Table Of ContentC
Campaigning: Political 1986, Kazee 1994). Generally the rather obvious
benefits far outweigh the costs of winning for those
withtherequisitepoliticalambition;butcostsmustbe
At the microlevel, political campaigning involves an
weighed—loss of privacy, loss of time with family,
individualcandidateattemptingtowinpoliticaloffice.
frequentlylossofincome.Similarly,theevidentcosts
Atthemacrolevel,politicalpartiesseektogainseatsin
oflosing arealmostalwaysgreater thanthebenefits;
governmentfortheirpartisansandultimatelytogain
butsomebenefitsdoaccruetolosers—makinganame
power or at least to share power in the relevant
foroneself,buildingupgoodwillwithpartyofficials.
governmental arena. At each level decisions must be
Beyond these broad generalizations, little is known
madeaboutcandidacies,organizationsmustbebuilt,
about how specific candidates make individual de-
messagesmust berefined, strategies must beset,and
cisionsgiventhedazzlingarrayofdifficult-to-estimate
thepublicmustbeconvincedtosupportthosewaging
variables(MaiselandStone1997).
aparticularcampaign.Onlycertainaspectsofpolitical
campaigns are viewed by the public. Frequently, the
actions taken away from public view are more de-
terminativeofsuccessandfailure. 1.2 Parties’ChoicesofCandidates
The ways in which political parties choose their
candidatesforofficevariessignificantlyfrompolitical
1. TheChoiceofCandidates systemtopoliticalsystemandfrompartytoparty.The
keyvariableinthisaspectoftheprocessrelatestothe
Decisions about who will run for office involve extenttowhichpartyorganizationcontrolsplaceson
decisionsbypotentialcandidatesastowhetherornot theballotcontrastedwithvotersactingindependently.
theywillrunanddecisionsbypoliticalparties,acting In the former, the process is often described as
undera varietyofrules,concerning whotheir candi- candidaterecruitment,inthelatter,candidateemerg-
dateswillbe. ence.
Atoneextremearethosesystemsinwhichpolitical
partiesslatetheircandidatesforoffice,rankingcand-
idates or placing them in safe constituencies. Most
1.1 TheDecisiontoRun
parties operating in electoral systems with propor-
Individuals who run for political office must exhibit tional representation follow this procedure. It is also
political ambition beyond the desire to simply serve followed in systems with strong party systems, in
their community. Campaigning for and serving in whichcitizensvotemoreforpartiesthantheydofor
political office involves personal costs and public individualcandidates.ManyEuropeansystemsfitthis
exposure that deter many from seeking office. How- description(HixandLord1997).
ever,eventhoseambitiousforelectiveofficemustmake At the other extreme are systems, of which the
decisionsaboutwhatofficestoseekandwhentoseek UnitedStates isprototypical, inwhichvoters choose
those offices (Jacobson and Kernell 1981). These partycandidatesinprimaryelections.Theshapeofthe
decisionsarebasedonacomplex,often-implicitcost- electorate in primary elections varies considerably
benefit analysis. Potential candidates weigh the costs frompolitytopolity.Intheory,primaryelectionsare
andbenefitsofbothwinningandlosing.Theirdecision open only to members of one political party or
calculuscanbesummarized: another, but in actual practice how membership is
definedvariesaccordingtolocalrulesandcanbequite
p (cid:1)p (B (cid:2)C )(cid:3)p(B(cid:2)C) restrictive or totally open. In either case, voters in
r w w w l l l
the primary elections determine the party nominee,
wherep (cid:1)probabilityofrunning;p (cid:1)probabilityof evenifthatnomineewouldnothavebeenthechoiceof
r w
winning; p (cid:1)probability of losing; B (cid:1)benefit of partyofficials(Maisel1999).
l w
winning;C (cid:1)costofwinning;B (cid:1)benefitoflosing; Manysystemsarehybrids,withpartyofficialsand
w l
C (cid:1)costoflosing. the voters sharing power. The US presidential nom-
l
The difficulty that potential candidates face in inating system stands as perhaps the most complex
making these decisions relates to the uncertainty meansofchoosingpartycandidates.Delegateselected
regardingvirtuallyalloftherelevantvariables(Maisel to national party conventions make the actual nom-
1433
Campaigning:Political
inations.Somedelegatesareselectedbecauseoftheir specialize in media advertising, polling, direct mail,
positions within the party or as elected officials with telephonebanks,fundraising,andvirtuallyeveryother
partyaffiliations;othersarechosenatpartymeetings aspect of campaigning; other firms are structured to
(orcaucuses)heldinlocalcommunities;stillothersare take over all or many aspects of a campaign. Some
chosen by the voters in primary elections, based on workinparticulargeographicareas.Othersareready
lists of delegate candidates approved by the presi- to sell their services anywhere throughout an entire
dential campaigns they seek to support (Polsby and nationoreveninternationally.
Wildavsky2000,Wayne2000).
3. DefiningMessagesandSettingStrategy
2. TheCampaignOrganization
A political campaign requires getting a message to
Inpolitieswithstrongpartysystems,campaignorgan-
voters.To do that, a candidate must define what the
izationstendtobeparty-centered.Inthesecases,the
message is and must devise a strategy to reach the
voters cast their ballots for candidates as represent-
voters who will be swayed by that message. Again,
atives of a party. The party defines the campaign
how this is to be done varies with whether the
messageandcommunicatesittothevoters.Theparty
campaign inquestion is party-centeredor candidate-
raises the money to fund the campaign, does the
centered.
pollingnecessarytounderstandwhattheelectorateis
For party-centered campaigns, the message is the
thinking, and structures the campaign strategy and
partyplatform,andthevoterstobereachedatthosein
tactics.Typicallyfull-time,year-roundpartyworkers
theparty’scoreconstituencyandotherstowhomthe
performallthesefunctionsortheyarecontractedout
messagemightappealinaparticularyear.Neitherthe
toprofessionals.
messagenorthestrategyvarymuchfromyeartoyear,
Wherestrongpartysystemsdonotexist,individual
though marginal changes are made as the context
candidates must build their own organizations. In
changes—andthesemarginalchangesmightwellspell
thesecases,candidatesaremostconcernedwiththeir
thedifferencebetweenvictoryanddefeat.
