Bernard

Thinking Geographically in Regards to Power Dynamics of the Social Environment: Its

Effect on Health (Revised)
Catherine Bernard
Dr. Herod
GEOG 4921
1 May 2016

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Abstract
Behavior, as it relates to health outcomes, is best predicted through socio-historical interactions,
weighted by scale, which provide context to current interactions and seemingly intangible power
dynamics that make up the social environment. Through a stance that is dialectical and nonjudgmental, making use of critical reflection, successful and functional solutions that address the
maladaptive appropriation of stimuli by the individual may be created. Health is correlative with
the degrees of power of individuals. The nature of these power dynamics is that they are
internalized and constantly re-established through habitual behaviors, reaffirming geographically
contingent social constructions. Behavior is geographically contingent, meaning people at
specific spaces and times have certain avenues and resources available to them for behavior to be
enacted based upon a myriad of environmental, socio-historical, and biological factors. This lens
provides a more holistic approach to the understanding of behavior, particularly maladaptive
behavior that can result in physical health problems. The purpose of this paper is to argue that the
interpretive value geographers provide with regard to behavior and health is both warranted and
necessary in health studies and policies.

Keywords: status syndrome, I-D compensation theory, cognition and

health, time-space geography, socio-historical interactions

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Too often, geography is limited to mapping the locations of mental health facilities or the
prevalence of mental illness rather than offering interpretations that are of quality: Geographers,
with their broadness of knowledge about the world in which we live, as well as their expertise in
thinking geographically about research problems, have much to offer to the mental health and
policy arenas (Jones, 2001, p. 233). Geography contextualizes psychology by providing a sociohistorical approach to interpreting culture (i.e., group behavior) rather than looking to establish
universal rules. The underlying thought process of this interpretation is that there is no ranking of
cultures and there is no need for universal social rules beyond biology. When understanding
individual behavior in psychology and public health, there are maladaptive coping mechanisms
that compromise health that are often seen as either lacking an explanation in medical science or
sound reason. The failing machine of modernist thinking, reductionist thinking, and policy
based in concepts that the affected lack agency beg for a change in perspective. Behavior is
geographically contingent, meaning people at specific spaces and times have certain avenues and
resources available to them for behavior to be enacted based on a myriad of environmental,
socio-historical, and biological factors. Postmodern geography provides a great approach from
which to understand and contextualize the action and possible actions of an individual or group:
Postmodernism corrects the bias towards historicism by putting space in the center of
explanations; spatial dialectics alongside the historical dialectic (Saitluanga, 2013, p. 2).
Pragmatically, a contextualized dialectical view creates a non-judgmental understanding of
behavior, providing a more objective stance in developing successful and functional solutions
that address the appropriation of the stimuli by the individual, resulting in the maladaptive
behavior that burdens the health care system.

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The following sections are an overview of how these complex social mechanisms for
behavior can be better understood when creating health policies regarding peoples behavior.
Within Behavior and Powered Social Gradients, a basic overview of these topics will be
discussed in enough detail to inform the reader of what they will need to understand in the
succeeding paragraphs. In Time-Space Geography and Behavior, the reader will be introduced
to I-D compensation theory and a great deal of the geography as it relates to the discussion of
behavior introduced in the first section. Subject Position, Language, and Vygotsky explores
identity, power and language, and Social Development Theory as it relates to the discussion of
interaction described in earlier paragraphs. Finally, Mindfulness, Dialectical/Critical View, and
Behavior synthesizes the previous sections while showing how geographers can contribute.
Behavior and Powered Social Gradients:
Behavior is a result of a process of perception that then translates into action. As defined
by the University of California San Francisco, a behavior is anything that can be reinforced or
rewarded. A reinforcer is anything that increases the likelihood that the behavior will be
performed again (UC San Francisco, 2015). However, this reward or punishment process is not
binary. Even before the behavior is enacted, it goes through a cognitive process; thus, it is more
complex than the simple explanation of behaviorism suggests. This cognitive process includes
perception. Cognition and perception, as seen through the success of Cognitive Behavioral
Therapy (Appendix C), are learned, more so than innate. They are learned through developing in
specific powered social constructions (agreed upon habits) of the persons social environment
that are, more often than not, internalized and seen as the way things are (Appendix A). This
perception/cognition acts as the framework in which all geographically contingent opportunities

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for behavior will be understood and appropriated, and will alter what an individual perceives as
available opportunities in an already limited feasibility of whatever the environment provides.
Understanding reinforcers and rewards is vital to a comprehensive understanding of the
opportunities an environment provides for repeatable behaviors. Rewards do not have to be
positive in the way people traditionally think of the term. All animals, including humans, can be
rewarded from even just variety in their stimuli, even if the variety causes physical pain or acts
as an escape. Animals have even been known to pick certain pains and punishments over others
(Siegler et al., 2003). There are biological predispositions that greatly affect behavioral choices
that humans, as social animals, are geared towards over mere self-interest that many mistakenly
attribute to behaviorism. Humans have an innate need to belong to a group. This is the primary
reason peoples perceived status, coined as subjective social status (SSS) by Michael Marmot,
has such a strong contingency on health.i This is beyond what would be deemed issues of
environmental justice. In terms of cognitive processes, as often noted by many forms of
psychoanalytic therapies, many do not even realize their own cognitive motives. People can
develop cognitive distortions, distortions of thoughts on reality that have become deeply
ingrained habits/processes of thought. This habitual thinking is necessary in creating mental
shortcuts for learned behavior in order to navigate the increasingly complex lives people lead.
However, when what is learned is deemed as incorrect by ones immediate social environment, it
can act as a source of suffering (Cialdini, 2012). This is by no means a thorough explanation of
reinforcers and rewards. Hopefully, it encourages the open minded thinking necessary for
understanding the variety of ways that are assumed to be not logical that the body can be
rewarded.

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A final note on the topic of behavior in terms of behaviorism from Schneiders The
Science of Consequences: How They Affect Genes, Change the Brain, and Impact Our World is
that reality is a collateral consequence of actions. The consequences reshape future behavior.
People learn the rules of social performance by playing the game, and those systems reward
certain behaviors until they are fixed social performances, also known as framework or habit
(Nightingale & Cromby, 1999). The culture, the consequences, the reality, and the language
are bound in that moment in time at a specific place; are very dynamic; and ultimately are an
instantaneous, desynchronized moment of consequence that creates yet another. Understanding
the way behavior is rewarded or reinforced is ultimately studied in an effort to not only
understand and predict behavior but also to change or influence behavior.

