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Rapid Responses: Rapid Responses published:
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"Safety valve" effect of spanking.
- George Bruce Alcorn (28 January 2000)
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Non-violent discipline
- Paul Duff (30 January 2000)
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Re: "Safety valve" effect of spanking.
- Jayant S Vaidya (31 January 2000)
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Making too much of the available data
- Roderic Phillips (31 January 2000)
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Child discipline
- Richard Fry (31 January 2000)
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Guidance on child discipline
- C O Lister (1 February 2000)
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Giving Guidance on Child Discipline
- Jeannette Phillips (1 February 2000)
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Child Discipline
- M C Spencer (4 February 2000)
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Weak Evidence for Smacking Ban
- Robert E Larzelere (5 February 2000)
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Ban on Disciplinary Physical Punishment not supported by Research
- Den A Trumbull (9 February 2000)
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Weak Evidence For a Smacking Ban
- Robert E Larzelere (19 February 2000)
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Smacking and verbal abuse of children by parents
- John Price (19 April 2000)
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George Bruce Alcorn, Rural G.P. Riverton, South Australia
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I have read the article on child discipline and the effect of physical punishment on the child. One of the apparently forgotten effects of spanking a child is the effect on the parent. I found that spanking a child who persisted in unwanted behaviour had two effects - firstly it did stop the unwanted behaviour in the child, and perhaps more importantly, it provided a structured outlet for parental anger. If an unwanted behaviour persisted past three warnings that it was unacceptable, including a clear warning that a spanking would result, I found that spanking the child limited the physical damage I could inflict. The structured response to unacceptable behaviour imposed a limit on me as well as on the child. I wonder if there have been any studies to examine the increase or decrease in damage to children as a result of parents having no structure to limit their aggression towards children. I am aware of the anger I felt towards irritating children when I was tired and irritable myself, and believe that the structured response to the childrens' discipline prevented me from harming them in ways that are truly unacceptable. Competing interests: a parent of four children all of whom were spanked at some time, although the frequency of spanking diminished from the first child to the last. |
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Paul Duff, Rural GP Bright Victoria Australia
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Sir, Can I respond to the editorial by Waterston, by asking that when parents finally take their doctor's advice to change to non-smacking discipline methods that they get the technique working before venturing out in public. How many times have I had our family visit to a restaurant disrupted by someone else's screaming toddler, kicking chairs and throwing food? When I turn thoughtfully to the "enlightened" parent/s I get the apologetic.. we're using the 'ignore this behaviour' look. Well I'm sorry but my family and I can't, s/he's making too much noise! My advice to my patients is to get all this sorted out at home before trying it in public. Sure it's a lot more trouble to up and leave the supermarket when little Johnny's wrecking the place and come back later but it makes life a hell of a lot easier for the rest of us. It also means that you defuse the situation before your own discomfort takes you to a stage where you are ready to seriosly harm them, which is the Governments aim in the first place. This debate is not about smacking, it is about effective parenting. That's what is missing and what so many parents fail to do. | |||
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Jayant S Vaidya, Hon Lecturer University College London
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Following the same logic, could I suggest it should be legal and socially acceptable that one should have the right and duty to spank one's colleagues and other adults who are irritating? As a structured "safety valve"..!!! :^) |
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Roderic Phillips, Paediatrician Royal Children's Hospital, Melbourne
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The opinion presented by Tony Waterston, BMJ 2000; 320: 261-262, regarding physical punishment of children makes too much of the available data. The subheading "Physical punishment works no better than other methods and has adverse effects" could equally well have read, "Physical punishment works as well as other methods and has no worse adverse effects." Working with children, I see a stream of impossibly behaved children whose parents have a policy of not smacking. The parents have listened to the 'experts' and are struggling to cope with a variety of alternative strategies while their youngsters makes their life hell. The parents have often adopted a variety of manipulative behaviours designed to keep little Johnny from screaming in the supermarket if he isn't given his icecream. Timeout is used inappropriately, rewards become bribes and "incentives" become used as weapons. I believe that given time, energy and commitment, optimal parenting does not require smacking. Unfortunately, those requirements are often lacking. Smacking itself can of course be inappropriate and harmful but many parents use it at times because they find it to be quick and effective. Waterston argues that smacking "teaches that violence is a solution to interpersonal conflict". As a parent, I suspect that this is taught more effectively by television, bombs and ethnic cleansing than by receiving a smack when you are two. |