ownelections,notthatofthosewhosharethisparty
For candidate-centered campaigns these decisions
label. Candidates choose campaign managers whose
are among the most crucial. Candidates must decide
solegoalisvictoryforthatonecandidate.Theybuild
whether to stick with the party message or to devise
personalorganizationstohandletheimportantfunc-
one of their own; they must decide what particular
tionsofcampaigning—doingresearchtodevelopissue
issues will play best to their voters; and they must
positionsandtocounteropponents’proposals;polling
figure out who precisely those voters are. Campaign
the public to ascertain perceptions of the candidate
strategists divide the electorate in a variety of
and reactions to strategies; writing speeches; com-
ways—by demographic characteristics, by economic
municating with the press; developing and placing
interests, by geographic locations. The goal is to use
advertisements;sending outdirectmailappeals,tele-
research and polling data to determine what appeals
phoning and leafleting the district; scheduling and
will work with which audiences and to have the
preparing for candidate appearances; and perhaps
candidateaddressthoseaudiencesappropriately.For
mostimportant,raisingmoney.Forlargerand more
incumbents seeking re-election, the strategic con-
expensive campaigns, all of these functions are per-
siderationofteninvolvesrelyinguponstrengthsdemon-
formedbypaidworkersorvolunteersinacandidate’s
strated earlier. For challengers, the strategy must be
own organization, or bought with campaign cont-
to find an opponent’s weakness and to emphasize
ributions.
one’sownstrengths.
Recentcampaignorganizationshavebeenlessable
Effectivecampaignstrategiesremainmoreartthan
to handle all of these functions, and two means of
science.Professionalpoliticalcampaignersknowwhat
coping have emerged. For campaigns in smaller
has worked in the past. But many strategists learn
constituencies, the candidate often performs all of
thoselessons.Thesuccessfulstrategistsarethosewho
thesefunctionshimorherself.Theyaredonemoreor
can see how to change the approach as the context
less well depending on the skill of the candidate, the
changes,asisoftensaidinthemilitary,‘nottorefight
time available, the level of competition, and the
thelastwarbuttoplanforthenextone.’
sophistication that is expected in campaigning for
office(Maisel1999).
Even those with relatively high budget campaigns
oftenfindthattheycannothirestafftoperformallof
4. CommunicatingwiththeVoters
the necessary campaign activities. These candidates
frequently turn to paid political consultants, experts To be effective, a political campaign must be able to
from outside the campaign who specialize in certain sendthemessageithasdevisedtotheaudienceithas
aspectsofthecampaignprocessandselltheirservices targeted. Campaign messages are communicated in
to many campaigns during any election cycle. Firms twoways,throughfreemediaandpaidmedia.
1434
Campbell,DonaldThomas(1916–96)
4.1 FreeMediaCo(cid:1)erage Bibliography
Political campaigns seek free media coverage in AnsolabehereSA,IyengarS1995GoingNegati(cid:1)e:HowAttack
whatever form they can, whenever they can. Candi- AdsShrinkandPolarizetheElectorate.FreePress,NewYork
dates want to be reported on in newspapers and HixS,LordC1997PoliticalPartiesintheEuropeanUnion.St.
newsmagazines; they want to grant interviews on Martin’sPress,NewYork
Jacobson GC, Kernell S 1981 Strategy and Choice in Cong-
radio; they want their events covered on television.
ressionalElections.YaleUniversityPress,NewHaven,CT
Freemediacoverageisadvantageousnotonlybecause
Kazee TA (ed.) 1994 Who Runs for Congress? Ambition,
thereisnocostbutalsobecausetheviewerseesnews
Context,andCandidateEmergence.CongressionalQuarterly,
coverage of a candidate as giving that candidate a Washington,DC
senseoflegitimacy;thecandidateisseenaspartofthe Maisel LS 1986 From Obscurity to Obli(cid:1)ion: Running in the
day’s news, not as part of a paid advertisement. Congressional Primary, rev. edn. University of Tennessee,
However,freemediaisuncontrolledexposure.Camp- Knoxville,TN
aignstrategistscantrytostructurewhattopicswillbe MaiselLS1999PartiesandElectionsinAmerica:TheElectoral
covered—and campaigns are exploring increasingly Process,3rdedn.Rowman&Littlefield,Lanham,MD
Maisel LS,StoneWJ1997Determinantsof candidate emer-
sophisticatedmeanstodothis—buttoofrequentlythe
gence in U.S. House elections: an exploratory study.
message delivered is very different from the message Legislati(cid:1)e Studies Quarterly 22: 79–96: Current work
thecandidateseekstoconvey.
from the Candidate Emergence Project can be found at
http:(cid:1)(cid:1)socsci.colorado.cdu(cid:1)CES(cid:1)home.html
Polsby NW, Wildavsky A 2000 Presidential Elections: Strat-
4.2 PaidMediaAd(cid:1)ertising egiesandStructuresofAmericanPolitics,10thedn.Chatham
HousePublishers,NewYork
The opposites apply to paid advertising. Paid medi- WayneSJ2000TheRoadtotheWhiteHouse2000.St.Martin’s
Press,NewYork
a—whether in the form of television, radio, or print
advertisements,ofInternetsites,orofdirectmail—is
L.S.Maisel
costlyandisoftenviewedbytheprospectivevoteras
theslantedmessageitinfact is.However,these paid
media also have the distinct advantage of allowing a
candidate to emphasize exactly the message desired.
Thesemessagescanbenarrowcast,thatisdesignedfor
anddirectedtospecifictargetaudiences.Theseadscan Campbell, Donald Thomas (1916–96)
create images, discuss positions, or—increasingly in
recentyears—attackanopponent,allinpreciselythe
DonaldThomasCampbell,bornNovember20,1916
waystrategistsfeelwillbemosteffectiveforaspecified
in Grass Lake, Michigan, died May 6, 1996 in
audience.
