Cover Page

Table of Contents

Praise Page

Title Page

Copyright

Preface

Acknowledgments

Human Behavior and the Core Competencies (EPAS)

About the Authors

Chapter 1: Introducing the Cell to Society Framework

On the Importance of Transdisciplinary Approaches

Change and Adaptation: Biological and Cultural Evolution

Components of the Cell to Society Framework

Summary

Key Terms

Chapter 2: Genes and Behavior

Distal Context

Proximal Mechanisms

Genes and Behavior Over the Life Course

Summary

Key Terms

Chapter 3: Stress and Adaptation

Distal Context

Proximal Mechanisms

Stress and Adaptation Over the Life Course

Summary

Key Terms

Chapter 4: Emotion

Distal Context

Proximal Mechanisms

Emotional Development and Psychosocial Relations Over the Life Course

Summary

Key Terms

Chapter 5: Executive Functions

Distal Context

Proximal Mechanisms

Executive Functions and Psychosocial Relations Over the Life Course

Summary

Key Terms

Chapter 6: Temperament

Distal Context

Theories of Temperament

Proximal Mechanisms

Disorders Related to Temperament

Temperament Over the Life Course

Summary

Key Terms

Chapter 7: Personality

Distal Context

Proximal Mechanisms

Personality Over the Life Course

Summary

Key Terms

Chapter 8: Cognition and Learning

Distal Context

Intelligence

Learning

Motivation

Interpersonal Neurobiology

Technological Advances to Understand the Mind

Cognitive Development Across the Life Course

Summary

Key Terms

Chapter 9: Social Exchange and Cooperation

Distal Context

Game Theory

Cooperation

Homans's Elementary Forms of Social Behavior

Emotion and Social Exchange

Experiments Involving Social Exchange

Reciprocity and Fairness

Neuroscience of Social Exchange and Cooperation

Power

Altruism

Exchange and Cooperation Over the Life Course

Summary

Key Terms

Chapter 10: Social Networks and Psychosocial Relations

Distal Context

Attachment: The Developing Self in the Context of Others

Social Relationships Across the Life Course

Social Networks: Peers, Family, and Community

Current Innovations in Community Building

Hierarchies and Power

Summary

Key Terms

Chapter 11: Technology

Distal Context

Technology and Society: Major Theoretical Frameworks

Technological Determinism

Technology and Its Distribution in a Society

Computers and Information Technology

Social Media

The Dark Side of Internet and Computer Use

Integrating Technology Into Behavioral Interventions

Technology Over the Life Course

Summary

Key Terms

Chapter 12: The Physical Environment

Distal Context

Geography and Economics Intersect

Diffusion of Religion Around the Globe

Ecosystems Theory

Steward's Cultural Ecology

Climate

Natural Disasters

Urban Ecology

Built Environment

The Effect of Setting: Jails and Prisons

Office Spaces and Productivity

Tools for Spatial Analysis

Spatial Effects and Variation Over the Life Course

Summary

Key Terms

Chapter 13: Institutions

Background and Distal Context

Proximal Mechanisms

Example: Conflict and Energy

Juvenile Justice Through Supreme Court Decisions

Impact of Economic Institutions on Human Behavior

Institutions Over the Life Course

Summary

Key Terms

Chapter 14: Belief Systems and Ideology

Distal Context

Patriotism and Nationalism

Religious Ideology

Race, Gender, and Class Ideologies

What Is Culture?

A Brief History of the Culture Concept

The Culture Concept in Classical Antiquity

Practice Implications

The Problem of Confirmatory Bias

Belief Systems and Ideology Over the Life Course

Summary

Key Terms

Glossary

References

Preface

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Author Index

Subject Index

Praise for Human Behavior: A Cell to Society Approach

 

Human Behavior: A Cell to Society Approach represents the most contemporary knowledge about the role both biology and technology play in human development and behavior. The material is represented in a way that is intellectually challenging yet accessible, and the use of the case studies, spotlight topics, and expert's corner keep the reader interested and engaged.”

Rachel A. Fusco, Assistant Professor
University of Pittsburgh, School of Social Work

“The authors provide social workers with an essential tool to navigate the new cross-disciplinary environment. Their take on HBSE content will enable students to communicate with researchers and practitioners across disciplines about the complex factors impacting health and well-being in today's world.”

