Behaviorism and Mental Health

Recently National Public Radio ran a program on California’s state psychiatric hospitals.  There has reportedly been an enormous increase in patient violence in recent years, including the murder of a female employee in October 2010.

Staff are demanding that some remedial measures be undertaken.  Committees are meeting; politicians are giving speeches.  But the violence continues.

Reportedly the state is spending more than $500 per day per patient – that’s more than $180,000 per year!  But the violence continues.

How did we get to this point?

Over the past 50-60 years, American psychiatrists, in collaboration with their pharmaceutical allies, promoted the idea that all unusual or disturbing behavior was caused by a mental illness.  Intellectually this concept is meaningless, but it resonated in the popular consciousness, and psychiatry’s promotional efforts have been enormously successful.  Perhaps too successful!

Anyone charged with a serious violent crime in the United States can play the “crazy” card, and will almost certainly be able to find a psychiatrist who will testify that his (or her) criminal activity was caused by an underlying mental illness, and that hospitalization is the correct disposition.

Much of this kind of nonsense has been written into law.  In many cases judges find their hands are tied, and the individual is sent to a “hospital” for “treatment.”

The fact is that these individuals are not sick in any meaningful sense of the term.  They commit acts of violence for the same reason that other people commit acts of violence – because they haven’t been adequately trained in the suppression of anger and aggression.

Our society’s solution to uncontrolled anger and aggression is prison.  Now I’m not suggesting that our prisons are doing a great job in this regard.  But that is what’s available – and is used widely – unless, of course, the miscreant plays the “crazy” card.  Then he goes to a so-called hospital to be treated for a so-called illness.  And in this context the violence continues more or less unabated.

At least in prison precautions are taken to protect staff and other inmates from violent predatory offenders.  But in a “hospital” setting such measures would be seen as militating against the therapeutic milieu.

The chickens are coming home to roost.  The psychiatrists took us down this road to promote their own business interests.  And business is booming.  $180,000 per year per “patient!”

But the violence continues – and will continue, as long as we remain mired in the inane psychiatric view of unusual or disturbing behavior.  Aggressive behavior is neither an illness nor a symptom of an illness.  And efforts to “treat” it as such are doomed to failure.  Psychiatry’s track record in this area is extremely poor, and yet we go on throwing money at them!  Maybe they’re right – perhaps we all are crazy!

The concept of personality is very firmly established in mental health circles and in academic psychology.  It is also widely used in common speech, and is frequently offered as having explanatory value, when in fact it has none.

Consider the following conversation:

“Why is Mary so quiet and reserved?”

 “Oh, that’s just her personality.”

Or

“Why is Michael so aggressive and argumentative?”

 “That’s his personality.”

In statements like this the term “personality” is presented as if it explained the behavior in question, when in fact it is merely descriptive.  The responder to the question, “Why is Mary so quiet and reserved?” might just as well have said:  “Because she is so quiet and reserved.”  The so-called explanation adds nothing in terms of understanding how Mary got to be quiet and reserved.

As I have discussed elsewhere – the acid test for an explanation is to ask:

“How do you know she has this kind of personality?”

And, of course, the only possible answer is – because she is so quiet and reserved.  In other words, the only evidence for the explanation is the very behavior it purports to explain.  This kind of circular illogicality is rife in the mental health field.

Of particular note in this regards is Criterion B in the DSM:

“At least two of these identities or personality states recurrently take control of the person’s behavior.” (p 529, DSM-IV-TR)

Here “personality” is being conceptualized as a sort of driver that gets into the pilot’s seat and causes the individual to behave in this way rather than that.  And then – heaping nonsense on nonsense – that driver gets out and lets another one take the controls; etc., etc..

I realize, of course, that economic considerations can dull the critical faculties, but how professional people who have spent eight plus years in college can adapt themselves to, and even promote, this kind of gibberish is beyond me.

I’m now in retirement, but during my professional career I usually (almost always) wore a suit and tie when I went to work.  I enjoyed my work, and I was very comfortable in that role.

But I’m also a committed remodeler.  Apart from the time when I was acutely ill, I’ve always had at least one remodeling project on the go – literally all my adult life.

So when I got home from work, I changed “uniforms.”  Off with the suit and tie, on with the paint-splattered jeans, plaid shirt, scruffy sweater, and tool belt.  And here again, I was very comfortable.

