The Paradox of Control: The Paradox of Control: Gelassenheit, Stoicism, Gelassenheit, Stoicism,

Personal Control and GodPersonal Control and God

Thomas V. MerluzziThomas V. MerluzziUniversity of Notre DameUniversity of Notre DameNotre Dame, Indiana USANotre Dame, Indiana USA

tmerluzz@nd.edutmerluzz@nd.edu

Thanks to Thanks to

Steve Fredman for discussions on ancient Steve Fredman for discussions on ancient philosophy and galessenheitphilosophy and galessenheit

Niels for friendship, colleagueship, and an Niels for friendship, colleagueship, and an invitation to Denmarkinvitation to Denmark

OverviewOverview

Historical PerspectivesHistorical Perspectives

Psychological Perspectives on ControlPsychological Perspectives on Control

Development of Control BeliefsDevelopment of Control Beliefs

Primary and Secondary ControlPrimary and Secondary Control

Faith and ControlFaith and Control– Types of Religious Problem SolvingTypes of Religious Problem Solving

Integrating Types and Control TheoryIntegrating Types and Control Theory

Lao TsuLao Tsu

Tao Te ChingTao Te Ching– Wei wu weiWei wu wei

““doing not-doing”doing not-doing”

““Less and less do you need to force things, until Less and less do you need to force things, until finally you arrive at non-action.”finally you arrive at non-action.”

Lao TsuLao TsuCan you coax your mind from its wandering and keep to the Can you coax your mind from its wandering and keep to the

original oneness?original oneness?

Can you let your body become supple as a newborn Can you let your body become supple as a newborn child’s?child’s?

Can you cleanse your inner vision until you see nothing but Can you cleanse your inner vision until you see nothing but the light?the light?

Can you love people and lead them without imposing your Can you love people and lead them without imposing your will?will?

Can you deal with the most vital matters by letting events Can you deal with the most vital matters by letting events take their course?take their course?

Can you step back from your own mind and thus Can you step back from your own mind and thus understand all things?understand all things?

StoicismStoicism

Seneca, Epictetus, Marcus AureliusSeneca, Epictetus, Marcus Aurelius

Filtered through Pierre HadotFiltered through Pierre Hadot– Happiness consists in the demands of goodHappiness consists in the demands of good– Happiness is accessible to all within this lifeHappiness is accessible to all within this life– World viewWorld view

Fatalism – external causes and fateFatalism – external causes and fate

– However, “what does depend on us is to will However, “what does depend on us is to will to do good and act in conformity with reason.”to do good and act in conformity with reason.”

Referred to as coherenceReferred to as coherence

StoicismStoicism

Coherence sounds paradoxical Coherence sounds paradoxical – Sets stage for detachment from outcomesSets stage for detachment from outcomes

Stoics espouse a process modelStoics espouse a process model– Do good and detach from externalsDo good and detach from externals– Everything outside moral intention is Everything outside moral intention is

indifferentindifferent– Helps us navigate in an uncertain worldHelps us navigate in an uncertain world

StoicsStoics

SenecaSeneca– ““Disaster is virtue’s opportunity.”Disaster is virtue’s opportunity.”– Not opposed to goals or confidenceNot opposed to goals or confidence

Efficacy in moral intention and behavior with no Efficacy in moral intention and behavior with no expectations about the outcomesexpectations about the outcomes

Meister EckhartMeister Eckhart

Late 13Late 13thth early 14 early 14thth century Dominican century Dominican– Wrote many sermons, which are now Wrote many sermons, which are now

becoming more popularbecoming more popular– Moral liberation is also intellectual liberationMoral liberation is also intellectual liberation– GelassenheitGelassenheit

Detachment, serenity Detachment, serenity – from suffering and painfrom suffering and pain

– Teachings are in line with Christian asceticismTeachings are in line with Christian asceticism

Martin HeideggerMartin Heidegger

Secular version of GelassenheitSecular version of Gelassenheit– A phenomenonological experience that A phenomenonological experience that

represents a process by which we arrive at represents a process by which we arrive at “releasement”“releasement”

““Active waiting”Active waiting”

Was interested in translating the TaoTe Was interested in translating the TaoTe Ching but never was able to complete it. Ching but never was able to complete it.

