Personal Responsibility in Health Care

PERSONAL RESPONSIBILITY IN HEALTH CARE

Christopher Ebbe, Ph.D.    2-11

ABSTRACT:  How the issue of mandating health insurance purchase interacts with our human tendency to forgive the unfortunate outcomes of a person’s risk-taking is examined. 

KEY WORDS:  health insurance, risk-taking, risk assessment

One of the chief points of conflict regarding last year’s Federal health care law was (and is) the mandate that all citizens purchase health coverage, or pay an annual fine to contribute to health care expenses.  Opponents believe that this requirement is a violation of the Constitution, and this contention will be determined in the courts.  Proponents believe that the mandate is the only way to finance the health care to be provided under the new law, since, as with all insurance, participation by a large number of people who receive little in the way of benefits (who are “healthy,” in this case) is necessary in order for expensive benefits to be available to those with more health problems.  (If only those who are unhealthy pay, then their premiums for coverage will be much closer to what the health care would cost them out-of-pocket, and this would not really be insurance.)

Since another important element of the new health care system is that applicants for coverage cannot be denied coverage because of health problems that they already have, proponents fear that if people had the option of not purchasing coverage as long as they don’t need it, they would rush to purchase coverage when they do need it and would then be covered even though they had not “done their part” to fund the total system over time (and would presumably stop that coverage again as soon as they were well).  Depending on how many people did this, this ploy could make coverage significantly more costly for those who purchase and continuously maintain coverage.  (The new health care law deals with the issue of those who truly cannot afford coverage by providing them assistance to purchase coverage.)  All major treatments are now so expensive that very few people have the cash (or the financial future) to actually pay out of pocket.

It is ironic that the Republican Party, which ordinarily views itself as strongly valuing personal responsibility, is in this case supporting the individual’s right to “scam the system.”  They might argue that they want everyone to take responsibility for their own health care coverage (or lack of it) by doing away with the mandate, but the results of this position include the system providing a great deal of health care that is not paid for directly by the recipient or by any health care coverage.  Opponents of mandatory health insurance have no good advice for those of us who do not want to pay the extra cost-spreading charges used by hospitals and doctors to cover the care they provide to those who have no coverage and insufficient cash.

One solution to this problem of opting not to pay for coverage until needed might be to allow insurance companies to charge an extra amount to those who enroll only when they become ill, based on the amount of time that they previously did not have coverage.  (This is similar to Medicare Part D coverage, which costs more per month the later a person enrolls.)

Another solution would be not to provide health care, even emergency room care, to those who do not have coverage or the cash to pay.  This would be an appropriate response to the individual’s decision not to have coverage, but it would also be an unpalatable solution in the eyes of most people, since particularly when faced with an emergency need, it seems to be hard-wired into us through evolution (or other means) to provide that care.  It is hard to imagine a person dying in front of health care personnel and those personnel not providing care simply because the person can’t pay (which is why most states require emergency care to be provided regardless of coverage or ability to pay).  Beyond emergency care, the health care system often provides care to those who cannot pay or are unlikely to ever be able to pay and then charges their paying clients more in order to make up for this loss.  This “cost-spreading” could be legally prohibited as well.

This situation faces us with an interesting dilemma—whether to strictly enforce the consequences of being irresponsible by not purchasing health coverage (or risk-taking, depending on your view) by not providing care, or to be more forgiving and provide the care anyway, which rewards being irresponsible and also takes away the incentive for many more people to drop their coverage, too.  Because life is complicated and always to some extent unpredictable, it appears that we have evolved to be quite forgiving about responsibility failures.  We know that circumstances could defeat our own efforts to be responsible and avoid harm and that we would then want others to help us anyway.

We are well aware that we sometimes forget things or get things mixed up, even though most of the time we don’t, and we know, for example, that our attention sometimes wanders while driving, but we don’t want that to invalidate our driving or health care coverages.

The situation is different, however, when a person has the ability to be responsible and chooses not to be.  How would we feel if we forced those who choose not to purchase health coverage to sign a statement notifying them that they will not be treated for future injuries or ailments?  If they choose to forego coverage, knowing that they will not be treated, could we really turn them away later?  Would they believe that we would turn them away later?

