Many theories have been developed from the social perspective, but one that has been particularly significant is James Averill's, which will be reviewed in this section , , According to Averill, "an emotion is a transitory social role a socially constituted syndrome that includes an individual's appraisal of the situation and that is interpreted as a passion rather than as an action" , p. These transitory social roles and syndromes are generated by social norms and expectations, and so, by these means, social norms and expectations govern an individual's emotions.
Averill employs the notion of a syndrome to indicate that each emotion like fear, anger or embarrassment , covers a variety of elements. A syndrome is a collection of all of the appropriate responses of a particular emotion, any of which may at certain times constitute an emotion response, but none of which are essential or necessary for that emotion syndrome. It also consists of beliefs about the nature of the eliciting stimuli and perhaps some natural that is, non-social elements. All of these various components are linked together for an individual by principles of organization.
These principles are what allow the various elements to be construed coherently as one particular emotion For example, grief is a syndrome. Every individual who understands this syndrome may at different times have the following grief responses: shock, crying, refusing to cry that is, keeping a stiff upper lip , declining to eat, neglecting basic responsibilities, and so on. Further, the conditions that the individual understands should elicit grief are also part of this syndrome: the death of a loved one, the loss of a valuable object, a setback at work, rainy days, and so forth.
Bringing these parts together into one coherent whole are the mental constructs that allow an individual to construe all of these various elements as grief. An individual labels both his response at a funeral and his response to his favorite baseball team losing as grief, even if the two responses have nothing in common.
Additionally, with an understanding of the grief syndrome an individual can judge when others are experiencing grief and whether another individual's grief is genuine, severe, mild, and so on.
The idea of emotions as transitory social roles is distinct from the notion of a syndrome, but characterizes the same phenomena, in particular, the eliciting conditions and the responses for an emotion. In Averill's theory, transitory social roles are the roles that individuals adopt when they choose to play a particular part in a situation as it unfolds. That being said, although the individual chooses the role, Averill stresses that the emotional responses are interpreted by the agent as passive responses to particular situations, not as active choices.
The transitory social roles are rule governed ways of performing a social role, and so individuals adopt a role that is consistent with what a given situation calls for. For example, a grief response is appropriate at a funeral, but different grief responses are appropriate at the burial and at the service before the burial. In order to have an emotion response that is consistent with social norms and expectations, the individual must understand what the role they are adopting means in the context in which it is used.
Summarizing these different resources from Averill's theory, the syndromes are used to classify emotions and demarcate them from each other. The transitory social roles are useful for explaining how the emotion responses relate to the society as well as the specific social context. Considering an emotion as a syndrome, the individual has a variety of choices for the emotion response.
The transitory social role imposes rules that dictate which response is appropriate for the situation. For example, the possible responses for anger may include pouting, yelling, hitting, or perhaps no overt behavior at all. In a particular situation, say a baseball game, a player may adopt a social role that includes pushing the umpire as an anger response. Yelling at the umpire would have been another role the player could have adopted. However, social norms and expectations dictate that pouting in this situation would not be an appropriate response. The third category of theories contains those that attempt to describe the emotion process itself.
Generally speaking, the emotion process begins with the perception of a stimulus, although in some cases the "stimulus" may be internal, for example, a thought or a memory. The early part of the emotion process is the activity between the perception and the triggering of the bodily response that is, the emotion response , and the later part of the emotion process is the bodily response: changes in heart rate, blood pressure, facial expression, skin conductivity, and so forth.
Most of the theories that will be considered in this section focus on the early part of the emotion process because—according to these theories—the specific emotion that occurs is determined during this part of the process. There is, however, disagreement about how simple or complex the early part of the emotion process might be, which has lead to competing cognitive and non-cognitive theories.
These two types of theories are discussed in this section, as is a third type, the somatic feedback theories. The cognitive theories contend that the early part of the emotion process includes the manipulation of information and so should be understood as a cognitive process. This is in contrast to theories that state that the generation of the emotion response is a direct and automatic result of perceiving the stimulus—these non-cognitive theories are discussed below.