Power is the ability to influence the behavior of others. This can be accomplished by: 1)
altering their access to environmental resources, resulting in alternate actions/behaviors, 2) using
environmental resources to incentivize certain desired behaviors or thwart certain undesired
behaviors, and 3) controlling/altering others perception in a purposeful way to create the desired
behavior. When this power has become habitual in nature rather than an active creation of
knowledge, it tends to create the subjective experience of being beyond understanding with a
sense of permanence. When the power belongs to groups and organizations, it becomes known as
institutionalized power. It can be as basic as accepted powered language. However, power exists
as a dynamic of power. It is not merely hierarchal or controlled by one individual. Individuals
have a degree of power through their own behavior as highlighted by Foucault. Power is found at
all levels of social strata, where the surveillance, control, and discipline focused on the body

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producing the behavior is constantly forming and reforming the acceptable social norms of
behavior and presentation in a society.
These social norms are spatially and temporally specific. Each stratum has varying
degrees of power to shape these expected behaviors within their spatial and temporal bounds
(Butler & Parr, 1999). Similarly, group orders, hierarchies, gender roles, division of labor, etc.,
are partaken of in specific modes of spatial and temporal organization. The way these factors are
organized and the ideology behind the organization will notably alter the subjective experience
of spatial and temporal organization, as will be discussed in a later paragraph (Marmot, 2004).
As credited to Ruth Butler in her work on doing gender, the social construction, in this case of
gender, is not just a label but a reinforced, acceptable behavior that is constantly reestablished as
people perform the behavior. Social norms and presentation fall under similar lines. The
behavioral doing of these power dynamics allows these dynamics to continue, often in the form
of habit that can seem and feel almost entirely intangible: [Behavioral habit] is seen to render
invisible power relations that structure society while being complicit in reproducing these power
relationsunderlying and invisible dynamics within fields that are credited with agency,
shaping the opportunities and actions of the incumbents of various positions, without those
incumbents being necessarily aware of that fact (Lea et al., 2015 p. 51). Power dynamics
sustained through habitual behavior demonstrate its internalization, which is why contributions
from behavioral or cultural geographers can be so paramount in the field of healthcare.
People internalize the power dynamics of their social environment, translating these
dynamics into a large number of health issues beyond what the physical environment can
produce. The internalized powered structures sustained through habitual behavior have a
physical effect on brain chemistry and, ultimately, the overall status of body chemistry. Brain

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chemistry can be altered not only by behavior but also by the cognitive understanding of the
underlying meaning of their relations and subjective experiences outside of the actions that are
studied. [C]urrent researchis revealing that mind and behavior (e.g. that which happens with
psychotherapy), equally influence brain chemistry (Walker, 2006). This concept of
perceived/subjective status often reflects the individuals degree of control (also known as
autonomy) and social connectedness. A severe juxtaposition of subjective social status (SSS) and
actual social status is an indicator of cognitive distortions. A persons SSS is the best predictor of
good health and longevity as seen in numerous studies such as the famous Whitehall studies. The
Whitehall II study highlights the fact that SSS follows a social gradient (Singh-Manoux et al.,
2003). This is known as Status Syndrome as defined by famed epidemiologist Michael Marmot.
Status Syndrome is more pervasive than is indicated by merely a single bell curve or
gradient of societys health. It mirrors the ecological framework in that SSS results from a
combination of multiple social gradients of the immediate and expansive social environment.
The strongest impact of the individuals subjective experience is derived from the immediate
social environment. As many geographers know of Toblers First Law of Geography:
Everything is related to everything else, but near things are more related than distant things.
SSS, if expanded to include questions of the immediate social environment and weighted
properly adjusting for proximal stimuli having the greatest impact and less so the more distal in
the ecological framework, in a sense, works as a more measurable version of a concept known as
intersectionality. Intersectionality refers to the interconnected nature of social categorizations
such as gender, class, race etc. as they apply to a given individual or group, creating overlapping
and interdependent systems of discrimination or disadvantage affecting the power of someone in
his/her time-space. SSS is a much sharper, though by no means perfect, measure with which to

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study this phenomenon. This internalization of these power dynamics within the social
environment both alters cognition and available resources, thus affecting available options for
behavior. The best predictor of overall health and resiliency is SSS (Marmot, 2004). But is there
a way to exempt ones self from the effects of Status Syndrome? Can anyone avoid the
internalization of the power dynamics by which they find themselves accosted?
As health is highly contingent on the social environment, and the operation of a social
environment may not be conducive to ones health, some might desire to remove themselves
from the social environment in their area. However, there is no opting out of the social
hierarchy to improve health. In fact, as mentioned in the earlier discussion regarding genetic
predisposition to stimuli, loneliness works against human biology and can kill. Multiple
demographics in multiple settings have been studied across the globe, indisputably proving that
people need people (Marmot, 2004; Gerst-Emerson & Jayawardhana, 2015). Human bodies,
from development to maturity, will be stunted or the structure will become inflamed without
such company and contact (Chen, 2015; Siegler et al., 2003). The greatest risk to man is
banishment, exile, isolation, loneliness, and these conditions constitute the greatest punishment
that can be inflicted on man (Weaver, 2001). In terms of social capital, the person will suffer the
consequences of not having the resources that come with having reasonable social capital.
However, in public health, loneliness is now being considered a public health issue. Those who
work in community building and policy are now working to treat it as such (Gerst-Emerson &
Jayawardhana, 2015). Loneliness alone affects the bodys anxiety response, causing it to engage
and stay engaged. Humans are social animals. The mental condition of loneliness, social capital
aside, has physical health ramifications. The discussion of mental health as it relates to public
policy and overall physical health cannot be ignored.

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Mental health issues have become a major source of strain on the healthcare system, with
some of the most burdensome health issues resulting from stress and anxiety. A stressful stimuli
that is seen as continuous can cause the endocrine system to engage and stay engaged in a way
that is detrimental to a persons health, resulting in health repercussions ranging from mood
disorders to heart attacks (Appendix D). However, the initial biological reaction is appropriate as
it is the accurate reaction to the perceived stimulus, but the health effects are not desirable and its
effect on mood, physical body structure, and thoughts are equally undesirable. As a result, it is
labeled as maladaptive (Marieb, 2001). This is particularly the case when others do not see the
perceived stimulus at an equal threat level. This response is determined as undesirable as a result
and efforts are made to remediate the behavior. This lack of agreement on threat level can be the
result of unintentional reward for anxious behavior, a miscommunication or misunderstanding of
the nature of the threat level from either party, or the result of a previously adaptive behavior that
has lost its relevance in a dynamic social environment. It is vital to remember that the concept of
threat is relative and what constitutes a threat can vary based on socio-economic status, gender,
etc. Protective factors against these threats are, once again, relative (Marmot, 2004). This is
where context becomes so crucial: risk factors are most influential when based on sociohistorical interaction. These interactions are built on socio-historical contexts that establish and
more accurately predict maladaptive behavior than any biological factor (Appendix B). The
following sections require a basic understanding of cognitive behaviorism, social gradients in
health, and power structures to fully grasp how yet another confounding factor, time and space,
affect the manifestation of behavior. A particularly burdensome maladaptive behavior for the
health care system that is currently receiving a lot of attention is anxiety.

