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Psychology PSY1011
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Chapter 1
INTRODUCING PSYCHOLOGY
Psychology as a discipline has changed immensely since its humble beginnings. There is an amazing array of
professional and applied areas that people with psychological training now work in. In this opening chapter,
we provide an overview of psychology as a discipline and many of the more specialised areas in which
psychologists work. However, the main focus is on providing an understanding of the theoretical and applied
work of the discipline of psychology. It is important to note that the knowledge that you will gain from using
this book underpins much of human behaviour, which is relevant and may be applied to many other disciplines
and professions. We describe the linkages that tie these areas to one another and to other subjects, such
as economics and medicine, and how research in psychology is being applied in everyday life. We then tell the
story of how psychology developed and the various ways in which psychologists approach their work.
LEARNING OBJECTIVES
On completion of this chapter, you should be able to:
1.1 define psychology 1.4 understand the diversity of psychology
1.2 understand the history of psychology 1.5 develop an awareness of the knowledge, skills and values
1.3 describe the role of the scientific method in the study that reflect the science and application of psychology,
of psychology and the possible career pathways in psychology.
APPLYING PSYCHOLOGY
1 Can studying psychology equip you with skills such as good oral and written communication skills and numeracy
skills, well-developed computer skills, the ability to find and research information, and environmental awareness?
2 What other settings, other than psychological practice, do psychologists work in?
Express Bring your learning to life with interactive study and exam preparation tools that support your textbook.
CourseMate Express includes quizzes, videos, concept maps and more.
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Chapter 1: Introducing Psychology
INTRODUCTION
A diverse range of employment opportunities is on offer when you study psychology. Studying
psychology at an undergraduate level provides you with a range of skills and competencies that CHAPTER
enable you to work in many different fields. In addition, some people choose to pursue postgraduate OUTLINE
studies and become registered psychologists. In this book, we endeavour to provide you with the ● The world of
knowledge to consider different pathways for your future studies and employment. psychology: an
Here are a number of people who have used the skills and knowledge gained in their study in overview
psychology: ● A brief history of
1 Nadine completed an undergraduate degree in psychology and then decided to seek psychology
employment before pursuing further studies. She worked in events management, where she ● Approaches to
was able to effectively use her excellent oral and written communication skills, knowledge of the science of
human behaviour, and problem-solving ability in a timely and ethical manner. After a year in psychology
the workforce, Nadine decided to study counselling at a postgraduate level. ● Human diversity
2 Michelle found her dream job working as a regional training coordinator after completing her and psychology
undergraduate degree in psychology. She works in a remote location assisting people as part of ● Studying and
a mental health and drug service. Her teamwork and oral communication skills are invaluable working in
to her role. psychology in
3 After completing a four-year degree in psychology, Frank went on to complete a Graduate Australia and
Training Program in the public service. After developing his skills in human resources, Frank New Zealand
now manages a human resources department within a university.
4 Donna received an honours degree in psychology and was able to apply her high-level research
skills when she started work in a large metropolitan hospital’s sleep clinic. Using her knowledge
and understanding of psychological theories related to sleep, Donna has progressed in her place
of employment and now coordinates the sleep clinic.
5 Gerry completed a Master of Applied Psychology degree where he focused on community
psychology. He sought employment in a non-government organisation in a regional
location, where his role involves working with families to support children with learning
difficulties.
6 As a graduate with a Master of Applied Psychology with a clinical focus, Josey completed
supervised practice that enabled her to establish her own private clinical practice, which now
employs three clinical staff.
7 Following completion of her honours degree in psychology, Eleanor went on to do a PhD
during which she completed groundbreaking research into effective behavioural interventions
for children with autism spectrum disorder. She now works as an academic in a university and
also consults privately with other organisations.
The people described above are doing fascinating work in different areas, and some are employed
as psychologists in one or more of psychology’s many specialty areas, or subfields. Most of these
people took their first psychology course without realising how many of these subfields there are, or
how many different kinds of jobs are open to people who study psychology. But each of these people
found something in psychology – perhaps something unexpected – that captured their interest, and
they were intrigued. And who knows? By the time you have finished this book and your course, you
may have found some aspect of psychology so compelling that you will want to make it your life’s
work too. At the very least, we hope you enjoy learning about psychology, the work of psychologists,
and how that work benefits people everywhere.
There are a number of perspectives that underpin the structure of this book. In each chapter, we
will highlight the application of psychological knowledge and skills through the appropriate Graduate
Attributes of the Australian Undergraduate Psychology Program: knowledge and its application,
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Chapter 1: Introducing Psychology
research skills, critical and creative thinking skills, values and ethics in psychology, communication
and interpersonal skills, and psychological literacy. An important aspect of this text is the focus on
using psychological knowledge and the development of psychological literacy.
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Chapter 1: Introducing Psychology
47 special interest groups (for example, Aboriginal and Torres Strait Islander peoples and psychology,
psychologists in oncology, and so on).The New Zealand Psychological Society has eight professional
institutes and special interest groups which members may join: clinical, community, counselling,
criminal justice and forensic, educational and developmental, organisational, health, and special
interest group (coaching). These groups provide members with opportunities to attend professional
development activities and meet with other psychologists who work in similar areas of practice.
The Australian Psychological Society and the New Zealand Psychological Society have a reciprocal
relationship. For more on these societies and the Psychology Board of Australia, see the upcoming
‘Studying and working in psychology in Australia and New Zealand’ section.
Let’s take a quick look at the typical interests and activities of psychologists in each subfield.
Please be aware that we are using the term ‘psychologist’ loosely to include psychological scientists
(who work in different subfields) as well as registered psychologists. We will describe their work in
more detail in later chapters.
Biological psychology
Biological psychologists, also called physiological psychologists, use high-tech scanning devices and biological psychologists
other methods to study how biological processes in the brain affect, and are affected by, behaviour and psychologists who analyse
the biological factors
mental processes (see Figure 1.1). Have you ever had the odd feeling that a new experience, such as
influencing behaviour and
entering an unfamiliar house, has actually happened to you before? Biological psychologists studying mental processes; also called
this illusion of déjà vu (French for ‘already seen’) suggest that it may be due to a temporary malfunction physiological psychologists
in the brain’s ability to combine incoming information from the senses, creating the impression of
two ‘copies’ of a single event (Brown, 2004). In Chapter 3, ‘Biological aspects of psychology’, we
describe biological psychologists’ research on many other topics, such as how your brain controls your
movements and speech, and what organs help you cope with stress and fight disease.
Cognitive psychology
cognitive psychologists
TRY THIS Stop reading for a moment and look left and right.Your ability to follow this suggestion, psychologists who study the
to recognise whatever you saw, and to understand the words you are reading right now are the result mental processes underlying
of mental, or cognitive, abilities. Those abilities allow you to receive information from the outside judgement, decision making,
world, understand it and act on it. Cognitive psychologists (some of whom prefer to be called problem solving, imagining
and other aspects of human
experimental psychologists) study mental abilities such as sensation and perception, learning and thought or cognition;
memory, thinking, consciousness, intelligence and creativity. Cognitive psychologists have found, for also called experimental
example, that we don’t just receive incoming information – we mentally manipulate it. Notice that psychologists
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the drawing in Figure 1.2 stays physically the same, but two different versions emerge, depending on
which of its features you emphasise.
Image from American Journal of Psychology. Copyright 1961 by the Board of Trustees of the University of Illinois. Used with permission of the University of Illinois Press.
Applications of cognitive psychologists’ research are all around you. The work of those whose
engineering psychology special interest is engineering psychology – also known as human factors – has helped designers create
a field in which psychologists computer keyboards, mobile phones, MP3 players, websites, aircraft instrument panels, car navigation
study human factors in the
systems, nuclear power plant controls, and even TV remotes that are more logical, easier to use and
use of equipment and help
designers create better less likely to cause errors.You will read more about human factors research and many other aspects
versions of that equipment of cognitive psychology in several chapters of this book.
Developmental psychology
developmental Developmental psychologists describe the changes in behaviour and mental processes that occur
psychologists from birth through old age and try to understand the causes and effects of those changes (see
psychologists who seek to
Figure 1.3). Their research on the development of memory and other mental abilities, for example,
understand, describe and
explore how behaviour and is used by judges and lawyers in deciding how old a child has to be in order to serve as a reliable
mental processes change witness in court or to responsibly choose which divorcing parent to live with.The chapter on human
over a lifetime development describes other research by developmental psychologists and how it is being applied in
areas such as parenting, evaluating day care, and preserving mental capacity in elderly people.
Images from Shaffer, D. (1985). Developmental Psychology: Theory, Research and Applications. Copyright © Wadsworth, a part of Cengage Learning Inc. Reproduced by permission. www.
cengage.com/permissions
personality
psychologists Personality psychology
psychologists who study the
characteristics that make
Personality psychologists study individuality – the unique features that characterise each of us.
individuals similar to or Using personality tests, some of these psychologists seek to describe how your own combination of
different from one another personality traits, like your fingerprints, differs from everyone else’s in terms of traits such as openness
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Chapter 1: Introducing Psychology
to experience, emotionality, reliability, agreeableness and sociability. Others study the combinations of
personality traits that are associated with the appearance of ethnic prejudice, depression or vulnerability
to stress-related health problems. And personality psychologists interested in positive psychology
are trying to identify and understand the human strengths that help people to remain optimistic, even
in the face of stress or tragedy, and to find happiness in their lives (Snyder & Lopez, 2009).
Snapshot
Psychology and health education
Have you ever thought about what hearing
loss sounds like? As we age, many of us will
suffer from hearing loss. For some, our work
contexts affect our range of hearing. However,
think of the impact of new technologies that
enable us to listen to mobile music 24/7. This
‘sonic silence’ exhibit has been developed
to educate people about hearing loss; it is a
listening booth that simulates different types
of noise-induced hearing problems.
In Australia and New Zealand, clinical, counselling, community and health psychologists have a
master’s degree or a doctorate in psychology. All of these psychologists differ from psychiatrists, who
are medical doctors specialising in abnormal behaviour (psychiatry). You can read more about the
work of clinical, counselling, community and health psychologists in Chapter 12, ‘Health, stress and educational
psychologists
coping’, and in Chapter 14, ‘Psychological disorders and treatment’. psychologists who study
methods by which
Educational and school psychology instructors teach and
students learn, and who
Educational psychologists conduct research and develop theories about teaching and learning. The apply their results to
results of their work are applied in programs designed to improve teacher training, refine school improving those methods
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Chapter 1: Introducing Psychology
curricula, reduce truancy rates, and help students learn more efficiently and remember what they
learn. For example, they have supported the use of the ‘jigsaw’ technique, a type of classroom activity
in which children from various ethnic groups must work together to complete a task or solve a
problem. These cooperative experiences appear to promote learning, generate mutual respect, and
reduce intergroup prejudice (Aronson, 2004).
school psychologists School psychologists provide support to teachers and students, and they help to identify academic
psychologists who work problems and to set up programs to improve students’ achievement and satisfaction in school.They are also
with teachers and students,
involved in activities such as the early detection of students’ mental health problems, and crisis intervention.
assist in diagnosing students’
academic problems, provide
counselling to students, and Social psychology
set up programs to improve
students’ achievement Social psychologists study the ways in which people think about themselves and others, and how
people influence one another. Their research on persuasion has been applied to the creation of
social psychologists
safe-sex advertising campaigns designed to stop the spread of AIDS (acquired immune deficiency
psychologists who study
how people influence syndrome) or quit smoking campaigns. Social psychologists also explore how peer pressure affects
one another’s behaviour us, what determines who we like (or even love; see the Snapshot ‘Got a match?’), and why and how
and mental processes, prejudice forms. They have found, for example, that although we may pride ourselves on not being
individually and in groups
prejudiced, we may actually hold unconscious negative beliefs about certain groups that affect the
way we relate to people in those groups. Chapter 15, ‘Social cognition and influence’, describes these
and many other examples of research in social psychology.