Two observations demonstrate some of the motivation for the cognitive position. First, different individuals will respond to the same event with different emotions, or the same individual may at different times respond differently to the same stimulus. For example, one person may be relieved to be laid-off from her job, while a co-worker greets the same news with dread. Or one person may, as a young woman, be excited to be laid-off from her job, but several years later find being laid-off frightening. As the psychologists Ira Roseman and Craig Smith point out, "Both individual and temporal variability in reaction to an event are difficult to explain with theories that claim that stimulus events directly cause emotional response" , p.
Second, there is a wide range of seemingly unrelated events that cause the same emotion. None of these events share any physical feature or property, but all of them can cause the same response. Roseman and Smith provide an example using sadness and comment on the consequence of this example for a theory of emotion:. These examples pose problems for theories claiming that emotions are unconditioned responses to evolutionary specified stimulus events or are learned via generalization or association , p. Cognitive theories account for these two observations by proposing that the way in which the individual evaluates the stimulus determines the emotion that is elicited.
Every individual has beliefs, as well as goals, personal tendencies, and desires in place before the emotion causing event is encountered. It is in light of these factors that an individual evaluates the event. For example, different emotions will occur depending on whether an individual evaluates being laid-off as consistent with her current goals or inconsistent with them. Judgment theories are the version of the cognitive position that have been developed by philosophers.
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The basic idea, as Robert Solomon puts it, is that an emotion is "a basic judgment about our Selves and our place in our world, the projection of the values and ideals, structures and mythologies, according to which we live and through which we experience our lives" , p.
Judging in this context is the mental ability that individuals use when they acknowledge a particular experience or the existence of a particular state of the world; what Martha Nussbaum calls "assent[ing] to an appearance" , p. Taking anger as an example, in Solomon's theory, "What constitutes the anger is my judging that I have been insulted and offended " , p.
Nussbaum has a similar, but more detailed, description of anger as the following set of beliefs: "that there has been some damage to me or to something or someone close to me; that the damage is not trivial but significant; that it was done by someone; that it was done willingly; that it would be right for the perpetrator of the damage to be punished" , p. In some contexts, Nussbaum treats judgments and beliefs interchangeably and it is sometimes the case that a series of judgments constitute the emotion. Elaborating upon her example, Nussbaum points out how the different beliefs are related to the emotion.
She notes that, "each element of this set of beliefs is necessary in order for anger to be present: if I should discover that not x but y had done the damage, or that it was not done willingly, or that it was not serious, we could expect my anger to modify itself accordingly or recede" , p. Thus, a change in an individual's beliefs—in his or her way of seeing the world—entails a different emotion, or none at all. Judging is the central idea in these theories because it is something that the agent actively does, rather than something that happens to the individual.
This in turn reflects the judgment theorists' claim that in order to have an emotion the individual must judge evaluate, acknowledge that events are a certain way. Of course, one can make judgments that are not themselves emotions. For example, the judgment that the wall is red, or the judgment that the icy road is dangerous. One way to distinguish the judgments that are emotions from those that are not is to suggest like Nussbaum that the judgment must be based on a certain set of beliefs.
If those beliefs are present, then the emotion will occur; if they are not, then it won't. A second response is to be more specific about the nature of the judgment itself. The judgments related to emotions are, as Solomon says, "self-involved and relatively intense evaluative judgments The judgments and objects that constitute our emotions are those which are especially important to us, meaningful to us, concerning matters in which we have invested our Selves" , p. It is also important to note that, although these theories claim that emotion is a cognitive process, they do not claim that it is a conscious or a deliberative process.
As Solomon says, "by 'judgment', I do not necessarily mean 'deliberative judgment' One might call such judgments 'spontaneous' as long as 'spontaneity' isn't confused with 'passivity'" , p. For example, the judgment that I have been insulted and offended does not necessarily require any conscious mental effort on my part.
