Comprehensive sex education is effective against the spread of HIV

Comprehensive sex education is an effective means of reducing the risk among adolescents and young adults of contracting HIV, the virus that causes AIDS. That is the conclusion of a review of over 15 years of prevention research by the world’s largest professional organization of psychologists, the American Psychological Association (APA).

Surveys show that by the age of 15 about one in five adolescents has had sex. Most of those who remain sexually active do not consistently use condoms. More than half of new HIV infections occur among those under the age of 25. Unprotected sex is, by far, the major cause of infections within this age group. Experts believe that youth typically do not consider themselves in danger of infection, and lack authoritative information concerning risk factors for contracting HIV.

Unfortunately, sex education in the schools is a contentious issue in some quarters. Although the majority of parents support comprehensive sex education programs for their children, some individuals express concern that sex education might have the unintended result of encouraging sexual experimentation among young people who might not otherwise become sexually active. Some, who favor sex education, advocate that only abstinence be promoted to teens as an HIV prevention measure. It is sometimes suggested that condoms are not effective in protecting against the virus. Research, however, has demonstrated that such concerns and suggestions are unjustified.

Contrary to the belief of some, comprehensive sex education programs that provide information concerning the appropriate use of condoms do not promote sexual activity among young people. Comprehensive sex education programs, and programs that promote abstinence only, are both effective in delaying the onset of sexual intercourse, according to psychologist Maureen Lyon, Chair of the APA committee charged with investigating the matter. Nevertheless, there remains a significant disadvantage in the abstinence only approach.

Programs that exclusively promote virginity pledges, abstinence only, and abstinence until marriage are actually more risky than more comprehensive sex education programs. That is because when participants in abstinence only programs do become sexually active, they are less likely to use condoms, thus increasing their risk of pregnancy and sexually transmitted diseases (STDs). Comprehensive sex education, however, provides the best protection from teen pregnancy and STDs like HIV.

Comprehensive sex education programs are those that provide authoritative information about human sexuality and reproduction, encourage abstinence, promote condom use for sexually active persons, and encourage fewer sexual partners. Such programs also emphasize the importance of prompt diagnosis and treatment of STDs, and teach young people effective skills for communicating about sexual matters.

The APA committee report recommends that educational programs that are intended to help prevent the transmission of HIV and other STDs among young people be based upon sound empirical research. Further, new programs, such as abstinence-only and abstinence until marriage programs should be tested against programs that have a demonstrated track record of effectiveness before being approved for widespread use.

Other APA recommendations focus upon the need to educate policy makers about research concerning the failure of abstinence-only and abstinence until marriage programs in preventing the spread of HIV among young people.

The full APA report from the Ad Hoc Committee on Psychology and AIDS is available for download at http://www.apa.org/releases/sexed_resolution.pdf.

What is the status of sex education in primary schools in Thailand? I would enjoy hearing the views and experiences of parents, students, and educators in the region. Please send me your stories by email, or post to my web log.

Polarizing decision by cardinals predictable

News commentators are atwitter about Pope Benedict XVI, the new leader of the Roman Catholic Church. After just two days of meetings in the historic Sistine Chapel, the conclave of 115 cardinals named Cardinal Josef Ratzinger of Germany to be the successor to John Paul II who died on April 2 at the age of 84.

Vatican experts in tune with the views of the new Pope have variously characterized him as “unstintingly conservative,” “archconservative,” “neoconservative,” “authoritarian,” “a tough disciplinarian,” “a hard-line guardian of conservative doctrine,” even “divisive,” “a polarizing person,” “a doctrinal watchdog,” and “God's Rottweiler.” In his former position as head of the Congregation for the Doctrine of the Faith, Ratzinger had staunchly defended church doctrine against attempts by dissidents to promote liberal reforms from within.

The selection of a Pope in the conservative tradition of John Paul II was undoubtedly gratifying to the more traditionalist members of the Roman Catholic Church. It was, however, a crushing blow to many moderates among the faithful who had been hoping and praying for a more progressive papacy.

It wasn’t long after Ratzinger was named before observers and commentators were advancing various theories to explain why the cardinals had selected a man with such extreme and rigidly conservative views, over his more moderate or progressive rivals. The decision to select a theological conservative was, however, highly predictable, in view of a principle from the archives of social psychology.

