The Self-Control Expenditure

A 4-year-old girl stares at the marshmallow.  It looks really good.  But the man who is in charge told her that if she waits until he returns, she can have two of them.  Her mouth begins to water.  The seconds click away on the wall clock until finally she can’t bear it anymore.  She snatches it up and almost swallows it whole.  Little did she know that the cameras were rolling, and she and many other young kids her age were part of a long-term experiment (that later came to be known as the Stanford Marshmallow studies) to see just much self-control predicts all sorts of later outcomes.

Ten to fifteen years later, these same children were assessed on many factors.  The results were astounding.  The longer children waited for the two marshmallows, the more likely they were to be rated as being more attentive, competent, organized, self-motivated, optimistic, and intelligent.  Perhaps the most stunning finding was the significant correlation between the number of seconds a 4-year-old took to grab the marshmallow and their SAT scores.  Those who did not grab the marshmallow scored on average 200 points higher than those who did.

In 2010, a study entitled A gradient of childhood self-control predicts health, wealth, and public safety was published.  The authors had followed 1,000 children from birth through thirty-two years.  They wanted to determine what different factors could predict adult outcomes.  Three factors emerged:  self-control, IQ, and socioeconomic status (SES).  Self-control was defined as skills related to self-discipline, conscientiousness, and perseverance.  A child’s self-control at the age of three, regardless of their IQ and SES, was significantly associated with the following areas at age thirty-two:  physical health, substance dependence, socioeconomic status, wealth, single- vs. two- parent rearing, financial planfulness/difficulties, and likelihood of criminal conviction.  Although early self-control was a significant predictor at a young age, improved self-control was associated with improved outcomes in all areas.

Every day legislators are charged with the prospect of determining how to use taxpayer money.  Policy makers have begun to realize what researchers have known for some time.  Skills that are grounded in self-control are critical in promoting optimal development.  They are also vital in managing the financial demands of this country.  The first lesson came after examining outcomes from fifty years of preschool programming designed to target at-risk youth.  Despite failing to produce sustained gains in IQ (compared to 10-year-old at-risk children not in the programs), something else very curious happened in this group.  Decreased work absenteeism, teen pregnancy, school dropout, delinquency, welfare assistance, out-of-wedlock births coupled with higher salaries and a greater percentage of home ownership emerged by the time children in these programs turned forty.

This message couldn’t be clearer than when it comes to health care.  Statistics indicate that almost 70% of all adults in this country are overweight or obese. Obesity has more than quadrupled in adolescents and doubled in children over the last three decades.  Obesity is on the verge of overtaking smoking as the leading cause of death in the United States, and health care costs rise exorbitantly because of obesity. Meanwhile, studies continue to pour in about the negative effects of obesity on mental health in addition to obvious physical consequences, including for our kids. Two headlines in 2013 (published through Medscape) offered the following warnings: Stop the Pop: Soda Linked to Aggression, Inattention in Kids and Early ‘Junk Food’ Exposure Risks Kids’ Mental Health. Although some of the culpability lies with the food industry and others, such as marketers, eating remains a personal decision (albeit one admittedly fraught with many convoluted factors) deeply shrouded in the issue of self-control.

Problems of obesity and related difficulties are just one way in which self-control finds itself in the center of the healthcare debate.  As Americans, our insatiable consumption for pharmaceuticals and other quick fixes belies more disciplined, safer approaches that repeatedly can be shown to be successful in alleviating many negative health outcomes.  Although self-control is best taught to children, science is in increasingly indicating that it can be learned and developed at all ages.  Willpower remains one of, if not the most important entity, when it comes to an individual and nation’s attempt to reduce its own healthcare woes.

As we look to address the problem of unsustainable healthcare spending, bulging premiums, and physician shortages, it seems we are impelled to consider how much we believe that even slight improvements in a nation’s ability to wait on the metaphoric marshmallow could be the first really step forward in the healthcare crisis.  Practically speaking, findings regarding self-control suggest a few courses of action.  One, financial resources and legislation to promote these practices should be supported not just at young ages, but with parents and other adults in many different forums.  But in the context of our current practices, it seems increased emphasis should make it clear that all of us in the medical field should not only integrate this in our daily lives, but also our practices.

When a medication is prescribed or a procedure is done before any lifestyle change is required, then we as healers are undermining one of the most key ingredients in any type of change—the human person. We are not demanding more from ourselves and each other when we settle for a “band-aid approach” that does not create sustainable practices.  As a psychologist, I recognize that very often families come to us in crisis, and our best intent is to help them as soon as possible.  But sometimes the best help comes when we provide time, clear communication, and motivation to take another road than the one currently being taken.  It can be a tough and unsettling road at times, but the end result is what we all desire.  For health care to truly improve, we must stop being enamored by all that others and technology can do for us, and start asking what we can do for ourselves to improve even just a little each day.

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