When You See What You Like You Want It - Science Has Proved

"Strong cravings for alcohol can be sparked by the mere sight, smell and taste of a person’s favorite drink,"

- say scientists, who are about to publish their findings in Biological Psychiatry, a prestigious psychiatric journal, as reported by Science Daily article today.

This revolutionary scientific finding has opened our eyes on one of the most interesting aspects of human behavior: when we see something that we like, we start to want it. Turns out, alcoholics can abstain from drinking for a long time, but as soon as they see their favorite drink in an engaging environment (such as their neighborhood bar), their desire to consume the drink increases dramatically.

To discover this curious fact the scientists used the help of the rat behavioral model. They first trained the rats to drink alcohol in a special "bar cage". It isn't mentioned what types of drinks were served, which is one of the shortcomings of the study: after all, the rats' behavior would probably differ if they were offered vodka versus martini or beer (in which case domestic or imported could also make a difference). It was reasonably clear, however, that the rats enjoyed their drinking experience. Then the animals were put into a different cage, and deprived from alcohol. After a certain period of abstinence they were allowed to go back to the bar, and before the scientists knew it they were drinking again like there was no tomorrow.

“This effect is highly detrimental to humans who are trying to abstain from drinking,”

- says lead author Nadia Chaudhri, Ph. D., with the Ernest Gallo Clinic and Research Center at UCSF.

These humans, as her words imply, are hopelessly trapped inside the control centers of their essentially animal bodies that divert them from their chosen path and towards their favorite drink.

To help such unfortunate individuals, the scientists propose to broaden the context of the exposure-based therapies. The experiment has shown that when the drinks were no longer available even at the bar cage, the rats would gradually lose their interest to alcohol, and start to engage in other activities like mating and generally scratching around. Therefore, the alcoholics should, as part of their therapy, visit their favorite bars with the therapist, but - and here the ingenious scientific thought unveils itself - they shouldn't drink anything there.

"These contexts could be real, i.e., visiting bars or liquor stores, could be created using virtual reality techniques, or could simply be recreated by patients as they imagined visiting places that triggered their urges to drink,”

- says John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System.

It is easy to imagine how much this study can change the lives of alcoholics once its results are put into practice. And those of you who are not yet alcoholics (at least not the ones treated by psychiatrists) could also take a lot out of this study. If you know you want something, but shouldn't have it - you must never allow yourself to see it, smell it, or, perish the thought, taste it. Otherwise, your desire may increase. You've been warned!

Behavioral Therapy Doesn't Work Because People Are Not Stupid Enough

Behavioral therapy comes in many flavors, but they all more or less share the same outcome: either the therapy doesn't work, or it works but in such a way that it better didn't.

The reason for this is the basic error of assuming that people are stupid enough. I am not talking about the kind of stupidity that is the opposite of being a Nobel prize winner; but in order for behavioral therapy to work people must be so stupid as to not understand what is going on around them. Otherwise they quickly figure out the rules of the game, and refuse to participate if it gives them too much trouble.

Behavioral therapy is based on clever application of positive and negative stimuli in order to support or eliminate certain types of behavior. A textbook example: if the room is too cold (negative stimulus), the subject will set the thermostat up (desired behavior); thus, without any complicated analysis or dream interpretation business we have achieved the change in behavior, which is all we need after all (right?).

The problems start when we try to reproduce the situation in the real world. In the real world someone needs to go and set that thermostat down first, so as to create the negative stimulus. At this moment the subject, who is not stupid enough, says: "Wait a minute! Why are you doing this? Are you trying to manipulate me?" - and the whole ingenious plan goes down the drain.

Glance through any book on dog training, and then any behavioral therapy manual. You will notice a lot of similarities in approach; sometimes you will find it difficult to remember which book is which. But even being as stupid as a dog is still not enough! Anyone who attempted to train a dog knows that he will play along while he finds it funny; but at some point he will look at you suspiciously: "I thought we were playing, and turns out you're trying your silly methods on me?" From then on, if you persist in your attempts, you will only make the dog angry and put your relationship at risk.

To successfully train a dog, one must somehow convince him that being a good dog can be a lot of fun. You cannot explain it, or manipulate a dog into thinking so. The ability to convey the message is a matter of talent. All good trainers incorporate the principles of behavioral science in their work, but they do it "from within" - unobtrusively and naturally. Simply following a set of rules and methods does not work even with dogs, not to mention human beings.

Sometimes, however, the human beings are smart enough to realize that they have to go through therapy and follow the trainer's instructions. They will not get angry, but instead will play a double game, convincing everybody and themselves that they really don't see the person who enters the room and sets the thermostat down. They trick themselves into being genuinely surprised when the room becomes cold, and allow themselves to act upon the urge to get rid of the negative stimulus and reach the desired behavior. In so doing, they become persuaded that they really improve.