Bethlehem,Pennsylvania,thusendingacareermarked
The critical concerns about political campaigns
byanarrayofsuperlatives.Prolificscholarandauthor,
today relate to paid media. Many fear that effective
original thinker, ebullient teacher with a notable
political messages cannot be conveyed in 30-second
twinkleinhiseye,andgenerouscolleague,Campbell
advertisements, the medium preferred by advertising
was widely regarded as the most important social
executives. Others complain that the emphasis on
sciencemethodologist of thetwentieth Century. Sev-
negative, attack advertising has poisoned the atmo-
eral of Campbell’s articles vie with one another as
sphere that surrounds political life, keeping some of
among the most widely cited pieces of social science
the best candidates from running (Ansolabehere and
scholarship.Repeatedlyhecoinedphrasesanyoneof
Iyengar 1995). Virtually everyone bemoans the exor-
which most scholars would be proud to have con-
bitantcostsofcampaigns,costsspurredbyrelianceon
ceived,forexample,‘quasi-experiments,’‘unobtrusive
paid media. However, political campaigns will cont-
measures,’‘internalandexternalvalidity,’and‘plaus-
inuetorelyonpaidmediasolongastheyareeffective
ible rival hypotheses.’ His concepts are incorporated
incommunicatingacandidate’smessagetothetarget
as fundamental in several fields—psychology, soci-
audience; for that is the means to electoral succ-
ology, anthropology, organization and management
ess—the ultimate message of a campaign’s effect-
sciences, public policy, evaluation, education, and
iveness.
philosophy—andincommonusebyscholarsunaware
of their inventor. Moreover, Campbell’s welcoming
See also: Advertising: Effects; Electoral Systems;
andself-criticalpersonalstyle,modeledonhisschol-
Electronic Democracy; Mass Media, Political Econ-
arship,ledhimtoembraceandexamineall‘plausible
omyof;MediaandSocialMovements;MediaEffects; rival hypotheses’ and endeared him to students and
Media,Uses of;PartyIdentification;PoliticalMach- colleaguesalike.
ines; Political Money and Party Finance; Political CampbellreceivedhisB.A.(1939)andPh.D.(1947),
Parties;Polling;PrimaryElections;Voting,Sociology bothinPsychology,fromtheUniversityofCalifornia
of;Women’sSuffrage (Berkeley),andtaughtatseveralinstitutions,including
1435
Campbell,DonaldThomas(1916–96)
Ohio State University (1947–50), the University of tion of the physical world and mechanisms for
Chicago(1950–53),SyracuseUniversity(asN.Y.State compensating for these errors. (Campbell later de-
BoardofRegentsAlbertSchweitzerProfessor,1979– clared profound ‘ambivalence’ toward the use of
82) and Lehigh University (as Distinguished Uni- disguised measures; see Kidder and Campbell 1970.)
versity Professor of Sociology-Anthropology, Psy- Campbell explored the sources and loci of bias and
chologyandEducation,1983–96),butthemajorityof developedandrefinedmethodsforillustratingandfor
his scholarly years were spent as professor of psy- minimizing these biases. For example in Jacobs and
chology at Northwestern University (1953–79) with Campbell (1961) he demonstrated how consensus in
whichCampbell’snameandreputationare‘perman- the‘reality’ofanarbitrarilyinventedbutsharedgroup
entlyandinextricablyco-identified’(Campbell1981). norm could persist over generations of experimental
Campbell’s honors include a Fulbright Visiting subjects. In a series of crosscultural explorations
ProfessorshipinSocialPsychologyatOxford(1968), Campbell and co-workers (e.g., Segall et al. 1966)
theDistinguishedScientificContributionAwardfrom explored sources of validity and invalidity in percep-
theAmericanPsychologicalAssociation(1969),elec- tions of ‘in-groups’ and ‘out-groups,’ and the differ-
tion to the National Academy of Sciences and the ential susceptibility to perceptual illusions between
AmericanAcademyofArts&Sciences(1973),theKurt Europeanandnon-Europeancultures.
Lewin Memorial Award from the Society for the Campbell and Fiske (1959) published ‘Convergent
PsychologicalStudyofSocialIssues(1974),presidency andDiscriminantValidationbytheMultitrait,Multi-
oftheAmericanPsychologicalAssociation(1975),the method Matrix,’ a complex and frequently cited
Williams James Lectureship at Harvard (1977), the analysis of the need for multiple measures of under-
MyrdalPrizeinScience(1977),andtheDistinguished lying constructs (traits) and of the need for the
ContributionAwardfromtheAmericanEducational demonstrated capacity of methods to distinguish
ResearchAssociation(1981).Inaddition,twoannual amongtraitsifoneistominimizeirrelevantmeasure-
awardsaregiveninhisname:TheDonaldCampbell mentartifacts.Sinceeverymeasureispartiallyinvalid,
AwardforSignificantResearchinSocialPsychology multipleanddistinctivemethodsarecalledfortoyield
(1982–) and the Donald Campbell Award from the a‘heterogeneityofirrelevancies.’CampbellandFiske
PolicyStudiesOrganization,toan‘outstandingmeth- exploredthevalueofsimultaneouslydeployingmaxi-
odologicalinnovatorinpublicpolicystudies’(1983–). mally different measures of an underlying trait (in
Campbell received honorary degrees from numerous pursuit of convergent validation) and of different
universities, including Oslo, Michigan, Chicago, and traitsmeasuredthesameway(inpursuitofdiscrimi-
SouthernCalifornia. nant validation). Only by demonstrating that an
ButCampbellfeltmosthonoredbythevastarrayof underlying trait can be measured in various distinct
books dedicated to him, a list that grew steadily in ways and that the chosen measurement strategies
severaldisciplinesbeforeandafterhisdeath. distinguishamongmeasuredtraits,canoneminimize
theimpactofmisleadingartifacts.
By the early 1960s Campbell had established an
enviable reputation for the vigor and reach of his
1. MajorContributions
campaign for advancing the methods and theory
Whenhedied,Campbell’sresume(cid:1) listedmorethan230 associatedwithissuesofvalidity.Hisreputation was
publishedbooks,monographs,andarticles.Anybrief furtheradvancedwiththepublicationwith(Campbell
discussionofhiscontributionsmustnecessarilyfocus andStanley1963)of‘ExperimentalandQuasi-exper-
on a few. Best known as a methodologist, with imentalDesignsforResearch,’awidelycirculatedwork
considerable scholarly work in the areas of exper- (elaborated as Cook and Campbell 1979) in which
imental design, measurement, and social experimen- they popularized the terms ‘internal’ and ‘external’
tation,Campbellisperhapsrememberedespeciallyfor validity:
hisexplorationsoftheconceptofvalidity.Hewasalso
awell-regardedepistemologistwithakeeninterestin Internal validity is the basic minimum without which any
the sociology of science. To each domain, Campbell experiment is uninterpretable: did in fact the experimental
treatment make a difference in this specific experimental
brought his unique mind to bear on the problem of
instance?Externalvalidityasksthequestionofgeneralizabi-
knowledge production. In a remarkable array of
lity:Towhatpopulations,setting,treatmentvariables,and
works, Campbell explored from several perspectives
measurement variables can this effect be generalized?
the inevitable fallibilities inherent in both observers (CampbellandStanley1963).
andmethodsinaccuratelyportrayingtheworld.