The last issue that needs to be addressed concerns the bodily response. All of the judgment theories state that judgments are necessary for an emotion. While these theories acknowledge that in many cases various bodily responses will accompany the emotion, many do not consider the bodily response an integral part of the emotion process.
Nussbaum believes that this can be demonstrated by considering the consequences of having the requisite mental states while not having a bodily response:. There usually will be bodily sensations and changes involved in grieving, but if we discovered that my blood pressure was quite low during this whole episode, or that my pulse rate never went above sixty, there would not, I think, be the slightest reason to conclude that I was not grieving.
If my hands and feet were cold or warm, sweaty or dry, again this would be of no critical value , p. Some judgment theorists are, however, more accommodating and allow that the bodily response is properly considered part of the emotion, an effect of the judgments that are made.
Thus, William Lyons describes his theory, the causal-evaluative theory, as follows:. The causal order is important, emotion is a psychosomatic state, a bodily state caused by an attitude, in this case an evaluative attitude , pp. In theory such as Lyons', the bodily response is considered part of the emotion process and the emotion is determined by the cognitive activity—the judgment or evaluation—that occurs Lyons , pp. Cognitive appraisal theories are the cognitive theories that have been developed by psychologists.
Like the judgment theories, the cognitive appraisal theories emphasize the idea that the way in which an individual evaluates or appraises the stimulus determines the emotion. But unlike the judgment theories, the cognitive appraisal theories do not rely on the resources of folk psychology beliefs, judgments, and so forth.
The cognitive appraisal theories also offer a more detailed analysis of the different types of appraisals involved in the emotion process. This section will focus on Ira Roseman's theory , which was one of the first cognitive appraisal theories. As an early contribution, Roseman's theory is in some ways simpler than more recent cognitive appraisal theories and so will serve as a good introduction.
Similar models are offered by Roseman, Antoniou, and Jose , Roseman , Lazarus , and Scherer [, ]. The basic theoretical framework is the same for all of the cognitive appraisal theories. The main differences concern the exact appraisals that are used in this process. Roseman's model, which is described in Table 3, has five appraisal components that can produce 14 discrete emotions.
The appraisal components and the different values that each component can take are motivational state appetitive, aversive , situational state motive-consistent, motive-inconsistent , probability certain, uncertain, unknown , power strong, weak , and agency self-caused, other-caused, circumstance-caused. The basic idea is that when a stimulus is encountered it is appraised along these five dimensions.
Each appraisal component is assigned one of its possible values, and together these values determine which emotion response will be generated. Table 3. The different appraisal components in Roseman's theory are motivational state, situational state, probability, power, and agency. The arrows point to the different values that each appraisal component can take.
Each emotion type takes the values that its placement in the chart indicates. When the emotion is placed such that it lines up with more than one value for an appraisal component e. Adapted from Roseman , p. For example, for joy, the situational state must be appraised as motive-consistent, the motivational state as appetitive, agency must be circumstance-caused, probability must be certain, and power can be either weak or strong.
Notice also that the different emotions all use the same appraisal components, and many emotions take the same values for several of the components. For example, in Roseman's model, anger and regret take the same values for all of the appraisals except for the agency component; for that appraisal, regret takes the value self-caused and anger takes other-caused. Just like the judgment theorists, Roseman and the other appraisal theorists say that these appraisals do not have to be deliberate, or even something of which the individual is consciously aware.
To illustrate this, consider someone accidentally spilling a glass of water on you versus intentionally throwing the glass of water on you. According to Roseman's theory, in the first case, the agency appraisal would most likely be circumstance-caused. In the latter case, it would be other-caused. As a result, different emotions would be elicited. Most people have had an experience like this and can see that determining these values would not take any conscious effort.