We have other circumstances that relate to this as well, as when people are injured bungee-jumping or sky-diving or rock-climbing.  Many of us think that since those people know that they could be injured or killed doing these clearly risky activities, their health insurance companies could legitimately refuse to cover any unfortunate results of these activities.  On the other hand, it goes against our natures, apparently, to actually carry out this denial of care when the injuries occur.

Human beings have apparently evolved to readily tolerate risks, even though we often evaluate these risks poorly (minimizing the risk of sky-diving if we want to engage in sky-diving, for example, while as a parent greatly overestimating the risk of childrens’ vaccines).  Our attraction to gambling illustrates our ability to subjectively underestimate the chances of losing and overestimate the chances of winning!  We underestimate the risk of having a car accident, while probably overestimating the risks of eating trans-fats or fast food.  We don’t even know the relative risks of car accidents versus sky-diving, and even if we did know, most of us would continue to subjectively underestimate the risk of car accidents (because everyone drives, and because we “need” to drive for important purposes), and overestimate the risk of sky-diving (because it is completely optional and seems to much more frightening to most people).

The conclusion to this analysis is that since it is not psychologically acceptable to actually refuse care to those who choose not to purchase insurance, we will either give them a somewhat free ride or we must require that they purchase insurance.  (Note that this conclusion would apply even if last year’s health care law had not passed.)  If they are honest about the matter, opponents of mandatory insurance should acknowledge that it is OK with them for people to get a “free ride” and OK with them for the rest of us to pay for unfunded care by paying more ourselves.  Of course, it may be perfectly fine for the body politic to agree, democratically, to accept cost-spreading, but it should be publically acknowledged that the rest of us are paying the freight, and we should be informed of what that extra charge is.

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Relativity of Perceptions

RELATIVITY OF PERCEPTIONS

Christopher Ebbe, Ph.D.   2-11

ABSTRACT:  The challenges of passing on values and beliefs to those who come after us, in a world of change, are discussed.  The implications of this for passing on our values and beliefs and for finding the best solutions for societal problems are explained:  for us to know our own values and beliefs better, for us to become better able to express our values and beliefs verbally, and for us to become better able to listen to and seek to understand and use the values and beliefs of others.

KEY WORDS:  values, beliefs, assumptions, definitions, generational differences, objectivity

The smooth operation of societies depends on having considerable similarity among all members, in terms of their values, beliefs, explanations for events, and definitions of words.  Clearly, those who value family solidarity will differ from those who value risk-taking and adventure when it comes to legislation and tax structure.  Those who believe that strict fidelity is essential for marriage will differ from those who think that “open marriage” is feasible.  Those who believe that any fetus is a human being or a person will differ from those who believe that personhood begins at birth or late in pregnancy.  Differences in values, beliefs, explanations, and definitions produce most of the conflict in society, and the more diversity there is in these matters, the more conflict there will be regarding adoption of expectations and rules that must apply to everyone.

We are relatively aware of differences on these matters in the present moment, when issues are discussed, but we are poor at understanding the contextual differences that lead to cultural evolution across generations—i.e., changes over time in values, beliefs, and explanations.  For example, those who share a particular set of values and assumptions about violence may find violence in movies or songs stimulating, all the while assuming that their underlying abhorrence of violence will be absorbed and taken forward identically by the next generation.  However, the next generation grows up viewing more violence than their predecessors, and this shapes a changed attitude toward violence.  They will find it more acceptable and less abhorrent, because they are more used to having it in their lives, even if only through the media.  They would still “vote against” violence, but it will be just a little more acceptable and less abhorrent to them than to their parents.

The important point is that each of us judges things from our present vantage point, and those judgments are based on our particular lifetime of experience, so unless the next generation has exactly the same (particularly early) experience, they will be “coming from” a different base when they make their judgments about things as adults.  We tend to assume that everyone has the same base when we make predictions about what others think and feel and what they will do, when in fact they do not have the same base that we do.  We make this assumption of similarity for ease of thought, since it is much more difficult to empathically understand those who are different from us, in order to make predictions about them, and it can be upsetting as well when we recognize these differences.