Snapshot
Got a match?
Some commercial matchmaking services, such as eHarmony
(eharmony.com.au), apply social psychologists’ research on interpersonal
relationships and attraction in an effort to pair up people whose
characteristics are most likely to be compatible. According to eHarmony,
it uses the data of over 200 000 couples globally to identify personality
dimensions which influence how well two people are suited to
eHarmony
one another.
organisational
psychologists psychologists Organisational psychology
who study ways to improve
Organisational psychologists conduct research on leadership, stress, competition, pay rates and other
efficiency, productivity and
satisfaction among workers factors that affect the efficiency, productivity and satisfaction of people in the workplace. They also
and the organisations that explore topics such as worker motivation, work team cooperation, conflict resolution procedures
employ them and employee selection methods. Learning more about how businesses and organisations work –
sport psychologists or fail to work – allows organisational psychologists to make evidence-based recommendations
psychologists who explore for helping them work better. Today, companies all over the world are applying research from
the relationships between organisational psychology to promote the development of positive organisational behaviour. The results
athletic performance and
include more effective employee training programs, ambitious but realistic goal-setting procedures,
such psychological variables
as motivation and emotion fair and reasonable evaluation tools, and incentive systems that motivate and reward outstanding
performance.
forensic psychologists
psychologists who assist
in jury selection, evaluate Other subfields
defendants’ mental
competence to stand trial, and
Our list of psychology’s subfields is still not complete. There are sport psychologists, who use
deal with other issues involving visualisation and relaxation training programs, for example, to help athletes reduce excessive anxiety,
psychology and the law focus attention, and make other changes that let them perform at their best. Forensic psychologists
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(see the Snapshot ‘Linking psychology and law’) may assist police and other agencies in profiling
criminals, evaluating the mental competence of defendants, providing psychological reports for
court processes, and performing many other tasks related to psychology and the law. Environmental environmental
psychologists study the effects of the environment on people’s behaviour and mental processes. psychologists
psychologists who study
The results of their research are applied by architects and interior designers as they plan or remodel
the effects of the physical
university residences, shopping malls, auditoriums, hospitals, prisons, offices and other spaces to make environment on behaviour
them more comfortable and functional for the people who will occupy them. and mental processes
Snapshot
Linking psychology and law
Forensic psychologists research the types of
training required to appropriately carry out an
More information about the subfields we have mentioned – and some that we haven’t – are
available on the websites of the Australian Psychological Society (www.psychology.org.au) and the
New Zealand Psychological Society (www.psychology.org.nz).
Where do the psychologists in all these subfields work? Table 1.1 contains a summary of where
the approximately 20 000 psychologists in Australia and the 1000 psychologists in New Zealand find
employment, as well as the kinds of things they typically do in each setting.
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Chapter 1: Introducing Psychology
LINKAGES
If you follow the many linkages among psychology’s chapter has a special Linkages section that discusses the ties
subfields as you read this book, you will come away not only between material covered in the chapter, or the interrelation
with threads of knowledge about each subfield but also with to another psychological subfield.
an appreciation of the fabric of psychology as a whole. Each
LINKAGES
Can subliminal messages Does psychotherapy work? What makes some people
help you lose weight? so aggressive?
So if you want to understand psychology as a whole, you have to understand the linkages among
its subfields.To help you recognise these linkages, we highlight three of them in a ‘Linkages’ diagram
at the end of each chapter – similar to the one shown here. Each linkage is represented by a question
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Chapter 1: Introducing Psychology
that connects two subfields, and the chapter numbers indicate where you can read more about each
question (look for ‘Linkages’ symbols in the margins of that chapter). We pay particular attention to APPLYING
one of the questions in each diagram by discussing it in a special ‘Linkages’ section. If you follow the PSYCHOLOGY
linkages in these diagrams, the relationships among psychology’s many subfields will become much What other
settings, other
clearer. We hope that you find this kind of detective work to be interesting and that it will lead you
than psychological
to look for the many other linkages that we did not mention. Tracing linkages might even improve practice, do
your results in the course, because it is often easier to remember material in one chapter by relating psychologists
it to linked material in other chapters. work in?
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Chapter 1: Introducing Psychology
eaten (Rozin et al., 1998). What if you didn’t remember that you just had lunch? Would you have
started eating that second plate of food?
To explore this question, Rozin conducted a series of tests with R. H. and B. R., two men who
had suffered a kind of brain damage that left them unable to remember anything for more than
a few minutes. (You can read more about this condition, called anterograde amnesia, in Chapter 6,
‘Memory’.) The men were tested individually, on three different days, in a private room where
they sat with a researcher at lunchtime and were served a tray of their favourite food. Before and
after eating, they were asked to rate their hunger on a scale from 1 (extremely full) to 9 (extremely
hungry). Once lunch was over, the tray was removed and the researcher continued chatting, making
sure that each man drank enough water to clear his mouth of food residue. After 10 to 30 minutes, a
hospital attendant arrived with an identical meal tray and announced, ‘Here’s lunch’. These men had
no memory of having eaten lunch already, but would signals from their stomachs or their blood be
enough to keep them from eating another one?
Apparently not. Table 1.2 shows that in every test session, R. H. and B. R. ate all or part of the
second meal and in all but one session ate at least part of a third lunch that was offered to them 10 to
30 minutes after the second one. Rozin conducted similar tests with J. C. and T. A., a woman and a
man who had also suffered brain damage but whose memories had not been affected. In each of two
test sessions, these people finished their lunch but refused the opportunity to eat a second one.These
results suggest that the memory of when we last ate can indeed be a factor in guiding decisions
about when to eat again. They also support a conclusion described in Chapter 10, ‘Motivation and
emotion’; namely, that eating is controlled by a complex combination of biological, social, cultural
and psychological factors. As a result, we may eat when we think it is time to eat, regardless of what
our bodies tell us about our physical need to eat.
a
B. R. began eating his third meal but was stopped by the researcher, presumably to avoid illness.
From Rozin, P., Dow, S., Moscovitch, M., & Rajaram, S. (1998). The role of memory for recent eating experiences in onset and cessation of meals: Evidence from the amnesic syndrome.
Psychological Science, 9, 392–396. Reprinted by permission of Sage Publications, Inc.
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Chapter 1: Introducing Psychology
Rozin’s study illustrates the fact that although psychologists often begin with speculation
about behaviour and mental processes, they take additional steps towards understanding those
processes. Using scientific methods to test their ideas, they reach informed conclusions and
generate new questions. Even psychologists who don’t conduct research still benefit from it.They
are constantly applying the results of their colleagues’ studies to improve the quality, accuracy
and effectiveness of their teaching, writing or service to clients and organisations. For example,
practising clinical psychologists are combining their psychotherapy skills with research from
cognitive, organisational and sport psychology to help business executives, performing artists and
athletes excel (Hays, 2009).
The rules and methods of science that guide psychologists in their research are summarised in
Chapter 2, ‘Research in psychology’. We have placed that chapter early in the book to highlight
the fact that without scientific research methods and the foundation of evidence they provide,
psychologists’ statements and recommendations about behaviour and mental processes would carry
no more weight than those of astrologers, psychics or tabloid journalists. Accordingly, we will be
relying on the results of psychologists’ scientific research when we tell you what they have discovered
so far about behaviour and mental processes and also when we evaluate their efforts to apply that
knowledge to improve the quality of human life.
IN REVIEW
The world of psychology: an overview
SUBFIELDS FOCUS
Biological Biological factors influencing behaviour and mental processes
The mental processes underlying judgement, decision making, problem solving,
Cognitive
imagining and other aspects of human thought or cognition
Seeking to understand, describe and explore how behaviour and mental processes
Developmental
change over a lifetime
Clinical Seeking to assess, understand and change abnormal behaviour
The study methods by which instructors teach and students learn, and who apply
Educational
their results to improving those methods
How people influence one another’s behaviour and mental processes, individually and
Social
in groups
Ways to improve efficiency, productivity and satisfaction among workers and the
Organisational
organisations that employ them
Other
• Forensic – issues involving psychology and the law
• Community – working with communities and individuals to prevent psychological disorders by striving for change in
social systems
• Personality – the characteristics that make individuals similar to or different from one another
• Health – effects of behaviour and mental processes on health and illness, and vice versa
• Environmental – effects of the physical environment on behaviour and mental processes
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Snapshot
Wilhelm Wundt (1832–1920)
In an early experiment on the speed of mental processes, Wundt (third from left) first
measured how quickly people could respond to a light by releasing a button they had
been holding down. He then measured how much longer the response took when they
held down one button with each hand and had to decide, based on the colour of the light,
which one to release. Wundt reasoned that the additional response time reflected how
Alamy/INTERFOTO
long it took to perceive the colour and decide which hand to move. As noted in Chapter 7,
‘Cognition and language’, the logic behind this experiment remains a part of research on
cognitive processes today.
Edward Titchener, an Englishman who had been a student of Wundt’s, used introspection in his
own laboratory at Cornell University. He studied Wundt’s basic elements of consciousness, as well
as images and other aspects of conscious experience that are harder to quantify. One result was that
Titchener added ‘clearness’ as an element of sensation (Schultz & Schultz, 2004).Titchener called his
approach structuralism because he was trying to define the structure of consciousness.
Wundt was not alone in the scientific study of mental processes, nor was his work universally
accepted. Some of his fellow German scientists, including Hermann Ebbinghaus, believed that
analysing consciousness through introspection was not as important as exploring the capacities
and limitations of mental processes such as learning and memory. Ebbinghaus’ own laboratory
experiments, in which he served as the only participant, formed the basis for some of what we know
about memory today.
