Thursday, July 17, 2008

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.

3 comments:

goingincognito said...

I found your journal entry from a comment you left someone in the antipsychiatry livejournal community. Basically I hate hate hate the pyschiatry system so very much. my mom soley relies on psychiatric drugs to make her feel better but she's never really gotten better... she has this negative thinking pattern that seriously bothers me and always has and always will. my brother is an alcoholic who has had three DUIs so as a mother she's very distraught by that. she always is worried that something bad will happen and has serious anxiety. because my mother believes psychiatric drugs work so well she is severely worried that I can't live without them. I'm trying to explain to her that I don't want them or need them but it's so hard... how on earth does one deal with that sort of trouble? my mom says she is going to see a CBT and I really hope she does because I don't know what else is going to help her stop worrying about everything all the time. I'm going to school for family and consumer science because I don't think anyone really think eventually people will not know how to consume things anymore - especially psychiatric drugs. It's just a very messed up cycle in my opinion. I myself ended up in psychiatric care because I lost two of my best friends (ridiculous immature reasons... I'm 20 and so of course girls my age can be very catty and gossipy). I became depressed and suicidal but now that I'm "medicated" and "over the whole thing" I see that I'm okay and now I have to try and get off all this damn medication... but my psychiatrist is a holy rolling god believer and it's so hard to get her to believe me because her main intentions are to make me happy... I'm happy now but it's just so annoying to have to make a doctor believe that I'm ok... how do I explain that my depression and suicidal behaviors are situational when they have pictures of my brain that show that my brain is not normal compared to that of an average person. (I've had brain scans done).... I don't believe my brain is really all that "bad" to be honest... sure I'm different than most people but why do I have to be labeled with mood disorders NOS and now they are trying to tell me I'm bipolar!!!! WHAT?!?!? I'm so not bipolar ... I'm just a free thinking person who enjoys music, love, and peace. i'm just so frustrated right now. *sigh*

skpsycho said...

Dear Sarah, thank you for your comments! It is great to know that somebody finds my writings interesting, and even helpful :) I think you have all the reasons to be frustrated, and I am very sorry about what happened to you. Especially because, although I don't know you, some of your life values that you described in your comments are very close to me. I also know from experience that it will be extremely difficult for you to get yourself liberated from psychiatry "services", although with careful effort it is possible.

Like you mentioned, it is ridiculous to have to prove to a psychiatrist that you're happy, because you stop being happy in the process :) But unfortunately modern American psychiatry (in general) views people as machines whose feelings and mental states are rigid, and can always be named and accounted for.

Psychiatry is part of the culture where you grew up, and it is hard for you to think of it critically. You might be angry at it, but you might still think that what happened to you was an unfortunate exception. If you study the matter further, you will see that it is a rule. The psychiatric system is a very well-lubricated machine, and it cares more of its own mechanisms than of the needs of the patients.

There are a few things you need to remember, however, if you don't want to get in further trouble. First of all, the genetic views of psychiatric disorders are very strong nowadays (although in my opinion it is nonsense). What it means for you is that with a few family members suffering from different behavioral problems, you are viewed as a candidate for treatment almost by default; thus, your starting position is tough. Second, any sign of rebellion on your side will be seen as a new symptom of the progressing disorder - and you must never forget that.

People who are in charge of your life now have very different views from yours of what your life should be like, and they are full of energy and desire to make you happy - as they see it - even against your own will. What is most important, they do have the power to make their plans a reality. Please remember that. To rebel them directly would be like trying to stop the train by pushing it in the opposite direction; the train will crush you without even noticing it. What you actually want to do is walk away from the train altogether, and enjoy the nature. But again, to do it will be difficult, because the psychiatrists will try to follow you; so, the process will require a lot of careful thinking, planning, and even acting (as in pretending).

The idea of lying to your psychiatrist may seem unthinkable, but it actually may be ok - after all, it is ok for them to be lying to you, right? For example, there is absolutely no way one can see a mood disorder on your brain scans. It is not even a simplification, it is an outright and deliberate lie, and it makes me furious to think about it, and the other lies used to confuse people and bring them into submission. Manipulating your psychiatrist may also seem dangerous, because the idea is that they are so perspicacious that they see you through; but today many psychiatrists actually believe words more then anything else, so it could be ok if done with a reasonable skillfulness. (Don't assume, however, that your psychiatrist is evil; most likely she is also a victim of the system and really believes what she is doing.)

The pills are a separate story. Doctors want you to keep taking them, but after a while they will start creating more problems than they solve. On the other hand, you must never attempt to stop the medication abruptly. The consequences of this can be unpredictable. If you decide to come off of it, it must be done slowly and carefully, and preferably with the help of an understanding professional.

To sum it all up: your situation is difficult but not hopeless :). It seems that you are intellectual and independent enough to start taking your life in your own hands. Don't trust me: do your independent research. Read wikipedia on any controversial subject, follow the links and use your common sense. My advice is not good for everybody; some people are much better off taking pills and conforming to the rules all their life. If you decide that you want to be free from psychiatry, don't act impulsively: think and plan carefully. You might want to change the environment, for example move to a different state or even a different country for a while. Or something else might work for you, that's up to you to figure out. But I wish you a lot of luck, and I will be glad to talk to you more if you need it in the future (possibly by email if it will involve confidential information).

Sorry for a long reply, and all the best to you :) sk

Anonymous said...

Why do you have to prove anything to the psychiatrists? You don't answer to them. Don't let them tell you what to do.
I'm behind what skpsycho says about the pills.