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Time-Space Geography and Behavior
Organized behavior within a certain space of set boundaries where interaction occurs to
produce a certain lifestyle for certain groups of varying sizes is the foundation of agrarian
societies that are present and deemed most civilized today. However, it has only been this way
for an extremely short time in human history. Humans once lived in groups where their behavior
was rewarded more frequently than in the settled societies of today. Humans, like most animals,
still retain the adaptation that leads to functioning best in small temporal windows with
immediate feedback. This is outlined in I-D (Immediate-Delayed) Compensation Theory:
individuals function best when they receive frequent feedback from their environment that they
are progressing toward their goals, and develop coping mechanisms to compensate for
environments that do not satisfy this biological need (Martin, 1999). The delayed return of long
term risk-reward games exists as a part of settled societies and creates a level of insecurity one
purposefully binds themselves to for the potential of greater rewards:
To cope with this insecurity, people developed complex cultural mechanisms such as
contracts and agents to enforce them (Cohen, 1985) and justifying stories such as just
world beliefs (Martin,1999). In the context of I-D compensation theory, these coping
mechanisms reflect peoples attempts to create conditions compatible with their
immediate return biology. (Martin et al., 2014 p. 24).
Coping mechanisms are built on the cultures defined appropriate behaviors to deal with
this delay and the compounding risks associated with them.
This recent shift from nomadic to agrarian societies has led to an instability between
humans immediate return need biology and the delayed return reward of modern societies:
These arrangements may give people the reassurance they seek, but they do so at a cost. They

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heighten conformity and obedience and reduce autonomy as well as exploration (Martin et al.,
2014, p. 20). As mentioned previously in the discussion of Marmots Status Syndrome,
autonomy is a major correlative part of health. However, autonomy is not isolated individualism,
as it is typically interpreted as by western cultures, but relational. Autonomy in immediate return
environments lends itself to accept a world of many correct answers rather than just one, which
once again, is against typical western reductionist thinking. When members act with the
autonomy of others in mind, autonomy of the individual is preserved while receiving the highest
benefits. Japan is a salient contemporary example of this. As Marmot notes, Japan preserves
health in spite of rigid hierarchy, revealing that it is not the existence of hierarchy that can be
detrimental to health, but rather how the hierarchy is operated. That is, if hierarchy is structured
to benefit individuals as equals or if it is powered in such a way that implies individuals have
disparate social value, it will affect the health of the individual internalizing the behavior that
supports that structure and ideology. Anxiety is a survival mechanism. If all human life within a
society is not valued equally, peoples unconscious feelings of security will be undermined. This
leads to a rise in subconscious anxiety that is biologically legitimate in terms of the body trying
to compensate for that lack of protection for an individuals social investment. As discussed in ID compensation theory, these individuals constantly have to fight off evidence that a just world
does not exist, as will be discussed in a few paragraphs. The language associated with the culture
and the values instilled by such a society reveal this, as many social scientists such as Marmot
have noted by analyzing how people in each culture define success in myriad facets of life. Even
if what the culture champions as the key to happiness does not fulfill its people, many will persist
in attempting to seek those rewards, even as this pursuit exacerbates instability (Marmot, 2004).

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The instability caused by the individuals need for feedback juxtaposed with the longterm risks needed for a settled society produces anxiety: If peoples efforts are not appropriately
rewarded, they suffer emotional distress with consequent stimulation of biological stress
pathways (Marmot, 2004, p. 136). According to I-D compensation theory, anxiety is a concern
when individuals fail to satisfy their immediate return needs. Thus, to rephrase Marmot,
stimulation of the biological stress pathways produces anxiety that is detrimental to both physical
and mental health when an individual fails to be rewarded in an appropriate, timely manner
conducive to their biology. Anxiety is a survival mechanism that works to protect our personal
well-being. But in these delayed systems, the endocrine system has the potential to over-engage
as part of a stress response in a detrimental manner due to environments that can cause
seemingly unwarranted negative mental affect. In reality, the nature of settled society is so
oriented to times and spaces that are not of the present that generalized anxiety is a legitimate
biological reaction if the individual has lost the mental commitment to the cultural mechanisms
and justifying stories of their culture. This is why the popularized concept of mindfulness has
been found to be so effective: it reorients individuals to their biology in spite of the demands of
their environment (Martin et al., 2014). When anxiety is produced in this manner, it is often seen
as without cause. Provided a brain scan does not reveal a structural brain issue, individuals
should be given the benefit of the doubt that their maladaptive behavior derives from a legitimate
rewarded behavior channel. Geographers note that certain institutions exist to produce a specific
citizen, and the production of behavior in large groups in regards to mental and social ills is
essentially the same.
So much of what are considered to be both mental and social ills derive from the
compensations necessitated by a shift from nomadic to agrarian societies in terms of rewards:

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Not only are peoples compensations associated with justifying stories and reassuring
social mechanisms, they may also be associated with rumination, negative affect, and
heightened self-focus (Martin & Tesser, 2006). Interestingly, these are the basic
ingredients of many phenomena that have been identified by social psychologists (e.g.
dissonance, prejudice, defensive self-esteem). So according to I-D compensation theory,
when people adopt an immediate return orientation they may be less susceptible to these
phenomena. (Martin et al., 2014 p. 24)
People make a place. It is artificial to separate the two. It is the collective action of
maladaptive coping that creates the social phenomena known as prejudice, hostile environments,
etc. This group behavior ingrains itself in people of a place (Marmot, 2004). Peoples collective
actions within set spatial boundaries, designated as a place such as a city, create personalities
of cities. Cities are not short tempered or welcoming, people are. The agreed social norms of
behavior create social environments that reward a certain personalityii. Social environments are
difficult to change due their origins in socio-historical contexts and the defensive mechanisms in
place within groups and cultures. The challenges posed by this inertia are important in public
health. The gender imbalance of depression across Europe is an example that highlights this.
Power dynamics that root themselves in social capital inequality, i.e. power dynamics that have
an undertone of all people not being inherently equal, lead to a high prevalence of behavioral
health issues. The historically strongly patriarchal Roman Empire that once occupied southern
Europe has had lasting effects on cultures in that region. Their languages, organizations, and
social behaviors reflect that history. This provides the best explanation of the stark visible
differences in the ratio of experiences of clinical depression in females and males in southern
versus egalitarian northern Europe (World Health Organization; Meyer, 2015; Vauclair et al.,

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2014). This is an example of how socio-historical contexts are effective at revealing what in an
environment is producing higher levels of mental health issues compared to other areas. While
urban planners can, to a degree, facilitate environments that reward certain behaviors, the
personality of a city, the social environment, derives from a variety of socio-historical factors
that cannot be separated from the physical environment and the way in which societies have
developed in terms of creating spaces that are navigated in certain conceptions of space and time.
The social environment is built on qualitative experiences and conceptions of space and
time. It will vary from society to society, as noted by famed geographer David Harvey.
Transportation and spaces that allow for community members to congregate and connect have a
profound effect on human health (Grant et al., 2009). The social constructions surrounding the
subjectivity of space and time directly influence the way people organize their lives, assess and
judge social behaviors, and their perception and feelings. This effect on interaction has strong
influences on the social constructions that individuals will actively commit to in the performance
of behavior: Such deep struggles over the meaning and social definition of space and time are
rarely arrived at directly (Harvey, 1990, p. 421). The way individuals are taught to navigate the
immediate social environments through the socially constructed norms for behavior creates a
more predictable instantaneous, desynchronized moment of collateral consequence. This is why
an understanding of space is not a philosophical issue but a result of social and historical
practices over time (Harvey, 1990). The mind is constantly creating these mental shortcuts and
routines based on cultural habit. The behavior seems uncontrollable when triggered by stimuli
from their familiar immediate environment. Success in habit breaking often requires becoming
more aware of and changing lifestyle and routine, or removing triggering stimuli. This change in
temporal and spatial relations separates the individual from the triggering stimuli that has