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Richard Fry
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Waterston articulates the current arguments for restraint and possible legislation on physical punishment well1. Why then, as a child psychiatrist and family therapist who espouses and promotes these ideas daily in my professional practice, and as a father with two children under five against whom my wife and I have never raised a hand (though sorely tempted), do I still demur? I think it is because I do not wish the State to be placed where it does not belong. Similar arguments apply and applied to child sexual abuse and seatbelt legislation. Both are now "state-intervenable" matters. Why is smacking different? The best I can come up with (and it may not be intellectually rigorous) is that I also believe, professionally and personally, that it is important that parents be in charge of their children. In this sense the use of physical punishment is qualitatively different from sexual abuse. There is a benign aim in the use of punishment that cannot be said to exist in CSA, albeit that all the evidence suggests there are better ways to get to the aim. We must allow for individuality in parenting styles, and the spectacle of children suing their parents for physical chastisement does not encourage me to believe that this would produce more benign environment for that child or, more importantly for public policy, children as a whole. Indeed it may only lead to inversion of the, perhaps unpolitically correct but bald fact that parents need to be more powerful than children in the hierarchical structure that we call family, and at the very least represents the best we have yet come up with for successful child-rearing, in early years at least. Public education, as cited by Waterston in Sweden, may be a more effective route to change, and the prominence given to this subject by the BMJ is most welcome. Let us hope that the debate, and consequent changing of minds, continues but let us not try to impose values that may not lead where we want to go. Perhaps the government has got it right? Richard Fry 1 Waterston T. Giving guidance on child discipline. BMJ 2000;320:261 -2. (29 January.) |
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C O Lister
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Dear Sir, In his article "Giving guidance on child discipline" (BMJ 29th. January 2000) Dr.Waterston rightly states that "there can be no more important activity within society than bringing up our children, and discipline is crucial to this." Few, I think, would disagree with this view. Unhappily it does not necessarily follow that the total absence of physical punishment will achieve this goal in the societies in which we actually live, for reasons that he has in fact set out in his paper. In this respect it is worth noting that whilst most research on child discipline has been done in the USA, the behaviour of American children would not lead on to suppose that the research had had much impact on them. Of far greater significance are Dr.Waterston's observations with regard to parental behaviour. Whilst in an ideal world all parents should understand that children respond well to routine, to consistency of parental reaction, to involvement in decision making and to explanation of the reasons for discipline, the truth is that we do not live in such a world. As Dr.Waterston rightly perceives "Children learn best from what they see and model their behaviour on that of their parents." The question is whether all parents are an ideal model for their children, and there is of course the wider question as to whether all that children see provides them with an ideal role model? In a society in which to an increasing extent both parents will be away from home all day, will the example of child carers (whoever they may be) provide children with an adequate role model, particularly in the formative pre-school years of life? This talk of the ills of physical punishment has been going on for half a century or more, yet if the growth in our prison population has any relationship to self-discipline, it would seem that we are a long way off identifying those factors that lead to adequate self-discipline in adults, and I would suggest that adult indiscipline is to a major extent the product of childhood indiscipline. Whilst as a society we pay lip-service to the role of the mother and of parents, in practice we grossly undervalue their worth and do nothing in economic terms to assist the parental role which Dr.Waterston so rightly identifies as crucial in terms of children's behaviour patterns. Until society makes it possible for parents to observe the positive factors for behavioural control that he has identified, some more practical guidelines need to be set out, and it may be that a little physical chastisement may not be out of place. Dr.C.O.Lister |
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Jeannette Phillips