Gestalt psychologists
Around 1912, other German colleagues of Wundt, including Max Wertheimer, Kurt Koffka and
Wolfgang Köhler, argued against his efforts to break down human experience or consciousness into
its component parts. They were called Gestalt psychologists because they pointed out that the whole
shape (Gestalt in German) of conscious experience is not the same as the sum of its parts.Wertheimer
pointed out, for example, that if a pair of lights goes on and off in just the right sequence, we don’t
experience two separate flashing lights but a single light that appears to ‘jump’ back and forth. You
have probably seen this phi phenomenon in action on advertising signs that create the impression of
a series of lights racing around a display. Movies provide another example. It would be incredibly
boring to look one at a time at the thousands of still images printed on a reel of film. Yet when
those same images are projected onto a screen at a particular rate, they combine to create a rich and
seemingly seamless emotional experience. To understand consciousness, then, said the Gestaltists, we
have to study the whole ‘movie’, not just its component parts.
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Chapter 1: Introducing Psychology
causes of these people’s physical problems were not physical. The real causes, he said, were deep-
seated problems that the patients had pushed out of consciousness (Friedman & Schustack, 2003).
He eventually came to believe that all behaviour – from everyday slips of the tongue to severe forms
of mental disorder – is motivated by psychological processes, especially by mental conflicts that occur
without our awareness, at an unconscious level. For nearly 50 years, Freud developed his ideas into a
body of work known as psychoanalysis, which included a theory of personality and mental disorder, as
well as a set of treatment methods. Freud’s ideas are by no means universally accepted, partly because
they were based on a small number of medical cases, not on extensive laboratory experiments. Still,
he was a groundbreaker whose theories have had a significant influence on psychology and many
other fields.
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Chapter 1: Introducing Psychology
psychology. However, he thought it was utterly unscientific to use behaviour as the basis for
making inferences about consciousness, as structuralists and functionalists did – let alone about
the unconscious, as Freudians did. In 1913, Watson published an article titled ‘Psychology as the
behaviourist views it’. In it, he argued that psychologists should ignore mental events and base
psychology only on what they can actually see in overt behaviour and in responses to various stimuli
(Watson, 1913, 1919).
Watson’s view, called behaviourism, recognised the existence of consciousness but did not
consider it worth studying because it would always be private and therefore not observable
by scientific methods. In fact, said Watson, a preoccupation with consciousness would prevent
psychology from ever being a true science. He believed that the most important determinant
of behaviour is learning and that it is through learning that animals and humans are able to
adapt to their environments. Watson was famous for claiming that, with enough control over the
environment, he could create learning experiences that would turn any infant into a doctor, a
lawyer or even a criminal.
The American psychologist B. F. Skinner was another early champion of behaviourism.
From the 1930s until his death in 1990, Skinner worked on mapping out the details of how
rewards and punishments shape, maintain and change behaviour through what he termed ‘operant
conditioning’. By conducting a functional analysis of behaviour, he would explain, for example, how
parents and teachers can unknowingly encourage children’s tantrums by rewarding them with
attention and how a virtual addiction to gambling can result from the occasional and unpredictable
rewards it brings.
Many psychologists were drawn to Watson’s and Skinner’s vision of psychology as the learning-
based science of observable behaviour. In fact, behaviourism dominated psychological research from
the 1920s through the 1960s, while the study of consciousness received less attention, especially in
the United States. (The section ‘In review: A brief history of psychology’ summarises behaviourism
and the other schools of thought that have influenced psychologists over the past century.)
Psychology today
Psychologists continue to study all kinds of overt behaviour in humans and in animals. By the end
of the 1960s, however, many had become dissatisfied with the limitations imposed by behaviourism
(some, especially in Europe, had never accepted it in the first place).They grew uncomfortable about
ignoring mental processes that might be important in more fully understanding behaviour (for
example, Ericsson & Simon, 1994). The dawn of the computer age influenced these psychologists
to think about mental activity in a new way – as information processing. Computers and rapid
progress in computer-based biotechnology began to offer psychologists exciting new ways of
studying mental processes and the biological activity that underlies them. As shown in Figure 1.1,
for example, it is now possible to literally see what is going on in the brain when a person reads or
thinks or makes decisions.
Armed with ever more sophisticated research tools, psychologists today are striving to do what
Watson thought was impossible: to study mental processes with precision and scientific objectivity.
In fact, there are probably now as many psychologists who study cognitive and biological processes
as there are who study observable behaviours. So mainstream psychology has come full circle,
once again accepting consciousness – in the form of cognitive processes – as a legitimate topic
for scientific research and justifying the definition of psychology as the science of behaviour and
mental processes.
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IN REVIEW
A brief history of psychology
SCHOOL OF THOUGHT EARLY ADVOCATES GOALS METHODS
Edward Titchener,
To study conscious
Structuralism trained by Wilhelm Experiments; introspection
experience and its structure
Wundt
To describe the organisation
of mental processes: ‘The Observation of sensory–
Gestalt psychology Max Wertheimer
whole is different from the perceptual phenomena
sum of its parts’
To explain personality and
behaviour; to develop
Psychoanalysis Sigmund Freud Study of individual cases
techniques for treating
mental disorders
To study how the mind works
Naturalistic observation of
Functionalism William James in allowing an organism to
animal and human behaviour
adapt to the environment
To study only observable
Observation of the relationship
John B. Watson, behaviour and explain
Behaviourism between environmental stimuli
B. F. Skinner behaviour through learning
and behavioural responses
principles
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As its name implies, the biological approach to psychology assumes that behaviour and mental processes brain mapping
are largely shaped by biological processes. Psychologists who take this approach study the psychological tell us?
effects of hormones, genes and the activity of the nervous system, especially the brain (see the Snapshot Biological
‘What can brain mapping tell us?’). So if they are studying memory, they might try to identify the psychologists
changes taking place in the brain as information is stored there (Figure 6.15, in Chapter 6, ‘Memory’, are able to
provide further
shows an example of these changes). If they are studying thinking, they might look for patterns of brain
understanding
activity associated with, for example, making quick decisions or reading a foreign language.
to many areas
Research discussed in nearly every chapter of this book reflects the enormous influence of the of psychology,
biological approach on psychology today.To help you better understand the terms and concepts used
Biological processes also figure prominently in an approach to psychology based on Charles Darwin’s
1859 book On the Origin of Species. Darwin argued that the forms of life we see today are the result
of evolution – of changes in life forms that occur over many generations. He said that evolution
occurs through natural selection, which promotes the survival of the fittest individuals. Those
whose behaviour and appearance allow them to withstand the elements, avoid predators and mate
are able to survive and produce offspring with similar characteristics. Those less able to adjust (or
adapt) to changing conditions are less likely to survive and reproduce. Most evolutionists today see
natural selection operating at the level of genes, but the process is the same. Genes that result in biological approach
characteristics and behaviours that are adaptive and useful in a certain environment will enable the an approach to psychology
in which behaviour and
creatures that inherit them to survive and reproduce, thereby passing those genes on to the next
behaviour disorders are seen
generation. According to evolutionary theory, many (but not all) of the genes that animals and as the result of physical
humans possess today are the result of natural selection. processes, especially those
The evolutionary approach to psychology assumes that the behaviour and mental processes of relating to the brain and
to hormones and other
animals and humans today are also the result of evolution through natural selection. Psychologists
chemicals
who take this approach see cooperation as an adaptive survival strategy, aggression as a form of
territory protection, and gender differences in mate selection preferences as reflecting different ways natural selection the
evolutionary mechanism
through which genes survive in future generations (Griskevicius et al., 2009). The evolutionary
through which Darwin said
approach has generated a growing body of research (for example, Buss, 2009; Confer et al., 2010); in the fittest individuals survive
later chapters, you will see how it is applied in relation to topics such as helping and altruism, mental to reproduce
disorders, temperament and interpersonal attraction. evolutionary approach
an approach to psychology
that emphasises the
The psychodynamic approach inherited, adaptive aspects
of behaviour and mental
The psychodynamic approach to psychology offers a different slant on the role of inherited processes
instincts and other biological forces in human behaviour. Based on Freud’s psychoanalysis, this
approach assumes that our behaviour and mental processes reflect constant and mostly unconscious psychodynamic
approach a view
psychological struggles within us (see Figure 1.5). Usually, these struggles involve conflict between developed by Freud that
the impulse to satisfy instincts (such as for food, sex or aggression) and the need to follow the rules emphasises the interplay
of civilised society. So psychologists taking the psychodynamic approach might see aggression, for of unconscious mental
example, as a case of primitive urges overcoming a person’s defences against expressing those urges. processes in determining
human thought, feelings
They would see anxiety, depression or other disorders as overt signs of inner turmoil.
and behaviour
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Photodisc
Freud’s original theories are not as influential today as they once were (Mischel, 2004a), but you
will encounter modern versions of the psychodynamic approach in other chapters when we discuss
theories of personality (see Chapter 3, ‘Personality’), psychological disorders and psychotherapy (see
Chapter 14, ‘Psychological disorders and treatment’).
Snapshot
Why is he so aggressive?
Psychologists who take a cognitive-behavioural approach suggest that behaviour
is not shaped by rewards and punishments alone. They say that children’s
aggressiveness, for example, is learned partly by being rewarded (or at least
Shutterstock.com/Lopolo
not punished) for aggression but also partly by seeing family and friends acting
aggressively. Furthermore, attitudes and beliefs about the value and acceptability
of aggressiveness can be learned as children hear others talk about aggression
as the only way to deal with threats, disagreements and other conflict situations
(for example, Cooper, Gomez & Buck, 2008; Wilkowski & Robinson, 2008).
Recall, though, that the peak of behaviourism’s popularity passed precisely because it ignored
everything but observable behaviour. That criticism has had an impact on the many behaviourists
who now apply their learning-based approach in an effort to understand thoughts, or cognitions,
as well as observable behaviour. Those who take this cognitive-behavioural, or social-cognitive, approach
explore how learning affects the development of thoughts, attitudes and beliefs and, in turn, how
these learned cognitive patterns affect overt behaviour.
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Snapshot
The humanistic approach Cognitive
science at
Mental events play a different role in the humanistic approach to psychology (also known as the work
phenomenological approach). Psychologists who favour the humanistic perspective see behaviour as
Some cognitive
determined primarily by each person’s capacity to choose how to think and act.They don’t see these
psychologists
choices as driven by instincts, biological processes, or rewards and punishments but rather by each undertake work
individual’s unique perceptions of the world. So if you see the world as a friendly place, you are likely in cognitive skill
to be optimistic and secure. If you perceive it as full of hostile, threatening people, you will probably acquisition, where
be defensive and fearful. the main interest
Like their cognitively oriented colleagues, psychologists who choose the humanistic approach is in how practice
would see aggression in a cinema queue as stemming from a perception that aggression is justified. leads to improved
performance
Whereas the cognitive approach leads psychologists to search for laws governing all people’s thoughts
and knowledge.
and actions, humanistic psychologists try to understand how each individual’s unique experiences
This has obvious
guide that person’s thoughts and actions. In fact, many who prefer the humanistic approach claim implications for
that because no two people are exactly alike, the only way to understand behaviour and mental education in general
processes is to focus on how they operate in each individual. Humanistic psychologists also believe and specifically the
that people are essentially good, that they are in control of themselves, and that they have an innate development of
tendency to grow towards their highest potential. educational software
The humanistic approach began to attract attention in North America in the 1940s through the for children.
writings of Carl Rogers, a psychologist who had been trained in, but later rejected, the psychodynamic
approach. We describe his views on personality in Chapter 13, ‘Personality’, and his psychotherapy
methods in Chapter 14, ‘Psychological disorders and treatment’. Another influential figure of the
same era was Abraham Maslow, a psychologist who shaped and promoted the humanistic approach
through his famous hierarchy-of-needs theory of motivation, which we describe in Chapter 10,
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‘Motivation and emotion’, and Chapter 13, ‘Personality’. Today, the impact of the humanistic
approach to psychology is limited, mainly because many psychologists find humanistic concepts and
predictions too vague to be expressed and tested scientifically. It has, however, helped inspire the
theories and research in positive psychology that are now becoming so popular (Snyder & Lopez,
2009). (For a summary of all the approaches we have discussed, see the section ‘In review: Approaches
to the science of psychology’.)