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become associated with the habit as well as the destruction and rebuilding of their own timespace systems (Cialdini, 2012; Harvey, 1990; Lea et al., 2015). This phenomenon of changing
and rebuilding extends past the mere individual.
This commitment to the values of a delayed return society does not only have an effect on
individual mental health, but it also has staggering effects on how cultures and communities view
and remediate social ills. The social environment, being on powered social gradients of varying
degrees, translates into people in society having varying degrees of social capital in both the
immediate and expansive social environments. Like any investment, the ways a healthy social
capital economy works are similar to how a healthy fiscal economy works: diversifying assets,
trust in the system, perceived fairness, degrees of invested risk, knowing the value and how to
invest, and perceived helpfulness (Marmot, 2004). Social capital is similar to monetary capital.
The environment someone resides in reflects the nature of impoverished social capital in a
similar but distinct manner from being fiscally poor and has correlative health effects. In order
for societies to successfully work in terms of these risky long-term rewards, individuals must
commit to the cultural system in place. This, in return, requires a degree of trust that, like so
much understood in capitalist systems, their investment of social capital will lead to fair or just
rewards. There is no security and trust in the system if there is no commitment to the idea that
there is expected compensation for their investment. This is reaffirmed in Hafers study:
Hafer found that participants who believed in a just world and who had focused on their
long-term goals were more likely than those who focused on their courses to blame the
innocent victim. It would be pointless for those participants to pursue their long-term
goals, if the world was not just. Yet the existence of an innocent victim suggests that the
world is not just. So, they distorted that reality. They construed the innocent victim as

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blameworthy. In short, the delayed return orientation (i.e., focus on long-term goals) led
the participants to maintain a fixed interpretation of events even when the interpretation
did not map on to reality. (Martin et al., 2014, p. 22).
Unfortunately, the necessary mental commitment to social constructions of delayed return
societies lends its hand to culturally acceptable cognitive distortions. Those developing policy
should be kept aware of these blind spots that can impede sound creation of solutions in the form
of governing behavior. A great deal of time in the study of geography and other disciplines that
examines public policy is committed to the effect of fiscal disparities and social inequalities, but
understanding aspects of these inequalities in terms of social capital would be the next great step
for a variety of geographic subsets: political geography, critical geography, geography of the
effect of hazards, etc. Being aware that these powered institutions are in fact groups of behavior
and that capitalism is no more than a title of a specific group behavior, researchers, policy
makers, and others in the field of changing behavior should keep in mind how pervasive the
social constructions of these seemingly irrational, maladaptive, or ineffective behaviors are.
Subject Position, Language, and Vygotsky:
Everything in life is a negotiationevery single interaction. This does not merely extend
to just interacting with others. People renegotiate identity through creating different subject
positions often in the wake of major life events, such as taking on a disabled identity. Rather than
campaigning for change in their environments, they renegotiate the self within pre-existing
power dynamics. Seemingly simple changes in language can have a profound effect on the
cognitive process, and thus behavior, in ways that can be greatly beneficial or detrimental to an
individuals health and coping (Butler & Parr, 1999). This discovery has led to the widespread
popularization and success of cognitive therapies such as Dialectical Behavior Therapy,

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Cognitive Behavior Therapy, Acceptance and Commitment Therapy, and mindfulness based
additions to other cognitive therapies. The success of these therapies highlights that words are
much more powerful when used as tools to facilitate change and connection as opposed to
when used to try to describe some objective reality, particularly in terms of how an
individuals perception will affect their health (Walker, 2006). Policy and professionals assisting
the health of individuals through targeting behavior need to focus on the more relevant
questionWhat [changes does the individual in question need in order to improve their health]
and what new ways of speaking or conversing might help? (Walker, 2006). Language asserts
power over whatever is being described. There emerges a stark difference between language
describing the physicality of the person and the social constructions and cultural factors
surrounding the physicality of the person.
Geographers have long known the power of using language to assert power over groups
and space from country boundaries to landmarks: Indeed, the very act of naming geographical
entities implies a power over them, most particularly over the way in which places, their
inhabitants and their social functions get represented and thus influences the way they are
interpreted (Harvey, 1990, p. 419). As Foucault notes, this understanding of how a group is
represented is powerful in terms of behavior. Self-fulfilling prophecies are the tendency of
individuals to gravitate towards what they believe is expected of them (Butler & Parr, 1999).
Language is pervasive in the mind in the form of social constructions that are then used to frame
the cognitive process that will ultimately be used in the process of acting/behaving. How
individuals create their subject position and the framework, through scaffolding, for how they
will establish and contextualize problems is strongly rooted in the language available and
surrounding the obstacles to human desires: OHalon concludes that if our language creates the

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problem then why not leverage the use of language and create a problem that is easiest to solve
(Walker, 2006). As popularized by Bruno Latour, this language and knowledge can only be built
on that to which an individual has been exposed. This too limits the types of behavior, through
geographic contingencies, to the types of knowledge and language available. This reveals that
habit keeps power in place, but the clich knowledge is power is key. Those who can establish
habits for others through using powered language to describe group understanding ultimately
possess greater power over behavior than their peers (Appendix A). This creates starker
inequalities in power. Paraphrasing Foucault, having a monopoly over what constitutes
knowledge provides a great deal of control over the cognitive options available to appropriate
both physical and social environmental stimuli that will ultimately result in a more limited set of
behaviors that the individual can act on in any given situation. A psychological theorist created a
framework to highlight this development of cognition.
Vygotsky, a researcher who looked mainly at child development, developed a theory
called Social Development Theory, in which he argues that social behavior and interaction are
developed though previous social interaction, which precedes initial development of those skills.
Cognition is the end product of socialization with scaffolding from a More Knowledgeable Other
(MKO). Behavior is first learned through interaction. Following this learning opportunity, the
individuals will appropriate this knowledge themselves. The Zone of Proximal Development
(ZPD) is the zone from which individuals can learn a task on their own, extending the
improvement of that ability to perform a task with MKO guidance. Ultimately their ability to
learn and apply that knowledge, now without the MKO, will act as the outer limit. Individuals
are active learners where the MKO facilitates meaning construction. The focus of this theory was
on the connections between people and the socio-cultural context surrounding the language used

