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Control, or the perception of control, governs much of human behavior.

Most people want to feel like they have individual power over their lives. This sense of control and power to influence future events produces feelings of competence and personal power and the availability of choices in any given situation. Most of us feel that we have at least some control over our individual destinies, (Langer and Rodin 151). Each person has a unique perception of the underlying causes of events in their lives and this outlook has a huge impact on their psychological and overall well-being (Weis, par. 1). The events in an individuals life have underlying causes. The origin of these causes is what defines a concept called Locus of Control (commonly known as LOC). (Kosslyn and Rosenburg, 315). The notion of Locus of Control was developed by psychologist Julian Rotter during the 1950s. Rotters concept of Locus of Control eventually gained public acceptance and became a fundamental factor in assessing personality. The Locus of Control concept was later refined to better assess an individuals perception of control. Twelve years later, Rotter modified his original Locus of Control model, and the Locus of Control Scale was developed. (Graffeo, par. 3). The Locus of Control Scale aimed to better measure and to reliably identify the overall perceptions people had. Using this updated scale, two distinct groups were discovered and were clearly defined (Graffeo, par. 3). One group is labeled as having an internal locus of control. Internals feel that control over their lives and the events that happen around them come from within themselves. Therefore, internals feel personally responsible for their own successes or failures. The second group is described as having an external locus of control. This classification of people attributes events in their lives to certain external

forces above or beyond themselves. External forces can be any number of things, including fate, luck, or powerful others (i.e. doctors, lawyers, professionals, or supernatural beings and deities). Externals tend to feel less personally responsible for what happens to them because they view the causes of life experiences as being outside of human control. (Kosslyn and Rosenberg 315). In general, a more internal locus of control seems more rational and socially desirable. People with an internal locus of control tend to be more proactive, motivated and achievement-oriented than externals. They expect to succeed, and are not easily influenced by the thoughts and opinions of others. In general, internally-oriented people are more successful overall (Neil par. 8 and Wise par. 1). Locus of control has proven to have profound affects not only on psychological well-being, but also on physical health. (Graffeo, par. 1). Due to its success in personality evaluation, the LOC model was also applied in numerous other scenarios, including health-related issues. The importance of Locus of Control in health related circumstances was introduced and adapted in the 1970s by psychologists Wallston, Wallston, Kaplan, and Maides by 1976 (Graffeo, par. 3). These psychologists adapted and refined Rotters original theory to apply specifically to health issues. This concept became known as the Health Locus of Control or HLC. Instead of focusing on personality traits, Health Locus of Control stressed the individuals assessment of present circumstances as well as the contributing factors that determined their overall outlook (Mackey, par. 1). [They] examined the degree to which individuals believe their health is controlled by internal or external factors. External beliefs are premised on

the notion that ones health outcome is under control of the powerful others (i.e. medical professionals) or is determined by fate, luck, or chance. Internal beliefs characterize ones health condition as being the direct result of ones own actions. (Mackey, par. 1). This applied Rotters original Locus of Control concept to health related situations. Health Locus of Control (HLC) recognizes and uses the same notion of internal and external perceptions, but does not concentrate on their influence on personality. Instead, the importance of both the sense of control overall and the perceptions about control are emphasized. The concept of Health Locus of Control was then accepted into popular thought. In 1976, Kaplan, Maides, Wallston and Wallston developed a Multidimensional Health Locus of Control Scale (MHLC) to further aid in classifying the attributions of an individuals perceived control. (Gaffeo, par. 4) These researchers first detected the use of LOC in the medical community in observations of recently diagnosed diabetics and medical professionals in a classroom setting. The medical staffers were attempting to get the patients and their families to develop an internal LOC that would better the chances of controlling their illness and improve overall quality of life, (qtd. in Gaffeo, par. 3). The relationship between quality of life and Locus of Control has been tested in a number of different scenarios, and the two undoubtedly have a direct correlation. Knowing more about this relationship will inevitably aid in treatment of certain health conditions. (Mackey, par. 2). Any treatment or recuperation program should impress a strong sense of control on their patients. If patients have control over even trivial aspects of their daily life, the perception of control and influence on their own lives ensues. From

that perception of control, feelings of self-reliance and the impression of ongoing selfefficacy emerge. The treatment of patients in nursing homes, mental institution, and certain rehabilitation-type treatments are all situations in which patients should be prompted to feel a sense of control. The impression of control has been repeatedly proven to have an overwhelming impact on an individuals health, well-being, and overall quality of life. More studies similar to this one were conducted with different types of patients and changed variables. The results and conclusions of an overwhelming majority of these studies all revealed a similar conclusion: Internal LOC has been congruent with positive health improvements and psychological well-being. (Mackey, par. 2). This idea is supported first by the devastating effects of external perceptions. If people feel they have no control over future outcomes, they are less likely to seek solutions to their problems. The far-reaching effects of such maladaptive behaviors can have serious consequences, which has led so many social psychologists to examine the origin of locus control and its impact on the social world. (Wise, par. 1) Seligman studied Locus of Control and he defined a loss of control as inconsistency between an individuals behaviors and outcomes. This shows that external LOC is often a result of continued reinforcement of expectancies. External LOC is detrimental to emotional, physical, and cognitive health and efficacy. (qtd. in Wise par. 3) Lack of control can lead to learned helplessness, a state where an individual feels like the events in his/her life are out of their control, and therefore assumes that the future will be the same. (Wise par. 5) Lack of control can also evoke a number of negative feelings such as anxiety, anger, outrage, depression, helplessness, intense feelings of stress, and most importantly, physical illness.