Descartes' Error: Emotion, Reason, and the Human Brain
The values are set outside of conscious awareness. Unlike some of the judgment theorists, all of the cognitive appraisal theorists agree that the appraisals are followed by a bodily response, which is properly consider part of the emotion process. Roseman suggests that once the appraisals have been made, a response that has the following parts is set in motion: 1 "the thoughts, images, and subjective 'feeling' associated with each discrete emotion," 2 "the patterns of bodily response," 3 the "facial expressions, vocal signals, and postural cues that communicate to others which emotion one is feeling," 4 a "behavioral component [that] comprises actions, such as running or fighting, which are often associated with particular emotions," and 5 "goals to which particular emotions give rise, such as avoiding some situation when frightened or inflicting harm upon some person when angered " , pp.
Non-cognitive theories are those that defend the claim that judgments or appraisals are not part of the emotion process. Hence, the disagreement between the cognitive and the non-cognitive positions primarily entails the early part of the emotion process. The concern is what intervenes between the perception of a stimulus and the emotion response. The non-cognitive position is that the emotion response directly follows the perception of a relevant stimulus. Thus, instead of any sort of evaluation or judgment about the stimulus, the early part of the emotion process is thought to be reflex-like.
The non-cognitive theories are in many ways a development of the folk psychological view of emotion. This is the idea that emotions are separate from the rational or cognitive operations of the mind: cognitive operations are cold and logical, whereas emotions are hot, irrational, and largely uncontrollable responses to certain events. The non-cognitive position has also been motivated by skepticism about the cognitive theories. The non-cognitive theorists deny that propositional attitudes and the conceptual knowledge that they require for example, anger is the judgment that I have been wronged are necessary for emotions.
Advocates of the non-cognitive position stress that a theory of emotion should apply to infants and non-human animals, which presumably do not have the cognitive capabilities that are described in the judgment theories or the cognitive appraisal theories. With respect to the non-cognitive theories themselves, there are two different approaches.
The first develops an explanation of the non-cognitive process, but claims that only some emotions are non-cognitive. The second approach describes the non-cognitive process in a very similar way, but defends the idea that all emotions are non-cognitive. Paul Ekman originally developed what is now the standard description of the non-cognitive process , and more recently Paul Griffiths has incorporated Ekman's account into his own theory of the emotions This section will review the way in which Ekman and Griffiths describe the non-cognitive process.
The next section will examine a theory that holds that all emotions are non-cognitive, a position that Ekman and Griffiths do not defend. Ekman's model is composed of two mechanisms that directly interface with each other: an automatic appraisal mechanism and an affect programme.
Griffiths adopts a slightly different way of describing the model; he treats Ekman's two mechanisms as a single system, which he calls the affect program. Griffiths also suggests that there is a separate affect program for each of several emotions: surprise, fear, anger, disgust, sadness, and joy , p. As noted in section one, Griffiths identifies this class of emotions, the affect programs, historically.
There must be an appraiser mechanism which selectively attends to those stimuli external or internal which are the occasion for activating the affect programme Since the interval between stimulus and emotional response is sometimes extraordinarily short, the appraisal mechanism must be capable of operating with great speed. Often the appraisal is not only quick but it happens without awareness, so I must postulate that the appraisal mechanism is able to operate automatically.
It must be constructed so that it quickly attends to some stimuli, determining not only that they pertain to emotion, but to which emotion, and then activating the appropriate part of the affect programme , p. The automatic appraisal mechanism is able to detect certain stimuli, which Ekman calls elicitors.
Elicitors can vary by culture, as well as from individual to individual. On a more general level, however, there are similarities among the elicitors for each emotion.
These are some of the examples that Ekman offers:. Disgust elicitors share the characteristic of being noxious rather than painful; One of the common characteristics of some of the elicitors of happiness is release from accumulated pressure, tension, discomfort, etc. Loss of something to which one is intimately attached might be a common characteristic of sadness elicitors.