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to mediate the social environment. The learning of the use of the tools or communication serves
more than a social function: the internalization of these tools leads to higher thinking and
cognitive skills (McLeod, 2014; Siegler et al., 2003). While this theory was developed
specifically for the childrens development, it is not too far a leap to extend this theory to the
development of adults throughout their lifespan, as knowledge, personal development, and
behavior do not stagnate upon physical maturation. Coping mechanisms, as learned behavior, fall
within this framework of learning. This theory provides a sound framework to understand, in a
schematic similar to that of the ecological framework, an aspect of behavior regarding the
cognitive process that anchors behavior in geography.
Mindfulness, Dialectical/Critical View, and Behavior:
Mindfulness can be defined as the process of actively making new distinctions about
objects in ones awareness[they] live in the present, adjust their knowledge in response to
subtle changes in their environment and behave more authentically (Martin et al., 2014, p. 3).
Knowledge is power is profoundly true in this case, as greater mindfulness, also known as
mental flexibility, gives a person a greater ability to problem solve beyond the social
constructions or power structures that bind them. Mindfulness reduces automatic acceptance of
these social constructions, empowering the individual to appropriate their own knowledge with
greater adaptability and sensitivity to shifts in their environment (Martin et al., 2014). A mindful
perspective is not just a more flexible mindset for problem solving but also a mindset that is
more accepting of multiple ways of accomplishing tasks through creating a more immediate
return society type mindset.
Dialectical insight is associated with immediate return societies: as long as the method
works, there is no one right way. Dialectical insight is defined as parts having no independent

Bernard 21
existence as parts, and asserts there is no one correct way of dividing a whole into parts because
this depends upon which particular aspect of the whole is being studied (Nightingale & Cromby,
1999). This fluidity rather than heightened conformity allows for flexible power structures that
do not oppress. When individuals that make up groups feel their ideology is being questioned,
they often employ defensive psychological mechanisms to protect their just worldview and way
of life. Martin describes this as mindless behavior and cultural geographers consider it habitual
behavior. Having insight into, being mindful, of this pseudo-separation of the whole provides
greater flexibility in subject position when addressing behavioral problems in the community
with policy.
To a geographer familiar with Marxist dialectics and the ideology of postmodernism,
dialectical insight and mindfulness are ultimately concepts that are old hat. This concept of
mindfulness is nothing more than the critical reflection famed geographers like Harvey and
renowned philosophers like Foucault have already uncovered about group behavior when it is
called culture or capitalism. Instead of the term mindfulness, many geographers and other
social scientists use the term critical, such as critical geography or critical reflection:
Critical reflection is an active rebellious practice that drives individuals into action as they
identify the exercises of power that pins them into place and the fault lines for the production of
spaces of resistance (Nightingale & Cromby, 1999, p. 31). Foucault went as far as to note that in
terms of the social capital described earlier, this process of critical reflection identifies the
subjective investments we make in our everyday practice and traces them to networks of
institutional power that contain us. Once again, knowledge is power. It allows the individual to
think in terms of multiple subject positions, and use varieties of language to leverage the problem
to its most solvable dilemma; it takes problem solving that is a useful tool and prevents it from

Bernard 22
consuming the individual. Harvey states it best: The historical geography of space and time
facilitates critical reflection on who we are and what it is we might be struggling for. What
concepts of space and time are we trying to establish? (Harvey, 1990, p. 432). Whether mindful
individually or using critical reflection to view institutions, it is a tapestry of legitimate actions of
behavior from the variety of available geographically contingent options. Policies to change
behavior have to look beyond what is, at first glance, looks like the rewarded logical behavior
and truly look at the influence of social constructions on cognition and habitual behaviors. Our
health depends on it.
Conclusion:
Geographers have long looked at behavior of groups mindfully, however, without looking
at neighboring academic disciplines, the field as a whole has failed to contribute all it has to offer
in public policy. In an ever-changing, dynamic world, resolving problems systematically by
origin of behavior rather than its manifestation will lead to more effective and adaptable policy.
Behavior is geographically contingent where people in specific spaces and times are limited to
actions and resources available to them based on a myriad of environmental, socio-historical, and
biological factors. Understanding the ways maladaptive behavior is being rewarded is not the
same as excusing or justifying the behavior. An understanding of the actual channels of rewards
provides better preventive and remediating policy in regards to maladaptive behaviors.
As noted by Saitluanga, postmodernism as an ideology does not believe in the rationality
of human actions. In this paper, the assumption of this ideology is that theorists succumbed to a
misunderstanding of cognitive behaviorism, that is, the expansive ways behavior may be
rewarded that may appear as lacking rationality. No text was found suggesting that these
theorists knew this. The position expressed in this paper is meant to be an opening for discussion

Bernard 23
and thought. A continuation of research epigenetics/gene-environment interactions, the
psychology of habit, the efficacy of mindfulness in the long-term, and political geography are
starting points for further inquiry that would continue to enrich this movement of western
cultures policy initiatives, as seen in the recent publications of similar research in the UK. Based
on what can be ascertained by contextualizing the practice of psychology both its
implementation and the way it is understood, how can the variety of disciplines working at a
variety of scales better address undesired or maladaptive behavior to improve the health and
well-being of their target demographics?

Bernard 24
Appendix A:
Berger and Luckmanns 1966 The Social Construction of Reality (from Narrative
Therapy) by Jill Friedman and Gene Combs (Walker, 2006).
Imagine two survivors of some ecological disaster coming together to start a new
society. Imagine that they are a man and a woman who come from very different cultures. Even
if they share no language, no religion, and no presuppositions about how labor is to be divided,
or what place work, play, communal ritual, and private contemplation have in a good society, if
culture of any sort is to continue, they must begin to coordinate their activities. As they do this,
some agreed-upon habits and distinctions will emerge: certain substances will be treated as food,
certain places found or erected to serve as shelter, each will begin to assume certain routine daily
tasks, and they will almost certainly develop a shared language.

Between the two founding members of the emerging society, the habits and distinctions that arise
will remain tenuous, easily changeable, almost playful, even while they attain a measure of
objectivity by the mere fact of their formation (Berger & Luckmann, 1966, p. 58). They will
always be able to remember, This is how we decided to do this, or It works better if I assume
this role. They will carry some awareness that other possibilities exist. However, even in their
generation, institutions such as childcare, farming, and building will have begun to
emerge.

For the children of the founding generation, This is how we decided will be more
like This is how its done. Mothers and farmers and builders will be treated as always-havingexisting types of people. The rough-and-ready procedures for building houses or planting crops

Bernard 25
that our original two survivors pieced together will be more-or-less codified as the rules for how
to build a house or plant corn. In all likelihood laws will have been written about where, when,
and how buildings may be built or crops may be planted. It is hard not to imagine that customs
governing the proper rites for starting a family or harvesting a crop will have come to be, and
that certain individuals will be identified as the proper people to perform those rites. Institutions
like womens societies and masons guilds will have begun to emerge.

By the fourth generation of our imaginary society, This is how it is done will have
become This is the way the world is; this is reality. As Berger and Luckmann (1966, p. 60) put
it, An institutional world is experienced as an objective reality.
Appendix B:
Maps can tell surprising stories. About a year ago, Northwestern University
psychologist Joan Chiao pondered a set of global maps that confounded conventional notions of
what depression is, why we get it, and how genes the so-called depression gene in particular
interact with environment and culture.
Chiao had run across data suggesting that many East Asians seemed to carry the
depression gene shorter variants, that is, of a mood-regulating gene known as the serotonin
transporter gene, or SERT at unusually high rates. Yet though dozens of studies over the prior
15 years had shown these short SERT genes made people more prone to react to trouble by
becoming depressed or anxious,* it was not Chiaos impression that this association held for
most Asians. Then again, no one had gathered the data.
So she gathered it. Chiao and one of her grad students, Katherine Blizinsky, found all the
papers they could that studied serotonin or depression in East Asian populations. These papers,

Bernard 26
along with similar studies in other countries and some World Health Organization data on mental
health, painted a pretty good picture of short-SERT variant and depression rates not just in North
American and Europe, but in East Asia. A pretty good picture but seemingly twisted in the
middle. The eastern half was upside down. For while East Asians carried the short-SERT
depression gene variants at almost twice the rate (70-80%) that white westerners did (40-45%),
they suffered less than half the rates of anxiety and depression.
You can see it in the maps. Below, the first map shows prevalence of the short-SERT
depression gene, and the second shows prevalence of depression. Their colors should line up,
but instead they conflict.