Sarah Gehlert, PhD
E. Desmond Lee Professor of Racial and Ethnic Diversity at the Brown School of Social Work, Washington University

Human Behavior: A Cell to Society Approach provides social workers in training with foundational knowledge about human adaptation to the social environment from neurobiological through psychosocial perspectives across the life-cycle. Information and illustrations are well organized and clearly communicated, derived from classic and cutting-edge theory and research, and include case vignettes and attention to technology. This knowledge broadens reader understanding of client, family and community, and social problems, and prompts consideration of multiple congruent intervention approaches.”

Kurt C. Organista, PhD, Professor,
University of California, Berkeley, School of Social Welfare

“This bold new approach brings Human Behavior in the Social Environment into the 21st Century. Highly recommended.”

Paul T. Shattuck, PhD
Associate Professor
Brown School of Social Work, Washington University

Title Page

Preface

We feel there is a need for an evolution, if not revolution, in the human behavior and the social environment (HBSE) curriculum. Despite the widespread acceptance of the person-in-environment conceptualization, there are few advanced approaches that can truly delineate this overall metaphor in a cutting-edge transdisciplinary scientific framework. We propose a new integrative perspective, a cell to society approach, which represents a leap forward in the advancement of human behavior for the helping professions.

Specifically, a cell to society approach to HBSE advances an integrative understanding of human behavior from the cellular level to global institutions, and across human history (e.g., Bowles, Choi, & Hopfensitz, 2002; Fuentes, 2009). The transdisciplinary and historical appreciation of human life experience cultivates an intellectual understanding of behavior beyond what has typically been put forth. Indeed, we know that human behavior is influenced by myriad factors, spanning from communication among neurons that influence brain structure and behavioral regulation to the ways in which structural and environmental conditions and socioeconomic life changes shape life course trajectories over time (e.g., Spear, 2010; Turrell, Lynch, Leite, Raghunathan, & Kaplan, 2007). The cell to society approach can account for complex, multilevel processes that shape human development and well-being. For instance, we can use the approach to reach across disciplines to consider how relationally based self-regulation capacity in infancy, as influenced by institutional and structural conditions, can lead to differential developmental trajectories. The cell to society approach also can enable the understanding of the social networking structure of human service organizations and its impact on persons and populations, as well as geospatial disparities in health and well-being. Although many schools and departments of social work often split the HBSE course sequence into two courses reflecting micro or individual-level orientation and a macro or systemic societal focus, we take a decidedly integrative, biosocial, multiple-level-of-influence approach that allows students to appreciate the transactional forces that shape life course opportunities and challenges among diverse populations in the United States and around the world. Our perspective allows us both to connect students to the roots and principles of the profession and simultaneously to move them forward into the transdisciplinary scientific landscape, where integrative and dynamic modeling of health and well-being of the human condition will transform the ways in which social work professionals work with clients and client systems.

Although a developmental lens is important as a guiding framework for understanding client systems, our current HBSE curricula often have relied solely on this approach at the expense of integrating a more holistic person-environment perspective that is more compatible with our profession's unique principles. Thus, students' criticism has largely been that they already know this information from their undergraduate social sciences classes. What typically follows, then, becomes either earnest attempts to be waived out of the class or to otherwise petition to get out of taking the sequence. However, we see HBSE foundation coursework as an essential core of the MSW curriculum—in fact, one of the most important parts of the curriculum in social work education. It is a place where micro, meso, and macro dimensions can be truly integrated. We see HBSE as a forum and opportunity for students to become transformational thinkers and leaders in the profession. The result is a stronger intellectuality and credibility for the profession as a whole.

We have tremendous respect for those who teach human behavior and HBSE courses. The sheer magnitude of material that is potentially involved could literally encompass multiple courses. Indeed, many of us spend our entire academic careers on these topics yet often feel like we have hardly scratched the surface of all there is to know. Thus, we recognize that there is a tension between being comprehensive and achieving depth. Our goal was to accomplish both. However, we do so not within a conventional textbook style, but one that is meant to be read. Although we cover the Educational Policy and Accreditation Standard (EPAS) competencies and include figures, tables, and informational inserts such as spotlight topics in each chapter, the emphasis is more on engaging concepts and translating research. Our signature Expert's Corner in each chapter highlights the key scholars in a respective discipline on a human behavior topic, bringing together a transdisciplinary network of experts from across the biological and social sciences.

