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If denial of money stands for denial of three person psychology, over-valuation of money is equally fraught with psychological danger. Midas discovered that money cannot buy you love-you cannot eat or drink gold, be warmed by it, or lie comfortably on it at night. For St Paul it was not money, but love of money that was the root of all evil. Money and love are separate realms: the danger lies in confusing them. When Christ said ‘render unto Caesar' he underlined his remark by pointing to a coin with Caesar's head on it. God and Caesar should not be confused. But what if Caesar becomes a God? This was what Marx (Bottomore & Reubel, 1963) saw as the essence of capitalism. In his discussion of Timon of Athens he shows how Shakespeare depicts the ‘yellow slave', the ‘glittering precious gold'
...that will make black white, foul fair; Wrong right; base, noble; old, young; coward valiant... Will knit and break religions; bless th'accurst; Make the hoar leprosy ador'd; place thieves...
Thou common whore of mankind... (Bottomore & Reubel, 1963, pp. 180-81) But money is not just earth; it is earth transformed by labour. Marx saw both the transformational quality of money and its capacity for perversity:
...the transformation of all human and natural qualities into their opposite, the universal confusion and inversion of things; it brings incompatibles into fraternity. ...It is the universal whore, the universal pander [Pander was the go between who spoke Troilus's love to Cressida]...the divine power of money resides in its essence as the alienated and exteriorised species-life of men. ...What I as a man am unable to do...is made possible for me by means of money. Money therefore turns each of these faculties into something which in itself it is not, into its opposite. (Bottomore & Reubel, 1963, p. 181)
For young Marx money disrupts a natural order, just as for Lacan language separates the infant eternally from the realm of true desire. Both retain a prelapsarian vision which is ‘pre-oedipal', and, in Fenichel's (1946) phrase, ‘pre-pecuniary'. The deification of money is a perverse response to pre-oedipal emptiness. If I cannot have love, then at least I will have money; my unsatisfied greed turns to money-lust as I amass my fortune; by seeking riches at least I deprive others of the goods which I imagine them to enjoy. In Orson Wells' Citizen Kane, all Kane's money cannot bring Rosebud back from the fire, but at least it can comfort him in his loss and, through inciting envy, punish the world for having inflicted it upon him.
In therapy, love without money is an illusion, a denial of oedipal reality; money without love is a perverse attempt to compensate for pre-oedipal failure. Therapists who are simply in it for the money will be unable to reach their patients' deepest longings; therapists who pretend that money does not matter risk creating a collusive denial of reality. Money belongs to the oedipal phase and the advent of the father in the child's mind. The pre-pecuniary world is maternal, pre-oedipal. We need to experience boundless love-and its limits.
The paradox of money is that it can be the reality, but symbolize the fantasy. For something new to emerge there has to be intercourse between these two principles. Sex is 'spending'and, with luck, leaves us 'spent'-but what it produces is something that is not just sex. Money is needed for new birth, but money that only begets money is sterile.
In a typical piece of early analytic brilliance, Ferenczi (1952) traces the origins of the love of money from the infant's excitement and interest in faeces (his first 'gift'), through playing with mud and sand, to collecting stones until the coprophilic patient becomes a miser admiring his heap of gold. He even suggests that the love of music may have its origins in farting! These classical psychoanalytic theorizings are a manifestation of the monadic universe of early Freud, for whom music can only arise from the child's own body, rather than from the interactive pattern of singing and rocking of the mother-infant dyad-not to mention genetic ability and social conditioning! A contemporary interpersonal perspective sees the world of the infant as interactive from the start. Neither love nor money can be understood outside of relationships. What matters is the symbolism of the use to which the object is put, its relational co-ordinates, rather than the object itself. How a person handles their money-or their sexuality, or their attitude towards death-becomes the main issue.
Thus, as mentioned, denial of the significance of money may represent a regressive wish to return to the pre-pecuniary state of mother-infant mutual absorption. Hoarding money may be a manifestation of the more general tendency to cling to objects based on insecure attachment patterns in childhood. Money fills the psychic void and is clung to in the absence of a reliable primary object. In the contemporary Kleinian model, negotiating the oedipal situation depends on the capacity to cope with separation, and to view the parental couple from the outside with relative equanimity. Perhaps the beginnings of the capacity to understand algebra and therefore to exchange money productively starts here, since the child may identify with one or other parent, and begin to sense how family positions are interchangeable.