Fig 1. Known prevalence of S-S and S-L serotonin transporter gene variants worldwide.
Yellow denotes low rates, orange middling rates (around 40-50%, and red high, around 80%.
From Chiao and Blizinsky 2009.

Bernard 27

Fig 2. Percentages of populace diagnosed with mood disorders at some time in lifetime.
Again, yellow is low, in the single digits, while red is high, around 20%, and gray areas lack
sufficient data. If the prevalance of the depression gene predicted the prevalence of depression,
then this map should look much like the one above it. But especially if you look at North
American and Asia, which are the areas in interest here it doesnt. It looks almost assbackwards. From Chiao and Blizinsky 2009. Gray areas lack sufficient data.
You can chart the data in other ways too, and it still looks weird. A well-established gene
variant that is supposed to predict depression seems to predict just the opposite in East Asia.
Squaring two maps with a third
Why did fewer East Asians get depressed even though more of them carried the
depression risk gene? It wasnt as if life in East Asia was stress free. The gene seemed to
generate vulnerability in one culture and resilience in another.
As Chiao recognized, several possibilities offered themselves. Might depression be
underdiagnosed in East Asians and overdiagnosed in westerners? It might but probably not
enough to account for a complete reversal of the risk dynamic. Perhaps most East Asians carried

Bernard 28
some other gene that canceled the SERT genes depression risk? Again, could be, but it seemed
an awfully strong effect.
To Chiao, these sorts of explanations couldnt reconcile the two maps. The maps did start
to make sense, however, when Chiao considered them in light of gene-culture evolutionary
theory (aka dual inheritance theory). This is the notion that genes and culture influence each
other, and that culture can shape the way genes express themselves and even how they evolve. To
Chiao, the mismatch between the SERT map and the depression map smelled of gene-culture
effects. The gene in question was obviously SERT. So what was the cultural suspect? What
cultural difference between western whites and East Asians might affect both the prevalence and
apparent effect of the so-called depression gene?
And what jumped out of that question, both to Chiao and Blizinsky and to Baldwin
Way and Matthew Lieberman, a pair of UCLA researchers who happened to be asking the same
questions in California, was the difference between individualism and collectivism.
This individualism collectivism distinction comes not from Mao, but from a Dutch
organizational sociologist named Geert Hofstede. Back in the 1970s, Hofstede did a massive
study for IBM of several hundred thousand of the companys workers in 70 countries. Hofstede
found several cultural factors that shaped business practices differently in IBM offices around the
globe, the most famous of which became the spectrum between individualistic cultures,
which emphasize a persons independence, and collectivist cultures, which emphasize a persons
interpersonal, social, and civic connections. The study wielded enormous influence and made
the collectivism individualism spectrum a staple of certain strains of sociological studies. (For
other echoes, see here.) And as another map from Chiaos paper shows, the white west generally
leans toward individualism while East leans toward collectivism.

Bernard 29

Fig 3. Collectivism in world cultures. Yellow is low in collectivism, red is high. From
Chiao and Blizinsky 2009.
So how does individualism-v-collectivism relate to depression and depression genes?
Here Chiao and Blizinsky, as well as Way and Lieberman (these connections were apparently
ripe) turned to another emerging idea: That the short SERT gene seems to sensitize people not
just to bad experience, but to all experience, good or bad. (I explored this sensitivity gene or
differential susceptibility hypothesis at length in an Atlantic article last December and am now
working on a book about it.) Both Chiao & Blizinsky and Way & Lieberman published papers
within the last year laying all this out: Chiao and Blizinsky last December (abstract; pdf), Way
and Baldwin this June (abstract; pdf download; Replicated Typo has a good write-up here). And
both pairs assert that these short SERT variants make people sensitive to social experience in
particular.
Way and Lieberman, for instance, note several studies in which the short, or S/S variant,
seems to magnify both the negative and positive effect of social support.
In a study of depressive symptomatology, when short/short individuals had experienced
more positive than negative events over the last 6 months, they had the lowest levels of

Bernard 30
depressive symptomatology in the sample (Taylor et al., 2006), indicating that short/short
individuals are more sensitive to positive life events as well as negative ones. Subsequent
research has shown that this relationship between life events and affect for individuals with the
short/short genotype was primarily driven by the social events, as the nonsocial events were not
significantly related to affect (Way and Taylor, 2010). Other groups have found heightened
sensitivity to positive social influences amongst short allele carriers as well, which has even been
documented using neurochemical measures (Manuck et al., 2004). Thus, these results suggest
that the 5-HTTLPR moderates sensitivity to social influence regardless of its valence [that is,
whether the experience is positive or negative].
Because short/short individuals are more sensitive to the social realm, social support
appears to be more important for maintaining their well-being. In support of this claim,
short/short individuals exposed to a natural disaster (a hurricane) were at no higher risk for
depression than long/long individuals provided they perceived that they had good social support
(Kilpatrick et al., 2007). However, if short/short individuals exposed to this disaster perceived
that they did not have good social support they had a 4.5 times greater risk for depression.
Similarly, a randomized control trial designed to improve nurturant and involved parenting
reduced adolescent risky behavior, but only amongst those with the short allele (Brody et al.,
2009b). A similar differential sensitivity was seen among adolescents in foster care. If the
short/short individuals had a reliable mentor present in their life they were at no higher risk for
depression than adolescents with the other genotypes. However, if they did not have such support
they were at a high risk for depression (Kaufman et al., 2004). Thus being embedded in a richly
interconnected social network, as is present in collectivistic cultures, might be particularly important for maintaining the well-being of short/short individuals.