Inhisearliestpublication,‘TheIndirectAssessment Another widely cited treatise, Unobtrusi(cid:1)e Mea-
of Social Attitudes’ (1950), Campbell evidenced an sures: Non-reacti(cid:1)e Research in the Social Sciences
aspectoftheinterests thatwould become theoverall (Webb et al. 1966) evolved during affable lunchtime
focusofhisscholarlylife:theimperfectionsintroduced conversations with colleagues from different depart-
by human observers and methods, including the ments. Over several years these colleagues sought to
scientific method, in the search for veridical descrip- identifyrelativelyunbiased,nonreactivewaysofmea-
1436
Campbell,DonaldThomas(1916–96)
suringbehavior.Afrequentlycitedexampledescribes Inabrillianttongue-in-cheeksectionofthisarticle
ways a Chicago museum tried to identify the popu- Campbelladvised‘trappedadministratorswhosepol-
larity of its exhibits. ‘Obtrusive measures’ included itical predicament will not allow the risk of failure’
questioning visitors leaving the museum; an ‘unob- how to capitalize on ‘threats to validity’ to assure
trusive measure’ was the frequency with which mu- positiveresults(Campbell1969b).Forexample,were
seumstaffhadtoreplaceworntilesinfrontofexhibits. theytoaccepttheoccasional‘gratefultestimonial’asif
Bythatindex,theexhibitofbabychickshatchinglive itwerearepresentativeoutcome,toreserveinterven-
and wet from quivering eggs was by far the most tionsforcarefullyselectedsubpopulationsmostlikely
popular. to succeed, and to eliminate from their analyses all
Campbell’s participation in an interdisciplinary thosewhoprematurelyquittheprogram,‘successful’
conference spawned his brilliant foray into the so- programoutcomescouldbevirtuallyassured.
ciology of science entitled ‘Ethnocentrism of Disci- Campbell continued in various fora to insist that
plines:AFishscaleModelofOmniscience’(1969a).On socialscientistshavebothobligationsandopportun-
reading a paper ‘in an area of high relevance’ to his itiestotesttherelevanceoftheirtheoriesandmethods
own work by esteemed fellow social psychologist in the service of public good. In this, Campbell’s
William McGuire, Campbell realized and then ack- unswervingconcern was with the biases affecting the
nowledgedthathehadnot‘readorread-atevenhalfof generation of knowledge. For example, in his too-
McGuire’s citations, and was not at all aware of the infrequently cited ‘Assessing the Impact of Planned
existence of another sizeable proportion’ (Campbell Social Change’ (1975) Campbell again displayed re-
1969a).Whilemanyscholarsmightreactwithchagrin, markable methodological and sociological insight in
Campbell instead reflected on how the ‘highly ar- generalizingtheproblemofdatavalidityinthepolicy
bitrary’ organization of universities and academic arenainthefollowingway:
fieldsskewedknowledgeproduction:
Themoreanyquantitativesocialindicatorisusedforsocial
Thusanthropologyisahodgepodgeofallnoveltiesventuring decision-making, the more subject it will be to corruption
into exotic lands—a hodgepodge of skin color, physical pressures,andthemoreaptitwillbetodistortandcorrupt
stature, agricultural practices, weapons, religious beliefs, thesocialprocessesitisintendedtomonitor(Campbell1975).
kinship systems, history, archeology, and paleontology…
Thus psychology is a hodgepodge of sensitive subjective Corrupted indicators remain a persistent and only
biography, or brain operations, or school achievement
vaguelyexploredsourceofreal-worldinvalidity(e.g.,
testing,offactoranalysis,ofMarkovprocessmathematics,of
Cochranetal.1980).
schizophrenicfamilies,oflaboratoryexperimentsongroup
Another highly influential, widely circulated piece
structure in which persons are anonymous…Thus econo-
micsisahodgepodgeofmathematicswithoutdata,ofhistory wentunpublishedfornearly20years:in‘Methodsfor
ofeconomicinstitutionswithoutmathematicsortheory,of theExperimentingSociety’Campbellattemptedspecifi-
anidealmodelofpsychologicalman…(Campbell1969a) cally to design a strategy for a society willing to test
innovationsandtheirintendedeffects.Hearguesfora
Campbell took a breathtaking leap when he con-
societythatwould
ceivedthe‘mythofunidisciplinarycompetence,’dem-
onstratinghowsocial,administrative,structural,and vigorouslytry out possible solutionsto recurrent problems
political supports which accrue over time around andwouldmakehard-headed,multidimensionalevaluations
arbitrary disciplines ultimately create incentives that ofoutcomes,andwhentheevaluationofonereformshowed
reinforce these arrangements and punish others of ittohavebeenineffectiveorharmful,wouldmoveontotry
equal epistemological worth. Campbell detailed the otheralternatives(Campbell,inOverman1988).
inevitable consequence—biased knowledge produc-
tion—and offered a model of ‘interdisciplinary Surveying the multitude of societal reforms under-
narrowness’ for mitigating this ‘ethnocentrism of way at the time, many of which he endorsed (e.g.,
disciplines.’ Alexander Dubcek in Czechoslovakia, Salvador
Bythelate1960s,followingVietnamWarprotests, Allende,inChile),Campbellargued:
campusunrest,andanationalfocusonurbaninequi-
Thereisnosuch(experimentingsociety,committedtoreality
ties, Campbell began trying conscientiously to in-
testing, self-criticism, to avoiding self-deception) anywhere
fluencethedesign,implementation,andevaluationof
today.Whileallnationsareengagedintryingoutinnovative
social policies. In ‘Reforms as Experiments’ (1969b) reforms, none of them are yet organized to adequately
Campbell introduced a range of real-world quasi- evaluatetheoutcomesofthesereforms(Overman1988).
experiments (attempts to approach the standards of
experimentation even where random assignment of Afterspecifyingrequirementsofsuchan‘experiment-
subjects to conditions is unachievable)—each tested ing society’ Campbell attempted in various ways to
against standards of ‘internal and external vali- determineconditionsunderwhichtheseresultsmight
dity’—to the practical world of social reform. That beachievable. For example, after Allende was assas-
articlefrequentlyiscitedasthemostimportantsingle sinated in Chile, Campbell invited Chilean social
workinthefieldnowknownas‘programevaluation.’ scientistRicardoZun(cid:2)iga toNorthwestern University
1437
Campbell,DonaldThomas(1916–96)
specifically to reflect on the conditions that might knowforcertain?…Ouronlyhopeascompetentknowersis
allowvigorous,large-scalereformstobetested. that we be the heirs of a substantial set of well-winnowed
Campbell made other major contributions in his propositions(Campbell,inOverman1988).