IN REVIEW
Approaches to the science of psychology
APPROACH CHARACTERISTICS
Emphasises activity of the nervous system, especially of the brain; the action of hormones
Biological
and other chemicals; and genetics
Evolutionary Emphasises the ways in which behaviour and mental processes are adaptive for survival
Emphasises internal conflicts, mostly unconscious, which usually pit sexual or aggressive
Psychodynamic
instincts against environmental obstacles to their expression
Emphasises learning, especially each person’s experience with rewards and punishments; the
Behavioural cognitive-behavioural approach adds emphasis on learning by observation and the learning of
certain ways of thinking
Emphasises mechanisms through which people receive, store, retrieve and otherwise process
Cognitive
information
Emphasises individual potential for growth and the role of unique perceptions in guiding
Humanistic
behaviour and mental processes
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Snapshot
Mary Whiton Calkins (1863–1930)
Mary Whiton Calkins studied psychology at
Harvard University, where William James
described her as ‘brilliant’. Because she was a
woman, though, Harvard refused to grant her a
encourages or discourages particular behaviours and thoughts; it also allows people to understand
and know what to expect from others in that culture. It is a kind of group adaptation, passed along by
tradition and example rather than by genes from one generation to the next (Castro & Toro, 2004).
Culture determines, for example, whether children’s education will focus on skill at hunting or
reading, how close people stand during a conversation, and whether or not they form lines in public
places. Psychologists and anthropologists have found that cultures can differ in many ways (Cohen,
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Chapter 1: Introducing Psychology
2009). They may have strict or loose rules governing social behaviour. They might place great value
Snapshot
The impact on achievement or on self-awareness. Some seek dominance over nature; others seek harmony with
of culture it. Time is of great importance in some cultures but not in others.
Culture helps shape A culture is often associated with a particular country, but most countries are actually multicultural;
almost every aspect in other words, they host many subcultures within their borders. Often, these subcultures are formed
of our behaviour and by people of various ethnic origins.The population of Australia, for instance, includes Africans, Asians,
mental processes, Europeans, Britons and New Zealanders. In each of these groups, the individuals who identify with
from how we dress
their cultural heritage tend to share behaviours, values and beliefs based on their culture of origin,
to how we think
to what we believe
thus forming a subculture. In many countries, there are already indigenous cultures, such as Australian
is important. Aboriginal and Torres Strait Islander peoples, Māori in New Zealand, Native Americans in the
Because we grow United States, and First Nations, Inuit and Métis peoples in Canada.
up immersed in our Like fish unaware of the water in which they are immersed, people often fail to notice how
culture, we may their culture or subculture has shaped their thinking and behaviour until they come in contact with
be unaware of its people whose culture or subculture has shaped different patterns (see the Snapshot ‘The impact of
influence on our culture’). Consider hand gestures, for example. The ‘thumbs up’ sign means that ‘everything is OK’
own thoughts and
to people in Australia and New Zealand but is considered a rude gesture in Nigeria and Bangladesh.
actions until – like
these young women
And although making eye contact during social introductions in Australia and New Zealand is
who emigrated from usually seen as a sign of interest or sincerity, it is likely to be considered rude in Japan. Even some
Africa to Sydney – of the misunderstandings that occur between men and women in the same culture can be traced
we encounter people to slight, culturally influenced differences in their communication styles (Tannen, 2001, 2012). For
Shutterstock.com/Ruud Morijn Photographer
whose culture has decades, the impact of culture on behaviour and mental processes was of concern mainly to a
shaped them in relatively small group of researchers working in cross-cultural psychology. In the chapters to come,
different ways. however, you will see that psychologists in almost every subfield are now looking at how ethnicity,
gender, age and many other sociocultural variables can influence behaviour and mental processes. In
short, psychology is striving to be the science of all behaviour and mental processes, not just of those
in the cultures where it began.
Psychology has a role to play in promoting the health and wellbeing of people from all cultures.
However, with respect to Aboriginal Australians and Torres Strait Islander peoples, and the Māori
culture, psychology has often neglected to develop knowledge and understanding of human
behaviour in a culturally appropriate manner. This is examined in much more depth in Chapter 16,
‘Culture and psychology’, and in Chapter 17, ‘Indigenous psychology’.
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represents more than 1000 psychologists and aims to establish and enforce high standards within the
profession. It became an independent organisation in 1967. The New Zealand Psychologists Board
is responsible for the registration of psychologists in New Zealand.
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a member of current and future global communities, to positively engage with any opportunities
you are given to develop both your psychological literacy and your global citizenship (Charlton &
Lymburner, 2011; Cranney & Dunn, 2011a).
As implied above, psychological literacy can be seen as the ‘Gestalt’ or ‘whole’ of the evolving
graduate attributes that should be acquired by those undertaking a psychology major program.
Listed below are the evolving graduate attributes and associated learning outcomes that reflect a
combination of:
1 the psychology educator consensus reported by Cranney and Botwood (2012; pp. 19–22)
2 the minimalist proposed APAC Standards (Australian Psychology Accreditation Council, 2016)
3 the program learning outcomes endorsed by the Australian Psychological Society (Morrissey, 2016).
Knowledge
Graduates will be able to comprehend and apply a broad and coherent body of knowledge of
psychology, with depth of understanding of the underlying principles, theories and concepts in the
discipline, using a scientific approach, including the following topics:
i individual differences in capacity, behaviour and personality, including cultural, ethnic and
gender diversity
ii psychological health and wellbeing, and evidence-based interventions
iii psychological disorders and evidence-based interventions
iv learning and memory
v cognition, language and perception
vi motivation and emotion
vii neuroscience and biological bases of behaviour
viii life-span developmental psychology
ix social psychology
x intercultural diversity and cultural awareness
xi Australian Aboriginal and Torres Strait Islander perspectives in psychology
xii moral and ethical frameworks and their relationship to the science and practice of
psychology
xiii psychological assessment and measurement
xiv research methods and statistics
xv the history and philosophy underpinning the science of psychology
xvi sociocultural, historical and professional influences on research and practice in psychology
xvii psychology’s relationship to cognate disciplines and professions.
Research skills
Graduates will be able to apply the basic knowledge and skills required to ethically design, conduct,
evaluate and report studies to address psychological questions across a variety of domains (including
program evaluation), specifically:
i framing research questions
ii undertaking literature searches
iii critically analysing theoretical and empirical studies
iv formulating testable hypotheses
v operationalising variables
vi choosing an appropriate methodology to test the hypotheses
vii designing appropriate questionnaires/surveys as needed
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iv demonstrating the capacity to design, implement and evaluate programs of behaviour change
v demonstrating cultural responsivity – the capacity to engage respectfully with members of
different cultures and diverse groupings (one aspect of global literacy).
Careers in psychology
The decision to study psychology can be extremely rewarding, as many different career pathways
become available to you. The information in this section on such pathways is brief and is intended
only as an overview of the study of psychology.A more detailed overview with additional information
is available online – see Appendix A, ‘Careers for psychology graduates’.
Courses in psychology aim to provide you with an understanding of why humans behave in a
particular way, why they differ from one another, and how they are affected by living and working
together. An undergraduate course provides the basis for the study of psychology at higher levels but
also equips you with basic skills in analysing, understanding, researching, changing and evaluating
human behaviour, as well as exploring the interaction between people and their physical and social
environments.
What is a psychologist?
A psychologist is someone who has undergone at least four years of tertiary training in an
accredited, formally recognised psychology program and who then engages in further study or
undertakes two years of approved supervised practice. The websites of the Psychology Board
of Australia (www.psychologyboard.gov.au/Registration/General.aspx) and the New Zealand
Psychologists Board (www.psychologistsboard.org.nz/looking-to-register) provide details of the
general registration requirements for psychologists in Australia and New Zealand.
While an undergraduate degree in psychology provides you with many skills, it does not allow
you to call yourself a psychologist. The websites of the Australian Psychological Society (www.
psychology.org.au/studentHQ/studying/study-pathways) and the New Zealand Psychological
Society (www.psychology.org.nz/study-careers) are useful references when it comes to assessing the
different pathways to becoming a psychologist.
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2 as a trainee psychologist who has completed either a master’s degree or a doctoral degree
followed by supervised practice approved by the Psychologists Board.
Psychological societies
The professional body that regulates and oversees the profession of psychology in Australia is the
Australian Psychological Society (APS; www.psychology.org.au); the body with these responsibilities
in New Zealand is the New Zealand Psychological Society (NZPsS; www.psychology.org.nz).
The APS establishes the standards required to practise psychology as a profession. Since January
2000, the minimum requirement for APS membership has been six years – this requirement also
applies to membership of one of the nine colleges representing specialist areas within psychology
(in New Zealand, these are referred to as institutes or divisions). This means that the training of
psychologists in Australia follows a model where the first four years provides a foundation in the
discipline and science of psychology, and professional training is provided in the last two years.There
are many students who do not wish to complete such a period of study and training to become
qualified psychologists, and who leave university with a three-year undergraduate degree with a
major in psychology and supporting studies in other areas. As mentioned previously, these students
will still have developed the skills and competencies to seek employment in many diverse areas.
The APS also collaborates with the tertiary education sector to make sure that the profession has
access to current and accurate information and training in psychology. In addition, it supervises and
develops the guidelines for professional matters and training programs.
The APS represents over 20 000 members.There are varying levels of membership which require
different educational requirements. For example, students of psychology may join APS as a student
member. However, to become a full member, APS requires completion of the full six years of training
in an accredited program, or the equivalent of a master’s degree in psychology.
The NZPsS was first established in 1947 and became incorporated in 1967. It is the main society
in New Zealand for practising psychologists, academics, students and other subscribers, representing
over 1000 members. While the NZPsS has a national office in Wellington, it also caters to specialist
interest groups and branches which are geographically defined. Similar to the APS, the NZPsS
is responsible for the code of ethics that spells out the responsible behaviour and commitment
expected of all psychologists in the country. Membership of the NZPsS is available to those who
have either a doctorate in psychology or an honours or master’s degree in psychology.