Bernard 31
This starts to explain the purported interplay of the S/S allele and a collectivist culture: If
short-SERT people get more out of social support, a more supportive culture could buffer them
against depression, easing any selective pressure against the gene. Meanwhile the genes growing
prevalence would make the culture increasingly supportive, since those who carry it might be
more empathetic. Studies have shown, for instance, that short-SERT people more readily
recognize and react to others emotional states. In one still-unpublished study a favorite of
mine marriage partners with S/S SERT alleles more accurately read and predicted their
spousess emotional states than did people (sometimes those same partners) with L/L variants.
This could make for some interesting dynamics at the breakfast table over the years.
A conversation between genes and culture
One major piece of the puzzle remains: How did the short SERT variant, which has
generally been painted as bad news, become so prevalent in East Asia in the first place? Good
question. The short-SERT variant appeared in humans only in the last 100,000 years. It was
during this same period that humans moved out of Africa and spread around the globe. And it
was during this time that the this S/S variant thrived in particular in people who moved east and
took up residence in East Asia. Why did it blossom so spectacularly? And what came first, the
high S/S rates or the collectivist culture?
Here the gene-culture dynamic must walk on tiptoes, as the sketchy evidence forces
caution. Yet it can offer some speculative hypotheses. Drawing on work by Corey Fincher and
Randy Thornhill, for instance, Chiao speculates that both a collectivist culture and the socially
sensitive S/S allele gained ground when high pathogen loads along human migration routes from
Africa to East Asia rewarded socially sensitive, collectivist behaviors that defended against
pathogens. (The high pathogen loads in turn rose from the warm, most climates and abundant

Bernard 32
bird and mammal life in those regions.) The heightened danger of infection, that is, may have
selected for a more group-oriented mindset, such as more attention to group rules regarding
sanitation, food preparation, and whatever elemental medical care (such as stopping to rest)
might have helped people avoid or survive infection. The adjustment would have been partially
cultural: Those who followed these practices would suffer less infection. But (the argument goes)
the adjustment would also have been genetic, as selection favored an S/S SERT variant that made
carriers more likely to observe the rules.
Im not quite sure what to think of this idea. A paper exploring the link between high
pathogen loads and lower IQ recently came under fire, and this may too; yet Chiao cites a strong
correlation. Meantime, Replicated Typo offers an alternative but compatible mechanism for this
gene-culture evolution, based more directly on migration routes. In any case, as Chiao notes,
pathogen loads offer just one among several possible environmental or cultural factors, not
mutually exclusive, that might have selected for collectivist behavior and socially sensitive
genotypes, creating a feedback loop increasingly friendly to behavior, gene, and a particular
culture.
The new math
This is a lot to wrap your mind around. If you consider yourself of hard-nosed empirical
bent, you might, after you take a deep breath or a long walk, cast about about for a westerntype study that runs along more classic gene-environment lines. If you did, you would soon reel
in a 2004 study of badly abused children. This study, by Joan Kaufman and others at the Yale
genetic psychiatry lab of Joel Gelernter, looked at 57 school-age children who were so badly
abused they were moved to foster homes.

Bernard 33
First the researchers crossed the kids depression histories with their SERT genotypes.
They found the expected: maltreated kids with the short SERT gene the double whammy
suffered mood disorders at almost twice the rate as did maltreated kids who had the L-S or L-L
variants or, for that matter, short-SERT kids with no maltreatment.
So far, so predictable. Then Kaufman laid both the depression scores and the SERT types
across the kids level of social support. She defined social support quite narrowly: contact at
least monthly with a trusted adult/mentor figure outside the home. This modest, closely defined
social support, however, eliminated about 80% of the combined risk of the risk gene and the
maltreatment. It virtually inoculated kids against extreme maltreatment and a proven genetic
vulnerability.
It makes you wonder: Whats the real toxin in situations like this? We tend to view bad
experience abuse, violence, extreme stress, family strife as toxic, and risk genes as semiimmunological weaknesses that let the toxin take hold. And maltreatment is clearly toxic. Yet if
social support can almost completely block the effects of a severe toxin in a vulnerable
individual, isnt a lack of social support almost as toxic as the severe maltreatment? Even this
clever studys design and language frame social support as a protective add-on. But this
framing implies that humanitys default state is isolation. its not. Our default state is connection.
To be unconnected to feel alone is to endure a trial almost as noxious as regular beatings
and sharp neglect.

The University of Chicago psychologist John Cacioppo and William Patrick explore this
beautifully in their book Loneliness, And Michael Lewiss hysterically funny article about the
Greek credit crisis, published just a few days ago, suggests that a hyper-individualistic default

Bernard 34
state doesnt serve the world economy too well, either. Lewis describes how the Greek credit
crisis, which currently threatens to spread to the European and perhaps the global economy, arose
partly because a break in the social contract created an every-man-for-himself ethic in Greece,
since everyone assumes everyone else cheats and that no one pays taxes. He signs off with this:
Will Greece default? Theres a school of thought that says they have no choice. On the
face of it, defaulting on their debts and walking away would seem a mad act: all Greek banks
would instantly go bankrupt, the country would have no ability to pay for the many necessities it
imports (oil, for instance), and the country would be punished for many years in the form of
much higher interest rates, if and when it was allowed to borrow again. But the place does not
behave as a collective It behaves as a collection of atomized particles, each of which has
grown accustomed to pursuing its own interest at the expense of the common good. Theres no
question that the government is resolved to at least try to re-create Greek civic life. The only
question is: Can such a thing, once lost, ever be re-created?
If Greece doesnt do some fast gene-culture evolution toward collectivism, the whole
world may get depressed.
As gene-culture theory gets hold of the kind of data that allows for papers like Chiaos, I
suspect well see a growing stream of studies showing that genes have different effects in
different cultures. A few weeks back, for instance, Ed Yong wrote up a
fascinating paper by Heejung Kim and colleagues demonstrating that a particular variant of an
oxytocin receptor made Americans, but not Koreans, more likely to seek emotional social
support in times of distress. As Yong noted, these studies all but insist that we may need to
expand our definition of environment when we consider gene-environment interactions.

Bernard 35
Many studies have looked at how nature and nurture work together but in most cases, the
nurture bit involves something social thats either harsh or kind, such as loving or abusive
parenting. Kims study stands out because it looks as cultural conventions instead, and Ebstein
says that it provides an interesting new avenue for researching gene-environment interactions.
In a sense, these studies are looking not at gene-x-environment interactions, or GxE, but
at genes x (immediate) environment x culture GxExC. The third variable can make all the
difference. Gene-by-environment studies over the last 20 years have contributed enormously to
our understanding ofmood and behavior. Without them we would not have studies, like these led
by Chiao and Way and Kim, that suggest broader and deeper dimensions to what makes us
struggle, thrive, or just act differently in different situations. GxE is clearly important. But when
we leave out variations in culture, we risk profoundly misunderstanding how these genes and
the people who carry them actually operate in the big wide world.
_________
*This so-called depression gene is, to most researchers, either of two short versions
of the serotonin transporter gene SLC6A4, and known by some as SERT. SERT appears to
regulate levels of the neurotransmitter serotonin and to be crucial to mood, among other things.
Because we effectively get one half of this gene from each parent either a long or a short
each of us carries a version that is either long-long (L/L), long-short (L/S), or short-short
(S/S). As many have pointed out, depression is far more complicated than one gene , which is
probably why even the depression gene is so clearly probabilistic rather than predictive. But as
well see shortly, its far more complicated than that.
Yet others may recall that this depression-risk view of the gene was aggressively
challenged by Risch et alia. That view got a lot of attention. Less attention went to the several