Well over 300 psychological studies have produced compelling evidence of an interesting group phenomenon known as the group polarization effect. According to this research, if individuals are initially inclined toward a particular viewpoint or ideology, decisions made by them as a group are likely to be more extreme than decisions they would have each made individually. If individuals are initially inclined to take risks, for example, a decision by a group comprising those individuals is likely to be riskier than their individual decisions might suggest. If cautious individuals make a collective decision, the decision of the group is likely to be even more cautious than their mean individual decisions. The group process, then, tends to enhance members’ preexisting tendencies.

Obviously, groups usually consist of people whose views are somewhat similar. That is because people are attracted to groups that reflect attitudes and values similar to their own. A person holding libertarian views, for example, would seem more likely to join a group that values and promotes individual freedom than one that promotes authoritarianism. Likewise, views of the members of the conclave of cardinals would be expected to reflect the conservatism and orthodoxy characteristic of the Roman Catholic hierarchy. But why would group decisions be more polarized than individual decisions of the group members? Three explanations have emerged.

According to the persuasive arguments explanation, during group discussion a greater number of arguments favoring the predominant point of view are presented, and with a greater degree of persuasiveness, reflecting the dominant bias of group members. These arguments, in turn, influence individuals’ positions in the direction of the extreme.

Researchers have found that group polarization occurs even when specific arguments are not presented. According to the social comparison explanation, as members of the group are exposed to the positions of other group members, they discover more support for their own opinion than they had initially expected. This creates a new perspective of the group norm, implicitly providing members permission to move to a more radical extreme. Thus, in the event that the cardinals did nothing more than vote, making the results known to the group would have a further polarizing effect.

A third explanation known as social categorization is based upon the tendency of people to identify themselves as members of social groups. Members of a group are generally inclined to want to distinguish themselves from other people and groups. In doing so, they may emphasize the distinguishing characteristics of the group, often moving to a more extreme position in order to distance themselves from others. Each of these three arguments receives some support in the literature.

The cardinals, of course, would prefer to think that the Holy Spirit guided their decision. If so, the influence of the Holy Spirit appears strikingly similar to social processes at work in secular decision-making groups. Further, if group polarization holds true, it seems highly unlikely that a theologically liberal Pope could ever emerge from a conclave of conservative cardinals.

A celebration of unity and diversity

When we look at individuals we encounter in a international resort community such as Pattaya, we can’t help but be struck by the diversity of appearance, language and culture represented in the human family. A few people we encounter, perhaps those similar to us in appearance or ethnicity, seem rather familiar to us. Others seem very, very… strange!

Issues of human similarities and differences were explored last week in the Round Square Regional Conference attended by 136 student delegates from 17 schools from five countries, including Thailand, Canada, Singapore, Australia, and New Zealand. It was my honor to be invited by imaginative conference organizer Paul Crouch, to take part in the event. It was hosted by the Regent’s School, Pattaya on location at their new Ideals Learning Center, tucked away in a remote corner of beautiful Koh Chang.

The topic of my presentation with Regents students Liisa Toompuu and Natasha Fortune, was stereotypes and impression formation. We presented some interesting findings from social psychologists concerning how humans form stereotypes. In summary, people with whom we share something in common, such as a country of origin, an ethnic identity, even support for a team of athletes, comprise what social scientists label “ingroups.” Those excluded from our ingroups form our “outgroups.”

It is found that we generally exhibit a bias in favor of those in our ingroups, compared to those in our outgroups. We also tend to perceive diversity among members of our ingroups, while viewing members of outgroups as largely homogeneous. Finally, our initial impressions of people often remain, despite contradictory evidence which we might later encounter.

The conference theme of “same same but different,” is a “tinglish” phrase familiar to those acquainted with social life in English speaking parts of Thailand. Proposed by Regent’s student Girish Balakrishnan, the theme served to introduce delegates to the provocative concept of human homogeneity and diversity, with a dash of our colorful local slang.

The theme touched virtually every aspect of the six day event, from “Sawadee,” the exciting opening ceremony at the Regent’s Globe Theatre, through activities and presentations, to the climactic finale, “Choc dee,” the closing ceremony, consisting of drama performances prepared by each of the eight “gluums” or small groups. Throughout the event student delegates and their teachers were exposed to various elements of traditional Thai culture, most for the first time.

