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Wednesday, September 4, 2024

Stereotype threat

From Wikipedia, the free encyclopedia

Stereotype threat is a situational predicament in which people are or feel themselves to be at risk of conforming to stereotypes about their social group. It is theorized to be a contributing factor to long-standing racial and gender gaps in academic performance. Since its introduction into the academic literature, stereotype threat has become one of the most widely studied topics in the field of social psychology.

Situational factors that increase stereotype threat can include the difficulty of the task, the belief that the task measures their abilities, and the relevance of the stereotype to the task. Individuals show higher degrees of stereotype threat on tasks they wish to perform well on and when they identify strongly with the stereotyped group. These effects are also increased when they expect discrimination due to their identification with a negatively stereotyped group. Repeated experiences of stereotype threat can lead to a vicious circle of diminished confidence, poor performance, and loss of interest in the relevant area of achievement. Stereotype threat has been argued to show a reduction in the performance of individuals who belong to negatively stereotyped groups. Its role in affecting public health disparities has also been suggested.

According to the theory, if negative stereotypes are present regarding a specific group, group members are likely to become anxious about their performance, which may hinder their ability to perform to their full potential. Importantly, the individual does not need to subscribe to the stereotype for it to be activated. It is hypothesized that the mechanism through which anxiety (induced by the activation of the stereotype) decreases performance is by depleting working memory (especially the phonological aspects of the working memory system).

The opposite of stereotype threat is stereotype boost, which is when people perform better than they otherwise would have, because of exposure to positive stereotypes about their social group. A variant of stereotype boost is stereotype lift, which is people achieving better performance because of exposure to negative stereotypes about other social groups.

Some researchers have suggested that stereotype threat should not be interpreted as a factor in real-life performance gaps, and have raised the possibility of publication bias. Other critics have focused on correcting what they claim are misconceptions of early studies showing a large effect. Meta-analyses and systematic reviews have shown significant evidence for the effects of stereotype threat, though the phenomenon defies over-simplistic characterization.

Empirical studies

As of 2015, more than 300 studies have been published showing the effects of stereotype threat on performance in a variety of domains. Stereotype threat is considered by some researchers to be a contributing factor to long-standing racial and gender achievement gaps, such as under-performance of black students relative to white ones in various academic subjects, and under-representation of women at higher echelons in the field of mathematics.

The strength of the stereotype threat that occurs depends on how the task is framed. If a task is framed to be neutral, stereotype threat is not likely to occur; however, if tasks are framed in terms of active stereotypes, participants are likely to perform worse on the task. For example, a study on chess players revealed that female players performed more poorly than expected when they were told they would be playing against a male opponent. In contrast, women who were told that their opponent was female performed as would be predicted by past ratings of performance. Female participants who were made aware of the stereotype of females performing worse at chess than males performed worse in their chess games.

A 2007 study extended stereotype threat research to entrepreneurship, a traditionally male-stereotyped profession. The study revealed that stereotype threat can depress women's entrepreneurial intentions while boosting men's intentions. However, when entrepreneurship is presented as a gender-neutral profession, men and women express a similar level of interest in becoming entrepreneurs. Another experiment involved a golf game which was described as a test of "natural athletic ability" or of "sports intelligence". When it was described as a test of athletic ability, European-American students performed worse, but when the description mentioned intelligence, African-American students performed worse.

Other studies have demonstrated how stereotype threat can negatively affect the performance of European Americans in athletic situations as well as the performance of men who are being tested on their social sensitivity. Although the framing of a task can produce stereotype threat in most individuals, certain individuals appear to be more likely to experience stereotype threat than others. Individuals who highly identify with a particular group appear to be more vulnerable to experiencing stereotype threat than individuals who do not identify strongly with the stereotyped group.

The mere presence of other people can evoke stereotype threat. In one experiment, women who took a mathematics exam along with two other women got 70% of the answers right, whereas women who took the same exam in the presence of two men got an average score of 55%.

The goal of a study conducted by Desert, Preaux, and Jund in 2009 was to see if children from lower socioeconomic groups are affected by stereotype threat. The study compared children that were 6–7 years old with children that were 8–9 years old from multiple elementary schools. These children were presented with the Raven's Matrices test, which is an intellectual ability test. Separate groups of children were given directions in an evaluative way and other groups were given directions in a non-evaluative way. The "evaluative" group received instructions that are usually given with the Raven Matrices test, while the "non-evaluative" group was given directions which made it seem as if the children were simply playing a game. The results showed that third graders performed better on the test than the first graders did, which was expected. However, the lower socioeconomic status children did worse on the test when they received directions in an evaluative way than the higher socioeconomic status children did when they received directions in an evaluative way. These results suggested that the framing of the directions given to the children may have a greater effect on performance than socioeconomic status. This was shown by the differences in performance based on which type of instructions they received. This information can be useful in classroom settings to help improve the performance of students of lower socioeconomic status.

There have been studies on the effects of stereotype threat based on age. A study was done on 99 senior citizens ranging in age from 60–75 years. These seniors were given multiple tests on certain factors and categories such as memory and physical abilities, and were also asked to evaluate how physically fit they believe themselves to be. Additionally, they were asked to read articles that contained both positive and negative outlooks about seniors, and they watched someone reading the same articles. The goal of this study was to see if priming the participants before the tests would affect performance. The results showed that the control group performed better than those that were primed with either negative or positive words prior to the tests. The control group seemed to feel more confident in their abilities than the other two groups. Other studies have found that stereotype activation in older adults can improve memory performance, resulting in a distinction between stereotype threat mechanisms in aging compared with other groups.

Many psychological experiments carried out on Stereotype Threat focus on the physiological effects of negative stereotype threat on performance, looking at both high and low status groups. Scheepers and Ellemers tested the following hypothesis: when assessing a performance situation on the basis of current beliefs the low status group members would show a physiological threat response, and high-status members would also show a physiological threat response when examining a possible alteration of the status quo (Scheepers & Ellemers, 2005). The results of this experiment were in line with expectations. As predicted, participants in the low status condition showed higher blood pressure immediately after the status feedback, while participants in the high-status condition showed a spike in blood pressure while anticipating the second round of the task.

In 2012, Scheepers et al. hypothesized that when high social power is stimulated 'an efficient cardiovascular pattern (challenge)' is produced, whereas, 'an inefficient cardiovascular pattern' or threat is caused by the activation of low social power (Scheepers, de Wit, Ellemers & Sassenberg, 2012). Two experiments were carried out in order to test this hypothesis. The first experiment looked at power priming and the second experiment related to role play. Both results from these two experiments provided evidence in support for the hypothesis.

Cleopatra Abdou and Adam Fingerhut were the first to develop experimental methods to study stereotype threat in a health care context, including the first study indicating that health care stereotype threat is linked with adverse health outcomes and disparities.

Some studies have found null results. The single largest experimental test of stereotype threat (N = 2064), conducted on Dutch high school students, found no effect. The authors state, however, that these results are limited to a narrow age-range, experimental procedure and cultural context, and call for further registered reports and replication studies on the topic. Despite these limitations, they state in conclusion that their study shows "that the effects of stereotype threat on math test performance should not be overgeneralized."