This book
In each of the chapters to come, a brief introductory section is devoted to pointing out what aspects
of that chapter are relevant to which graduate attributes and to psychological literacy. If such a
psychological literacy and graduate attributes section had been prepared for this first chapter, it
would have read as follows.
This chapter is, of course, your introduction to psychological literacy and graduate attributes –
what they are and why they are important. Specifically, it is an introduction to:
1 the history and philosophy of science and psychology (part of knowledge)
2 how psychological principles can be applied meaningfully in personal and professional contexts
(part of integration and application)
3 the way in which psychological knowledge, skills and attitudes can be relevant to professional
development (part of integration and application).
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CHAPTER REVIEW
Express
SUMMARY
Psychology is the science that seeks to understand behaviour and mental processes and to apply that understanding in the service of
human welfare.
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3 You are marooned on a tropical island with a dangerous 7 The concepts of behaviour and mental processes
criminal. In your suitcase are four books on psychology. include .
If you believe that the criminal’s behaviour is primarily due a personality traits
to unconscious conflicts, you should choose the book written
b sensory abilities
by to find more information.
c intelligence
a Sigmund Freud
d all of the above
b William James
8 A major difference between psychologists and psychiatrists is
c John Watson
that psychiatrists .
d Wilhelm Wundt
a have more training in psychological testing
4 Larry says that people act the way they have learned to act.
b are medical doctors
He believes that if others stop rewarding a person’s annoying
behaviour, that behaviour will decrease. Larry most likely takes c are more active in research
a(n) approach to psychology. d all of the above
a behavioural 9 Ali argues that, compared to men, women’s greater selectivity
b cognitive in choosing a mate is an adaptive strategy that makes it more
likely that fathers will be good providers. This view is rooted in
c evolutionary
the approach to psychology.
d humanistic
a evolutionary
5 Psychology is best defined as the science of .
b behavioural
a behaviour and mental processes
c cognitive-behavioural
b psychological disorders and conditions
d humanistic
c personality development
10 Paul tells his wife that she won’t ever be able to understand
d neurons and hormones him unless she can begin to understand his own unique view
6 Research on the factors that lead people to be happy and of the world. Without realising it, Paul is expressing a basic
satisfied with their lives is known as psychology. principle of psychology.
a developmental a psychodynamic
b humanistic b cognitive-behavioural
c positive c humanistic
d existential d cognitive
TALKING POINTS
When they discover that you are taking a psychology course, family and friends tend to want to know what you are learning about
(and they might worry that you will ‘analyse’ them!). It can be tough to give a short answer, so here are a few talking points to help you
summarise this chapter without giving a lecture (we’ll offer others for each chapter to come).
1 Psychology is the science that explores behaviour and mental 5 Some psychologists study human problems; others focus on
processes. learning about human strengths.
2 Psychologists’ research is widely applied in the service of 6 Sigmund Freud was a medical doctor, not a psychologist.
human welfare. 7 Some kinds of behaviour and thinking are the same for
3 Clinical psychology is the most famous subfield, but everyone, everywhere; others are influenced by people’s
psychology also includes a wide range of other subfields. gender, ethnicity and cultural background.
4 Registered psychologists have postgraduate degrees in
psychology; psychiatrists have medical degrees.
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FURTHER READING
Now that you have finished reading this chapter, how about exploring some of the topics and information that you found most
interesting. Here are some places to start.
RECOMMENDED BOOKS
D. B. Baker (ed.), Oxford Handbook of the History of Psychology: International Perspectives Alan M. Goldstein (ed.), Forensic Psychology (Wiley, 2006) – an overview of the role of
(Oxford University Press, 2011) – provides an understanding of the history of psychological science in the legal system.
psychology and includes international examples and information. Daniel Kahneman,Thinking Fast and Slow (Farrar, Straus and Giroux, 2013) – summarises
Paul Bell, Environmental Psychology (Wadsworth, 2001) – applications of psychology to decades of Daniel’s research and explains how he thinks we think.
solving problems in natural and artificial environments, including university campuses.
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Chapter 1: Introducing Psychology
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Chapter 2
BIOLOGICAL ASPECTS
OF PSYCHOLOGY
Before you read the next sentence, close your eyes and touch your nose. This task is easy, but it is not
simple. To get the job done, your brain used specific nerves to tell your eyelids to close. It used other nerves
to tell your hand to extend a finger and then sent a series of messages that moved your arm in just the right
direction until it received a message that your finger and your nose were in contact. This example illustrates
that everything you do – including how you feel and think – is based on some kind of biological activity in
your body, especially in your brain. This chapter tells the story of that activity, beginning with the neuron,
one of the body’s most basic biological units. We describe how neurons form systems capable of receiving and
processing information and translate it into behaviour, thoughts and biochemical changes.
LEARNING OBJECTIVES
On completion of this chapter, you should be able to: 3.3 identify the functions of different divisions of the nervous
system and describe the research techniques used to
3.1 describe the organisation of the nervous system
investigate brain function
3.2 outline the processes involved in communication within
3.4 outline the chemistry of psychology: the role of
the nervous system
neurotransmitters and the endocrine system
3.5 outline the endocrine system.
APPLYING PSYCHOLOGY
1 How can elite athletes and professional musicians create changes in the part of their brain that controls movement by
imagining practising their skilled movements?
2 Can differences between hormones in men and women account for some of the differences between the sexes?
3 Is it possible to show the neural foundations of specific thought processes and emotions, such as religious beliefs or
romantic love?
Express Bring your learning to life with interactive study and exam preparation tools that support your textbook.
CourseMate Express includes quizzes, videos, concept maps and more.
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10,000. One hundred and fifty-four of these were for families whose homes were
in the districts surveyed, but who were not at home at the time of the first survey.
These were omitted during the second survey, irrespective of whether individuals
were at home. In this group are also included a few in which children were at
home, but were unable to give reliable information. Fifteen of the 194 families
gave insufficient information, and 25 refused to co-operate. The small number in
this last group speaks well for the efficiency and methods of the inspectors. All
families accepted for tabulation co-operated to the best of their ability, and we
believe that the records are as accurate as this type of work may be made.
Dr. Niven, in the work referred to by Carnwath, made an inquiry covering
1,021 houses, with a population of 4,721. Five hundred and three households or
almost exactly one-half, were invaded in either the summer 1918, or the autumn-
winter 1918 epidemic. This proportion of families is quite similar to our own, but
it must be pointed out that Niven was not studying the same two epidemics that
we are discussing. Two hundred and sixty-six of his total households, or 26.05
per cent. were invaded in the autumn epidemic.
Previous to the present time the author has been unable to find records of
investigators having used this method of studying influenza to any appreciable
extent. Certainly there has been nothing done on the subject previous to the last
pandemic. Since then Frost has studied, as indicated in his report, family
incidence to the extent of determining the relationship to overcrowding and to
economic status, and Niven has studied family incidence with special reference
to immunity.
Thomas Sydenham, speaking of the epidemic of 1675, says that: “No one
escaped them whatever might be his age or temperament, and they ran through
whole families at once.”
According to Waldschmidt, during the epidemic of 1712, in Kiel, ten or more
persons were frequently taken ill in one house.
In 1732, Huxam tells us that, “not a house was free from it, the beggar’s hut
and the nobleman’s palace were alike subject to its attack, scarce a person
escaping either in town or country, old and young, strong and infirm, shared the
same fate.”
Metzger says that the influenza was so universal in March, 1782, that in very
many houses all of the inmates were attacked. On the other hand, Mertens did
not believe the influenza a contagion during the same epidemic for the reason
that according to his observations now only one, and again all, of the members of
a family, were stricken.
In 1833, in Königsberg, according to Hufeland, parents, children, and servants
were frequently smitten with the disease at the same time, so that strange help
had to be obtained for the family.
Parkes taught that, “Persons in overcrowded habitations have, particularly in
some epidemics, especially suffered, and several instances are on record of a
large school or a barrack for soldiers being first attacked, and of the disease
prevailing there for some days before it began to prevail in the town around.
Sometimes, on the other hand, schools and prisons have escaped. A low, damp,
ill-ventilated and unhealthy situation appears to predispose to it, and in some
instances, in hospital patients, it has assumed a malignant character. In other
cases again, hospital patients have escaped; for example, the old people in the
Salpêtrière in 1837, when the younger attendants were attacked.”
Effect of overcrowding.—The family or household forms a social unit in which
human intercourse is very close, and in which the opportunities for contact
infection either direct or indirect are manifold. In addition to all of the
opportunities which each individual has for contracting the disease outside of the
family every case in the family exposes every other member many times during
the day. One of the first questions arising in a study of the disease in the family
is, therefore, whether the size of the family in and of itself exerts any
predisposing influence on the total incidence in any one family. Are large
families more likely to have a greater percentage of cases than small families? We
have endeavored to answer this question by grouping together all families
containing only one individual, all of those with two, three, four, etc., and
determining the percentage of individuals contracting influenza in each of the
groups. The standard for comparison is the percentage of the total 10,000 who
contracted the disease in either year, or in both. 19.71 per cent. of all persons
canvassed contracted influenza in 1918–19. Reference to Table IV shows that of
persons living in families of one, 17.95 per cent. developed the disease; of those
in families of two, 18.46 per cent.; in families of three, 19.96 per cent.; in families
of four, 20.10 per cent.; and in families of from five to seven, between 22 and 23
per cent. Families of over seven all showed lower, but varying incidence of the
disease. As is seen by the table, they comprise only a small number of families.
TABLE IV.
The incidence of influenza in families of different sizes.
(Influence of size of family).
Total No. of Number of these individuals who
No. of individuals developed influenza.
No. of such
individuals included in 1918. 1920. Total.
families.
in family. all such Per Per Per
families. No. No. No.
cent. cent. cent.
1 39 39 7 17.95 3 7.69 10 24.42
2 260 520 96 18.46 55 10.58 151 29.04
3 359 1077 215 19.96 128 11.88 343 31.85
4 396 1584 319 20.10 169 10.67 488 30.81
5 375 1875 423 22.56 203 10.83 626 33.39
6 264 1584 361 22.79 151 9.53 512 32.32
7 179 1253 279 22.27 109 8.70 388 30.96
8 103 824 156 18.93 55 6.67 211 25.61
9 57 513 85 16.57 21 4.09 106 20.66
10 28 280 40 14.14 26 9.29 66 23.57
11 15 165 10 6.06 7 4.24 17 10.30
12 4 48 0 0.0 5 10.42 5 10.42
13 2 26 5 19.23 3 11.54 8 30.77
14 1 14 0 0.0 0 0.0 0 0.0
In 1920, 9.55 per cent. of the entire canvassed population contracted the
disease. The table shows that 7.69 per cent. of all individuals in families of one
contracted influenza, and between 10 and 12 per cent. in families of from two to
five individuals. Above the family of five the incidence rates again are lower and
varying within wide limits. The last column shows the percentage of individuals
by size of family contracting the disease in either or both epidemics.