application of evolutionary theory to the realm of
ideas. Campbell, the eternal epistemologist, focused In the heady intellectual mix he created and sus-
in particular on the joint operation of the ‘blind- tained, Campbell was known for changing his mind
variation-and-selective-retentionprocessfundamental whenpersuadedbycarefullytestedevidence,andfor
toallinductiveachievements,toallgenuineincreases challengingotherstodothesame.Forexample,over
in knowledge.’ In his ‘evolutionary epistemology,’ the years Campbell was persuaded by sociologist
whichperhapsreceiveditsfullestfloweringinhisessay Howard S. Becker and others to appreciate the
honoring Karl Popper (in Overman1988), Campbell falsifiabilityofcarefullywroughtcasestudies,inspite
endorsedthenaturalselectionparadigmforexplaining of their failure to live up to his long-cherished
the production of knowledge. Through the selective methodologicalcriteria(Campbell,inOverman1988).
winnowing of ideas, Campbell argued, what survive In return, he prompted qualitatively-oriented col-
over time are those ideas that are most meritorious, leagues to persist in reconsidering the validity claims
particularlyaseachissubjectedto‘criticalrealism.’ inherent intheir ownwork (see, forexample, Becker
In his William James lectures, Campbell (1977) 1986).Forthisopen-mindedness,Campbellisrevered
summarizedhisperspectiveinthisway: by quantitative and qualitative methodologists alike
(seePatton1999).
I am a fallibilist and antifoundationalist. No part of our Campbell also influenced legions of colleagues to
systemofknowledgeisimmunetocorrection.Thereareno reflect honestly on their own work. He talked and
firmbuildingblocks,eitherasindubitableandthereforevalid
wrote openly about his own insecurities and frustra-
axioms, or in any set of posits that are unequivocal once
tions, including how late in his career he began to
made.Norarethereanyunequivocalexperiencesorexplicit
write,droughtsinhisownproductivity,hisdiscomfort
operationsonwhichtofoundacertaintyofcommunication
inlieuofacertaintyofknowing. with the production pressure and relentless expec-
I am some kind of a realist, some kind of a critical, tation of genius when he was a young assistant
hypothetical, corrigible, scientific realist. But I am against professor at the University of Chicago, his frequent
direct realism, naive realism, and epistemological compla- bouts of depression, and the times when he believed
cency(Campbell,inOverman1988). hisstudentsandcolleagues‘carriedhim.’
He explained his messy desk cheerfully by saying
that he ‘filed archeologically,’ and as long as no one
2. Legacy moved things around he could find whatever he
wanted. Amazed colleagues would watch him reach
Campbell’slegacyisvastandpronounced.Itaffectsa
intoapileandpullouttheprecisepapersrelevantto
widerangeofsocialscientistsaswellaspublicpolicy
theirdiscussions.
scholarsandpractitioners,andisreflectedinthework
Although its publishers have sold thousands of
ofhundredsofhisstudentsandmoredistantheirs.He
copies of Experimental and Quasi-Experimental
introduced fundamentally new ways of thinking that
Designs for Research and students return to it year
are taken for granted today about how we perceive,
after year, Campbell never received any royalties; he
discover,andassessaccumulatedknowledge.Manyof
asked only for unlimited copies to give freely to his
his concepts are now fundamental throughout the
colleagues.
social and policy sciences. Campbell is the most
Consideration of Campbell’s legacy would be in-
important intellectual figure in the history of evalu-
completewithoutadiscussionofhispersonalstyle,for
ationresearch.Thestrategiesheemployedin‘Reforms
it,too, promotedtheproductionofknowledgewhile
asExperiments’forunearthingandillustratingthreats
providing his colleagues with a vital and successful
to interpretations of policy implementation are an
paradigm. It would understate Campbell’s colossal
often-cited model for exploring complex data (see
influence if there were no mention of his towering
Tufte1983).
warmth, kindness, and generosity, and his deeply
Inremarkablyvivid,fetchingbutpreciselanguage,
honest and self-critical perspective on his own work
Campbellrepeatedlycapturedthecentralimportance
(Campbell 1981). Campbell was remarkably able to
of fallibilities inherent in human observers and their
reflectonhisownfallibilitiesandtocreateconditions
methods as they accumulate knowledge about the
thatwouldmodelhisepistemology,andimproveboth
world,andthusoftheimportanceofmultipleperspec-
hisworkandtheworkofothers.Examplesarediverse
tives, the triangulation of methods, and an open
andlegendary:hewouldoftensendarequestedreprint
processwherebyideasaretestedagainstoneanother
accompanied by a colleague’s critical rejoinder. He
topromotethewinnowingeffectsofcompetition.
was always in pursuit of contrary evidence and
Thus,intheJameslectures,Campbellstatedthat
counter-intuitive examples, particularly if they con-
Wearecousinstotheamoeba,andhavereceivednodirect fronted his own work. He encouraged students to
revelation not shared with it. How then, indeed, could we write minority sections to project reports if they
1438
Cancer-pronePersonality,TypeC
disagreed with him or with an emerging majority. Kidder L, Campbell DT 1970 The indirect testing of social
Campbellwasresolutelyencouragingofothersandin attitudes.In:SummersG(ed.)AttitudeMeasurement.Rand
fact was thought by some to ‘suffer fools gladly.’ He McNally,Chicago
Overman ES (ed.) 1988 Methodology and Epistemology for
gave three grades: A, B, and incomplete. If the data
Social Science: Selected Papers of Donald T. Campbell.
collectedindissertationsfailedtosupportanticipated
Chicago
hypotheses,orfailedtoreplicatepublishedfindingsin PattonMQ1997Utilization–FocusedE(cid:1)aluation,3rdedn.Sage,
theliterature,Campbellurgedstudentstowriteupthe BeverlyHills,CA
apparentreasonsfortheobtainedresults. SegallMH,CampbellDT,HerkovitsMJ1966TheInfluenceof
Over time, Campbell connected his early deep CultureonVisualPerception.Bobbs-Merrill,Indianapolis,IN
philosophical explorations to a program of practical TufteER1983TheVisualDisplayofQuantitati(cid:1)eInformation.
work that will continue to guide generations of GraphicsPress,Cheshire,CT
scholarsandpractitioners.Campbelllivesonthrough Webb EJ, Campbell DT, Schwartz RD, Sechrest L 1966
Unobtrusi(cid:1)e Measures: Nonreacti(cid:1)e Research in the Social
his voluminous work in many fields, through his
Sciences.RandMcNally,Chicago
students,andthroughtheiradoptionofhisstyle.