Numerous meta-analyses and systematic reviews have shown significant evidence for the effects of stereotype threat. However they also point to ways in which the phenomenon defies over-simplistic characterization. For instance, one meta-analysis found that with female subjects "subtle threat-activating cues produced the largest effect, followed by blatant and moderately explicit cues" while with minorities "moderately explicit stereotype threat-activating cues produced the largest effect, followed by blatant and subtle cues".

Mechanisms

Although numerous studies demonstrate the effects of stereotype threat on performance, questions remain as to the specific cognitive factors that underlie these effects. Steele and Aronson originally speculated that attempts to suppress stereotype-related thoughts lead to anxiety and the narrowing of attention. This could contribute to the observed deficits in performance. In 2008, Toni Schmader, Michael Johns, and Chad Forbes published an integrated model of stereotype threat that focused on three interrelated factors:

  1. stress arousal;
  2. performance monitoring, which narrows attention; and,
  3. efforts to suppress negative thoughts and emotions.

Schmader et al. suggest that these three factors summarize the pattern of evidence that has been accumulated by past experiments on stereotype threat. For example, stereotype threat has been shown to disrupt working memory and executive function, increase arousal, increase self-consciousness about one's performance, and cause individuals to try to suppress negative thoughts as well as negative emotions such as anxiety. People have a limited amount of cognitive resources available. When a large portion of these resources are spent focusing on anxiety and performance pressure, the individual is likely to perform worse on the task at hand.

A number of studies looking at physiological and neurological responses support Schmader and colleagues' integrated model of the processes that produce stereotype threat. Supporting an explanation in terms of stress arousal, one study found that African Americans under stereotype threat exhibit larger increases in arterial blood pressure. One study found increased cardiovascular activation amongst women who watched a video in which men outnumbered women at a math and science conference. Other studies have similarly found that individuals under stereotype threat display increased heart rates. Stereotype threat may also activate a neuroendocrine stress response, as measured by increased levels of cortisol while under threat. The physiological reactions that are induced by stereotype threat can often be subconscious, and can distract and interrupt cognitive focus from the task.

With regard to performance monitoring and vigilance, studies of brain activity have supported the idea that stereotype threat increases both of these processes. Forbes and colleagues recorded electroencephalogram (EEG) signals that measure electrical activity along the scalp, and found that individuals experiencing stereotype threat were more vigilant for performance-related stimuli.

Researchers found that women experiencing stereotype threat while taking a math test showed heightened activation in the ventral stream of the anterior cingulate cortex (ACC).

Another study used functional magnetic resonance imaging (fMRI) to investigate brain activity associated with stereotype threat. The researchers found that women experiencing stereotype threat while taking a math test showed heightened activation in the ventral stream of the anterior cingulate cortex (ACC), a neural region thought to be associated with social and emotional processing. Wraga and colleagues found that women under stereotype threat showed increased activation in the ventral ACC and that the amount of this activation predicted performance decrements on the task. When individuals were made aware of performance-related stimuli, they were more likely to experience stereotype threat. However, a study using fMRI to investigate stereotype threat in older adults showed heightened activation in parietal midline regions including the posterior cingulate cortex (PCC) and precuneus during both working memory and episodic memory tasks. The heightened activation in these brain areas also was associated with better memory accuracy, inconsistent with the notion that stereotype threat always leads to impaired performance.

A study conducted by Boucher, Rydell, Loo, and Rydell has shown that stereotype threat not only affects performance, but can also affect the ability to learn new information. In the study, undergraduate men and women had a session of learning followed by an assessment of what they learned. Some participants were given information intended to induce stereotype threat, and some of these participants were later given "gender fair" information, which it was predicted would reduce or remove stereotype threat. As a result, participants were split into four separate conditions: control group, stereotype threat only, stereotype threat removed before learning, and stereotype threat removed after learning. The results of the study showed that the women who were presented with the "gender fair" information performed better on the math related test than the women who were not presented with this information. This study also showed that it was more beneficial to women for the "gender fair" information to be presented prior to learning rather than after learning. These results suggest that eliminating stereotype threat prior to taking mathematical tests can help women perform better, and that eliminating stereotype threat prior to mathematical learning can help women learn better.

Original study

"The Effects of Stereotype Threat on the Standardized Test Performance of College Students (adjusted for group differences on SAT)". From J. Aronson, C.M. Steele, M.F. Salinas, M.J. Lustina, Readings About the Social Animal, 8th edition, ed. E. Aronson

In 1995, Claude Steele and Joshua Aronson performed the first experiments demonstrating that stereotype threat can undermine intellectual performance. Steele and Aronson measured this through a word completion task.

They had African-American and European-American college students take a difficult verbal portion of the Graduate Record Examination test. As would be expected based on national averages, the African-American students did not perform as well on the test. Steele and Aronson split students into three groups: stereotype-threat (in which the test was described as being "diagnostic of intellectual ability"), non-stereotype threat (in which the test was described as "a laboratory problem-solving task that was nondiagnostic of ability"), and a third condition (in which the test was again described as nondiagnostic of ability, but participants were asked to view the difficult test as a challenge). All three groups received the same test.

Steele and Aronson concluded that changing the instructions on the test could reduce African-American students' concern about confirming a negative stereotype about their group. Supporting this conclusion, they found that African-American students who regarded the test as a measure of intelligence had more thoughts related to negative stereotypes of their group. Additionally, they found that African Americans who thought the test measured intelligence were more likely to complete word fragments using words associated with relevant negative stereotypes (e.g., completing "__mb" as "dumb" rather than as "numb").

Adjusted for previous SAT scores, subjects in the non-diagnostic-challenge condition performed significantly better than those in the non-diagnostic-only condition and those in the diagnostic condition. In the first experiment, the race-by-condition interaction was marginally significant. However, the second study reported in the same paper found a significant interaction effect of race and condition. This suggested that placement in the diagnostic condition significantly impacted African Americans compared with European Americans.

Stereotype lift and stereotype boost

Stereotype threat concerns how stereotype cues can harm performance. However, in certain situations, stereotype activation can also lead to performance enhancement through stereotype lift or stereotype boost. Stereotype lift increases performance when people are exposed to negative stereotypes about another group. This enhanced performance has been attributed to increases in self-efficacy and decreases in self-doubt as a result of negative outgroup stereotypes. Stereotype boost suggests that positive stereotypes may enhance performance. Stereotype boost occurs when a positive aspect of an individual's social identity is made salient in an identity-relevant domain. Although stereotype boost is similar to stereotype lift in enhancing performance, stereotype lift is the result of a negative outgroup stereotype, whereas stereotype boost occurs due to activation of a positive ingroup stereotype.

Consistent with the positive racial stereotype concerning their superior quantitative skills, Asian American women performed better on a math test when their Asian identity was primed compared to a control condition where no social identity was primed. Conversely, these participants did worse on the math test when instead their gender identity—which is associated with stereotypes of inferior quantitative skills—was made salient, which is consistent with stereotype threat. Two replications of this result have been attempted. In one case, the effect was only reproduced after excluding participants who were unaware of stereotypes about the mathematical abilities of Asians or women, while the other replication failed to reproduce the original results even considering several moderating variables.