Some patients insist on paying, usually in cash, at the end of every session. These are people who can never forget money. A monthly bill enables one temporarily to abandon the world of necessity and to enter the pre-oedipal world of desire, but for some this is too dangerous. Nothing must be left owing, no trace of dependency is allowable. Not to pay immediately would mean to depend on trust, on a word that is a bond, and this must be avoided at all costs. One such man had never forgiven his mother for producing two further sons after him, when he was convinced he was all she ever wanted. How could he possibly trust his therapist not to take advantage of his dependency and to betray him too?
Other patients cannot bear to be reminded of their financial obligations to the therapist. Forgetting to pay a bill, or announcing that one cannot afford to go on with therapy is not necessarily aggressive or retaliatory, but can arise out of a sense of overwhelming deprivation. Here the therapist is seen as the perverse one: ‘all you really care about is my money'. Therapists who insist on their fee may have to tolerate powerful projections in which they contain the patients' greed, and are seen as unreasonable, callous and grasping. They have to be able to hang on to their own sense of value without guilt, to acknowledge that we do live in a deeply unfair world without resorting to martyrdom and self-deprivation. Here the existence of publicly funded psychotherapy is crucial since it acknowledges that the ability to pay should not be the main criterion for receiving therapy.
Psychotherapy and the NHS-can we afford it?
Let us turn therefore to the battle for resources for psychotherapy within publicly funded mental health services, and to see how some of the themes so far outlined underpin that struggle and its difficulties. The last 10 years have seen a determined assault on public psychotherapy throughout the Western world. Until the last decade or so, indefinite in-patient or out-patient psychoanalytic therapy was fairly freely available in the USA for those who were insured. The same was largely true of publicly funded therapy in Canada, Germany and Australia. The UK was anomalous in that mental health here has always been relatively underfunded, and within mental health services, psychotherapy has always been a poor relation-a cinderella of cinderellas. Nevertheless, the College of Psychiatrists has always had a flourishing psychotherapy section, and the repute of British psychoanalysis meant that centres such the Tavistock Clinic, and the Cassel and Henderson Hospitals commanded an international reputation, and not-ungenerous NHS funding.
Today all is utterly changed. In the USA the average length of stay in the Menninger Clinic, a famous in-patient psychoanalytic unit for very difficult cases, was 11 months in 1989; today it is 9 days (Gabbard, 1997). Care managers require therapists to justify the prescription of psychoanalytic therapy and will only pay for treatments if the published evidence supports its efficacy. There is an increasing trend towards short bursts of brief therapy, which often produce immediate gain only to be followed by relapse. Intensive in-patient care is replaced by less highly staffed hostels. The same trend is to be seen in the UK. The Tavistock Clinic, Henderson and Cassel Hospitals have all been subject to intensive external audit and review, only saved from closure by determined campaigns. Psychotherapy Departments have come under threat, and at the time of writing several are in danger of being closed.
How can we understand this attack on psychotherapy? First, we should not forget that the attacks come from institutions which are themselves beleaguered. Health Authorities are cash-strapped, insurance company shareholders want minimum payouts, managers are fighting for their jobs. Psychotherapy, a traditional focus for medical scepticism, is a soft target. Closure of a psychotherapy unit is a token of managerial potency less likely to cause public outcry than shutting down a paediatric unit.
Second, in an increasingly technology-based medical culture, psychotherapy almost uniquely requires no 'kit'-just a room, two chairs and a well-trained professional. Modem medicine mints money for the pharmaceutical companies and medical supply industry. Its pre-eminent place in national economies-around 10% of most GDPs-cannot be put down to the altruism of governments alone, but depends on the multinational enterprises who profit from supplying (and in some cases creating) the need for treatments generated by ill-health. When governments try to limit the use of an expensive drug, the pharmaceutical industry immediately mounts a complex and subtle counter-campaign for the hearts and minds of doctors, including showing how more expensive drugs are really much cheaper in the long run. But there is no well-funded 'lobby' for psychotherapy other than that which professionals can generate themselves.