A.C.Gordon
See also: Evolutionary Epistemology; Experimental
Design: Large-scale Social Experimentation; Exper-
imental Design: Randomization and Social Exper-
iments; Experimentation in Psychology, History of;
Cancer-prone Personality, Type C
ExternalValidity;Foucault,Michel(1926–84);Inter-
nal Validity; Panel Surveys: Uses and Applications;
Pearson, Karl (1857–1936); Quasi-Experimental De- Type C has emerged as a behavioral pattern, coping
signs;Reform:Political;UnobtrusiveMeasures style,orpersonalitytypethatpredisposespeopleto,or
isariskfactor,intheonsetandprogressionofcancer.
TypeChasbeendescribedasbeingover-cooperative,
stoical or self-sacrificing, appeasing, unassertive,
Bibliography patient, avoiding conflict, compliant with external
authorities, unexpressive, suppressing or denying
Brewer M, Collins B 1981 Scientific Inquiry and the Social
Sciences.Jossey-Bass,SanFrancisco negativeemotions,self-sacrificing,andpredisposedto
CampbellDT1950Theindirectassessmentofsocialattitudes. experiencing hopelessness and depression (Bleiker
PsychologicalBulletin47(1):15–38 1995,Eysenck1994,Temoshok1990).
CampbellDT1969aEthnocentrismofdisciplinesandthefish- Sincethemid-twentiethcentury,thecontributionof
scale model of omniscience. In: Sherif M, Sherif C (eds.) psychosocialfactorstocancerhasbeenanimportant
InterdisciplinaryRelationshipsintheSocialSciences.Aldine, research topic. A search of the literature shows an
Chicago
exponential growth: while only nine publications
Campbell DT 1969b Reforms as experiments. American Psy-
appeared from 1951 to 1955, between 1995 to 1999
chologist24:409–29
more than 300 hundred documents dealing with this
Campbell DT 1975 Assessing the impact of planned social
change.In:LyonsG(ed.)SocialResearchandPublicPolicies. topic have been published in scientific journals
PublicAffairsCenter,DartmouthCollege,Hanover,NH (Psychlit and Medline database). This article deals
Campbell DT 1977 Descripti(cid:1)e Epistemology: Psychological, withthe‘stateoftheart’ofTypeCanditsroleasarisk
Sociological, and E(cid:1)olutionary. William James Lectures. factorintheonsetandprogressionofcancer.
HarvardUniversity,Cambridge,MA
CampbellDT1981AnotherPerspecti(cid:1)eonaScholarlyCareer.
In:BrewerMB,CollinsBE(eds.)ScientificInquiryandthe
SocialSciences.Jossey-Bass,SanFrancisco 1. HistoricalO(cid:1)er(cid:1)iew
Campbell DT, Fiske DA 1959 Convergent and discriminant
Thebeliefthatpersonalitycontributestotheetiology
validationbythemultitrait–multimethodmatrix.Psychologi-
calBulletin56:81–105 ofdiseaseisasoldasthehistoryofhumanthought.In
Campbell DT, Stanley JC 1963 Experimental and quasi- the third millennium BC, Hippocrates stated that
experimental designs for research on teaching. In: Gage N melancholichumor(causedbyasurplusofblackbile)
(ed.) Handbook of Research on Teaching. Rand McNally, caused cancer, and Galen (second century AD) ob-
Chicago served that neoplasm was more likely to occur in
Cochran N, Gordon AC, Krause M 1980 Proactive records: melancholicanddepressedthaninsanguinewomen.
Reflectionsonthevillagewatchman.Knowledge2(1):5–18
It is in the twentieth century that experimental
Cook TD, Campbell DT 1979 Quasi-experimentation Design
evidence about relationships between cancer and
andAnalysisIssuesforFieldSettings.RandMcNally,Chicago
personality are found. During the first half of the
Jacobs RC, Campbell DT 1961 The Perpetuation of an
arbitrarytraditionthroughseveralgenerationsofalaboratory twentiethcentury,investigationsweremadefromthe
microculture. Journal of Abnormal & Social Psychology 62: perspectiveofpsychoanalyticaltheory,andwithinthe
649–58 fieldofpsychosomaticmedicine.Themostimportant
1439
Cancer-pronePersonality,TypeC
characteristics in cancer patients found through em- propertiesanddifferentlevelsofgeneralizability,and
pirical research mentioned: loss of important rela- theirscorescan,therefore,begeneralizedtodifferent
tionships, inability to express negative emotions, universes,presentingdifficultiesforthecomparability
tensionconcerningparentalrelationships,andsexual ofresults.Overrecentdecadesmuchmoreattentionto
problems. Type C measurement has been paid, and these
Finally, it is from the second half of the twentieth methodological problems have been partially over-
century that the role of behavioral and psychosocial come.
conditionsintheonsetandprogressionofcancerhas
beeninvestigatedsystematicallyinresearchprograms,
groups,andlaboratories,followingatrackparallelto
2.2 CancerCharacteristics
researchinTypeA,Coronarypronebehavior.Agood
deal of clinical observations and research data has Cancerisnotahomogeneousentity;bothcancertypes
beenproducedaboutasystematiclinkbetweensome (melanoma, sarcoma, etc.) and cancer sites (lung,
psychosocial factors and cancer. At the same time, breast,skin,etc.)varywithregardtoetiology,course,
there have been comprehensive reviews of psycho- mortality, heritability, and risk factors. Also, cancer
oncology research, and strong criticism of its meth- always implies a process, and psychological factors
odological flaws. Thus, before presenting the main may act at different stages of this process; this fact
traits constituting Type C, the most important diffi- introducesimportantresearchproblems.Forexample
cultiesinvolvedinitsresearchwillbediscussed. Kreitleretal.(1993)statedthatemotionalrepression
may be a response to the threat posed by the cancer
diagnosis.Severalstudieshavedealtwiththetimingof
psychological assessment and its relationship to
2. DifficultiesintheStudyofCancer-prone
cancer, but the relationships between psychosocial
Personality,TypeC
conditions and neoplastic processes require sophis-
Temoshok and Heller (1984) described Type C re- ticatedandcomplexresearchdesigns,andthesehave
search in a very illustrative fashion, as ‘comparing yettobefullydeveloped.