Long-term and other consequences

Decreased performance is the most recognized consequence of stereotype threat. However, research has also shown that stereotype threat can cause individuals to blame themselves for perceived failures, self-handicap, discount the value and validity of performance tasks, distance themselves from negatively stereotyped groups, and disengage from situations that are perceived as threatening.

Studies examining stereotype threat in Black Americans have found that when subjects are aware of the stereotype of Black criminality, anxiety about encountering police increases. This, in turn, can lead to self-regulatory efforts, more anxiety, and other behaviors that are commonly perceived as suspicious to police officers. Because police officers tend to perceive Black people as threatening, their reactions to these anxiety-induced behaviors are commonly more harsh than reactions to White people with the same behavior, and influences whether or not they decide to shoot the person.

In the long run, the chronic experience of stereotype threat may lead individuals to disidentify with the stereotyped group. For example, a woman may stop seeing herself as "a math person" after experiencing a series of situations in which she experienced stereotype threat. This disidentification is thought to be a psychological coping strategy to maintain self-esteem in the face of failure. Repeated exposure to anxiety and nervousness can lead individuals to choose to distance themselves from the stereotyped group.

Although much of the research on stereotype threat has examined the effects of coping with negative stereotype on academic performance, recently there has been an emphasis on how coping with stereotype threat could "spillover" to dampen self-control and thereby affect a much broader category of behaviors, even in non-stereotyped domains. Research by Michael Inzlicht and colleagues suggest that, when women cope with negative stereotypes about their math ability, they perform worse on math tests, and that, well after completing the math test, women may continue to show deficits even in unrelated domains. For example, women might overeat, be more aggressive, make more risky decisions, and show less endurance during physical exercise.

The perceived discrimination associated with stereotype threat can also have negative long-term consequences on individuals' mental health. Perceived discrimination has been extensively investigated in terms of its effects on mental health, with a particular emphasis on depression. Cross-sectional studies involving diverse minority groups, including those relating to internalized racism, have found that individuals who experience more perceived discrimination are more likely to exhibit depressive symptoms. Additionally, perceived discrimination has also been found to predict depressive symptoms in children and adolescents. Other negative mental health outcomes associated with perceived discrimination include a reduced general well-being, post-traumatic stress disorder, anxiety, and rebellious behavior. A meta-analysis conducted by Pascoe and Smart Richman has shown that the strong link between perceived discrimination and negative mental health persists even after controlling for factors such as education, socioeconomic status, and employment.

Mitigation

Additional research seeks ways to boost the test scores and academic achievement of students in negatively stereotyped groups. Such studies suggest various ways in which the effects of stereotype threat may be mitigated. For example, there have been increasing concerns about the negative effects of stereotype threats on MCAT, SAT, LSAT scores, etc. One effort at mitigation of the negative consequences of stereotype threat involves rescaling standardized test scores to adjust for the adverse effects of stereotypes.

Perhaps most prominently, well replicated findings suggest that teaching students to re-evaluate stress and adopt an incremental theory of intelligence can be an effective way to mitigate the effects of stereotype threat. Two studies sought to measure the effects of persuading participants that intelligence is malleable and can be increased through effort. Both suggested that if people believe that they can improve their performance based on effort, they are more likely to believe that they can overcome negative stereotypes, and thus perform well. Another study found that having students reexamine their situation or anxiety can help their executive resources (attentional control, working memory, etc.), rather than allowing stress to deplete them, and thus improve test performance. Subsequent research has found that students who are taught an incremental view of intelligence do not attribute academic setbacks to their innate ability, but rather to a situational attribute such as a poor study strategy. As a result, students are more likely to implement alternative study strategies and seek help from others.

Research on the power of self-affirmation exercises has shown promising results as well. One such study found that a self-affirmation exercise (in the form of a brief in-class writing assignment about a value that is important to them) significantly improved the grades of African-American middle-school students, and reduced the racial achievement gap by 40%. The authors of this study suggest that the racial achievement gap could be at least partially ameliorated by brief and targeted social-psychological interventions. Another such intervention was attempted with UK medical students, who were given a written assignment and a clinical assessment. For the written assignment group, white students performed worse than minority students. For the clinical assessment, both groups improved their performance, though the gap between racial groups was maintained. Allowing participants to think about a positive value or attribute about themselves prior to completing the task seemed to make them less susceptible to stereotype threat. Self-affirmation has also been shown to mitigate the performance gap between female and male participants on mathematical and geometrical reasoning tests. Similarly, it has been shown that encouraging women to think about their multiple roles and identities by creating self-concept map can eliminate the gender gap on a relatively difficult standardized test. Women given such an opportunity for reflection did equally well as men on the math portion of the GRE, while women who did not create a self-concept map did significantly worse on the math section than men did.

Increasing the representation of minority groups in a field has also been shown to mitigate stereotype threat. In one study, women in STEM fields were shown a video of a conference with either a balanced or unbalanced ratio of men to women. The women viewing an unbalanced ratio reported a lower sense of belonging and less desire to participate. Decreasing cues that reflect only a majority group and increasing cues of minority groups can create environments that mitigate against stereotype threat. Further research has focused on constructing environments such that the physical objects in the environment do not reflect one majority group. For instance, in one study, researchers argued that individuals make decisions about group membership based on the group's environment and showed that altering the physical objects in a room boosted minority participation. In this study, removing stereotypical computer science objects and replacing them with non-stereotypical objects increased female participation in computer science to an equal level as male peers.

Directly communicating that diversity is valued may also be effective. One study revealed that a company's pamphlet stating a direct value of diversity, compared to a color blind approach, caused African Americans to report an increase in trust and comfort towards the company. Promoting cross-group relations between people of varying backgrounds has also been shown to be effective at promoting a sense of belonging among minority group members. For instance, a 2008 study indicates that students have a lower sense of belonging at institutions where they are the minority, but developing friendships with members of other racial groups increased their sense of belonging. In 2007, a study by Greg Walton and Geoffrey Cohen showed results in boosting the grades of African-American college students, and eliminating the racial achievement gap between them and their white peers over the first year of college, by emphasizing to participants that concerns about social belonging tend to lessen over time. These findings suggest that allowing individuals to feel as though they are welcomed into a desirable group makes them more likely to ignore stereotypes. The upshot is that if minority college students are welcomed into the world of academia, they are less likely to be influenced by the negative stereotypes of poor minority performance on academic tasks.

One early study suggested that simply informing college women about stereotype threat and its effects on performance was sufficient to eliminate the predicted gender gap on a difficult math test. The authors of this study argued that making people aware of the fact that they will not necessarily perform worse despite the existence of a stereotype can boost their performance. However, other research has found that merely providing information is not enough, and can even have the opposite effect. In one study, women were given a text "summarizing an experiment in which stereotypes, and not biological differences, were shown to be the cause of women's underperformance in math", and then they performed a math exercise. It was found that "women who properly understood the meaning of the information provided, and thus became knowledgeable about stereotype threat, performed significantly worse at a calculus task". In such cases, further research suggests that the manner in which the information is presented –– that is, whether subjects are made to perceive themselves as targets of negative stereotyping –– may be decisive.