Modern Conceptions of Modern Conceptions of GelassenheitGelassenheit

MindfulnessMindfulness– Focus on the here and nowFocus on the here and now– Heightened awarenessHeightened awareness– Used with chronic pain patientsUsed with chronic pain patients

Pain becomes intimately intertwined with “self” and Pain becomes intimately intertwined with “self” and the social context (John Kabat-Zinn)the social context (John Kabat-Zinn)

Transform identity from a “pain patient” to a Transform identity from a “pain patient” to a “person with pain”“person with pain”

Make peace with their painMake peace with their pain

NiebuhrNiebuhr

Serenity PrayerSerenity Prayer– God grant me the strength to change the God grant me the strength to change the

things I can change, accept the things I things I can change, accept the things I cannot change and the wisdom to know the cannot change and the wisdom to know the differencedifference

12 step programs – first step is to accept 12 step programs – first step is to accept that there is a power greater than minethat there is a power greater than mine

Personal ControlPersonal Control

BuddismBuddism– Doing not-doingDoing not-doing

StoicimStoicim– Control over our intentions and behaviorControl over our intentions and behavior– Moral imperativeMoral imperative– Outcomes not controllableOutcomes not controllable

GelassenheitGelassenheit– DetachmentDetachment– ReleasementReleasement

Modern “Western” Perspectives on Modern “Western” Perspectives on Psychological Control Psychological Control

Rather pervasive concept in mental and Rather pervasive concept in mental and physical healthphysical health– Self-controlSelf-control– Self-regulationSelf-regulation– Self-relianceSelf-reliance– Self-efficacySelf-efficacy– AgencyAgency

All typically associated with positive coping All typically associated with positive coping and adjustment to illnessand adjustment to illness

Control and Western Concepts Control and Western Concepts of Healthof Health

Derived from male sex role characteristicsDerived from male sex role characteristics

Definition of health is socially and Definition of health is socially and culturally informedculturally informed

Psychological ControlPsychological Control

Opposite of control not valued in our Opposite of control not valued in our societysociety– PassivityPassivity– WithdrawalWithdrawal– SubmissivenessSubmissiveness– HelplessnessHelplessness– ImpulsivityImpulsivity– Behavior ExcessesBehavior Excesses

Control: Psychology versus Faith?Control: Psychology versus Faith?

Psychological perspectivePsychological perspective– Emphasis on personal controlEmphasis on personal control

Positive outcomes related to degree of personal controlPositive outcomes related to degree of personal controlPerceived, “illusory” control (S. Taylor)Perceived, “illusory” control (S. Taylor)

Faith perspectiveFaith perspective– Emphasis on deferring controlEmphasis on deferring control

Positive outcomes related to the relinquishing of controlPositive outcomes related to the relinquishing of control– Trust in GodTrust in God– ““Turn it over to God”Turn it over to God”– Niebuhr’s serenity prayerNiebuhr’s serenity prayer– ““Thy will be done on earth as it is in heaven”Thy will be done on earth as it is in heaven”

Approaches toApproaches to Psychological Control in the Psychological Control in the

Context of IllnessContext of Illness

Psychological Control: Psychological Control: Self-RegulationSelf-Regulation

Self-controlSelf-control– Self-regulationSelf-regulation

In children – In children – – emotional self-regulationemotional self-regulation– ADHDADHD

In adults – In adults – – IndependenceIndependence– Problem solvingProblem solving– Dysregulation = addictionsDysregulation = addictions

Premise is that our behavior affects the world Premise is that our behavior affects the world – ActionsActionsOutcomes Outcomes (Carver & Scheier, 1998)(Carver & Scheier, 1998)

– Alternative to self-regulation no relation between our Alternative to self-regulation no relation between our actions and outcomesactions and outcomes

Stoics, ZenStoics, Zen

Psychological Control: Psychological Control: Learned HelplessnessLearned Helplessness

Learned Helplessness Learned Helplessness (Seligman, 1975)(Seligman, 1975)

– Motivational, cognitive, and emotional deficits Motivational, cognitive, and emotional deficits due to prolonged exposure to non-contingent due to prolonged exposure to non-contingent eventsevents