The average size of all families was 4.7 individuals.
If we consider only those family groups having over 1,000 individuals as being
sufficiently large to be representative, we may conclude that families of from
three to seven individuals show no progressive increase in influenza incidence
with increase in size of the family. But all the available evidence indicates that
other things being equal, the age incidence is a very important factor. Its
influence will be felt in the subject under consideration, and it will modify the
results. Thus, families of one or two are almost invariably adults; families of
three are very frequently made up of two adults and a child or infant, while
families of from five to seven will be more likely to have a high proportion of
young adults—the age period more seriously affected.
The next question arising is whether those families, large or small, which are
living in crowded circumstances, are more likely to develop the disease. Arbitrary
standards must be chosen as indices of crowding. We have chosen two in order
that they may check each other. The first is based upon the number of
individuals sleeping in a bedroom. Families are classified as follows: Maximum
sleeping in a single bedroom, 1; maximum sleeping in a single bedroom, 2;
maximum per bedroom, 3, 4, etc.
The second standard of crowding is based upon the ratio of the number of
individuals in the family and the number of rooms occupied. One person living in
one room is not crowded; two in two rooms, three in three rooms, four in four
rooms, eight in eight rooms, twelve in twelve rooms, are not crowded. Two
people living in one room four in two rooms, six in three rooms, twelve in six
rooms, are decidedly more crowded. On the contrary, one individual in two
rooms, two in four, three in six, four in eight, five in ten, etc. have an unusual
amount of room.
The ratios P⁄R are then throughout, ¹⁄₁, ²⁄₁, ½. These are used as dividing lines.
All families with ratios higher than ²⁄₁ are classed as very crowded. Families with
ratios above ¹⁄₁ up to and including ²⁄₁ are classed as crowded. Families with
ratios above ½ up to and including ¹⁄₁ are classed as roomy, and those with ratio
of ½ or lower are classified as very roomy.
Classifying all families in all six districts according to these last four degrees of
crowding, we find, as is shown by Table V, that there is a progressive increase in
the proportion of families with one or more cases of the disease, with increase in
the extent of crowding.
According to the standard first described we find as is shown in Table VI that
families with three, four and five individuals sleeping in a single room show a
progressive increase of incidence over those families with but one or two per
bedroom. This again is shown best in the total for all families, but is borne out in
a study of each district. These statistics are however of little value for the study of
the effect of overcrowding, because crowded families are usually large families.
With an influenza incidence of 20 per cent. we would theoretically expect every
family of five or larger to have one or more cases. This would amount to 100 per
cent. infected families and such a state would not only influence, but dominate
the statistics regarding overcrowding.
TABLE V.
Effect of crowding on development of influenza in families.
(A higher proportion of crowded households than roomy are invaded).
(Standard used: ratio of number individuals to number rooms).
Proportion of these families visited by influenza.
In both
Total
No. of In 1918– epidemics
Living In 1920. families
such 19. (Recurrent)
conditions. invaded.
families. .
Per Per Per Per
No. No. No. No.
cent. cent. cent. cent.
District I.
V. Cr. 53 30 56.61 15 28.31 12 22.64 31 58.49
Cr. 195 107 54.87 59 30.26 43 22.05 123 63.08
R. 79 36 45.57 24 30.38 18 22.78 42 53.16
V. R. 16 7 43.75 1 6.6 0 0.0 8 50.00
District II.
V. Cr. 4 1 25.00 1 25.00 1 25.00 1 25.00
Cr. 137 70 51.09 31 22.63 2 8.76 89 64.96
R. 208 70 33.65 39 18.75 7 8.17 92 44.23
V. R. 103 20 19.42 7 6.80 2 1.94 25 24.27
District III.
V. Cr. 13 9 69.23 2 15.38 1 7.69 10 76.92
Cr. 213 99 46.48 65 30.52 40 18.78 124 58.22
R. 143 62 43.36 35 24.48 15 10.49 82 57.34
V. R. 21 8 27.59 2 6.89 2 6.89 8 38.09
District IV.
V. Cr. 0 0 0 0 0
Cr. 27 18 66.67 8 29.63 5 18.52 21 77.77
R. 137 72 52.55 50 36.49 21 15.33 101 73.72
V. R. 95 38 40.00 27 28.42 12 12.63 53 55.79
District V.
V. Cr. 6 2 33.33 4 66.67 2 33.33 4 66.67
Cr. 110 67 60.91 37 33.64 25 22.73 79 71.82
R. 209 104 49.76 70 33.49 38 18.18 146 69.86
V. R. 14 3 21.42 3 21.42 0 6 42.84
District VI.
V. Cr. 0 0 0 0 0
Cr. 2 1 50.00 0 0.0 0 0.0 1 50.00
R. 92 57 61.96 23 25.00 14 15.22 66 71.74
V. R. 189 65 34.39 46 24.34 19 10.05 92 48.68
Per Per Per
Living No. of No. No. No. Per
cent. cent. cent. Total.
conditions. families. 1918. 1920. both. cent.
1918. 1920. both.
Very
80 43 53.75 25 31.25 18 22.50 50 62.50
crowded
Crowded 693 372 53.68 201 29.00 126 18.18 447 64.50
Roomy 865 394 45.55 244 28.21 125 14.45 513 59.31
Very Roomy 443 143 32.28 87 19.64 36 8.13 194 43.79
Per Per Per Per
All Total 1918 1920 Both Total
cent. cent. cent. cent.
2081 952 45.75 557 26.77 305 14.66 1204 57.86
TABLE VI.
Effect of crowding.
(Standard used: maximum number sleeping in one bed room.)
Proportion of these families with cases of
influenza.
Maximum No. No. of Total
In 1918– In both
sleeping per such In 1920. families
19. epidemics.
room. families. invaded.
Per Per Per Per
No. No. No. No.
cent. cent. cent. cent.
District I.
1 16 6 37.50 4 25.00 3 18.75 7 93.75
2 93 52 55.91 31 33.33 20 21.51 63 67.74
3 145 65 44.83 47 32.41 27 18.62 85 58.62
4 79 43 54.43 25 31.65 17 21.52 51 64.56
5 24 11 45.83 11 45.83 6 25.00 16 66.67
6 10 3 30.00 3 30.00 1 10.00 5 50.00
District II.
1 90 15 16.67 7 7.77 2 2.22 20 22.22
2 211 68 32.23 36 17.06 14 6.64 90 42.65
3 115 59 51.30 23 20.00 10 8.69 72 66.61
4 33 20 60.60 11 33.33 6 18.18 25 75.76
5 3 1 33.33 2 66.67 1 33.33 2 66.67
6 0 0 0 0 0
District III.
1 26 10 38.46 3 11.54 2 7.69 11 42.31
2 179 73 40.78 47 26.26 23 12.85 97 54.19
3 145 72 49.66 37 25.52 23 15.86 86 59.31
4 39 20 51.28 15 38.46 8 20.51 27 69.23
5 8 5 62.50 2 25.00 1 12.50 6 75.00
6 0 0 0 0 0
District IV.
1 53 15 28.30 15 28.30 6 11.32 24 45.28
2 165 80 48.48 56 33.94 22 13.33 114 69.09
3 42 29 69.05 15 35.71 10 23.81 34 80.95
4 5 4 80.00 0 0.0 0 0.0 4 80.00
5 0 0 0 0.0 0 0
6 0 0 0 0 0
District V.
1 23 8 34.77 6 26.08 1 4.35 13 56.52
2 156 70 44.37 48 30.77 24 15.38 94 60.26
3 130 81 62.31 44 33.84 27 20.77 98 75.38
4 27 18 66.66 14 51.85 12 44.44 20 74.07
5 6 3 50.00 4 66.67 3 50.00 4 66.67
6 1 0 0.00 0 0.00 0 0.00 0 0.00
District VI.
1 120 42 35.00 24 20.00 10 8.33 56 46.67
2 146 77 52.74 34 23.29 22 15.07 89 60.96
3 10 5 50.00 5 50.00 1 10.00 6 60.00
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
Total
1 328 96 29.27 59 17.99 24 7.32 131 39.94
2 450 420 44.21 252 26.53 125 13.16 547 57.57
3 587 311 52.98 171 29.13 98 16.69 381 64.91
4 183 105 57.38 65 35.52 43 23.50 127 69.39
5 41 20 48.78 19 46.34 11 26.83 28 68.29
6 11 3 27.27 3 27.27 1 9.09 5 45.45
An objection will be raised, and justly so, that we have up to this point been
studying influenza in families irrespective of how many cases there are in each
family. Until now the family with one case was classified exactly the same as the
family with eight cases. In the following classification we have taken first all
families with a maximum of one sleeping in one room, and sub-divided these
into families with no influenza, those with one case, two cases, etc. We have
likewise classified families with maxima from two to six per bedroom. For the
sake of brevity we will consider only the last column of Table VII, influenza
incidence among the individuals of the various classes of families for both
epidemics. Study of the table will show a correspondence in the other columns.
Solitary cases were more numerous in families with but one or two per bedroom
(27 per cent.) and less frequent in families with three, four and five per bedroom,
(23 per cent., 18 per cent., and 20 per cent., respectively). The families of six per
bedroom form such a small group that here again they should not be considered.
Multiple cases become progressively more numerous as the number of
individuals per bedroom increases (14 per cent. in families of one per bedroom,
29 per cent. in two per bedroom, 41 per cent. in three, 51 to 52 per cent. in four,
and 45 per cent. in five). Fifty-eight per cent. of families with a maximum of one
per bedroom, 43 per cent. with two per bedroom, 35 per cent. with three, 31 per
cent. with four and 35 per cent. with five had no influenza at all.
But here again, the fact that crowded families are usually large families
interferes with drawing any conclusions. A family with four per bed room would
generally be larger than one with two per bed room.
Frost observed that, considering the ratio of incidence in total white
populations irrespective of housing as 100, and after adjusting all groups to a
uniform sex and age distribution, the ratio where there were more than 1.5
rooms per person was 77, from 1 to 1.5 rooms per person the ratio was 94, and
for individuals averaging less than one room per person it was 117. The attack
rate showed a consistent increase as the number of rooms per person
decreased.
Woolley observed, “Housing, if one includes in the term overcrowding, has
surely been an important factor in spreading the epidemic. Whether it has had
any appreciable effect upon the incidence of complications is a question. The
epidemic has certainly gone faster and was over sooner because of the crowding;
the hospital was filled sooner than it should have been as a result of the rapidity
of spread of the disease, and overcrowding of the hospital occurred when with a
less rapid spread it would not have occurred; but whether the number of
fatalities or the number of pneumonias was greater than they should have been
with less crowded conditions may be doubted.”