Criticism

Some researchers have argued that stereotype threat should not be interpreted as a factor in real-world achievement gaps. Reviews have raised concerns that the effect might have been over-estimated in the performance of schoolgirls and argued that the field likely suffers from publication bias.

According to Paul R. Sackett, Chaitra M. Hardison, and Michael J. Cullen, both the media and scholarly literature have wrongly concluded that eliminating stereotype threat could completely eliminate differences in test performance between European Americans and African Americans. Sackett et al. argued that, in Steele and Aronson's (1995) experiments where stereotype threat was mitigated, an achievement gap of approximately one standard deviation remained between the groups, which is very close in size to that routinely reported between African American and European Americans' average scores on large-scale standardized tests such as the SAT. In subsequent correspondence between Sackett et al. and Steele and Aronson, Sackett et al. wrote that "They [Steele and Aronson] agree that it is a misinterpretation of the Steele and Aronson (1995) results to conclude that eliminating stereotype threat eliminates the African American-White test-score gap." However, in that same correspondence, Steele and Aronson point out that "it is the stereotype threat conditions, and not the no-threat conditions, that produce group differences most like those of real-life testing."

In a 2009 meta-analysis, Gregory M. Walton and Steven J. Spencer argued that studies of stereotype threat may in fact systematically under-represent its effects, since such studies measure "only that portion of psychological threat that research has identified and remedied. To the extent that unidentified or unremedied psychological threats further undermine performance, the results underestimate the bias." Despite these limitations, they found that efforts to mitigate stereotype threat significantly reduced group differences on high-stakes tests.

In 1998, Arthur R. Jensen criticized stereotype threat theory on the basis that it invokes an additional mechanism to explain effects which could be, according to him, explained by other, at the time better known and more established theories, such as test anxiety and especially the Yerkes–Dodson law. In Jensen's view, the effects which are attributed to stereotype threat may simply reflect "the interaction of ability level with test anxiety as a function of test complexity". However, a subsequent study by Johannes Keller specifically controlled for Jensen's hypothesis and still found significant stereotype threat effects.

Gijsbert Stoet and David C. Geary reviewed the evidence for the stereotype threat explanation of the achievement gap in mathematics between men and women. They concluded that the relevant stereotype threat research has many methodological problems, such as failing to adjust for pre-existing mathematics scores and not having a control group, and that some literature on this topic misrepresents stereotype threat as being more well-established than it is. It was only when using the studies that used adjusted mathematics scores, and not when including the studies that did not make such adjustments, that they found evidence for an effect of stereotype threat.

Publication bias

A meta-analysis by Flore and Wicherts (2015) concluded that the average reported effect of stereotype threat is small, and that those reports may be inflated by publication bias. They argued that, correcting for this, the most likely effect size may be near zero.

Ganley et al. (2013) examined stereotype threat in a well-powered (total number approximately 1000) multi-experiment study and concluded that "no evidence that the mathematics performance of school-age girls was impacted by stereotype threat" was found. Positing that large, well-controlled studies have tended to find smaller or non-significant effects, the authors argued that evidence for stereotype threat in children may reflect publication bias. They also suggested that, among the many underpowered studies run, researchers may have selectively published those in which false-positive effects reached significance.

A 2020 meta-analysis by Liu et al. found that, while publication bias may inflate the effectiveness of interventions to mitigate stereotype threat, the level of bias is insufficient to overturn the consensus that such interventions are associated with performance benefits. The authors broke down the studies they analyzed into three types – belief-based, identity-based, and resilience-based – finding greater evidence for publication bias in the last of these and more robust evidence for the effectiveness of intervention in the first two types.

Tuesday, September 3, 2024

Stereotypes of Hispanic and Latino Americans in the United States

A political cartoon by Edmund S. Valtman from 1961 depicting stereotypical negative caricatures of Cubans, Brazilians (with a "Mexican" aspect), and former Cuban prime minister Fidel Castro

Stereotypes of Hispanic and Latino Americans in the United States are general representations of Americans considered to be of Hispanic and Latino ancestry or immigrants to the United States from Spain or Latin America, often exhibited in negative caricatures or terms. Latin America comprises all the countries in the Americas that were originally colonized by the Spaniards, French, or Portuguese. "Latino" is the umbrella term for people of Latin American descent that in recent years has supplanted the more imprecise and bureaucratic designation "Hispanic." Part of the mystery and the difficulty of comprehension lie in the fact that the territory called Latin America is not homogeneous in nature or culture. Latin American stereotypes have the greatest impact on public perceptions, and Latin Americans were the most negatively rated on several characteristics. Americans' perceptions of the characteristics of Latin American immigrants are often linked to their beliefs about the impact of immigration on unemployment, schools and crime.

Portrayal in films and television

Lack of representation

When discussing how Hispanic and Latino individuals are represented in television and film media, it is also important to acknowledge their vast underrepresentation in popular programming. The individuals are often stereotyped on television, but they are rarely even seen. Latino Americans represent approximately 18% of the U.S. population but only 0.6 to 6.5% of all primetime program characters, 1% of television families, and fewer than 4.5% of commercial actors. That poses the issue that Hispanic and Latino characters are not rarely seen, but even when they are, they are more than likely to be stereotyped. In the unlikely case that they are depicted, they are more likely to be limited to stereotypic characters, usually negatively. In September 2021, Bryan Dimas, co-founder of Latinx in Animation, mentioned an animated series with about 52 episodes which never "had a person of color that was a writer...other than one of the executive producers and some of the production crew," but said that shows are moving away from "having white writers writing for Black characters or Asian characters or Latino characters," and said that he believed there was a wave of more diverse representation in the future.

Stereotypical representation

Stereotypical representation of Hispanic and Latino characters are typically negatively presented and attack the entire ethnic group's morality, work ethic, intelligence or dignity. Even in non-fiction media, such as news outlets, Hispanics are usually reported on in crime, immigration, or drug-related stories than in accomplishments. The stereotypes can also differ between men and women. Hispanic and Latino men are more likely to be stereotyped as unintelligent, comedic, aggressive, sexual, and unprofessional, earning them titles as "Latin lovers", buffoons or criminals. That often results in the individuals being characterized as working less-respectable careers, being involved in crimes (often drug-related), or being uneducated immigrants. Hispanic characters are more likely than non-Hispanic white characters to possess lower-status occupations, such as domestic workers, or be involved in drug-related crimes. Hispanic and Latina women, similarly, are typically portrayed as lazy, verbally aggressive, and lacking work ethic. Latinas in modern movies follow old stereotypes. Latinas are still deemed as "less than", objectified and known for being to be alluring to others. Because of this, many Hispanics are treated terribly and seen as invaders to Americans. 

Resulting perspectives

According to Qingwen, "the impact of television portrayals of minorities is significant because of the ability of television images to activate racial stereotypes and the power exerted by visual images." Non-Hispanic white Americans who lack real-life contact with Hispanic or Latino individuals are forced to rely heavily on television and film, their only source of exposure to the ethnic group, as the foundation of perceiving Hispanic and Latino individuals. If nearly all of the few representations of the individuals are negatively stereotyped, non-Hispanic and Latino white individuals are likely to carry the perception into real life, embedding that stereotypical image of Hispanic and Latino individuals into their consciousness. Bandura's Social Cognitive Theory gives insight into how the stereotypical character representations are carried into the real world and points to the way in which individuals' perceptions are limited to what they have experienced. Those who lack real-life contact with the stereotyped individuals are unable to counter the television portrayals of this ethnic group with a more realistic and less negative image.