The situation thus grows worse than if there was no therapy at all. The patient now thinks that he is prepared for the life's misfortunes, but it is only an illusion; therefore his vulnerability actually increases. Besides, the long-term consequences of playing an idiot are not well-studied.

Drug Therapy: Does The Easiest Mean The Best?

From a conversation with a psychiatrist one typically gets the impression that the medications are the most powerful tool for treating mental disorders. Yes, you can try therapy, or lifestyle modifications, but if you are dealing with anything serious, the drug treatment is the only thing that has the real power to help.

At least partly, this conviction is based on the practical difficulty to use alternative treatments. For example, good psychotherapy exists but is hard to find and expensive; life style is possible to modify, but it requires significant time and energy invested into patient education and follow-up. Some patients cannot use these treatments even if they want to, because their mental disturbances result in the inability to understand and follow complex directions. The lifestyle modifications may be unattainable for economic or social reasons: someone whose entire family of nine lives in a one-bedroom apartment might want to modify his lifestyle, but be unable to do so.

A pill is certainly the easiest means of treatment, whether or not the most helpful. It can be used in any circumstances and by people of any economic, educational or social background. It is therefore true that medication therapy may be usable in cases when other types of treatment may not; however, any further implications about efficacy are much harder to prove.

Taking Medication Is Voluntary

Taking a psychiatric medication is a voluntary act. Unless you are brought to a psychiatric hospital by ambulance, or suspected of being a possible danger to yourself or others, or not obeying the directions of hospital personnel, or hallucinating, or not agreeing to take the drugs voluntarily for too long when the doctor deems it necessary, you cannot be given a medication against your will.

Don’t Talk About It! Do It!

(re-posted from my old blog, skpsycho.wordpress.com)

In response to the critique of the psychiatric medications, many people try to discredit the effectiveness of psychotherapy. In math this is called ex adverso, or proof by contradiction; when one is unable to prove his rightness, he tries instead to prove that his opponent is wrong. But in math this approach is used very carefully, and only with two mutually exclusive hypotheses. In psychiatry, as in politics, the presumed mutual exclusiveness of the poles is only an illusion, a classic “choice without choice”. If you’re asked to choose between a coffee from McDonalds and from Dunkin Donuts, then you’re screwed if what you really wanted was a good coffee, or a tea, or if, for that matter, you were not thirsty at all.

Notwithstanding the bias behind the statement, if someone says to me that psychotherapy doesn’t work, I will probably agree. Because the person saying so is most likely referring to the classic American understanding of psychotherapy: “talk therapy.” It is just what it says: two people talk about the problems of one of them. I carry no illusions about such therapy, in part for reasons that I have discussed elsewhere. In my opinion, the majority of people who benefit from talk therapy belong to one of the two categories: those whose problems are so insignificant that they can be helped by a sincere conversation with any intelligent being (and they should really go talk to their friends instead), and those who don’t want to change anything in their life and prefer to use the therapist as a kind of garbage can for their perpetually accumulating waste.

Fundamentally, all that the stereotypical talk therapy can do is generate new words. It allows the client to verbalize his feelings, give coherent definitions to his problems, and re-formulate his “wrong” principles in a different way. If the therapy is successful, the client can gain insight (which is learn to describe his internal happenings in words), reach new understanding (which is improve the wordings of his personal law-book of life) and, hopefully, achieve the improvement (which is also a word).

The whole system is based on a presumption that if you say the right words, the right doings will follow. But the universe doesn’t quite work this way. The acknowledgment of your sins by itself doesn’t cure those who suffer from them, nor does it teach you to live your life differently. To define and describe yourself as kind and balanced a person is not quite the same as to become one in reality; no more so then proclaiming yourself a violinist teaches you to play.

In fact, it works in exactly the opposite way. The more you talk, the less you’re able to do. Moreover, filling your head with the nicely-formulated verbal solutions to your problems discourages you from seeking the real, nonverbal solutions. Planning the future prevents you from perceiving the present. Conceptualizing your experiences spoils all the fun. Producing the more and more elaborate descriptions of your life leaves you no time to actually live it.

Good therapy, therefore, should be more like teaching, or coaching; the art being taught, the art of living. A good coach, does not talk much with his students; his role is to motivate them and gently correct their mistakes while they practise, practise, and practise. There’s no point in having conversations about the art of swimming; one simply needs to get into the water, and swim until he does it well. It may help to have a responsible adult nearby at first to save you if you lose control; but once you’re resuscitated, there’s no need to discuss it for too long - simply jump into the water and try again. The danger of talking about it too much is that eventually you may become completely convinced that you are capable of swimming. With this conviction under your belt you will proudly drown in the first real river on your way.

Don’t talk about it! Do it. Don’t verbalize your feelings; feel them. Don’t acknowledge that you’re bad; become good. Don’t apologize; start behaving differently. Don’t thank; accept. Don’t seek the correct definitions; definition is just a word.

If you don’t have a Zen master nearby as you’re reading this, take something heavy from your desk and, without saying what it is, hit yourself on your head.