Why does effort hurt?

Via (http://to.pbs.org/1tP1RUZ)
Via (http://to.pbs.org/1tP1RUZ)

Psychologist Robert Kurzban has observed an apparent paradox in human motivation: Many activities which promote our evolutionary fitness—such as eating and sex—are pleasurable, and their pleasantness motivates us to do them. However, other fitness-enhancing activities which require involved, effortful work produce a feeling of mental exertion, which is unpleasant, and encourages us not to do them, or only do them as much as we need to. In short, it’s often painful to advance our own well being. If it’s good for us, why isn’t it fun to concentrate on work, or defer gratification now under the promise of greater rewards later?

Reviewing the literature on the question, Kurzban summarizes his own theory, by which boredom and the strain of attention are crude efforts to represent the magnitude of the opportunity costs agents incur by working on a single task for a long period of time:

Kurzban et al. [24••] have advanced a similar proposal, but, according to this view, the costs of exerting self-control are neither intrinsic [25] nor energetic [17]. Instead, their focus is on opportunity costs. To see the structure of the argument, consider the habituation paradigm, used to measure what pre-verbal infants find novel. Day and McKenzie [26], for instance, presented infants with images of cubes from different angles, finding that their young subjects decreased their looking time at these cubes, as much as they did to a cube being presented from the same orientation repeatedly. The idea behind the use of looking time is that a tableau the baby finds familiar will be boring, and thus will not be worthy of much continued attention; a surprising scene, in contrast, merits more attention, in the same way that an adult might let her gaze linger on something they were not expecting to see. More attention translates to greater looking time indicates greater surprise; less attention connotes boredom.

A key function of the systems that direct attention likely has to do with the value of gathering information: information carries value, so organisms’ brains have design features that motivate them to attend to more informative stimuli over less informative stimuli [27]. Boredom, on this construal, is the feeling the baby gets when little additional information is to be gained from continued attention [28 and 29]. The marginal benefit of attending elsewhere is greater than the marginal benefit of continuing to inspect the experimenter’s scene. Foraging organisms move to a new patch when the opportunity cost of staying is overtaken by the expected benefit of moving on [30]. Similarly,information foraging organisms such as humans move on in an adaptive way. The (opportunity) cost of gathering no new information explains why boredom is unpleasant; looking away reduces this unpleasant sensation.

The habituation paradigm illustrates the problem of simultaneity. Because one cannot look in more than one place at once, looking at one thing carries the cost of looking at everything else. Related, some computational systems in the brain can, in principle, be used for many different tasks–e.g., executive systems–necessitating decisions regarding which task to prioritize. Similarly, memory systems, which can maintain only a finite number data structures [ 31]. This limit requires decisions about which structures to keep in working memory.

According to the opportunity cost view, when systems that can be used for multiple purposes are engaged in a task, the potential benefit of ending the present task in order to perform some other task is computed. This computation is the opportunity cost of persisting in whatever it is that one is doing, which increases over time (e.g., [32]). When this cost is sufficiently great, outweighing the computation of the (potentially long term benefits of persisting), the task is abandoned [12].

The reason, according to this view, that even some fitness-good tasks are unpleasant is that the system or systems that compute the costs and benefits of persisting seem to be designed to favor short-term benefits. Tasks that recruit executive systems might be fitness-good in the long term, but they do not yield short-term gains, or associated phenomenological reward. The increasingly aversive sensation over time is due to the aggregation of opportunity costs [23]. It is plausible that similar arguments might be marshalled to explain the unpleasant sensation of resisting other temptations, such as marshmallows; not eating a sweet carries the (short term) cost of the foregone calories [33].

When “curing” hurts

Painting of a cat by mental patient Louis Wain (1860-1939).
Painting of a cat by mental patient Louis Wain (1860-1939).

Mental health advocate Marvin Ross implores patients, clinicians,  researchers, and advocates to be clear-eyed about the likelihood of “recovering” from schizophrenia:

[I]t has long been recognized that there are three outcomes to schizophrenia. Roughly a third are treatment resistant and remain very ill, a third can be helped with meds and other treatment modalities to improve sufficiently to lead a reasonable but disabled life, and a third will have one psychotic episode, receive treatment and never have another or any long term deficits.

According to the Treatment Advocacy Center, 10 years after diagnosis, “one-fourth of those with schizophrenia have recovered completely, one-fourth have improved considerably, and one-fourth have improved modestly. Fifteen percent have not improved, and 10 percent are dead.”

How do you think the families of the majority of those with non recoverable schizophrenia or the individuals themselves will feel when we hold up to them what is achievable by only 25%? And, we tell them that it is achievable. Why can’t I (or my son or daughter) achieve that. Have I done something wrong? Cancer is an interesting analogy. There is not one cancer but many. And each cancer has its own unique characteristics and prognosis.

Non melanoma skin cancer (basal cell and squamous cell) have 5 year survivals of 95% and 90%. In contrast, the 5 year survival for pancreatic cancer ranges from 1% for stage IV to 14% from stage 1A. Imagine if we told those with stage IV pancreatic cancer not to worry because 5 year survival is 95%. Ridiculous isn’t it but that is what we tell people with schizophrenia. Don’t worry, you should be able to recover because 25% do.

Now, I’m not saying to abandon hope but rather to be realistic and pushing recovery is not realistic if it is not qualified.

The second problem was mentioned to me by my friend Kathy Mochnacki of Home on the Hill in Richmond Hill Ontario. She pointed out that if you claim that recovery is possible, then why continue doing research. People can recover so no need for it. Of course, scientists know better but they are dependent on funding from governments and other agencies.

So, let’s all inject some scientific reality into a very troubling and serious disease.