Stereotypes in news media

Between 2001 and 2010, the Hispanic population increased significantly in the United States, marking Hispanics as the largest minority in California. The news media began negatively framing Hispanics as criminals, illegal immigrants, dangerous and violent, further perpetuating prejudice, discrimination, and stereotypes of Hispanics. According to Loyola Marymount University researchers Santiago Arias and Lea Hellmueller:

"Research shows that on English-language news media networks, during the 1990s, negative attitudes started to arise against Hispanics-and-Latinos. This began after voters approved California Proposition 187 in 1994."

Proposition 187 was a 1994 ballot initiative to establish a California-run citizenship screening system and prohibit illegal aliens from using non-emergency health care, public education, and other services in the state. Arias and Hellmueller stated that the proposition spurred a slate of negative images and claims associated with Hispanics and Latinos in the United States, and affected the Hispanic community greatly by limiting employment opportunities, increasing maltreatment in the criminal justice system, and perpetuating victimization through violent hate crimes against Latinos. Studies show that from 2003 to 2007, violent hate crimes against Latinos rose by 40%.

Instead of focusing on positive attributes related to Hispanics and Latinos, Arias and Hellmueller wrote that news media content focused mainly on stereotypes and misjudgments when they addressed the population. As a result, news media programs helped build a "semantic meaning of the Hispanic-and-Latino identity as a metonym for illegal immigration."

"This discourse consists of promoting the idea that crime and undocumented immigrants, and the costs of illegal immigration in social services and taxes directly result from the increase of Hispanics-and-Latinos in the United States."

According to Arias and Hellmueller, the news media portrayed Hispanics as the enemy, consistently labeling them as illegal immigrants and violent criminals without statistics or facts to support their claims. A 2002 study conducted by Chiricos and Escholz examined race and news media content and investigated how news media content primes the local public's fear of crime.

"The findings suggested fear of crime forms part of a new 'modern racism'; that is, that local television news may contribute to the social construction of threat in relation to both minorities; television over-represents African Americans and Hispanics in crime news in relation to their share of the general population."

Another study conducted by Waldman and colleagues analyzed three cable commentators: Lou Dobbs, Bill O'Reilly, and Glenn Beck and their discussion of illegal immigration. These results concluded that 70% of the Lou Dobbs Tonight episodes in 2007 contained discussion of illegal immigration, 56% of the O'Reilly Factor episodes in 2007 discussed illegal immigration and Glenn Beck discussed illegal immigration in 28% of his year 2007 programs. As a result of popular shows labeling Hispanics as "illegal immigrants" and often portraying Hispanics in a negative light, the programs gave anti-immigration activists a platform for discrimination.

In attempt to verify the accuracy of stereotypes held against Latinos, studies conducted at Harvard and Michigan showed that undocumented and foreign-born immigrants were far less likely to commit acts of deviance, crime, drunk driving, or any kind of action that may jeopardize US citizens' well-being. In addition, the study found that the incarceration rate of foreign-born citizens is five times less the rate of native-born citizens.

Hispanics and crime

According to several scholars, the stereotypes of Hispanics are similar to the ones associated with African-Americans. Often characterized as being drug traffickers, drug users, dangerous and violent, Hispanics are subjected to much stereotyping in the United States in relation to crime, especially by their white counterparts. However, contrary to popular belief, Hispanic immigrants commit crime at lower rates than the general population.

Stereotypes of Hispanic and Latino men

Latino male stereotypes are drug dealer, Latin lover, greaser and bandito. Latinos males are also stereotyped as hypersexual, aggressive and "macho".

Cholo

A very common stereotype of Hispanic/Latino males is that of the criminal, gang member or "cholo". It is connected to the idea of Hispanic/Latinos being lower class and living in dangerous neighborhoods that breed the attitude of "cholo". Cholo and chola are terms often used in the United States to denote members of the Chicano gang subculture. The individuals are characterized by a defiant street attitude, a distinctive dress style, and the use of caló, slang, speech. In the United States, the term "cholo" often has a negative connotation and so tends to be imposed upon a group of people, rather than being used as a means of self-identification. That leads to considerable ambiguity in the particulars of its definition. In its most basic usage, it always refers to a degree of indigeneity.

"Illegal alien"/ "job stealer"

Hispanic/Latinos are frequently seen as the "others" in the United States despite their large percentage of the population. The otherness becomes a lens in which to view them as foreign or not being American. That mentality creates the illegal stereotype and the concept of job stealing. Generally, the term "immigrant" has positive connotations in relation to the development and operation of democracy and US history, but "illegal aliens" are vilified. The term "illegal alien" is defined as "a foreign person who is living in a country without having official permission to live there." Although many Latino/Hispanic Americans were born in the United States or have legal status, they can be dismissed as immigrants or foreigners who live without proper documentation taking opportunities and resources from real Americans. Immigrants have been represented as depriving citizens of jobs, as welfare-seekers, or as criminals. Especially with the recent political/social movement in the United States for stricter immigration law, Americans are blaming Hispanics for "stealing jobs" and negatively impacting the economy.

Homogeneous origin

A very common stereotype, as well as mentality, is that all Hispanic/Latino individuals have the same ethnic background, race and culture, when in reality there are numerous subgroups with unique identities. Americans tend to explain all of Latin America in terms of the nationalities or countries that they know. For instance, in the Midwest and the Southwest, Latin Americans are largely perceived as Mexicans, but in the East, particularly in the New York and Boston areas, people consider Latin Americans through their limited interactions with Dominicans and Puerto Ricans. In Miami, Cubans and Central Americans are the reference group for interpreting Latin America. The idea of homogeneity is so extensive in U.S. society that even important politicians tend to treat Latin America as a culturally-unified region.

Hard-labor worker or uneducated/lazy

There are two conflicting common stereotypes in accordance with employment that male Hispanic/Latinos tend to fall into a manual labor worker or an unemployed/lazy citizen. Many Hispanic/Latino Americans have equally as much education and skill level but are seen as "hard labor workers" such as farmhands, gardeners and cleaners. This stereotype goes along with that of the immigrant in believing all Hispanics/Latinos work in hard labor fields and manual labor only because they arrive in the country illegally, which is false. Latin Americans are also often pictured as not strongly inclined to work hard, despite the conflicting stereotype of working manual labor jobs. Today, negative stereotypes against certain ethnic groups about low cognitive abilities exist in many world regions, including stereotypes about people with a Latino background in the United States.

Machismo

Latino masculinity, which is already coded as violent, criminal, and dangerous (Collins 1991; Ferguson 2000; Vasquez 2010), makes the racial project of controlling images systematically restrict Latinos' lives. Machismo is depicted as the cult of male strength, which implies being fearless, self-confident, capable of making decisions, and able to support one's family. It also emphasized an acceptance of male dominance over women, including the valorization of Don Juanism, and, in its extreme form, a defense of the traditional division of labor (women in the kitchen and taking care of the children and men as providers). Hollywood movies, along with some American scholars and other people in the country, tend to regard machismo as unique to Latin America.