The rate of change in society has increased greatly over the last fifty years and may still be increasing.  This means that the next generation is guaranteed to have a significantly different assumptive base than we did.  Some parents are concerned enough about these changes to home-school their children, but even this will not shield them from the changed world outside.

The current generation of young people is involved in social networking, which means that they are much more in touch with others through electronic means than their parents were growing up.  They are getting used to others knowing about their lives and making details about their lives available to others (sometimes to unintended others) that would seem to parents matters that should be kept private.  Thus, the meaning of “privacy” and perhaps the importance of it will be different when today’s young people are running society.

Similarly, the current experience of communications being short and therefore necessarily more “shallow” (e.g, the Twitter limit of 142 characters in every Tweet) will mean that current young people will be less interested in in-depth analysis of issues, because they will have no (or little) experience of such in-depth discussions and won’t view them as valuable.  (This may mean that good thinking will become a job in itself, since it will be a specialty activity done well by only a small group of persons and will still vw valuable for some purposes!)

Because of the greater frequency of divorce these days, the words of commitment in marriage vows or promises of one lover to another already mean less, because young people (and even middle-agers) see that there is very little chance of “forever” or “always.”

Adding to divorce the observation of the frequency of affairs and adultery will mean that fewer young people are entering marriage with hopes of fidelity, and many young people also see less reason to avoid something they want to do simply because it is prohibited or violates a promise they have made.  Thus, people are likely to become less trustworthy and behavior less predictable, because promises and doing what is expected have become less valuable.  The relative anonymity of electronic communications and relationships also makes promises to others and the impact of our behavior on others seem less important than in face-to-face relationships.

A further complication in making good decisions about future consequences is that most adults “forget” what they thought and felt twenty or more years ago, “remembering” instead something constructed more out of the present than out of the past, so that they cannot meaningfully assess the results of certain changes or proposed changes in society.

One implication of this contextual or “base” change issue is that if we wish to hand on our values and beliefs to those who come after us, we will need to be much more explicit about doing so.  In centuries past it was relatively effective to just let people observe what was around them while growing up, because it was quite similar to what their parents observed, but now it is quite different.  (We could also slow down the rate of change, but given human beings’ penchant for novelty and reduction of pain, it is very unlikely that this could be accomplished.)  Unfortunately, young people do not have the breadth of observation to know when change is good and when it is bad, and our society’s worship of “the new” makes the wisdom of age something believed to be worthless, when in fact it might be very accurate.  (It takes a long time and much observation to know that most medical research and breakthroughs should not be believed when first reported and will undergo considerable change before being confirmed, if they ever are, just as it takes a long time to know that the government is actually not in control of the economy, despite the promises of candidates to change this or that about the economy.) 

Parents in particular must do more “teaching” about values and beliefs, if they want their children to adopt them and understand them.  As a consequence, they must be prepared also to explain themselves when questioned by children, rather than saying only “because I said so.”  The vague and often contradictory teachings of churches and schools regarding values and beliefs can no longer be relied on give children a good base from which to make decisions.

The ability to think clearly about what we believe and why we believe it is also essential for public debate of issues in a democracy.  Discussions by people who can do this are searches for similarities and differences and for understanding the emotional sources of the other person’s views.  They also stimulate us to revise our own views, based on what we learn from and about the other person.  This is far different from simply trying to convince the other person to change his or her mind (or give up).  (The non-cognitive nature of our assumptions is one important reason why discussion of societal and other emotional issues is so difficult for us, because so few people can state what they believe and can only try to shout down those who are expressing something different.  The biggest challenge here is to see clearly what is emotion and what is fact—what we want to believe versus what the evidence supports.)

