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 individual’s 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 1950’s. Rotter’s 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 individual’s

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 1970’s by psychologists Wallston,

Wallston, Kaplan, and Maides by 1976 (Graffeo, par. 3). These psychologists adapted

and refined Rotter’s 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 one’s health outcome is under control of the powerful

others (i.e. medical professionals) or is determined by fate, luck, or

chance. Internal beliefs characterize one’s health condition as being the

direct result of one’s own actions. (Mackey, par. 1).

This applied Rotter’s 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

individual’s 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 self-

efficacy 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 individual’s 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 individual’s

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 increased-

responsibility.

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 increased-

responsibility, 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 Rotter’s 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 reinforces…Individuals 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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