Actions are uncorrelated with outcomes Actions are uncorrelated with outcomes – However, we retain the belief that they should be However, we retain the belief that they should be

correlatedcorrelatedContrast with Stoicism, GelassenheitContrast with Stoicism, Gelassenheit

Construct that accounts for depression Construct that accounts for depression (Levenson, 1973)(Levenson, 1973)

Suspension of means-ends beliefs Suspension of means-ends beliefs (E. Skinner et al., 1988)(E. Skinner et al., 1988)

– Premise that certain actions produce desired or prevent Premise that certain actions produce desired or prevent undesired outcomes is repeatedly disconfirmedundesired outcomes is repeatedly disconfirmed

Can we appreciate the complex relation between Can we appreciate the complex relation between actions and outcomes?actions and outcomes?

Psychological Control: Self-EfficacyPsychological Control: Self-Efficacy

Self-efficacySelf-efficacy– Beliefs/Expectations about our ability to Beliefs/Expectations about our ability to

execute actions execute actions (behaviors, thoughts)(behaviors, thoughts) (Bandura, 1997)(Bandura, 1997)

Two types of expectanciesTwo types of expectancies1. Behavior (Actions) expectancy (self-efficacy)1. Behavior (Actions) expectancy (self-efficacy)

2. Outcome expectancy 2. Outcome expectancy

What is the likelihood of Y if I do X at this level of What is the likelihood of Y if I do X at this level of competencecompetence

Self-EfficacySelf-Efficacy

Choose behaviors that will maximize Choose behaviors that will maximize outcomesoutcomes– Persist in behaviors where the outcome is Persist in behaviors where the outcome is

valuedvalued

Cause-effect relation may be illusoryCause-effect relation may be illusory– May not reflect actual physical relationships in the worldMay not reflect actual physical relationships in the world– We “force” correlations between our behavior and We “force” correlations between our behavior and

desired outcomesdesired outcomes– Perceived control paradigmPerceived control paradigm

Seneca and self-efficacySeneca and self-efficacy

Failures of ControlFailures of Control

Type A behavior pattern Type A behavior pattern (Friedman & Rosenman, 1974)(Friedman & Rosenman, 1974)

– High risk for MI and repeat MIHigh risk for MI and repeat MI– Anger and cynical hostilityAnger and cynical hostility

Misattributions about others Misattributions about others – antagonistic or threateningantagonistic or threatening

Control to counteract perceived control by othersControl to counteract perceived control by others

Unmitigated Agency Unmitigated Agency (Helgeson & Lepore, 1997)(Helgeson & Lepore, 1997)

– Agency (excessive control) unmitigated by Agency (excessive control) unmitigated by communion (connection with others) not an communion (connection with others) not an effective coping strategyeffective coping strategy

Failures of ControlFailures of Control

The Bernie Siegel EffectThe Bernie Siegel Effect– Attributing the cause of recurrence of cancer Attributing the cause of recurrence of cancer

to lack of control over negative thoughtsto lack of control over negative thoughts– ““The prison of positive thinking” The prison of positive thinking” (D. Spiegel)(D. Spiegel)

– High personal control/ High personal High personal control/ High personal responsibilityresponsibility

– Too much control attributed in the face of Too much control attributed in the face of uncertaintyuncertainty

Self-blame ensuesSelf-blame ensues

Development of Control BeliefsDevelopment of Control Beliefs

Not a static conceptNot a static conceptChanges throughout the Changes throughout the lifespanlifespan

Early Adulthood (22-35) Early Adulthood (22-35)

Hyper-ControlHyper-Control– ““Personal Fable” in adolescencePersonal Fable” in adolescence

Belief in complete controlBelief in complete control

– Perceived invulnerabilityPerceived invulnerability– May actually perceive danger but also willing May actually perceive danger but also willing

to take risksto take risks– Low incidence of fatal diseasesLow incidence of fatal diseases– Dominant factors in life satisfactionDominant factors in life satisfaction

Family life (independence from family)Family life (independence from family)Standard of livingStandard of living

Middle Age (35-44)Middle Age (35-44)