Although this book advances a theoretical perspective, it is ultimately rooted in the principles of empirical science and the evidence-based paradigm. Throughout we review research studies from leading scientific journals to firmly tie cell to society rubrics to leading-edge data. The cell to society perspective is predicated upon a viewpoint of scientific research consisting of empirical and conceptual aims. Empirical aims seek to gather data or facts and to link theoretical constructs with them in a cycle of exchange toward greater interpretation, intervention, and renewed data collection. Conceptual aims relate to implicit or explicit worldviews, assumptions, and strategic commitments that occur prior to theoretical construction and empirical discovery. In science, conceptual aims are usually neglected, either unconsciously or consciously. However, these underlying concepts or ideas still remain to influence scientific findings and theories. As such, rendering them explicitly increases overall clarity for the benefit of others.

Paradigms are essentially worldviews that set forth rules that govern the conduct of knowledge acquisition. They help people in particular arenas solve problems and interpret the world. Can the cell to society approach be evaluated given that it is more of a paradigm? Comparisons and evaluations of paradigms can be performed based on criteria such as logical structure and internal consistency, scope, parsimony, novelty and innovation, and empirical tests or outcomes of scientific theories that emanate from them. Further, paradigms can be examined to the extent they show where and how to intervene and help others and organize preexisting data (Magnarella, 1993). From the outset we believe it is important to clearly render the major assumptions that guide this book. The following five assumptions and strategies serve as a starting point for elaborating the cell to society approach: (a) human behavior and social life are too complex to efficiently understand without a coherent outline or conceptual framework, (b) human behavior is both determined and allows for choice and agency, (c) it is advantageous for helping professionals to utilize scientific models aimed at ameliorating human problems, (d) some paradigms can explain and direct interventions better than others, and (e) human social problems are shaped largely by the practical problems imposed by collective survival.

In our view, social work perspectives and values are compatible with the aims of the cell to society approach. This compatibility is based upon a consistent theme of scientifically understanding the origins of individual and social phenomena within the boundaries or constraints imposed by biology, environment, human institutions, and ideas. Such understanding is cultivated not only for the sake of knowledge, but also to increase human happiness, decrease human suffering, and promote social justice. The lesson is that scientifically credible knowledge can guide more effective solutions. Our hope is that the cell to society approach elaborated in this book provides a foundation for helping professionals to be sophisticated, credible, and (most important) effective agents of social welfare and social change.

Acknowledgments

There are a number of people we would like to thank for seeing this book to its completion. First, we would like to thank the team at Wiley, including Rachel Livsey and Amanda Orenstein. They were a pleasure to work with from beginning to end. We would also like to thank research assistants Kristen Peters, for her hard work on several tedious tasks, and Davina Abujudeh, for her input on case studies. Finally, we appreciate the many reviewers who gave their time to read and make numerous thoughtful comments, including Rachel Fusco, Kurt Organista, Carmen Ortiz-Hendricks, Emily Nicklett, Paul Shattuck, Sarah Gehlert, Christy Sarteschi, Brandy Maynard, Christopher Salas-Wright, Michael Mancini, and Shannon Cooper-Sadlo. The book is far better because of their input.

Human Behavior and the Core Competencies (EPAS)

At the outset we would like to note that this book provides coverage of the 10 core competencies in the Educational Policy and Accreditation Standards, with special emphasis on knowledge of human behavior in the social environment (see Item 7). However, this book exceeds and transcends these core competencies by using the innovative and cutting-edge cell to society approach. The grid at the end displays the 10 competencies and their coverage across the 14 chapters.

10 Core Competencies (CSWE Educational Policy & Accreditation Standards)

1. Identify as a professional social worker and conduct oneself accordingly. (Competency 2.1.1)
2. Apply social work ethical principles to guide professional practice. (Competency 2.1.2)
3. Apply critical thinking to inform and communicate professional judgments. (Competency 2.1.3)
4. Engage diversity and difference in practice. (Competency 2.1.4)
5. Advance human rights and social and economic justice. (Competency 2.1.5)
6. Engage in research-informed practice and practice-informed research. (Competency 2.1.6)
7. Apply knowledge of human behavior and the social environment. (Competency 2.1.7)
8. Engage in policy practice to advance social and economic well-being and to deliver effective social work services. (Competency 2.1.8)
9. Respond to contexts that shape practice. (Competency 2.1.9)
10. Engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities. (Competency 2.1.10a–d)

Chapter 1: Introducing the Cell to Society Framework

Chapter 1 covers all 10 of the EPAS core competencies, with attention to distinguishing, appraising, and integrating multiple sources of knowledge for use in professional decision making to advance the goals of the profession. The chapter helps readers critically analyze the complexities of how culture and socioenvironmental factors shape life-course development. It draws on the empirical, theoretical, and practice literature to help readers comprehensively understand the needs of social work populations.