Third, there is a pervasive masculine culture within medicine which views psychotherapy as ‘women's work', and so not worth paying for. A recent survey showed that only about a fifth of labour in the UK was paid employment. ‘Wages for housework' was a slogan of 1970s feminism which has perhaps had some impact via the attendance allowance for which carers for ill relatives are eligible, but the housewife who is a compulsive cleaner is more likely to be referred as a case of OCD than become a millionaire! Just as men returning from work ask their partners ‘what have you been doing all day', implying that housework consists of unskilled tasks which they could have completed in half the time, so medical men view psychotherapy as ‘just chats', an optional extra-which they themselves would love to do if they were not tied up with the important business of techno-med-and certainly not requiring any special expertise or training.
Fourth, psychotherapy is a victim of the short-termism that is endemic in our culture. Dawkins (1977) makes the point that resistance to the theory of evolution is largely due to the inability of the human brain to comprehend the immensity of geological time. Once that is grasped, often via computer models, the logic of natural selection becomes inescapable. Similarly, despite the undoubted value of brief psychotherapy in selected cases, the evidence suggests there is a ‘dose-response curve' in psychotherapy, and that the more the therapy the greater the gain (Orlinsky et al., 1994). As with child development, change in therapy is often imperceptibly slow unless monitored with sophisticated measures over a period of time. The benefits of psychotherapy may well take 3-5 years or even longer to manifest themselves, and this is outside the thinking time of many research-funding bodies and almost all managers and politicians on short-term contracts. Psychotherapy needs not just money, but money sustained over time.
Unforseen benefits of the attack on psychotherapy
This assault on public therapy has, paradoxically, had positive consequences. The past decade has seen determined moves towards the establishment of a psychotherapy profession prepared to justify its expertise, training, and unique contribution to social and health care, and hence legitimate expectation of funding. Adversity has concentrated the mind of the profession in some useful ways.
There have been several studies looking not just at the effectiveness of psychotherapy, which is now well-established (Roth & Fonagy, 1996), but its cost-effectiveness. Cost-effectiveness can be measured in a number of different ways. First, it can be straightforwardly compared with the cost of other treatments such as drugs. Thus in schizophrenia, family intervention greatly reduces relapse rates and hence hospitalization and so is highly cost-effective (Brooker et al., 1994).
Second, ‘offset-costs' compare the utilization of medical services before and after an intervention, and are useful for looking at the impact of expensive psychotherapeutic interventions such as inpatient therapy.
An important UK example of the latter approach is the Henderson study (Dolan, 1996) which looked at total ‘cost to the exchequer' of personality-disordered patients before and after spending a year at the Henderson. The total spend in terms of social security benefits, use of medical and psychiatric resources, and drug costs was calculated. Despite the relatively high cost of therapy itself (around 440,000 per patient), they found that the treatment had ‘paid for itself' within 2 years of discharge, in reducing patients' dependency on services and benefits, helping people to get jobs and pay taxes. The preliminary results of this study played a significant part in saving the Henderson from closure. Similar reasoning has enabled our own district Health Authority to set aside a sum of money for what in NHS terms is intensive psychotherapy (twice-weekly for up to 2 years), based on the argument that this will in the long run save money which would be spent on costly referrals to other agencies (ECRs).
These are subtle (and costly!) studies, which focus on the immediate financial consequences of successful treatment of mental illness. The ‘social cost' of psychological ill-health is still probably underestimated however, since the impact of depression, alcoholism and drug addiction on the economy and the environment generally is much greater than can be captured by current research methods. There is a need for a third generation of cost-effectiveness studies looking at these aspects.
Another benefit of the intrusion of money into the organization and planning of public psychotherapy has been the emergence of a much clearer view of what kinds of therapy, delivered by what level of skilled practitioner, are most appropriate for what kinds of patients, suffering from which kinds of difficulties. Now that psychoanalysis is no longer ‘the only game in town' (Eisenberg, 1986) we can more successfully match patient to therapy. Family intervention in schizophrenia is helpful, psychoanalysis, on the whole, is not; cognitive behaviour therapy is good for mild to moderate depression, but probably less useful than psychoanalytic psychotherapy in borderline personality disorder, and so on (Roth & Fonagy, 1996). In a public health context we can go beyond the needs of the individual patient to the psychotherapeutic needs of a defined population and begin to exercise psychotherapeutic triage with a clearer conscience, concentrating our efforts on those patients for whom our efforts are most likely to make a real difference, while offering the less ill brief counselling in general practice, and the more intractable cases less expensive supportive therapy. We can, like any good capitalist, spend our psychotherapeutic money wisely (Holmes & Lindley, 1998).