TABLE VII.
Relationship between crowding and number of cases in the family.
(Influenza appeared more frequently in crowded households and such families
more frequently had multiple cases.)
Families with maximum per bed room of one.
(58.23 per cent. of these had no influenza.)
Two
Invaded Invaded in Total
Invaded or
Cases Total in 1918– both families
in 1920. more
developing such 19. epidemics. invaded.
cases.
in family. families.
Per Per Per Per Per
No. No. No. No.
cent. cent. cent. cent. cent.
1 85 55 17.68 37 11.89 7 2.25 311 27.33
2 32 26 8.36 16 5.14 10 3.22 10.28
3 9 8 2.57 2 0.64 1 0.32 2.88 } 14.44
4 4 3 0.96 4 1.28 3 0.96 1.28
5 0 0
6 0
7 0
8 0
2 per bed room.
(43.35 per cent. of these had no influenza.)
1 254 169 18.27 112 12.11 27 2.92 925 27.46
2 135 112 12.11 64 6.92 41 4.43 14.59
3 79 65 7.03 38 4.11 24 2.59 8.54
4 40 35 3.78 16 1.73 11 1.18 4.32
} 29.17
5 11 9 0.97 8 0.81 6 0.64 1.18
6 3 3 0.32 0 0.0 0 0.0 0.32
7 2 2 0.22 1 0.11 1 0.11 0.22
8 0 0
3 per bed room.
(35.34 per cent. of these had no influenza.)
1 136 104 17.84 50 8.58 18 3.08 583 23.33
2 103 77 13.21 55 9.43 29 4.97 17.67
3 59 51 8.75 29 4.97 21 3.60 10.12
4 43 40 6.86 16 2.76 13 2.23 7.37
} 41.33
5 22 22 3.77 9 1.54 9 1.54 3.77
6 12 12 2.06 5 0.86 5 0.86 2.06
7 2 2 0.34 0 0 0.34
8 0
4 per bed room.
(30.79 per cent. of these had no influenza.)
1 31 24 13.64 10 5.68 3 1.70 176 17.61
2 22 19 10.80 13 7.39 10 5.68 12.50 } 51.60
3 37 32 18.18 25 14.20 20 11.36 20.92
4 14 11 6.25 6 3.41 3 1.70 9.09
5 9 9 5.12 4 2.27 4 2.27 5.12
6 4 3 1.70 2 1.19 1 0.59 2.27
7 3 3 1.70 0 0 1.70
8 0
5 per bed room.
(35 per cent. had none.)
1 8 6 15.00 4 10.00 2 5.00 40 20.00
2 6 5 12.50 4 10.00 3 7.25 15.00
3 3 2 5.00 2 5.00 1 2.50 7.50
4 2 1 2.50 2 5.00 1 2.50 5.00
}
5 4 2 5.00 3 7.50 1 2.50 10.00
45.00
6 2 2 5.00 2 5.00 2 5.00 5.00
7 0
8 1 0 0.0 1 2.50 0 0.0 2.50
6 per bed room.
(50 per cent. had none.)
1 2 1 10.00 1 10.00 0 0.0 10 20.00
2 1 1 10.00 1 10.00 1 10.00 10.00 }
3 2 1 10.00 1 10.00 0 0.0 20.00 30.00
4 0
5 0
6 0
7 0
8 0
The housing methods in the cantonments and even in the tent camps resulted
in a degree of congestion and close physical contact among individuals that was
attained in no civil communities with the possible exception of some institutions.
In cantonments the number of men in individual rooms ranged from 30 to 100
and even under the best circumstances there was very evident close crowding. An
individual in any of these large rooms contracting a contagious disease had
opportunities to spread it by contact and by droplet infection not only to one or
two others, as in the case of the average family, but to a large group of the men in
the same room. A vicious circle was thus formed which tended to propagate the
disease throughout any camp with utmost rapidity. Brewer has compared the
influenza incidence rate in the principal white organizations at Camp
Humphreys with the floor space allowed each man in the respective
organizations, and concludes that, “It is not proper or just to attribute the
differences shown, alone to the amount of floor space allowed each organization,
but it certainly points very strongly to the fact that the incidence of the disease
varied with the density of the population, although not with mathematical
regularity.” Brewer cites regiments which although housed alike showed definite
variation in the influenza incidence. This merely shows that other factors also
play a part. Thus, in one instance, the difference in the two regiments was in
length of service. Brewer also found that among the white troops the incidence of
pneumonia appears to vary with the density of the population.
V. C. Vaughan has reported on the relationship between incidence in tents and
in barracks at Camp Custer. From this one observation it would appear that the
incidence is little changed under the two conditions.
“During September and October, 1918, a study was made on the relationship, if
any, of influenza to methods of living. Of the command, 3,633 were in tents. The
morbidity per thousand in these was 129. There were in barracks 36,055. The
morbidity per thousand among those was 275. At first glance the lower morbidity
of those in tents is striking, but going further into the matter it was found that
the entire morbidity of the Quartermaster Corps was very low. Of the Depot
Brigade 2,881 were in tents, with a morbidity of 128 per thousand, while 3,824
were in barracks, with a morbidity of 134 per thousand.”
Howard and Love offer three reasons why during the last four months of 1918
the deaths from influenza and pneumonia in the Army in the United States ran at
a rate nearly three times as high as that among our troops in France: First, that
the troops in the United States were recent recruits and therefore more
susceptible to disease; second, that probably many of the troops in France who
had seen much longer service had had the disease in mild form in the early
spring; and, third, that the method of housing was entirely different in France.
There the men were spread over a wide territory and whenever in rest area they
were billeted in houses rather than crowded into barracks. Furthermore, they
were living much more in the open. It was found that in commands of the Service
of Supply, where troops were housed in barracks with a large number of men to a
single room, the epidemic ran much the same course with high mortality, as it
did in the cantonments in the United States. The percentage of infection and the
fatalities from influenza and pneumonia in France were much greater among
troops of the S. O. S. than among troops at the front.
Domestic cleanliness.—We have studied the relationship between influenza
incidence and the cleanliness of the household by the same method used in
studying overcrowding. In Table VIII we have classified according to cleanliness
and according to the number of cases developing in each family. We have had
four subdivisions, “very clean,” “clean,” “dirty,” and “very dirty.” There is greater
opportunity for erroneous results in this table than in the one preceding because
the standards of cleanliness are difficult to define. As a matter of fact we are
guided entirely by the inspector’s own impression of each household, as she
examined it during her visits. The following is an excerpt from the instructions
given each inspector on this subject:
“A few words on this subject may describe much. State of cleanliness of the
individual, slovenly condition, dust and dirt, foulness of air noticed on first
entering, condition of children, of kitchen sink, etc., should be noticed, and
good or bad features recorded. In the poorer districts not a few families will be
found in which the cleanliness, considering the surroundings, is quite
laudable. Of particular importance are amount of daylight, ventilation, care of
bathroom and toilet, garbage, whether windows are kept open at night.”
On the basis of these returns we have classified the families as indicated, but
each inspector was governed to a certain extent by the average cleanliness of her
district, and it is difficult to compare the cleanest tenement with any of the
districts of well-to-do individuals. We will therefore probably find it more
profitable and more nearly accurate to combine the groups and classify them
only as “clean” and “dirty.”
TABLE VIII.
Relationship between cleanliness and number of cases in family.
(Clean families were invaded less frequently and had solitary cases more often than
did dirty households.)
Very clean.
(47.62 per cent. had none.)
Cases in Total Per Per Per
’18. ’20. Both. Total. Per cent.
families. families. cent. cent. cent.
1 124 72 15.65 50 10.87 8 1.74 460 26.96
2 53 41 8.91 27 5.87 15 3.25 11.52
3 37 33 7.17 13 2.82 9 1.95 8.04
4 18 16 3.48 8 1.74 6 1.30 3.91 }
5 4 3 0.65 2 0.43 1 0.21 0.87 25.42
6 3 3 0.65 0 0.0 0 0.0 0.65
7 2 2 0.43 1 0.21 1 0.21 0.43
8 0 0 0 0
Clean.
(41.52 per cent. had none.)
Per Per Per
Cases. Families. ’18. ’20. Both. Total. Per cent.
cent. cent. cent.
1 301 212 18.45 120 10.44 31 2.70 1149 26.19
2 177 143 12.45 91 7.92 57 4.96 15.40
3 101 83 7.22 52 4.53 34 2.96 8.79
4 52 47 4.09 20 1.74 15 1.26 4.53 }
5 30 29 2.52 17 1.48 16 1.22 2.61 32.29
6 8 7 0.61 3 0.26 2 0.17 0.70
7 3 3 0.26 0 0.0 0 0.0 0.26
8 0 0 0 0
Dirty.
(36.89 per cent. had none.)
Cases in Total Per Per Per
’18. ’20. Both. Total. Per cent.
families. families. cent. cent. cent.
1 79 59 17.40 36 10.62 16 4.72 339 23.30
2 58 48 14.16 29 8.55 19 5.61 17.11
3 37 31 9.14 22 6.49 17 5.01 10.91
4 26 22 6.49 12 3.54 8 2.36 7.67
}
5 6 5 1.79 4 1.18 3 0.94 1.77
39.81
6 7 7 2.06 4 1.18 4 1.18 2.06
7 0 0 0 0
8 1 0 0.0 1 0.29 0 0.0 0.29
Very dirty.
(39.26 per cent. had none.)
1 22 16 14.95 8 7.47 2 1.85 107 20.56
2 11 8 7.47 6 5.10 3 2.80 10.28 }
3 14 12 11.21 10 9.35 7 6.54 13.08 40.18
4 7 5 4.67 4 3.73 2 1.85 6.54
5 6 6 5.10 1 0.93 0 0.0 5.61
6 3 3 2.80 2 1.85 2 1.85 2.80
7 2 2 1.85 0 0.0 0 0.0 1.87
8 0 0 0 0
But even without combining in this way, the table shows us that for both years
27 per cent. of the very clean families, 26 per cent. of the clean, 23 per cent. of
the dirty and 21 per cent. of the very dirty, had but one case, while 25 per cent. of
the very clean, 32 per cent. of the clean, 40 per cent. of the dirty, and 40 per cent.
of the very dirty, had multiple cases.
The cleaner the family the less is the likelihood of multiple cases.
It is rather difficult to find concrete examples of the influence of domestic
habits and environment in the 1918 pandemic. The remarkably high incidence
among the natives of India and among the American Indians might by some be
attributed to unfavorable environment. Lynch and Cumming obtained records
from a large number of institutions and from business concerns having their own
records, and discovered that the influenza incidence was higher in those
institutions where dish washing was done manually than in those in which
mechanical washing was performed. They appear to conclude that the difference
in the two methods of washing dishes was the cause for the greater incidence in
influenza, thus bearing out their theory of the propagation of influenza chiefly
through eating utensils. On the contrary it is possible that the presence of the
mechanical washer is an indication of advanced methods, greater care in the
kitchen, and better hygiene probably not only in the kitchen and dining room,
but throughout the institution.
