How to Compress Your Morbidity

Let's talk about dieing. I don't mean death itself, which has all kinds of philosophical and religious issues attached to it, but rather the physical and mental processes leading up to death, which involve more factual, scientific issues.

All of us will die and nobody knows exactly when. Despite the uncertainty as to the timing of death, most of us have an idealized model of how we want to die: continued high level of physical and mental functioning for as long as possible and then rapid decline just before the end. This period of decline in which we are infirm, diseased, disabled and/or demented is called morbidity, and we wish it to be as short as possible, followed by a quick and painless death.

About 30 years ago a gerontologist by the name of J.F. Fries proposed what he called "the compression of morbidity hypothesis." According to Fries, there are natural limits on how long humans can live, and improvements in health care, life style, and reductions in the effect of environmental risks are steadily progressing us to a maximum life expectancy, which he believed at the time was about 85 years. He proposed that the same factors that produce a longer life would also produce a "compression" of morbidity because they would lead to a lower incidence of chronic disease and a higher age of onset of chronic disease.

The compression of morbidity hypothesis is certainly attractive because it fits our idealized model of dieing, and it would be great if it were correct. Unfortunately the gerontological research over the last 30 years seems to indicate that Fries was wrong on two counts. First, life expectancy in at least one country (Japan) has now exceeded Fries' proposed limit of 85, and is still increasing almost linearly in most countries (Christensen et. al, 2009), though there is perhaps some leveling off in the U.S. (Crimmins & Beltrán-Sánchez, 2010):

Large declines in mortality rates in recent decades have translated into sizable increases in survival at older ages. For example, in the United States, the probability of a 65-year-old surviving to age 85 doubled between 1970 and 2005, from about 20% in 1970 to about 40% in 2005 (Bell & Miller, 2005). Similar or greater increases in survival at older ages have been reported in most developed countries among people aged 80 years or older since the 1970s (Kannisto, 1994, 1997; Vaupel, 1997). As life expectancy has increased, the modal age at death has steadily increased so that death in low-mortality countries most frequently occurs to people in their late 80s and 90s (Robine, 2010). Even death rates among people above age 100 have declined significantly in recent years leading to an increasing number of centenarians (Kannisto, Lauritsen, Thatcher, & Vaupel, 1994; Robine, Saito, & Jagger, 2003; Vaupel, 2010). This steady rise of life expectancy even at the oldest ages indicates that humans are not yet pushing up against a fixed limit, one that cannot be exceeded, which is a central tenet underpinning the compression of morbidity hypothesis." (Crimmins & Beltrán-Sánchez, 2010)

Although this may seem like good news -- we're living longer -- the data also show incidence of disease and disability has increased, not decreased in elderly populations, contrary to the compression of morbidity hypothesis (Christensen et. al, 2009; Crimmins & Beltrán-Sánchez, 2010). With respect to physical mobility problems, for example, data from the National Health Survey compared the percent of people in different age groups in 1998 and 2006 who reported being unable to perform at least one of the following: walking 1/4 mile, walking up 10 steps, standing or sitting for 2 hr, and standing, bending, or kneeling without using special equipment. The results show no support for a compression of this kind of morbidity:

For a number of other sources of morbidity, like cardiovascular disease, stroke & heart attack, diabetes, & cancer, the research comparing 1998 and 2006 indicates "There is no hint of a declining prevalence of disease over these eight years....The most striking change over the ten-year period is the increase in all the CVD conditions among older males; for females, the increase among the oldest group only occurs in the prevalence of stroke. Older men and women show an increased prevalence of cancer. Diabetes increases are seen through much of the adult age range" (Crimmins & Beltrán-Sánchez, 2010). Since mortality rates in older age groups have been decreasing during the same period, this means the number of survivors of these diseases has generally increased, often with decreased functioning associated with the management of the disease.