Chapter 2: Genes and Behavior

Chapter 2 focuses on EPAS Competencies 1, 2, 3, 6, 7, and 9, with specific attention to using knowledge from the biological and behavioral/social sciences to guide assessment and ethical reasoning in social work practice.

Chapter 3: Stress and Adaptation

Chapter 3 focuses on EPAS Competencies 1, 3, 4, 5, 6, 7, 9, and 10, with attention to the role of oppression and marginalization on developmental opportunities across the life course. It emphasizes the detrimental effects of economic and social injustice on human development.

Chapter 4: Emotion

Chapter 4 focuses on EPAS Competencies 1, 3, 6, 7, 9, and 10, with attention to the use of evidence-based practice to guide assessment, and on judiciously using theories from the biological, behavioral, and social sciences to understand the developmental challenges and opportunities of client populations.

Chapter 5: Executive Functions

Chapter 5 focuses on EPAS Competencies 1, 3, 5, 6, 7, 9, and 10, with attention to using the scientific knowledge base to shape the effective delivery of services.

Chapter 6: Temperament

Chapter 6 focuses on EPAS Competencies 1, 2, 3, 4, 6, 7, 9, and 10, with attention to the importance of developing culturally informed skills that promote equity and social inclusion.

Chapter 7: Personality

Chapter 7 focuses on EPAS Competencies 1, 3, 4, 6, 7, 8, 9, and 10, with attention to differential diagnosis and a focus on the interpersonal dynamics and contextual factors that shape professional relationship development.

Chapter 8: Cognition and Learning

Chapter 8 focuses on EPAS Competencies 1, 3, 6, 7, 8, 9, and 10, with attention to applying the scientific knowledge base to guide assessment and service delivery for diverse social work populations. It emphasizes contextual influences on human development and learning potential.

Chapter 9: Social Exchange and Cooperation

Chapter 9 focuses on EPAS Competencies 1, 3, 4, 5, 6, 7, 8, and 9, with attention to examining how power and privilege impact social work practice across systems; and on identifying how oppression and discrimination influence client-system behavioral functioning.

Chapter 10: Social Networks and Psychosocial Relations

Chapter 10 focuses on EPAS Competencies 1, 3, 5, 6, 7, 8, 9, and 10, with attention to understanding current human development and family formation trends across practice contexts, and implications for social work practice.

Chapter 11: Technology

Chapter 11 focuses on EPAS Competencies 1, 3, 4, 6, 7, 8, 9, and 10, with attention to applying relevant scientific and technological processes to work with client populations. It also develops critical assessment skills to effectively meet the changing needs of diverse social work populations.

Chapter 12: The Physical Environment

Chapter 12 focuses on EPAS Competencies 1, 3, 4, 5, 6, 7, 8, and 9, with attention to understanding community development trends across contexts and the implications for developing and evaluating programs and policies.

Chapter 13: Institutions

Chapter 13 focuses on EPAS Competencies 1, 3, 5, 6, 7, 8, and 9, with attention to understanding how laws, policies, and governing agreements influence social work clients' life course trajectories. Attention is focused on identifying and engaging relevant institutional stakeholders to advocate for social and economic well-being.

Chapter 14: Belief Systems and Ideology

Chapter 14 focuses on EPAS Competencies 1, 2, 3, 4, 5, 6, 7, 8, and 9, with attention to how the political process and social ideologies contribute to advancing or impeding human development. Attention is focused on evaluating the strengths and weaknesses of theoretical perspectives applied in macro practice.

The Cell to Society Perspective and EPAS Core Competencies

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About the Authors

Michael G. Vaughn is Professor in the School of Social Work at Saint Louis University. A practitioner for many years in the areas of youth development and delinquency prevention, homelessness, and economic self-sufficiency, he continues to provide consultation and service to numerous community and government agencies. His transdisciplinary research, composed of more than 200 peer-reviewed articles, books, and book chapters, has been published across outlets in numerous fields including social work, psychology, psychiatry, criminology, epidemiology, medicine, and general social science.