Interference with ongoing activity might be characteristic of some anger elicitors , pp. Related to Ekman's notion of an elicitor, Griffiths suggests that this system includes a "biased learning mechanism," which allows it to easily learn some things, but makes it difficult for it to learn others. For example, it is easier for humans to acquire a fear of snakes than a fear flowers Griffiths, , pp. Furthermore, this system "would have some form of memory, storing information about classes of stimuli previously assessed as meriting emotional response" , p. The second mechanism that Ekman describes, what he calls the affect programme, governs the various elements of the emotion response: the skeletal muscle response, facial response, vocal response, and central and autonomic nervous system responses , p.
According to Ekman, this is a mechanism that "stores the patterns for these complex organized responses, and which when set off directs their occurrence" , p. Griffiths also points out that the affect programs recall that, in Griffiths' parlance, affect program refers to the whole system have several of the features that Fodor identified for modular processes. In particular, when the appropriate stimulus is presented to the system the triggering of the response is mandatory, meaning that once it begins it cannot be interfered with or stopped.
The affect programs are also encapsulated, or cut off from other mental processes , pp. Ekman appears to have been aware of the modular nature of this system when he wrote, "The difficulty experienced when trying to interfere with the operation of the affect programme, the speed of its operation, its capability to initiate responses that are hard to halt voluntarily, is what is meant by out-of-control quality to the subjective experiences of some emotions" , p.
Ekman and Griffiths both believe that this system accounts for a significant number of the emotions that humans experience, but neither think that it describes all emotions. Ekman says that the automatic appraisal mechanism is one kind of appraisal mechanism, but he also believes that cognitive appraisals are sometimes utilized.
Griffiths defends the view that the vernacular term emotion does not pick out a single psychological class. In addition to the affect program emotions, he suggests some emotions are cognitively mediated and some are socially constructed. An alternative view is that the emotion process is always a non-cognitive one. That is, a system like the one described by Ekman and Griffiths accounts for all occurrences of emotion.
This position is defended by Jenefer Robinson , , It is also similar to the theories developed by William James and, more recently, Jesse Prinz a , which are discussed in the next section. See Zajonc , for another important defense of the non-cognitive position. In her "exclusively non-cognitive" theory, Robinson claims that any cognitive processes that occur in an emotion-causing situation are in addition to the core process, which is non-cognitive.
She acknowledges that in some cases, an emotion might be caused by cognitive activity, but this is explained as cognitive activity that precedes the non-cognitive emotion process. For example, sometimes an individual's fear is in response to cognitively complex information such as the value of one's investments suddenly dropping.
In this case, a cognitive process will determine that the current situation is dangerous, and then what Robinson calls an affective appraisal will be made of this specific information and a fear response will be triggered. As Robinson describes this part of her theory, "My suggestion is that there is a set of inbuilt affective appraisal mechanisms, which in more primitive species and in neonates are automatically attuned to particular stimuli, but which, as human beings learn and develop, can also take as input more complex stimuli, including complex 'judgments' or thoughts" , p.
This explanation allows Robinson to maintain the idea that emotions are non-cognitive while acknowledging that humans can have emotions in response to complex events. This aspect of her theory can also be used to explain how an individual can be cognitively aware that he or she has been unjustly treated, or been unexpectedly rewarded, but not experience any emotion for example, anger, or sadness, or happiness —a situation which does seem to occur sometimes.
For example, the cognitive appraisal may indicate that the individual has been unjustly treated, but the affective appraisal will not evaluate this as worthy of an emotion response. Robinson also suggests that the non-cognitive process may be followed by cognitive activity that labels an emotion response in ways that reflect the individual's thoughts and beliefs.
The non-cognitive process might generate an anger response, but then subsequent cognitive monitoring of the response and the situation causes the emotion to be labeled as jealousy. Thus, the individual will take him or herself to be experiencing jealousy, even though the actual emotion process was the one specific to anger , The theories discussed in this section have varied in the importance that they place on the bodily changes that typically during the emotion process. The judgment theorist Martha Nussbaum is dismissive of the bodily changes, whereas the cognitive appraisal theorists that is, the psychologists hold that the bodily response is a legitimate part of the process and has to be included in any complete description of the emotions.