A particularly memorable part of the event for this writer was our participation in the Songkran festival with the island locals. The students, dressed in colorful floral Songkran shirts, were transported by boat to a remote fishing village where the local inhabitants introduced them to the joys of water-throwing. At first seemingly bewildered by playful children splashing water on their overheated bodies, the students soon joined in the fun, launching strategic attacks upon their miniature assailants.

Later, the group braved refreshing liquid sniper attacks on the road to the village temple, where members of the community warmly greeted us with ice cold glasses of coconut milk. We were then seated to hear a welcoming address by the village authority. A live musical performance and traditional Thai dance routine followed, especially prepared for us by the village elders. We obtained live fish from our hosts for release into the nearby stream as a traditional act of merit making.

The monks were on hand for chanting, and to receive the traditional sprinkling of water and good wishes from guests and locals. The elders were next to receive a sprinkling, followed by the teacher participants. A few villagers tenderly applied damp powder to our faces. It wasn’t long before the students and teachers joined the locals with their individual interpretations of traditional Thai dancing.

Songkran festival, particularly when observed in the gentle traditional way, is an elegant and at times emotional celebration of Thai culture and traditions. I have previously taken part in similar ceremonies, both here and in Thai communities in the U.S. Nevertheless, observing the joy of so many young people from foreign cultures experiencing Songkran for the first time, and the pride of the Thais in sharing their culture with us was an experience that is hard to beat.

While Songkran is a uniquely Thai tradition, it seems to have universal human appeal, reminding us once again that, although we are each unique, we are undeniably “same same.”

Aspects of religious philosophies that might promote mental health

With the recent death of Pope John Paul II, the world’s attention is drawn to events within the Roman Catholic Church, the selection of a papal successor, and various issues related to religion and spirituality. Taking a psychological perspective of these events, we might ask, in what ways religious teachings could serve to enhance the mental health of the believer.

Undoubtedly, there are certain aspects of religious practices that reflect poorly upon the practitioner’s mental health. Practices, such as stoning sinners to death, the concept of religious wars, suicides and homicides motivated by religious zeal, for example, seem quite barbaric and incompatible with modern notions of psychological health. For now, however, I shall focus on the psychologically healthy aspects of religious philosophies.

Notable religious leaders such as Pope John Paul II, Mahatma Gandhi, Archbishop Desmond Tutu, Dr. Martin Luther King, Jr., and Mother Theresa, seem to personify psychologically healthy values and behaviors. The lives of these remarkable people suggest that their religious philosophies may have served to complement and enhance their respective mental health status. What religious beliefs might have such an effect?

Religionists often express a belief that humans are inclined by nature to commit sin, acts that are contrary to the will of God. Nevertheless, God is usually portrayed as a loving and merciful being who accepts us in spite of our sinful acts.

Similarly, psychological theorists such as Albert Ellis and Aaron Beck identified certain disturbed emotions, irrational beliefs, and deviant behaviors as being unhealthy and self-defeating. The humanistic psychotherapist Carl Rogers recommended that therapists assume an attitude of unconditional positive regard toward therapy patients, believing this to facilitate their personal growth. This notion was taken a step further by Ellis, who encourages his clients to adopt an attitude of “unconditional self acceptance,” (USA).

Religious philosophies teach that God allows people free will to choose to do good or evil. According to such teachings we can, with God’s help, avoid activities that are harmful to ourselves and others. Clinical psychological theory recognizes the human propensity to pursue short-term need gratification that can be harmful to our long-range self-interests. We can, however, learn new habits of thought, emotion, and behavior that will foster greater tolerance of the discomfort that results from deferring short-term pleasures in the interest of gratifying our long-range goals and desires.

Religious philosophies also encourage us to show love and compassion for those who do wrong. We are taught to pray for them, and help them turn away from wrongdoing. We are not to judge others, because we too are sinners.

Psychological theory, particularly Rational Emotive Behavior Therapy (REBT) points out the uselessness of damning others for their misbehavior. While we might not like or approve of their behavior, demanding that they behave otherwise serves only to create emotional disturbance for ourselves. It is considered healthier to accept the fact that people can and do behave quite despicably at times. Ellis and other cognitive theorists teach “unconditional other acceptance,” (UOA). Accordingly, although we consider their acts as wrong, we can realistically learn to view them as imperfect humans who are capable of both good and evil deeds.