Now that you're suitably depressed, let me point out that the studies reviewed above deal with population trends and don't negate the possibility of individual factors that might contribute to compression of morbidity. Indeed, there is data showing that life-style choices (diet, exercise, weight control, preventative health-care, etc.) may compress morbidity for specific individuals, though more studies along this line are needed to be more definitive. In one study, 418 people were followed over 12 years (1986-1998) in terms of how their lifestyles (smoking, exercise, weight) related to morbidity patterns. Those with healthier lifestyles showed either a slight increase in morbidity over time with no acceleration of disability before death, or only a brief period of accelerated morbidity before death (Hubert, et. al., 2002), consistent with the idea of morbidity compression. In short, it is certainly possible to have some degree of control over your own individual morbidity pattern.

Another more optimistic point is that even if we must live with disease or disability in our later years, there are more ameliorative resources available all the time. As Christensen et. al. (2009) have noted, the rising use of assistive technology and improvements in housing standards, public transport, accessibility of buildings, changes in social policies, shifting gender roles, and the social perception of disability may loosen the link between disease and functional limitation of disability. Of course, these things are somewhat dependent upon governmental policy and therefore the political climate. Given our current health care debates in the U.S. we may find ourselves well behind other developed countries in offering preventive and ameliorative resources.


References

Christensen, K., Doblhammer, G., Rau, R.Vaupel, J.W.(2009). Ageing populations: the challenges ahead. Lancet. 2009 October 3; 374(9696): 1196–1208

Crimmins, E.M., & Beltrán-Sánchez, H. (2010). Mortality and morbidity trends: is there compression of morbidity? Journal of Gerontology: Social Sciences, 66B(1), 75–86.

Fries, J. F. (1980). Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 303, 1369–1370.

Hubert HB, Bloch DA, Oehlert JW, Fries JF. (2002) Lifestyle habits and compression of morbidity. J Gerontol A Biol Sci Med Sci. 2002 Jun;57(6):M347-51.

Crosshairs and Causality

The January 8th shooting in Tuscon Arizona of Representative Gabrielle Giffords has grabbed the nation's attention in a big way. Predictably, pundits are punditing, politicians are politicizing, and academics (like me) are academizing as to the cause and meaning of this tragic event.

Mass shootings are sadly not new to us, but they still evoke horror and revulsion. And this one has an added impact because of its political context. I think much of the social turmoil in the wake of the shooting can be seen as a desperate effort to cope with the uncertainty and unpredictability it represents. The threat that horrific unexpected events pose to our understanding of the world around us is one of the most unpleasant of human emotions, and we go to great lengths to reduce it, sometimes by adopting simplistic causal theories that we believe can explain away the event's initial incomprehensibility.

The causal theories we adopt are likely to be those that are in line with our general world view, and also that serve specific psychological functions for us. The January 8th shooting occurred in a climate of political rhetoric that has become increasingly vitriolic, and some have suggested this as the primary cause. Others, particularly those who have been noted for using such language (like Sarah Palin) have vigorously rejected rhetoric as a cause and instead label the shooter's behavior as simply "insane," or "crazy," thereby absolving anyone of culpability.

The cultural and psychological context of causal theories becomes particularly apparent when you look at the way the Giffords shooting has been reported in the foreign media. Analysis of world media coverage by The Global Post, found that "Many commenters in the foreign press around the world said they were little surprised given America's lax gun laws and recent history of mass shootings. Still other media outlets ignored the American tragedy entirely. For example, in Europe the story has generally been covered much less than in the U.S. According to the Global Post's Michael Goldfarb, "The French press is consumed by the murder of two Frenchmen murdered in Niger by an African subsidiary of Al Qaeda. The German press has major flooding along the Rhine to contend with. But the lack of prominence given to the story could be down to this: For many in Europe, violence of the sort that occurred in Tucson on Saturday is almost expected in America." Ouch.

In other parts of the world the media reflected on the meaning of the event in terms of their own social dynamics. Global Post correspondents Erik German and Solana Pyne noted that in Latin America, "Lima’s El Comercio, Peru’s biggest newspaper, published a profile of Daniel Hernandez, the young Gifford staffer who held a bandage over the Congresswoman’s wounds before paramedics arrived on the scene. The “Hispanic angel,” El Commercio wrote, “saved the life of congresswoman Gabrielle Giffords.” As to causal analyses, Argentina’s biggest daily, Clarin, published a 500-word piece by their Washington correspondent, Ana Baron, who focused heavily on Arizona’s tough stance on Latino immigration and what she described as the “growth of hatred and intolerance in U.S. politics.”