Meanwhile, all of the non-cognitive theorists agree that bodily changes are part of the emotion process. However, the cognitive theories all maintain that it is the cognitive activity that determines the specific emotion that is produced that is, sadness, anger, fear, and so forth. Ekman's automatic appraisal mechanism and Robinson's affective appraisals are both supposed to determine which emotion is generated. The further question is whether there is a unique set of bodily changes for each emotion.
The cognitive appraisal theorist Klaus Scherer claims that each appraisal component directs specific bodily changes, and so his answer to this question is affirmative ; Griffiths says that is likely that each affect program emotion has a unique bodily response profile , pp. Nevertheless, although answering this question is important for a complete understanding of the emotions, it does not greatly affect the theories mentioned here, which are largely based on what occurs in the early part of the emotion process.
The somatic feedback theorists differ from the cognitive and non-cognitive positions by claiming that the bodily responses are unique for each emotion and that it is in virtue of the unique patterns of somatic activity that the emotions are differentiated.
Thus, according to these theories, there is one set of bodily changes for sadness, one set for anger, one for happiness, and so on. In any case, it is the feedback that the mind or brain gets from the body that makes the event an emotion. William James was the first to develop a somatic feedback theory, and recently James' model has been revived and expanded by Antonio Damasio , and Jesse Prinz a, b. Somatic feedback theories suggest that once the bodily response has been generated that is, a change in heart rate, blood pressure, facial expression, and so forth , the mind registers these bodily activities, and this mental state the one caused by the bodily changes is the emotion.
James describes it this way: "the bodily changes follow directly the perception of the exciting fact [that is, the emotion causing event], and Note that James' theory overlaps with the non-cognitive theories insofar as James suggests that when the stimulus is perceived, a bodily response is triggered automatically or reflexively , p. The way in which he describes this process is just as central to the non-cognitive theories as it is to his own: "the nervous system of every living thing is but a bundle of predispositions to react in particular ways upon the contact of particular features of the environment.
The neural machinery is but a hyphen between determinate arrangements of matter outside the body and determinate impulses to inhibition or discharge within its organs" , p. Hence, according to James, when the appropriate type of stimulus is perceived that is a bear , this automatically causes a bodily response trembling, raised heart rate, and so forth , and the individual's awareness of this bodily response is the fear.
A consequence of this view is that without a bodily response there cannot be an emotion. This is a point that James illustrates with the following thought experiment:. If we fancy some strong emotion, and then try to abstract from our consciousness of it all the feelings of its characteristic bodily symptoms, we find we have nothing left behind, no "mind-stuff" out of which the emotion can be constituted, and that a cold and neutral state of intellectual perception is all that remains , p.
Jesse Prinz has recently expanded upon James' theory. For Prinz, as for James, the emotion is the mental state that is caused by the feedback from the body. However, Prinz makes a distinction between what this mental state registers and what it represents. According to Prinz, an emotion registers the bodily response, but it represents simple information concerning what each emotion is about—for example, fear represents danger, sadness represents the loss of something valued, anger represents having been demeaned. Like James, Prinz suggests that the bodily response is primarily the result of a non-cognitive process.
In Prinz's example in Figure 1, there is no mental evaluation or appraisal that the snake is dangerous, rather the perception of the snake triggers the bodily changes. In this case, Prinz says that the bodily changes that occur in response to perceiving a snake can be explained as an adaptation. Our bodies respond in the way that they do to the perception of a snake because snakes are dangerous, and so danger is what the mental state is representing a, p.
Likewise, we can assume that there is some probability of rejection, but how to come up with a specific value is not obvious.