Matt DeLisi is Professor and Coordinator of Criminal Justice Studies and Affiliate with the Center for the Study of Violence at Iowa State University. Professor DeLisi has nearly 20 years of practitioner and consultant experience in the fields of criminal justice, juvenile justice, and social/human services. A Fellow of the Academy of Criminal Justice Sciences, Professor DeLisi has authored more than 200 scholarly publications across several fields in the social and behavioral sciences. A reviewer for nearly 100 journals, Dr. DeLisi is Editor-in-Chief of The Journal of Criminal Justice.

Holly C. Matto, Associate Professor, received her MSW from the University of Michigan and her PhD from the University of Maryland. Since 2000, Dr. Matto has taught theories of human behavior, direct practice, and research methods in social work master's and doctoral programs. Dr. Matto has more than 15 years of research and clinical social work practice experience in the addictions field. Her research focuses on both assessment practices and interdisciplinary treatment interventions with diverse substance abuse populations. She is currently conducting a clinical trial with Inova Fairfax Hospital and Georgetown University that uses neuroimaging technology to examine functional and structural brain change associated with behavioral health interventions for substance-dependent adults.

Chapter 1

Introducing the Cell to Society Framework

Solving major social problems and making positive changes in the lives of individuals, groups, communities, and societies is a complex task. Humans are a highly social species whose behavior is impacted by biological, psychological, and broad environmental factors. People in the helping professions have the enormously difficult task of intervening across a multitude of levels through a range of practices and policies. To do so effectively, social workers, counselors, public health workers, and other helping professionals require a deep understanding and appreciation of human behavior. Although it has been recognized in social work and related professions that human behavior is a biopsychosocial phenomenon and that people interact within environments, a stronger elaboration of these principles for the benefit of social work is needed. We use the term cell to society to denote that human behavior is impacted by processes ranging from those occurring at the smallest levels of biological organization to the largest levels of social and physical environmental systems. Concomitant with this task is the need to root these theoretical principles in the best scientifically available data. This book combines these two major tasks within an overarching framework to advance the overall effectiveness of helping others.

Many years ago, esteemed scholar Kurt Lewin (1936) wrote a simple equation, B = f(I, E), that simply means behavior (B) is a function (f) of the interaction between the individual (I) and the environment (E). Although the equation is simple, what it entails about the individual and the environment is not. There are many layers to the individual (e.g., biological and psychological) and environment (e.g., climate and political) that are very difficult to apprehend without a map or blueprint to guide the effort. The cell to society framework demonstrates how multiple units of analysis and disciplinary perspectives can be brought to bear for understanding and intervening in human behavior across levels of analysis. From molecular genetics to neuropsychological functioning to psychological traits and conditions to behavior within the modifying effects of technology and environment, the cell to society approach incorporates research from the natural and biological sciences and the social sciences to produce a comprehensive and scientifically accurate account of empirical phenomena for the helping professions.

The cell to society framework is broad and expansive, beginning with genes and moving to larger levels of physiological organization that impact human behavior such as stress, emotion, and executive functions in the human brain. We order these domains to reflect their evolutionary development. For example, emotional centers of the human brain evolved prior to development of rational thinking areas (MacLean, 1990; Massey, 2002). These biologically based domains influence the development of temperament, personality and micro-level social exchanges. However, it should be kept in mind that human development and behavior are plastic, meaning that external input from the environment molds and shapes us in myriad ways. Therefore, the cell to society framework goes beyond individual, biologically based domains to address successive levels of macro-level environmental influences that surround the individual. These levels include the nature of exchange and cooperation between individuals, social networks and psychosocial relations, technology, the physical environment, and belief systems and ideologies. These components are very necessary for collective survival, as every society must produce for itself (and reproduce itself), doing so using technology, institutions, and associated belief systems and ideologies that interact with specific environments.

The cell to society framework we are proposing is justified by virtue of the multidimensional nature of human behavior and the need for a general synthesis that incorporates biological and sociocultural science in a coherent fashion. The cell to society approach is therefore a conceptual strategy designed to integrate cutting-edge developments from multiple disciplines within a biological and cultural evolutionary framework for guiding and advancing knowledge for the helping professions (e.g., social work and public health). As a synthesis, the cell to society framework is ultimately based on seminal research and numerous empirical studies drawn from such diverse fields as anthropology, behavior genetics, neurobiology, cultural geography, economics, psychology, primatology, and macrosociology. The cell to society framework begins at smaller units at the person level (e.g., genes) and builds outward to larger units such as the physical environment and institutions (see Figure 1.1). Unlike many models, the cell to society approach is of broad scope and can inform clinical, individual, community, and global level frameworks.