These examples illustrate (a) how the emotional impact of an event is moderated by the personal and culture context in which it is perceived, (b) the motivated nature of causal analysis, and (c) how simplistic explanations can satisfy our yearning for clarity and understanding. But the true situation is most certainly far more complex and not amenable to sound bites. One of my favorite columnists (E.J. Dionne) has as usual offered what I regard as an astute insight into these things and I'll close this blog with his words:

It is not partisan to observe that there are cycles to violent rhetoric in our politics. In the late 1960s, violent talk (and sometimes violence itself) was more common on the far left. But since President Obama's election, it is incontestable that significant parts of the American far right have adopted a language of revolutionary violence in the name of overthrowing "tyranny."

It is Obama's opponents who carried guns to his speeches and cited Jefferson's line that the tree of liberty "must be refreshed from time to time with the blood of patriots and tyrants."

It was Sharron Angle, the Republican candidate against Senate Majority Leader Harry Reid in Nevada, who spoke of "Second Amendment remedies." And, yes, it was Palin who put those gun sights over the districts of the Democrats she was trying to defeat, including Giffords.

The point is not to "blame" American conservatism for the actions of a possibly deranged man, especially since the views of Jared Lee Loughner seem so thoroughly confused. But we must now insist with more force than ever that threats of violence no less than violence itself are antithetical to democracy. Violent talk and playacting cannot be part of our political routine. It is not cute or amusing to put crosshairs over a congressional district.

Liberals were rightly pressed in the 1960s to condemn violence on the left. Now, conservative leaders must take on their fringe when it uses language that intimates threats of bloodshed. That means more than just highly general statements praising civility.

Thoughts for a New Year

The year 2011 marks the beginning of the second decade of my retirement. A good time for some reflection and prognostication. ** [Warning: This may get a little boring, so feel free to go do something more interesting, like sorting your socks.]**

My wife and I retired in 2000 at age 55. Such a young retirement age may seem almost hopelessly unattainable for most people in the current economic climate, but conditions were much better then. We were fortunate to be able to finance our retirement through a combination of prudent savings, conservative investing, and 30+ years of contributions to a state teachers' pension plan. Oh, and we didn't have kids.

Looking back at these last ten years, I have to say that on the whole they have been really, really, good. In analyzing the reasons I feel so positive about this past decade, I've of course relied on my psychological training and my ability as a university professor to concoct an answer to any question whatsoever, regardless of whether I know what I'm talking about.

Retirement is an exercise in existential angst management second only to being a teenager (well, and for men maybe a Mid-Life Crisis). These times confront you with fearsome challenges to define your values and  goals, and to set a life course that will have a major impact on your emotional, social, and psychological well-being. The problem in both cases is that there is really no road map or set of guidelines to follow, and this lack of clarity can be quite scary.

Sure, you can make plans to do X or Y, as people often do when they retire: "I'm going to start a new business;" "I want to play every Robert Trent Jones course in the world;" I want to sail the South Pacific; "I'm going to buy an RV and travel;" "I'm going to learn Sanskrit;" "I'll clean out my garage." But having a plan doesn't really address the angst issue, even though it makes you feel like you've got everything under control. The truth is that over the past ten years, and indeed over the previous 55 years, the best experiences I've had were (a) unplanned and (b) unexpected.

Retirement has forced me to confront issues of what and who I am -- issues that I thought I had resolved during my career. In fact I now realize just how much my career was a defining structure that provided answers to these questions and gave my life meaning and purpose. When retirement removed that structure I had to confront the questions anew.  And since we moved away from the academic environment to a completely different cultural setting, I didn't even have the old social situations and institutions to ease the existential burden.

So, what I have learned, and why has it made me happy? Here's a partial list:

• Existential questions probably don't have final answers.  When you accept this, continuing to ask them and to explore temporary answers can actually be very satisfying and even fun.
• Learning new things and learning more about old things is a vital source of  my happiness, and learning can occur at any time and in any place if you let it.
• If you look closely at something, you will often find an amazing world in the details.
• Worrying is truly a waste of time that could be better spent doing something that enhances happiness.
• The qualities of people and things that we think make us happy or unhappy are not inherent in them.  Happiness isn't caused by people or things, but rather by our reactions to them.
• Compassion is the best antidote for anger.  And of course, you can't be happy and angry at the same time.