The superiority of internal attitudes is also proven by the many results of numerous experiments. MacArthur and MacArthur focused on proving the advantages of internal locus of control on overall health and well-being in their research. The psychologists ultimately concluded that a sense of control (as experienced by internals) provided improved psychological health, better self-reports on health, and, most importantly, a lower rate of death. (qtd. in Graffeo, par. 5) Establishing a sense of control is especially imperative in environments such as nursing homes. As people age, they tend to become more internal, but this internal sense of control rapidly declines with very old age. (Neil, par. 8) Marshall revealed that age is associated with personal responsibility for events that occur, excluding self-blame for circumstances concerning health. A decreased internal locus of control may be parallel with physical illness. (Mackey, par. 11). People already have a decreased morale as they progress through old age. The elderly become discouraged the more they lose the ability to do certain things or have a much harder time accomplishing things that had once been easy. They feel like they are losing control the more they age, and death becomes much more real and daunting. An elderly person entering a nursing home represents a huge milestone, maybe in part because of cultural assumptions. This milestone represents the final acceptance of impending death and the submission to give up any independency. Therefore, nursing homes represent lack or loss of personal power to control their decisions, lives, daily activities, influence on their destinies, and an overall realization that they will no longer be self-reliant. (Langer and Rodin, 152) Langer and Rodin conducted an experiment in 1976 to test the consequences of the perception of control with the elderly. They hypothesized that since there was already

a decrease in morale, which the loss in autonomy creates a deterioration of health, then giving patients in a nursing home increased personal responsibility will increase their alertness, activity level, and satisfaction, (Langer and Rodin, 152). The experimenters ultimately worked with Arden House Nursing Home in Connecticut. The facility was state-run and was said to be the best around because of its great medical care, facilities, and conditions for the residents. There were four floors and rooms were randomly assigned to residents upon arrival, and were based on availability. The residents were all very similar in socioeconomic standing and had fairly comparable health conditions. The floors of residents were therefore essentially equal. Two floors were selected for the experiment, and they were ranging from age 65 to 90. The second floor was designated as the control group and the fourth floor was selected to be treated with a sense of increasedresponsibility. The administrator of the home agreed to work with the experimenters for three weeks. He called a floor meeting with both floors separately to address some new information. The residents of the fourth floor, the group with increasedresponsibility, were told that they were to care for themselves and could decide what to do each day. This concept was stressed and the group was told that they had the responsibility to care for themselves and that the staff was merely there to help them when they need it; therefore, they were responsible for communicating their needs or desires to the hospital staff. They were then given very small details about events or regulations in the home, but the experimenters used these minute decisions to reiterate their responsibility and control. The second floor residents, or the control group, were then spoken to. The administrator communicated a very

similar message to the second floor, but it was made clear that many of their decisions were made or would be in the future. A few days after these original messages were communicated; they continued to be reinforced by the nursing home staff. The results of this experiment were astounding. The increased control group was much happier and more social and had an overall higher morale than the residents of the control group. The most compelling conclusion from this study was that the residents who had a slightly higher sense of control over their environment were the residents with a noticeably improved condition: 93 percent of the increased control group had an improved condition compared to only 21 percent of residents on the second floor. Langer and Rodin concluded, mechanisms can and should be established for changing situational factors that reduce real or perceived responsibility in the elderly. Furthermore, this study adds to the body of literature suggesting that senility and diminished alertness are not an almost inevitable result of aging, (Langer and Rodin, 155). Although there is obvious evidence that proves the importance of locus of control on health and well-being, there are a number of objections that must be considered. Locus of Control is considered to be an important factor in personality, therefore yielding the misconception that Locus of Control is seen as a stable, underlying personality construct. (Neil, 11) Even though evidence, such as the Langer and Rodin experiment, clearly suggests that perceived control is directly linked to psychological and physical health, there is also some evidence to suggest otherwise. (Neil, 11) The strongest evidence suggesting this is Rotters idea that:

Locus of Control beliefs come from specific experiences and past reinforcement history. Reinforcement Theory by Skinner (1938) argues that what controls behavior are reinforcesIndividuals who have a history of successful attempts at health control are more likely to be internal than are those who have been unsuccessful in their attempts. (Mackey, par. 3) This learned reinforcement can also be attributed to parents and childhood circumstances. Socioeconomic status also can play a huge role in locus of control. The greater accessibility of positive reinforcements for middle-class children might explain why they are more internal. (Mackey, par. 5-6) Prior experiences, and especially experiences with illness, also play a role. This oppositional evidence can be disproved by the mere fact that the concept of Locus of Control is multidimensional and has many aspects. The evidence that suggests a positive correlation is not suggesting that there are no other factors that contribute to the attributions of people and their perception of control.

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