Figure 1.1 Major Domains in the Cell to Society Approach

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In this chapter, we delineate the major conceptual and theoretical underpinnings of the cell to society framework. Namely, we discuss the importance of employing theories and research from multiple disciplines, incorporating biological and cultural evolution, embracing systems thinking and complexity, utilizing science and the scientific method, and taking a life-course perspective. We then provide an overview of the domains that represent the major areas of the cell to society approach, which will be the focus of subsequent chapters: genes and behavior, stress and adaptation, emotion, executive functions, temperament, personality, cognition and learning, exchange and cooperation, social networks and psychosocial relations, technology, the physical environment, and belief systems and ideology.


Case Study: Malia's Different Abilities
Malia is 52 years old and has a spinal cord injury—well, technically, amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease.1 All Malia really cares about, though, is walking normally again (without so much tripping and stumbling), and ceasing to be such a burden to her family. Although Malia's speech is becoming slurred and she is progressively finding it difficult to swallow, frequent visits to her nutritionist have helped her by adjusting her diet. She does find the muscle weakness and cramps, fatigue, and pain intolerable at times, but her care team works together to help her when she has flare-ups like this. Although she has difficulty managing the small motor movements required for getting dressed, she winnowed out her wardrobe, retaining only the easiest styles. She has replaced the fancier garments of her recent past, those with buttons, zippers, or fancy fasteners, with simple pull-on shirts and sweaters that help her maintain independence in dressing herself, at least for now. So far, Malia has not lost any cognitive functioning; she is aware of everything that is going on with her bodily functions and has not suffered any memory deterioration or thinking problems. However, when you ask her how she's feeling, she will tell you that she feels increasingly isolated and “down” much of the time. She is not sure if it is depression, but she knows her motivation has decreased and her sense of pleasure in life and relationships is not as full as it once was. At one point recently, when she returned home from a doctor's visit, she expressed the frustration and disappointment of her progressive illness like this: “I feel like I'm the manager of a losing baseball team. You have to show up, but you know you're going to lose.” Some days just mustering the motivation to get up and out of bed can be almost too much for her to bear. Other days, she says, she has a “sunnier disposition” and better perspective on managing her illness.
What helps her, you might ask? Malia says it helps to avoid thinking about the tube feeding and respiratory failure that's bound to come, and to “distract herself from the inevitability” of this incurable illness. She also says lots and lots of support has been very helpful. And she doesn't mean the kind of support that well-intentioned people often give her: help with the door, sympathetic looks, trying to talk for her as she slurs her speech, or underestimating and overlooking the functional capacities she still has. The kind of support that Malia says really helps her is the genuine, silent patience that comes from those friends who slow down and take their time with her. Malia likes best the kind of support that does not underestimate her functional capacity, but does not overlook her functional limitations, either; the kind that balances both, takes time for the relational connections, not just the tasks at hand, and appreciates her continued contributions as a partner in the friendship, as opposed to a dependent to be pitied and cared for. Of course, other, more concrete and tangible levels of support that come from her multidisciplinary care team, like medication to help control her pain, and a computer-based communication aid to help when her speech becomes increasingly difficult to manage, are also helpful to her. Malia has experienced some physical and mental success (muscle management and improved nighttime sleep, respectively) by engaging in physical therapy–directed exercises, such as simple walking and swimming regimens and range of motion and stretching exercises. She has authorized the occupational therapist to make some limited structural alterations to her home, such as a ramp to her door in anticipation of the day she will become reliant on a wheelchair for her mobility, but she is reluctant to do much more than that right now, to keep the environment as a space that reminds her of her independence and, as she puts it, so that the place doesn't end up looking like “the home of a dying disabled person!”