 See you in another ten years.

Bankers' Math -- Part Cinq

My wife and I just returned from a delightful month traveling in Argentina. One thing we discovered that was not so delightful is that Bankers in Argentina are just as bad as everywhere else, particularly in how much they control people's access to their own money and how they profit from routine transactions.

We found that small merchants in Argentina prefer cash over credit cards as payment -- this saves them paying the credit card companies a percentage for each transaction and fees for maintaining a credit processing account. Many of the restaurants and hotels we stayed in were managed by the owners themselves. These operations usually have a small profit margin, so giving 2-4% to a credit card company can really hurt. There is also a certain ... uh, shall we say "flexibility" in reporting cash transactions for tax purposes. Several of our hotels would not accept credit cards at all, and others offered discounts up to 10% for paying in cash. The same was true in many restaurants. I should note that this practice is not confined to Argentina -- we've encountered it with increasing frequency in other countries as well, for example in Belgium and France when we were traveling there a year ago and in Greece this past June. And we've found that it isn't restricted to mom-and-pop retail operations -- even Government-run museums and cultural sites in these countries increasingly refuse credit or debit cards.

The bottom line is that we need cash as we travel. In the old days that meant carrying a wad of traveler's checks (parents, you might have to explain to your kids what these are) and then regularly cashing them at intervals at some bank or currency exchange office, often a time-consuming process. These days traveler's checks are the most expensive and inconvenient way to get cash and we don't carry them any more, or we may take just a small amount as emergency backup funds.

ATM's (MSM's -- "money spitting machines," as we call them) are now the primary way for travelers to get foreign currency, even in the poorest and least developed countries. Of course, both the local bank and your own bank will charge you a fee for each transaction, and these fees have gone up considerably in the last year or so. As I wrote in Bankers' Math, Part Quatre , my bank here in Hawaii, First Hawaiian, recently doubled their fee for a foreign ATM withdrawal to $5.00 per transaction, presumably because the cost of electrons has skyrocketed. To our great irritation we found that all the banks in Argentina charge about $4.00 per ATM transaction, so potentially a traveler in Argentina will pay $9 every time he or she gets money! If you get $100 worth of pesos, that's a 9% surcharge -- rather exorbitant in my humble opinion.

One way to counter this is to withdraw as much as you can. For example, if you take out $500 in foreign currency, the fees will amount to just 1.8% of the transaction, and you will also reduce the number of withdrawals you'll need to make during the trip, lowering the total amount spent in fees.

Ah, but the banker's are on to this strategy!!! They limit the maximum amount of a transaction, and it is clearly to their advantage to keep it low so that you will have to visit the MSM more often. By the way, it isn't your bank that places this limit -- it is the bank that owns the ATM. On our recent trips to Europe and Greece we were able to withdraw $400-500 routinely. However, in Argentina we were limited to $250 at every bank we tried, which amounts to a charge of 3.6%, slightly worse than a credit card fee (as explained below, we do have a strategy for getting around this, but it isn't available to everyone). I wouldn't be surprised if lower limits and higher fees have also been instituted in Europe, but I don't know for sure.

Bankers' Math: lower limits + higher fees = more profit for us!

My wife and I are fortunate enough to qualify for an ATM card from our retirement investment company (Vanguard) that waives the transaction fee, and we also have obtained a Capital One credit card that does not assess foreign transaction fees. For the time being, then, we have held our own against these forms of Bankers' Math. However, our advantages here may be lost at any time because they are under control of .... you guessed it.... Bankers.

"Call" of the Wild

Once a month my local hiking club organizes a day-hike to some interesting area. Most of the people in the club are "mature" adults -- meaning the real hard-core young adventure types aren't with us. Still, the group consists of mostly fit people who are serious about exercise and enjoying the great outdoors, and the hikes are often in fairly remote and wild places.