This state of affairs (the difficulties of empathy when others are different from us in basic assumptions; our wish to assume uniformity in basic assumptions, even when untrue; our inability to stop change; our inaccurate belief that the “new” will always be good) challenges us to be able to state what we believe and explain why we believe it or prefer it, something that few today can do (because their values and assumptions were adopted largely by observation and imitation and not by more cognitive or verbal learning).  All members of society are urged, therefore, to begin a much closer examination of what they believe, to find out what flaws it has and if it is “really” what they believe.  It will take considerable effort for many of us to become able to say clearly what we believe and to listen patiently to others’ statements on the same issue, in order to objectively and seriously evaluate those other points of view and use them to improve our own views.  This is as key for making our democracy function well as it is for passing on the values and beliefs that we wish to preserve.

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Compassion

 

COMPASSION

Christopher Ebbe, Ph.D. 12-10

ABSTRACT:  Compassion is defined and described as a very valuable social feeling.  The psychological processes involved in compassion are described, and ways of enhancing one’s compassion are detailed.

KEY WORDS:  compassion, love, empathy, acceptance

Wisdom, maturity, and compassion are the keys to living wisely, deeply, and compassionately (which in my opinion is a life with the greatest likelihood of including peacefulness, success, loving and gratifying relationships, good self-esteem, satisfaction, contentment, and fulfillment).

Compassion will be understood here as an attitude and a feeling state composed of warm concern for another with regard to perceived negative feelings or life status of that other person, together with a desire for positive life status and outcomes for the person.  Compassion is based in an empathic understanding of the status and outcomes of that person or persons.  It implies that one will manage his behavior so that it will not lead to negative life status and outcomes for the person of concern, and it may (but need not) lead to actions designed to enhance the life status and outcomes of the person.  Theoretically one could also feel compassion for more than one person, as well as for non-human beings and for the earth (and even for oneself).

Compassion is the sympathetic tug at our heartstrings that we feel on observing or becoming aware of a person’s emotional pain, distress, or suffering.  We might feel compassion for the bereaved, for a rejected spouse or lover, for victims of an earthquake, or for a child disappointed in grades or sports accomplishments.  We might feel compassion for those suffering from living under a brutal government.  Compassion does not require that suffering be above a certain level to qualify, and we can even feel compassion for those suffering from the results of their own poor choices, such as the genuine grief of a spouse being divorced for having an affair.  (Self-induced suffering can, of course, be a larger behavioral pattern in the person’s life that is causing him significant problems.)

If it is expanded to concern for all persons, compassion is like having a loving attitude toward the whole world, with the addition of wanting any suffering and distress to be alleviated.

Webster’s Ninth Collegiate dictionary defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it,” which is consistent with the above description.

HOW COMPASSION IS VALUABLE TO US ALL

Human beings thrive emotionally on being understood, having our feelings and concerns recognized by others, and knowing that others are positively disposed toward us—all elements of compassion.  We all warm to and value people who have this knowledge of us and these feelings toward us.  (Only those who are extremely afraid of losing love and being betrayed reject compassion and refuse to allow themselves to warm to it.)  The more people we have around us who have warm, positive concern for us, the more comfortable we are (and the more likely we are to also be compassionate ourselves).  Almost everyone would choose to have more rather than fewer compassionate persons as friends and associates.

THE PROCESSES OF COMPASSION

Compassion occurs through an empathic process of being aware of the emotional state of another.  Deepening and sharpening our empathy capacities can therefore broaden and deepen our compassion.

Compassion is above all else a feeling of warm concern for the person and wanting the person’s distress or suffering to be reduced.  This requires that we be able to step outside of our personal concerns sufficiently to be genuinely concerned for another person—concerned for that person’s sake only and not for ourselves or regarding the impact of the situation on ourselves.  The desire for a positive outcome for another must flow from the warm, positive feeling of relationship that we feel with the other person, even if we do not know that person.  This relationship may be the fellow-feeling that we can have with any other person, simply because we are both human beings.

The feeling of positive concern for others is maximized if we can relate to all others and not just to our closest friends and relatives.  If we are concerned only for these closest others and not for more distant persons, compassion would in many cases be more appropriately termed love.