And the change-over wasn’t merely outward.  In my professional life, problems had to be approached with tact and circumspection.  A great deal of sensitivity to people’s feelings was necessary.  Understanding and compassion were essential ingredients.  The worksites, on the other hand, were all about decision-making and action – getting things done!

From time to time I would encounter people that I knew in the professional sphere while I was dressed in my remodeler attire, and they would almost always register some surprise.  So I really was a sort of Dr. Jekyll and Mr. Hyde.  You might even say I had two “personalities.”   And I suspect that there are a great many people who are the same – people who find that doing something completely different in their spare time is the best rest and recuperation from their professional responsibilities.

So why am I (and others like me) not considered eligible for a diagnosis of multiple personality disorder?

Well – because I know that I am the same person playing the different roles.  Criterion C. in the DSM is:

“Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.” (p 529, DSM-IV-TR)

So the critical point is that according to the APA, a person is talking and functioning like a normal adult, but other times talks and functions like a ten-year-old child, but doesn’t realize that she’s shifting back and forth!

But the only evidence that the individual is unaware of the switching back and forth is the individual’s self report.  And – believe it or not – people sometimes fib!

The APA and the thousands of psychiatrists who promote this gibberish have created a “crazy” role that subservient, suggestible people can easily play.  And, of course, it’s a win/win game:  the psychiatrists win because they get their money; the pharmaceutical companies win because they get another person hooked on their products, and the “patient” wins because he or she gets an easy role which seems to relieve one of many of life’s responsibilities.  Of course, in the long run the “patient” is destroyed – but psychiatry seldom concerns itself with the long run.

Although I’ve had a very long career in the mental health field, and have worked with literally thousands of clients, I have never encountered anyone who presented the “symptoms” of multiple personality disorder.

If an adult client in my office had started talking in a child’s voice, I would simply have asked:  “Why are you talking to me in that childlike way?” and encouraged cogency and realism.  If this were not forthcoming, I would have terminated the session.

This approach is in marked contrast to that of the DSM believers, who would start “working with” the “child.”  This is encouragement of crazy behavior, and in my view almost all cases of so-called multiple personality disorder are therapist-induced and therapist-maintained. When you’re working with vulnerable, suggestible people, if you encourage craziness, that’s what you get.

There are no mental illnesses!

Next Post:  Multiple Personality Disorder, Continued

MPD became an official APA “diagnosis” with the publication of DSM-III in 1980.  It has since been renamed as dissociative identity disorder.  The criteria are:

A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

B. At least two of these identities or personality states recurrently take control of the person’s behavior.

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures).  Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.   (DSM-IV-TR, p 529)

The drive to include this so-called illness in the psychiatric classification system was spearheaded by Dr. Connie Wilbur, a New York psychiatrist.  Dr. Wilbur collaborated with a journalist named Flora Schreiber in the production of a book named Sybil (1973).  In the book, which purported to be factual, Dr. Wilbur diagnoses and treats a female patient (whom they named Sybil – her real name, as later disclosed, was Shirley Mason) for multiple personality disorder.  The book became a best seller, was translated into several foreign languages, and was made into a movie and a TV program.

In the book and in the movie, Dr. Wilbur is presented as the tireless champion who works diligently to “cure” Sybil by helping the patient remember that she had been the victim of horrendous sexual abuse from her mother.  The book also recounts the techniques used by Dr. Wilbur to help the patient “recover” these repressed memories.

Sybil is especially noteworthy in that it was the stimulus that sent a sizeable segment of the mental health profession down the multiple personality side-road, with its emphasis on “finding” and “identifying” increasing numbers of personalities within each client, and “recovering” the traumatic memories that “caused” the problem in the first place.

Both Connie Wilbur and Flora Schreiber kept very detailed records, and some of this material was archived and has now become available.  Earlier this year, Free Press, a division of Simon and Schuster, published Sybil Exposed by Debbie Nathan, an award-winning journalist.  The book is meticulous and painstaking, and highly credible.  Here are some quotes.

p xviii “What I found was shocking but utterly absorbing.  The papers revealed that Sybil’s sixteen personalities had not popped up spontaneously but were provoked over many years of rogue treatment that violated practically every ethical standard of practice for mental health professions.