"Latin lover"

The "latin lover" stereotype is a Hispanic male who is seen as sexually sophisticated and is a threat to white women.

Stereotypes of Hispanic and Latina women

Entertainment and marketing industries

According to a Framing Latinas: Hispanic women through the lenses of Spanish-language and English-language news media, a 2010 paper by Teresa Correa, Latinas have been historically depicted as possessing one of two completely-contrasting identities. They have been depicted as either "virginal", "passive" and "dependent on men" or as "hot-tempered", "tempestuous", "promiscuous" and "sexy". A 2005 study conducted by Dana Mastro and Elizabeth Behm-Morawitz, professors of communication studies at the University of Arizona, found depictions of Latina Americans on primetime television are both limited and biased. The study analyzed the frequency and the quality of the depictions of Hispanic individuals on primetime television in 2002. The study found that "Latinas were the laziest characters in primetime... they were the least intelligent, most verbally aggressive, embodied the lowest work ethic, and (alongside whites) were the most ridiculed." According to the same studies, the marketing industry has also played a role in stereotyping females with Hispanic origin by using the stereotypical identities to sell product. Specifically, the bodies of Latina women have been used and sexualized to sell product targeted to men. According to Mary Gilly, a professor of business at the University of California Irvine, Latina women, in particular, are eroticized in the marketing industry because of their frequent portrayal as "tempestuous", "promiscuous" or "sexy".

Fiery Latina and the hot señorita

Stereotypical identities that have spurred from the idea that Hispanic and Latina women are "hot-tempered", "tempestuous", "promiscuous" and "sexy" include the "fiery Latina" and the "hot señorita". Both stem from the fact that Hispanic and Latina women are continually sexualized and eroticized in popular programming and in the entertainment industry as a whole. Recent examples include Sofia Vergara's character on Modern Family, but examples date back to the 1920s and 1930s with "Dolores del Río playing the exotic and passionate lover of the 1920s, and Carmen Miranda playing sexy and bombshell characters in the 1930s and 1940s." In Modern Family, Vergara portrays Gloria Delgado-Pritchett, a "trophy wife" often seen in provocative clothing and high heeled shoes. She often has trouble pronouncing English words and speaks with a heavy accent. Among the contemporary depictions accused of promoting the "Latina bombshell" include Iris Chacón's image, Naya Rivera in Glee, and Shakira and Jennifer Lopez's music videos.

Fertility threat

One reason for Latinas being stereotyped as hyper-sexualization is the idealistic picture of large Latino families with multiple children because of Latinas wrongly thought of as being highly sexual in nature. That has created the political and social threat of Latina's "hyper-fertility" in which there is a concern that the hypothetical fertility and birthing rates of Latinas is much more than that of non-Hispanic white women, adding to the threat of the Latino presence in the United States (Gutiérrez 2008; Chavez 2004).

A study compared the sexual activity of non-Hispanic white women and Latinas in Orange County, California, where there is a high population of Mexican American families. Non-Hispanic white women began sexual relations about a year younger than all of the Latinas in the survey reported. The non-Hispanic white women were more likely to report having had five or more sexual partners, but Latinas were more likely to report no more than two. Both non-Hispanic white women and Latinas showed a trend towards fewer children per household. In fact, second-generation Latinas were shown to have fewer children than non-Hispanic white women.

News and media

According to several sources, the entertainment industry can be credited with the creation and frequent reinforcement of the stereotypes, but the news is particularly important in the maintenance of these stereotypes. Unlike the entertainment and marketing industries, according to several studies, the press produces representations that are based on "reality". A 1994 study by Macrea et al., found stereotypes are generalizations that our culture has defined for us, and that using stereotypes is "more efficient". Thus, according to Macrea et al., journalists, because of time and space constraints, may be more likely to rely on stereotypic portrayals.

Correa found that both Hispanic Americans have been underrepresented in news media and that their limited portrayal have been depicted as a burden on contemporary American society. The 2016 election of President Donald Trump brought the issue to the forefront of American news, and issues relating specifically to immigration perpetuated stereotypes of Hispanic and Latino Americans as criminals.

Inaccuracies

Lazy stereotype

Ethnic-minority students, who are in the lower-income bracket, are more likely to attend schools that are overcrowded, dangerous and limited in the opportunities offered for advanced coursework with experienced teachers. Because of the inequalities in education, the graduation rate for Latino students is substantially below the rate for white students.

Contrary to the belief that Hispanics are "lazy", a study by Andrew J. Fuligni has shown that "students from ethnic minority backgrounds often have higher levels of motivation than their equally achieving peers from "pan-white" backgrounds.... Latin American and Asian families have significantly higher values of academic success and a stronger belief in the utility of education." The high level of motivation comes from Hispanics having a greater sense of obligation to support, assist, and respect the family.

A common misconception about Latinos and language learning is that not being able to speak English is a sign of unwillingness to learn. Some immigrants, from Mexico and other Latin countries, live in the United States for decades without acquiring a basic command of English. The primary reason is that it is difficult to learn a second language as an adult. Another reason is that finding time to learn a new language while struggling to financially support and spend time with family may be impossible.

Job-stealing stereotype

The "job-stealing Hispanic" stereotype is also false. According to Pastora San Juan Cafferty and William C. McCready, "a preliminary study of labor market competition among the black, Hispanic, and non-Hispanic white population (Borjas, 1983) found no evidence that Hispanics had a negative impact on the earnings of the other two groups." Hispanics are not "taking away" jobs that non-Hispanic groups want. The blue-collar jobs Hispanics obtain are low paying and have few fringe benefits, leading to little or no health insurance coverage.

Criminal stereotype

The aggressive "Hispanic gang member/criminal" stereotype, which is often see in movies and on television, is inaccurate. Gang-suppression approaches of numerous police departments have become "over-inclusive and embedded with practices that create opportunities for abuse of authority." This means most of the gang enforcement police stops are based on racial profiling. These stops involve no reasonable suspicion of criminal activity and oftentimes include non-gang members.

Impacts

Trouble establishing identities

Hispanic youth have a more difficult time establishing a positive school identity because of the negative academic stereotypes regarding their racial-ethnic group. The academic stereotypes, which negatively affect the academic performance of Latinos, focus on inability, laziness, and a lack of interest and curiosity.

Adolescence makes teenagers come face to face with deeply-rooted social issues, and the challenges they face can be daunting. For young Latinas in particular, the societal and emotional issues that they must come to terms with can be complicated. These issues can be complicated because they are learning who they are and what they want their role to be in society, but they also must fight against the stereotypes that have been imposed upon them by culture. Positive identity formation for young Latinas may be more difficult to achieve than it is for young Anglo girls. Some have postulated that providing young Latinas with the concepts of feminism may enhance their abilities to believe in themselves and improve their chances of realizing that they have the abilities to be successful because of who they are, not because of who they married. However, a recent study published in the Journal of Adolescent Research found that young Latinas may have a "different perspective" on feminism than their Anglo counterparts. The study found that Latinas experienced feminism differently because of cultural values; young Latinas "face an intricate balance between future family and career goals in their identity development." Some Latinas interviewed in the study expressed concern that if they told a young man that they were feminists, "they might assume that the girls didn't like men" and a large number also opposed the ideas of feminism and equality because of traditional values. The study ultimately determined that the majority of the young Latinas interviewed considered themselves to be feminists but a relatively large minority of the young women rejected the idea of feminism and equality because they were fearful of possible female superiority and endorsed traditional family values and female occupations.