Economic status.—Although in our survey information has been obtained
regarding the economic status of the various families we would not stress this
phase of our subject. Obviously the amount of money an individual has in his
bank will not directly influence the amount of influenza he will have in his home.
As nearly an accurate classification by wealth is by the separation into the
districts, Districts I and III being very poor, District II poor, Districts IV and V
moderate, and VI well-to-do. From Chart XXVI we see no definite relationship
between influenza incidence and economic status.
Dr. Niven has had similar experiences. He remarks that the disease does not
appear to have affected especially any class or section of the community. Rich
and poor suffered alike. Inquiry in some towns shows that the epidemic not
infrequently started in the well-to-do districts and only later involved the poorer
and less prosperous areas.
We cannot state with any degree of accuracy in what section of Boston the
1920 recurrence first began. The sections studied are for relatively small portions
of the city, and it is possible or probable that the original increase was in some
area outside of our districts. In the districts studied the earliest increase in
reported cases was from the section of the city known as Dorchester (Districts IV
and V), where there was some increase in December, 1919. The latest definite
increase was in the Irish district of South Boston. Geographically these two areas
are quite near. The relative insusceptibility of the Irish population is probably a
much more important factor in the difference.
Frost found after classifying the white population canvassed in Little Rock and
San Antonio according to economic status, and adjusting the incidence rate in
each group to a uniform sex and age distribution, that the ratios of incidence in
each economic group to incidence in total white population did show an increase
with increasing poverty. “Notwithstanding that the classification according to
economic status is a very loose one, based solely on the judgment of inspectors
with widely different standards, a considerably higher incidence is shown in the
lower as compared to the higher economic group.”
Parsons, in 1891, discussed the influence of poverty, but believed that it is the
concomitants of poverty which were the cause of the higher incidence among the
poor.
“Sanitary conditions do not seem to have had any influence in determining the
occurrence of influenza, and what share they have had in determining its extent
or fatality cannot yet be decided. On the occasion of the last great epidemic, Dr.
Peacock concluded, ‘The more common predisponents to disease, e.g., defective
drainage, want of cleanliness, overcrowding, impure air, deficient clothing,
innutritious or too scanty food, powerfully conduce to the prevalence and fatality
of influenza.’ And Dr. Farr showed that in the last six weeks of 1847, while in the
least unhealthy districts of London the annual rate of mortality was raised from a
mean rate of twenty per 1,000 to thirty-eight, in the unhealthiest districts it was
raised from a mean rate of twenty-seven to sixty-one.
“That overcrowding and impure air must have a powerful influence in aiding
the development of the epidemic follows from what we have seen of its greater
prevalence among persons associated together in a confined space; and though
rich and poor have alike been sufferers from the epidemic, and even royal
personages have been fatally attacked by it, it cannot be doubted that poverty
must have in many cases conduced to a fatal issue in persons, who, if placed
under more favorable circumstances, might have recovered, seeing that it often
involves not only inferior conditions of lodgment, but also want of appropriate
food, of sufficient warmth and clothing, and of ability to take the needed rest.”
Distribution of the disease through the household.—During the autumn and
winter epidemic of 1918 there was considerable discussion, and particularly were
there popular newspaper reports of entire families being taken ill with influenza,
sometimes all on the same day. This was less true of 1920. But few of us are
personally acquainted with such instances and at best they must have been
relatively rare.
Among 1,236 families with influenza in either epidemic we found only 94 or
7.6 per cent. in which the entire family contracted the disease. No family
consisting of over seven individuals was reported as having all the members of
the family sick in either epidemic. Over two-thirds of the families with even
numbers of individuals (464 out of 605) suffered the illness of less than half of
the household. One quarter of all families of more than one (539 out of 2,107)
had but one case per family. Over a third of all families of over two individuals
(745 out of 2,006) had two or less cases per household. As a rule there were at
least one and usually several individuals in each household who did not
contract influenza.
That as a rule the disease did not appear explosively in a family; but that cases
developed successively, is indicated by the fact that out of 577 families
contracting influenza in the epidemic of 1920 the cases were all of simultaneous
development in but fifteen. In thirteen of these, two individuals fell ill on the
same day and no subsequent cases developed. In the other two families three
individuals came down on the first day and no other cases developed. In addition
there were, out of the 577 families, fourteen in which there were two or more
cases developing on the first day of the invasion, but which were followed on
subsequent days by later cases in the same family. Again, there were eleven
families in which two or more cases occurred simultaneously at an interval of
one or more days after the development of a single prior case.
We may say that as a rule in the 1920 epidemic, cases of influenza developed
in families successively and not simultaneously. In only 29, or 5 per cent. of the
families contracting the disease in 1920, did more than one case develop on the
first day of the appearance of the disease in the family.
A certain difficulty in determining the date of onset is that we must rely upon
the patient’s statement. One individual may have been sick for hours or days
before a second member coming down with the disease called forth recognition
of the fact that they both had it.
Unfortunately we are not able to give similar statistics for the 1918–19
epidemic. Our investigation occurred so long after the epidemic that specific
dates of onset of the disease would have been entirely unreliable. The nearest
date we have attempted to obtain was the month of the attack.
Dr. A. L. Mason states that 63 cases came under his observation in the
epidemic of 1889 as occurring in groups in families. In but six instances were two
persons attacked on the same day. The average interval between cases in the
same household was four days. Sometimes a week or more elapsed. Whole
families were never stricken at once.
Parsons in 1891 concluded from the results of questionaires sent to physicians
that in the first spread, 1889–90, there was an interval between cases in
individual households just as we have described. Among the replies to his
questionaires nine described intervals of one day and under, six described
intervals of two days, three of three days, three of four days, and four replies
described intervals of more than four days.
Leichtenstern observed likewise: “In large families the contagious character of
influenza is evidenced by the fact that the other members of the family become
sick one after the other following the first case. This rule of succession is most
easily seen in the early or late period of an epidemic and is less noticeable at the
height, where the opportunity for all the members of the family to acquire the
influenza outside the home is enormous. This latter fact explains why, when all
sicken at once, the disease appears to be miasmatic in origin. There are many
examples where other members of a family living with a sick individual remained
unaffected. Parsons reports such cases, and this was so frequently the case that
some British physicians state that it is the rule that there is but one case in a
family or that the cases are widely separated in time. This was only partly true
during the period of the pandemic and was very frequent in the epidemic
following it. In this respect influenza acts like the common contagious diseases,
diphtheria, scarlet fever, measles, etc., while the difference lies in the short
incubation period and the very high contagiousness of the disease.”
That West, in England, had observed the same phenomenon is indicated by
the following quotation: “How is it, for instance, that one member of a household
may be picked out and the others escape, though they are susceptible, as is
shown by their acquiring the disease shortly after in some other way?”
Again Leichtenstern wrote: “It is noteworthy that influenza on ships usually
did not occur explosively, but spread gradually, and on ships usually lasted
several weeks, as on the Bellerophon, from the 27th of March to the 30th of
April; on the Canada from the 11th of April to the 24th of May; on the Comus
from the 10th of April to the 3d of May.
“The German Marine Report states, ‘Everywhere on the ships the disease
began not suddenly but gradually.’ The frigate Schwalbe first had a large number
of cases only on the 6th day after the beginning of the epidemic. There are,
however, some exceptions, where the disease has begun suddenly with the
greatest violence on ships as on land. Such was true of the frigate Stag which on
the 3d of April, 1833, neared the influenza infected coast of Devonshire, and as it
came under the land wind the epidemic suddenly broke out with great violence.
Within two hours forty men took sick. Within six hours the number had
increased to sixty. Within twenty-four hours 160 men were sick. As Parkes has
remarked the evidence is insufficient that there had been no communication
with the coast. There have been other examples of sudden outbreaks on ships, as
on a Dutch frigate in the harbor of Mangkassar, where 144 men out of 340 took
sick in a few days (1856); on the Canopus (1837) in the harbor of Plymouth,
where on the 15th of February three-fourths of the men took sick with influenza.”
Garvie, in reporting his personal experiences with influenza in 1918 in an
industrial area in England, experiences not based on statistical study, concludes
that there are two types of cases, the sporadic case which occurs mainly among
the wage-earning members of the family and has little tendency to affect other
members of the household, and second, the type of case where a large number of
individuals in the household are affected. He called this the “household wave.” If
we interpret him aright he really means that there are either single or multiple
cases, and that the single cases are more apt to occur in the wage-earner, the
individual who is more exposed on the outside of the household. He also believes
that the household wave is more severe in character than the so-called sporadic
case, and is accompanied by a greater number of complications.
Armstrong, in his survey in Framingham, examined influenza convalescents.
He found that of these 10 per cent. were in families in which no other cases had
developed, and 87 per cent. were in families where one or more additional cases
had occurred. In three per cent. information was lacking.
It is important in studying the literature on this subject to distinguish between
definitely established fact and less definite description. Thus one is still left in
some doubt when one reads in a London letter in the Journal of the American
Medical Association for 1915 concerning the epidemic in London at that time
that, “whenever it has seized an individual it has usually run through the entire
household. Whole offices have succumbed.”
The first case in the family.—Chart XXVII shows clearly that in both
epidemics in our experience the wage-earner was much more frequently the first
case in a family than was any other occupation. The individuals whose
occupations kept them at home were second. Infants, as was to be expected, were
recorded as being “first case” in the smallest number of instances.
In 1889 the distribution was practically the same. Parsons found that out of
125 households the first case was a bread-winner in 96; a housekeeper in nine; a
child at school in thirteen; a child not at school in two families. In the last five
families the first case was in adults, occupation not given. This order is identical
with our own. Neither our own observations nor those of Parsons consider the
relative proportions of wage earners in the population as a whole. The results are
nevertheless suggestive.
H. F. Vaughan reached comparable results for the 1920 epidemic in Detroit.
During the first few weeks the age groups from 20 to 29 showed a relatively
much more frequent influenza incidence than did children up to ten years. In
later weeks of the epidemic there was a relative increase in the incidence among
children and decrease among young adults. He concluded that the disease first
attacks the young adult and from this group it extends into the home.
In the Local Government Board Report for 1891, H. H. Murphy distinguishes
three groups or ways in which the disease may be brought into the family. The
examples will be found to be characteristic for any epidemic and for any country:
Group A.—Cases of single exposure.
“Household 1.—Mr. Q. goes to London daily. Was ill with influenza on
December 25th. No other case in this house till January 15th.
“Household 2.—Mrs. A. called on Mr. Q. on December 31st, and had a few
minutes’ conversation with him. She was taken ill on January 3d. There was a
Christmas family gathering at this house, and this is how the other members
were affected: Mr. B., January 6th; Miss C., Mrs. D., and Master D., January 8th;
Mr. J., January 10th; Mr. H., January 11th.
CHART XXVII.