Behaviorism and Mental Health

Fear is the normal human response to imminent danger. It is an adaptive response, in that it is helpful to survival, and it occurs in almost all animal species. When our cave-dwelling ancestors were attacked by mountain lions, they probably experienced acute fear. This fear gave them an extra burst of energy to flee the danger, or, if flight were impossible, to turn and fight.

Today in most parts of the world, there is little danger of attack from wild animals. As areas develop economically and culturally, these kinds of acute dangers are systematically eliminated or at least drastically reduced. Close encounters with tornadoes, hurricanes, rattlesnakes, car accidents, etc., can still arouse full-blown fear responses, but most people in developed countries can go months – even years – without experiencing these kinds of situations.

Anxiety, however, is a different matter. Anxiety is essentially a fear response that doesn’t quite take off. It is a constant feature of modern life. Just as industrial and commercial development entailed the systematic reduction of acute dangers, it involved an equally systematic increase in situations that provoke anxiety. Indeed, it could be argued that the production and maintenance of anxiety is an integral component of modern marketing.

The purpose of commercials is to generate within people feelings of insecurity and concern. The range of worries that are exploited in this way is limited only by the imaginations of the marketers. From all quarters we are bombarded with anxiety-producing messages, such as: you are not attractive; your television set is too small; your car is too old; your clothes are out of style; your hair is too gray (or oily, or dry); your libido is inadequate; your kitchen is outdated; your breasts are too small (female); your penis is too small (male); your computer is too old; your house needs to be painted; you have too little hair on your head; you have too much hair every where else, etc., etc… The purpose of these messages is to generate within us feelings of anxiety and insecurity so that we will buy more stuff. Of course the “fix” is only temporary, and the process continues pretty much from cradle to grave.

It is not being suggested that the marketers invented anxiety. Our ancestors in the caves probably experienced concern and anxiety if they heard unusual noises from outside the cave at night. This kind of anxiety is useful in that it increases vigilance and prepares the organism for a rapid response should this become necessary. In modern life there are many situations in which a certain amount of anxiety is appropriate and adaptive. On the highway, for instance, a sudden increase in the traffic density usually elicits a measure of anxiety. This anxiety sharpens our attention and helps us avoid mishaps. Similarly, most people will experience some anxiety if caught out in a severe storm, especially in tornado country. These are natural stressors and the anxiety they provoke is appropriate and helpful.

In addition, people who have had unpleasant experiences will likely feel some anxiety if exposed to similar circumstances later in life, and, in fact, will generally go to considerable pains to avoid such circumstances. People, for instance, who were teased and taunted during childhood will often in later life avoid situations where they might be exposed to criticism or ridicule.

What the marketers have done, however, is they have taken this natural adaptive mechanism and exploited it endlessly for their own gain and to the detriment of the public. In this they have been extraordinarily successful, so that at present we experience worry and anxiety – not only with regards to genuine concerns – but also with regards to an enormous range of matters which are truly trivial and inconsequential. What used to be the land of the free and the home of the brave has degenerated into a nation of worriers and fretters. But the fundamental point is that anxiety, in and of itself, is normal – it is an integral part of our normal day-to-day existence, and serves a useful purpose. What the American Psychiatric Association and the pharmaceutical companies have done, however, is redefine anxiety as a pathology – an illness – that needs to be treated by taking pills.

The DSM lists the following anxiety disorders:

Panic disorder without agoraphobia
Panic disorder with agoraphobia
Agoraphobia with out panic disorder
Specific phobia
Social phobia
Obsessive compulsive disorder
Posttraumatic stress disorder
Acute stress disorder
Generalized anxiety disorder
Anxiety disorder due to a general medical condition
Substance induced anxiety disorder
Separation anxiety disorder
Sexual aversion disorder

And of course,

Anxiety disorder not otherwise specified (n.o.s.)

The list is self-explanatory and is designed to cover as wide a range of anxiety-provoking situations as possible. The inclusion of the n.o.s. diagnosis at the end of the list ensures that anyone experiencing anxiety or worry concerning any matter whatsoever can be assigned a diagnosis and can enter the ranks of the “mentally ill.” DSM specifies that for a diagnosis to be made, the anxiety has to “interfere with the person’s functioning” or “cause marked distress”. In practice, these qualifiers are sufficiently vague that virtually anyone can be given an anxiety diagnosis. People who go to counselors for help with stress or life choices are often assigned a diagnosis of Generalized Anxiety Disorder. They are “enrolled” in the ranks of the mentally ill, and their numbers swell the already inflated statistics quoted in the first post (Proliferation of Mental Disorders)

Consider, for instance, a person who for several years has succumbed to the Madison Avenue hype. This individual has bought a new house, a big car, an entertainment center, membership at an expensive country club, etc. Although apparently wealthy, he actually has no money in the bank and is completely dependent on his paycheck to remain solvent. He now receives information that his company is considering lay-offs, and he fears that his name may be on the list. Meanwhile, he discovers that his sixteen-year-old son is doing drugs, his fourteen-year-old daughter is sexually active, and his wife has been “seeing” someone else. Understandably, he is becoming somewhat anxious. In fact, he is beside himself with worry. He’s not sleeping well. He’s gone off his food, and he’s beginning to make serious mistakes in his work. He doesn’t actually see much of his family, but when he does, he finds himself being increasingly irritable and grouchy.

Although this is a purely hypothetical case, there are a great number of people in our society who are living variations of this kind of scenario – sometimes for years on end. Their lives have become untenable, and their anxiety and worry are entirely appropriate. Things are out of control. They need to be worried, and they need to be taking corrective action.

If our hypothetical worrier goes to a mental health practitioner, however, he will be given a diagnosis of Generalized Anxiety Disorder (an invented illness) and a prescription for anti-anxiety pills. He is given the false and destructive message that the problem is simply an illness – a chemical imbalance – and that taking the pills will correct the imbalance in the same way that insulin injections enable a diabetic to function normally. The notion that his life is out of control and that certain fundamental changes need to be made is seldom even addressed.

For an excellent account of how a drug manufacturer promoted generalized anxiety disorder to market a new drug, see Brendan Koerner’s article “Disorders Made to Order” in the July/August 2002 issue of Mother Jones.

The APA’s criteria for a diagnosis of Generalized Anxiety Disorder are listed below:

A. Excessive anxiety and worry (apprehensive expectations), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children

(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of [another mental disorder]

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance…. or a general medical condition ….or [another mental disorder].

The reader will readily appreciate that our hypothetical worrier described above, and the millions more in the same boat, are easily embraced within the above criteria. If this individual goes to a mental health center, he will be given a “diagnosis” and a prescription for an anxiolytic. The chances are slim that he will receive any counseling with regards to stress reduction, relationships, or lifestyle. The essential message he receives is that his life and his habits are fine, but that he has a “chemical imbalance” in his brain that is causing him to feel upset and worried, and that the pills will take care of it.

In this context, it is important to remember that the vast majority of mental health diagnosing is based on the uncorroborated self-reports of the patient. If you tell a psychiatrist that you are very tense and anxious and that you can’t sleep, can’t focus on your work, and are irritable with your family – and if you make it sound convincing – you will be given a diagnosis of Generalized Anxiety Disorder and a prescription for an anxiety-reducing drug.

The APA and the pharmaceutical companies have jointly developed this spurious system in which all human problems, including normal reactions to stress, are declared mental illnesses which need to be “treated” with drugs. These tactics are focussed on people of all ages and all walks of life. Notice in the criteria for generalized anxiety disorder cited above, how much easier it is to assign this diagnosis to a child (one item instead of three).

Next Post: Posttraumatic Stress Disorder