Career ControlCareer Control– Attainment: Success in career and material Attainment: Success in career and material

world….but also….world….but also….– Come to terms with aging Come to terms with aging (Sheehy, 1995)(Sheehy, 1995)

– Develop/Revisit/Refine value orientationDevelop/Revisit/Refine value orientation– Dominant factors in life satisfactionDominant factors in life satisfaction

Standard of livingStandard of living

Family life (quality of relationships – spouse, Family life (quality of relationships – spouse, children)children)

Late Middle Age (45-64)Late Middle Age (45-64)

Control in TransitionControl in Transition

– Balance work and relationshipsBalance work and relationships– Moral aspects of work and social responsibilityMoral aspects of work and social responsibility

Reflection on the bigger pictureReflection on the bigger picture

Generativity – helping the formation of the next generationGenerativity – helping the formation of the next generation

– Experiences losses Experiences losses Deaths as well as physical staminaDeaths as well as physical stamina

Rapid increase in mortality due to heart disease, cancer, etc.Rapid increase in mortality due to heart disease, cancer, etc.

– CaregivingCaregivingMen may become more nurturing and accepting of careMen may become more nurturing and accepting of care

Late Middle Age (45-64) Con’t Late Middle Age (45-64) Con’t TransitionTransition

– Dominant factors in life satisfactionDominant factors in life satisfactionFamily lifeFamily life

SATISFACTION WITH HEALTHSATISFACTION WITH HEALTH

Standard of livingStandard of living

– Cognitive shift in health consciousnessCognitive shift in health consciousnessAttempts to maintain, regain, or grieve loss of Attempts to maintain, regain, or grieve loss of health health (Merluzzi & Nairn, 1999)(Merluzzi & Nairn, 1999)

Late Adulthood (65+)Late Adulthood (65+)

Limits of ControlLimits of Control– Come to terms with limitations of controlCome to terms with limitations of control– Much more illnessMuch more illness

““Expected” versus “Unexpected” illnessExpected” versus “Unexpected” illness– Come to expect more illness with agingCome to expect more illness with aging

– Termination of employmentTermination of employment– Loss of independenceLoss of independence– Dominant factors in life satisfactionDominant factors in life satisfaction

Family lifeFamily lifeStandard of livingStandard of livingSATISFACTION WITH HEALTHSATISFACTION WITH HEALTH

Developmental Context Developmental Context of Control Beliefs – Summing Upof Control Beliefs – Summing UpEarly and middle adulthoodEarly and middle adulthood– Emphasis on controllabilityEmphasis on controllability– Unexpected illness more devastatingUnexpected illness more devastating

Older adultsOlder adults– Reconciliation of control beliefs with realityReconciliation of control beliefs with reality

Does not result in total loss of controlDoes not result in total loss of control– Compensatory strategy Compensatory strategy (Freund & Baltes, 2002)(Freund & Baltes, 2002)

Selection, Optimization, CompensationSelection, Optimization, Compensation

– Relative norming – “compared to others…”Relative norming – “compared to others…”

““Reality” changes across the lifespanReality” changes across the lifespan– ““Unexpected” becomes more “expected”Unexpected” becomes more “expected”

Two Forms of ControlTwo Forms of Control

Primary ControlPrimary Control– Change the environmentChange the environment

Secondary ControlSecondary Control– Change ourselvesChange ourselves

Primary and Secondary ControlPrimary and Secondary Control

Primary Control Primary Control – Bringing the environment in line with our wishesBringing the environment in line with our wishes

Imposing controlImposing control

Oriented to outcomesOriented to outcomes

Early Adulthood and Middle AgeEarly Adulthood and Middle Age

Higher demand for control in young adulthoodHigher demand for control in young adulthood

Secondary ControlSecondary Control– Bringing ourselves in line with environmental forcesBringing ourselves in line with environmental forces

Coming to terms with the limits of controlComing to terms with the limits of control

Outcomes are not controllable OROutcomes are not controllable OR

Outcomes are internalOutcomes are internal

Late adulthoodLate adulthood

Secondary ControlSecondary ControlTypes of Secondary ControlTypes of Secondary Control– Attributions of outcomes to Attributions of outcomes to

Severe limited ability (negative outcomes)Severe limited ability (negative outcomes)