apples, oranges and fruit salad,’ expressing its com-
plexityandmethodologicaldifficulties.Inotherwords
it involves different constructs, assessed through dif- 2.3 Subjects(cid:1)SampleCharacteristics
ferent instruments, in different samples of subjects
withdifferenttypesofcancerandotherdiseases,and Several authors have pointed out that sociodemo-
usingdifferentdesigns. graphicvariablesmaybeassociatedwithmedicaland
The heterogeneity of factors contributing to the environmentalriskfactors.Amongsociodemographic
noncomparability of psycho-oncology literature can characteristics, age seems to be the most important,
beconsideredinthefollowingways:(a)thenatureand since cancer incidence and prevalence increases with
measurementofpsychologicalphenomena,(b)cancer age, and several personality characteristics are also
characteristics(type,site,andstageintheprocess),(c) associated with age (e.g., introversion). When cancer
samplecharacteristics,and(d)designsused. groups are compared with other participants, age
shouldbecontrolled(e.g.,Ferna(cid:1)ndez-Ballesterosetal.
1998).
In order to test the psychological risk factors of a
2.1 TheNatureandMeasurementofPsychological
given disease or illness through psychological co-
Phenomena
variation,comparisonbetweenhealthyandillsubjects
Personality type, coping style, stress or emotional isnotenough.Itisessentialtodistinguishalsobetween
response,orbehavioralpatternareconstructswitha the target illness and other illnesses. Cancer patients
variety of conceptualizations in psychology. This havebeencompared,aswellaswithnormalpatients,
problematic issue has been overcome by Eysenck with patients suffering from cardiovascular and di-
(1994); in short, the subject’s response to a given gestive problems, chronic diseases and benign path-
stressful situation cannot be understood without ologies,andwithaccidentvictims,amongothers.
takingintoconsiderationtheirstressorperceptionand
the behavioral pattern used in coping with stress—
botharestablepersonalityconditions.
2.4 Designs
Tothisconceptualproblem,amethodologicalone
shouldbeadded.Asconstructs,alltypesofvariables Science requires strategies or designs for testing
must be operationalized through psychological hypotheses; thatis, when and under what conditions
measures. From semistructured interviews and pro- units (subjects) will be observed and measured.
jective techniques to well-developed questionnaires, Authorsagreethatthebestdesignforstudyingagiven
hundreds of measures have been used in psycho- riskfactorisaprospectiveone.Subjects(recruitedat
oncologyresearch,whichhavedifferentpsychometric randominthecommunityorasamemberofagiven
1440
Cancer-pronePersonality,TypeC
group) are assessed in the relevant target behaviors not feeling anger or irritation, and in their relation-
andpsychologicalconstructs,andaremonitoreduntil ships they report avoiding arguments with others
someofthemdevelopcancerandothersdonot.Also, by using reason and logic, often contrary to their
inlongitudinalstudiessubjectsalreadydiagnosedwith feelings. For example, in a quasiprospective study,
cancer are monitored during different stages of the within a breast cancer prevention program, Fer-
illness process, from diagnosis to progression, treat- na(cid:1)ndez-Ballesterosetal.(1997)comparedtheration-
ment,andsurvivalordeath. ality (as well as other somatic characteristics) of
In quasiprospective designs psychological evalu- healthy women (N(cid:1)96), women with benign breast
ation is carried out before cancer diagnosis, but this disease(N(cid:1)90)andwomenwithbreastcancer(N(cid:1)
period is usually very short. This type of design is 122). Healthy women were matched with women
commonlyusedwithincancerpreventionprogramsin with benign breast pathology or with breast cancer.
which all subjects are assessed in psychosocial All were assessed before diagnosis. Results show
characteristics and, after diagnosis, subjects with that women with breast cancer differed significantly
cancer are monitored. This type of design has two from healthy women and those with benign breast
mainflaws:psychologicalcharacteristicsaremeasured pathology. Any other review on this topic yields the
when subjects have already developed cancer, and same results: emotional expression is one of the psy-
subjects attending a prevention campaign cannot be chologicalhallmarksofcancer(Bleiker1995,Eysenck
considered to be in a neutral context. Furthermore, 1994,SpiegelandKato1996,Temoshok1990).
this situation is quite heterogeneous, since while Unfortunately, however, experimental data does
several subjects may already be suspicious about not describe the nature of these psychological
lumpsorlesions,othersaremerelyparticipatingina characteristics, nor whether cancer subjects fail to
preventive—or‘normal’—situation. perceiveorfeeltheiremotionalinternalphysiological
Inretrospectivedesigns,subjectsalreadydiagnosed reactionsorwhethertheysimplyfailtoexpressthem
orbeingtreatedforcancerarecomparedwithcontrol (verballyorotherwise).
groups in a set of psychological characteristics. Such
retrospectivedesignsarehighlycriticizedbecausethey
donottelluswhetherpsychologicalcharacteristicsare 3.2 Depression
the cause or the result of cancer (e.g., Kreitler et al.
Consideration of medical anamneses also suggests
1993).
that depression is a frequent precursor of cancer;
Allofthesedesignscanbeconsideredas‘descriptive’
feelings of helplessness and hopelessness are also
or ‘correlational’ research strategies. However, there
found in several studies. For example, the Western
are also experimental designs; in these, the ‘inde-
Electric Health longitudinal study monitored 2,020
pendent’ variable (a psychological or personality
employeeswiththepurposeofinvestigatingcoronary
condition) is manipulated in order to measure its
disease risk factors. As a measure of personality and
causalorfunctionalrelationshipwiththe‘dependent’
personal and social adjustment the Minnesota
variable(cancer).
Multiphasic Personality Inventory (MMPI) was ad-
In sum, several of these conceptual and methodo-
ministered. At the 17-year follow-up, 4 percent had
logical problems have been overcome, while others
died of cancer. As reported by Shekelle et al. (1981),
continuetobetheobjectofcriticism.
therewasatwofoldincreaseintheoddsofdeathfrom
cancer in men with psychological depression. This
resultwasconsistentacrosssitesandtypesofcancer.