Every other month the hike is publicized in the local newspaper and non-members are encouraged to join us. Not long ago one of these public hikes was a trek along an old historic trail that crossed some very difficult and remote terrain. The challenge of the trail and the isolated setting fostered an appreciation of the hardships and simplicity of an earlier time. I was enjoying the scenery and the physical exertion, chatting occasionally and briefly with fellow hikers, but mainly absorbing the uniqueness of the moment as I hiked alone.

From behind me I suddenly heard a very loud voice describing the beauty of the trail and how wonderful the hike was -- not unusual comments to hear but not at a such a startling volume level. When I looked back I saw a newbie talking into a cell phone, apparently so eager to share their experience with the person at the other end that they didn't mind violating the serenity of the group around them.

There are lots of aspects of this we could explore, like the need for norms of etiquette surrounding cell phone use, or the implications for society when the superficiality of technology-mediated relationships makes people desperate to maintain constant contact with others. The aspect I want to focus on, though, is how technology is changing our perception of natural settings and altering the way we interact with nature.

As my example indicates, many natural areas that used to be remote and cut off from easy communication with the outside are now accessible with a quick cell phone call. The access can include sound, still photos, and even video. Besides cell and internet links, gps technology makes navigation a matter of reading an lcd screen instead of paying close attention to the surroundings (I've written before about my own infatuation with gps -- see my blogs of 7/6/09 and 2/14/10).

This technology has made the "wild" seem less forbidding and more amenable to casual human activity, even when this is demonstrably untrue. One result is that people underestimate the risks and dangers that natural environments may pose. Rangers in our National Parks have seen this first hand, according to a recent investigative NYT article. For example, Jackie Skaggs, spokeswoman for Grand Teton National Park in Wyoming reports “Every once in a while we get a call from someone who has gone to the top of a peak, the weather has turned and they are confused about how to get down and they want someone to personally escort them. The answer is that you're up there for the night.” People with cellphones call rangers from mountaintops to request refreshments or a guide; in Jackson Hole, Wyoming, one lost hiker even asked for hot chocolate.

One particularly telling instance of how perceptions of nature have changed is recounted in the same article:

"One of the most frustrating new technologies for the parks to deal with, rangers say, are the personal satellite messaging devices that can send out an emergency signal but are not capable of two-way communication. (Globalstar Inc., the manufacturer of SPOT brand devices, says new models allow owners to send a message with the help request.) In some cases, said Keith Lober, the ranger in charge of search and rescue at Yosemite National Park in California, the calls “come from people who don’t need the 911 service, but they take the SPOT and at the first sign of trouble, they hit the panic button.”

But without two-way communication, the rangers cannot evaluate the seriousness of the call, so they respond as if it were an emergency.

Last fall, two men with teenage sons pressed the help button on a device they were carrying as they hiked the challenging backcountry of Grand Canyon National Park. Search and rescue sent a helicopter, but the men declined to board, saying they had activated the device because they were short on water.

The group’s leader had hiked the Grand Canyon once before, but the other man had little backpacking experience. Rangers reported that the leader told them that without the device, “we would have never attempted this hike.”

The group activated the device again the next evening. Darkness prevented a park helicopter from flying in, but the Arizona Department of Public Safety sent in a helicopter whose crew could use night vision equipment.

The hikers were found and again refused rescue. They said they had been afraid of dehydration because the local water “tasted salty.” They were provided with water.

Helicopter trips into the park can cost as much as $3,400 an hour, said Maureen Oltrogge, a spokeswoman for Grand Canyon National Park.

So perhaps it is no surprise that when the hikers pressed the button again the following morning, park personnel gave them no choice but to return home. The leader was issued a citation for creating hazardous conditions in the parks."

For me, the telling point in this account is the group leader saying that without the emergency device he would have never attempted the hike. As park rangers have noted, visitors who get into trouble often acknowledge that they have pushed themselves too far because they believe that in a bind, technology can save them.

As this example illustrates, technology may be insulating us from the reality of natural dangers and the necessity of relying on our own knowledge, skill, and courage in experiencing nature. We regard nature as an extension of our hi-def televisions, Iphones, and computers -- configurable to our own user preferences and changing interests, and as having an "Undo" button if we make mistakes.