Luck or chance (positive or negative outcomes)Luck or chance (positive or negative outcomes)

– Secondary control that may be faith-based Secondary control that may be faith-based Powerful others – forces beyond our control Powerful others – forces beyond our control (positive or negative outcomes)(positive or negative outcomes)

– God referenced controlGod referenced control

Interpretive control – seek to understand and Interpretive control – seek to understand and derive meaning from uncontrollable events derive meaning from uncontrollable events (transform negative to positive)(transform negative to positive)

– Meaning referenced controlMeaning referenced control

Faith and ControlFaith and Control

Faith Perspectives on Control Faith Perspectives on Control (Pargament, 1997)(Pargament, 1997)

– Self-Directing Self-Directing (Primary Control)(Primary Control)

God gives people freedom to direct their own livesGod gives people freedom to direct their own lives

I have controlI have control

– Collaborative Collaborative (Primary and Secondary Control)(Primary and Secondary Control)

Problem solving process held jointly by the Problem solving process held jointly by the individual and Godindividual and God

Shared control with GodShared control with God

– Deferring Deferring (Secondary Control)(Secondary Control)

God is the source of all solutionsGod is the source of all solutions

God has controlGod has control

Research on the Structure of Research on the Structure of Religious ControlReligious Control

Healthy group of church membersHealthy group of church members(Hathaway & Pargament, 1990)(Hathaway & Pargament, 1990)

– Found 3 distinct control stylesFound 3 distinct control stylesCollaborative, Deferring, Self-directingCollaborative, Deferring, Self-directingAlthough Collaborative and Deferring somewhat correlatedAlthough Collaborative and Deferring somewhat correlated

Persons with cancer Persons with cancer (Nairn & Merluzzi, 2003)(Nairn & Merluzzi, 2003)

– Found that the Collaborative & Deferring styles are Found that the Collaborative & Deferring styles are veryvery highly correlated highly correlated

– Thus, just two control styles foundThus, just two control styles foundCollaborative/Deferring and Self-DirectingCollaborative/Deferring and Self-Directing

– highly negatively correlatedhighly negatively correlated

Comparison of Collaborative/Deferring Comparison of Collaborative/Deferring and Self-Directingand Self-Directing

Collaborative/ Collaborative/ Self-DirectingSelf-Directing

DeferringDeferring

Self-Directing (-)Self-Directing (-) 7.52* 7.52* 11.86*11.86*

Self-Directing (+)Self-Directing (+) 21.7021.70 20.6420.64

Attend Religious ServicesAttend Religious Services 4.28* 4.28* 3.40* 3.40*

Pray, how oftenPray, how often 7.24* 7.24* 4.25* 4.25*

How religiousHow religious 4.10* 4.10* 3.00* 3.00*

SP Well Being (Faith)SP Well Being (Faith) 13.21*13.21* 9.35* 9.35*

SP Coping EfficacySP Coping Efficacy 76.31*76.31* 62.28*62.28*

Comparing C/D and SDComparing C/D and SD

Collaborative/ Collaborative/ Self-DirectingSelf-Directing

DeferringDeferring

SP Well Being (Meaning)SP Well Being (Meaning) 34.2434.24 34.27 34.27

Coping Self-efficacyCoping Self-efficacy 97.3897.38 102.53102.53

Quality of Life (FACT)Quality of Life (FACT)

PhysicalPhysical 12.8712.87 12.0412.04

Social/FamilySocial/Family 28.2328.23 29.0029.00

EmotionalEmotional 11.6511.65 10.4010.40

FunctionalFunctional 27.1227.12 29.0929.09

MindfulnessMindfulness 64.79*64.79* 69.32*69.32*

30

20

10

30

20

10

30

20

10

Collaborative

Deferring

Self-Directing

Collaborative/

Deferring (CD)

Self-Directing

(SD)