Malia says the social workers she has come in contact with have been very helpful. They have helped her and her family members better understand the medical, emotional, and financial dimensions of the disease, and as she says, they have helped her plan for her future while still helping her live in the moment, day to day, with dignity and purpose. She said her social workers constantly work with her toward her goal of living interdependently and taking what she needs from those who can help, while acknowledging and maximizing what she still has control over. Her social workers have worked with legal counsel in helping her draft a durable power of attorney and a living will, and have located ALS support groups for her caregivers. Her care team has told her about complex rehabilitation technology (CRT): medically necessary customized technology, typically customized mobility devices and services used by people with disabilities, which often require continuous technology assessment, evaluation, and adjustment to tailor the products to individual needs. These are the type of mobility devices she will need in the near future, and they are different than other types of standard medical devices in their specialization and individualized fit requirements. The customized process of product alignment, assessment, continuous evaluation, and adjustment will be done by her interdisciplinary team, which includes a rehab technology professional certified by the Rehabilitation Engineering and Assistive Technology Society of North America. Her social workers have told her that professional groups like these are encouraging policy makers to make Medicare changes that would offer unique coverage for CRTs to better meet the needs of people requiring these devices, as part of the Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012. Advocacy efforts like Roll on Capitol Hill, the United Spinal Association's annual legislative advocacy event, address issues like this that impact the independence and well-being of those living with spinal cord injury and disease.
Malia's doctors have told her that scientists are not certain of the origins of ALS, but some scientific hypotheses are currently being explored: too great an accumulation of free radicals, autoimmune response, or too much glutamate in the bloodstream. Other scientists, like Dr. Moses Chao, professor of cell biology, physiology, neuroscience, and psychiatry at the NYU School of Medicine and past president of the Society for Neuroscience, suggest that important new cutting-edge neuroscientific studies are showing successful stimulation of the spinal cord through electrical, chemical, and physical (treadmill) interventions. Dr. Chao believes that such interventions “stimulate the neurons in the spinal cord” in a way that facilitates locomotion and activates the motor system. Malia knows she doesn't have much time, according to current statistics. She hopes these scientific discoveries can be advanced in a timely manner so she might benefit from them. But if she ends up dying before that time, her only hope is that she can live out her final months, weeks, and days in dignity and with those she loves most.
In this case example, we saw how Malia's physical health affected her thinking patterns around what it means to be independent, her emotions and ensuing struggle with mild depression, and her interpersonal relationships as she worked with her professional care team and informal caretakers to try to maintain positive supporters in her life who could help her with the emotional and instrumental aid she needed to get through each day. As Malia's social workers can attest, existential and spiritual questions will continue to emerge as end-of-life care (hospice services) are introduced when Malia's degenerative condition progresses to its final stage. We saw how technological advancements, such as customized rehab technologies that include individually tailored mobility and communication devices, can enhance and prolong independence for those who need such assistance. And we saw how legislative advocacy, such as the United Spinal Association's annual Roll on Capitol Hill, can increase awareness and bring about policy changes, such as advocating for a new Medicare benefit category for conditions that require these customized products and services.
We have also seen a lot of systems at work. We have seen that the human body is a system where the physical outcomes associated with a medical condition can influence the person's psychological response (mood and emotion); and how a person's mood can, in turn, influence the behavioral motivation to make decisions about one's health condition. We have seen other systems at work as well. Malia is part of a family system, some members of whom have taken on the caretaking role to help Malia manage her illness. The strain of caregiving may lead such family members to seek support for themselves, by engaging in an ALS support group where they may receive educational, emotional, and interpersonal support for their care of Malia. The social workers working with Malia are also part of a multidisciplinary care team, a system made up of helping professionals from unique and specialized disciplines organized to help with Malia's physical, psychological, familial, and financial needs. Understanding the patterns of interactions within this system (e.g., the way members from each discipline communicate information and ideas to the rest of the team) will help members influence the way in which the care plan is developed and enacted. Malia also is indirectly affected by the political system. Because Malia is struggling with ALS in 2012, she benefits from the Americans With Disabilities Act of 1990. But because Malia is struggling with ALS in 2012, she currently is not a beneficiary of a separate Medicare benefit for CRT, a change currently on the legislative advocacy agenda of groups such as the United Spinal Association.
Critical Thinking Questions:

On the Importance of Transdisciplinary Approaches

In 1974, the late anthropologist Marvin Harris, commenting on the need to traverse and transcend multiple disciplinary fields to understand the puzzles of human behavior, wrote, “Nothing in nature is quite so separate as two mounds of expertise” (Preface, p. vii). By this, Harris was referring to the tendency of scientific disciplines to develop bodies of knowledge and understanding that are often all but entirely independent of the knowledge of other disciplines. For instance, what psychology has to say about child or adolescent development may be markedly distinct from the perspectives arising from sociology or anthropology. In developing the cell to society framework in this book, we draw from the insights of Harris and other scholars who advocate the utility of an approach that draws from multiple disciplines. We ignore disciplinary boundaries quite simply because human behavior involves processes that are influenced by genetic, physiological, psychological, political, economic, and environmental factors. The history of the study of human behavior is replete with a broad literature strongly supporting the notion that factors exist that occur at multiple levels of analysis (i.e., genetic, cellular, hormonal, individual, family, community, nation). Because the study of human behavior is multidimensional in nature, its understanding necessarily will involve a host of disciplines (e.g., genetics, neuroscience, endocrinology, psychology, sociology, geography). This joining together and transcendence of disciplines toward a common understanding of complex phenomena can be termed transdisciplinary.

Transdisciplinary approaches imply a wider swath of knowledge than the term interdisciplinary and are gaining ascendancy across scientific fields because of their potential ability to solve problems that cut across multiple domains. Indeed, the Office of Behavioral and Social Sciences Research (OBSSR) has the mission of integrating behavioral and social science research across the many institutes of the National Institutes of Health, the largest funder of scientific research in the United States. The OBSSR uses a framework that organizes well-being across a continuum of biological and social factors that occur over the life course. Levels of organization range from the genomic to the global economic, with such domains as organ and community levels in between. One example of employing a transdisciplinary approach on a large scale is the funding of 17 mind-body centers in health. Such mind-body centers focus on fostering wellness and treating disease within a framework that takes seriously the connections between our psychological, social, and vocational wellness and our overall health and well-being. This effort involves the National Cancer Institute, the National Institute on Aging, the National Institute of Drug Abuse, and several other national institutes with research centers at several universities, including Columbia University, University of California at Berkeley, University of Utah, University of Pittsburgh, and many others, each with a focused investigative topic and ongoing information sharing.

What are the consequences of not using a transdisciplinary approach? Just as Harris has pointed out that nothing in nature is quite as separate as two mounds of expertise, one of the consequences of not using transdisciplinary reasoning is the myopic state of explaining human behavior strictly in terms of a unidisciplinary focus (e.g., just sociology). For instance, trying to understand a complex phenomenon such as interpersonal violence exclusively from a sociological perspective can lead to conclusions that fail to capture the entire problem. Simultaneously considering the nature of violence from the perspectives of behavioral genetics, psychology, anthropology, and even history can facilitate a much more nuanced and multifaceted understanding of why human beings sometimes hurt one another. Additional consequences include a lack of person–environment integration, which prevents isolated studies from being linked together, limits use of new methods, and keeps theories arising from various fields of knowledge fields from communicating with one another. Such communication breakdowns bring to mind the image of two ships passing in the night, both laboring strenuously to advance in their desired direction but entirely unaware of one another's presence and the benefits their communication—and collaboration—might yield. Although scholars often acknowledge the necessity for transdisciplinary approaches for comprehending and intervening in complex human problems (e.g., Caspi & Moffitt, 2006; Laub, 2006), overly narrow disciplinary training and indoctrination often hampers the effective execution of transdisciplinary knowledge gathering, which in turn inhibits theory development and testing. This is not to state that some disciplinary fields have not made major contributions on their own or that any solution is merely the sum of viewpoints from different fields. For some problems, certain disciplines may have more to offer. Despite the dominance of discipline-specific socialization and the tendency to view human behavior from a “strictly sociological,” “psychological,” or “biological” point of view, there is a growing realization that singular perspectives, although useful, are ultimately stagnant and limited.

With respect to social work and the helping professions, a cell to society conceptual framework that can begin to organize theories and research in productive ways is needed to account for individuals' biological structure and dynamics across successive levels of context. This framework also ought to be able to form links across disciplines and identify points of intervention at both the individual and population levels. Although individuals in the helping professions may not be able to intervene across the many levels needed, possessing a fuller understanding and appreciation of human behavior as a transdisciplinary experience allows helping professionals to look beyond their areas of expertise to see new possibilities and collaborations for effecting change at various levels.

Change and Adaptation: Biological and Cultural Evolution

Evolution can be an intimidating concept and often a controversial one when invoked in the study of human behavior. Most people typically think of biology when they see or hear the term evolutionTable 1.1