The problem is that nature doesn't always play along.

Willpower, Diet Coke, and Buddha

Sixteen years ago I quit smoking. It was one of the hardest things I have ever done. For weeks and months during this time I had to exert constant self-control over the urge to resume the habit. A lot of this effort involved being vigilant to events and situations that used to automatically trigger smoking and then willfully blocking the urge to light up a cigarette. It was also necessary to exert control over an emotional response that was evoked by not having access to cigarettes -- a feeling of panic that non-smokers probably can't relate to at all. During this period I was irritable, of course, but also often forgetful, distracted, and downright muddled (even more than usual).

Social Psychologists have focused a great deal of research on the mechanisms of self-control and the consequences of exerting this kind of cognitive effort. Examples of behaviors that have been studied in this context include managing the impression we think we are making on others, suppressing our prejudices and stereotypes, coping with fear of dying, controlling our spending, holding back aggression, and limiting the amount of food or alcohol we ingest (see Galliot et. al, 2007 for references).

A consistent finding in these studies is that self control is a depletable resource. The prominent social psychologist Roy Baumeister summarized this research as follows: "...self-control appear[s] vulnerable to deterioration over time from repeated exertions, resembling a muscle that gets tired. The implication [is] that effortful self-regulation depends on a limited resource that becomes depleted by any acts of self-control, causing subsequent performance even on other self-control tasks to become worse" (Baumeister et. al, 2007). For example, in one study people who exerted self control by eating healthy vegetables instead of more temping chocolate candy and cookies gave up faster on a subsequent frustrating task as compared to people who had not exerted self-control. This depletion phenomenon would certainly account for my irritability and befuddlement during my struggle to quit smoking -- my mind muscle was pooped.

It isn't necessary to invoke a new-agey concept of "psychic energy" to account for these data. The cognitive activity involved in self-control is firmly tied to physiological processes in the brain -- an organ that uses 20% of the body's calories and yet has just 2% of its mass. A major source of energy for the brain is glucose, or blood sugar, which is converted to neurotransmitter chemicals that fuel the brain. A series of recent experiments by Gailliot et. al. (2007) have demonstrated that exerting self control depletes glucose, whereas other kinds of cognitive activity that are more automatic do not, and that lowered levels of glucose result in impaired self control on subsequent tasks. Increasing glucose levels, either by allowing them to rebound naturally or by ingesting glucose rich drinks, was found to restore performance on self-control tasks. An ironic implication of this (untested, as far as I know) is that dieters who drink artificially sweetened soda may lower their blood sugar level and thus may make it harder for themselves to stick to their weight-loss diets.

What I have outlined here is called the Strength Model of Self-Control, and it clearly has a great deal of empirical support. For me the most important thing in the model is not just that self-control or willpower is a depletable resource, but rather that there are ways of developing greater self-control such that depletion is lessened -- an extension of the "muscle" analogy suggested by Baumeister. Research has indicated that...

"...just as exercise can make muscles stronger, there are signs that regular exertions of self-control can improve willpower strength... These improvements typically take the form of resistance to depletion, in the sense that performance at self-control tasks deteriorates at a slower rate. Targeted efforts to control behavior in one area, such as spending money or exercise, lead to improvements in unrelated areas, such as studying or household chores. And daily exercises in self-control, such as improving posture, altering verbal behavior, and using one’s nondominant hand for simple tasks, gradually produce improvements in self-control as measured by laboratory tasks. The finding that these improvements carry over into tasks vastly different from the daily exercises shows that the improvements are
not due to simply increasing skill or acquiring self-efficacy from practice." (Baumeister et. al., 2007)

There are other ways of improving self-control not mentioned by Baumeister, including techniques offered by some religious traditions, such as Buddhism, which stresses the development of self control over one's thoughts, perceptions, and emotions through meditation. Whatever the technique, the positive implication is clear: self-control "...appears to facilitate success in life in many spheres, and, crucially, it appears amenable to improvement. Indeed, self-control can be grouped with intelligence among the (rather few) traits that are known to contribute to success in human life across a broad variety of spheres; yet unlike intelligence,
self-control appears amenable to improvement from psychological interventions, even in adulthood" (Baumeister et. al., 2007)


References

Baumeister, R. F., Bratslavsky, E., Vohs, Kathleen D., & Tice, D. M. (2007). The Strength Model of Self-Control. Current Directions in Psychological Science, 16 (6): 351-355.