Understanding human choices in their natural context is harder than understanding the rules of a laboratory game. What's more, the way people respond to social situations is somewhat subjective and variable. The anxious and avoidant might respond to rejection more strongly than the emotionally secure. In a world where something that is rational for one person may be irrational or even unfathomable for another, prescribing a rational or adaptive response is difficult. So Plato's rationalism may not win the day either. Darwin would argue that the influence of emotions on decision-making has survived the rigors of natural selection.
In review, we see three reasons why this may be so. One reason, as noted in the preceding paragraph, is that emotions give useful guidance whenever the environment fails to provide all the information needed for thoughtful analysis. The other reason is an asymmetry that might be lurking behind the two Damasio studies. When looking at the two gambling studies, it is tempting to discard emotions from the process of decision-making. If they help in one context and hurt in another the net outcome seems to be a zero effect. It may be the case, however, the type of context in which emotions help is more common in our world than the type of context in which they hurt.
The final reason not to discard emotions remains the fact that they make us act quickly and decisively. Bechara, A. Insensitivity to future consequences following damage to human prefrontal cortex, Cognition, 50 , Shiv, B. Investment behavior and the negative side of emotion. Psychological Science, 16, I love reading psychology mainly related to the humans behavior and cognitive processes. I believe that you will consider my theory as ridiculous but I will be greatly thankful if you help me out or at least share your opinion on the question.
I think that the reason always has the last word when making a decision in different cases. If we take Freud's theory for the Id, Ego and Super-ego and we add the emotions, then we could say that a given emotion is affecting our Ego, then our Super-ego is giving an opinion, if this particular emotion could be expressed in real world with it's default expression, based on a conclusion that involves the moral, social, personal barriers, goals and models of behavior we know.
In other words, if we hear a funny story should we laugh out loud or we should just smile regarding the environment we are currently situated in, would that be at work, at home or drinking beer with friends you know for a long long time. After that our reason under the affect of the emotion and based on the conclusion of our Super-ego decides how we should act.
For example if you are at work, surrounded by your colleagues you would choose to just smile and laugh silently while if you are with your longtime friends you would laugh out loud. Do you think that even under a strong affection we are still making decisions with our reason rather than emotions? As I already said I will be really thankful if you at least share your opinion with me.
My knowledge is nothing compared to yours so an advice from a specialist would be great. Thank you in advance good sir! If I understand your question correctly, you are proposing that despite the emotions' apparent control of the situation it is always the reason that decides the final reaction. You gave the example of a joke told to you in front of long-time friends, in contrast to the same joke told to you in front of work colleagues.
Even though the emotion is presumably the same in both situations, your reaction is different. The answer is not as obvious as the fact that something other than the original emotion is controlling the final decision. This final variable that ultimately decides your reaction to a situation could be either one of two things: either reason again, as you are proposing, or another greater emotion, which is personally what I believe to be the case. Let me explain my thinking to you, and I would love you if you critiqued my ideas in response.
With any stimulus, social or otherwise, we first experience an emotion a "first impression" that we would act upon immediately if we did not learn as children to think things through and be rational "think before you act". So our first emotions are superseded by reason. That would be the end of the story, if our emotions did not have the tricky little ability to become overwhelming at a moment's notice.
When this happens, our reason is routed and we respond purely or mostly on emotion. This can also happen when we consciously allow our emotions to overwhelm us, for example when we decide key word to listen to music, or as you said when we listen to a joke expecting to laugh. In such a case, our emotions are free to rule. However, you have noticed that our actions, even when not under the influence of reason, still seem to be influenced by something. I propose that they are under the influence of a different, greater emotion.
This emotion is basically the sense of what is socially acceptable at the given moment. That is why even when the joke the emotion is the same, the amount you laugh the reaction varies depending on your social setting. However, analysis of the incident also revealed many latent, or blunt end, causes. The procedure was the surgeon's last of six scheduled procedures that day, and delays in the outpatient surgery suite had led to production pressures as well as unexpected changes in the make up of the operating room team. Furthermore, the patient only spoke Spanish and no interpreter was available, meaning that the surgeon who also spoke Spanish was the only person to communicate directly with the patient; this resulted in no formal time-out being performed.