Dr. Wilbur had approached Sybil’s health problems with a predetermined diagnosis that brooked no alternative explanations.  In her therapy she had made extravagant, sadistic use of habit-forming, mind-bending drugs.  And she had treated the patient day and night, on weekdays and weekends, inside her office and outside, making house calls and even taking Sybil with her to social events and on vacations.  She fed Sybil, gave her money, and paid her rent.  After years of this behavior, the archives revealed, the two women developed a slavish mutual dependency upon each other.  Toward the end of their lives they ended up living together.”

p 88  “To treat these problems, Connie wrote prescriptions for powerful, habit-forming drugs, many of which had just been patented in the 1950s and were being aggressively marketed by pharmaceutical companies.  To help her sleep, Shirley got tablets of Seconal, a highly addictive barbiturate.  Taking it regularly and then trying to withdraw can cause anxiety, vivid dreams, and even hallucinations.  Connie treated Shirley’s menstrual pains with Demerol, an opiate related to heroin. It is extremely habit-forming, with side effects that include light-headedness, confusion, and blacking out.  Shirley also got Edrisal and Daprisal for her monthly pain.  Both combined aspirin with amphetamines – now commonly known as speed, which if taken excessively can cause hallucinations and paranoia.  Edrisal and Daprisal eventually proved so addictive that they were yanked from the market.  But they were readily available in the 1950s, along with the narcotics and barbiturates Connie prescribed.  Soon Shirley was in her second semester at Teachers College, still managing to attend classes and complete her school work.  But she spent her free time half zonked on mind-bending medications.”

p 99 “When Shirley felt particularly depressed or anxious, she frequently doubled, even quintupled, her prescribed dosages of Daprisal, Demerol, Dexamyl, Edrisal, Equanil, and Seconal.  And Connie added Serpatilin, a combination of a tranquilizer and the stimulant Ritalin, as well as Thorazine, a medicine originally prescribed to relieve nausea and the kind of pain Shirley experienced with her periods.  Thorazine would later be recognized as a potent antipsychotic whose side effects, particularly at high doses, include restlessness, confusion, blackouts, and unusual thoughts and behaviors.  With this powerful drug and all the uppers and downers, Connie also gave Shirley Phenobarbital, another barbiturate, on top of her regular, intravenous doses of Pentothal.”

In 1958 Shirley wrote Dr. Wilbur a letter recanting all the multiple personality material, including the alleged sexual assaults by her mother.  Dr. Wilbur interpreted the letter as a major defensive maneuver which demonstrated that the client had indeed been sexually assaulted by her mother and needed further therapy!

I strongly recommend this book to anyone who has an interest in mental health matters.

It is clear from Sybil Exposed that Dr. Wilbur had an agenda.  She wanted to establish multiple personality disorder as a legitimate “diagnosis,” and through leading questions and subtle encouragement elicited this kind of behavior from her client.  Dr. Wilbur, of course, was an extreme case.  But the same kind of thing goes on in psychiatric offices and clinics worldwide.  Psychiatrists view their clients through the lens of DSM.  And what do they find as the underlying cause of the client’s problem? A mental illness!

There are no mental illnesses.  Understanding people involves a great deal more than assigning them labels.

I came across this on Yahoo! News.

BOSTON (AP) — Gay rights groups say they’re pleased the oldest Roman Catholic newspaper in the United States has retracted an opinion column suggesting the devil may be responsible for gay attraction.

The column in the Boston archdiocese’s The Pilot newspaper was titled “Some fundamental questions on same-sex attraction.” It was written by an adviser at the U.S. Conference of Catholic Bishops. It said “scientific evidence of how same-sex attraction most likely may be created provides a credible basis for a spiritual explanation that indicts the devil.”

The 182-year-old newspaper withdrew the online column Wednesday and posted the author’s apology.

The gay Catholics group DignityUSA says the column was outrageous and inflicted “tremendous damage on the souls” of gay people.

The Human Rights Campaign said Thursday it’s a shame the archdiocese ran a column ignoring the science about sexual orientation.

The logic (if I may stretch the word a little) behind this sort of thing would be something like:  the sin of same-sex attraction is caused by the devil.  But if you were to ask:  “how do you know it’s caused by the devil?” the only possible response is:  “because it’s a sin.”

The assertion (that same sex orientation is caused by the devil) is presented as a conclusion, when in fact it is contained within the premises.  To assert that same sex orientation is caused by the devil explains nothing.  Besides, positing the devil in the context of “scientific evidence” suggests that the writer is not conversant with the nature of science.

At least they had the grace to apologize.