Using our capacities for empathy, we sense the psychological state of the other person and come to appreciate the subtleties and complexity of that person’s feelings and thoughts, including the distress that she feels.  This requires experiencing, albeit from a distance, the other person’s feelings and intuiting her thoughts, and doing this for long enough that we have time to arrive at a comprehensive understanding of the person.

Using our empathic understanding of the other person and her distress or negative psychological state, we imagine a better state or outcome for the person, whether that is simply relief of suffering or the achievement of a positive feeling state.  The quality of our empathy will determine whether our imagined improved condition for that person is what the person would actually want or benefit from.  If we are motivated to possibly take action to help, it can be even more effective to find out directly from the person what outcomes she views as desirable.  (There will be times, of course, when we “know” that the outcomes desired by the person are in fact not in her best interest, which leaves us with a dilemma.)

Having compassion does not require that we act to create the desired positive outcome for the other person, but to do so would flow naturally from feeling compassion.

It is important that we not be envious of another person’s positive outcomes, or else we could not sincerely want positive outcomes for him.

WHAT COMPASSION IS NOT

Compassion is not simply concern, since it must also include desire that the other person’s distress be alleviated.

Compassion is not simply helping others, since it must also include felt concern.  Helping others may flow from compassion, but it can also be a way for the helper to avoid feeling another’s pain.

Compassion is not love, since love involves also (1) wanting to be close or closer to the loved one and (2) wanting and acting to bring about what is best for the loved one, in a proactive sense as well as by alleviating distress.  Compassion and love do share, however, a similar warm, positive feeling or stance toward the others involved, as well as a desire for those others to feel “good” rather than “bad.”

Feeling compassion for others does not aim at getting anything back.  It does seek reciprocity.

Compassion is not pity, since pity is defined as “sympathetic sorrow...,” while compassion is awareness and concern regarding another’s distress.

Compassion is not feeling sorry for another, since feeling sorry for someone is often an isolating response rather than warm concern (along the lines of “I sure wouldn’t want to be that person”).  (In recent years, many people inaccurately understand pity to be feeling sorry for another.)

Compassion is not felt from a consciously superior position, since that would probably not include a warm, positive feeling toward the other person.

Most people whom we perceive to be compassionate are stable and trustworthy in those feelings—i.e., if they have compassion for us today, they will have compassion for us another time also, given the same circumstances.  There are some, though, who mouth concern but whose feelings are capricious.  One test for this might be whether the person claiming to be concerned is actually in touch with the pain of the person he is concerned about.  To feel compassion involves feeling another’s pain empathically, though in diluted form.  The person feeling compassion chooses to pay this price because feeling concern for and relatedness with others is desirable.  Those who do not wish to pay this price skip the step of contemplation of the other person’s situation and pain, not living with it long enough to have a comprehensive empathic sense of the other person’s psychological state.  Some of these people, who wish not to feel the other person’s pain, immediately throw significant energy into alleviation of that pain.

ENHANCING COMPASSION

Enhancing or maximizing compassion in us all is desirable because the more connection we feel with others (and especially with all others), the more giving, understanding, and trustworthy we are likely to be toward others (and they toward us).  The concern and relationship that we feel with others and the desire that we feel that they have positive (rather than negative) status and outcomes make it more likely that we will express to others that concern and the understanding that it requires, and they make it more likely that, going beyond compassion, our concern will turn into action aiming to achieve positive outcomes for others.

Since compassion requires empathy, for appreciating the experience and psychological state of the other, enhancing our empathic capacities can increase our capacity for compassion.  The biggest barriers to better empathy are being inaccurate in our understanding of others, being unwilling to feel the negative feeling states of others, and judging and rejecting those whose behavior we dislike.  Having better empathy calls on us to (1) understand others in greater detail and more accurately, (2) be better able to tolerate others’ negative states and distress so that we can truly understand them, and (3) accept others as they are, so that we can feel compassion even for those whose behavior we find repugnant.  It is easy to feel sorry for those who suffer because of “misfortune” but much harder to feel genuine concern about and to wish for a better state for those who have harmed others (e.g., those who have murdered or molested others) or those who suffer because of their own “bad” choices (anorexics, adulterers, etc.)!