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EDITOR. Like Waterston I believe that physical punishment of children should be strongly discouraged. Although I agree that the main reason for the frequent use of physical punishment is parents' lack of awareness of alternative strategies, I think this has more to do with the ability to change behaviours than the availability of advise. Many parents experience either psychological difficulties such as depressive illness, or a variety of other psychosocial stresses. Often their own experiences of childhood and relationships with parents have been deficient and sometimes even abusive leading to problems with attachments and trust in adulthood. Webster-Stratton has reported that this group of parents will often find it especially difficult to effectively use help with parenting. I would suggest that the majority of parents who smack their children feel guilty and make enormous efforts to use other methods. For many of these parents being simply "educated" about parenting is insuffiecient. Instead they need to be aware that they will be helped and supported by non-critical professionals that they can trust. Such help is currently only patchily available through agencies such as Newpin, local-authority run family centres, primary care groups via health visitors and child and adolescent mental health services. In addition before they can benefit many struggling parents require social and therapeutic assistance for themselves. As Dr.Waterston states in his editorial the majority of parents in this country smack their children. This phenomenon has not occurred by accident. Many current parents have been "trained" by their childhood experiences to do so and these learnt behaviours require considerable efforts to change. Although we need to give a clear message that physical chastisement if ineffective and if used regularly, harmful, making it illegal would deter many parents from seeking help with their parenting for fear of punishment. It could also deter children who are physically abused from speaking up, as there is now plenty of evidence that abused children protect their parents. One other possible consequence of banning physical punishment could be an increase in emotional abuse, with the long-term sequellae of this. Therefore there needs to be a major drive to make help, support and training available to all parents who need it in whatever form it is required. Taylor et al emphasise the importance of socioeconomic factors in parenting. Making physical methods of discipline illegal at this point in time runs the risk of targetting mainly the most emotionally and materially deprived parents in our society. 1, Waterston, T. Giving guidance on child discipline. BMJ 2000;7230:261-262. 2, Webster-Stratton C, & Herbert, M. Troubled families-problem children. Working with parents: A collaborative process. Chichester : Wiley, 1994. 3, Taylor J, Spencer N, Baldwin, N. Social, economic, and political context of parenting. Arch Dis Child 2000;82: 113-120. Jeannette Phillips, Consultant Child and Adolescent Psychiatrist, Invicta Community Care NHS Trust, Unit 1 Twisleton Court, Priory Hill, Dartford, DA1 2EN. |
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M C Spencer
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Editor - Tony Waterston's editorial, BMJ 29th January, page 261, is most welcome in view of government reluctance to legislate against parent- inflicted corporal punishment. We constantly hear expressions of concern over violence and indiscipline in school. Does it not occur to our legislators that we cannot deny to teachers the only disciplinary measure that many children understand. Physical methods of control should be outlawed alike for parents and those in loco parentis. M.C.Spencer. |
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Robert E Larzelere, Associate Professor University of Nebraska Medical Center
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A ban of a medical intervention would never be supported by a BMJ editorial on the basis of such meager evidence as was used to support the parental intervention of smacking.1 "Significant adverse effects" and a failure to "learn the desired behaviour" were based on a literature review that is unpublished2 and includes studies of severe corporal punishment such as "beating with a stick,"3 "still hurt the next day,"4 5 "burning,"6 "authorities involved" due to being "severely harmed,"7 and "using a knife or gun."8 9 This is like supporting a ban on surgery for cancer due to one unpublished review of studies of knifing in cities with hospitals. Most of the studies in the cited review were cross-sectional, which cannot disentangle the causal direction between spanking and child misbehavior.2. The editorial did cite the only prospective study of nonabusive physical punishment that has found it to be associated with subsequent aggression. That study found that the 4% of kindergarten children who had not been spanked by a parent in the previous year were less aggressive on the playground than the other 96% who had been spanked.10 Since they did not control for how aggressive they were in the first place, it may have been that the most mild-mannered children cooperated easily at home and, the next year, on the playground. In the only published review of child outcomes of nonabusive or customary physical punishment, only 8 studies had taken the misbehavior levels of the children into account.11 All eight of those studies, including four clinical trials, found nonabusive spanking to have beneficial child effects when used to back up milder disciplinary tactics with 2- to 6-year-old children. Used in this manner, smacking makes milder tactics more effective, not "harder to use" as concluded by Waterston.1 One of those clinical trials was cited in the BMJ editorial to support the statement that "physical punishment is no more effective than other methods."12 That clinical trial found only one of three alternative disciplinary tactics to be as effective as a two-swat spank in enforcing time-out: a brief room isolation enforced by holding the door shut. This is like saying that a long-used drug should be banned once any other drug has proven to be equally effective, even when that alternative drug is not being recommended. The whole pattern of findings is what you would expect for surgery for cancer. Those who had such surgery last year would now be more likely to suffer from cancer-related problems than people who had no such surgery last year. But causally conclusive studies that took the original