Does all this mean that Mammon now rules psychotherapy just as it does every other aspect of modern society? In accepting the language of cost-effectiveness are psychotherapists betraying the essence of our discipline. Or, on the other hand, do we retreat into the private world of the consulting room as compensation for our feelings of powerlessness within society?
I believe there is a genuine dilemma here. If psychotherapy is to be valued by society, recognized as a profession, and seen as worth paying for as a vital contribution to mental health services, then we have to argue that what we offer is our skills, not merely our selves. We need to make the case that those skills are as important as those of heart surgeons with their training and their 'kit'. Our ‘interpersonal technology' has to rank with the biomedical technology of other branches of medicine.
And yet we know in our hearts that our skills are inseparable from who we are. A ‘good therapist' is much more than someone who has spent a lot of money on training and been to the right institutes. We know that at one level Ferenczi (1952) was right when he said that ‘it is the physicians' love that cures the patient'. This is underlined by the evidence from psychotherapy research which suggests that 'common' or ‘nonspecific factors'-reliability, nonjudgementalness, consistency and warmth-contribute as much or more to good therapy outcomes as do specific techniques such as interpretations or cognitive interventions. The evidence seems to suggest that with difficult patients training and experience make a difference, but this is much less easy to show with less ill cases (Stein & Lambert, 1995). There is almost a conspiracy of silence about this, since to admit it might undermine our professional aspirations.
Our income and our status seem to depend on being able to demonstrate that psychotherapy is just another technical procedure: that people with schizophrenia need family therapy in the same way that diabetics need insulin. Yet we know that few people go into psychotherapy as an occupation purely for the money. Ultimately, psychotherapy is a labour of love, a vocation. We do it because we enjoy it and it provides its own reward-that is the privilege of our profession. Society envies the rich, but even more so artists and sportsmen, people who do what they do for its own sake, out of some inner necessity rather than external compulsion. At some level we sense that the market is ultimately devoid of meaning and can never offer the love and understanding we crave. In the end, the pre-pecuniary world comes first.
The establishment of the NHS, ‘free at the point of entry' in Britain was a socialist attempt to remove money from one central arena of public life. That principle has survived the Thatcher years-just. As money increasingly infiltrates the workings of the health service, psychotherapy is a bastion of the doctor-patient relationship, of the narrative as opposed to the technological aspects of medicine (Roberts & Holmes, 1998). Like art, therapy represents an opposing principle of non-instrumentality, of ‘being with' rather than ‘doing to' the patient (Wolff, 1971). As Marx suggested, the greater the emptiness of the inner world the more the perverse search for external power and riches, a search which in turn fuels even greater feelings of emptiness. The attack on psychotherapy in medicine is often an envious assault from a system frenzied in its craving for the latest technological advance or a means to stave off death: ‘If only we had enough money all the problems of living and dying could be solved'. Taking money from psychotherapy (robbing the poor to pay the rich) comes from a half-conscious envious recognition that therapy can face realities which those whose world is driven only by money find unbearable.
However, it is unwise for therapists to retreat to a precarious moral superiority. We must learn to live in two worlds, rendering unto Caesar as well as our own Gods (Holmes & Lindley, 1998). As psychotherapists we are perhaps trustees of a deeper reality. But, in order to keeping working for the joy of working, to celebrate things as they are as opposed to things that can be bought, to offer real therapy rather than retail therapy-money is needed.
Resume L'argent, en psychotherapie, peut etre une force du bien ou du mal. Fenichel a postule un stade de developpement “pre-pecuniaire”, correspondant au stade pre-oedipien, pendant lequel le petit enfant peut reclamer le droit a une surabondance d'amour, libre de contraintes financieres. Par opposition, le stade oedipien signifie apprendre la valeur des choses, leur “taux de change”, et les limites de l'amour et de la generosite. Une therapie confue comme un pur travail d'amour ne peut pas aller au-dela du stade pre-pecuniaire; une therapie qui se limite a des honoraires et i un nombre fixe de consultations n'arrive pas a atteindre le plus profond des relations humaines. L'analogie entre la therapie et la prostitution montre comment des relations pecuniaires peuvent se deguiser de fafon perverse en relations pre-pecuniaires. La crise actuelle de la psychotherapie financee par les fonds publics est consideree i la lumiere de ces idees. Les effets benefiques imprevus de cette crise, envisageant la possibilite d'une culture plus tolerante et multidisciplinaire, sont egalement consideres.