Understanding others in greater detail and more accurately requires learning more about the subtleties of thoughts, feelings, and motives of people.  Paying greater attention to our own complexity is a first step—recognizing all of our emotions, even the unpleasant and embarrassing ones, noticing all of our thoughts, even those we don’t like, and acknowledging how we criticize, judge, and reject others.  Applying the same standards to ourselves that we apply to others can be enlightening!

Our ability to tolerate the negative states of others that we experience empathically can be enhanced by learning to tolerate and live with our own negative emotions better.  For most of us this means accepting these negative feelings and allowing ourselves to really experience them before we can automatically deny or repress them and before we process them or allow them to fade.  This does not mean liking negative states but simply allowing ourselves to experience them fully instead of immediately and automatically pushing them away or altering them.

Accepting others even when we don’t like them or like their behavior is a different approach to interpersonal relations than most of us learn growing up.  Most of us use rejection and harming others as our way of trying to get them to change their behavior (hurting, shaming, embarrassing, criticizing, ignoring, distancing, guilt-tripping), but a more positive approach is to accept everyone basically as a person but use communication and education to seek change in their behavior.  This means that we would state clearly what we don’t like to the other person (after considering honestly whether the other person’s behavior is truly harmful rather than just inconvenient for us).  We would ask the other person for the specific change of behavior that we want, and if possible we would suggest other behaviors that could achieve the other person’s goals just as well or better.  This communication should be done in an accepting or neutral rather than a critical tone, since a critical tone is another method of punishing.  Many people will object that if you don’t punish such people, they will never change, but these people are assuming that the way they themselves were treated (punishment) is how others should be treated, and they may never have experienced the pull toward positive behavior that genuine acceptance creates.  It is a fact that an accepting atmosphere leads to more significant change than a punishing environment, partly because the target person has no need to fight against the request for change.

Compassion has as its motive power the desire for the alleviation of distress or suffering in others, so in order to have compassion, one must care about others and their experience.  Caring means that the feelings of others matter to one and that one is interested enough in others’ status that one is aware of their experience.  In our modern world many people restrict their caring only to those close to them, so compassion could be enhanced by expanding that circle of caring.  It might seem unbearably unpleasant to be aware of the distress of so many others when it seems so impossible to do anything meaningful about it, but an individual such as yourself, who approaches everyone around him (acquainted or not) with compassion, does influence those others to be more caring and compassionate themselves, and this influence can spread.

Compassion is enhanced the more we are capable of selfless concern.  We are naturally motivated to take care of ourselves and do right by ourselves, but we can also consider the needs of others independent of how it might affect us, if we practice this consideration, particularly by seeing things from the point of view of the other person (utilizing accurate empathy).  In any case, the diminished distress of the person for whom we feel compassion would not affect us negatively, as long as we were not envious of her improvement!

Compassion is enhanced through feeling kinship with all other persons.  We can care meaningfully about not only those we know and love but about everyone on the planet, if we consider and appreciate that every one of them has the same emotions, most of the same thoughts and fears, and the same desires and basic life goals that we do, even if those occur in a different language or in a different type of house than we have.  We cannot influence the lives of all those other people separately, but we can through our attitude toward every individual make this a more comfortable and encouraging world for everyone.

In the “real world,” our interest in and concern for others often arises from a felt similarity (thinking or feeling that we are like the other person), but this will tend to restrict one’s compassion to those who we perceive to be like ourselves.  It is quite possible to extend your compassion to everyone if your warm, positive regard for others includes everyone and you are willing to see deep enough into another person to realize that he or she is in fact just like you in many meaningful ways.

Since love and compassion have in common the desire for the distress of others to be alleviated, compassion can be enhanced by expanding one’s circle of love—i.e., feeling love even toward strangers.  This love toward strangers will necessarily be an attenuated love, involving warm, positive feelings but not the same desire to be close to and intertwined with the other person, but practicing love is another way to approach being compassionate.  It adds greatly to our own felt life experience to approach everyone with a loving attitude.