3. PersonalityCharacteristicsinCancerPatients
Also,thisassociationpersistedafteradjustmentshad
Evidence from prospective, quasiprospective, retro- beenmadeforage,cigarettesmoking,useofalcohol,
spective,andexperimentalstudiesconvergesonaset familyhistoryofcancer,andoccupationalstatus(see
ofpsychologicalcharacteristicsthatseemtoactinthe Depression,Hopelessness,Optimism,andHealth).
onset and progression of all types of cancer. Let us In spite of these impressive results, it is unclear
examinethesecharacteristics. whetherthesestatesareantecedentsorconsequences
ofcancer,andresearchdataisinconsistentinthisarea.
3.1 EmotionalExpression
3.3 InterpersonalStyle
This appears to be at the core of Type C. That is,
suppression, repression, inhibition and(cid:1)or denial of In the medical literature, cancer patients have been
negative emotions seem to be the central character- described by their doctors as ‘extremely pleasant’ in
istics of the cancer-prone personality (see Emotions their interactions with them. There is evidence from
and Health). Cancer patients (in comparison to con- retrospective, quasiprospective, and prospective
trols) are described as anti-emotional and alexitimic, studies, as well as from experimental studies, that
with a tendency to control their negative feelings cancerpatients—incomparisontocontrolsubjects—
(mainly anger, aggressiveness, hostility); they report yieldsignificantlyhigherscoresintestsassessingneed
1441
Cancer-pronePersonality,TypeC
for harmony, self-sacrifice, and unassertiveness. For by Grossarth-Maticek and Eysenck (1990) on the
example, in a quasiprospective study Ferna(cid:1)ndez- basis of cancer-prone characteristics (emotional ex-
Ballesterosetal.(1998)compared,intermsofneedfor pression, assertiveness, coping, etc.), and it was at-
harmony (as well as rationality), three groups of temptedtomanipulatethemthroughbehaviortherapy
women with breast cancer (before diagnosis (74), techniques.In1983,mortalityandcausesofdeathfor
during treatment (105), and during the follow-up the2,563subjectsofthestudywereascertained.Ofthe
(132))withhealthywomen.Bothpersonalityvariables selectedsubjects,38percentofrisksubjectshaddied,
correctly classified 86 percent of the participants (87 ascomparedto10percentoftherandomsample.
percentofthebreastcancerpatientsand82percentof In the cancer therapy group deaths were signi-
thehealthyparticipants)and,moreover,nosignificant ficantly fewer than in the control group, and there
differences in rationality and need for harmony were were no deaths from cancer. In marked contrast, 60
foundtoberelatedtothestageofthecancerprocess. percentofthedeathsinthecontrolgroupwerefrom
This behavioral pattern can be understood as a cancer. Although Grossarth-Maticek’s studies have
coping style for stressful situations, as a personality been criticized for certain methodological short-
characteristic, or as a defense mechanism against comings (questionnaires used were not in a standard
anxiety. form, and there was no report on psychometric
properties),theirimpressiveresultsareinaccordance
withthewell-establishedeffectsofpsychosocialtreat-
3.4 Stressors,Stress,Strain,andCoping
ment, which significantly increases survival in cancer
Mechanisms
patients(e.g.,SpiegelandKato1996).
Cancer patients’ anamneses usually show that an Fromdescriptiveandexperimentalstudiesitcanbe
antecedent of cancer disease is a subject’s life event. summarizedthatcancer-proneorTypeCpersonality
However, as already mentioned, it is important to is a psychological configuration with two main con-
differentiate between the external stressor, the sub- ditions:(a)suppressionofnegativeemotions(suchas
ject’s appraisal and coping style, and the stress anger and anxiety), which includes not only lack of
reaction (see Stress and Health Research). As under- verbalexpressionofemotionsbutalsocorresponding
lined by several authors, stress is the response of a interpersonal behaviors and (b) inappropriate stress
given subject to their perception of a stressor—a coping mechanisms, leading to feelings of hopeless-
stimulus or situation perceived as threatening. Also, ness,helplessness,anddepression.
however, subjects have different mechanisms for Finally, what mechanisms can be assumed to link
copingwithstress.Forexample,CooperandFaragher psychologicalcharacteristicswithcancer?
(1993) pointed out that subjects who experienced a
stressfulsituationtheyperceivedasthreateninghada
3.5 MechanismsthatLinkPsychologicalFactors
significantly higher cancer risk. In a retrospective
withCancer
study, Watson et al. (1984) compared breast cancer
patients and healthy controls. Breast cancer patients Fromamentalisticand(cid:1)ordualisticperspective,psy-
weremorelikelythancontrolstoreportatendencyto chological characteristics observed in cancer patients
controlemotionalreactions,particularlyanger. havebeenconsideredasthoughthe‘soul’(ormental
However, evidence about psychosocial influences entities) were affecting the body. This position has
on cancer incidence and progression comes not only been brought up to date through empirical evidence
from descriptive studies—there are also important frombothpsychologicalandbiologicalliteraturethat
experimentalresults.Forexample,Grossarth-Maticek support the relationship between personality and
carried out an experimental study within the emotions and the autonomic, endocrinological and
Heidelberg prospective study. In 1971, 1,026 healthy immunesystems.
personsfromarandomsampleofthepopulationwere O’Leary(1990),inherreviewofstressresponseand
assessed in a wide set of psychosocial and medical the immune system, referred to the fact that chronic
variables. Also, 1,537 subjects were selected on the stressisassociatedwithasuppressionoftheimmune
basis oftheir increasedpsychosocialand clinical risk function,and that personalityand copingstyles may
of cancer or cardiovascular or circulatory disease. enhanceordegradetheimmuneresponse.Aspointed
Criteria used included chronic depression and hope- out by Spiegel and Kato (1996), chronic and acute
lessness, chronic excitement and anger, heavy smok- stress are associated with reductions in various
ing, hypertension, high blood cholesterol, and high measures of the immune function, and, moreover,
blood sugar. From the 1,537 high-risk subjects, 100 psychological intervention positively influences hall-
wereselectedwhowerethoughttohaveanespecially marksoftheimmunesystem.
high risk of cancer (and also of CV disease). Half of Insum,asSpiegelandKato(1996)conclude,‘there
these subjects were selected randomly and given is a nonrandom relationship among various psycho-
psychological therapy intended to decrease the re- social factors and cancer incidence and progression
spective risk. This therapy, which has been called thatcanonlypartially(underlineadded)beexplained
‘creativenovationbehaviourtherapy,’wasdeveloped bybehavioral,structural,orbiologicalfactors.’
1442