Research shows that many Latinos in the United States do not identify as "American" but instead with their or their parents' or grandparents' country of origin. One of the reasons is the misbelief that to be an American, one needs to be white. Latinos who have experienced racial discrimination are more likely to identify as Latino or Latino American than simply American because they feel they are not treated as "real" Americans.[35]

Mental instability

A study by Suárez-Orozco and Suárez-Orozco (2001) has shown that the internalization of perceived stigmatized identity of Hispanics can lead to resigned helplessness, self-defeating behavior, and depression.

Academic performance

Findings from an experimental study of college-bound Hispanic students showed that when Hispanic students were faced with stereotype threat, their academic performance suffered. Results of the study showed that Latino students who internalized racial stereotypes performed worse on a standardized test than Hispanic students who did not internalize those same stereotypes. The negative impact of racial stereotypes on student performance has implications for the overall educational journey of Hispanic and Latino students. Performing poorly on standardized tests could lead to limitations in the options available for furthering education. Another experimental study of Latino undergraduate students found that Latino students in the stereotype threat condition performed worse on an exam than all other students with which they were compared (Latino students in non-stereotype threat condition and white students in both stereotype threat and non-stereotype threat conditions). A study by Fischer (2009) found that Hispanic college students who internalize negative stereotypes about themselves tend to spend fewer hours studying, which further decreases their academic performance.

Psychosurgery

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Psychosurgery

Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorders. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt. The first significant foray into psychosurgery in the 20th century was conducted by the Portuguese neurologist Egas Moniz who, during the mid-1930s, developed the operation known as leucotomy. The practice was enthusiastically taken up in the United States by the neuropsychiatrist Walter Freeman and the neurosurgeon James W. Watts who devised what became the standard prefrontal procedure and named their operative technique lobotomy, although the operation was called leucotomy in the United Kingdom. In spite of the award of the Nobel prize to Moniz in 1949, the use of psychosurgery declined during the 1950s. By the 1970s the standard Freeman-Watts type of operation was very rare, but other forms of psychosurgery, although used on a much smaller scale, survived. Some countries have abandoned psychosurgery altogether; in others, for example the US and the UK, it is only used in a few centres on small numbers of people with depression or obsessive-compulsive disorder (OCD). In some countries it is also used in the treatment of schizophrenia and other disorders.

Psychosurgery is a collaboration between psychiatrists and neurosurgeons. During the operation, which is carried out under a general anaesthetic and using stereotactic methods, a small piece of brain is destroyed or removed. The most common types of psychosurgery in current or recent use are anterior capsulotomy, cingulotomy, subcaudate tractotomy and limbic leucotomy. Lesions are made by radiation, thermo-coagulation, freezing or cutting. About a third of patients show significant improvement in their symptoms after operation. Advances in surgical technique have greatly reduced the incidence of death and serious damage from psychosurgery; the remaining risks include seizures, incontinence, decreased drive and initiative, weight gain, and cognitive and affective problems.

Currently, interest in the neurosurgical treatment of mental illness is shifting from ablative psychosurgery (where the aim is to destroy brain tissue) to deep brain stimulation (DBS) where the aim is to stimulate areas of the brain with implanted electrodes.

Medical uses

All the forms of psychosurgery in use today (or used in recent years) target the limbic system, which involves structures such as the amygdala, hippocampus, certain thalamic and hypothalamic nuclei, prefrontal and orbitofrontal cortex, and cingulate gyrus—all connected by fibre pathways and thought to play a part in the regulation of emotion. There is no international consensus on the best target site.

Anterior cingulotomy was first used by Hugh Cairns in the UK, and developed in the US by H.T. Ballantine Jr. In recent decades it has been the most commonly used psychosurgical procedure in the US. The target site is the anterior cingulate cortex; the operation disconnects the thalamic and posterior frontal regions and damages the anterior cingulate region.

Anterior capsulotomy was developed in Sweden, where it became the most frequently used procedure. It is also used in Scotland and Canada. The aim of the operation is to disconnect the orbitofrontal cortex and thalamic nuclei by inducing a lesion in the anterior limb of internal capsule.

Subcaudate tractotomy was the most commonly used form of psychosurgery in the UK from the 1960s to the 1990s. It targets the lower medial quadrant of the frontal lobes, severing connections between the limbic system and supra-orbital part of the frontal lobe.

Limbic leucotomy is a combination of subcaudate tractotomy and anterior cingulotomy. It was used at Atkinson Morley Hospital London in the 1990s and also at Massachusetts General Hospital.

Amygdalotomy, which targets the amygdala, was developed as a treatment for aggression by Hideki Narabayashi in 1961 and is still used occasionally, for example at the Medical College of Georgia.

There is debate about whether deep brain stimulation (DBS) should be classed as a form of psychosurgery.

Effectiveness

Success rates for anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and limbic leucotomy in treating depression and OCD have been reported as between 25 and 70 percent. The quality of outcome data is poor and the Royal College of Psychiatrists in their 2000 report concluded that there were no simple answers to the question of modern psychosurgery's clinical effectiveness; studies suggested improvements in symptoms following surgery but it was impossible to establish the extent to which other factors contributed to this improvement. Research into the effects of psychosurgery has not been able to overcome a number of methodological problems, including the problems associated with non-standardised diagnoses and outcome measurements, the small numbers treated at any one centre, and positive publication bias. Controlled studies are very few in number and there have been no placebo-controlled studies. There are no systematic reviews or meta-analyses.

Modern techniques have greatly reduced the risks of psychosurgery, although risks of adverse effects still remain. Whilst the risk of death or vascular injury has become extremely small, there remains a risk of seizures, fatigue, and personality changes following operation.

A 2012 follow-up study of eight depressed patients who underwent anterior capsulotomy in Vancouver, Canada, classified five of them as responders at two to three years after surgery. Results on neuropsychological testing were unchanged or improved, although there were isolated deficits and one patient was left with long-term frontal psychobehavioral changes and fatigue. One patient, aged 75, was left mute and akinetic for a month following surgery and then developed dementia.

By country

China

In China, psychosurgical operations which make a lesion in the nucleus accumbens are used in the treatment of drug and alcohol dependence. Psychosurgery is also used in the treatment of schizophrenia, depression, and other mental disorders. Psychosurgery is not regulated in China, and its use has been criticised in the West.

India

India had an extensive psychosurgery programme until the 1980s, using it to treat addiction, and aggressive behaviour in adults and children, as well as depression and OCD. Cingulotomy and capsulotomy for depression and OCD continue to be used, for example at the BSES MG Hospital in Mumbai.

Japan

In Japan the first lobotomy was performed in 1939 and the operation was used extensively in mental hospitals. However, psychosurgery fell into disrepute in the 1970s, partly due to its use on children with behavioural problems.