To practice compassion, identify some other person or persons to focus on.  Contact a place within yourself where you feel warm and positive, and focus on the other person while feeling that warm, positive feeling, including them in that warm, positive space.  Attend carefully to that person, with interest, in order to empathically understand his situation and feelings, particularly feelings of distress or suffering.  Take time to see the whole person and understand him comprehensively.  Relate to that person through your memory of having had similar feelings yourself.  Let concern for the other person arise in your feelings, and be aware of your desire for his distress to be alleviated.  Let this stance guide your future actions as they might affect that other person, whether or not you act directly to alleviate his distress of the moment. 

In order to make compassion a central part of your personality, try to maintain this concern and warm, positive stance toward everyone you interact with, as well the other people in the world.

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Re-creating and Changing the Emotional Past

RE-CREATING OR CHANGING THE EMOTIONAL PAST

Christopher Ebbe, Ph.D.    2-11

In response to our human motivation to be in a positive emotional state, we often seek to re-create in our current lives a positive emotional state from the past, often unconsciously.  This is an important motive for many people in having and raising children—to re-create the presumably positive feelings associated with their time in their families of origin, particularly in very early childhood when each of us is totally cared for as the center of our mother’s world.  For the most part, this motive is unconscious and operates only on a feeling level

A primary motive of those who are interested in the lives of media and music stars and those who identify with sports teams and players is to once again be, like the envied star, the darling of the universe, the most important person in the world, as they felt as infants and as they believe that their stars feel currently.  When we watch others, our nervous systems participate in their movements and feelings, however subliminally (“mirror neurons”? empathy?), and to that extent, for those moments, we feel like them and “are” them, both physically and emotionally.  We can also imitate them in various ways in our daily lives. In the other direction, this process also includes the satisfaction that we feel when some of these figures are embarrassed or discredited, since that proves that “they are no better than we are.” 

Some politicians may be initially motivated by similar desires to be loved, important, and looked up to, but the inevitable and brutal results of having a certain number of their constituents dissatisfied with or even hating them quickly disabuses them of this vain hope.

Even substance abuse can be viewed as an unconscious effort to re-create a positive past experience, perhaps the bliss of being held and fed as an infant (which may be our most positive experience in life), or perhaps to make up for what we did not have in that regard.

You may wonder about actions which seem to stem from the absence of a previous gratification.  For example, some people seem motivated to create a family and/or raise children in order to correct a past negative experience in their own families—in order to have a happy family this time or to themselves avoid some of the negative childrearing behaviors of their parents.  Similarly, some may watch star gossip or sports to finally achieve the adulation and importance that they missed out on as infants.  It may be that we all receive some gratification of these “needs,” even if very little, and that this is enough to establish a memory of the gratification.  Having an inadequate amount of such fundamental gratifications may lead to even more motivation for more of these gratifications than those of us have who had more of them early.  An equally important motive in this desire to improve the past, however, is affirming that life can be good and can deliver on its “promises” and to disconfirm the fear of such people that life may inevitably be a cold and disappointing affair.

Some people also repeat or re-create negative experiences, which seems at first counterintuitive, but these are efforts either to re-do those negative situations to turn them into positive ones (marrying someone similar to an unloving parent in order to prove that one can “make” that person love one) or to live out those negative experiences in the view of others until someone intervenes to help and to “make the situation right.”

What are the implications of this insight?  It is not necessarily the case that if we were more objective or realistic about these unconscious efforts to feel better (and that we therefore reject or denigrate these desires) that we would be happier.  The value of knowing about these “needs,” desires, or drives is in being able to gratify them in other ways and in knowing that we can work within ourselves psychologically to reduce the needs through insight, acceptance, meditation, or other means.  As adults we will never be the center of attention or have the degree of unconditional love that we have as infants, unpleasant as that may be for us to accept!  We can, however, have sufficient appreciation and love that it reminds us (unconsciously) of those golden days, and this can give us some pleasure.

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