Gailliot, M.T., Baumeister, R.F., DeWall, C.N., Maner, J.K., Plant, E.A., & Tice, D.M., et al. (2007). Self-control relies on glucose as a limited energy source: Willpower is more than a metaphor. Journal of Personality and Social Psychology, 92, 325–336.

The REAL Lesson From This Election

**We interrupt our regularly scheduled blog with this special election year commentary. In case you miss it this time, the message will be repeated two years from now, though the names of the political parties will likely be reversed.**

This campaign season has seen a lot of chest-thumping and mud-slinging. The Republicans by all accounts are poised to win back most of the congressional seats they lost two years ago, and most likely will take over the House of Representatives.

If this occurs it will not be a mandate to return to the policies and practices of the past, nor will it represent a massive endorsement of the ill-informed, simplistic, extreme views of the Tea Party.

It will be a cry from the electorate to make our government work. I'm writing this just before Election Day, and the most recent polls are very clear -- though the Republicans are going to gain seats in congress, the Republican Party is at historic lows in popularity. Rather than endorsing Republican policies and philosophy, people are desperate for a change that will lead to a sense of stability and progress rather than gridlock and confusion. As Jim Lehrer recently commented, "... polling shows that people also want both sides to work together. They don't want any more gridlock. They don't want any more stalemates. So, if the Republicans take control, they're going to have to work with the Democrats, the Democrats who are already there are going to have to work with the Republicans, or this whole thing isn't going to work."

Polls also indicate a very sobering disconnect between opinion and fact that may make the Republican victory short-lived. According to a recent article in Bloomberg News, "...by a two-to-one margin, likely voters in the Nov. 2 midterm elections think taxes have gone up, the economy has shrunk, and the billions lent to banks as part of the Troubled Asset Relief Program won’t be recovered." But these beliefs are demonstrably wrong:

"The Obama administration has cut taxes — largely for the middle class — by $240 billion since taking office Jan. 20, 2009. A program aimed at families earning less than $150,000 that was contained in the stimulus package lowered the tax burden for 95 percent of working Americans by $116 billion, or about $400 per year for individuals and $800 for married couples. Other measures include breaks for college education, moderate-income families and the unemployed and incentives to promote renewable energy...Still, the poll shows the message hasn’t gotten through to Americans, especially middle-income voters. By 52 percent to 19 percent, likely voters say federal income taxes have gone up for the middle class in the past two years.

In an October report to Congress, released as the Troubled Asset Relief Program turned 2 years old, the Treasury said it had recovered most of the $245 billion spent on the Wall Street bank part of the plan and expects to turn a $16 billion profit. But in the poll, 60 percent of respondents say they believe most of the money to the banks is lost, and only 33 percent say most of the funds will be recovered.

Separate from the aid for the Wall Street banks, the Treasury says the payouts for insurers such as New York-based American International Group will end with a small loss on the investment, as will the bailout for automakers. Only assistance to mortgage lenders, projected to reach about $45 billion, won't be repaid, the Treasury says.

The perceptions of voters about the performance of the economy are also at odds with official data.

The recession that began in December 2007 officially ended in June 2009. In the past year, the economy has grown 3 percent, and it is expected to show improvement in the second quarter of this year. A year and a half after stocks hit their post-financial crisis low on March 9, 2009, the benchmark Standard & Poor's 500 Index has risen 75 percent, and it's up 15 percent this year.

But voters aren't seeing the better climate: 61 percent of the 1,000 respondents in the poll — which has a margin of error of 3.1 percentage points — say the economy is shrinking this year, compared with 33 percent who say it is growing."

Both parties are responsible for this confusion -- the Republicans for their successful obfuscation of the facts, and the Democrats for failing to clearly and forcefully communicate the true record.

The real lesson from this election, then, is that in two years the fortunes of a party can change completely. And changes based on mistaken beliefs may be particularly vulnerable to reversal.