Eastern mystical philosophies such as Buddhism promote an attitude of acceptance of suffering and difficulties which are an inevitable part of life. Other religionists accept adversities as a mysterious part of God’s plan. God is trustworthy, and out of tribulations we can receive blessings. A similar idea is reflected in Ellis’s teachings concerning unconditional life acceptance (ULA). Adversity is an unavoidable part of the lives of all of us. When we view these events as awful and catastrophic, we make them worse and harder to manage. It is considered more constructive work to increase our tolerance of frustrating life events.

It seems likely that these, and many other religious teachings are helpful and compatible with healthy and effective mental and emotional health, although religious belief is not a necessary component of mental health.

The two faces of denial

During the course of our lives, a few emotionally charged events seem to remain as fresh as if they had occurred only yesterday.

For me, such an event took place on April 11, 1962. I was a nerdy eleven year-old growing up in New Orleans. My best friend Teddy had invited me to join the Boy Scouts. After school I phoned home from Teddy’s house to ask my mother’s permission to join the troop. She deferred answering, urgently instructing me to come directly home. I did.

When I arrived at home my mother was seated on her bed. Her eyes were red and puffy. In her hand she clutched a wad of crumpled tissues. My father, she told me, had passed away that morning. I don’t remember much more of what she told me, but when we were done, I retired alone to my bedroom. From there I could hear my mother sobbing uncontrollably in the next room. I would hear her crying for many years after that. I eventually cried too, but not for some time.

At first, I didn’t really believe my father had died, or if he had died, I thought it was just a matter of time before he would be back with us. At his funeral I can remember the thought occurring to me that I must be in some terrible nightmare. I kept telling myself it would soon be over and things would return to normal.

When I was a young boy, my father was a significant part of my world. To the local community he was a celebrity, a widely known and well loved radio personality. To me he was a warm, and loving father, a family man, larger than life. I could not imagine what my life would be like without him. I can even remember developing elaborate plans for things that I might do or say that would magically put an end to the horrible nightmare and bring my father back to me. I missed him terribly. I still do.

As time moved on, that kind of thinking occurred to me less and less. The void that was created by my father’s death became filled, to some degree by other people and events of the 1960’s. My father’s unexpected death at the age of 39 was a tremendous blow for me, my mother and my four siblings, but we survived. In time, I learned to accept that my father would not return.

This capacity we humans have to deny that an unpleasant reality exists was formally recognized by the psychoanalytic theorist Sigmund Freud. “Denial,” he believed, is one of a number of “defense mechanisms” we use to prevent or reduce our experience of anxiety. Denial can be quite useful in helping us function and cope when faced with events that might otherwise be disabling. In this way, denial is viewed as a valuable adaptive resource we can use, at least for a time, to help deal with adversity.

There is, however, another face of denial. It can become a serious liability if it persists long after the appearance of the adversity, or interferes with vital functions. This was brought home to me when I worked in a rehabilitation facility that treated individuals who had suffered spinal cord injury, which results in muscle paralysis and loss of body sensations. My colleagues and I learned to have a healthy respect for the role of denial in helping those with new injuries cope with the medical verdict that they would never walk again. There was, however, certain knowledge and skills these patients needed to develop during their stay in the facility. These skills would enable them to avoid debilitating and life-threatening medical complications, such as bladder infections and pressure sores. When denial resulted in a patient’s refusal to develop these skills, we had to intervene. We learned to do so in such a way as to encourage learning while leaving the patient’s hope for a miraculous recovery intact, a sensitive balancing act.

On the surface, the denial of an unpleasant reality may seem a bit crazy. It can keep an alcoholic, for example, from admitting the severity of his addiction, a domestic abuser from seeking the necessary help to change his abusive behavior, the family of a patient in a persistent vegetative state opposing her right to die.

To be sure, modern psychology offers more elegant methods of handling adversity and loss, however, such methods might not be readily available when people need them most. In certain circumstances, such as that of an eleven year old grieving the sudden loss of his father, denial could be considered a benign, even healthy form of craziness.