level of cancer into account would find that such surgery reduced subsequent cancer -related problems relative to no intervention, although perhaps equally as much as an alternative intervention, such as radiation treatment. The editorial also cited another unpublished study13 to conclude that Swedish "public opinion on the need for physical punishment changed dramatically after a public education campaign." The so-called dramatic change was artificially created by comparing entirely different survey questions asked in 1981 and in 1994. The 1994 survey question most similar to the previous question showed an increased support for mild or moderate physical punishment as sometimes necessary - from 26% in both 1978 and 1981 to 34% in 1994.14 The same Swedish survey found that "only" 32% of the generation born after 1979 had received corporal punishment from their father, compared to 34% in the next oldest generation. Other Swedish studies have found a 498% increase in child abuse cases under the age of 7 in criminal statistics and a 672% increase in assaults by minors against minors from 1981 through 1994. 15 16 It is difficult to attribute this increase to the spanking ban when spanking has changed very little. But we need an unbiased explanation of these increases in child abuse and youth violence before emulating the Swedish experiment.17 Given all this, it is reassuring to see the proposed British legislation strive for a balance between "anything goes" and a 100% smacking ban. As Waterston noted, parents are already motivated to find alternatives to smacking, and positive parent-child involvement and enhancing positive behaviors are good places to start. The most difficult puzzle for parents and scientists concerns effective methods for decreasing misbehavior. Eighteen studies in the 1996 review investigated alternative disciplinary tactics as well as spanking.11 Only grounding was more effective than spanking, in two studies of older children. In contrast, nine alternatives were associated with more detrimental child outcomes than was spanking. Parents need to be empowered with more effective alternatives, not dis-empowered by premature bans on traditional disciplinary tactics. 1. Waterston T. Giving guidance on child discipline. British Medical Journal (BMJ) 2000;320:261-262. 2. Gershoff ET. The effects of parental corporal punishment on children: A process model and meta-analytic review. Tempe, AZ: Arizona State University, 1999. 3. Engfer A, Schneewind KA. Causes and consequences of harsh parental punishment: An empirical investigation in a representative sample of 570 German families. Child Abuse and Neglect 1982;6:129-139. 4. Holmes SJ, Robins LM. The influence of childhood disciplinary experience on the development of alcoholism and depression. Journal of Child Psychology and Psychiatry and Allied Disciplines 1987;28:399-415. 5. Holmes SJ, Robins LN. The role of parental disciplinary practices in the development of depression and alcoholism. Psychiatry 1988;51:24-36. 6. Rohner RP, Kean KJ, Cournoyer DE. Effects of corporal punishment, perceived caretaker warmth, and cultural beliefs on the psychological adjustment of children in St. Kitts, West, Indies. Journal of Marriage and the Family 1991;53:681-693. 7. Dodge K, Pettit GS, Bates JE, Valente E. Social-information- processing patterns partially mediate the effect of early physical abuse on later conduct problems. Journal of Abnormal Psychology 1995;104:632-642. 8. Muller RT. Family aggressiveness factors in the prediction of corporal punishment: Reciprocal effects and the impact of observer perspective. Journal of Family Psychology 1996;10:474-489. 9. Muller RT, Hunter JE, Stollak G. The intergenerational transmission of corporal punishment: A comparison of social learning and temperament models. Child Abuse & Neglect 1995;19:1323-1335. 10. Strassberg Z, Dodge KA, Pettit GW, Bates JE. Spanking in the home and children's subsequent aggression toward kindergarten peers. Development and Psychopathology 1994;6:445-461. 11. Larzelere RE. A review of the outcomes of parental use of nonabusive or customary physical punishment. Pediatrics 1996;98:824-828. 12. Roberts MW, Powers SW. Adjusting chair timeout enforcement procedures for oppositional children. Behavior Therapy 1990;21:257-271. 13. Durrant JE. The status of Swedish children and youth since the passage of the 1979 corporal punishment ban. London: Save the Children, 1997. 14. Sanden A. Spanking and other forms of physical punishment: A study of adults' and middle school students' opinions, experience, and knowledge. Stockholm: Statistics Sweden, 1996. 15. Wittrock U. Barmisshandel i kriminalstatistiken, 1981-1991 [Violent crimes against children in criminal statistics, 1981-1991]. KR Info 1992;7. 16. Wittrock U. Barmisshandel, 1984-1994 [Violent crimes against children, 1984-1994]. KR Info 1995;5:1-6. 17. Larzelere RE, Johnson B. Evaluation of the effects of Sweden's spanking ban on physical child abuse rates: A literature review. Psychological Reports 1999;85:381-392. Robert E. Larzelere
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Den A Trumbull, Pediatrician Pediatric Healthcare