Paradox-ers

CD + SD

Three Types Of People

H

H

LH

L L

H H H

Differences in the Three TypesDifferences in the Three TypesParadox-ers highest on all scales of the Cancer Behavior Paradox-ers highest on all scales of the Cancer Behavior Inventory (agentic coping)Inventory (agentic coping)– Maintaining Activity and Independence : Maintaining Activity and Independence : PP>C/D=SD>C/D=SD– Coping with Side EffectsCoping with Side Effects PP>C/D=SD>C/D=SD– Positive AttitudePositive Attitude PP>CD>SD>CD>SD– Seeking Medical InformationSeeking Medical Information PP>C/D=SD>C/D=SD– Emotional RegulationEmotional Regulation PP>C/D=SD>C/D=SD– Seeking SupportSeeking Support PP>C/D>SD>C/D>SD

Religiousness Religiousness P = CD > SDP = CD > SD

TrendsTrends– Social Support Social Support CD>SD>PCD>SD>P– AdjustmentAdjustment P=CD>SDP=CD>SD

Contextualizing of ControlContextualizing of Control

Optimizing HealthOptimizing Health– For a well population in terms of esteem and For a well population in terms of esteem and

adjustmentadjustmentSelf-Directing and CollaborativeSelf-Directing and Collaborative

– for prevention of illness and promotion of healthfor prevention of illness and promotion of health

– For those coping with serious illnessFor those coping with serious illnessSelf-Directing less effectiveSelf-Directing less effectiveCollaborative and Deferring correlated and more Collaborative and Deferring correlated and more effectiveeffectiveParadox-ers approach most effective? Most Paradox-ers approach most effective? Most flexible?flexible?

– Able to “live” with the seemingly opposing strategiesAble to “live” with the seemingly opposing strategies

Continuum of ControlContinuum of Control

Self-Directed Deferring

Health/ Acute Illness Chronic Illness

Prevention Acceptance

Primary Control Secondary Control

Engagement Detachment

Younger Older

Paradox-er is able to move along this continuum depending upon the context of coping

Integrating Types and Integrating Types and Control TheoryControl Theory

Self-Directing TypeSelf-Directing Type– Control over Behavior and Outcome Control over Behavior and Outcome

expectancyexpectancyHigh correlation of behavior (action) and outcome High correlation of behavior (action) and outcome expectanciesexpectanciesHigh expectations for certain outcomesHigh expectations for certain outcomesWorks for preventionWorks for preventionCause – Effect attributionCause – Effect attributionRigid perspective of God as uninvolvedRigid perspective of God as uninvolved

Integrating Types and Integrating Types and Control TheoryControl Theory

Collaborative/Deferring TypeCollaborative/Deferring Type– Increasing recognition of the uncertainty of Increasing recognition of the uncertainty of

outcomesoutcomes– Secondary control (trust in a powerful God) is Secondary control (trust in a powerful God) is

a hedge against hopelessnessa hedge against hopelessness– Effective when coping with serious diseaseEffective when coping with serious disease– God as partner or completely in controlGod as partner or completely in control

Integrating Types and Integrating Types and Control TheoryControl Theory

Paradox-ersParadox-ers– Most flexible – most adaptable to all situationsMost flexible – most adaptable to all situations

High behavior expectanciesHigh behavior expectancies– Likely to engage in coping behaviors, BUT…..Likely to engage in coping behaviors, BUT…..– Flexible outcome expectancies based on uncertainty of Flexible outcome expectancies based on uncertainty of

the situationthe situation– Flexible perspective on GodFlexible perspective on God– OR – they are merely pragmatistsOR – they are merely pragmatists

QuestionsQuestions

Should people who are ill be indifferent to Should people who are ill be indifferent to the outcomes as the Stoics suggest?the outcomes as the Stoics suggest?

When does Gelassenheit have value?When does Gelassenheit have value?

More QuestionsMore Questions

– Is illness a “reality” check on the limitations of Is illness a “reality” check on the limitations of personal control?personal control?

Does moving from health to illness change our perspective Does moving from health to illness change our perspective on control AND our relationship with God?on control AND our relationship with God?

Does serious illness “cause” a convergence of collaborative Does serious illness “cause” a convergence of collaborative and deferring problem-solving or coping styles?and deferring problem-solving or coping styles?

– Is the Paradox approach the most flexible and most Is the Paradox approach the most flexible and most effective?effective?

Need for qualitative and longitudinal researchNeed for qualitative and longitudinal research

How do they live with the paradox of control and deferring?How do they live with the paradox of control and deferring?