Zusammenfasung In der Psychotherapie kann Geld eine negative oder positive Macht darstellen. Fenichel postulierte ein Entwicklungsstadium “pra-pekuniar'; die einer praodipalen Phase
entspricht, in der das Kind sein Recht einfordern kann auf ein UbermaB an Liebe, unbehindert durch finanzielle Zwange. Im Gegensatz dazu bedeutet das ddipale Stadium, daJ3 man den Wert der Dinge erlernt, ihren “Kurswert” und die Grenzen von Liebe und GroBzuaiakeit Therapie begriffen als eine reine Liebesarbeit, kann nicht hinter das “pra-pekuniare” Stadium blicken, Therapie, die sich auf Gebuhren und eine festgesetzte Anzahl von Sitzungen beschrankt, kann nicht die tiefsten Ebenen menschlicher Begegnung erreichen. Die Analogie zwischen Therapie und Prostitution zeigt wie finanzielle Beziehungen sich widernatirlich als “pra-pekuniar” maskieren konnen. Die derzeitige Krise in offentlich finanzierter Psychotherapie wird im Lichte dieser Ideen diskutiert. Unvorhergesehene Vorteile dieser Krise, die zu der Moglichkeit einer toleranteren und multidisziplinaren psychotherapeutischen Kultur fahren, werden beschrieben.
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JEREMY HOLMES Department of Psychiatry, North Devon District Hospital, Barnstaple, Devon EX31 4JB, UK
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Money Profiles as Related to Work-Related Attitudes: An Examination of the Money Ethic Endorsement Among Citizens in the USA
Thomas Li-Ping Tang, Department of Management and Marketing, College of Business Middle Tennessee State University Murfreesboro, Tennessee 37132 USA
Theresa Li-Na Tang, FISI-Cendant Brentwood, TN 37027 USA
Roberto Luna-Arocas, Department of Administration and Marketing University of Valencia Valencia, Spain
This research was supported by funds from the Faculty Research and Creative Activity Committee of Middle Tennessee State University.
Address all correspondence to Thomas Li-Ping Tang, PO Box 516, Department of Management, College of Business, Middle Tennessee State University, Murfreesboro, TN 37132 USA. Telephone: (615) 898-2005, Fax: (615) 898-5308, e-mail: firstname.lastname@example.org
A total of 564 citizens in the United States was classified into four money profiles based on the six Factors (Good, Evil, Achievement, Respect, Budget, and Power) of the Money Ethic Scale (Tang, 1992) using cluster analysis. Money Repellers (15.54%) have the lowest scores on Factors Good and Power and the highest on Factor Evil. Apathetic Money Handlers (31.08%) have the lowest scores on Factors Respect and Achievement and the highest on Budget. Careless Money Admirers (30.16%) have the lowest scores on Factors Budget and Evil. Achieving Money Worshipers (23.22%) have the highest scores on Factors Good, Respect, Achievement, and Power. Achieving Money Worshipers have the highest level of organization-based self-esteem, the Protestant Work Ethic, intrinsic and extrinsic job satisfaction, and satisfaction with social and self-actualization needs, whereas Money Repellers have the lowest. Apathetic Money Handlers have the highest level of satisfaction with physiological and safety needs. Results offer further support for the Money Ethic Scale and the four money profiles.
Keywords: Money Profiles, Money Ethic Endorsement, and Work-Related Attitudes
Money Profiles as Related to Work-Related Attitudes: An Examination of the Money Ethic Endorsement Among Citizens in the USA
Money can be considered as the instrument of commerce and as the measure of value (Smith, 1776/1937). Managers may use money to attract, retain, and motivate their employees (Chiu, Luk, & Tang, 1998; Milkovich & Newman, 1999; Opsahl & Dunnette, 1966; Whyte, 1955). Although money is used universally, the meaning of money is in the eye of the beholder (McClelland, 1967). People’s attitudes toward money are learned through the socialization process, established early in childhood, and maintained in adult life (Furnham & Argyle, 1998). Money attitudes may reflect people’s life experiences (Furnham, 1984; Wernimont & Fitzpatrick, 1972) and may be used as a “frame of reference” to examine their everyday life (Tang, 1992, p. 201).