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The art of child rearing is a complex process where the outcome of a parent's efforts is influenced by many factors unique to the child, the parent, the environment, and the context. Dr. Waterston's editorial promoting a ban on all disciplinary physical punishment does not respect this complexity and oversimplifies the debate of a parent's use of spanking (smacking). Dr. Waterston cites the American Academy of Pediatrics consensus conference on corporal punishment as a source of defense for his position. As a participant at the conference, I would like to clarify some of the committee's findings: The group's goal was to develop consensus statements regarding "the scientific evidence on the long and short-term effects of corporal punishment on children." The proceedings of the conference were published as a supplement to the October 1996 issue of Pediatrics. Definitions were the first order of business for the group: Corporal Punishment: "bodily punishment of any kind." Spanking: "physically non-injurious, intended to modify behavior, and administered with the open hand to the buttocks or the extremities." Using these strict definitions prevented the common mistake of mixing abusive physical punishment with non-injurious disciplinary spanking. With these definitions, the committee could not reach any strong conclusions favoring or opposing a parent's use of disciplinary spanking between the ages of 2 and 11 years. Central to the conference, however, was an exhaustive review of the literature on corporal punishment presented by clinical psychologist, Dr. Robert Larzelere. In his review he found stronger evidence of beneficial than detrimental effects of nonabusive spanking by parents with preschool children, ages 2 to 6 years. Dr. Diana Baumrind of University of California, Berkley, noted in her response to his review, "As Dr. Larzelere's review of quality studies documents, a blanket injunction against disciplinary spanking by parents is not scientifically supportable." The conference Co-chairpersons, Drs. Stanford Friedman and Kenneth Schonberg, concluded "Given a relatively 'healthy' family life in a supportive environment, spanking in and of itself is not detrimental to a child or predictive of later problems...[T]here is a lack of research related to the use of corporal punishment."1 Developmental research indicates that optimal child outcomes result from authoritative parenting which combines positive encouragement with consistent behavioral control of the young child.2 Dr. Waterston describes the process of encouragement well, but leaves parents short- handed on techniques for behavioral control. Young children need correction and punishment at times, but this fact is often ignored by physical punishment opponents. Timeout and disapproval are effective behavioral management tools, but they are not sufficient to control all problem behavior with all young children. Physical punishment, when properly applied, can augment nonphysical measures and optimize the behavioral control process. To remove nonabusive physical punishment from the repertoire of parents of young children could promote child abuse and lead to increases in violence among older, unruly children. This seems, from statistics, to have been an effect that the Swedish ban has had on that society. I would urge the makers of public policy in the United Kingdom to move slowly, objectively and scientifically in analyzing this issue. A more in -depth analysis of this subject can be found in an article on the Internet at: www.frc.org/fampol/fp96jpa.html Den A. Trumbull, MD
1. Friedman, Stanford B., MD, Schonberg, S. Kenneth, MD, & Sharkey, Mary (eds). "The Short and Long Term Consequences of Corporal Punishment." supplement to Pediatrics, 1996; 98 (4):857-858. 2. Baumrind, D. The development of instrumental competence through socialization. Minnesota Symp Child Psych. 1973;7:3-46. |
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Robert E Larzelere
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A ban of a medical intervention would never be supported on the basis of such meager evidence as was used recently to support a ban of the parental intervention of smacking.1 "Significant adverse effects" and a failure to "learn the desired behaviour" were based on a literature review that is unpublished2 and includes studies that incorporated severe types of corporal punishment such as "beating with a stick," "still hurt the next day," "burning," and "using a knife or gun." Most reviewed studies were cross-sectional, which cannot disentangle the causal direction between smacking and child misbehavior.2 In the only published review of child outcomes of nonabusive or customary physical punishment, only 8 studies could disentangle the causal effects of smacking.3 All eight of those studies, including four randomized clinical trials, found nonabusive smacking to have beneficial child effects when used to back up milder disciplinary tactics with 2- to 6-year -olds. Smacking then makes milder tactics more effective, not "harder to use" as concluded by Waterston.1 Another unpublished study4 was cited to conclude that Swedish "public opinion on the need for physical punishment changed dramatically after a public education campaign" following their 1979 smacking ban. The so- called dramatic change was artificially created by comparing entirely different survey questions before 1982 and in 1994. The 1994 survey question most similar to the previous question showed an increased endorsement of mild or moderate physical punishment as sometimes necessary - from 26% in both 1978 and 1981 to 34% in 1994.5 The 1994 Swedish survey also found that corporal punishment of teenagers was as prevalent after the 1979 ban as in prior generations and that, overall, corporal punishment had decreased very little.5 Consequently, it is reassuring to see the British proposal aim for a middle ground between the status quo and a 100% smacking ban. As Waterston1 noted, parents are already motivated to find alternatives to smacking, and positive parent-child involvement and enhancing appropriate child behaviors are good places to start. The most difficult puzzle for parents and professionals concerns effective methods for decreasing misbehavior. Eighteen studies in the 1996 review investigated alternative disciplinary tactics as well as smacking.3 Only grounding was more effective than smacking, in two studies of older children. In contrast, nine alternatives were associated with more detrimental child outcomes than was smacking. Parents need to be empowered with more effective alternatives, not dis- empowered by premature bans on traditional disciplinary tactics. Robert E. Larzelere, Ph.D.
