of the uncertainty of outcomes • Secondary control (trust in a powerful God) is a hedge against hopelessness • Effective when coping with serious disease • God as partner or completely in control

45. Integrating Types and Control Theory • Paradox-ers • Most flexible – most adaptable to all situations • High behavior expectancies • Likely to engage in coping behaviors, BUT….. • Flexible outcome expectancies based on uncertainty of the situation • Flexible perspective on God • OR – they are merely pragmatists

46. Questions • Should people who are ill be indifferent to the outcomes as the Stoics suggest? • When does Gelassenheit have value?

47. More Questions • Is illness a “reality” check on the limitations of personal control? • Does moving from health to illness change our perspective on control AND our relationship with God? • Does serious illness “cause” a convergence of collaborative and deferring problem-solving or coping styles? • Is the Paradox approach the most flexible and most effective? • Need for qualitative and longitudinal research • How do they live with the paradox of control and deferring?