On the one hand, for many managers and researchers, money is a motivator (e.g., Gupta & Shaw, 1998; Lawler, 1971). Most people in our societies work very hard for their money. In America, money is how we keep score and income is used to judge success (Rubenstein, 1981). Employees’ beliefs about money are also clearly related to their actual economic behavior. On the other hand, according to the motivator-hygiene theory of motivation, pay is considered as a hygiene factor and not a motivator (Herzberg, Mausner, & Snyderman, 1959). Others support this notion (Cameron & Pierce, 1994; Kohn, 1993, 1998; Pearce, 1987; Pfeffer, 1998).
Tang and his associates (Luna-Arocas & Tang, 1999; Tang, Tillery, Lazarevski, & Luna-Arocas, 1999) assert that people, in general, may have positive, indifferent, and negative attitudes toward money. Moreover, it is possible to classify people into money profiles based on the Money Ethic Scale (Tang, 1992, 1995; Tang & Luna-Arocas, 1999; Tang & Kim, 1999a; Tang, Luna-Arocas, & Whiteside, 1997). Luna-Arocas and Tang (1999) examined university professors in the USA and Spain and identified four money profiles using the 15-item Money Ethic Scale (Tang & Luna-Arocas, 1999): Achieving Money Worshiper, Careless Money Admirer, Apathetic Money Handler, and Money Repeller. The five factors of the Money Ethic Scale are: Budget, Evil, Equity, Success, and Motivator.
Achieving Money Worshipers have the most positive attitudes toward money. They worship money as their Success and Budget money carefully. Money Repellers have the most negative attitudes toward money. They consider that money is Evil and is not Success. The other two clusters of people fall between these two extremes. That is, Careless Money Admirers have somewhat positive and indifferent attitudes toward money. They value Success but do not Budget money carefully. Apathetic Money Handlers have somewhat negative and indifferent attitudes toward money. They think that money is neither Evil nor a Motivator and tend to have high intrinsic job satisfaction and life satisfaction. They may adopt the simplicity movement, scaling back, living on less, and liking it.
It is also interesting to note that, in that sample, American professors who teach in the College of Business have the highest income among all different colleges. Further, most of Business professors (75%) are in the Achieving Money Worshiper cluster. Thus, high-income professors have the most positive attitudes toward money and the highest satisfaction with pay and pay administration. They also tend to have the highest work ethic and the longest work experiences. Money Repellers have the most negative attitudes toward money, the lowest income, the lowest work ethic, and the lowest satisfaction with pay administration.
Moreover, Tang, Tillery, Lazarevski, and Luna-Arocas (1999) investigated 30 university students in the College of Management at Kiril and Methodi University and 60 small business owners and employees in large organizations in Skopje, the capital of the Republic of Macedonia. The same four money profiles are also identified in the Macedonian sample. The largest cluster for working people is Achieving Money Worshiper (45.0%) and the smallest one is Apathetic Money Handler (6.7%). For students, the largest money profile is Money Repeller (53.6%). Again, those who have money tend to have the most positive attitudes toward money and are Achieving Money Worshipers. It appears that the four money profiles can be consistently identified in different populations and cultures using the 15-item Money Ethic Scale.
The main purpose of the present study is to investigate the money profiles using the original 30-item, six-factor Money Ethic Scale (Tang, 1992) in a sample of citizens in the United States. The six money factors are Good, Evil, Achievement, Respect, Budget, and Power. Several different variables are examined in this study. Relevant literature will be reviewed below.
The Increasing Importance of Money
In the wake of global competition, organizations are increasingly interested in reducing labor costs and increasing worker productivity. Money may play an important role in achieving these goals. Money does improve performance quantity and does not erode intrinsic motivation (Gupta & Shaw, 1998). However, the jury is still out regarding the impact of financial incentives on performance quality (Gupta & Shaw, 1998). For the past two decades, there is a significant increase regarding the importance of money and income in the USA and in many countries around the world (Abramson & Inglehart, 1995; England, 1991; Gottlieb & Yuchtman-Yaar, 1983; Mitchell & Mickel, in press; Mitchell, Mickel, Dakin, & Gray, 1998; Tang, Tang, Tang, & Dozier, 1998).