Bernard 36
strong rebuttals and critiques noting that Rischs challenge was a) was rather selective in its
choice of studies to include in its meta-analysis, b) weighted the studies in odd ways, so that the
small ones least likely to see a genetic association were weighed as heavily as the large ones that
were more likely to detect such associations; and c) ignored altogether a huge body of
physiological work that details mechanisms through which SERT variants could affect ones
sensitivity to environment. As I noted in an earlier post, that leaves intact the SERT-depression
links main framework. (Dobbs, 2010).
Appendix C:
Cognitive-behavioral therapy is an action oriented form of psychosocial therapy that assumes
that maladaptive, or faulty thinking patterns cause maladaptive behavior and negative emotions.
(Maladaptive behavior is behavior that is counterproductive or interferes with everyday living).
The treatment focuses on changing an individuals thoughts (cognitive patterns) in order to
change his or her behavioral and emotional state.
Source: http://medical-dictionary.thefreedictionary.com/cognitive-behavioral+therapy
Appendix D:
As stated in Joshua Millers Maymester UGA PSYC 3230 class, Anxiety can be present
without depression, but depression cannot be present without anxiety. According to the World
Health Organization (http://www.who.int/mental_health/media/en/242.pdf), depression is the
second greatest burden worldwide in health care. However, the WHOs current measurement of
depression does not account for all the physical ailments, from gastrointestinal diseases and
disorders to cancers, that can result from undiagnosed anxiety, can be exacerbated by anxiety, or
may be prolonged or become chronic. To clarify, diagnosable anxiety must impair day-to-day
life. One can have detrimentally high levels of anxiety but still have sufficiently healthy coping

Bernard 37
mechanisms to make it day-to-day without being identified as having diagnosable anxiety. Even
those suffering from impairment due to their anxiety often go undiagnosed, particularly if they
are from a minority or impoverished demographic. Everyone has some degree of anxiety as a
defense mechanism; the question is how much of it is contributing to compromised health. As the
prolonged engagement of the endocrine system results in greater white blood cell activity,
inflammation occurs, which seems, in turn, to lower levels of antiviral compounds, interferons.
The decreased levels of interferons and the high inflammation that correlates strongly with the
decreased levels of interferons lead to detrimental physical health effects as the human body is
not structured to withstand these kinds of inflictions for long periods of time (Chen, 2015).

Bernard 38
References
Butler, R., & Parr, H. (1999). Mind and body spaces : geographies of illness, impairment and
disability. London ; New York : Routledge, 1999.
Chen, A. (2015, November). Loneliness may warp our genes, and our immune systems.
Retrieved from URL.
Cialdini, R. [influenceatwork]. (2012, November 26). Science of persusasion [Video file].
Retrieved from https://www.youtube.com/watch?v=cFdCzN7RYbw.
Dobbs, D. (September 14, 2010). The depression map: genes, culture, serotonin, and a side of
pathogens. Retrieved from http://www.wired.com/2010/09/the-depression-map-genesculture-serotonin-and-a-side-of-pathogens/
Gerst-Emerson, K., & Jayawardhana, J. (2015). Loneliness as a public health issue: the impact of
loneliness on health care utilization among older adults. American Journal Of Public
Health, 105(5), 1013-1019. doi:10.2105/AJPH.2014.302427
Grant, M., Barton, H., Coghill, N., & Bird, C., (2009, October). Evidence review on the spatial
determinants of health in urban settings. Retrieved from URL.
Harvey, D. (1990). Between Space and Time: Reflections on the Geographical
Imagination. Annals of the Association of American Geographers, (3). 418.
Jones, J. (2001). The geography of mental health. Epidemiologia E Psichiatria Sociale, 10(4),
219-224. doi:10.1017/S1121189X00005388
Lea, J., Cadman, L., & Philo, C. (2015). Changing the habits of a lifetime? Mindfulness
meditation and habitual geographies. Cultural Geographies, 22(1), 49.
doi:10.1177/1474474014536519

Bernard 39
Marieb, E. N. (2001). Human anatomy & physiology. San Francisco : Benjamin Cummings,
c2001.
Marmot, M. (2004). The status syndrome : how social standing affects our health and longevity.
New York, N.Y. : Times Books/Henry Holt, 2004.
Martin, L. L. (1999). I-D Compensation Theory: Some Implications of Trying to Satisfy
Immediate-Return Needs in a Delayed-Return Culture. Psychological Inquiry, (3). 195.
Martin, L. L., Sanders, M. A., Kulkarni, A., Anderson, W. C., & Heppner, W. L. (2014). I-D
compensation: Exploring the relations among mindfulness, a close brush with death, and
our hunter-gatherer heritage. In A. le, C. T. Ngnoumen, E. J. Langer, A. le, C. T.
Ngnoumen, E. J. Langer (Eds.) , The Wiley Blackwell handbook of mindfulness (Vols I
and II) (pp. 290-311). Wiley-Blackwell.
McLeod, S. (2014) Lev vygotsky. Retrieved from
http://www.simplypsychology.org/vygotsky.html.
Meyer, E., (2015, February). Why northern Europe is more egalitarian than southern Europe.
Retrieved from URL.
Nightingale, D. J., & Cromby, J. (1999). Social constructionist psychology : a critical analysis of
theory and practice. Buckingham [England] ; Philadelphia : Open University Press, 1999.
Parr, H. (1998). The politics of methodology in `post-medical geography': mental health research
and the interview. Health And Place, 4341-353. doi:10.1016/S1353-8292(98)00030-6
Saitluanga, B. L. (May 1, 2013). Postmodern geography. Retrieved from
http://www.slideshare.net/BenjaminLSaitluanga/postmodern-geography
Schneider, S. M., & Reyes Ren, C. (2012). The science of consequences : how they affect genes,
change the brain, and impact our world. Amherst, N.Y. : Prometheus Books, 2012.

Bernard 40
Siegler, R., DeLoache, J., & Eisenberg, N. (2003). How children develop. New York, NY, US:
Worth Publishers.
Singh-Manoux, A., Adler, N.E., & Marmot, M.G., (2003). Subjective social status: its
determinants and its association with measures of ill-health in the Whitehall II study.
Social Science and Medicine. 56, 1321-1333.
UC San Francisco. [UC San Francisco (UCSF)]. (2015, September 20). What is dialectical
therapy for adloescents (DBT)? [Video file]. Retrieved from
https://www.youtube.com/watch?v=Stz--d17ID4.
Vauclair, C.M., Marques, S., Lima, M.L., Bratt, C., Swift, H.J., & Abrams, D., (2014). Subjective
social status of older people across countries: the role of modernization and employment.
Journals of Gerentology, Series B: Psychological Sciences and Social Sciences, 70(4),
650-660.
Walker, M.T. (2006). The social contruction of mental illness and its implications for the
recovery model. International Journal of Psychosocial Rehabilitation. 10 (1), 71-87
Weaver, J. (2001). Other words: American Indian literature, law, and culture. Norman :
University of Oklahoma Press, c2001.
World Health Organization. Gender disparities in mental health. Retrieved from
http://www.who.int/mental_health/media/en/242.pdf.

i Cognitive dissonance is having inconsistent thoughts, beliefs, or attitudes, especially as relating to behavioral decisions
and attitude change. When ones SSS does not match their actual social status, its own set of problems can arise; however
for the sake of keeping this paper concise, there is no need to go into this subset of the topic.
ii Personality is developed while temperament is the inborn tendencies of behavior as defined by How Children Develop
by Siegler et al., 2003.