Computer monitors in the operating room had been placed in such a way that viewing them forced nurses to turn away from the patient, limiting their ability to monitor the surgery and perhaps detect the incorrect procedure before it was completed. The systems approach provides a framework for analysis of errors and efforts to improve safety.
There are many specific techniques that can be used to analyze errors, including retrospective methods such as root cause analysis or the more generic term systems analysis and prospective methods such as failure modes effect analysis. Root cause analysis and similar retrospective analysis techniques is discussed in more detail in the dedicated Primer. Failure modes effect analysis FMEA attempts to prospectively identify error-prone situations, or failure modes, within a specific process of care.
FMEA begins with identifying all the steps that must occur for a given process to occur. Once this process mapping is complete, the FMEA then continues by identifying the ways in which each step can go wrong, the probability that each error can be detected, and the consequences or impact of the error not being detected.
The estimates of the likelihood of a particular process failure, the chance of detecting such failure, and its impact are combined numerically to produce a criticality index. This criticality index provides a rough quantitative estimate of the magnitude of hazard posed by each step in a high-risk process.
Assigning a criticality index to each step allows prioritization of targets for improvement. For instance, an FMEA analysis of the medication-dispensing process on a general hospital ward might break down all steps from receipt of orders in the central pharmacy to filling automated dispensing machines by pharmacy technicians. Each step in this process would be assigned a probability of failure and an impact score, so that all steps could be ranked according to the product of these two numbers. Steps ranked at the top i.
FMEA makes sense as a general approach, and has been used in other high-risk industries. However, the reliability of the technique and its utility in health care are not clear. Different teams charged with analyzing the same process may identify different steps in the process, assign different risks to the steps, and consequently prioritize different targets for improvement.
Similar concerns have been raised about root cause analysis. In attempting to prevent active errors, the differentiation between slips and mistakes is crucial, as the solutions to these two types of errors are very different. Reducing the risk of slips requires attention to the designs of protocols, devices, and work environments—using checklists so key steps will not be omitted, implementing forcing functions to minimize workarounds , removing unnecessary variation in the design of key devices, eliminating distractions from areas where work requires intense concentration, and implementing other redesign techniques.
Reducing the likelihood of mistakes, on the other hand, typically requires more training or supervision, perhaps accompanied by a change in position if the mistake is made habitually by the same worker, or disciplinary action if it is due to disruptive or unprofessional behavior. Such an approach may have an impact on the behavior of an individual who committed an error, but does nothing to prevent other frontline workers from committing the same error, leaving patients at risk of continued harm unless broader, more systemic, solutions are implemented.
Addressing latent errors requires a concerted approach to revising how systems of care work, how protocols are designed, and how individuals interact with the system. Specific solutions thus vary widely depending on the type of latent error, the severity of the error, and the availability of resources financial, time, and personnel available to address the problem.
An appropriate systems approach to improving safety requires paying attention to human factors engineering , including the design of protocols, schedules, and other factors that are routinely addressed in other high-risk industries but are only now being analyzed in medicine. Creating a culture of safety in which reporting of active errors is encouraged, analysis of errors to identify latent causes is standard, and frontline workers are not punished for committing slips, is also essential for finding and fixing systematic flaws in health care systems.
Human Factors Engineering. Root Cause Analysis. Case a year-old woman with an incorrect operation on the left hand. In Conversation with Getting to the Root of the Matter. Taylor-Adams S, Vincent C. Understanding and responding to adverse events. The wrong patient. Clinical Risk Management. Enhancing Patient Safety. Vincent CA, ed.
London: British Medical Journal Publications; ISBN Error in medicine. Human Error. Teaching medical students to recognise and report errors.