Australia and New Zealand

In the 1980s there were 10–20 operations a year in Australia and New Zealand. The number had decreased to one or two a year by the 1990s. In Victoria, there were no operations between 2001 and 2006, but between 2007 and 2012 the Victoria Psychosurgery Review Board dealt with 12 applications, all them for DBS.

Europe

In the 20-year period 1971–1991 the Committee on Psychosurgery in the Netherlands and Belgium oversaw 79 operations. Since 2000 there has been only one centre in Belgium performing psychosurgery, carrying out about 8 or 9 operations a year (some capsulotomies and some DBS), mostly for OCD.

In France about five people a year were undergoing psychosurgery in the early 1980s. In 2005 the Health Authority recommended the use of ablative psychosurgery and DBS for OCD.

In the early 2000s in Spain about 24 psychosurgical operations (capsulotomy, cingulotomy, subcaudate tractotomy, and hypothalamotomy) a year were being performed. OCD was the most common diagnosis, but psychosurgery was also being used in the treatment of anxiety and schizophrenia, and other disorders.

In the UK between the late 1990s and 2009 there were just two centres using psychosurgery: a few stereotactic anterior capsulotomies are performed every year at the University Hospital of Wales, Cardiff, while anterior cingulotomies are carried out by the Advanced Interventions Service at Ninewells Hospital, Dundee. The patients have diagnoses of depression, obsessive-compulsive disorder, and anxiety. Ablative psychosurgery was not performed in England between the late 1990s and 2009, although a couple of hospitals have been experimenting with DBS. In 2010, Frenchay Hospital in Bristol performed an anterior cingulotomy on a woman who had previously undergone DBS.

In Russia in 1998 the Institute of the Human Brain (Russian Academy of Sciences) started a programme of stereotactic cingulotomy for the treatment of drug addiction. About 85 people, all under the age of 35, were operated on annually. In the Soviet Union, leucotomies were used for the treatment of schizophrenia in the 1940s, but the practice was prohibited by the Ministry of Health in 1950.

North America

In the United States, the Massachusetts General Hospital has a psychosurgery program. Operations are also performed at a few other centres.

In Mexico, psychosurgery is used in the treatment of anorexia and aggression.

In Canada, anterior capsulotomies are used in the treatment of depression and OCD.

South America

Venezuela has three centres performing psychosurgery. Capsulotomies, cingulotomies and amygdalotomies are used to treat OCD and aggression.

History

Early psychosurgery

Evidence of trepanning (or trephining)—the practice of drilling holes in the skull—has been found in a skull from a Neolithic burial site in France, dated to about 5100 BC although it was also used to treat brain cranial trauma. There have also been archaeological finds in South America, while in Europe trepanation was carried out in classical and medieval times. The first systematic attempt at psychosurgery is commonly attributed to the Swiss psychiatrist Gottlieb Burckhardt. In December 1888 Burckhardt operated on the brains of six patients (one of whom died a few days after the operation) at the Préfargier Asylum, cutting out a piece of cerebral cortex. He presented the results at the Berlin Medical Congress and published a report, but the response was hostile and he did no further operations. Early in the 20th century, Russian neurologist Vladimir Bekhterev and Estonian neurosurgeon Ludvig Puusepp operated on three patients with mental illness, with discouraging results.

1930s–1950s

Although there had been earlier attempts to treat psychiatric disorders with brain surgery, it was Portuguese neurologist Egas Moniz who was responsible for introducing the operation into mainstream psychiatric practice. He also coined the term psychosurgery. Moniz developed a theory that people with mental illnesses, particularly "obsessive and melancholic cases", had a disorder of the synapses which allowed unhealthy thoughts to circulate continuously in their brains. Moniz hoped that by surgically interrupting pathways in their brain he could encourage new healthier synaptic connections. In November 1935, under Moniz's direction, surgeon Pedro Almeida Lima drilled a series of holes on either side of a woman's skull and injected ethanol to destroy small areas of subcortical white matter in the frontal lobes. After a few operations using ethanol, Moniz and Almeida Lima changed their technique and cut out small cores of brain tissue. They designed an instrument which they called a leucotome and called the operation a leucotomy (cutting of the white matter). After twenty operations, they published an account of their work. The reception was generally not friendly but a few psychiatrists, notably in Italy and the US, were inspired to experiment for themselves.

In the US, psychosurgery was taken up and zealously promoted by neurologist Walter Freeman and neurosurgeon James Watts. They started a psychosurgery program at George Washington University in 1936, first using Moniz's method but then devised a method of their own in which the connections between the prefrontal lobes and deeper structures in the brain were severed by making a sweeping cut through a burr hole on either side of the skull. They called their new operation a lobotomy.

Freeman went on to develop a new form of lobotomy which could be dispensed without the need for a neurosurgeon. He hammered an ice pick-like instrument, an orbitoclast, through the eye socket and swept through the frontal lobes. The transorbital or "ice pick" lobotomy was done under local anesthesia or using electroconvulsive therapy to render the patient unconscious and could be performed in mental hospitals lacking surgical facilities. Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in psychiatric hospitals. Freeman's patients included 19 children, one of whom was 4 years old.

The 1940s saw a rapid expansion of psychosurgery, in spite of the fact that it involved a significant risk of death and severe personality changes. By the end of the decade, up to 5000 psychosurgical operations were being carried out annually in the US. In 1949, Moniz was awarded the Nobel Prize for Physiology or Medicine.

Beginning in the 1940s various new techniques were designed in the hope of reducing the adverse effects of the operation. These techniques included William Beecher Scoville's orbital undercutting, Jean Talairach's anterior capsulotomy, and Hugh Cairn's bilateral cingulotomy. Stereotactic techniques made it possible to place lesions more accurately, and experiments were done with alternatives to cutting instruments such as radiation. Psychosurgery nevertheless went into rapid decline in the 1950s, due to the introduction of new drugs and a growing awareness of the long-term damage caused by the operations, as well as doubts about its efficacy. By the 1970s, the standard or transorbital lobotomy had been replaced with other forms of psychosurgical operations.

1960s to the present

During the 1960s and 1970s, psychosurgery became the subject of increasing public concern and debate, culminating in the US with congressional hearings. Particularly controversial in the United States was the work of Harvard neurosurgeon Vernon Mark and psychiatrist Frank Ervin, who carried out amygdalotomies in the hope of reducing violence and "pathologic aggression" in patients with temporal lobe seizures and wrote a book entitled Violence and the Brain in 1970. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1977 endorsed the continued limited use of psychosurgical procedures. Since then, a few facilities in some countries, such as the US, have continued to use psychosurgery on small numbers of patients. In the US and other Western countries, the number of operations has further declined over the past 30 years, a period during which there had been no major advances in ablative psychosurgery.

Ethics

Psychosurgery has a controversial history, and despite modifications, still raises serious questions about benefit, risks, and the adequacy with which consent is obtained. Its continued use is defended by references to the "therapeutic imperative" to do something in the case of psychiatric patients who have not responded to other forms of treatment, and the evidence that some patients see improvement in their symptoms following surgery. There remain however problems concerning the rationale, indications and efficacy of psychosurgery, and the results of the operation raise questions of "identity, spirit, relationships, integrity and human flourishing".

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