1. Waterston T. Giving guidance on child discipline. British Medical Journal (BMJ) 2000;320:261-262. 2. Gershoff ET. The effects of parental corporal punishment on children: A process model and meta-analytic review. Tempe, AZ: Arizona State University, 1999. 3. Larzelere RE. A review of the outcomes of parental use of nonabusive or customary physical punishment. Pediatrics 1996;98:824-828. 4. Durrant JE. The status of Swedish children and youth since the passage of the 1979 corporal punishment ban. London: Save the Children, 1997. 5. Sanden A. Spanking and other forms of physical punishment: A study of adults' and middle school students' opinions, experience, and knowledge. Stockholm: Statistics Sweden, 1996. |
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John Price
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EDITOR - Waterston (1) rightly calls attention to the possibility that corporal punishment may be harmful to children. But this debate should consider other ways in which parents make their children fearful and lower their self-esteem. In the adult psychiatric clinic it is not rare to find patients who have been made to feel unwanted, bad or worthless by the purely verbal behaviour of a parent. These parental inputs may well be more harmful than smacking, and we should consider whether a parent inhibited from smacking a child by custom or by law might revert to verbal abuse in order to discharge their feelings of irritation with a naughty child. The topic of parental chastisement of children is of interest to evolutionary biology (2,3). There is a very wide variation in the way parents treat children, ranging from the abuse mentioned above to the most fulsome outpourings of love and praise. This adds to the wide variation in sensitivity to punishment which we see in children. As a result, there is a large variation in adult self-esteem, first pointed out by Abraham Maslow (4). There may be co-evolved psychological mechanisms by which the interaction of parents and children induces this variation. We have suggested (5) that the life-long traits of high and low self-esteem may be looked on as alternative strategies for dealing with the social environment, and that the variation between high and low self-esteem may be induced by parent/child interaction, and maintained by negative frequency- dependent selection (for instance, there is an advantage in having low self-esteem if everyone else has high self-esteem). In the debate on smacking children, it is important to bear in mind the different sensitivities of children to punishment, the possibility that inhibiting physical punishment may increase more harmful forms of verbal punishment, and the possibility that we are dealing with an evolved psychological mechanism for inducing in the child a level of self-esteem which will give it the best chance of reproductive success in the environment into which it is born. This is not to support the "naturalistic fallacy" that smacking is good because it has evolved through natural selection. Rather, in forming our opinions we should be aware of as much information as possible at both ultimate (evolutionary) and proximate (social) levels of causation. John Price 1. Waterston T. Giving guidance on child discipline: physical punishment works no better than other methods and has adverse effects. British Medical Journal 2000;320:261-262. 2. Stevens A, Price J. Evolutionary Psychiatry: A New Beginning. Second edition. London: Routledge, 2000. 3. Price JS. Subordination, self-esteem and depression. In Sloman L, Gilbert, P, eds. Subordination and Defeat: An Evolutionary Approach to Mood Disorders and their Therapy. Mahwah NJ, Lawrence Erlbaum, 2000, 165-177. 4. Maslow AH. Dominance-feeling, behavior, and status. Psychological Review 1937;44:404-429. 5. Price JS, Sloman L, Gardner R, Gilbert P, Rohde P. The social competition hypothesis of depression. British Journal of Psychiatry 1994;164:309-135. |
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