Richard G. Petty, MD

The Changing Landscape of Self-Help

By Richard G. Petty, M.D.

The self-help movement has been through three phases, and we are now entering a fourth phase, which is the most exciting of all.

Thoughts and writings reflect social concerns as well as helping to create them. Apart from simply reading books and listening to programs, it is valuable to know where a set of ideas came from, so that we can see whether they are likely to be of any relevance to us today. A careful review of the time when certain self-help materials were written can be very revealing. Consider for a moment this rough break down of the key words that we can use for describing recent decades:

1960s: Hedonistic
1970s: Narcissistic
1980s: Materialistic
1990s: Apathetic
2000s: Integration and Responsibility

So materials written in each decade were designed to mesh with people’s wants and desires. Just for your own interest, look at any books that you own and see that I am correct. Books from the 1960s emphasized personal freedom and pleasure. While many from the 1970s suggested that we should build our self-esteem and develop our personalities.

The first phase began with those philosophers, both Eastern and Western, who first began to talk about human freedoms and our capacity as humans to use the powers of our minds to influence our emotions, beliefs, attitudes and life circumstances. There is a clear line running from Plato and Aristotle, through philosophers like Marcus Aurelius (the same person who was such an important figure at the beginning of the movie Gladiator), Saint Augustine, Francois de La Rochefoucauld, Emanuel Swedenborg, Benjamin Franklin, Thomas Jefferson and Emerson. In the east, both Buddha and Lao-Tzu talked about the way in which our minds construct our reality.

The second phase built on the insights of these good people with the growth of the "Positive Thought" movement, which started rather over a hundred years ago and revolved around the idea that "thoughts are things," and was buttressed by folk psychology. That is common sense psychology. Names like Ernest Holmes, Charles Haanel, Napoleon Hill and Earl Nightingale were some of the standard bearers of this phase. The trouble with commonsense psychology is that a lot of common sense turns out to be wrong. Let me give you an example. In recent years there has been a lot written about self-esteem. This remains a poorly defined term in psychological research, but the National Association for Self-Esteem (NASE) defines healthy self-esteem as "the experience of being capable of meeting life’s challenges and being worthy of happiness."

The theory has been that if you have low self-esteem, that is a bad thing; so boosting your self-esteem must be a good thing. Indeed entire educational systems have been built up around this idea. I lived through a time in Britain when some people tried to ban competitive games on the grounds that competition is bad and that if someone lost, it might damage their self-esteem and cause them psychological damage.

There is a very interesting study that came out in 1989, comparing mathematical competence in students in eight different countries. Korean students ranked the highest in mathematical skills, while those in the United States had the lowest rating. Now the study had an interesting sting in the tail: the researchers asked the students to rate how good they thought they thought they were at mathematics. The American students, who did so poorly, actually had the highest overall opinion of their ability, while the Koreans who had the best results had the lowest opinion of their abilities.

I was reminded of that study by watching a few minutes of an early episode of American Idol on which Simon Cowell was skewering some of the contestants, who then protested loudly despite that they were brilliant, despite having just given a lamentable performance. There is good quality scientific research that has shown that self-esteem has little or no effect on personal goals, academic achievement, healthy lifestyles or interpersonal relationships. Indeed, there are several studies suggesting that inflated self-esteem may be dangerous: extremely high self-esteem can make some people narcissistic and is a feature of many sociopaths and some psychiatric illnesses. People who have exaggerated views about their self-worth often become hostile if they are criticized or rejected. It seems clear that boosting self-esteem on its own does not seem to do anything very much. But having it raised by achievement is very valuable.

The third phase of development of the self-help movement incorporated some pop psychology and some experimental work. I am thinking of pop psychology like the false dichotomy of right and left hemispheres of the brain, or the primacy of channeling emotion to get tasks completed. It led to claims that all that was necessary for success was to learn this, or master that, and you would be successful beyond your wildest dreams. We were instructed to live more passionately, to generate a burning desire for something, to have an unshakable belief that we would be successful, to set clear goals, to create a plan of action, to persist, affirm, visualize, give ourselves permission to succeed. The list goes on and on. I am quite certain that each of them was correct and that each has helped a lot of people, but in our changing world, mastering any one of those will not be as effective as using all of them together. We also saw the problems that could sometimes occur when folk took little bits of psychological research out of context and tried to apply it to human problems.

We are now entering a fourth phase, in which sophisticated empirical research is driving a new psychological enterprise. Much of the credit for this new approach must go to Marty Seligman at the University of Pennsylvania, who has become the guru of positive psychology. I know that many people have been surprised when I, and others, make self-help recommendations, not based solely on my personal experience, but also rooted in careful research. We are now entering an exciting time, and the challenge is to see which self-help programs really hold water, and to use the scientific method to improve them further. For the scientific method is not simply a tool for establishing the truth of a proposition, it is also a method for improving what we have.

The time has come for us all to insist that when we are presented with new programs, we must hold them to a higher standard and that they provide us with evidence that they work, or backup for their theories. If they do not, we can, of course, still use them, but we must be aware of their limitations. Time was, that it was enough to say that if the student did not get the message, it was their fault: they just weren’t ready, or did not have the background. But that really is changing: our problems, and our need for growth are now too urgent to allow us that luxury.

And that leads us to the final point: what constitutes evidence? Clearly nobody expects a mystic or inspirational writer to do some sort of a blinded study to show that their material works. An important concept is what we refer to as levels of evidence. In the past it was often thought that the only kind of evidence to be of any value in clinical decision making had to have been obtained by randomized controlled trials. Yet we all know from experience that there are other types of evidence. A teacher or a colleague may have recommended a course of action based on experience or observation, and this can provide valuable guidance. In the scientific world we now recognize four types of clinical evidence:

  1. Individual reports
  2. Case series and uncontrolled observational studies
  3. Retrospective database analyses
  4. Controlled analytic studies, including randomized clinical trials

So we are not limited to one kind of evidence: there are many. And each type can be used to inform the improvement of programs.

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